ft bumilsu

8/17/2019 FT Bumilsu

1/30

FARMAKOTERAPI PADA

WANITA HAMIL DAN

MENYUSUI

Drs. Budi Raharjo, A!.SFRS


2/30

Far"a#o$id$"io%o&i

♦Wa'i!a ha"i% ra!a( "i'u" ) j$'is o*a! or %$*ih♦+$ja%a $'a#i! saa! ha"i%- '$ri, "ua%,

"u'!ah, o$d$"a, "asu# a'&i', s$r!a $'a#i!

%ai' s!- DM, i' $#si a!au hi$r!$'si♦)/ 0 1a'i!a ha"i% &u'a#a' o*a! ja'a $'d$#

♦23 0 1.h"% &u'a#a' o*a! d !ri"$s!$r $r!a"a

♦S$"ua o*a! d! "asu# #$ ASI4 S$*$raa *a'a# 5 P$'&aruh d *ai 5

♦P$r%u $du#asi d 1a'i!a ha"i% 6 "$'usui


3/30

Drugs Use

in Pregnancy


4/30

P$r#$"*a'&a' $"*rio 6 ja'i'♦

P$r iod$ $r#$"*a'&a' ja'i' "a'usia )7 "i'&&u,!$r *a&i "$'jadi ) !ri"$s!$r 8"s&9"s& ) *u%a':

♦Taha $r#$"*a'&a' ja'i' !$r*a&i ), ai!u Pra9$"*rio'i#, E"*rio'i# da' ;a'i' 8$!us:

♦Pra9$"*rio'i# "u%ai #o's$si s" hari #$


5/30

T$ra!o&$'$sis

♦T$ra!o&$' ada%ah *aha' aau' a'&di*$ri#a' d 1a'i!a ha"i% & d!"$'$*a*#a' a!au *$r$'&aruh !$rhada

"a%or"asi a!au #$%ai'a' isio%o&is a!au $r#$"*a'&a' ji1a ja'i' a!au ada a'a#

saa! %ahir

♦Ha'a ) 0 o*a! !$r*u#!i !$ra!o&$'i# ♦S$ri'& !jd d !h $"*rio'i# !a# !ahu

#a%o sd& ha"i%


6/30

Tra's$r O*a! "$%a%ui P%as$'!a

♦S$*a&ia' *$sar o*a! *$rdiusi s@r "udah#$ d%" ja'i' "$%$1a!i %as$'!a♦O*a! & %ioi%i#9!d# !$r9io'#a' %*h "udah

"$%$1a!i %a@$'!a dariada o*a! & o%ar ♦O*a! & *$rsia! *asa %$"ah !$rj$*a# d%"sir#u%asi ja'i' 8H ja'i' s$di#i!


7/30

E$# O*a! !$rhada ;a'i'...

♦O*a! & %$1a! %a@$'!a d! *$r$$#%a'&su'& d ja'i' 8dosis C


8/30

E$# O*a! !$rhada ;a'i'

♦E$# !$r&a'!u'& 1a#!u 8!ri"$s!$r: $"*$ria', "is- h$'o*ar*i!a%!ri"$s!$r III $rdaraha' '$o'a!us

!ri"$s!$r I a'o"a%i @o'&$'i!a%,

♦Eos o*a! d as$

Pr$9$"*ro'i# R$so' A%%9or9No!hi'& #$"a!ia' ja'i'4

E"*ro'i# dis"oro&$'$sis>&a'&&u

a' or&a'o&$'$sis>@a@a! @o'&$'i!a%


9/30

P$ru*aha' Far"a#o#i'$!i#a♦K%ir$'s **r "i'&&u #$ha"i%a' +FR

"$'i'a! /3 0, sh&-K%ir$'s o*a! & $#s#r$si u!a"a %1! &i'ja%

8%i!hiu", **r β9%a@!a": "$9↑,

Dosis ru"a!a' harus di!i'a!#a'

♦M$!a*o%is"$ "$'i'a! a#i*a! i'du#si$'i" o%$h ro&$s!$ro' !ai $$#

i'diGidua% *$rGariasi 6 su%i! dir$di#siM$!a*."$!hado'$ 6 h$'!oi' "$↑ d

!ri"$s!$r III, sh& dosis $r%u di↑4 Tai "$!a*

!h$oh%%i' "$↓,dosis $r%u di↓


10/30

P$ru*aha' Far"a#o#i'$!i#a♦o%u"$ dis!ri*usi 1a'i!a ha"i% "$↑,

sh& %oadi'& dos$ $r%u di ↑ *i%aDi*u!uh#a' $$# o*a! & @$a!, a!au

E$# o*a! !&! #adar o*a! u'@a# d%" %as"a

♦Pro!$i' P%as"a 8A%*u"i' 6 a@id α9

&%@oro!$i': "$ ↓, o*a! *$*as "$ ↑Ph$'!oi' *$*as "$ ↑, !ai "$!a*o%is"

