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LABORATORIUM ILMU FARMASIFAKULTAS KEDOKTERAN UNIVERSITAS ISLAM MALANG 2014Tugas Farmasi

04 April 2014Pembimbing:Yudi Purnomo, S.Si, Apt, M.Kes 1.Gastro-Intestinal System 1.1 Dyspepsia and gastro-oesophageal reflux disease1.1.1 Antacids and simeticoneMagnesium trisilicateMixtureSF(Contains about 6mmol of sodium in 10ml, laxative)Co-magaldroxSuspensionSF195/220 (low sodium, bowel neutral)

1.1.2 Compound alginates and proprietary indigestion preparationGaviscon AdvanceLiquid (Contains 4.6 mmol of sodium in 10ml, plus 2 mmol of potassium)Tablets (Contains 2.25 mmol of sodium per tablet, plus 1 mmol of potassium)Gaviscon InfantOral powderSF(Contains 0.92 mmol of sodium per dose)

1.2 Antispasmodics and other drugs altering gut motilityAntimuscarinicsDicycloverine HydrochlorideSyrup 10mg/5mlHyoscine butylbromideInjection 20mg in 1mlTablets 10mgAntispasmodicsMebeverineTablets 135mg

Drugs altering gut motilityMetoclopramideTablets 10mgSyrup 5mg/5mlInjection 10mg/2mlDomperidoneTablets 10mgSuspension 5mg/5mlSuppository 30mg

1.3 Antisecretory drugs and mucosal protectants1.3.1 H2receptor antagonistsRanitidineTablets 150mg, 300mgEffervescent tablets 150mg, 300mgSyrup 75mg/5mlInjection 50mg in 2ml

1.3.3 Chelates and complexesSucralfateTablets 1gOral Suspension 1g in 5ml1.3.4 Prostaglandin analoguesMisoprostolTablets 200 micrograms

1.3.5 Proton Pump Inhibitors (PPIs)OmeprazoleCapsules 10mg, 20mg, 40mgDispersible tablets 10mg, 20mg, 40mgLansoprazoleCapsules 15mg, 30mgDispersible tablets 15mg, 30mgPantoprazoleTablets 20mg, 40mgInjection 40mgEsomeprazoleTablets 20mg, 40mg

1.4 Acute diarrhoea1.4.2 Antimotility drugsLoperamideCapsules 2mgOral SyrupSF1mg/5mlOrodispersible Tablets2mg (For reducing stoma output in ileostomy patients with high stoma output of greater than 2L over 24 hours only. Hospital prescribing and supply)Codeine phosphateTablets 15mg, 30mgSyrup 25mg/5ml

1.5 Chronic bowel disorders1.5.1 AminosalicylatesMesalazineAsacolMRtablets 400mg, 800mgMezavantXLtablets 1.2gPentasatablets 500mgFoam enema 1gSuppositories 500mg, 1gSulfasalazineTablets e/c 500mg

1.5.2 CorticosteroidsBudesonideCapsules - Enteric coated granules 3mgCapsules - Modified release 3mgHydrocortisoneFoam enema 10%PrednisoloneTablets (non-enteric coated) 1mg, 5mg, 25mgRetention enema 20mgRectal foam 20mgSuppositories 5mg

1.5.3 Drugs affecting the immune responseAzathioprine UTablets 25mg, 50mgNeoral(ciclosporin) UCapsules 10mg, 25mg, 50mg, 100mgOral solution 100mg/mlMercaptopurine UTablets 50mgMethotrexate UTablets 2.5mg

1.6 Laxatives1.6.1 Bulkforming laxativesIspaghula huskNSachets 3.5g

1.6.2 Stimulant laxativesBisacodylNTablets 5mgSuppositories 5mg (paed), 10mgSennaNTablets 7.5mg sennosidesSyrup 7.5mg sennosides in 5mlDocusate sodiumNCapsules 100mgPaediatric oral solution 12.5mg/5ml,Adult oral solution 50mg/5mlGlycerolNSuppositories 1g, 2g, 4gCo-danthramerNCapsules 25/200Suspension 25/200 in 5ml

1.6.3 Faecal softenersArachis oil enemaNEnema 130ml1.6.4 Osmotic laxativesLactuloseNSolutionLiquid Paraffin & Magnesium HydroxideOral emulsionMacrogol oral powder, compoundNSachetse.g. Laxido, MovicolMovicolPaediatric PlainSachetsPhosphateNEnema 128mlSodium citrateNMicro-enema 450mg

1.6.5 Bowel cleansing solutions

PicolaxOral powderKlean-PrepOral powder

1.6.6 Peripheral opioidreceptor antagonists

Methylnaltrexone bromideNICE TA277: Methylnaltrexone for treating opioid-induced bowel dysfunction in people with advanced illness receiving palliative care (terminated appraisal)March 2013NICE is unable to recommend the use in the NHS of methylnaltrexone for treating opioid-induced bowel dysfunction in people with advanced illness receiving palliative care because no evidence submission was received from the manufacturer of the technology.

1.6.7 5HT4 Receptor Agonists

PrucaloprideTablets 1mg, 2mg

1.7 Local preparations for anal and rectal disorders1.7.1 Soothing haemorrhoidal preparationsAnusolCream, 23gSuppositories

1.7.2 Compound haemorrhoidal preparations with corticosteroids

ScheriproctSuppositoriesOintment

1.7.3 Rectal sclerosants

Phenol, oilyInjection 5% in 5ml

1.7.4 Management of anal fissures

Glyceryl TrinitrateRectogesicOintment 0.4% (Maximum duration of use - 8 weeks)Diltiazem OintmentUOnly whentreatment withGTN ointment has failedBotulinum Toxin AUInjection 100units / vial (Xeomin)

1.9 Drugs affecting intestinal secretions1.9.1 Drugs affecting biliary composition and flowUrsodeoxycholic acidCapsules 250mgSuspension 250mg/5mL

1.9.2 Bile acid sequestrants

ColestyraminePowder 4g sachet

1.9.4 Pancreatin

CreonCapsules 10,000Capsules 25,000 (High strength)Capsules 40,000 (High strength)CreonMicro20G Granule pack

Thank You2.CARDIOVASCULAR SYSTEM2.1 POSITIVE INOTROPIC DRUG2.1 Positive Inotropic Drug (Bipiridin)2.1.1 Cardiac Glycosides (digoxin)2.1.2 phospodiesterase inhibitor (exoximone, milrinore)

2.2 Diuretics2.2.1 Thiazides and releted diuretic (Hidroklorotiazid)2.2.2 loop diuretics (Furosemid, bumetanide)2.2.3 potassium sparring diuretics (Amilorid )2.2.4 potassium sparring diuretics with other diuretic (amiloride, triamteren)

2.3. ANTI ARRHYTHMIC DRUG2.3.1 Drugs for arrhytmia (qinidin sulphate)2.4 Beta-adrenoceptor blocking drugs (propanolol, atenolol)

2.5 Drug Effecting the renin-angiotensin system and some other antihypertensive drug 2.5.1 Vasodilator anti hypertensive drug (Hidralazin, minoxidil )2.5.2 centrally acting anti hypertensive drug (klonidin, metildopa)2.5.3 adrenergic neurone bloking group (reserpin, guanetidin)2.5.4 Alpha adrenoceptor blocking drugs (prazosin, doxazosin)2.5.5 drugs affecting the renin angiotensin system2.5.5.1 angiotensin converting enzyme inhibitor(captopril, lisinopril, ramipril)2.5.5.2 angiotensin II receptor antagonist (valsartan) Cont2.5.6 Ganglion blocking drugs (trimetafan)2.5.7 Tyrosine hydroxylase inhibitor (trimetaphan)

2.6 Nitrate, Ca Channal Blocker and Potassium activator2.6.1 Nitrate(ISDN)2.6.2 Ca Channel blocker (amlodipin, nifedipin)2.6.3 potassium channel blocker (amiodaron, dofetilide)2.6.4 peripheral and cerebral vasodilator2.6.4.1 peripheral vasodilator and related drugs (Minoxidil)2.6.4.2 cerebral vasodilation (nitrixe oxide)2.7 SYMPATHOMIMETIC2.7.1 Inotropic Sympathomimetic (dopamin, dobutamin, isoprenasin)2.7.2 vasoconstriction Sympathomimetic (noradrenalin, norepinephrine)2.7.3 cardiopulmonary recucitation (adrenalin, amiodaron, atropin)

2.8 anticoagulant and protamine2.8.1 Parenteral anticoagulants (heparin)2.8.2 oral anticoagulants (aspirin, sulfinpirazon, dipiridamol)2.8.3 Protamin sulphate (u/ menetralkan antikoagulan heparin, ex: Protamin sulphate ) 2.9 antiplatelet drug (Aspirin, clopidogrel)

