dr. Hadi Sarosa, M.

Kes
Physiologist
A. IMPULS LISTRIK 3.Monoamine
B. ZAT KIMIA :  Dopamin
NEUROTRANSMITTER  Histamin
1. Asetil kolin  NE
2. Asam amino  Serotonin
 Gama-aminobutyric acid 4. Neuropeptide
(GABA)  Somatostatin
 Glutamat  Endorphin
 Aspartat  Enkaphalin
 Glycine  substance P
Otak : listrik & Neurotransmitter
Potensial Membran
Neurotransmitter
 NEUROTRANSMITER
Glutamat eksitatorik

Aspartat
Asam Amino
Glisin
Gammaaminobutyric acid (GABA) Inhibitorik
Molekul Kecil
dopamin
Konvensional
Catecholamines ( Tirosin) epinefrin
Mono Amine
norepinefrin
Indolalamin (Tryptophan) serotonin
Asetilkolin Asetilkolin
Gas gas yang Oksida Nitrit
Molekul Kecil
dapat larut Karbon monosida
tak
Konvensional Endokanabinoida
Anandamida
Peptida pituitaria
Molekul
Neuropeptide Peptida hipotalamik
Besar
Peptida opiat
Neurotransmitter
 The Dopamine
Pathways

Nigrostriatal pathway
Substantia Nigra to Striatum
. Motor control
. Death of neurons in
this pathway can result in
Parkinson's Disease
Tuberoinfundibular pathway
Hypothalamus to Pituitary gland
. Hormonal regulation
Mesolimbic and Mesocortical pathways . Maternal behavior (nurturing)
Ventral Tegmental Area to Nucleus . Pregnancy
Accumbens, Amygdala & Hippocampus, . Sensory processes
and Prefrontal Cortex
. Memory
. Motivation and emotional response
. Reward and desire
. Addiction
. Can cause hallucinations and schizophrenia if
not functioning properly
The Serotonin Pathways

 Dihasilkan oleh nuclei

Raphe
 Dipengaruhi oleh obat
: Amphetamin, alkohol,
cocaine
Raphe Nuclei
 Berperan penting
dalam proses di otak :
pengaturan temperatur,
mood, lapar, nyeri dan
tidur

Problems with the serotonin pathway can cause obsessive-

compulsive disorder, anxiety disorders, and depression.
Most of the drugs used to treat depression today work by
increasing serotonin levels in the brain.
 Alcohol Caffeine
Glutamate and GABA decreases
glutamate
inhibits
GABA

(gamma-aminobutyric activity release

acid) are the brain's

major "workhorse"
neurotransmitters. Over PCP

half of all brain "angel

dust" Caffeine Alcohol
Tranquili
zers
increases increases increases increase
synapses release glutamate
activity
glutamate
activity
GABA
activity
GABA
activity
glutamate, and 30-40%
of all brain synapses
release GABA.
 Sedatif-Hipnotik dan Ansiolitik
• Golongan Barbiturat
– meningkatkan respon
GABA
– membuka kanal ion Cl-
meski tanpa GABA
• Golongan
Benzodiazepin
 Anti Depresan
Depresi : Kadar dopamin, serotonin dan NE menurun

1. Serotonin Spesific Reuptake inhibitor (SSRI)

misal : Fluoretin
2. Heterosiklik
mengeblok reuptake serotonin dan norepinefrin,
dan sebagai antagonis reseptor muskarinik.
sehingga kadar serotonin dan NE tinggi (misal :
desipramin, imipramin)
3. Serotonin Norephinefrin Reuptake Inhibitor (SNRI)
 Anti Depresan
4. MAO inhibitor
menghambat MAO
menghancurkan
serotonin, dopamin dan
NE (misal :
isokarboksamid)
5. Lain-lain
antagonis reseptor alfa 2
presinaptik sekresi serotonin
dan NE meningkat (misal :
Mirtazapiin)
 Antipsikotik (neuroleptik)
Psikotik : Kadar Dopamin & Serotonin >>
Typical neuroleptik
Untuk mengobati gejala positif
dengan menurunkan dopamin
Mekanisme :
mengeblok reseptor dopamin,
kolinergik muskarinik, alfa adrenergik
dan H-1 histaminergik
Contoh :
Klorpromasin, Haloperidol (potensi
besar namun efek samping paling
besar yaitu parkinson), Acetofenasin
Atypical, 5-HT DA Antagonist
Untuk mengobati gejala postif & negatif :
menghambat reseptor dopamin dan
serotonin
Mekanisme :
antagonis serotonin-dopamin, mengeblok
reseptor kolinergik muskarinik, alfa-1
adrenergik dan H-1 histaminergik
Contoh :
Clozapine, Quetiapine
 Parkinson
• Ganglia Basalis : serabut dopaminergik << 
asetyl cholin >>
1. Pengganti dopamin (terapi utama)
a. levodopa : prekursor metabolik dopamin
b. karbidopa : inhibitor dekarboksilase dopamin -> menurunkan
metabolisme levodopa -> kadar levodopa meningkat
c. tolkapon : inhibitor COMT (Catechol-O-Methyl-transferase) sehingga
levodopa bisa hidup lebih lama (waktu paro lebih panjang) dan kadarnya dalam
darah meningkat
2. Agonis reseptor dopamin (misal : bromokriptin, pergolid, pramipexole)
3. Antikolinergik (misal : triheksifenidil, benzotropin)