Kuliah 3 Pharmacologycal Aspect in Anemia - Copy

8/9/2019 Kuliah 3 Pharmacologycal Aspect in Anemia - Copy

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PharmacologycalPharmacologycalAspects in AnaemiaAspects in Anaemia

Eti Nurwening SholikhahDepartment of Pharmacology and Therapy

Faculty of MedicineUniversitas ad!ah Mada



What are vitamins?What are vitamins?

"omple# su$stances that regulate"omple# su$stances that regulate

$ody processes$ody processes

"oen%ymes &partners' with"oen%ymes &partners' with

en%ymes in reactionsen%ymes in reactions

No calories( thus no energyNo calories( thus no energy



CategoriesCategoriesFat-solubleFat-soluble

Dissolve in fatDissolve in fat

"an $e stored"an $e stored

Water-solubleWater-soluble

Dissolve in waterDissolve in water

"arried in"arried in

$loodstream( not$loodstream( notstoredstored

)( D( E( * )( D( E( * " and +,comple#" and +,comple#

vitaminsvitamins

) and D e#cess can) and D e#cess can

$e harmful$e harmful

E and * usually notE and * usually not

E#cess amountsE#cess amounts

may cause e#tramay cause e#trawork on kidneyswork on kidneys



Vitamin A (and carotenoids)Vitamin A (and carotenoids)

Functions-Functions-

. Normal visionNormal vision

. Protects fromProtects frominfectionsinfections

. /egulates/egulates

immune systemimmune system

. )ntio#idant)ntio#idant&carotenoids'&carotenoids'

Food sources-Food sources-

. 0iver0iver

. Fish oilFish oil

. EggsEggs

. Forti1ed milk orForti1ed milk or

other foodsother foods

. /ed( yellow(/ed( yellow(orange( and darkorange( and dark

green veggiesgreen veggies

&carotenoids'&carotenoids'



Vitamin D (theVitamin D (the

sunshine vitamin)sunshine vitamin) Functions-Functions-

. PromotesPromotes

a$sorption ofa$sorption of

calcium andcalcium and

phosphorusphosphorus

. 2elps deposit those2elps deposit those

in $ones3teethin $ones3teeth

. /egulates cell/egulates cellgrowthgrowth

. Plays role inPlays role in

immunityimmunity

Sources-Sources-

. Sunlight &45 . 46Sunlight &45 . 46

mins 7# a week'mins 7# a week'. Salmon withSalmon with

$ones$ones

. MilkMilk

. 8range !uice8range !uice&forti1ed'&forti1ed'

. Forti1ed cerealsForti1ed cereals



Vitamin Vitamin


. )ntio#idant( may)ntio#idant( may

lower risk forlower risk forheart disease andheart disease and

stroke( somestroke( some

types of cancerstypes of cancers

.Protects fattyProtects fatty

acids and vitaminacids and vitamin

))

Sources-Sources-

. 9egeta$le oils9egeta$le oils

. Foods made fromFoods made fromoil &salad dressing(oil &salad dressing(

margarine'margarine'

. NutsNuts

.SeedsSeeds

. :heat germ:heat germ

. reen( leafyreen( leafy

veggiesveggies



Vitamin ! Vitamin !


. 2elps $lood clot2elps $lood clot

. 2elps $ody make2elps $ody makesome othersome other

proteinsproteins

Sources-Sources-

. +ody can produce+ody can produce

on its own &fromon its own &from$acteria in$acteria in

intestines'intestines'


veggiesveggies

. Some fruits( otherSome fruits( other

veggies( and nutsveggies( and nuts



"hiamin (#$)"hiamin (#$)


. 2elps produce2elps produce

energy fromenergy fromcar$scar$s

Sources-Sources-

. :hole,grain and:hole,grain and

enriched grainenriched grainproductsproducts

. PorkPork

. 0iver0iver



%ibo&avin (#')%ibo&avin (#')


. Produce energyProduce energy

. "hanges"hangestryptophantryptophan

&amino acid' into&amino acid' into

niacinniacin

Sources-Sources-

. 0iver0iver

. ;ogurt and milk ;ogurt and milk

. Enriched grainsEnriched grains

. EggsEggs


veggiesveggies



iaciniacin


. 2elps $ody use2elps $ody use

sugars3fatty acidssugars3fatty acids. 2elps en%ymes2elps en%ymes

function normallyfunction normally

. Produces energyProduces energy

Sources-Sources-

. Foods high inFoods high in

protein typicallyprotein typically&poultry( 1sh(&poultry( 1sh(

$eef( peanut$eef( peanut

$utter( legumes'$utter( legumes'