2.10 Myocardial Infarction and fibrinolisis 2.10.1 Fibronolytic drugs (streptokinase, urokinase)2.11 antifibrinolytic drug and hemostatics (asam traneksamat)2.12 Lipid regulation drugs (simvastatin)2.13 local sclerosants (sodium tetradecyl sulphate )TERIMAKASIH3. Respiratory systemBronkodilator1.1 Adenoreseptor agonis (Bronkodilatasi)ex : Noradrenaline, phenylephrine, xylometazoline. (Alfa 1 agonist)1.2 Selective beta blocker ex : Salbutamol, Folmeterol, terbutaline1.3 Other adenoreseptor agonistex : Alfa 2 agonist (Agmatine, clonidine, xylazine dexmedetomidine.1.4 antimuscarinic bronkodilator (menghambat asetilkolin)ex : Atropin, lipratopium bromide1.5 Theophyline (golongan metilxantin, menghambat enzim fosfodiesterase) Other preparationsAminophylline injectionCaffeine citrate oral solutionCaffeine citrate intravenous injection1.6 Coumpound broncodilator preparationsex : salbutamol1.7 Peak flow meter, inhaler devices and nebuliser.ex : Nebuchamber, Volumatic, AeroChamber Plus, Pari Vortex

2. Cortocisteroid (relaksasi otot polos jalan nafas)ex : Methylprednisolone, prednison3. Cromoglicate, related therapy and leukotriens reseptor antagonist3.1 Cromoglicate, related therapy ex : Cromolyn Dan Nedocromil3.2 leukotriens reseptor antagonist (menurunkan reaktivitas bronkus, edema, hipersekresi)ex : Zafirlukost, montelukost, zileuton

4. Antihistamin, hiposensitisation, and allergic emergency4.1 AntihistamineNon-sedating antihistamines should be offered first line to all patients, especially children and adolescents.(Cetirizine, Fexofenadine, loratadine)Sedating antihistamin(Chlorphenamine(chlorpheniramine), Alimemazine(trimeprazine), Hydroxyzine4.2 Allergic immunotherapy (ex : Omalizumab)4.3 Allergic emergencyex : Adrenaline injection5. Respiratory stimulant and pulmonary surfactant5.1 Respiratory stimulant (ex : doxapram)5.2 Pulmonary surfactant (ex : poractant)6. Oxygen7. Mucolytics ex: Bromhexine, N-acetylcystein, Ambroxol8. Aromatic inhalationex : Aromatic ammonia9. Cough preparations9.1 Cough suppresantex : Codein, DMP9.2 Expectorant and demulcent preparationex : Doveri, glyceril guaiacolate, potio nigra conta tussim10. Systemic nasal decongestant ex : Pseudoefedrin, efedrin4.CENTRAL NERVOUS SYSTEMHipnotik & AnxiolitikHipnotik Golongan obat yang dapat menyebabkan kantuk dan memudahkan seseorang tertidur. Ex: Valium/Diazepam, Lorazepam, Midazolam, AlprazolamAnxiolitik: Benzodiazepin, non-Benzodiazepin (Buspiron)Barbiturat: Dietilbarbiturat, Fenobarbital, Tiopental, Pentobarbital

2. PsikosisAntipsikotik: Chlorpromazine, Halloperidol, RisperidonAntimanik: Litium Carbonat, Karbamazepin

3. AntidepresanTrisiklik: Amitriptilin, ImipraminMonoamine-Oxidase Inhibitor (MAOI): MoclobemideSelective Serotonin Reuptake Inhibition (SSRI): Sentralin, Fluvoxamin, Fluoxetin, ParoxetinAntidepresan lain: Trazodon, Mianserin, Maprolitin4. Central Nervous System StimulantsAmfetaminDekstroamfetaminMetamfetaminMDMA (ecstasy)MetilfenidatPemolin

5. Drugs used in the tratment of obesity 5HT (5 hidroksi triptofan)reuptake norepinephrine inhibitor (sibutramine)Stimulan (methylphenidate)lipase inhibitor (orlistat)agonist serotonin (phentermine)6. Drugs used in nausea and vertigoBetahistin DihidrokloridaMeklizinDimenhidrinatPerfenazinSkopolamin (emplastrum)

7. AnalgesikNon-opioid: Parasetamol, AsetosalOpioid: Morfin, Heroin, Kodein, Petidin, Metadon Neuropatic pain: Natrium Diklofenak, MeloxicamAntimigrain: Ergotamin, Caffein, Flunarizine, Cinnarizine8. AntiepileptikControl of epilepsy: Fenitoin, Fenobarbital, Karbamazepin, Diazepam, Klorazepam, Klobazam, Asam ValproatStatus epileptikus: Diazepam, Fenitoin, FenobarbitalFebril Konvulsi: Diazepam, Fenobarbital

9. Drugs used in ParkinsonismDopaminergik sentral: Levodopa, Bromokriptin, CarbidopaAntimuskarinik: oxybutynin klorida, tolterodine, trospium klorida, darifenacin, fesoterodine fumaratMengurangi gejalan Parkinson: Pramipexole (untuk mengurangi gejala dari Parkinson seperti tremor, kekakuan dan gerak yang lambat)

10. Drugs used for DementiaGalataminRivastigminDonepezilPentoxifilinPiracetamGinkogiloba5.ANTIBIOTIKANTIBACTERIAL DRUGSPenicillins Benzypenicillin and phenoxymethyplenicillin Benzylpenicillin, Phenoxymethylpenicillin (Penicillin V), Benzathine benzylpenicillin, Procaine benzylpenicillinPenicillinase-resistant penicillins FlucloxacillinBroad-spectrum penicillins Amoxicillin, Co- amoxiclavAntipseudomonal penicillins Piperacillin with TazobactamMecillinams PivmecillinamCephalosporins Cefalexin, Cefotaxime, Cefixime, Ceftazidime, Ceftriaxone, CefuroximeTetracyclines Oxytetracycline, DoxycyclineAminoglycosides Gentamicin, Tobramycin, Neomycin sulphateMacrolides Clarithromycin, Erythromycin, AzithromycinClindamycin Clindamycin Some other antibacterials Vancomycin, Sodium fusidate, ChloramphenicolSulphonamides and trimethoprim Trimethoprim, Co-trimoxazole, Sulfadiazine

Antituberculous drugs Rifampicin, Isoniazid, Ethambutol, Pyrazinamide, StreptomycinAntileprotic drugs DapsoneMetronidazole MetronidazoleQuinolones CiprofloxacinUrinary-tract infections Nitrofurantoin, FosfomycinANTIFUNGAL DRUGSTriazole antifungals Fluconazole, Itraconazole, VoriconazoleImidazole antifungals KetoconazolePolyene antifungals AmphotericinEchinocandin antifungals CaspofunginANTIVIRAL DRUGSHIV infection StribildHerpes virus infectionsHerpes simplex and varicella-zoster infection Aciclovir, ValaciclovirCytomegalovirus (CMV) infection ValganciclovirViral hepatitis Adefovir dipivoxil, Entecavir, Tenofovir disoproxil, Boceprevir, TelaprevirInfluenza Oseltamivir, ZanamivirRespiratory syncytial virus (RSV) Palivizumab

ANTIPROTOZOAL DRUGSAntimalarials Doxcycycline, Quinine sulphate, Quinine dihydrochloride, Artesunate, Clindamycin, Pyrimethamine/ Sulfadoxine, Artemether with lumefantrine, Chloroquine sulphate, PrimaquineAmoebicides MetronidazoleTrichomonacides MetronidazoleAntigiardial drugs MetronidazoleLeishmaniacides Sodium stibogluconate TrypanocidesDrugs for toxoplasmosis Pyrimethamine, SulfadiazineDrugs for pneumocystis pneumonia Co-trimoxazole, Pentamidine isetionate