"$ ↑4 #adar o*a! d%" %as"a *$rGariasi

#o'!ro% &$ja%a #%i'is #$ja'&


11/30

FDA a!$&or or Dru& Us$ i' Pr$&'a'@♦ Category A:o'!ro%%$d s!udi$s i' 1o"$' ai% !o d$"o's!ra!$ a ris# !o

!h$ $!us i' !h$ irs! !ri"$s!$r, 6 ossi*i%i! o $!a% har" a$ars

r$"o!$

♦ Category B : Ei!h$r a'i"a% s!udi$s do 'o! i'di@a!$ a ris# !o !h$ $!usa'd !h$r$ ar$ 'o @o'!ro%%$d s!udi$s i' r$&'a'! 1o"$' or a'i"a%

s!udi$s haG$ i'di@a!$d $!a% ris# *u! @o'!ro%%$d s!udi$s i' 1o"$' ai%

!o d$"o's!ra!$ a ris# !o !h$ $!us♦ Category C : Ei!h$r a'i"a% s!udi$s i'di@a!$ a $!a% ris# a'd !h$r$ ar$

'o @o'!ro%%$d s!udi$s i' 1o"$' or !h$r$ ar$ 'o aGai%a*%$ s!udi$s i'

1o"$' or a'i"a%

♦ Category D : Th$r$ is osi!iG$ $Gid$'@$ o $!a% ris# *u! !h$r$ "a*$@$r!ai' si!ua!io' 1h$r$ !h$ *$'$i! ou!1$i&h !h$ ris#

♦ Category X : Th$r$ is d$i'i!$ $!a% ris# *as$ o' s!udi$s o' a'i"a% orhu"a' or *as$ o' hu"a' $$ri$'@$a'd !h$ ris# @%$ar% ou!1$i&h!

a' *$'$i! !o r$&'a'! 1o"$'


12/30

Dru&s K'o1' T$ra!o&$'sDru&s K'o1' T$ra!o&$'s

9 AE I'hi*i!or

9 A%@oho%

9 A'dr o&$'s 8Da'ao%:

9 A'!i@o'Gu%sa'! 8@ar*a"a$ i'$, h$'!oi', Ga%roi@a@id:

9 A'!i'$o%as!i@ 8@@%ohos

ha"id$, "$!ho!r$a!$,$!@:9 o@@ai'$

9 Di$!h%s!i%*$s!$ro%

9 Iodid$s

9 Iso!r$!i'oi'

9 Li!hu"9 LiG$ a@@i'$

9 T$!ra@@%i'$ 8$s$@ia%%1$$#s (29(?:

9 Tha%ido"id$

9 Warari'


13/30

Dru&s Sus$@!$d T$ra!o&$'s

9B$'odia$i'$s8dia$a":

9Es!ro&$'s

9M$!hi"ao%$

9Jui'o%o'$s

9Ora% ho&%@a$"i@s

9Pro&$s!i's

9Tri@@%i@ a'!id$r$s9sa'!s


14/30

Dru&s 1i!h No'9!$ra!o&$'i@ AdG$rs$ E$@!s

9 A'!i!hroid a&$'!s

9 A"i'o&%@osid$s

9 Asiri'

9 Bar*i!ura!$s−β9*%o@#$rs9 B$'odia$i'$s

9a$i'$

9 h%ora"h$'i@o%

9 o@@ai'$

9 Diur$!i@s

9 Iso'iaid

9 Nar@o!i@s

9 Ni@o!i'$9 No's!$roida% A'!ii'%a"a9!or Dru&s

9 Ora% ho&%@$"i@s

9 Pro%!hioura@i%

9 Su%o'a"id$s


15/30

Wa'i!a Ha"i%8key point :

♦O*a! ha'a di*$ri#a' d 1a'i!a ha"i% *i%a "a'aa! %$*ih *$sar dariada risi#o ada ja'i'

♦Hi'dari $'&&u'aa' o*a! d !ri"$s!$r $r!a"a♦Bi%a $r%u o*a! i%ih o*a! & a%i'&

a"a'4 d& dosis $$#!i !$r$'dah 6s$si'a! "u'i'