. Enriched andEnriched and

forti1ed grainsforti1ed grains



Pyridoine (#*)Pyridoine (#*)


. 2elps $ody make2elps $ody make

non,essentialnon,essential

amino acidsamino acids

. 2elps turn2elps turn

tryptophan intotryptophan into

niacin andniacin and

serotoninserotonin. 2elp produce $ody2elp produce $ody

chemicals &insulin(chemicals &insulin(

hemoglo$in( etc'hemoglo$in( etc'

Sources-Sources-

. "hicken"hicken

. FishFish

. PorkPork

. 0iver0iver

. :hole grains:hole grains

. NutsNuts

. 0egumes0egumes



Folate (+olic acid)Folate (+olic acid)


. Produces DN) andProduces DN) and

/N)( making new/N)( making new

$ody cells$ody cells. :orks with vitamin:orks with vitamin

+47 to form+47 to form

hemoglo$inhemoglo$in

. May protect againstMay protect against

heart diseaseheart disease

. 0owers risk of neural0owers risk of neural

tu$e defects in $a$iestu$e defects in $a$ies

. "ontrols plasma"ontrols plasmahomocystine levelshomocystine levels&related to heart&related to heartdisease'disease'

Sources-Sources-. Forti1ed andForti1ed and

enriched grains andenriched grains and$reakfast cereals$reakfast cereals

. 8range !uice8range !uice

. 0egumes0egumes

. reen( leafy veggiesreen( leafy veggies

. PeanutsPeanuts

. )vocados)vocados



Vitamin #$'Vitamin #$'

(cobalamin)(cobalamin) Functions-Functions-

. :orks with folate:orks with folate

to make /+"<sto make /+"<s. =n many $ody=n many $ody

chemicals andchemicals and

cellscells

. 2elps $ody use2elps $ody usefatty acids3aminofatty acids3amino

acidsacids

Sources-Sources-

. )nimal products)nimal products

. MeatMeat

. FishFish

. PoultryPoultry

. EggsEggs

. Milk( other dairyMilk( other dairy



#iotin#iotin


. Produces energyProduces energy

. 2elps $ody use2elps $ody useproteins( car$s(proteins( car$s(

and fats fromand fats from

foodsfoods

Sources-Sources-

. :ide variety of:ide variety of

foodsfoods

. EggsEggs

. 0iver0iver

. :heat germ:heat germ

. PeanutsPeanuts

. "ottage cheese"ottage cheese

. :hole grain $read:hole grain $read



Pantothenic AcidPantothenic Acid

2elps produce2elps produce

energyenergy

2elps the $ody2elps the $odyuse proteins( fat(use proteins( fat(

and car$s fromand car$s from

foodfood

Sources-Sources-

. Found in almostFound in almost

all foodsall foods

. Meat( poultry( 1shMeat( poultry( 1sh

. :hole grain:hole grain

cerealscereals

. 0egumes0egumes

. MilkMilk

. Fruits( veggiesFruits( veggies



Vitamin CVitamin C


. 2elps produce2elps produce

collagen &connectivecollagen &connective

tissue in $ones(tissue in $ones(muscles( etc'muscles( etc'

. *eeps capillary*eeps capillary

walls( $lood vesselswalls( $lood vessels

1rm1rm

. 2elps $ody a$sor$2elps $ody a$sor$

iron and folateiron and folate

. 2ealthy gums2ealthy gums

. 2eals cuts and2eals cuts and

woundswounds

. Protects fromProtects from

infection( $oostsinfection( $oosts

immunityimmunity

. )ntio#idant)ntio#idant

SourcesSources

. "itrus fruits"itrus fruits

. 8ther fruits(8ther fruits(

veggiesveggies



De,cienciesDe,ciencies

/ickets &children and vitamin D'/ickets &children and vitamin D'

8steoporosis3osteomalacia8steoporosis3osteomalacia

&vitamin D'&vitamin D' Scurvy &vitamin "'Scurvy &vitamin "'

Night $lindness &vitamin )'Night $lindness &vitamin )'

+eri$eri &thiamin'+eri$eri &thiamin'



What are minerals?What are minerals?