ANTIHELMINTICS DRUGSDrugs for treadworms Mebendazole, PiperazineAscaricides Mebendazole, LevamisoleDrugs for tapeworm infections Niclosamide, PraziquantelDrugs for hookworms MebendazoleSchistosomicides PraziquantelFilaricides Diethylcarbamazine, IvermectinDrugs for cutaneous larva migrans Tiabendazole, AlbendazoleDrugs for strongyloidiasis Albendazole, Ivermectin6. Endocrine system Drugs Drugs used in diabetesInsulinType of Insulin & Brand NamesOnsetPeakDurationRole in Blood Sugar ManagementRapid-ActingHumalog or lispro15-30 min.30-90 min3-5 hoursRapid-acting insulin covers insulin needs for meals eaten at the same time as the injection. This type of insulin is often used with longer-acting insulin.Novolog or aspart10-20 min.40-50 min.3-5 hoursApidra or glulisine20-30 min.30-90 min.1-2 hoursShort-ActingRegular (R) humulin or novolin30 min. -1 hour2-5 hours5-8 hoursShort-acting insulin covers insulin needs for meals eaten within 30-60 minutesVelosulin (for use in the insulin pump)30 min.-1 hour2-3 hours2-3 hoursIntermediate-ActingNPH (N)1-2 hours4-12 hours18-24 hoursIntermediate-acting insulin covers insulin needs for about half the day or overnight. This type of insulin is often combined with rapid- or short-acting insulin.Long-ActingLong-acting insulin covers insulin needs for about one full day. This type of insulin is often combined, when needed, with rapid- or short-acting insulin.Lantus (insulin glargine)1-1 hourNo peak time; insulin is delivered at a steady level20-24 hoursLevemir (insulin detemir)1-2 hours6-8 hoursUp to 24 hoursPre-Mixed*Humulin 70/3030 min.2-4 hours14-24 hoursThese products are generally taken two or three times a day before mealtime.Novolin 70/3030 min.2-12 hoursUp to 24 hoursNovolog 70/3010-20 min.1-4 hoursUp to 24 hoursHumulin 50/5030 min.2-5 hours18-24 hoursHumalog mix 75/2515 min.30 min.-2 hours16-20 hours*Premixed insulins are a combination of specific proportions of intermediate-acting and short-acting insulin in one bottle or insulin pen (the numbers following the brand name indicate the percentage of each type of insulin).Oral Antidiabetics drugsGolonganSenyawaMekanisme KerjaSulfonilureaGliburida/GlibenklamidaGlipizidaGlikazidaGlimepiridaGlikuidonMerangsang sekresi insulin dikelenjar pankreas, sehingga hanyaefektif pada penderita diabetes yangsel-sel pankreasnya masihberfungsi dengan baikMeglitinidaRepaglinideMerangsang sekresi insulin dikelenjar pankreasTurunanfenilalaninNateglinideMeningkatkan kecepatan sintesisinsulin oleh pankreasBiguanidaMetforminBekerja langsung pada hati (hepar),menurunkan produksi glukosa hati.Tidak merangsang sekresi insulinoleh kelenjar pankreasTiazolidindionRosiglitazoneTroglitazonePioglitazoneMeningkatkan kepekaan tubuhterhadap insulin. Berikatan denganPPAR (peroxisome proliferatoractivated receptor-gamma) di otot,jaringan lemak, dan hati untukmenurunkan resistensi insulinInhibitor -glukosidaseAcarboseMiglitolMenghambat kerja enzim-enzimpencenaan yang mencernakarbohidrat, sehinggamemperlambat absorpsi glukosa kedalam darahTerapi hipoglikemia

1. Segera mengkonsumsi pisang atau roti atau karbohidrat kompleks lainnya2. Bisa juga menggunakan teh gula, air gula kental atau madu yang dimasukkan di bawah lidah.3. Jika penderita tidak sadar, injeksi glukosa 40% Intra vena 25 ml (encerkan 2x dengan aqua injeksi) juga infus glukosa 10% atau Dekstrose 10%. Bila belum sadar dapat diulang 25 cc glukosa 40% setiap 30 menit. Dapat diulang sampai 6x sampai penderita sadar. 1 flakon D40% 24 meq dapat menaikkan kadar gula darah 25-50 mg/dl. Periksa Gula Darah Sewaktu 30 menit setelah Intra vena terakhir.4. injeksi efedrin 25-50 mg (bila tdk ada kontra indikasi jantung pada jantung) atau glukagon 1 mg Intra muskuler.5. Sementara obat antidiabetesdihentikan dulu.

Treatment of hypoglicemicNephropathyIstirahat2.DietDiet disesuaikan dengan kebutuhan penderita, 35 Kcal/kgBB/hariProtein dibatasi 0,8 g/kgBB/hari bila ada albuminurACEI/ACEI+antagonis kalsium bila ada hipertensi3.MedikamentosaObat pertama :Insulun, bila gula darah tidak terkontrol dengan diet4.Hemodialis5.Transplantasi ginjal

Treatment of diabetic nephropathy and neuropathyDiagnostic and monitoring agentsLaboratory Tests in the Diagnosis and Management of Hyperglycemic EmergenciesPlasma glucoseSodiumSUNPotassiumCreatinineBicarbonateKetone bodiesChlorideOsmolalityBlood pH Criteria for the Diagnosis of DiabetesSymptoms of diabetes and a casual plasma glucose > 200mg/dl. Casual is defined as any time of day without regard to time since last meal. The classic symptoms of diabetes include polyuria, polydipsia, and unexplained weight lossORFPG 126mg/dl. Fasting is defined as no caloric intake for at least 8 h. Should be repeated on a separate occasion.OR2-h plasma glucose 200mg/dl during an OGTT. The test should be performed as described by the World Health Organization, using a glucose load containing the equivalent of 75g anhydrous glucose dissolved in water.ORA1C 6.5%. The test should be performed in a laboratory using a method that is NGSP certified and standardized tot he DCCT assay.Thyroid and Antithyroid DrugsThyroid hormones

Antithyroid drugsANTITIROID

Proses dihambat Contoh Transport I- Perchlorat, fluoborat, SCN Iodinasi tiroglobulin Thionamid, PTU, Mtimazol Reaksi Coupling Thionamid, Sulfonamid Pelepasan Hormon Garam Li, Iodida Deiodinasi iodotirosin Nitrotirosin Deiodinasi periverDer. TU, Amiodaron Corticosteroidcorticoteroids ComparedTypeDrugEquivalent DosesRelative Glucocorticoid PotencyRelative Mineralocorticoid PotencyShort-acting.Biological half life*:8-12 hoursCortisolHydrocortisone20 mg25 mg10.822Intermediate-acting.Biological half life:18-36 hoursPrednisoloneTriamcinoloneMethylprednisolone5 mg4 mg4 mg455100Long-acting.Biological half life:36-54 hoursDexamethasoneBetamethasone0.75 mg0.75 mg25-5025-5000MineralocorticoidsAldosteroneFludrocortisone0.3 mg2 mg015300150*Duration of adrenocorticotrophic hormone (ACTH) suppression after a single dose of the drug.Sex HormonesHormoneFunctionProgesteronePrepares uterus to receive conceptusMaintains uterus during pregnancyStimulates growth of mammary glandsRegulates secretion of LH and FSHAndrogensRequired for spermatogenesisInduce and maintain secondary sex characteristics of malesRegulate secretion of LH and FSHPromote increase in muscle mass and toneEstrogensNecessary for oogenesisStimulates growth and activity of mammary glandsStimulate growth of uterusInduce and maintain femal body shape and fat distributionRegulate secretion of LH and FSHRequired for skeletal maturation and bone mineralization in male and femalesReproductive hormonesHormonePrimary SourceSteroid HormonesProgestinsOvary, PlacentaAndrogensTestisEstrogensOvary, PlacentaProtein HormonesFSHAnterior PituitaryLHAnterior PituitaryProlactinAnterior PituitaryhCGPlacentaPeptide HormonesGnRHHypothalamus, PlacentaOxytocinPosterior PituitaryNatural HormoneAgonistAntagonistUseProgesteroneLevonorgestrelContraceptiveRU-486AbortifacientEstrogenMestranolContraceptiveRaloxifeneBreast Cancer-endorphinNaloxoneMale erectile dysfunctionExamples of Reproductive Hormone Agonists and AntagonistsHormone replacement therapy(HRT)replaces two female hormones that a womans body is no longer producing due tomenopause. These hormones are:oestrogen: the oestrogen used in HRT is taken from plants or from the urine of pregnant horsesprogesterone: HRT uses a synthetic version of progesterone calledprogestogen because it is easier for the body to absorbWhile there are more than 60 different preparations of HRT, the three main types are discussed below.Oestrogen-only HRTOestrogen-only HRT is usually recommended for women who have had their womb and ovaries removed during ahysterectomy. There is no need to take progestogen because there is no risk ofendometrial cancer(cancer of the lining of thewomb).

Oestrogen and HRTJenisKontinyuDosisEstrogen konjugasiOral0.3-0.4 mg17 estradiolOral1-2 mgTransdermal50-100 mgSubkutan25 mgEstradiol valerateOral1-2 mgEstradiolOral0,625-1,25Dosis Anjuran Sulih EstrogenDosis Anjuran Sulih ProgesteronJenisSekuensialKontinyuProgesteron300 mg100 mgMedroksiprogesteron asetat (MPA)10 mg2,5-5 mgSiproteon asetat1 mg1 mgDidrogesteron10-20 mg10 mgNormogestrol asetat5-10 mg2,5-5 mgHypothalamic and anterior pituitary hormones and anti-oestrogens

Anterior pituitary hormones TetracosactideSynacthenInjection 250 micrograms in 1ml (30 minute diagnostic test)Synacthen DepotInjection 1mg in 1ml(5 hour diagnostic test)GonadotrophinsChorionic Gonadotrophin (HCG)PregnylInjection with solvent 1500 units, 5000 unitsHuman Menopausal GonadotrophinsFostimonInjection powder for reconstitution 75 unitsfollicle-stimulating hormone

Growth hormoneSomatropinGenotropinInjection & Prefilled pens5.3mg (16 units), 12mg (36 units)Hypothalamic hormones GonadorelinInjection 100 microgram vial with diluent ProtirelinInjection 100 microgram/ml

Posterior pituitary hormones and antagonists

Posterior pituitary hormones DesmopressinDesmomeltSublingual tablets 120 micrograms, 240 microgramsDDAVPtablets 100 micrograms Tablets 200 micrograms Nasal spray 10 micrograms per metered spray,150 micrograms per metered sprayInjection 4 micrograms in 1ml,15 micrograms in 1mlTerlipressinInjection 1mg in 5ml

VasopressinInjection 20 units/ml

Antidiuretic hormone antagonists DemeclocyclineCapsules 150mg. Note:Demeclocycline may be used in the treatment of hyponatraemia resulting from inappropriate secretion of antidiuretic hormone.TolvaptanTablets 15mg. Note:Tolvaptan is only for use in patients with small cell lung cancer who have failed or not tolerated demeclocycline.

