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Data Tambahan Jurnal Reading
Data Tambahan Jurnal Reading
Dosage Adult : SC Palliation of prostatic carcinoma 3.6 mg every 28 days or 10.8 mg every 12
wk. Pituitary desensitisation before ovulation induction w/ gonadotrophins Depot 3.6
mg.
Adult: 3.6 mg injected into the anterior abdominal wall every 28 days or 10.8 mg every 12
wk. An anti-androgen is given several days before beginning of the treatment and
continued for at least 3 wk to prevent disease flare.
Subcutaneous
Pituitary desensitisation before ovulation induction with gonadotrophins
Adult: 3.6 mg as a depot inj. Monitor serum-oestradiol concentrations until they decline to
levels similar to those in the early follicular phase which takes about 7-21 days.
Special Precautions Urinary tract obstruction or spinal cord compression (when used for prostate cancer);
decreased bone density in women. Contraceptive measures should be taken to protect
against pregnancy. Monitor men at risk from tumour flare during the 1st mth of therapy.
Safety and efficacy on the usage of the 10.8 mg implant in women is not established.
Adverse Drug Vaginal bleeding and dryness, arthralgia, paraesthesias, increase in menstrual bleeding,
Reactions hot flushes, sexual dysfunction. Headache, emotional lability, depression, insomnia,
diaphoresis, dizziness, breast swelling/tenderness, Inj site reactions. Anaphylaxis.
Mechanism of Action Description: Goserelin is a potent inhibitor of pituitary gonadotrophin secretion. Initially, it
causes an increase in the serum levels of FSH and LH but chronic admin will lead to
sustained suppression of the pituitary gonadotrophin release causing regression of the sex
organs.
Pharmacokinetics:
Absorption: Almost complete (SC).
Excretion: >90% excreted in urine (as unchanged drug and metabolites); 2-4 hr
(elimination half-life).
Oral
Breast cancer
Oral
Anovulatory infertility
Adult: 20 mg daily on days 2-5 of the menstrual cycle, increase if necessary in subsequent
cycles. Max: 80 mg daily. Women w/ irregular menstruation: Initial course may begin on
any day and a 2nd course may start 45 days later.
Contraindications History of DVT or pulmonary embolism. Pregnancy and lactation. Concomitant coumarin-
type anticoagulant therapy.
Adverse Drug Hot flushes, GI intolerance, nausea, fluid retention, vag bleeding or discharge, pruritus
Reactions vulvae, dry skin, rashes, alopecia, headache, depression, dizziness, fatigue, confusion,
muscle cramps, transient thrombocytopenia and leucopenia, thromboembolism, uterine
fibroids, endometrial changes (e.g. polyps, hyperplasia), menstruation suppression, cystic
ovarian swelling, increased liver enzymes, hypertriglyceridaemia. Rarely, loss of visual
acuity, blurred vision, cataracts, retinopathies, corneal opacities, retinopathies, hepatitis,
cholestasis, interstitial pneumonitis.
Potentially Fatal: Stroke, pulmonary embolism, uterine sarcoma, endometrial cancer.
Category D: There is positive evidence of human foetal risk, but the benefits from use in
pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-
threatening situation or for a serious disease for which safer drugs cannot be used or are
ineffective).
Monitoring Perform periodic CBC (e.g. platelet counts) and LFTs. Routine gynaecological monitoring
Parameters and any abnormal symptoms (e.g. abnormal vag bleeding or discharge, pelvic pain,
menstrual irregularities).
Overdosage Symptoms: Neurotoxicity (e.g. gait disorders, hyperreflexia, tremor, dizziness), changes in
ECG (QT prolongation). Management: Symptomatic treatment.
Drug Interactions Increases dopaminergic effect of bromocriptine. Increased risk of thromboembolic events
w/ cytotoxic drugs. Increased risk of bleeding w/ platelet aggregation inhibitors. May
mutually reduce effects w/ hormone preparations particularly oestrogens (e.g. OCs).
Reduced plasma levels w/ CYP3A4 inducers (e.g rifampicin) and CYP2D6 inhibitors.
Increased plasma levels w/ CYP3A4 inhibitors.
Potentially Fatal: Significant increase in anticoagulant effect w/ coumarin-type
anticoagulants (e.g. warfarin).
Lab Interference False-negative oestrogen receptor determination if performed soon after discontinuance of
tamoxifen therapy. May cause increases in serum thyroxine concentration.
Perimenopause terjadi dengan baik sebelum Anda secara resmi mengalami menopause.
Padahal, menurut Klinik Cleveland, wanita memasuki tahap ini 8 sampai 10 tahun menjelang
menopause. Hal ini terjadi pada usia 30an atau 40an.
Perimenopause ditandai dengan penurunan estrogen, yang merupakan hormon wanita utama
yang diproduksi oleh ovarium. Tingkat estrogen juga bisa naik dan turun lebih sporadis daripada
siklus 28 hari normal, yang dapat menyebabkan menstruasi yang tidak teratur dan gejala lainnya.