/egulate $ody processes/egulate $ody processes

ive structure to things in theive structure to things in the

$ody$ody No calories &energy'No calories &energy'

"annot $e destroyed $y heat"annot $e destroyed $y heat



Categories o+ mineralsCategories o+ minerals

Ma!or mineralsMa!or minerals

. "alcium"alcium

. PhosphorusPhosphorus

. MagnesiumMagnesium

. ElectrolytesElectrolytes

&sodium( chloride(&sodium( chloride(

potassium'potassium'

Trace minerals Trace minerals

. "hromium"hromium

. "opper"opper

. FlourideFlouride

. =odine=odine

. =ron=ron

. ManganeseManganese

. SeleniumSelenium

. >inc>inc



CalciumCalcium

+one $uilding+one $uilding

Muscle contractionMuscle contraction

2eart rate2eart rate

Nerve functionNerve function

2elps $lood clot2elps $lood clot



PhosphorusPhosphorus

enerates energyenerates energy

/egulate energy meta$olism/egulate energy meta$olism

"omponent of $ones( teeth"omponent of $ones( teeth

Part of DN)( /N) &cell growth(Part of DN)( /N) &cell growth(

repair'repair'

)lmost all foods( especially protein,)lmost all foods( especially protein,

rich foods( contain phosphorusrich foods( contain phosphorus



agnesiumagnesium

Part of ?55 en%ymes &regulatesPart of ?55 en%ymes &regulates

$ody functions'$ody functions'

Maintains cells in nerves( musclesMaintains cells in nerves( muscles "omponent of $ones"omponent of $ones

+est sources are legumes( nuts(+est sources are legumes( nuts(

and whole grainsand whole grains



lectrolyteslectrolytes

"hloride-"hloride-

. Fluid $alanceFluid $alance

. Digestion of food( transmits nerve impulsesDigestion of food( transmits nerve impulses

PotassiumPotassium

. Maintains $lood pressureMaintains $lood pressure

. Nerve impulses and muscle contractionNerve impulses and muscle contraction

SodiumSodium. Fluid $alanceFluid $alance

. Muscles rela#( transmit nerve impulsesMuscles rela#( transmit nerve impulses

. /egulates $lood pressure/egulates $lood pressure



Sources-Sources-

. Salt &sodium chloride'Salt &sodium chloride'

. Fruits( veggies( milk( $eans( 1sh(Fruits( veggies( milk( $eans( 1sh(chicken( nuts &potassium'chicken( nuts &potassium'



.ron.ron

Part of hemoglo$in( carries o#ygenPart of hemoglo$in( carries o#ygen

+rain development+rain development

2ealthy immune system2ealthy immune system Sources-Sources-

. )nimals &heme' vs@ plants &non,heme')nimals &heme' vs@ plants &non,heme'

. +etter a$sor$ed from heme+etter a$sor$ed from heme

. "onsume vitamin " with non,heme"onsume vitamin " with non,heme

. Forti1ed cereals( $eans( eggs( etc@Forti1ed cereals( $eans( eggs( etc@



AntioidantsAntioidants

Slow or prevent damage to $ody cellsSlow or prevent damage to $ody cells

May improve immune function and lowerMay improve immune function and lower

risk for infection and cancerrisk for infection and cancer "arotenoids . $eta carotene &familiar'"arotenoids . $eta carotene &familiar'

9itamin "9itamin "

9itamin E9itamin E

Found in colorful fruits3veggies and grainsFound in colorful fruits3veggies and grains



PhytonutrientsPhytonutrients

Phyto . plantPhyto . plant AASparkB $ody processes that may 1ght( orSparkB $ody processes that may 1ght( or

reduce risk for some diseasesreduce risk for some diseases Fruits3veggiesFruits3veggies E#amples-E#amples-

. "arotenoids"arotenoids

. 0utein0utein

. 0ycopene0ycopene

. FlavanolsFlavanols

. Pre$iotics3pro$ioticsPre$iotics3pro$iotics

. Soy$eansSoy$eans



Functional FoodsFunctional Foods

Foods that provide $ene1ts $eyondFoods that provide $ene1ts $eyond

$asic nutrition$asic nutrition

PhytonutrientsPhytonutrients Pre$iotics3pro$ioticsPre$iotics3pro$iotics

Fatty 1sh3omega ?<sFatty 1sh3omega ?<s

Soy proteinSoy protein 8ats &heart,healthy'8ats &heart,healthy'

Fla#seedFla#seed



:ater:ater



WaterWater =nvolved in every process of the $ody=nvolved in every process of the $ody /epresents large portion of $ody<s mass/epresents large portion of $ody<s mass

. Men- 6C,6Men- 6C,6

. :omen- ,6?:omen- ,6?