Drugs affecting bone metabolismCalcitonin (salmon) injectionTeriparatide injection - specialist use ony - 1st line treatment of osteoporotic vertebral crush fractureBisphosphonates Alendronicacidtablets (once weekly tablets) - preferred oral bisphosphonates in osteoporosis

Other endocrine drugsBromocriptine and other dopaminergic drugsRecommended:Cabergoline(TLS Amber)Alternative:Bromocriptine(TLS Amber 1 month)Specific Indication:Quinagolide(TLS Red)the treatment of hyperprolactinaemia &prolactinomas where other treatments have failed, arecontraindicated or the patient has had adverse effects.Quinagolide offers a non-ergot derived treatment option.

Drugs affecting gonadotrophinsDanazol(TLS Amber 1 month)Gonadorenlin analoguesBuserelinnasal sprayTLS Red for uterine fibroid reduction& fertility treatments and TLS Amber for endometriosisGoserelin3.6mg implantTLS Red for uterine fibroid reduction & fertility treatments and TLS Amber for endometriosisTriptorelin(DecapeptylSR) 3mg injection

Metyrapone and trilostaneSpecific indication: (TLS Blue)Metyrapone- management of Cushing's syndrome.

7. OBSTETRICS, GYNAECOLOGY AND URINART-TRACT DISORDER7.1 Drug in obstetrics7.1.1 prostaglandin dan oxytocinYaitu obat yang berfungsi untuk menginduksi aborsi ( kelahiran), dan berfungsi sebagai pemacu kontraksi uterus juga dapat sebagai obat meminimalisir pengeluaran darah dari lepasnya plasenta.Ex: misoprostol, oxytocin, dinoprostone.7.2 treatment of vaginal and vulval conditions7.2.1 preparation for vagina atrophyAtrophy vagina biasanya terjadi pada wanita- waninta yang kekurangan hormon esterogen biasanya pada wanita-wanita yang sudah menopouse.Ex: extradiol, estriol7.2.2 anti infective drugsInfeksi pada vagina:Contoh: Candidiasis : cotrimoksazoleGonnorrhea: ampicilin Trikomonas: metronodazole7.3 kontrasepsi7.3.1 combine hormone kontrasepsiBiasa yang dipakai kombinasi esterogen dan progesteron Ex:Ethinylesstradiol dengan norethisterone : loestrinEthinylestradiol dengan desogestrel: mercilon

Perentral progesteron kontrasepsi:Depo- profera (medroxyprogesterone acetat 150 mg/ml)Noristerat (norethisterone anantate 200 mg/ml)Implant:Implanon (containing etanogestrel 68 mg)Intra uterine device (IUD)Levonogestrel (progestin) MIRENA (Progestogen)Spermicidal kontrasepsiSpermididal (delfen)SpermicidKontrasepsi lain:Kondom, condom vagina.

7.4 drugs for genito-urinary disorder7.4.1 drugs for urinary retentionAlpha blocker: doxazosin, indoramin ,terazosin7.4.2 drugs for urinary frequency,enuresis and incontinenceEx: flavoxate hydrochloride, propineprine hydrochloride, trospium chlorida7.4.3 drugs used in urological pain(Alkalisasi dan keasaaman urin, Cystitis, gangguan ginjal) Ex: potasium citrate ,sodium bicarbonate (penetral asam pada pasien asidosis tubulus renalis),sodium citrate

Bladder instillations and urological n surgery(blood clots, bladder cancer, interstitial cistitis) Ex: sodium sitrate, mytomycin,dimethyl sulfoxideCatheter patency solution -chlorhexidine 0,02%Mandelice acid 1%Sodium cloride 0,9%7.4.5 Drugs for erectile dysfuntionEx: alprostadil (prostaglandin E1) pemberian secara iv Apomorphine: pemberian tablet sublingual/ inj subkutan 8. MALIGNANT DISEASE AND IMMUNOSUPRESSIONCytotoxic drugsAlkylating drugs BendamustineBusulfan CarmustineChlorambucilCyclophosphamideIfosfamideLomustineMelphalanThiotepaTreosulfanAnthracyclines and other cytotoxic antibioticsBleomycinDacintomycinDaunorubicinDoxorubicinPegylated DoxorubicinEpirubicinIdarubicinMytomycinAlkylating drugsChlormethine hydrochlorideMustargenChlorethamine hydrochlorideCyclophosphamideCytoxanCyclometCycloxanEstramustine PhosphateEmcytEstracytIfosfamideEndoxanCytoxanMelphalanAlkeranThiotepaThioplexThiotepaTreosulfanTreosufanDihydroxybusulfanOvastat

Cytotoxic AntibioticsDaunorubicinCerubidinDoxorubicin HydrochlorideEpirubicin HydrochlorideIdarubicin hydrochlorideMitomycin

Sex hormones and hormone antagonist in malignant diseaseEstrogensDiethylstilbestrolProgesteronsMedroxyprogesteron acetateMegestrolNorethisteroneHormone antagonistBreast cancer :- Anastrazole -Exemestane -Letrozole - Tamoxifen

Gonadorelin analogues and gonadotrophin-releasing hormone antagonistGonadorelin AnaloguesBuserelinTriptorelinAnti androgensBicalutamideCyproteroneAbirateroneGonadotrophin- releasing hormone antagonistDegarelixSomastostatin analoguesOctreotidLanreotideOther antineoplastic drugsAmsacrineBevacizumabBexaroteneBortezomibCetuximabCrisantaspaseDacarbazineHydroxycarbamideTretinoinCarboplatin9. Nutrition and bloodIron deficiency anaemias Oral iron Ferrous fumarate Tablets 210mg (equivalent to 68mg ferrous iron per tablet)Syrup 140mg/5mL (equivalent to 45mg ferrous iron per 5mL)2. Ferrous sulphateTablets 200mg (equivalent to 65mg ferrous iron per tablet)

3. Sodium feredetate (Sytron )Elixir SF 190mg in 5ml (equivalent to 27.5mg of ferrous iron4. Polysaccharide- iron complex (Niferex) Elixir (equivalent to approximately 500 micrograms of ferrous iron per drop) - 30ml dropper bottle only. Parenteral iron Iron dextran (CosmoferInjection 50mg/ mL) Iron sucrose (Venofer ) Injection20mg/ mL Drugs used in megaloblastic anaemiasFolic acid Tablets 5mg Tablets 400 microgram N Syrup SF 2.5mg in 5ml Syrup SF 400 microgram in 5ml N Folic Acid injection 15mg/ ml U2. Hydroxocobalamin Injection 1mg/ mL3. Cyanocobalamin SLS Tablets 50 micrograms Drugs used in hypoplastic, haemolytic and renal anaemias Aranesp (Darbepoetin alfa) Prefilled syringes 10, 15, 20, 30, 40, 50, 60, 80, 100, 150, 130, 300, 500 micrograms SureClick 20, 40, 60, 80, 100, 150, 300, 500 micrograms2. Eprex (Epoetin alfa)Prefilled syringes 1000, 2000, 3000, 4000, 10,000, 40,000 units3. NeoRecormon(Epoetin beta) Prefilled syringes 500, 2000, 3000, 4000 units4. Iron overload Desferrioxamine Injection 500mg Drugs used in platelet disorders Idiopathic thrombocytopenic purpuraEltrombopag Tablets 25mg, 50mg2. Romiplostim Injection, powder for reconstitution 250 microgram vial Essential thrombocythaemia Anagrelide Capsules 500 microgramsDrugs used in neutropenia1. Filgrastim (Neupogen) Injection 30 million units (300 micrograms) in 1ml vial or pre- filled syringeInjection 48 million units (480 micrograms) in 1.6ml vial or pre- filled syringe2. Filgrastim (Zarzio) Injection 30 million units (300 micrograms) in 0.5mlpre- filled syringeInjection 48 million units (480 micrograms) in 0.5mlpre- filled syringe3.Lenograstim (Granocyte) Pre- filled syringe 13.4 million units (105 micrograms)Pre- filled syringe 33.6 million units (263 micrograms) Oral preparations for fluid and electrolyte imbalance Oral potassium Potassium Chloride Sando- K Effervescent tablets each containing 12mmol potassium Kay- Cee- L Syrup SF containing 1mmol potassium per mlSlow- K Modified release tabletseach containing 8mmol potassiumManagement of hyperkalaemia (Potassium Removal) Polystyrene sulphonate resinsCalcium Resonium Powder calcium polystyrene sulphonate. Enema 30g in 100mL U2. Resonium A Powdersodium polystyrene sulphonate.2. Oral sodium and water Sodium chloride Slow Sodium Modified release tablets containing 600mg sodium chloride (equivalent to 10mmol Sodium)Oral solution 30% U3. Oral bicarbonate Sodium bicarbonate Capsules, sodium bicarbonate 500mg (approx. 6mmol each of sodium and bicarbonate) Parenteral preparations for fluid and electrolyte imbalanceProducts routinely used in Primary Care Sodium chloride 0.9% for injection: 5ml, 10ml, 20ml ampoules 50ml vials2. Water for injection N 5ml, 10ml, 20ml ampoules 3. Glucose 50% 50ml Min- I- jet,50ml vial U3. Oral Glucose Glucose 30% 10ml oral solution U Additional products for infusion are available for use in secondary care, please contact pharmacy1. Sodium bicarbonate Intravenous Infusion 1.26%, 2.74%, 4.2%,8.4%Intravenous Injection 8.4% Min- I- jet 4.2%, 8.4% Plasma and plasma substitutes Gelatin Gelaspan 4 % Intravenous infusion, succinylated gelatin 40g (4%)500mlIntravenous nutritionProprietary infusion fluids for parenteral feeding1. Intralipid10% 500mL2. Intralipid20% 500mL3. Triomel N4-700E Contains 4g Nitrogen/ litre; 1500mL bag4.TriomelN7-1140EContains 7g Nitrogen/ litre; 2000mL bag 5. Triomel N9-1070EContains 9g Nitrogen/ litre; 2000mL bag 6. Plasma- Lyte 148 (water)Solution for Infusion, pH 7.4, 1000mL7. Vamin14 1000mLSupplementary preparations

