Upload
annisa-sekar
View
217
Download
0
Embed Size (px)
Citation preview
8/18/2019 Farmakologi-ML Insulin_dr. Dorlina
1/36
Type of Insulin Preparation & Action
8/18/2019 Farmakologi-ML Insulin_dr. Dorlina
2/36
PENDAHULUAN:PENDAHULUAN:
Insulin :
▪ hormon utama yang mengontrol
metaolisme▪ effek : menurunkan kadar gula darah (BG)
▪ ↓↓ insulin (≡ insulin resistance) DM
konsekuensi
8/18/2019 Farmakologi-ML Insulin_dr. Dorlina
3/36
Fig . Insulin molecule
STRUKTUR KIMIA:STRUKTUR KIMIA:
8/18/2019 Farmakologi-ML Insulin_dr. Dorlina
4/36
SINTESIS & SEKRESI INSULINSINTESIS & SEKRESI INSULIN
8/18/2019 Farmakologi-ML Insulin_dr. Dorlina
5/36
Sintesis & sekresi
8/18/2019 Farmakologi-ML Insulin_dr. Dorlina
6/36
Faktor-faktor ang mem!engaruhi sekresi insulin
8/18/2019 Farmakologi-ML Insulin_dr. Dorlina
7/36
Fig . "-!hases release of insulin
8/18/2019 Farmakologi-ML Insulin_dr. Dorlina
8/36#fek insulin
Kerja (efek) insulin:Kerja (efek) insulin:
8/18/2019 Farmakologi-ML Insulin_dr. Dorlina
9/36
#fek insuli !ada saat !uasa dan makan
8/18/2019 Farmakologi-ML Insulin_dr. Dorlina
10/36
Fig. Insulin Signaling $ath%a
Mekanisme kerja insulinMekanisme kerja insulin
8/18/2019 Farmakologi-ML Insulin_dr. Dorlina
11/36Fig. Insulin Signaling $ath%a
8/18/2019 Farmakologi-ML Insulin_dr. Dorlina
12/36
armak!kine"ik Insulinarmak!kine"ik Insulin
GI' : dirusak sc i
!aru: inhalasi insulin
#liminasi : hati & gin*al gagal gin*al dosis diturunkan
masalah : fluktuasi insulin !lasma
fluktuasi gula darah
8/18/2019 Farmakologi-ML Insulin_dr. Dorlina
13/36
Sediaan insulinSediaan insulin
Prinsip:Prinsip:
1.1. Kerja cepat : (lispro dan aspart)Kerja cepat : (lispro dan aspart) Onset of actionOnset of action dandan duration of actionduration of action sangat cepatsangat cepat
Onset of action : 5-15 menit (lispro); 1-1! menit(aspart)Onset of action : 5-15 menit (lispro); 1-1! menit(aspart)
Punca" : 1 jamPunca" : 1 jam #uration of action : $-5 jam#uration of action : $-5 jam
men%erupai se"resi insulin endogen secara &siologismen%erupai se"resi insulin endogen secara &siologispada saat ma"anpada saat ma"an
Pem'erian :S S**Pem'erian :S S**
#apat dicampur dengan +P, lente atau ultralente#apat dicampur dengan +P, lente atau ultralentedalam satu siring tanpa mempengarui a'sorpsidalam satu siring tanpa mempengarui a'sorpsi
#i'eri"an segera se'elum ma"an (5 menit se'elum#i'eri"an segera se'elum ma"an (5 menit se'elumma"an)ma"an)
8/18/2019 Farmakologi-ML Insulin_dr. Dorlina
14/36
Sediaan insulinSediaan insulin
!. Kerja pende": (regular insulin)!. Kerja pende": (regular insulin)
Onset of actionOnset of action cepatcepat
Onset of action : $ menit (lispro)Onset of action : $ menit (lispro)
Punca" : ! dan $ jamPunca" : ! dan $ jam #uration of action : 5- jam#uration of action : 5- jam
,e/amer,e/amer →→ mula "erja dan lama "erjan%amula "erja dan lama "erjan%a
le'i lamale'i lama
Pem'erian : dapat di'eri"an i0 ("etoasidosisPem'erian : dapat di'eri"an i0 ("etoasidosissetela operasi atau infe"si a"ut)setela operasi atau infe"si a"ut)
#i'eri"an $ menit se'elum ma"an#i'eri"an $ menit se'elum ma"an
8/18/2019 Farmakologi-ML Insulin_dr. Dorlina
15/36
Sediaan insulinSediaan insulin
$. Kerja sedang : (lente+P,)insulin$. Kerja sedang : (lente+P,)insulin
+ ente insulin:ente insulin: ampuran $2 semilente (ampuran $2 semilente (onset of actiononset of action cepat) 3cepat) 3
42 ultralente insulin (42 ultralente insulin (onset and duration of actiononset and duration of action
panjang)panjang)+ +P,+P,
onset of actiononset of action lam'atlam'at
erdiri dari "om'inasi protamin dan insulin erdiri dari "om'inasi protamin dan insulin
Setiap mole"ul protamin mengandung 6 mole"ul insulinSetiap mole"ul protamin mengandung 6 mole"ul insulin
Setela pem'erian S en7im proteoliti" jaringanSetela pem'erian S en7im proteoliti" jaringanmendegradasi protaminmendegradasi protamin →→ insulin dapat dia'sorpsiinsulin dapat dia'sorpsi
8/18/2019 Farmakologi-ML Insulin_dr. Dorlina
16/36
Sediaan insulinSediaan insulin
8. Kerja panjang:8. Kerja panjang:
+ ultra lenteultra lente
+ 9largin insulin9largin insulin
Onset of action:Onset of action: 1-15 jam1-15 jam
Duration of action:Duration of action: 11-!8 jam atau le'i11-!8 jam atau le'i
iasan%a di'eri"an 1 "ali seari tapi "adang-iasan%a di'eri"an 1 "ali seari tapi "adang-
"adang ! "ali seari."adang ! "ali seari.
