Abuse (penyalahgunaan)Abuse (penyalahgunaan)

ToleranceTolerance

Dependence Dependence

Psychological dependencePsychological dependence

Physiological dependencePhysiological dependence

Withdrawal/ Abstinence syndromeWithdrawal/ Abstinence syndrome

Designer drugDesigner drug

Alasan AbuseAlasan Abuse

EuphoriaEuphoria

HalusinasiHalusinasi

Libido Libido

Perasaan bebas dari ikatan (disinhibisi)Perasaan bebas dari ikatan (disinhibisi)

Self confidenceSelf confidence

Drugs of abuseDrugs of abuse

Sedative hypnoticsSedative hypnotics Opioid AnalgesicsOpioid Analgesics StimulantsStimulants HallucinogensHallucinogens Marijuana (Marihuana)Marijuana (Marihuana) InhalantInhalant Steroid Steroid

Sedative hypnoticsSedative hypnotics

Ethanol, Barbiturate, Benzodiazepine (BZ)Ethanol, Barbiturate, Benzodiazepine (BZ) Secobarbital potensi adiksi yang tinggiSecobarbital potensi adiksi yang tinggi Efek : menurunkan anxietyEfek : menurunkan anxiety

menimbulkan perasaan relaxmenimbulkan perasaan relax

Overdose:Overdose:

Depresi pusat nafas dan SirkulasiDepresi pusat nafas dan Sirkulasi

KematianKematian

• Management:

*Jaga jalan nafas

*Ventilator

*Flumazenil

Withdrawal sedativeWithdrawal sedative

Excessive CNS stimulationExcessive CNS stimulation

anxiety, tremor, nausea vomitinganxiety, tremor, nausea vomiting

delirium, hallucinationdelirium, hallucination Kejang Kejang Sympathetic overactivitySympathetic overactivity

Treatment withdrawalTreatment withdrawal

Chordiazepoxide/ diazepamChordiazepoxide/ diazepam

Clonidine, propranololClonidine, propranolol

Opioid AnalgesicsOpioid Analgesics

Efek opioidEfek opioid i.v. heroin: orgasmic feeling, euphoria,i.v. heroin: orgasmic feeling, euphoria,

sedationsedation

i.v.opioid: cepat terjadi Tolerance, Psych.i.v.opioid: cepat terjadi Tolerance, Psych.

dan Physiological dependencedan Physiological dependence OverdosisOverdosis: pin point pupil, respiratory: pin point pupil, respiratory

depression, Comadepression, Coma

Treatment overdoseTreatment overdose

Pasien dengan physiological dependence:Pasien dengan physiological dependence:

Nalorphine, jaga jalan nafasNalorphine, jaga jalan nafas Pasien tanpa physiological dependence:Pasien tanpa physiological dependence:

Naloxon, jaga jalan nafasNaloxon, jaga jalan nafas

Withdrawal opioidWithdrawal opioid

Lacrimation, rhinorrhea, menguap, Lacrimation, rhinorrhea, menguap,

berkeringat, lemah, kulit spt kulit berkeringat, lemah, kulit spt kulit angsa,angsa,

nausea, vomiting, tremor, hyperpneanausea, vomiting, tremor, hyperpnea

Treatment:Treatment:

MethadoneMethadone

Buprenorphine (long acting opioid)Buprenorphine (long acting opioid)

Stimulants Stimulants

Caffeine and NicotineCaffeine and Nicotine

AmphetamineAmphetamine

CocaineCocaine

Caffeine and Nicotine• Toxicity

CNS stimulation

Cardiac stimulation

Respiratory paralysis

• Withdrawal

Lethargy

Irritability

Headache

AmphetamineAmphetamine

EffectsEffects Euphoria, self confidenceEuphoria, self confidence Chronic high dose abuse (psychotic state)Chronic high dose abuse (psychotic state) Overdose:agitation,tachycardia,hyperreflexiaOverdose:agitation,tachycardia,hyperreflexia Chronic abuse:necrotizing arteritis (cerebralChronic abuse:necrotizing arteritis (cerebral hemorrhage, renal failure hemorrhage, renal failure Tolerance and withdrawal:Tolerance and withdrawal: Appetite increased,sleepiness,exhaustion,Appetite increased,sleepiness,exhaustion, mental depression mental depression

Congeners of Amphetamine that have Congeners of Amphetamine that have hallucinogenic:hallucinogenic:

DOMDOM (Dimethoxy Methylamphetamine) (Dimethoxy Methylamphetamine) MDAMDA (Methylene Dioxyamphetamine) (Methylene Dioxyamphetamine) MDMA (ecstasy)MDMA (ecstasy) (Methylene Dioxy (Methylene Dioxy

MethamphetamineMethamphetamine

Cocaine

• Effect:

Euphoria, Self –Confidence,

Mental alertness

• Overdose:

Arrhythmia

Seizure

Respiratory distress

Chronic abuse:Chronic abuse:

Vasoconstrictive, HypertensiveVasoconstrictive, Hypertensive

Stroke, Myocard infarct Stroke, Myocard infarct

Withdrawal:Withdrawal:

Severe depression Severe depression

Hallucinogens Hallucinogens

Phencyclidine (PCP)Phencyclidine (PCP)

Most dangerous Most dangerous

Overdose: nystagmus, hypertensionOverdose: nystagmus, hypertension

seizureseizure Other Hallucinogens:Other Hallucinogens:

LSD, Mescaline, psilocybinLSD, Mescaline, psilocybin

Scopolamine, Other antimuscarinicScopolamine, Other antimuscarinic

Marijuana/marihuana • Active compound:

THC (Tetrahydrocannabinol)

CBD (Cannabidiol)

CBN (Cannabinol)

• Effects:

Euphoria, perasaan lepas, tertawa, spt

di alam mimpi

Vasodilatation, pulse rate increased

Habitual userHabitual user: reddened conyunctiva: reddened conyunctiva WithdrawalWithdrawal: A mild withdrawal: A mild withdrawal

Impairment of judgement andImpairment of judgement and

reflexes reflexes Therapeutic effectTherapeutic effect::

Menurunkan tekanan intra OcularMenurunkan tekanan intra Ocular

Antiemetic (Dronabinol)Antiemetic (Dronabinol)

Steroid Steroid

EffectEffect: Increase in muscle mass & strength: Increase in muscle mass & strength

EuphoriaEuphoria Excessive useExcessive use::

Behavioral effect, increases in libidoBehavioral effect, increases in libido

Cardiovascular, risk of myocard infarctCardiovascular, risk of myocard infarct

AcneAcne

MasculinizationMasculinization WithdrawalWithdrawal::

Fatigue and depression of mood Fatigue and depression of mood

DRUG MISUSEDRUG MISUSE

Salah diagnosisSalah diagnosis Salah memilih obatSalah memilih obat Dosis yang tidak tepatDosis yang tidak tepat Cara pemberian tidak tepatCara pemberian tidak tepat Terlalu banyak jenis (polifarmasi)Terlalu banyak jenis (polifarmasi)

Codein 10 mgCodein 10 mg Doveri 100 mgDoveri 100 mg Ephedrine 15 mgEphedrine 15 mg Aminophylin 160 mgAminophylin 160 mg CTM 3 mgCTM 3 mg Phenobarbital 15 mgPhenobarbital 15 mg