Addiphossolution20mL vial Calcium and magnesium Calcium supplements1. Adcal Chewable tablets containing 600mg calcium(15mmol)2. Sandocal-400 Effervescent tablets containing 400mg calcium (10mmol) 3. Sandocal-1000 Effervescent tablets containing 1000mg calcium(25mmol)4. Calcium Sandoz Syrup containing 108.3mg calcium (2.7mmol)in 5mlCalcium Gluconate 10% 10ml ampoule Calcium chloride 10% Min- I- jet 10ml Hypercalcaemia 1. Cinacalcet Tablets 30mg, 60mg, 90mg Magnesium1. Magnesiumglycerophosphate U Capsules containing 4mmol magnesium per capsuleLiquid containing 10mmol in 10mL 2. Magnesium sulphate Injection 50% (approximately 2 mmol magnesium per ml) 10ml amps.Phosphorus Phosphate supplements Phosphate- Sandoz Effervescent tablets containing the equivalent of 16.1mmol phosphate2. Phosphate mixture U Mixture 100mL, containing the equivalent of 527mmol phosphate/ LPhosphate- binding agents 1. Alu- CapCapsulesaluminium hydroxide475mgZincZinc 1. Zinc sulphate U Capsule 220mgVitamin A Vitamin AVitamin A and DCapsules vitamin A 4000 iu and vitamin D 400 iu 2. Vitamin A Injection 100,000 iu in 2mlHealthy Start Childrens Vitamin Drops Oral drops vitamin A 5000 units, vitamin D 2000 units, ascorbic acid 150mg/ ml Healthy Start Women's vitamin tablets Tablets vitamin C 70mg, vitamin D3 10 micrograms, folic acid 400 microgramsVitamin tablets (with calcium and iodine) for nursing mothers Tablets vitamin A 8mg, ascorbic acid 60mg, ergocalciferol 400 units, calcium hydrogen phosphate 190mg, potassium iodide 130 micrograms, ascorbic acid 60mgVitamin B1. Vitamin B Compound Tablets containing nicotinamide 15mg, riboflavin 1mg, thiamine 1mg 2. Vitamin B Compound Strong Tablets containing nicotinamide 20mg, pyridoxine 2mg, riboflavin 2mg, thiamine 5mg3. Thiamine Tablets 50mg, 100mgInjection 250mg in 5ml U 4. Pyridoxine Tablets 10mg, 20mg,50mg Injection 50mg/2ml U 5. Pabrinex Injection I/ M High potency Injection I/ V High potencyVitamin C1. Ascorbic AcidTablets 50mg,100mg, 500mgEffervescent 1g (Not NHS)Vitamin D1. Alfacalcidol Capsules 250 nanograms, 500 nanograms, 1 microgramOral drops 2 microgram in 1ml Injection 2 micrograms 1ml (1ml ampoules) 2. Calcitriol Capsules 250 nanograms, 500 nanograms Injection 1 microgram in 1ml, 2 micrograms in 1ml 3. Colecalciferol (vitamin D3) Liquid 3,000 units in 1mLU Capsules 50,000 units U 4. Ergocalciferol (vitamin D2) Injection 300,000 units in 1mlWith calcium1. Adcal D3 Chewable tablets containing 600mg calcium and 400 units of vitamin D (as vitamin D3)Caplets containing 300mg Calcium and 200units of vitamin D (as vitamin D3)Dissolve, effervescent tablets containing 600mg calcium and 400 units of vitamin D (as vitamin D3) 2. CalceosChewable tablets containing 500mg calcium and 400 units of vitamin D (as vitamin D3)3. Calcichew D3 Forte Chewable tablets containing 500mg calcium and 400 units of vitamin D (as vitamin D3) 4.Calcichew D3 500mg/400iu CapletsTablets containing 500mg calcium and 400 units of vitamin D (as vitamin D3)Vitamin E1.Alpha tocopheryl acetate Suspension 500mg in 5mlVita- E capsules 50mg (75iu), 268mg (400iu)Vitamin K1. Phytomenadione Injection 10mg in 1ml (KonakionMM) [Not for intramuscular injection]Injection (KonakionMM Paediatric) 2mg in 0.2ml[May be administered by mouth, intramuscularinjection or intravenous injection].2. Menadiol sodium phosphate Tablets 10mg Multivitamin preparations1. Vitamins Capsules BPC 2. Sanatogen A- Z Complete Tablets3. Abidec(Vitamin A 1333iu, ergocalciferol 400iu, thiamine 0.4mg, riboflavin 0.8mg, pyridoxine 0.8mg, nicotinamide 8mg, ascorbic acid 40mg per 0.6ml)Drops 25ml, 50ml4. Dalivit Vitamin Drops 25ml, 50ml5. Ketovite( Vitamin A 2500iu, ergocalciferol 400iu, choline chloride 150mg, cyancobalamine 12.5 microgram/5ml) Tablets Liquid Drugs used in metabolic disordersWilson's disease Penicillamine Tablet 125mgCarnitine deficiency Carnitine Oral liquid, 10%Oral liquid, Paediatric solution, 30%Injection 1g in 5ml Acute porphyriasAcute porphyriasHaem arginateNormosang Concentrate for IV infusion 25mg/ ml10.MUSKULOSKELETAL & JOINTDISEASE10.1.1 Non steroidal anti inflammatorydrugsIbuprofenTablets 200mg, 400mg, 600mgSuspensionSF 100mg in 5mlNotes:Ibuprofen remains the first line NSAID. If a patient says that they have tried ibuprofen check that they have taken an anti- inflammatory dose, at least 400mgNaproxenTablets 250mg, 500mgNotes:Patients at high risk from developing gastrointestinal adverse effects should be prescribed omeprazole 20mg.IndometacinCapsules 25mg, 50mgSuppository 100mgNotes:Indometacin is the first- line NSAID in the management of gout (see section 10.1.4).Its use is limited by high incidence of side effects such as headache and dizzinessMefenamic acidCapsule 250mgTablet 500mgFlurbiprofenTablet 50mg

DiclofenacTablets e/ c 25mg, 50mgDispersible tablets 50mgSuppositories 12.5mg, 25mg, 50mg, 100mgInjection 75mg in 3mlNotes:Diclofenac suppositories may be preferred to diclofenac injection (which may be painful when given IM) for the acute relief of pain eg. biliary colic.Voltarol Dispersible tablets are more suitable for short- term use in acute conditions for which treatment is required for no more than 3 months

CelecoxibTablets 100mg, 200mgTablets 100mg, 200mgHyaluronic acidConsultant Rheumatologist use onlyHyaluronic acid 20mg in 1ml prefilled syringe

10.1.2 CorticosteroidsDexamethasoneInjection 8mg in 2mlHydrocortisone acetateInjection 25mg in 1mlMethylprednisolone acetate (Depo- MedroneR)Injection 40mg in 1mlInjection plus lidocaine 40mg +10mg in 1ml

