gastropati nsaid blok 2 6
TRANSCRIPT
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GASTROPATI OBAT ANTI INFLAMASI NON STEROID (OAINS/NSAID)
dr. Saptino Miro, SpPDSub Bagian Gastroentero-HepatologiBagian Ilmu Penyakit Dalam – FK Unand
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Pemakaian OAINS (Obat Anti Inflamasi Non Steroid)
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Komplikasi Gastrointestinal
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OAINS Saluran CernaKardiovaskulerSerebrovaskuler
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Faktor Pertahanan Mukosa Lambung
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Page 10 Metabolisme asam arakidonat dlm proses inflamasi
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GASTROPATI OAINS
PROSES INFLAMASI LAMBUNG YANG DISEBABKAN OLEH PENGGUNAAN OAINS
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JENIS-JENIS OAINS
Inhibitor COX Non Selektif
Turunan Asam salisilat : Aspirin, natrium salisilat, kolin magnesium, sulfasalazin, olsalazin
Turunan para aminofel : Asetaminofen
Asam asetat Indol dan Inden : Indometasin dan sulindak
Asam asetat heteroaril : Tolmetin, diklofenak, ketorolak
Asam Arilpropionat : Ibuprofen, Naproksen, Ketoprofen, oksaprozin
Asam Antranilat (Fenamat) : Asam mefenamat, asam meklofenamat
Asam Enolat : Oksikam (Piroksikam, Meloksikam)
Alkanon : Nabumeton
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JENIS-JENIS OAINS
Inhibitor COX-2 Selektif
Furanon tersubsitusi diaril : Rofekoksib
Pirazol tersubsitusi diaril : Celecoxib
Asam Asetat Indol : Etodolak
Sulfonanilid : Nimesulid
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PEMILIHAN OAINS
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RISIKO KOMPLIKASI GASTROINTESTINAL
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Page 16Patogenesis Kerusakan Lambung yang Diinduksi OAINS
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Patofisiologi Gastropati OAINS
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Klasifikasi dan Etiologi
Aliran darah Mukosa
Sekresi Mukosa
Sekresi Ion Bikarbonat
Meningkatkan Pertahanan epitel
Prostaglandin
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FAKTOR RISIKO KOMPLIKASI GASTROINTESTINAL ATAS AKIBAT OAINS
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Diagnosis Gastropati OAINS
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Keluhan Gastropati OAINS
Perdarahan-Perforasi
Ulkus
Dispepsia
Tidak Bergejala
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DIAGNOSTIK
ENDOSKOPI
Kongesti MukosaErosi Kecil-Kecil
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PENATALAKSANAAN GASTROPATI OAINS
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Mencegah Ulkus Lambung
OAINS ARH2
OAINS Analog Prostaglandin
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ANTAGONIS RESEPTOR H2 (ARH2) DOSIS TINGGI
RANITIDIN 150 MG/HrEFEKTIF MENINGKATKAN pH LAMBUNGMENURUNKAN PERDARAHAN LAMBUNG
FAMOTIDINE 40 Mg 2x/hr EFEKTIF MENURUNKAN RISIKO ULKUS LAMBUNG
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Pengobatan
Text in here
• Riwayat Ulkus
• Penggunaan Obat Lain
• Jenis, Lama, Dosis OAINS
• Keluhan Gastrointestinal
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GOLDSTEIN (2008)PENELITIN DOUBLE BLIND MULTICENTER
ULKUS
ASPIRINCELECOXIB7%
ASPIRIN NAPROXEN23,3%
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MISOPROSTOL
Prostaglandin Sintesis AnalogTerapi Lini pertamaEfek Samping yang >>>
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Manajemen Pasien yg Mendapat aspirin
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KESIMPULAN
Obat anti inflamasi non steroid komplikasi gastrointestinal melalui penghambatan produksi prostaglandin
Faktor Risiko komplikasi gastrointestinal terkait OAINS : usia, kombinasi obat lain, kombinasi oains lain, gangguan kesehatan lain
Endoskopi merupakan standar emas diagnostik gastropati OAINS
Penghambat Pompa Proton Ulkus lambung dan komplikasi
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