13 - Farmako Dislipedimia

8/16/2019 13 - Farmako Dislipedimia

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Pharmacotherapy Update

inEndocrine System

dr. R. Setiadji, M.Sc


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Standar Kompetensi Dokter Indoesi


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The related drugs

• Oral hypoglycaemic – Insulin

• Hypolipidemic

• ntio!esity

•

ntithyroid• "orticosteroid


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Gejala dan Tanda

Data Penunjang

Diagnosis

Terapi

Non Obat


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Memilih obat P

%etap&an diagnosis

%etap&an tujuan pengo!atan

Susun &elompo& o!at manjur

'ilih o!at manjur !erdasar tujuan

Susun o!at manjur


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"hoose e))ecti*e drug )ollo+

IndicationMechanism

Side e))ect *aila!ility'osology

EVIDENCE BASED MEDICINE*

RCT

Cohort/CaseC

Time seriesTestimony


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• e*el I/ 0*idence o!tained )rom at least one properly designed

randomi1ed controlled trial

• e*el II/ 0*idence o!tained )rom +elldesigned controlled trials

+ithout randomi1ation

• e*el II2/ 0*idence o!tained )rom +elldesigned cohort or casecontrol

analytic studies, pre)era!ly )rom more than one center or research

group.

• e*el II3/ 0*idence o!tained )rom multiple time series +ith or +ithoutthe inter*ention. ramatic results in uncontrolled trials might also

!e regarded as this type o) e*idence.

• e*el III/ Opinions o) respected authorities, !ased on clinical

e5perience, descripti*e studies, or reports o) e5pert committees.

US Preventive Services Task


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Gunakan W! Guideline

DM tipe II• Menurun&an 77 8• Mening&at&an 77

• 7ila ada ri+ayat penya&it jantung

•

9ang mengham!at a!sorpsi glu&osa dari usus• 9ang memacu se&resi insulin

• 9ang mengham!at glu&agon


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Pharmacotherapy o" Dyslipidemia


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!bat Dislipidemi

• :elompo& o!at yang e)e&ti) • Statin e)e& samping

• ;iacin e)e& samping

•


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Drug Therapy

MG #o$ %eductase Inhibitors &Statins'

• Reduce " -–##> ? %< (–3@>

• Raise H" #–#>

•

Major side e))ects – Myopathy

– Increased li*er en1ymes

• "ontraindications

– !solute/ li*er disease

– Relati*e/ use +ith certain drugs

evidence


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MG #o$ %eductase

Inhibitors &Statins'

Statin Dose %ange

o*astatin 2@–-@ mg

'ra*astatin 2@–4@ mg

Sim*astatin 2@–-@ mg

Alu*astatin 2@–-@ mg

tor*astatin @–-@ mg

"eri*astatin @.4–@.- mg


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MG #o$ %eductase

Inhibitors &Statins' &continued'

Demonstrated Therapeutic (ene"its

• Reduce major coronary e*ents

• Reduce "H mortality

•Reduce coronary procedures B'%""7


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Kontro)ersi

• Sim*astatin dan amiodarone..D..D..D..D..DEideosDSerious Muscle Injury + Sim*

astatin miodarone "om!ination.mpg

• Statin dan &an&er

• ..D..D..D..D )ound to I;"R0S0 the ris& o) dying.mpg

http://var/Videos/Serious%20Muscle%20Injury%20w%20%20Simvastatin%20Amiodarone%20Combination.mpghttp://var/Videos/Serious%20Muscle%20Injury%20w%20%20Simvastatin%20Amiodarone%20Combination.mpghttp://var/Videos/Statins%20found%20to%20INCREASE%20the%20risk%20of%20dying.mpghttp://var/Videos/Statins%20found%20to%20INCREASE%20the%20risk%20of%20dying.mpghttp://var/Videos/Statins%20found%20to%20INCREASE%20the%20risk%20of%20dying.mpghttp://var/Videos/Statins%20found%20to%20INCREASE%20the%20risk%20of%20dying.mpghttp://var/Videos/Statins%20found%20to%20INCREASE%20the%20risk%20of%20dying.mpghttp://var/Videos/Serious%20Muscle%20Injury%20w%20%20Simvastatin%20Amiodarone%20Combination.mpghttp://var/Videos/Serious%20Muscle%20Injury%20w%20%20Simvastatin%20Amiodarone%20Combination.mpg


