7/22/2019 Steroid Sistemik

1/2

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

7/22/2019 Steroid Sistemik

2/2

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