FARMAKOLOGIKLINIK Rahmatini Bagian Farmakologi & Terapi Fakultas Kedokteran Universitas Andalas DEFINISI WHO ( 1988) Disiplin dalam bidang kedokteran berdasarkan prinsip ilmiah, menyatukan keahlian farmakologi & keahlian klinik dengan tujuan meningkatkan manfaat & keamanan obat KONSEP RESEPTOR OBAT EFEK OBAT + - KOMPLEK O+R KADAR OBAT DALAM PLASMA/SERUM . Rasional . Aman .TUJUAN FARMAKOLOGI KLINIK Terapi Efektif. Cost F.RATIONAL DRUG USE Ratio Benefit – Risk .Kinetika F Dinamika F Ekonomi . PHARMACOLOGICAL ASPECTS IN CLINICAL PRACTICE Pharmacokinetic Pharmacodynamic How drugs act The dynamics of drug conc. in the body * Absorption / bioavailability * Distribution * Biotransformation * Excretion . THERAPEUTIC DRUG MONITORING (TDM) . Provide useful information about the adequacy of the dosage regimen or the likehood toxicity .Measuring the plasma drug conc. Therapeutic Drug Monitoring (TDM) Ph dynamic Ph kinetic Druginteraction • Measuring/ interpreting plasma drug conc. • Therapeutic response • Side effects • Toxic effects . (mg/l) 40 30 Drug toxicity 20 Therapeutic level 10 m. relationship Drug conc.Time-drug conc.e.c Low therapy 1 2 Time (hour) 3 4 . Difficulty in ditinguishing between the effects of a disease and the toxic effects of a drug 4. in plasma . Drugs for prevention/ therapy of life threatening diseases or life saving drugs 3.Therapeutic Drug Monitoring (TDM) 1. Potent drugs drug amount is very small 5. Drugs that show variability of drug conc. Narrow margin of safety drugs 2. Factors that modify drug plasma concentration for a given dose • Drug formulation • Drug interaction • Environmental factors • Genetic variation • Renal and hepatic function . To see whether there is therapeutic response 2. To assess drug toxicity 3. To assess compliance .Reasons for monitoring drug treatment 1. Examples of difficulty in ditinguishing between the effects of a disease and the toxic effects of a drug 1.Heart Failure Nausea / anorexia / arrythmias 2. Digoxin toxicity Congest. Gentamycin toxicity Gram (–) septicaemia Renal damage . Pharmacokinetic parameters Cmax (peak) Half life AUC 24 Time Cmin (trough) .Drugs.plasma conc. (mg/l) First order elimination of a drug (t ½ : 2 hours) 20 10 The plasma conc. falls by half each half-life t ½ t ½ 5 2.5 2 Hours t ½ 4 6 .Visualisation of half-life Drug conc. Clinical application of half life (t½) * Designing drug dosage regimen * Determining time to reach steady state drug level which show clinical effect * Determining time to reach the drug level which have no clinical effect anymore . OBAT INDEK TERAPI LEBAR BATAS DOSIS TERAPI DAN DOSIS TOKSIK CUKUP LEBAR RELATIF LEBIH AMAN CONTOH: PARASETAMOL AMOKSISILIN ASETOSAL dll . CONSIDERATION Ph’kinetic Ph’dynamic Ph’economic RATIONAL & GOOD CLINICAL THERAPY . TUGAS CONTOH OBAT INDEK TERAPI LEBAR & SEMPIT FAKTOR –FAKTOR YANG MEMPENGARUHI RESPON PENDERITA TERHADAP OBAT . Alhamdulillah .