Selama tahap akhir perimenopause, tubuh Anda akan menghasilkan estrogen yang kurang dan
sedikit. Meskipun penurunan estrogen yang tajam, masih mungkin untuk hamil. Fase menopause
ini bisa berlangsung sekecil beberapa bulan dan selama empat tahun.
adalah perokok
Ketika sampai pada menopause, kebanyakan orang lebih memikirkan gejala daripada hal
lainnya.Ini bisa termasuk hot flashes yang terkenal, namun ada banyak perubahan lain
yang mungkin Anda alami selama masa transisi ini.
Gejala perimenopause dapat meliputi:
periode tidak teratur
menstruasi yang lebih berat atau lebih ringan dari normal
perubahan rambut
peningkatan denyut jantung
sakit kepala
kehilangan dorongan seksual
kesulitan konsentrasi
kelupaan
sakit otot
infeksi saluran kemih
masalah kesuburan (pada wanita yang mencoba hamil) Sebagai tingkat estrogen turun,
Anda mungkin mulai mengalami gejala menopause. Beberapa di antaranya bisa terjadi
saat Anda masih di tahap perimenopause. Anda mungkin mengalami:
hot flashes
keringat malam
depresi
kecemasan atau mudah tersinggung
mood swings
insomnia
kelelahan
kulit kering
kekeringan vagina
Sering buang air kecil
Perimenopause dan menopause juga dapat meningkatkan kadar kolesterol. Inilah salah
satu alasan mengapa wanita dalam masa pascamenopause memiliki risiko penyakit
jantung yang lebih tinggi. Terus tingkat kolesterol Anda diukur setidaknya setahun sekali.
Hubungi dokterKetika menghubungi dokter
Anda tidak perlu menghubungi dokter Anda untuk mendapatkan diagnosis
perimenopause atau menopause, namun ada beberapa contoh saat Anda pasti harus
menemui OB-GYN Anda. Anda mungkin sudah mengalami beberapa gejala awal, namun
ada tanda lain yang harus ditangani dengan dokter. Panggil segera jika Anda memiliki:
bercak setelah menstruasi
pembekuan darah selama periode menstruasi
perdarahan setelah hubungan seks
yang jauh lebih lama atau jauh lebih pendek dari biasanya
Anda juga harus menghubungi dokter Anda jika gejala perimenopause atau menopause cukup
parah untuk mengganggu kehidupan sehari-hari Anda.
krim
gels
patch kulit
Obat menopause lainnya lebih ditargetkan. Misalnya, resep krim vagina bisa meringankan
kekeringan sekaligus rasa sakit karena bersenggama. Antidepresan dapat membantu perubahan
mood. Bagi migrain, gabapentin (Neurontin), obat kejang, bisa menjadi pilihan.
Ada juga metode yang bisa Anda gunakan untuk meringankan gejala Anda di rumah. Olahraga
teratur dapat membantu memperbaiki mood, masalah penambahan berat badan, dan bahkan
(ironisnya) hot flashes Anda. Buatlah rencana untuk mendapatkan beberapa bentuk aktivitas fisik
dalam rutinitas harian Anda. Hanya tidak bekerja sebelum tidur, karena hal ini dapat
meningkatkan insomnia.
Cukup istirahat bisa terasa tidak mungkin jika Anda menghadapi insomnia. Cobalah
melakukan aktivitas santai tepat sebelum tidur, seperti yoga lembut atau mandi air hangat.
Hindari tidur siang hari, karena ini bisa mengganggu kemampuan tidur Anda di malam hari.
Berikut adalah beberapa metode lain yang bisa Anda coba untuk menghilangkan gejala:
Hindari makanan besar.
Berhenti merokok.
Hindari alkohol.
OutlookOutlook
Perimenopause dan menopause adalah fase peralihan yang mengindikasikan akhir masa
reproduksi Anda. Tentu ada penyesuaian yang harus dilakukan, tapi ingat tidak semua
aspek negatif. Dengan semua perawatan yang tersedia, Anda bisa melewati tahap ini
dengan lebih nyaman dengan sedikit kebebasan juga.
https://ww5.komen.org/BreastCancer/EarlyBreastCancer.html
Early breast cancer is cancer that is contained in the breast or has only spread to the lymph
nodes in the underarm area. This term often describes stage I and stage II breast cancer.
In the U.S., most breast cancers are found at these early stages.
With treatment, people with early breast cancer usually have a very good prognosis.
One large study found about 90 percent of women diagnosed between 1990-2004 with early
breast cancer lived at least 5 years beyond diagnosis [119].
With improvements in treatment since that time, survival for women diagnosed today is even
higher.
Treatment for early breast cancer usually involves some combination of surgery, radiation
therapy, chemotherapy, hormone therapy and/or targeted therapy.
Surgery
With either type of surgery, some lymph nodes in the underarm area (axillary nodes) may be
removed to find out whether the cancer has spread there.
Radiation therapy
Lumpectomy
Women who have a lumpectomy also have radiation therapy to the breast to get rid of any cancer
cells that may remain. This lowers the chances of the cancer coming back (recurrence) [2].
Mastectomy
However, in some cases, radiation therapy is used after mastectomy to treat the chest wall, the
axillary lymph nodes and the lymph nodes around the collarbone.
These drug therapies travel throughout the body to help ensure the body is completely rid of
cancer. They may be called systemic therapy or adjuvant therapy.
Some drug therapies are given by vein (through an IV) and others are given in pill form.