. Due to diGerences in +ody "omposition@Due to diGerences in +ody "omposition@Muscle has higher hydration level than fatMuscle has higher hydration level than fattissue@tissue@



WaterWater

Two main A:ater Two main A:ater"ompartmentsB"ompartmentsB

. =ntracellular Huid &="F'=ntracellular Huid &="F'

. E#tracellular Huid &E"F'E#tracellular Huid &E"F'Plasma 3 interstitial HuidPlasma 3 interstitial Huid

0ymph 3 "SF 3 Urine 3 etc0ymph 3 "SF 3 Urine 3 etc



Functions o+ #ody WaterFunctions o+ #ody Water

Serves as +ody<s transport mediumServes as +ody<s transport medium. as diGusion 3 nutrient transport 3as diGusion 3 nutrient transport 3

waste disposalwaste disposal

. 2eat dissipation2eat dissipation

. Ioint lu$rication Ioint lu$rication

. Provides AturgorB for cell structureProvides AturgorB for cell structure



Water #alanceWater #alance

Normally a$out 7@6 0 of HuidNormally a$out 7@6 0 of Huid

intake reJuiredintake reJuired

:ater o$tained from three:ater o$tained from threesources- 0iJuid( food( Ksources- 0iJuid( food( K

metabolism.metabolism.



Water .nta/eWater .nta/e

ormal 0 $'11 ml2dayormal 0 $'11 ml2day. ((

*3 42 eercise)*3 42 eercise)

Food 0 $111 ml 2dayFood 0 $111 ml 2day

etabolism 0 561 ml 2 dayetabolism 0 561 ml 2 day

. Up to 76 of water reJuirementUp to 76 of water reJuirement

. "om$ination of 2"om$ination of 2,, and 8and 87L7L as end resultas end result

of meta$olism@of meta$olism@



Water 7utputWater 7utput

8rine9 (8rine9 (:6; <:6; <''7)7) $611 ml2day$611 ml2day 42 high protein diets42 high protein diets

=/in9 vaporative cooling> 11 ml 2=/in9 vaporative cooling> 11 ml 2

day (day (

drastically 42 e@)drastically 42 e@) Water Vapor9 haled air> 561 ml2dayWater Vapor9 haled air> 561 ml2day

(Varies 42 climate e@)(Varies 42 climate e@) Feces9 '11 ml2day (mayFeces9 '11 ml2day (may signi,cantlysigni,cantly

42 illness)42 illness)



Water and erciseWater and ercise

2umidity greatly2umidity greatly ↑↑ 22778 loss8 loss

=ngest 55 ml $efore e#ercise=ngest 55 ml $efore e#ercise

Drink 8FTEN during e#erciseDrink 8FTEN during e#ercise



Bastric mptyingBastric mptying

Temperature- "old Huids empty Temperature- "old Huids emptyfasterfaster

9olume-9olume- ↑↑ volume fastervolume faster 8smolarity- Emptying is slowed8smolarity- Emptying is slowed

when liJuid is concentrated withwhen liJuid is concentrated with

simple sugars@simple sugars@



nergynergy

%euirement9%euirement9. Bro4th and maintenance o+ bodyBro4th and maintenance o+ body

tissuetissue

. aintenance o+ body temp@aintenance o+ body temp@

. involuntary muscle movementinvoluntary muscle movement

. Voluntary muscle movementVoluntary muscle movement

=ources9 +rom oidation $gm=ources9 +rom oidation $gm

. CA< $*/E (/cal)CA< $*/E (/cal)

. Fat 5/E (:/cal)Fat 5/E (:/cal)

