Farmasetika Dasar: Dosis dan Obat Tak Tercampurkan (OTT)

Tim Farmasetika Dasar Fakultas Farmasi UNPAD 2012

Tujuan Pembelajaran
Mahasiswa/i mampu:
1. Mengerti definisi dosis dan interaksi obat/OTT 2. Menjelaskan jenis-jenis dosis

3. Memahami dosis pada kondisi tertentu

4. Menghitung dosis berdasarkan rumusnya

Dosis/Takaran
Ukuran/konsentrasi obat yang diharapkan dapat mempunyai efek kerja/daya terapi pada orang dewasa

Jumlah yang pasti dari suatu obat yang digunakan pada satu kali kesempatan

Macam-macam Dosis
Dosis lazim/usual dose Dosis maksimal (TM) Dosis toksik Dosis letalis, LD50 Dosis kuratif

Dosis kombinasi (TM Berganda)

Faktor Penentuan Dosis

1. Umur 2. Berat Badan 3. Body Surface Area (BSA)

4. Jenis Kelamin
5. Status Patologi 6. Toleransi Obat 7. Waktu Pemakaian 8. Terapi dengan obat yang diberikan bersamaan

9. Bentuk Sediaan & Cara Pemakaian

Dokter
Terapi

Apoteker

Perawat

Pasien

Pencegahan Error

Pengukuran obat-dosis tepat

Pembungkusan
Serbuk, kapsul, cairan, setengah padat

Ukuran sendok
Sendok teh/cth (5ml) Sendok makan/C (15ml) Sendok bubur/Cp (10ml)

Pengukuran obat-dosis tepat

Ukuran yang dipakai
Padatan : gram, miligram Cairan : cc, mL, L (BJ) Tube, pulv, syrup, Fl (fles), gtt, ampul Angka romawi : X, L, M Timbangan kasar (menimbang > 1 kg) Timbangan besar (timbangan gram, > 1 g) Timbangan kecil (>50 mg) Timbangan halus/timbangan mg (< 50 mg) Untuk setengah padat : perkamen dilapisi parafin Untuk zat-zat kental : perkamen/cawan penguap Cairan : gelas ukur (cc), botol/cawan penguap (g)

Timbangan

Penimbangan

Dosing in Children
There are seven distinct age groups that are associated with different drug Cl and hence dosing requirements.

Dosing in children under 6 months of age is very complicated a specialist advice is usually needed.

Note that four of these ages are related to the paediatric age group. This reflects that the child is a continually changing pharmacokinetic and pharmacodynamic environment. The younger the child, the greater the rate of change.

Body Surface Area (BSA) calculation may be used when an establish dosage has not been determined by the drug company, as with some anticancer or specialized drugs.
Dosage: the determination and regulation of the size, frequency, and number of doses

Perhitungan TM untuk Anak-anak

Rumus Young

(anak 8 tahun) tahun, orang dewasa : 20 tahun)

Rumus Dilling

(anak > 8 tahun)

Rumus Talbot (Berdasarkan luas permukaan tubuh)

(Lpb orang dewasa = 1,73 m2)

Rumus Fried (bayi 1 tahun,n= dalam bulan)

..cont
Rumus Clark (berdasarkan berat badan dalam pon)

Rumus Evans anak-anak n = umur yang akan datang untuk obat antiinfeksi.antibakteri n = umur anak sekarang untuk obat sensitif (opiat) n = umur yang sudah lewat

Patients: 6 months12 years

Use surface area (SA) approach (Talbot)
1. Using nomograms :

Read SA from a nomogram

..cont
2. Without nomograms
SA(m2):

4W(kg) + 7 W (kg) + 90

cont
3. Using a calculator:
In the absence of an estimate of surface area,

an adjusted body weight can be used as

follows: This equation is derived from the fact that weight to the power of 0.7 (wt0.7) relates

better to surface area than to weight alone.

Dosing in Pregnancy
Pregnancy Drug effects

cont
1. 2. 3. Avoid all drugs if possible, including social drugs (e.g. smoking, alcohol, caffeine) Avoid drugs in the first trimester Choose drugs of proven safety or least toxicity

4.

Use short courses and the smallest doses

Dosing in Geriatric
Pada umumnya kecepatan absorbsi obat lebih lambat pada lansia dari pada dewasa muda karena faktor-faktor berikut: 1. Berkurangnya sekresi getah lambung sehingga kecepatan disolusi sediaan tablet & kapsul menurun, juga kadar ionisasi obat 2. Perubahan mukosa G.I. Dapat memperlambat transpor aktif obat
3. Perubahan kecepatan pengosongan lambung, motilitas usus, menurunnya aliran darah ke mesenterik

Membuat Serbuk Percobaan

Cara:
Semua zat dicampur (1/3- dari seluruh

campuran dalam resep), kemudian ditimbang 3

sendok rata dari serbuk percobaan, sehingga bisa diketahui berat rata-rata 1 sendok. Bila sudah diketahui berat 1 sendok, dapat diketahui dosisnya, apakah melebihi DM atau tidak.