ida" dapat dicampur dengan insulin lain dalam ida" dapat dicampur dengan insulin lain dalam
satu siringsatu siring
Pola a'sorpsi tergantung tempat inje"siPola a'sorpsi tergantung tempat inje"si
8/18/2019 Farmakologi-ML Insulin_dr. Dorlina
17/36
#ara $em%erian insulin#ara $em%erian insulin
8/18/2019 Farmakologi-ML Insulin_dr. Dorlina
18/36
8/18/2019 Farmakologi-ML Insulin_dr. Dorlina
19/36
,okasitem!atin*eksi
,okasitem!atin*eksi
8/18/2019 Farmakologi-ML Insulin_dr. Dorlina
20/36
'ael. Beera!a sediaan insuli ang di!akai di /S
8/18/2019 Farmakologi-ML Insulin_dr. Dorlina
21/36
Fig. Extent and DOA of various insulin
8/18/2019 Farmakologi-ML Insulin_dr. Dorlina
22/36
Fig. Extent and DOA of various insulin
8/18/2019 Farmakologi-ML Insulin_dr. Dorlina
23/36
Inikasi InsuliInikasi Insuli
DM ti!e 0
diabetic ketoacidosis, nonketotic coma
DM ti!e " ang tidak terkontrol hana dengan diit 121
!enggunaan *angka !endek : o!erasi infeksi /MI
gestational diabetes
EMG treatment of hyerkalemia
insulin 3 glucose ↓ e4tra cellular 53 (redistriution into the cell)
8/18/2019 Farmakologi-ML Insulin_dr. Dorlina
24/36
Pre$arasi insulinPre$arasi insulin
0. $ortale !en in*ections
". 6ontinuous Sucutaneous Insulin Infusion Deices
(6SII I7S8,I7 $8M$S)
9. Inhaled Insulin
8/18/2019 Farmakologi-ML Insulin_dr. Dorlina
25/36
0. $1'/B,# $#7 I7;#6'1S
- e!laceale cartridge of 0
8/18/2019 Farmakologi-ML Insulin_dr. Dorlina
26/36
". 617'I7818S S8B68'/7#18S I7S8,I7 I7F8SI17 D#=I6#S
(6SII I7S8,I7 $8M$S)
- !he most hysiologic method of insulin relacement
"ndividual basal # bolus insulin ∼ $G self monitoring result
- !he most hysiologic method of insulin relacement
"ndividual basal # bolus insulin ∼ $G self monitoring result
8/18/2019 Farmakologi-ML Insulin_dr. Dorlina
27/36
9. I72/,#D I7S8,I7
- /erosol insulin
- Small !article aleolar %all circulation
- a!id onset & short D1/
> to correct 2igh BG coer meal time
B8' not to !roide asal insulin coerage ?
- /erosol insulin
- Small !article aleolar %all circulation
- a!id onset & short D1/
> to correct 2igh BG coer meal time
B8' not to !roide asal insulin coerage ?
8/18/2019 Farmakologi-ML Insulin_dr. Dorlina
28/36
A' Hi$!likemia '****@ Menunda *ad%al makan
@ /ktiitas erleihan dari iasana
@ 5urang asu!an karohidrat
+' Insulin aller, & resis"an-e
- insulin allerg (t!e-0 h-sensitiit r4) er rare
- immune insulin resistance (IgG anti-insulin /)
#' Li$!,s"r!$., $aa "em$a" sun"ikan
- atro!h h!ertro!h sucutaneous fatt tissue
Efek sam$inEfek sam$in
8/18/2019 Farmakologi-ML Insulin_dr. Dorlina
29/36
8/18/2019 Farmakologi-ML Insulin_dr. Dorlina
30/36
ntidia'eti" Oral (#O)ntidia'eti" Oral (#O)
+ 9olongan Sulfonil urea9olongan Sulfonil urea Kontra indi"asi :ggn fungsi ginjal dan atiKontra indi"asi :ggn fungsi ginjal dan ati
#apat mele>ati plasenta#apat mele>ati plasenta
Klorpropamide : arus diindari pada pasien lansiaKlorpropamide : arus diindari pada pasien lansia
+ iguanidiguanid
8/18/2019 Farmakologi-ML Insulin_dr. Dorlina
31/36
ntidia'eti" Oral (#O)ntidia'eti" Oral (#O)
+Pengam'at alfa-glu"osidasePengam'at alfa-glu"osidase
onto a"ar'oseonto a"ar'ose
8/18/2019 Farmakologi-ML Insulin_dr. Dorlina
32/36
8/18/2019 Farmakologi-ML Insulin_dr. Dorlina
33/36
8/18/2019 Farmakologi-ML Insulin_dr. Dorlina
34/36
8/18/2019 Farmakologi-ML Insulin_dr. Dorlina
35/36
8/18/2019 Farmakologi-ML Insulin_dr. Dorlina
36/36