. Protein $/E (/cal)Protein $/E (/cal)



nergynergy

@' E 0 $cal@' E 0 $cal easurementseasurements

. Direct calorimetryDirect calorimetry

. .ndirect calorimetry.ndirect calorimetry #asal#asal metabolismmetabolism

. Amount o+ energy reuired toAmount o+ energy reuired to

carry out the basic processescarry out the basic processessuch as cellular activity heartsuch as cellular activity heart

beat respirationbeat respiration



#%#%99. an *6/g $@$/ cal2minan *6/g $@$/ cal2min

. 4oman 66/g 1@:$/ cal2min4oman 66/g 1@:$/ cal2min "otal"otal energyenergy reuirementreuirement99

time 3 number o+ unit 2mintime 3 number o+ unit 2min

FactorsFactors aGectingaGecting energyenergy reuirementreuirement . AgeAge

. nvironmental temp@nvironmental temp@

. DiseaseDisease

. PregnancyPregnancy

. nergy inta/energy inta/e



=peci,c dynamic=peci,c dynamic

action o+ +oodaction o+ +ood

"he increased o+ energy"he increased o+ energy

ependiture due to +ood metabolismependiture due to +ood metabolism

euals $1; o+ ependitureeuals $1; o+ ependiture cess energy inta/e is stored ascess energy inta/e is stored as

+at in the body+at in the body



FiberFiber

De,nitionDe,nition9 plant material that9 plant material that

canHt be digested by enIymescanHt be digested by enIymes

o+ B."o+ B." Found in the cell 4all andFound in the cell 4all and

4ithin cell o+ seed roots4ithin cell o+ seed roots

leaves +ruitsleaves +ruits



Composition9Composition9. Cellulose9 glucose polysaccharideCellulose9 glucose polysaccharide

tough ,brous strand lea+y veg@tough ,brous strand lea+y veg@. Pectin plant gum mucilages9 nonPectin plant gum mucilages9 non

cellulose polysaccharidecellulose polysaccharidePectin combine 4ith 4ater to +ormPectin combine 4ith 4ater to +orm

gelgelPlant gum to cover site o+ inJuryPlant gum to cover site o+ inJury

ucilages hold 4ater in seed toucilages hold 4ater in seed to

prevent dryingprevent drying

. Kignin9 gives the 4ood itsKignin9 gives the 4ood its

strength and shapestrength and shape



Analysis o+ ,ber9Analysis o+ ,ber9

. Crude ,ber contentCrude ,ber content

. %oughage%oughage

Gects o+ dietary ,bers9Gects o+ dietary ,bers9

. outhouth9/eeps teeth gum healthy9/eeps teeth gum healthy

. =tomach=tomach9 slo4 emptying o+ stomach 9 slo4 emptying o+ stomach

digestiondigestion

. =mall=mall bo4elbo4el9 viscosity transit time9 viscosity transit time

complete absorptioncomplete absorption. KargeKarge bo4elbo4el9 bacteria in stool <'7 stool9 bacteria in stool <'7 stool

bul/ de+ecation intracolonic pressurebul/ de+ecation intracolonic pressure

colonic transit timecolonic transit time



FiberFiber inin dietdiet9 depends on type o+9 depends on type o+

dietdiet FiberFiber hypothesishypothesis9 $:19 $:1

( degenerative disorder in 8!)( degenerative disorder in 8!)

Ko4 inta/e o+ ,ber related to theKo4 inta/e o+ ,ber related to the+ollo4ing disease9+ollo4ing disease9

Colonic disorder (con@ d@dc@capp)Colonic disorder (con@ d@dc@capp)

Disorder 4hich are 'dry to colonicDisorder 4hich are 'dry to colonicdisorder (h@h dvt pe)disorder (h@h dvt pe)

etabolic disorder (ob dm ac gs)etabolic disorder (ob dm ac gs)





AntioidantsAntioidants

Slow or prevent damage to $ody cellsSlow or prevent damage to $ody cells

May improve immune function and lowerMay improve immune function and lower

risk for infection and cancerrisk for infection and cancer "arotenoids . $eta carotene &familiar'"arotenoids . $eta carotene &familiar'

9itamin "9itamin "

9itamin E9itamin E

Found in colorful fruits3veggies and grainsFound in colorful fruits3veggies and grains