Cont
Contoh : R/ Natrii Subcarbonas 70 Papaverini HCl 2 sekali 250 mg (papaverine HCl) Magnesii Carbonas 7 sehari 1 gram Elaeosacch. Anisi 10 Kaolin 7 Mds. 3.dd.cth.1 Pro. Tn. Anwar Caranya : Seluruh serbuk ditimbang, kecuali papaverini HCl, lalu ditimbang 3 sendok teh rata (misal 1 sendok teh rata = 4 gram). Seluruh campuran beratnya = 96 gram Seluruh campuran ada = 96/4 = 24 sendok teh 1 sendok teh mengandung Papaverini HCl = 1/24 x 2 g = 83,30 mg Dosis sekali = 83,30/250 -------------------kurang dari DM Dosis sehari = 3 x 83,30 -------------------- kurang dari DM 1000 Dosis maksimum sekali dan sehari tidak dilampaui, maka campuran serbuk dapat dibuat dan diserahkan kepada pasien.

Contoh kasus 1
How many milligrams of a drug are in two tablets if one tablet contains 5 mg of the drug?
State the problem as a proportion: 5 mg : 1 tablet :: X : 2 tablets Remember the product of the means equals the product of the extremes: 1 tablet X = 5 mg 2 tablets Solve for X. Divide each side of the equation by the known value, 1 tablet,

and cancel units that appear in both the numerator and denominator:

Contoh kasus 2
A patient is scheduled to receive 0.05 mg levothyroxine P.O., but the only drug on hand is in tablets that contain 0.025 mg each. How many tablets should you give?
State the problem as a proportion: 0.025 mg : 1 tablet :: 0.05 mg : X The product of the means equals the product of the extremes: 1 tablet 0.05 mg = 0.025 mg X

Solve for X by dividing each side of the equation by 0.025 mg and canceling units that appear in both the numerator and denominator. Carefully check the decimal placement.

Contoh kasus 3
Your patient is receiving 500 mg of cefaclor in an oral suspension. The label reads

250 mg/5 ml, and the bottle contains 100 ml. How many milliliters of the drug
should you give? 1. Set up the first fraction with the known solution strength: 2. Set up the second fraction with the desired dose and the unknown number of

milliliters:
3. Put these numbers into a proportion: 4. Cross-multiply the fractions:

5. Solve for X by dividing both sides of the equation by 250 mg and canceling units that appear in both the numerator and denominator

You'll need to administer 10 ml of cefaclor to the patient.

Contoh kasus 4
A drug order calls for 60 mEq potassium chloride liquid as a one-time dose, but the

only solution on hand contains 20 mEq/15 ml. How many tablespoons should you give
the patient? 1. Convert the milliliters to tablespoons by using a conversion table. You'll see that 15 ml equals 1 tbs; therefore, 20 mEq of the solution on hand equals 1 tbs. 2. Set up the first fraction with the amount desired over the amount you have: 3. Set up the second fraction with the unknown amount desiredXin the appropriate position: 4. Put these fractions into a proportion: 5. Cross-multiply the fractions: 6. Solve for X by dividing each side of the equation by 20 mEq and canceling units

that appear in both the numerator and denominator: X = 3 tbs

Contoh kasus 5

Contoh kasus 6
Contoh : R/ Atropini Sulfas 0,5 mg Bellad. Extr. 15 mg Lactose q.s m.f.Pulv.dtd. No X S.t.dd.P.I Pro Tn. Abd. Hamid Menurut FI ed. III (1979) : DM untuk Atropini Sulfas : Sekali = 1 mg Sehari = 3 mg Jadi : Persentase satu kali =
Persentase satu hari =

Contoh kasus 7
Contoh : R/ Atropini Sulfas 0,5 mg Bellad. Extr. 15 mg Lactose q.s m.f. syr 60ml S.t.i.d. I cth Pro: Hamid (5 thn) Menurut FI ed. III (1979) : DM untuk Atropini Sulfas : Sekali = 1 mg Sehari = 3 mg DM Rumus 5 x 1 = 0,29 mg 5+12 Persentase satu kali 60ml/5ml=12 sendok 1 x 0,5 = 0,041 mg 12 0,041 x 100 = 14,1%/sendok 0,29 Persentase satu hari 0,041 x 3 x 100 = 13,9%/sendok 0,88

Contoh kasus 8 If the maintenance dose of a drug for 70 kg adult is 100 mg per day, what is the appropriate dose for a 15 kg child?
Using surface area
SA = 0.62 m2:

Using weight

Pustaka
1. Antoon, Melody C., Collins, Marissa R.K., Frazer, Christine., Greenawalt, Julia A., et al. 2007. Dosage Calculations: An Incredibly Easy! Pocket Guide. 1st Edition. Philadephia: Lippincott Williams & Wilkins.
2. Begg, Evan J. 2003. Instant Clinical Pharmacology. Blackwell Publishing Ltd UK. 3. Langley, Christopher A and Belcher, Dawn. 2008. Pharmaceutical Compounding and Dispensing. Chicago: Pharmaceutical Press. 4. Pickar, Gloria D. 2007. Dosage Calculations: A Ratio-Proportion Approach. 2nd edition. New York: Thomson.

OTT
Drug interaction:
Both in vitro and in vivo physically and chemically interaction Any in vivo incompatibility in which clinical effects of one drug may be desirably or undesirably altered by the prior, concurrent, or subsequent administration of the same or additional exogenous substances.

Pharmacology

Physyical

Interaction
Chemical

OTT

Foods

Pustaka
Martin, Eric W. 1971. dispensing Of Medication: Formerly husas Pharmaceutical Dispensing. 7th edition. Pennsylvania: Mack Publishing. 113-175

Terima Kasih
The only source of knowledge is experience
-Albert Einstein-