LEARNING OBJECTIVE

1. Definisi
2. Tujuannya
3. Dos dan contoh ubatan
4. Cara pemberian ubatan
5. Tindakan ubatan
6. Kesan sampingan
7. Kontraindikasi
8. Nasihat
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 INTRODUCTION
PAIN SOURCE

1. Visceral
- originated in smooth muscle (solid or hollow organs)
- difficult to localize (diffuse, gnawing, crampy)
- responds to opiods analgesic
2. Somatic (nociceptive)
- originate in skeletal muscle, ligament and joint.
- localized and constant (dull, sharp/ aching)
- prostaglandin mediated –typically responed to NSAIDs
3. Neurophatic
- peripheral or central nerve injury, not stimulation
- burning, tingling, shooting pain.
- poor responds to analgesic – better responds to adjuvant Tx
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Medicine classes to alleviate pain

1.Nonopiods (Nonnarcotic)
- salicylate
- Nsaid
- Acetaminophen (paracetamol)
2. Opiods (Narcotic)
- Opiods agonist
- treat moderate to severe
- morphine
- mixed opiods agonist
- treat moderate to severe
- common used in dentistry
- buprenorphine
- opiods antagonist
- mx of overdose
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 DEFINISI

- Analgesic that relieves pain selectively without blocking the

conduction of nerve impulses, markedly altering sensory
perception or affecting consciousness.
- Analgesic classified into two type
i) anti-inflammatory drugs
- which alleviate pain by reducing local inflammatory
responses.
- Opioids (Narcotic drugs)
- which act on the brain
- can induce sleep
- can used either in short term or long term relieve of severe
pain.
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PHARMACOTHERAPEUTIC INDICATION

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NONOPIOIDS
SALICYLATES
1. Aspirin
2. Choline salicylate
3. Diflunisal
4. Magnesium salicylate
5. Sodium salicylate

NSAID
1. Etodolac
2. Ibuprofen
3. Ketoprofen
4. Naprosyn

Acetaminophen
1. Tylenol (analgesic, antipyretic)

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 DOS DAN CONTOH UBAT
Nonopiods (nonnarcotics)
1. Salicylate
aspirin (Acetylsalicylate acid)
Dose: 2-11 years: 10-15 mg/kg PRN/TDS
12- older: 325 -650 mg PRN/TDS
Persediaan: suspension,tablet,suppository
Administration: oral,rectal

PHARMACOTHERAPEUTIC ACTION
- Works by blocking prostaglandin synthesis in the peripheral
nerves & hypothalamus portion of the brain.
- Inhibition of renal prostaglandin synthesis – < in renal blood
flow, - reduction in glomerulus filtration rate.
- Increase blood fibrinolytic activity
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PHARMACOTHERAPEUTIC EFFECT
GI
Acute
- Abdominal pain/discomfort
- Gastric mucosal lesion
- Nausea
- Vomitting
Severe
- Hemorrhage
- Peptic ulcers
- Perforation
- Small bowel enteropathy
- Esophageal ulceration
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Renal
- Interstitial nephritis
- Papillary necrosis
- Elevation in serum creatinine
- Elevation in blood urea nitrogen
- Protenuria
- Heamaturia
- Renal failure
Hematological
Rare
- Hypoprothrombinemia
- Thrombocytopenia
- Thrombocyturia
- Megaloblastic anemia
- Pancetopenia
- Aplastic anemia
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Hypersensitivity
- Bronchospasm
- Rhinitis
- Conjunctivitis
- Urticaria
- Angioedema
- Anaphylaxis

Dermatology
- Steven johnson syndrome
- Lichenoid eruption (damage between epidermis and dermis)
- Papiloerythroderma

Hepatic
- Hepatotoxicity
- Cholestatic hepatitis

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CONTRAINDICATION

1. G6PD (Glucose-6-phosphate dehydrogenese deficiency) –

hemolytic anemia
2. Kidney disease inhabits the kidney to
3. Hyperuricemia excrete uric acid
4. Influenza symptoms
5. Reye’s syndrome (rare)
- noninflammatory encelophaty
- fatty degenarative liver disease

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2. NSAIDs
Ibuprofen (Motrin)
Dose: 300 mg, 400 mg, 600 mg, 800 mg
TDS/QID
Recommended: 1200 mg – 3200 mg/day
Persediaan : Tablet,capsule 200mg,
suspension 100mg/2.5ml and 100mg/5ml
Administration: Oral

PHARMACOTHERAPEUTIC ACTION
- To inhibits prostaglandin synthesis rather than simply to
provide analgesia.