PhytonutrientsPhytonutrients

Phyto . plantPhyto . plant AASparkB $ody processes that may 1ght( orSparkB $ody processes that may 1ght( or

reduce risk for some diseasesreduce risk for some diseases

Fruits3veggiesFruits3veggies E#amples-E#amples-

. "arotenoids"arotenoids

. 0utein0utein

. 0ycopene0ycopene

. FlavanolsFlavanols

. Pre$iotics3pro$ioticsPre$iotics3pro$iotics

. Soy$eansSoy$eans



Functional FoodsFunctional Foods

Foods that provide $ene1ts $eyondFoods that provide $ene1ts $eyond

$asic nutrition$asic nutrition

PhytonutrientsPhytonutrients Pre$iotics3pro$ioticsPre$iotics3pro$iotics

Fatty 1sh3omega ?<sFatty 1sh3omega ?<s

Soy proteinSoy protein 8ats &heart,healthy'8ats &heart,healthy'

Fla#seedFla#seed



icronutrienticronutrient

supplementation insupplementation in

pregnancypregnancy



Micronutrient needs inMicronutrient needs in

pregnancypregnancy

. =ron=ron

. FolateFolate

. 9it )9it )

. >inc>inc

. 8therO8therO



=nfection=nfection

. Malaria =ntestinal helminthsMalaria =ntestinal helminths

other common infectionsother common infections

. Decreased nutrient intakeDecreased nutrient intake

. =ncreased nutrient use=ncreased nutrient use

. =nfection,speci1c insult=nfection,speci1c insult



OBAT-OBAT HEMATINIKOBAT-OBAT HEMATINIK



Eritropoesis normalEritropoesis normal

memerlukan:memerlukan: Zat besi (Fe)Zat besi (Fe)

Vitamin BVitamin B1212

Asam folat Asam folat

Defisiensi anemiaDefisiensi anemia

diatur oleh: eritopoetindiatur oleh: eritopoetin



Defisiensi besiDefisiensi besi anemiaanemia

mikrositik hipokromikmikrositik hipokromik Sebab:Sebab:

– perdarahanperdarahan

– kehamilankehamilan – arious abnormalities of the !utarious abnormalities of the !ut

– ba"i prematur (den!an status besi rendah)ba"i prematur (den!an status besi rendah)



B#S$B#S$

AbsorbsiAbsorbsi::

– di duodenum dan %e%unum proksimaldi duodenum dan %e%unum proksimal

– &'1 dari "an! dikonsumsi (&'1 dari "an! dikonsumsi (** +&'1 m!,hr)++&'1 m!,hr)+

bertambah bila persediaan kuran!bertambah bila persediaan kuran!

– diabsorbsi dalam bentuk ferro+ den!an transportdiabsorbsi dalam bentuk ferro+ den!an transport

aktif aktif

– ditin!katkan oleh: kobal+ inosin+ etionin+ itamin -+ditin!katkan oleh: kobal+ inosin+ etionin+ itamin -+

.-l+ suksinat+ sen"a/a asam lain.-l+ suksinat+ sen"a/a asam lain – menurun bila terdapat fosfat atau antasidamenurun bila terdapat fosfat atau antasida



TransportTransport

' setelah diabsorbsi+ diikat oleh transferin' setelah diabsorbsi+ diikat oleh transferin

' kalau tidak untuk eritropoesis+ disimpan' kalau tidak untuk eritropoesis+ disimpan

seba!ai feritinseba!ai feritin

EkskresiEkskresi

-- +& ' 1 m!,hari+& ' 1 m!,hari

' melalui sel epitel kulit 0 saluran erna "an!' melalui sel epitel kulit 0 saluran erna "an!

terkelupas+ kerin!at+ urin+ feses+ kuku+terkelupas+ kerin!at+ urin+ feses+ kuku+

rambutrambut

K b t hK b t h



KebutuhanKebutuhan

laki'laki de/asalaki'laki de/asa : 1 m!,hari: 1 m!,hari

/anita de/asa/anita de/asa : 12 m!,hari: 12 m!,hari/anita hamil 0 men"usui/anita hamil 0 men"usui : * & m!,hari: * & m!,hari

SediaanSediaan – !aram ferro!aram ferro absorbsin"a palin! efisien:absorbsin"a palin! efisien:

2&2&

– defisiensi+ perlu &'1m!,hr (intake 2'defisiensi+ perlu &'1m!,hr (intake 2'

m!)m!)

