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ANEMIA

NILAI LAB.
Hemoglobin : M < 13 g/dL dan F < 12 g/dL
Hemoglobin Jumlah Hb per unit volume whole blood
Hematokrit Volume hct per unit volume whole TERAPI FARMAKOLOGI
blood
RBC Jumlah hct unit volume whole blood Iron Deficiency Anemia (IDA)
MCV Mean Corpuscular Volume Lab Serum iron dan ferritin <<
Rata-rata volume RBC (Hct/RBC count) TIBC >>
MCH Mean Corpuscular Hemoglobin
Tx Ferrous sulfate 100-200 mg
Persentase colume Hb dalam RBC
(Hb/RBC count) (200 mg FS = 65 mg besi elemental)
Serum iron Kons. besi yg berikatan dg transferin Penyerapan terbaik sebelum makan
TIBC Total Iron-Binding Capacity Profilaksis = 1-2dd 1tab
An indirect measurement of the iron- (anak > 6 tahun 0,5-1 tab <6 tahun 0,25-0,5 tab)
binding capacity of serum transferrin Terapi = 3dd 1 tab
Transferrin (Serum iron/TIBC) x 100
Monitor 100-200 mg / ml (0,1-0,2 g/dl) per hari
saturation
Serum Ferritin Jumlah besi yg disimpan dalam liver, atau 2 g/dl dalam 3-4 minggu
spleen dan bone marrow cells Hb & Hct per minggu
(Best indicator of iron deficiency) ES Mual dan tinja berwarna berubah
Erythropoietin Healthy individuals require 10 to 30
level milliunits/mL of EPO to maintain Anemia Megaloblastik
normal Hb and Hct concentrations Lab Vit B12 (<150 pg/ml) / folate deficiency
MCV tinggi (100-140 fL) dan normal
Hct <<
Tx Vit B12 dan asam folat
Folic Acid Deficiency
Tx Asam folat 1-5 mg/hari
Anemia Chronic Disease
Lab MCV rendah
Serum ferritin normal atau tinggi
TIBC rendah
Tx Besi oral maupun PI tidak efektif
Rekombinan:
Epoietin alfa 50-100 IU/kgBB 3x /mgg
Darbepoietin alfa
Monitor Hb tiap 2 minggu (target 11-12g/dl)
Iron,TIBC, transferrin saturation,
ferritin level

KLASIFIKASI ANEMIA
Makrolitik  defisiensi vit B12 dan asam folat
Mikrositik  defisiensi besi dan sickle cell anemia
Normositik  blood loss, hemolisis, bone marrow
failure, dan anemia chronic disease

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DIABETES MELITUS
NILAI LAB. 6,5-7,5%  monotherapy
Hiperglikemia 7,6-9%  dual therapy
HbA1C ≥ 6,5% > 9%  insulin or triple therapy
GDP ≥ 126 mg/dl
(no caloric intake for at least 8 h)
GD2PP ≥ 200 mg/dl
GDA ≥ 200 mg/dl Insulin Secretagogues
Hipoglikemia SULFONILUREA
GDA < 70 mg/dl moA Merangsang sekresi insulin di
kelenjar pankreas
Korelasi HbA1C dan GDP
Efek glikemik Fasting & prandial
ES Hipoglikemik, peningkatan BB,
mual, diare, leukopenia, trombosi-
topenia, agranulositosis, anemia
aplastik
IO Sulfonamida, alkohol, salisilat dosis besar,
fenilbutazon, steroid, oksifenbutazon,
probenezida, kloramfenikol, MAO Inhibitor.
KI Px geriatri, wanita hamil, gangguan
fungsi hari atau ginjal, ketoasidosis
Contoh Glibenklamide
Dosis awal 2,5-5 mg; >10 mg dalam
2 dosis terbagi (max 20 mg/hari)
Efek hipoglikemik poten
Glipizide
ALGORITMA TERAPI Dosis awal 2,5-5 mg; >15 mg dalam
2 dosis terbagi (max 40 mg/hari)
Durasi lebih lama drpd gliben
Glikazide
Dosis awal 30 mg/hari; 60,90,120
mg/hari
Efek hipoglikemik sedang
Bs u/ px ggg hati & ginjal
Glimepiride
Dosis awal 1-2 mg/hari, 4 mg/hari
(max 8 mg/hari)
Onset pendek
Durasi lama
E hipoglikemik lbh < drpd gliben
BS u/ px ggg ginjal atau geriatri
Glikuidon
Dosis awal 15 mg/hari; 45-60
mg/hari dalam dosis terbagi (max
180 mg/hari)
Bs u/ px ggg hati & ginjal
NON-SULFONILUREA (GLINID)
moA Merangsang sekresi insulin di
kelenjar pankreas
Efek glikemik Prandial

