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PROTOKOL HEMANGIOMA KEVERNOSA

Nama : No. CM :
Tanggal lahir/ umur : BB/TB :
Jenis kelamin : Tanggal terapi dimulai:

Bulan I Bulan II Bulan III Bulan IV


Minggu Minggu Minggu Minggu
1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4
Bulan I
Tgl:........s/d..........
Propanolol
2 mg/kgBB/hari

Bulan II
Tgl:........s/d..........
Propanolol
2 mg/kgBB/hari

Bulan III
Tgl:........s/d..........
Propanolol
2 mg/kgBB/hari

Bulan IV
Tgl:........s/d..........
Propanolol
2 mg/kgBB/hari

Gambar lokasi
Hemangioma/
Ukuran diameter

Nama pengukur :.................... Nama pengukur :................. Nama pengukur :............... Nama pengukur :................

Richard J Antaya, MD,eMedicine,2005 Surakarta,......................................


Supervisor,
Drug Category: Propanolol -- propanolol belongs to agroup of drugs known as beta-blockers, wich are used to treat high blood pressure
and migraines. It is though to work by affecting some factors wich promote growth of haemangiomas with the mechanism of action of
propanolol may include vasoconstriction, decreased expression of VEGF and bFGF genes, down regulation of the RAF- mitogen
activated protein kinase pathway, or triggering of apoptosis of endothelial cells.

The main side effect of propanolol are low blood pressure, low blood sugar, slowing of the heart rate,wheezing.Because of this the
medicine need to be commended in hospital with appropriate monitoring.However the vast majority of infants tolerate the medicine
well,and shrinking of the haemangiomas can become evident within a few week of starting treatment.

ds are effective at slowing the growth and decreasing the size of proliferating hemangiomas. The mechanism of action has not been
elucidated completely; however, corticosteroids appear to act by potentiating vasoconstrictive effects of epinephrine and norepinephrine
on vascular smooth muscle. Evidence indicates that corticosteroids block estradiol receptors in hemangiomas in vitro. Wide variation in
response rates exists, from less than 40% to greater than 90%, depending on dose, duration of treatment, and age at which corticosteroid
therapy is initiated. Corticosteroid should be administered during the proliferative phase because they have a negligible effect on involuting
otherwise stable lesions. The oral route generally is preferred over intralesional therapy; however, the location, size, patient age, and
physician experience factor into the decision-making process.

Propanolol
Drug Name
Trigering of apoptosis of endothelial cells, vasoconstrition.
Starting dose 1mg/kg/day, increase dose when stable until on
Pediatric Dose
2mg/kg/day in 2 devided doses
Documented hypersensitivity; viral, fungal, or tubercular skin lesions;
Contraindications
infants with concurrent infection; underlying malignancy
Decreases effects of salicylates and toxoids (for immunizations);
Interactions phenytoin, carbamazepine, barbiturates, and rifampin decrease effects
of corticosteroids
Pregnancy B - Usually safe but benefits must outweigh the risks.
Caution in hyperthyroidism, osteoporosis, cirrhosis, nonspecific
ulcerative colitis, peptic ulcer, diabetes, and myasthenia gravis; adverse
effects of systemic corticosteroids include behavioral disturbances,
Cushing syndrome (from adrenal suppression with associated cutaneous
Precautions features), growth retardation, gastroesophageal reflux, peptic irritation
and possible ulceration, fluid and electrolyte disturbances,
hyperglycemia, hypertension, osteoporosis, and immune suppression;
most infants tolerate medications well, but close monitoring is required
and parental education regarding possible adverse effects is essential