– 3reparat parenteral diberikan han"a bila tidak3reparat parenteral diberikan han"a bila tidak

bisa diberikan per'oralbisa diberikan per'oral

#f k i#f k t i



#fek nonterapi:#fek nonterapi:

Iritasi saluran cerna:Iritasi saluran cerna:

– nauseanausea ' diare' diare – n"eri epi!astrikn"eri epi!astrik ' konstipasi' konstipasi

ToksisitasToksisitas

' terutama pada anak'anak' terutama pada anak'anak' neroti4in! !astroenteritis : n"eri perut+ muntah+' neroti4in! !astroenteritis : n"eri perut+ muntah+

diare berampur darah+ s"ok5diare berampur darah+ s"ok5

' Asidosis+ koma+ menin!!al' Asidosis+ koma+ menin!!al

' setelah konsumsi 1 !' setelah konsumsi 1 !

' antidotum: deferoksamin' antidotum: deferoksamin



ibo!la"in #Bibo!la"in #B$$%%

6oen4im dalam metabolisme flao'6oen4im dalam metabolisme flao'

protein dalam respirasi selprotein dalam respirasi sel

dapat men!atasi anemia normositik'dapat men!atasi anemia normositik'normokromiknormokromik

anemia ter%adi pada malnutrisi protein'anemia ter%adi pada malnutrisi protein'

kalorikalori 1 m!,hari peroral atau im1 m!,hari peroral atau im



&iridoksin #B&iridoksin #B''%%

6oen4im "an! meran!san! pertumbuhan heme6oen4im "an! meran!san! pertumbuhan heme

(e!isiensi(e!isiensi an5 mikrositik hipokromik+an5 mikrositik hipokromik+

an5 me!aloblastikan5 me!aloblastik

absorbsi Fe menin!katabsorbsi Fe menin!kat

Fe'bindin! protein %enuh+ hiperferemiaFe'bindin! protein %enuh+ hiperferemia

re!enerasi darah menurunre!enerasi darah menurun

hemosiderosishemosiderosis



KobalKobal

Biasan"a terdapat seba!ai ampuran dalamBiasan"a terdapat seba!ai ampuran dalamsediaan Fesediaan Fe

7enin!katkan absorbsi Fe melalui usus7enin!katkan absorbsi Fe melalui usus

#fek toksik: erupsi kulit+ struma+ an!ina+#fek toksik: erupsi kulit+ struma+ an!ina+

tinnitus+ tuli+ pa"ah %antun!+ sianosis+ komatinnitus+ tuli+ pa"ah %antun!+ sianosis+ koma

malaise+ anoreksia+ mual+ muntahmalaise+ anoreksia+ mual+ muntah



Vitamin B12 0 Asam folatVitamin B12 0 Asam folat

3entin! pada beberapa reaksi untuk sintesis3entin! pada beberapa reaksi untuk sintesis

D8AD8A

defisiensidefisiensi anemia me!aloblastikanemia me!aloblastik

S #Si k b l i # it i



Sianokobalamin #"itaminSianokobalamin #"itamin

B)$%B)$%sianokobalaminsianokobalamin

hidroksokobalaminhidroksokobalamin

kobalaminkobalamin

deoksiadenasil kobalamin 0deoksiadenasil kobalamin 0

metil kobalaminmetil kobalamin

(aktif dalam tubuh)(aktif dalam tubuh)

(e!isiensi *itamin B)$(e!isiensi *itamin B)$ de!enerasi SS3de!enerasi SS3



(e!isiensi *itamin B)$(e!isiensi *itamin B)$

de!enerasi SS3 de!enerasi SS3

9anda'tanda:9anda'tanda:

' !an!!uan hematopoesis' !an!!uan hematopoesis' !an!!uan neurolo!i' !an!!uan neurolo!i

' kerusakan sel epitel' kerusakan sel epitel

biasan"a karena malabsorbsibiasan"a karena malabsorbsi

– karena kekuran!an faktor intrinsik (anemiakarena kekuran!an faktor intrinsik (anemia

pernisiosa)pernisiosa)