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ES Hipoglikemik (lbh < drpd sulfonil), Efek glikemik Fasting & prandial
peningkatan BB ES Mual, muntah, nyeri pd area injeksi
IO Sda IO Acarbose, captopril
KI Sda KI Ggl ginjal
Contoh Repaglinide Contoh Exenatide
Nateglinide 2 mg/minggu
BIGUANIDA Liraglutide
moA Menurunkan produksi glukosa hati
dg menurunkan glikoneolisis &
glukoneogenesis
Efek glikemik
ES Mual, muntah, diare, asidosis laktat
(minim), BB turun
IO Sda
TIPE INSULIN
KI Ggg hepar, ginjal (SCr < 1,5 mg/dl), Rapid acting Onset in 15 minutes
peny. Jantung, wanita hamil, Duration 4-5 hours
keadaan gawat darurat Ex: Lispro, Humalog
Contoh Metformin Use before meals
Dosis awal 500 mg bid/tid; atau 850 Short/regular Onset in 30-45 minutes
mg bid bersama makan acting Duration 5-6 hours
THIAZOLIDINEDIONES Ex: Humulin R
moA Meningkatkan sensitivitas insulin &
Use before meals
<< glikoneogenesis
*<< TG & LDL, >> HDL Intermediate Onset in 2-4 hours
Efek glikemik Fasting & prandial acting Duration 10-16 hours (NPH) &
ES Peningkatan BB, edema, >> risk ggg 12-18 hours (Lente)
jantung, osteoporosis, ca. bladder Ex: NPH, Lente, Glargine
IO Loop diuretic Use in the morning or before
KI Px ggl jantung dg edema & hepar bedtime
Contoh Rosiglitazone Long acting Onset in 6-10 hours
2,4,8 mg (1-2/day)  effect up to Duration 20 hours or more
24 h Ex: Ultralente
Pioglitazone Use in the morning or before
15,30,45 mg (once daily)  effect bedtime
24 h
α-GLUCONIDASE INHIBITOR
moA Menghambat enzime α-glukonidase INTENSIVE INSULIN REGIMEN
pd dinding usus halus Step 1 : Determine total daily dose
Efek glikemik Prandial 0,5 units x body weight (kg)  72kg Px: 36 U
ES GI adverse effect Step 2 : Determine basal requirements 
IO Sda 40% of total daily dose
KI Ketoasidosis MDI: basal insulin subcutaneously at bedtime
Contoh Acarbose NPH: 14U/day
Dosis awal 50 mg; 150-600 mg/hari Step 3 : Determine meal requirements 
pada suapan pertama 60% of total daily dose
Miglitol Remaining of 35% before breakfast,
25,50,100 mg (1-3 times/day)  30% before lunch, 35% before dinner
effect up to 3 h MDI:meal insulin subcutaneously before each meal
Lispro: 8U subcutaneously before breakfast
DPP-4 INHIBITOR
Lispro: 6U subcutaneously before lunch
moA
Lispro: 8U subcutaneously before dinner
Efek glikemik Prandial
ES Risk pankreatitis, mahal
IO Sda SPLIT-MIXED INSULIN REGIMEN
KI Ggl jantung, ginjal, hati Step 1 : Determine total daily dose
Contoh Sitagliptin 0,5 units x body weight (kg)  72kg Px : 36U
25,50,100 (once daily)  effect 24 h Step 2 : Determine each dose 
Saxagliptin 2/3 of total daily dose before breakfast,
2,5-5 mg/hari 1/3 before dinner
GLP-1 AGONIST 24 IU before breakfast
moA 12 IU before dinner
Ega Kurniasari, S.Farm., Apt. - Page 3 of 4
Step 3 : Determine components of each dose
2/3 of each dose as basal insulin, 1/3 as meal
insulin
NPH 16U + 8U regular insulin sc before breakfast
NPH 8U + 4U regular insulin sc before dinner

HIPERTENSI

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