♦Dis#usi#a' d& asi$' u!# $'&&u'aa'

o*a! d $'a#i! #ro'is *i%a i'&i' ha"i%


16/30

Drugs and

Lactation


17/30

Transfer of Drugs into Milk

♦S$"ua o*a! !$rdis!ri*usi #$ da%a" ASI, diusi s4

♦Y& $'!i'& $r#iraa' j"% o*a! & "s# d%" ASI

♦Fa#!or & $'&aruhi %aju diusi- Far"a#o#i'$!i#ai*u, Sia! isio%o&is ASI, Sia! isi#o#i"ia1i o*a!4

♦ASI *$r*$da d& %as"a i*u- H %$*ih r$'dah, #aasi!as i#a!a' PP %$*ih r$'dah, #a'd&. %iid & !i'&&i

♦O*a! *asa %$"ah !$rj$*a# d%" ASI4

♦O*a! d& i#a!a' PP !i'&&i !rj$*a# d%" P%as"a

♦O*a! %ioi%i# #adar d%" ASI !i'&&i


18/30

Estimating Infant Exposure♦O*a! "asu# #$ ASI d& "$#a'is"$ diusi !ra's$%u9

%$r 8"%% "$"*ra' *io%o&is: d$raja! io'isasi

♦ “ “ Fraksi obat tak-terionisasi berdifusi melewatiFraksi obat tak-terionisasi berdifusi melewatimembran biologis” membran biologis”

♦D& "$'&$!ahui d$raja! io'isasi o*a! 8Ka: da' $r

*$daa' H a'!ara %as"a i*u da' ASI,"a#a RasioM>P 8Mi%#9P%as"a: s@r !$ori!is d! dihi!u'&

♦ Ni%ai H %as"a =,2 da' H susu =,3

♦Rasio U'9io'i$d 8U: 6 Io'i$d 8I: ru"usH$'d$rso'9Hass$%*a@h d $ui%i*riu", u'!u#-

Asa" L$"ah- %o& 8U>I: Ka H

Basa L$"ah - %o& 8I>U: Ka H


19/30

Estimating Infant Exposure

Sa%isi%a! Ka ),3

P%as"a 8H =,2: Mi%# 8H =,3:

8U'io'i$d: <

8Io'i$d: (/.


20/30

Estimating Infant Exposure

♦ ;i#a Rasio M>P d! di#$!ahui or dihi!u'& !$ori!is,

"a#a d! dihi!u'& dosis o*a! & di"i'u" *ai-Dosis *ai- Di'. "a! M>P o%.susu di"i'u"

di"a'a "a! ad% ra!a( #o's!r.o*a! %as"a i*u, *i%a

o%.susu & di"i'u" *ai !a# di#$!ahui &u'a#a' a'&#a #&BB>hari: #&BB>hari

L$G$% a"a' *i%a 0 dosis di*a1ah


21/30

P$'d$#a!a' u!# M$"i'i"a%isasi Eos *aiP$'d$#a!a' u!# M$"i'i"a%isasi Eos *ai

1.1. Tidak Minum ObatTidak Minum Obat4 **r j$'is o*a! s!- sa#i!

#$a%a, o*a! %u, d! dihi'dari d& #$rjasa"a i*u.

2.2. Tunda Pemberian ObatTunda Pemberian Obat4 ji#a i*u ada r$'@a'a u!#

"$'aih ASI, "a#a $'&&u'aa' o*a!>$"*$dah9

a' $%$#!i daa! di!u'da !$r%$*ih dahu%u.

3.3. Pili obat yg !edikit diek!kre!ikan dlm A"#Pili obat yg !edikit diek!kre!ikan dlm A"#4 u!#

#%as !$rai & sa"a d! dii%ih & a%i'& s$di#i!

"$%$1a!i ASI.

$.$. Pili alternati% rute &emberian lainnyaPili alternati% rute &emberian lainnya4 u!# #u9

ra'&i #o's!.o*a! d%" darah i*u "a#a di&u'a#a'

s$diaa' %o#a% 8"is. Kor!i#os!$roid i'ha%asi, d%%:


22/30


'.'. Tidak menyu!ui bayi &d !aat kon!tr. obat dlmTidak menyu!ui bayi &d !aat kon!tr. obat dlm

A"# mak!imalA"# mak!imal4 s@r u"u" #o's!r.o*a! d%" ASI@aai "a#s.-


23/30


*.*. Tidak menyu!ui bayi utk !ementara +aktuTidak menyu!ui bayi utk !ementara +aktu4

*i%a di&u'a#a' o*a! ja'a $'d$# s!% ros$duro$rasi>r1!' &i&i, s*%" !i'd."$dis9ASI dio"a

u!# d! di*$ri#a' d *ai. M$"o"a ASI 8!ai

!d# di*$ri#a' #d *ai: s$%a"a !$rai o*a! !$!adi%a#u#a' u!# "$'ja&a a%ira' ASI. ASI d! di*$ri