Primary dysmenorrhea
- To reduce elevated levels of prostaglandin activity in the
menstrual fluid.
-9/1/2018
To reduce resting and active intrauterine pressure. 12
Neurology

- Neuroprotective effect againt – parkinson’s disease

(Harvard Medical School, 2011)

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PHARMACOTHERAPEUTIC INDICATION

1. Rhemathoid arthritis
2. Osteoarthritis
3. Primary dysmenorrhoea (400 mg every 4 hour)
4. Episiotomy
5. Pyrexia
6. Pericarditis
7. Patent ductus arteriosus

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PHARMACOTHERAPEUTIC EFFECT
Gastrointestinal
1. Epigastric pain
2. Dyspepsia
3. Diarrhoea
4. Nausea and vomitting
5. Constipation
6. Abdominal cramp

CNS
1. Dizziness
2. Headache
3. Nervousness
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Dermatology
1. Maculopapular type (rash)
2. Pruritis

Special sense
1. Tinnitus

Metabolite/endocrine
1. Decrease appetite

CVS
1. Oedama
2. Fluid retention
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CONTRAINDICATION

1. Hypersensitivity
2. Syndrome of nasal polyps
3. Angioedma
4. Bronchospastic reactivity to aspirin
5. Other NSAIDs

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OPIOIDS
Agonist
1. Codeine
2. Hydrocodone
3. Hydromorphone
4. Meperidine
5. Morphine
6. Oxycordone
7. Pethidine (meperidine)

Mix agonist
1. Buprenorphine

Antagonist
1. Nalbuphine (Nubain) – semi syntethic opioids
2. Nalorphine
3. Naloxone
4. Pentazcine
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Opioids
Opioids agonist
Morphine(10mg/ml,15mg/ml,20mg/ml) (ampoule)
Dose: 0.2-0.5 mg/kg/dose (1-12Year)
(tablet/suspension)
0.05-0.2 mg/kg/dose (I/m,Iv,Sc)
(15-30 mg adult tablet)
Persediaan: Suspension, Infusion, tablet,
suppository
Administration : Oral,I/V, rectum,I/M, S/c

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PHARAMACOTHERAPEUTIC ACTION
CNS
- Direct action on the brain stem respiratory center
consequences
- reduction responsiveness of the brain stem
respiratory stem center to,
i) increase in carbon dioxide tension
ii) electrical stimulation
effect
- respiratory depression

- Direct effect on the cough center in the medula

Consequences
- Depresses of the cough reflex
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PHARMACOTHERAPEUTIC EFFECT

CNS
- Sedation
- Drowsiness
- Myoclonic spasm(overdose)
- Hyperalgesia(overdose)
- Granulomas (Long term))
- Paralysis(Long term)
- Delirium
- Seizure
- Tremors
- Dizziness
- Malaise
- confusion
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Respiratory
- Respiratory depression
- Bronchospasm (pulmonary disease)

GI
- Nausea
- Vomitting
- Dyspepsia
- Constipation
- Dry mouth
- I/O
- Increase biliary pressure

CVS
- Orthostatic Hypotension (Peripheral vasodilation)

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Psychiatric

- Fearfullness
- Agitation
- Thinking disturbance
- Paranoia
- Psychosis
- Hypervigilance (perception of environment threatened)
- Hallucination

Genitourinary
- Urinay retention – Cx urosepsis
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CONTRAINDICATION

- Respiratory depression
- Acute or chronic bronchiol asthma
- Paralytic illeus
- Hypersensitivity
- IHD secondary to Chronic lung disease
- Biliary or renal colic
- Acute alcholism
- Head injury
- Condition Intracranial pressure raised.

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 Glenmark Generics Inc., USA
Mahwah, NJ 07430

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Agonist
Pethidine (meperidine)
Dose: 50 mg/ml, 100 mg/ml (ampoule)
Administration: I/V

PHARMACOTHERAPEUTIC ACTION
Endorphine
- Pain reducing chemical found in the brain and spinal cord.
- Action of natural endorphins by combaining with the opioids
receptors in the brain and spinal cord.

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PHARMACOTHERAPEUTIC EFFECT

- Same with Morphine

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CONTRAINDICATION

1. Hypersensitivity
2. Diarrhoea
3. Bronchiol asthma
4. COPD
5. Co pulmonale
6. Respiratorry depression
7. Anoxia
8. Kyphoscoliosis
9. Acute alcholism
10. ICP
11. pregnancy
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 REFERENCESS
http://www.rxlist.com/ibuprofen-drug/side-effects-
interactions.html

http://doctorslounge.com/rheumatology/drugs/analgesics/narcotic
/pethidine.htm

http://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?
archiveid=22528

http://www.medicinenet.com/ibuprofen/article.htm

http://www.genrxinfo.net/drugs/Ibuprofen.htm

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www.drugs.com/sfx/aspirin-side-effects.htm

www.drugs.com/morphine.html

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