Download - Steroid Sistemik
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7/22/2019 Steroid Sistemik
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Prednisone tabs 20 mg no. XV
2.ddi
2 tab pagi
1 tab siang
Methylprednisolone tab 16 mg no.XXX
2.ddi
2 tab pagi
1 tab siang
Dexametasone tab 2mg no.XXV
2.ddi
2 tab pagi
2 tab siang
atau
Dexametasone tab 1.5 mg no. XXX
2.ddi
4 tab pagi
2 tab siang
Betamethasone tab 0.5 mg no. LXXV
5 tab x 3.ddi
Komplikasi
komplikasi Dosis mekanisme tx Intervensi Keterangantambahan
Osteoporosis Dimulai dri lowdose pred 5mg/day lebihdari 3 bulan.
Apoptosis osteoblast,impair absorbs ca,
- Calcium1500mg/day- Vit D2 400U/day- Thiazide
12.5-25mg.day (kalourinaru
cek: bonedensity, vit D, 24jam urinary ca.folo up: @ 3months.
Reversible: padausia mudaLoss 3-10% of bonedensity/year
Prednisone 1 mg/kgbb/day; berat 60 kg
Prednisone 60 mg/hari
Tablet (mg) Sediaantab
Vial Sediaan vial Ampul Sediaanampul
Hydrocortisone 240
Cortisone 300
Prednisolone 60 5 mg
Methylprednisolone 48 4, 8, 16 mg 7 strip 125 mg x 2
Triamcinolone 48 4 mg 2412
10 mg x 5ml40 mg x 10 ml
Dexamethasone 9 0.25, 0.5,0.75, 1 mg
2 5mg x 1 ml 4 mg/mlx 3 amp
4 mg/ml5 mg/ml
Betamethasone 7.2 0.5 mg 2 amp 4 mg/ml
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7/22/2019 Steroid Sistemik
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ca>250
mg/dl)-biphosponate
AVN >40 mgpred/dayterapi jangka
pendek > 20hari
Intraoseous HT,apoptosis osteoblast.Trombotic oklusi
decrease venousoutflow from bone
decrease arteriperfusiinfarct bone.
Jointreplacement
Xray, bone scan,mri
S n s: pain, limitasimotion in 1 or 2joint
Insulin
tolerance
>7.5 mg/day
pred
gluconeogenesis insulin Diet low cal, low
sugar, low fatCek FBS, beratbadan
Predileksi
Atherosclerosis
hypertension >10 mgpred/day
Retensi na,cathecolamin, Vascular
Smooth muscle
diuretik Diet low cal, lowfat, low Na
Diet high protein,K, CaCek BP, beratbadan
PredileksiAtherosclerosis,
kelainan jantunglainnya.
Supresi HPA
axis
After onset of
treatment5-20 mgpred/day >3mg
adrenal insuf:>20 mgpred/day > 3mg
Negative feedback,
adrenal supres
Tapering off Cek morning
plasma cortisolsetelah terapi 4mg.Keadaanmaintenancedose: cek plasmacortisol@ 2 bulan
Adrenal isuf:
lethargy, weaknes,nausea, anorex,fever, ortho hipo,hypoglycemi,weight loss.
Taper off:kurangi 5mg/dayuntuk pred >20, 15 mg
pred/daysuprestuberculinresponse.14 hari oralpred 40mg/dayinhibit
tuberculinresponse.
Inhib limfosit, monosit
Impair tipe 4hipersensitivity
Ppd test, anergy
panel
Pregnancy danlaktasi
Premature, low birthweight
Pake prednisoneato prednisolone
ga cross placenta
PediatricEarlyosteoporosis,growth retard
>0.75pred/kgbb/day
>2 mg/kg predatau >20mg/hari
Direct effect on impairCa, phosphor metabl.Decrease GH, inhibbone matrix formation.
GH