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Drug Therapy

(ile $cid Se*uestrants

• Major actions

– Reduce " # – 3@>

– Raise H" 3 – #>

– May increase %<

• Side e))ects

–


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(ile $cid Se*uestrants

Drug Dose %ange

"holestyramine 4–$ g

"olestipol #–2@ g

"olese*elam 2.$–3.- g


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(ile $cid Se*uestrants &continued'



• Reduce "H mortality


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+icotinic $cid

Drug ,ormDose %ange

Immediate release .#–3 g

BcrystallineC

05tended release –2 gSustained release –2 g


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+icotinic $cid &continued'


• Reduces major coronary e*ents

• 'ossi!le reduction in total mortality


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Drug Therapy

,ibric $cids

• Major actions

– o+er " #–2@> B+ith normal %

• Side e))ects/ dyspepsia, gallstones, myopathy

•

"ontraindications/ Se*ere renal or hepaticdisease


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,ibric $cids

Drug Dose

•


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,ibric $cids &continued'


• Reduce progression o) coronary lesions



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-ist o" antiobesity drug

•Orlistat

• Si!utramine

• Rimona!ant

• Met)ormin

• 05enatide

• 'ramlintide


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#ombined Therapy• "om!ined inter*ention o) a calorie

de)icit diet, increased physical acti*ity,and !eha*ioral treatment is most

success)ul )or +eight loss and

maintenance.Evidence Category A.

• ;ondrug inter*entions should !e

attempted )or at least $ months !e)oreconsidering

treatment.


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Drugs approved for long-term use ! t"e #DA ma! eused as part of a compre"ensive $eig"t loss program

including diet and p"!sical activit!% Evidence Categor! B%

• #or patients $it" a BMI of &' or aove $it" no

concomitant ris( factors or diseases

• #or patients $it" a BMI of ) or aove for t"ose $it"

concomitant ris( factors or diseases +"!pertension,

d!slipidemia, CD, t!pe ) diaetes, sleep apnea.

Pharmacotherapy


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Pharmacotherapy &continued'

• rugs should ne*er !e used alone.

• rugs should !e used in com!ination

+ith diet, e5ercise, and !eha*ior

modi)ication.


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Weight -oss DrugsDrug Dose $ction $d)erse E""ects

Si!utramine #, @, # mg ;orepinephrine, Increase in heart

BMeridiaC @ mg po =d dopamine, and rate and !lood

to start, may !e serotonin reupta&e pressure

increased to # mg inhi!itor.

or decreased to # mg.

Orlistat 2@ mg Inhi!its pancreatic ecrease in a!sorption

BenicalC 2@ mg po tid lipase, decreases o) )atsolu!le

!e)ore meals. )at a!sorption. *itamins so)t stools

and anal lea&age.


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!rlistat

•

Reduces intestinal )at a!sorption !y inhi!itingpancreatic lipase

• Sering !.a.!

• Steatorrhea

• iet lema& di&urangi, gejala !er&urang


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Sibutramine

•

ppetite suppresant• Increase !lood pressure

• ry mouth

• "onstipation

• Headache

• Insomnia


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%imonabant

•

"anna!inoid receptor antogonist, decreasingappetite centrally

• Increasing thermogenesis peripherally, increasing

energy e5penditure

• Re*erse the meta!olic e))ect o) o!esity, such asinsulin resistance and hyperlipidemia.

• Jeight loss has not to !e greater than other drug


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Met"ormin

t5t

http://var/www/Downloads/glucopgage%20BB.txthttp://var/www/Downloads/glucopgage%20BB.txt


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E.enatide

•

7yetta• ong acting analog o) hormon


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Pramlintide

•

Symlin• Synthetic analog o) hormone amylin

• Secreted !y pancreas in response to eating

• elays gastric emptying and promotes a )eeling o)

satiety

• 7eing tested as antio!esity

Bac(
http://c/Users/Ajie/Documents/pramlintide.txthttp://c/Users/Ajie/Documents/pramlintide.txt