Triamcinolone acetonideInjection 50mg in 5ml vialInjection 40mg in 1mlTriamcinolone hexacetonide UInjection 20mg in 1ml10.1.3 Drugs which suppress therheumatic disease processSodium aurothiomalateInjection 10mg in 0.5ml, 50mg in 0.5mlPenicillamineTablets 125mg, 250mgChloroquineTablets 250mgSyrup 68mg in 5mlDrugs affecting the immune responseLeflunomideTablets 10mg & 20mgMethotrexateTablets 2.5mg, 10mgNotes:if aspirin or other NSAIDs are given concurrently the dose of methotrexate should be carefully monitored. Patients should be advised to avoid self- medication with over- thecounter aspirin or ibuprofen.MetojectR Injection prefilledsyringe 10mg, 15mg, 20mg, 25mgCytokine modulatorsAbataceptOrenciaR Intravenous infusion 250mgAdalimumabHumiraR Injection 40mgCertolizumab PegolCimziaR Pre- filled syringe 200mgEtanerceptEnbrelR Injection 25mg & 50mgGolimumabSimponiR Injection 50mgInfliximabRemicadeR Intravenous infusion 100mgTocilizumabRoActemraR Intravenous infusion 20mg in 1ml10.1.4 Gout and cytotoxic inducedhyperuricaemiaAcute attacks of GoutIndometacinCapsules 25mg, 50mgSuppositories 100mgNaproxenTablets 250mg, 500mgColchicineTablets 500 micrograms

Long- term control of GoutAllopurinolTablets 100mg, 300mgNotes:The dose of allopurinol and colchicine should be reduced in patients with renal failure.FebuxostatTablets 80mg, 120mg

Hyperuricaemia associated with cytotoxic drugsRasburicaseIV infusion 1.5mg, 7.5mg vial10.1.5 Other drugs for rheumaticdiseasesOsteoarthritis does not recommend the use of chondroitin or glucosamine preparations. Therefore they are not included in the formulary.10.2.1 Drugs which enhanceneuromuscular transmissionPyridostigmineTablets 60mgEdrophonium chlorideInjection 10mg in 1mlNotes:Edrophonium is used as a diagnostic agent for myasthenia gravis.

10.2.2 Skeletal muscle relaxantsBaclofenTablets 10mgLiquidSF 5mg in 5mlDantrolene sodiumCapsules 25mg, 100mgNotes:Diazepam (section 4.1.2) may also be used. Sedation and, occasionally, extensor hypotonus are disadvantages

Nocturnal leg crampsQuinine sulphateTablets 200mg, 300mgNotes:Before use of quinine for nocturnal leg cramps, the risks should be carefully considered relative to the potential benefitsPatients should be monitored closely during the early stages for adverse effects as well as for benefit. Treatment should be interrupted at intervals of approximately 3 months to assess the need for further quinine treatment. Patients should be warned not to exceed the recommended dose. Serious side effects including irreversible blindness and death may occur with overdose

10.3.1 EnzymesHyaluronidasePowder for reconstitution 1500 unit amp10.3.2 Rubefacients, topical NSAIDS,capsaicin and poulticesTopical NSAIDs and counter- irritantsAlgesalRCream containing diethylamine salicylate 10%TransvasinRCreamIbuprofenGel containing 5%Notes:NICE clinical guideline 59 Osteoarthritis: Paracetamol and/ ortopical NSAIDs should be offered to patients with knee or hand osteoarthritis before considering oral NSAIDs, COX-2 inhibitors or opioids.Treatment should be reviewed after two weeks and stopped if not effective11. EYEPEMBERIAN OBAT PADA MATAPada dasarnya termasuk dalam 4 kelompok utamamengendalikan gangguan mata:Obat pelumas dan sediaan air mata buatanObat antinflamasi (mengurangi pembengkakan dan mata memerah)Obat antiinfeksi ( membunuh dan mengendalikan bakteri dan virus)Obat glaukomaCara pemberian obat untuk penyakit mata

LokalTetes mataSalep mataSistemik:Per oralSuntikanCONTROL OF MICROBIAL CONTAMINATIONSediaan untuk mata harus steril saat diberikan. Untuk menghindari kontaminasi, pipet atau tabung tidak boleh menyentuh mata ( atau apa pun ) .

Tetes mata yang digunakan di rumah tidak boleh digunakan 4 minggu setelah pembukaan pertama ( kecuali beberapa produk yang dapat bertahan sampai 6 bulan ) .

Tetes mata untuk digunakan dalam bangsal rumah sakit biasanya dibuang 2 minggu setelah pembukaan pertama .SEDIAAN OBAT-OBAT ANTIINFEKSI PADA MATAb. AntifungalEconazole Eye drops 1%c. AntivirusAcyclovirEye ointment 3%GanciclovirOphthalmic gel 0.15%

AntibacterialsChloramphenicol (Chlomycetin)Chlortetracycline (Aureomycin)Ciprofloxacin (Ciloxan)Framycetin sulphate (Soframycin)Fusidic acid (Fucithalmic)Gentamicin (Garamycin)Lomefloxacin (Okacyn - Black triangle)Neomycin sulphate (Neosporin)Ofloxacin (Exocin)Polymyxin B sulphate (Polyfax, Polytrim)Propamidine isetionate (Brolene )

Sediaan kortikosteroid dan anti inflamasi lainnyaKortikosteroidBetamethasone sodium phosphate 0.1% (eye drops, eye ointment)Betamethasone sodium phosphate 0.1% with neomycin sulphate 0.5% (eye drops, proprietary name Betnesol-N)Prednisolone acetate 1% (eye drops, proprietary name Pred-Forte)Prednisolone sodium phosphate0.03% (eye drops)Fluorometholone 0.1%, polyvinyl alcohol 1.4% (eye drops, proprietary name FML)b. Other anti-inflammatory preparationsSodium cromoglicate 2% eye drops has a prophylactic action, and is used to treat allergicconjunctivitisOlopatadine 1mg/1mL (eye drops, Opatanol) is anantihistamine which isan alternativetreatment for adults and children withocular signs and symptoms of seasonal allergic conjunctivitisMydriatics and cycloplegicsTropicamide 0.5% and 1% (eye drops) is an antimuscarinic drug.Cyclopentolate 0.5% and 1% (eye drops) is an antimuscarinic drug which is used as a mydriatic and cycloplegic both before and after ophthalmic procedures.Atropine 1% (eye drops) is the most potent antimuscarinic mydriatic and cycloplegic, producing complete cycloplegia which lasts for seven days or morePhenylephrine 2.5% and 10% (eye drops) is a mydriatic which is used prior to ophthalmic procedures.

Pengobatan GlaukomaAda dua mekanisme untuk menurunkan tekanan intraokuler:mengurangi produksi cairan matamemperbanyak pengaliran keluar cairan mataCHOLINERGIC AGONISTSPilocarpineCarbacholALPHA AGONISTSBrimonidineIopidineCARBONIC ANHYDRASE INHIBITORSDorzolamideADENERGIC AGONISTSEpinephrineDipivefrinBETABLOCKERSTimololMetipranololCarteololBetaxololLevobunolol

PROSTAGLANDIN ANALOGUESLatanoprost

Local AnastheticsAnastesi TopicalProparacaine hydrochloride (ophtaine, dll )Tetracaine hydrochloride ( pontocaine)Benoxinate hydrochlodirde2. Anastesi Lokal Untuk SuntikanLidocain hydrochloride (xylocaine)Procaine hydrochloride (novacaine)Bupivacaine hydrochloride (marcaine, sensorcaine)Etiocaine hydrochloride (duranest)

Miscellaneous Ophthalmic PreparationsTear deficiency, ocular lubricants and astringentsAcetylcysteine (Ilube)Carbomers (Viscotears) 0.2% (eye drops, single dose units)Hydroxyethylcellulose (Minims Artificial Tears)Hypromellose 0,3 % (Isopto)Liquid paraffin (Lacri-Lube)Yellow soft paraffin (Simple Eye Ointment)Polyvinyl Alcohol (eye drops proprietary name Liquifilm Tears)Povidine (Oculotect)Sodium chloride 0.9% dropsOcular Diagnostic and Perioperative Preparations and Photodynamic Treatment

Ocular diagnostic preparationsFluorescein 1%, 2% (single useeye drops) is recommended as a stain for diagnosis of corneal abrasions and herpes keratitis.It is also used in tonometry.Fluorescein 10% or 20% (injection) is used for assessment of retinal vascularisation, detection of retinal ischemia, chronic macular oedema and other retinal pathology.Indocyanine Green (injection) is used for assessment of choroidal circulation and subretinal neovascular membranes [unlicensed preparation].Ocular peri-operative drugsAcetylcholine chloride 1% plus mannitol 3%(Miochol-E) (solution for intra-ocular irrigation)Balanced salt solution (eye irrigation)Balanced salt solution plus (intra-ocular irrigation)Botulinum Toxin Type A 100 or 500 units (Botox or Dysport) (injection)Diclofenac sodium 0.1% (eye drops)Dimethylsilicone oil 1000cS (injection)Potassium ascorbate 10% (eye drops)Sodium chloride 5% (eye drops, eye ointment)Minims sodium chloride 0.9% (eye drops)Sodium hyaluronate 10mg/mL (Microvisc) (injection)Photodynamic TreatmentMetode ini menggunakan laser non-termal bersamaan dengan obat intravena untuk menghentikan atau memperlambat progresi kondisidegenerasi makular

