PLENO SCENARIO 4 Feeling Dizzy and Bluring Eyes after Injection

PLENO SCENARIO 4Feeling Dizzy and Bluring Eyesafter InjectionBy:TUTORIAL 5TUTORIAL 5Agus Fathul Muin F(1318011004)Dara Marissa Widya P(1318011045)Denny Andika K(1318011049)Dessy Nurlita(1318011051)I Made Afryan Susane I(1318011080)Intan Damaya Antika(1318011085)Khairul Anam(1318011093)Meylita Zahra Rezilia Elindra(1318011108)Putri Adelina Shazari(1318011129)Tasya Putri Atma Utami(1318011164)Widya Pebryanti M(1318011177)Wulan Noventi(1318011178)

SCENARIO 4Mrs. Sarah, 40 years old. Come to the doctor complaining about her joint discomfort. She feels it every morning in her knees and hands. Her knee is swelling and she feel ache in her arm. After following the historical diseases, Sarah said that often had cough, flu, and sorethroat. Because shes already bored for consuming drugs, Sarah is injected by analgetic. After the doctors asks about the history of drug allergic and she hasnt have it, Sarah is injected with an analgetic. Few times later, Sarah feels dizzy, blurring eyes and hard to breath. What is actually happened to Sarah?DIFFICULT WORDAnalgetic: those drugs that mainly provide pain reliefSTEP 2Diagnosis? Diagnosis differential?What is the risk factor?Phatogenesis and the etiology.Patofisiology of the symptoms.Lab examination.What is the treatment?

DIAGNOSIS AND DDDiagnosis differential:Rheumatoid ArthritisSjogren's syndromeSystemic Lupus ErythematosusStevens-Johnson syndrome

Diagnosis:Systemic lupus erythematosus features in rheumatoid arthritis

THE RISK FACTORS1. Sex Lupus is more common in women.

2. Age Although lupus affects people of all ages, it's most often diagnosed between the ages of 15 and 40.

3. RaceLupus is more common in African-Americans, Hispanics and Asians.ETIOLOGYLupus is caused by a complex interplay of genes, hormones, environmental factors, viral, certain drugs can cause lupus-like syndrome and exposure to ultraviolet light.PHATOGENESIS

Patofisiology

SYMPTOMSRashes:butterfly-shaped rash over the cheeks referred to as malar rashred rash with raised round or oval patches known as discoid rashrash on skin exposed to the sunMouth sores:sores in the mouth or nose lasting from a few days to more than a monthArthritis:tenderness and swelling lasting for a few weeks in two or more jointsLung or heart inflammation:swelling of the tissue lining the lungs (referred to as pleurisy or pleuritis) or the heart (pericarditis), which can cause chest pain when breathing deeplyKidney problem:blood or protein in the urine, or tests that suggest poor kidney functionNeurologic problem:seizures, strokes or psychosis (a mental health problem)LAB EXAMINATIONAntinuclear antibodies (ANAs)Anti-DNA antibodies

To be LO..TREATMENTNonsteroidal anti-inflammatory drugs.NSAIDs decrease swelling, pain and fever.Antimalarial drugs.Though these drugs prevent and treat malaria, they also help relieve some lupus symptoms, such as fatigue, rashes, joint pain or mouth sores.

To be LO..LEARNING OBJECTIVESMechanism of action from SLE drugs?What is analgetic drugs that can cause allergies?Laboratory examination?The difference of each characteristic symptoms between SLE and RA?Treatment for SLE?

Mechanism of action from SLE drugsCorticosteroidsThe frequently prescribed corticosteroids are highly effective in reducing inflammation and suppressing the immune response. These drugs may be used to control exacerbation of symptoms and are used to control severe forms of the disease. The drug is usually administered orally. During periods of serious illness, it may be administered intravenously; once the patient has been stabilized, oral administration should be resumed.

NSAIDsThe therapeutic effects of NSAIDs stem from their ability to inhibit the release of prostaglandins and leukotrienes, which are responsible for producing inflammation and pain. NSAIDs are very useful in treating joint pain and swelling and muscle pain. They may also be used to treat pleuritic chest pain. An NSAID may be the only drug needed to treat a mild flare; more active disease may require additional medications.Continue..AntimalarialsThe anti-inflammatory action of these drugs is not well understood. In some patients who take antimalarials, the total daily dose of corticosteroids can be reduced. Antimalarials also affect platelets to reduce the risk of blood clots and lower plasma lipid levels.

ImmunosuppressivesDrugs like azathioprine, methotrexate, and cyclosporine are referred to as antimetabolite agents. These drugs block metabolic steps within immune cells and then interfere with immune function. Cytotoxic drugs like cyclophosphamide work by targeting and damaging autoantibody-producing cells, thereby suppressing the hyperactive immune response and reducing disease activity.analgetic drugs that can cause allergiesCodeineMorphineNSAIDs such asibuprofenorindometachinAspirinLaboratory examinationAntinuclear antibody(ANA) testing and anti-extractable nuclear antigen (anti-ENA) form the mainstay ofserologictesting for SLE. Several techniques are used to detect ANAs. Clinically the most widely used method is indirectimmunofluorescence(IF). The pattern of fluorescence suggests the type of antibody present in the patient's serum.Direct immunofluorescencecan detect deposits of immunoglobulins and complement proteins in the patient's skin. When skin not exposed to the sun is tested, a positive direct IF (the so-calledlupus band test) is an evidence of systemic lupus erythematosus.ANA screening yields positive results in many connective tissue disorders and other autoimmune diseases, and may occur in normal individuals. Subtypes of antinuclear antibodies includeanti-Smithand anti-double strandedDNA(dsDNA) antibodies (which are linked to SLE) andanti-histone antibodies(which are linked to drug-induced lupus). Anti-dsDNA antibodies are highly specific for SLE; they are present in 70% of cases, whereas they appear in only 0.5% of people without SLE.The anti-dsDNA antibodytitersalso tend to reflect disease activity, although not in all cases.Other ANA that may occur in people with SLE areanti-U1 RNP(which also appears insystemic sclerosisandmixed connective tissue disease),SS-A(oranti-Ro) andSS-B(oranti-La; both of which are more common inSjgren's syndrome). SS-A and SS-B confer a specific risk for heart conduction block in neonatal lupus.Other tests routinely performed in suspected SLE arecomplement systemlevels (low levels suggest consumption by the immune system),electrolytesandkidney function(disturbed if the kidney is involved),liver enzymes, andcomplete blood count.The lupus erythematosus (LE) cell test was commonly used for diagnosis, but it is no longer used because theLE cellsare only found in 5075% of SLE cases, and they are also found in some people with rheumatoid arthritis, scleroderma, and drug sensitivities. Because of this, the LE cell test is now performed only rarely and is mostly of historical significance.characteristic symptoms between SLE and RAThere are many differences between lupus and RA. For instance, lupus might attack your joints, but it also affects your internal organs and your skin. Lupus can also cause life-threatening complications.RA, on the other hand, is not fatal. It attacks joints, primarily the fingers, wrists, knees, and ankles. RA can also cause joints to deform, while lupus doesnt.RAs pain is usually worse in the morning and gets better as the day progresses. But the joint pain caused by lupus is more constant throughout the day.Common symptoms of lupus include a butterfly-shaped rash on the face, inflammation of the heart and lungs, and sensitivity to sunlight. Joint pain and swelling are common, but they are never the only symptoms.Common signs of RA include joint stiffness and tenderness, as well as swollen or red joints.treatment for sle