– post !astretomipost !astretomi

– beberapa !an!!uan "an! men!akibatkanbeberapa !an!!uan "an! men!akibatkan

!an!!uan absorbsi!an!!uan absorbsi



KebutuhanKebutuhan

' 1' 1 µµ!,hari!,hari

' pada defisiensi tanpa komplikasi+ 1' pada defisiensi tanpa komplikasi+ 1 µµ!,hari!,hari

sudah menukupisudah menukupi

' bila faktor intrinsik berkuran!+ kebutuhan' bila faktor intrinsik berkuran!+ kebutuhan

menin!katmenin!katSumber alamiSumber alami::

makanan he/ani (hati+ !in%al+ %antun!)+ keran!makanan he/ani (hati+ !in%al+ %antun!)+ keran!

kunin! telur+ makanan lautkunin! telur+ makanan lautE!ek sampin+E!ek sampin+::

transient hipokalemia pada terapi defisiensi berattransient hipokalemia pada terapi defisiensi berat

Ab b iAbsorbsi



Absorbsi Absorbsi

'' diabsorbsi baik dan epat pada pemberiandiabsorbsi baik dan epat pada pemberian

seara im 0 skseara im 0 sk'' absorbsi pada pemberian peroral lambat diabsorbsi pada pemberian peroral lambat di

ileumileum

'' faktor intrinsik ekso!en han"a ber!una bilafaktor intrinsik ekso!en han"a ber!una biladefisiensi faktor intrinsikdefisiensi faktor intrinsik

'' setelah diabsorbsi+ hampir semua Vitsetelah diabsorbsi+ hampir semua Vit

B12 dalam darah terikat den!an proteinB12 dalam darah terikat den!an proteinplasmaplasma





(e!isiensi asam !olat(e!isiensi asam !olat pada kehamilanpada kehamilan

s"ndroma malabsorbsis"ndroma malabsorbsi alkoholismealkoholisme

anemia hemolitikanemia hemolitik

pen!!unaan obat'obat "n! men!hambat en4impen!!unaan obat'obat "n! men!hambat en4imdihidrofolat reduktase (trimetoprim+ metotreksat)dihidrofolat reduktase (trimetoprim+ metotreksat)

obat "an! berinteraksi pada absorbsi 0obat "an! berinteraksi pada absorbsi 0

pen"impananpen"impanan

anemia me!aloblastikanemia me!aloblastik





AbsorbsiAbsorbsi baik pada pemberian peroralbaik pada pemberian peroral

EkskresiEkskresi melalui !in%almelalui !in%alSediaan:Sediaan:

tablettablet

in%eksiin%eksi dalam multiitamindalam multiitamin

dalam tablet antianemia laindalam tablet antianemia lain

E!ek sampin+E!ek sampin+: san!at %aran!: san!at %aran!

dosis tin!!i: berinteraksi den!an antikonulsandosis tin!!i: berinteraksi den!an antikonulsan



HidroksiureaHidroksiurea

untuk terapi sikle ell anemiauntuk terapi sikle ell anemia efek sampin!:efek sampin!:

– depresi sistem hemopoetikdepresi sistem hemopoetik

– netropenianetropenia



ImunosuppressantsImunosuppressants SiklosporinSiklosporin

antithymocyte globulinantithymocyte globulin

terapi anemia aplastikterapi anemia aplastik

prednisonprednison

untuk anemia hemolitik: mensupresi antibodi $!untuk anemia hemolitik: mensupresi antibodi $!

"an! melapisi eritrosit pada anemia hemolitik"an! melapisi eritrosit pada anemia hemolitik

autoimunautoimun siklofosfamid dosis tin!!i dan radiasisiklofosfamid dosis tin!!i dan radiasi

untuk anemia aplastik berat "an! !a!al den!anuntuk anemia aplastik berat "an! !a!al den!an

terapi lainterapi lain

E it tiE it ti



EritropoetinEritropoetin ;ntuk terapi:;ntuk terapi:

anemia pada penderita infeksi .$Vanemia pada penderita infeksi .$V

anemia "an! berhubun!an den!an multipleanemia "an! berhubun!an den!an multiple

m"elomam"eloma

transplantasi sumsum tulan!transplantasi sumsum tulan!

monitor hematokrit semin!!u sekali sampaimonitor hematokrit semin!!u sekali sampai

terapai hematokrit normalterapai hematokrit normal

dapat men"ebabkan hipertensidapat men"ebabkan hipertensi

Documents

Kuliah 3 Pharmacologycal Aspect in Anemia - Copy