Lensa KontakLensa kontak adalah lensa korektif, kosmetik, atau terapi yang biasanya ditempatkan di korenea mata. Lensa kontak biasanya mempunyai kegunaan yang sama dengan kacamata konvensional tetapi lebih ringan dan bentuknya tak nampak saat dipakai. Fungsi lensa kontak yaitu mengubah arah sinar cahaya untuk memfokuskannya ke arah yang benar pada retina.12. Ear, Nose and Oropharynx

12. Ear, Nose and Oropharynxby Diah Bagus Pitoyo12.1 Drugs acting on the ear12.1.1 Otitis externa12.1.2 Otitis media12.1.3 Removal of ear wax

12.2 Drugs acting on the nose12.2.1 Drugs used in nasal allergy12.2.2 Topical nasal decongestants12.2.3 Nasal preparations for infection12.3 Drugs acting on the oropharynx12.3.1 Drugs for oral ulceration and inflammation12.3.2 Oropharyngeal anti- infective drugs 12.3.3 Lozenges and sprays 12.3.4 Mouth washes, gargles, and dentifrices 12.3.5 Treatment of dry mouth12.1 Drug acting on the ear12.1.1 Otitis externaAnti- inflammatory preparationsBetamethasone Ear drops: Betamethasone sodium phosphate 0.1%Prednisolone Ear drops: Prednisolone Sodium phosphate 0.5%Prolonged use of topical corticosteroids should be avoided.

Anti-infective preparationsClotrimazole Solution 1% Gentamicin Ear drop 0.3%

Anti- infective plus anti-inflammatory combination preparationsBetnesol- N Ear drops: Betamethasone sodium phosphate 0.1%, neomycin sulphate 0.5%Locorten- Vioform Ear drops: flumetasone pivalate 0.02%, clioquinol 1%Predsol-N Ear drops: prednisolone sodium phosphate 0.5%, neomycin sulphate 0.5%Gentisone HC Ear drops: hydrocortisone acetate 1%, gentamicin 0.3%Otomize Ear Spray: dexamethasone 0.1%, neomycin sulphate 3250 units/ ml, glacial acetic acid 2%Otosporin Ear drops: hydrocortisone 1%, neomycin sulphate 3400units, polymixin B sulphate 10,000 units / mlSofradex Ear drops: Dexamethasone 0.05%, framycetin sulphate 0.5%, gramicidin 0.005%

Other preparationsAcetic acid Ear spray 2%Aluminium acetate Ear drops 8% 12.1.2 Otitis mediaFor prescribing information refer to Antimicrobial Guidelines for Primary Care (Chapter 5).12.1.3 Removal of ear waxOlive Oil-N Ear drops Sodium bicarbonate Ear drops 5%Note: Olive oil eardrops are considered as the standard first line product for the removal of earwax. It is extremely cheap and skin reactions to it are almost unheard of. Sodium bicarbonate occasionally causes irritation.Some proprietary preparations contain organic solvents which may cause irritation e.g. Cerumol, and are not recommended. (See BNF) All preparations for removal of earwax listed in the BNF are available over the counter at a cost less than the current prescription charge.12.2 Drug acting on the nose12.2.1 Drugs used in nasal allergyBeclometasoneBeconase Aqueous nasal spray, 50 micrograms per spray

Fluticasone propionate Flixonase Nasal spray, 50 micrograms per sprayNotes: Flixonase to be used for perennial rhinitis.

Fluticasone furoateAvamys Nasal spray, 27.5 micrograms per spray Notes: Avamys to be used for allergic rhinitis.

Triamcinolone Nasacort Nasal spray, 55 micrograms per spray

Betamethasone sodium phosphateDrops 0.1%Notes: Drops 0.1%There are no published studies showing that any one nasal steroid is more effective than any other. Aqueous sprays tend to causeless irritation. GPs should prescribe Beconase as the first- line choice therapy for allergic rhinitis and ensure the patient knows how to use their nasal spray effectively.Beclomethasone nasal spray is consider ed as first line therapy. It is relatively cheap, effective and well tolerated, requiring twice daily administration. Systemic absorption may follow on from any nasal steroid particularly if the doses are high and prolonged.CSM recommends that when children are receiving prolonged treatment with nasal corticosteroids the height of the child should be monitored. If growth is slowed then paediatric referral should be considered.12.2.2 Topical nasal decongestantsXylometazoline hydrochlorideNasal drops 0.1% Paediatric nasal drops 0.05%

Ephedrine hydrochlorideNasal drops 0.5%, 1%Notes:Topical nasal decongestants containing sympathomimetics, ephedrine and xyometazoline, can cause rebound congestion following prolonged use (more than 7 days) and are therefore of limited value. Ephedrine nasal drops should be used with caution in infants under 3 months of age. There is no good evidence of value if irritation occurs it might narrow the nasal passage.

Sodium chlorideNasal drops 0.9% Note: Sodium Chloride 0.9 % given as nasal drops may help relieve nasal congestion by helping to liquefy mucous secretions.

Antimuscarinic Ipratropium bromideRinatec nasal spray 0.03% Notes: Ipratropium may be useful to treat non- allergic watery rhinorrhoea. It does not act directly to reduce blood flow to the nose but reduces watery secretions.12.2.3 Nasal preparations for infection and epistaxisFor treatment of acute sinusitis refer to Antimicrobial Guidelines for Primary Care (Chapter 5).

Betnesol- N Drops: Betamethasone sodium phosphate 0.1%, neomycin sulphate 0.5%

Nasal staphylococciNaseptinNasal cream: chlorhexidine hydrochloride 0.1%, neomycin sulphate 0.5%Mupirocin Bactroban Nasal ointment 2%Note: Mupirocin (Bactroban) should be kept in reserve to avoid resistance developing. It is particularly useful in a hospital setting to treat MRSA. To avoid the development of resistance, the treatment course should not exceed 7 days and the course not repeated on more than one occasion. Please seek advice from Infection Control or Microbiology.

EpistaxisBismuth and iodoform Paste Impregnated gauze12.3 Drug acting on the oropharynx12.3.1 Drugs for oral ulceration and inflammationBenzydamine Difflam oral rinse 0.15%Difflam spray 0.15%

HydrocortisoneBuccal tablets 2.5mg

Carmellose sodiumOrabase protective pasteOrahesivepowderCholine salicylate-NDental gel 8.7% For use in adults and children over 16 years onlyNotes: Benzydamine is useful to treat discomfort in a variety of ulcerative conditions. It may cause stinging, often reduced by dilution with an equal volume of water. Orabase is cheap and effective in providing mechanical protection of oral and perioral lesions. Corticosteroids are useful for some forms of mouth ulcers. Hydrocortisone pellets may be fairly easily placed near or on the ulcer site. All preparations for oral ulceration and inflammation are available over the counter.12.3.2 Oropharyngeal antiinfective drugsNystatin NOral suspension 100,000 units/ mlNotes:Due to the high sucrose content of nystatin suspension, 500mg/1ml, ensure that diabetic patients are aware of this. Nystatin is the first line choice, however miconazole may be considered due to the differing formulations.

Miconazole NOral gel SF 20mg/g12.3.3 Lozenges and spraysMerocetsLozenge: Cetylpyridinium chloride 1.4mg

MerocaineLozenge: Benzocaine10mg, cetylpyridinium 1.4mgNote: For symptomatic relief in hospital only. Not to be prescribed on FP10.12.3.4 Mouthwashes, gargles, and dentifricesChlorhexidine gluconateMouthwash 0.2%

HexetidineMouthwash 0.1%Notes:Sodium chloride mouthwash may be used to relieve pain from traumatic ulceration. A simple sodium chloride mouthwash may be made by adding one to two teaspoonfuls of salt to a pint of freshly boiled and cooled water. Chlorhexidine may be used as an antiseptic to prevent secondary infection in mouth ulcers or following oral surgery. It can also prevent the formation of plaque.All above products are available over the counter.12.3.5 Treatment of dry mouthGlandosaneAerosol spray