#a' %a&i s$&$ra s$!$%ah


24/30

Drug s Contraindicated during Breastfeeding

9 A"iodaro'$

9 A"h$!a"i'$

9 Bro"o@ri!i'$

9 o@@ai'$

9 @%ohosha"id$

9 @%osori'$

9 Dooru*i@i'9 Er&o!a"i'$

9 H$roi'

9 Iso!r$!i'oi'

9 Li!hiu"

9 Marijua'a

9 M$!ho!r$a!$

9 Ni@o!i'$ 8s"oo#i'&:

9 Ph$'%@@%idi'$


25/30

Drugs to be Use with Caution during Breastfeeding 9 A@$*u!o%o%

9 A%@oho% 8%ar&$ a"ou'!s:

9 A%%u"i'iu" a'!a@ids9 A"a'!adi'$

9 A'!id$ r$sa'!-a"!ri!i%i', a"oa9 i'$,d$sira"i'$, do"ira"i',doai',%uo$!i',%uGoa"i',

i"ir a"i' !raodo'$9 A'!is@ho!i@-@h%orro"a9

i'$,ha%o$rido%,"$oridhai'$,$rh$'ai'$

9 A!$'o%o%

9 h%ora"h$'i@o%

9 B$'odia$i'- dia$a",%ora9$a","idao%a",ra$a",ua$a",!$"a$a"

9 %$"as!i'$

9 +o%d Sa%!s

9 I'do"$!ha@i'9 M$!hado'$ 8C(3 "&>da:

9 M$!o@%ora"id$

9 M$!hi"ao%$

9 M$!ro'idao%

9 Na%idii@ a@id

9 Ni!roura'!oi'

9 Ph$'o*ar*i!a%

9 Pri"ido'$

9 Ph$'!oi'9 Sa%i@%a!$s

9 Su%o'a"id$

9 Su%asa%ai'$


26/30

Drugs that Affect Milk

Production

9Bro"o#ri!i'

9a*$r&o%i'$

9Thiaid$ diur$!i@

9o"*i'$d Ora% o'!ras$!iG$us$ ro&$s!i'

9Er&o!a"i'$

hould be a!oided in the breast-feeding hould be a!oided in the breast-feeding


27/30

Wa'i!a M$'usui..8key point :♦Sd! "u'i' hi'dari &u'a#a' o*a! d 1a'i!a "$'usui a!au h$'!i#a'

"*$ria' ASI *i%a o*a! a#a' %a'ju!

♦Pi%ih o*a! d& ESO !$ra"a' !$ru!a"ao*a! & !$%ah dir$#o"$'dasi#a'

a"a' u!# i*u "$'usui

♦Bi%a "i'u" o*a! a'!au ESO

♦ Wa#!u "i'u" o*a! s$&$ra s$!$%ah

"$'usui


28/30

Drug Safety Selection

Dru& %ass Duri'& Pr$&'a'@ Duri'& La@!a!io'

A'a%&$si@

A'!i@oa&u%a'!

A'!i@o'Gu%sa'!

A'!idia*$!i@

A'!ih$r!$'si

A'!i9i'$@!io'

A@$!a"i'oh$'

H$ari', LMWH

Ph$'o*ar*i!a%

I'su%i'

M$!h%doa

P$'i@i%%i'>$ha%o9sori'

A@$!a"i'oh$'

H$ari', Warari'

ar*a"a$i'>E!ho9

sui"id$>a%roi@I'su%i',To%*u!a"id$

AEI>a9a'!a&o'is!

P$'i@i%%i'>$ha%o9sori'

LMWH %o1 "o%$@u%ar 1$i&h! h$ari'4 AEI A'&io!$'si' o'G$r9

!i'& E'"$ I'hi*i!or


29/30

Drug Safety Selection

Dru& %ass Duri'& Pr$&'a'@ Duri'& La@!a!io'or!i@os!$roids

D$@o'&$s!a'

+I ro!$@!io'

Laa!iG$>S!oo%So!$'$r

Pr$d'iso'$

O"$!ho%aid$dro>sra

M&OH, A%OH,a9@ar*o'a!,ra'i!idi',su@ra%a!$

Ps%%iu">do@usa!$

Pr$d'iso%o'$

O"$!ho%aid$dro>sra

Su@ra%a!$,a"o!idi'

Ps%%iu">do@usa!$

M&OH Ma&'$siu" Hdroida4 A%OH A%u"i'iu" Hdroida


30/30

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