PilocarpineTablets 5mg

Notes: When treating dry mouth it may be worthwhile to first consider non- pharmaceutical measures e.g. sugar free boiled sweets, pineapple chunks, ice cubes or frozen tonic water. Glandosane should be prescribed within ACBS guidelines to treat dry mouth as a result of receiving, or having undergone, radiotherapy, chemotherapy or sicca syndrome.Pilocarpine tablets are indicated for the treatment of xerostomia following irradiation for head and neck cancer.13. SKIN13.1 Management of Skin Conditions13.1.1 Vehicles creams, gels, lotions, oinments, pastes13.1.2 Suitable quantities for prescribing13.1.3 Excipients and sensitisation13.1 Emollient and Barrier preparations13.2.1 EmollientsNon proprietary emollient preparationsAqueous cream, emulsifying ointment, hydrous ointment, parafin white and yellow softProprietary emollient preparationscetraben emollient cream, decubal cream, dermamist,dll13.2.2 Emollients bath additives13.2.3 Barrier preparations13.1 Emollient and Barrier preparations13.2.2 Emollients bath additivesAlpha keri bath, aveeno, dermalo, emollient medicinal bath oil13.2.3 Barrier preparations Non proprietary barrier preparations zinc cream, zinc ointment, zinc castor oil ointment Proprietary barrier preparations drapolene cream, medicaid, sudocream, vasogen.13.3 Topical Local Anaesthetics and Anti Pruritus Anti PruritusCalamine, doxepin hydrochloride Topical Local AnaestheticsPrilocain, lidocain Topical antihistamines tripelennamine HCL, doxepin HCL, dexpanthenol13.4 Topical CorticosteroidsHydrocortisoneHydrocortisone butyrateAclometasone dipropionateBeclometasone dipropionateBetamethasone estersClobetasol propionate

13.4 Topical CorticosteroidsClobetasone butyrateDesoximetasoneDiflucortolone valerateFludroxycortideFluocinolone acetonideFluocinonideFluocortoloneFluticasone propionateHalcinonideMometasone furoateTriamcinolone acetonide13.5 Preparations for eczema and psoriasis13.5.1 Preparations for eczema Ichthammol 13.5.2 Preparations for psoriasis Calcipotriol, calcitriol, tacalcitol, tazarotene, coal tar, dithranol,salicylic acid, acitretin (oral) 13.5.3 Drug affecting the immune response Ciclosporin, methotrexate, pimecrolimus, tacrolimus13.6 Acne and Rosacea13.6.1 Topical preparation for acne Benzoil peroxide, azelaic acid, antibiotics, adapalene, corticosteroids, salicylic acid 13.6.2 Oral preparation for acne Co-cyprindiol, isotretinoin13.7 Preparations for warts and calluses salicylic acidGlutaraldehydeSilver nitrateImiquimodPodophyllum 13.8 Sunscreens and Camouflagers13.8.1 Sunscreen preparation Delph, E45 sun, sunsense, tretinoin,13.8.2 Camouflagers Covermark, dermacolor13.9 Shampoo and other Preparations for Scalp conditions Alphosyl 2 in 1Betadinecapasal,NizoralSelsunMinoxidil13.10 Anti infective skin preparations13.10.1 Antibacterial preparations 13.10.1.1 Antibacterial preparations only use topically Neomycin sulphate, mupirocine, polymyxins, silver sulfadiazine 13.10.1.2 Antibacterial preparations also use systemically Fusidic acid, metronidazole

Cont13.10.2 Antufungal preparations Benzoic acid, clotrimazole, econazole nitrate, ketoconazole, miconazole nitrate, nystatin salicylic acid, dll13.10.3 Antiviral preparations Aciclovir, panciclovir, idoxuridine in dimethyl sulfoxide13.10.4 Parasiticidal preparations13.10.5 preparations for minor cuts and abrationsCont13.10.4 Parasiticidal preparations Benzyl benzoate, carbaryl, malathion, permethrine, phenothrin13.10.5 preparations for minor cuts and abrations Cetrimide cream, proflavine, collodium13.11 Skin Cleansers and Antiseptics13.11.1 Alcohols and saline Alcohol, sodium chloride13.11.2 Chlorhexidine salt chlorhexidine (cepton skin wash, hibisol solution)13.11.3 Cationic surfactants and soaps cetrimide13.11.4 Chlorine and Iodine chlorinated solutions (chlorasol solution), Iodine compounds (betadine, savlon)13.11.5 Phenolics Hexachlorophene, triclosan13.11.6 Astringents, oxidisers and dyes Hydrogen peroxide, potassium permanganate13.11.7 Preparation for promotion of wound healing Growth factor (regranex), varidase topical.Cont14. Immunological products and vaccinesActive immunityVaksin BCGVaksin PolioVaksin DPTVaksin HIB (Hemofilus Influensa)Vaksin ThypoidVaksin Hepatitis BHIVStorage and useAturan umum: sebagian besarharus didinginkan pada suhu 2-8o CDPT, Hib, hepatitis B, hepatitis A (tdk beku)OPV, Yellow fever (dapat dalam kead. beku)

Anti SeraBotulism Anti ToxinAnti Bisa UlarADS (Anti Diffteri Serum)ATS (Anti Tetanus Serum)

ImmunoglobulinVaricella zoster immunoglobulin.Cytomegalovirus (CMV) immunoglobulin.Imunisasi AktifDefinisi: pemberian antigen pada inang untuk menginduksi pembentukan antibodi dan imunitas seluler.Tujuan: menginduksi perlindungan terhadap berbagai bahan infeksiusBahan: materi yang diinaktivasi (mati) atau bahan hidup yang dilemahkanLebih disukai karena: kadar antibodi tinggi dipertahankan dalam jangka lebih lama frekuensi pemberian lebih jarangsecara beriringan membentuk imunitas seluler

Imunisasi PasifDefinisi: pemindahan imunitas pada inang menggunakan produk imunologis yang sudah terbentukTujuan: memberikan perlindungan terhadap antigenBahan: Imunoglobulin

Sasaran : Individu yang tidak mampu membentuk antibodi (agammaglobulinemia kongenital)Pencegahan penyakit ketika waktu tidak memungkinkan imunisasi aktif (misal: pasca paparan)Terapi penyakit tertentu yang secara normal dicegah dengan imunisasi (misal: tetanus)Terapi dalam kondisi imunisasi aktif tidak tersedia atau tidak dapat dilaksanakan (misal: tergigit ular)JENIS VAKSINVaksin Hidup Attenuatedbakteri atau virus hidup yang dilemahkandengan cara pembiakan berulang-ulangharus dpt berkembang biak respon imunrespon imun = infeksi alamiahbersifat labil, rusak oleh panas & cahayacontoh: campak, mumps, rubela, polio (virus) BCG, demam tifoid oral (bakteri)Vaksin Inactivated bakteri, virus/ komponennya yg dibuat tidak aktif dgn pemanasan atau bahan kimiatidak dapat replikasi seluruh dosis agtidak dapat menyebabkan penyakittidak dipengaruhi oleh ab yg beredarselalu membutuhkan dosis gandasedikit atau tidak menimbulkan respon selulercontoh: difteri, tetanus (toksoid) haemophilus influenza(polisakarida)

TATA CARA PEMBERIAN IMUNISASISebelum melakukan imunisasimemberitahu risiko vaksinasi dan tdk imunisasipersiapan bila terjadi reaksi ikutan baca dgn teliti informasi produktinjau apakah ada kontraindikasiperiksa pasien dan beri antipiretik bila perluperiksa kondisi vaksin (warna, kadaluarsa)pemberian sesuai jadwalberikan vaksin dengan tehnik yang benar

Setelah pemberian imunisasiberilah petunjuk kpd pengasuh/ortu apa yg harus dikerjakan dalam kejadian reaksi biasa atau reaksi ikutan yang lebih beratcatat imunisasi dalam rekam medis laporkan hasil imunisasi ke Dinkes periksa status imunisasi keluarga yg lain

Penyimpanan VaksinAturan umum: sebagian besarharus didinginkan pada suhu 2-8o CDPT, Hib, hepatitis B, hepatitis A (tdk beku)OPV, Yellow fever (dapat dalam kead. beku) PengenceranVaksin kering yang beku harus diencerkanDengan pelarut khususDigunakan dalam periode waktu tertentu, mis vaksin campak yg telah diencerkan cepat berubah warna pada suhu kamar.15. Anaesthesia DrugsGENERAL ANAESTHESIA :

1. Intravenous anaesthetic2. Inhalation anaesthetic3. Sedative and analgetic peri-operative drugs4. Anxiolytics and neuroleptics5. Non-opioid analgesic6. opioid analgesic7. Muscle relaxants8. Anticholinesterase used in anaesthesia9. Antagonists for central and respiratory depression 10. Drugs for malignant hyperthermia

LOCAL ANAESTHESIA ANAESTHESIA DRUGS Intravenous anaesthetic

Inhalation anaestheticNitrous oxide Halothane (Fluothane) Methoxyflurane (Penthrane) Enflurane (Ethrane) Isoflurane (Forane) Desflurane (Suprane) Sevoflurane (Ultane)Sedative and analgetic peri-operative drugspropofol,EtomidateKetamineFentanylMidazolamAnxiolytics and neurolepticsDiazepamMidazolamTemazepamDICLOFENACKETOROLACALFENTANILFENTANYLMORPHINEPETHIDINENon-opioid analgesicOpioid analgesicMuscle relaxantsNON-DEPOLARISING AGENTS :ATRACURIUM MIVACURIUMPANCURONIUMVECURONIUM ROCURONIUMDEPOLARISING AGENTS :SUXAMETHONIUMAnticholinesterase used in anaesthesiaedrophonium, neostigmineAntagonists for central and respiratory depression Drugs for malignant hyperthermiaDoxapram, Naloxone, FlumazenilDantrolene sodium225