Normally, the nervous system which coordinates the other systems in the body is divided into two groups, namely:
1. central nervous system (CNS), which consists of the brain and spinal marrow, and
2. peripheral nervous system, which includes;
- Autonomic nervous system (SSO), see section V, and
- Brain and spinal nerves
Peripheral nervous systems continue to function electrical nerve impulses to and from the central nervous system, through each neuront efferent (motor) and afferent neurons (sensory).
Exogenous impulses received by the recipient cells (receptors) to then forward it to the brain or spinal cord. Stimulation can be either a stimulant (stimuli) pain, temperature, feeling, sight, hearing, and so forth. Specifically will be discussed in this section is associated with nerve impulses of pain centers (in brain), central sleep (in the hypothalamus), and mental capacity, which becomes the skin function of the brain (cortex).
Awareness of pain is formed from two processes, namely acceptance of pain stimuli in the brain and the emotional reactions of individuals to it. Analgesic affect the first process by increasing the threshold-consciousness of pain, while narcotics suppress psychological reactions caused by pain stimuli iti.
On the other hand, CNS function can be suppressed entirely by non-specific by-zatt substances, such as relief centers and sedativa hipnotika. As a result kesdaran to exogenous impulses derived and reduced physical activity and mental health. These drugs do not affect behavior (behavior) specifically, as does the tranquilizer, which besides that is also efficacious against CNS depression. Physiologic antagonist of these drugs are substances that stimulate the CNS, namely analeptika (wekamin) and anti depresiva. Both types of these drugs affect the spirit and atmosphere of the soul berdasarkkan direct activity of the brain.
For practicality, a drug that works against the CNS can be divided into major categories, which are described in separate chapters, namely:
1. psikofarmaka (psychotropic), which includes:
a. psikoleptika: types of drugs generally suppress and / or certain fungsi2 menghambatt of SSP, namely hipnotika, tranquilizer, and antipsikotika
b. psycho-analepptika: type of drug that stimulates the CNS, namely antidepresiva and psikostimulansia (wekamin)
2. types of drugs for neurological disorders, such as antiepileptika, MS (multiple sclerosis), and Parkinson's disease.
3. Types of drugs that block or block pain: analgesics, general anestetika, and local
4. Vertigo drugs and migraine medicine.
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Antipsychotic drugs are the largest group in use to treat mental disorders. Antipsychotics known as neuroleptics, psychotropic, or a major tranquilizer. These drugs improve the process of thought and behavior of clients with psychotic symptoms, especially for people with schizophrenia, the drug is not in use to treat anxiety or depression. Basic theory states that the psychotic symptoms caused by an imbalance of neurotransmitters, dopamine, the brain. Antipsychotics inhibit dopamine receptors in the brain, thus restoring psychotic symptoms. Many of antipsychotics inhibit kemoreseptor and central regions triggers vomiting (emetic) in the brain, resulting in antiemetic effect.
Antipsychotics can be classified into two groups: phenothiazines and nonfenotiazin.
1. PhenothiazineAntipsychotics can be classified into two groups: phenothiazines and nonfenotiazin.
Phenothiazine first introduced to treat psychotic behavior on the client's psychiatric hospital is chlorpromazine hydrochloride. Phenothiazines aliphatic divided into three groups. Chlorpromazine is in the aliphatic group. Aliphatic phenothiazines produce a strong sedative effect, lowering blood pressure, and may cause extrapyramidal symptoms (EPS = extrapiramidal symptoms pseudoparkinsonisme). Phenothiazine piperazin produce effects that are, a strong antiemetic effect, and some lower blood pressure. Piperadin phenothiazines have strong sedative effect, causing less extrapyramidal symptoms, can lower blood pressure, and had no antiemetic effect.
Pharmacokinetic
Oral absorption of chlorpromazine and proklorperazin vary; liquid form has a faster absorption rate. Because chlorpromazine strongly binds to proteins and has a long half-life, then the drug may have accumulated. Both chlorpromazine and proklorperazin metabolized by the liver and excreted as metabolites in urine.
Pharmacodynamic
chlorpromazine mainly prescribed for psychotic disorders and proklorperazin for nausea and vomiting. Proklorperazin have anticholinergic effects and should not be given to clients with narrow angle glaucoma. Because hypotension is a side effect of phenothiazines, then any given antihypertensive drugs at the same time may cause additive hypotensive effects. Narcotics and sedatives-hiponotik provided with phenothiazines may cause additive CNS depression. Antacids reduce the absorption rate of the two drugs.
2. Nonfenotiazin
Nonfenotiazin which is often given is butirofenon haloperidol (Haldol), a pharmacological behavior similar to the phenothiazines.
Pharmacokinetic
Haloperidol well absorbed through the gastrointestinal mucosa. This drug has a long half-life and high binding to proteins, so that this drug can be accumulated. Most of haloperidol is excreted into the urine.
Haloperidol modify the effect of dopamine by blocking dopamine receptors, so that sedation and EPS can occur. The drug is used to control psychosis and reduce the signs of agitation in adults and in children. Haloperidol have anticholinergic effects, so be careful in giving these drugs to clients with riwyat glaucoma.
Haloperidol modify the effect of dopamine by blocking dopamine receptors, so that sedation and EPS can occur. The drug is used to control psychosis and reduce the signs of agitation in adults and in children. Haloperidol have anticholinergic effects, so be careful in giving these drugs to clients with riwyat glaucoma.
Side effects and adverse reactions
There are some side effects that often occur associated with antipsychotics. Many of antipsychotics have anticholinergic effects, such as dry mouth, increased heart rate, urinary retention, and constipation. Blood pressure decreased on the use of antipsychotics; types of aliphatic and piperidine cause decreased blood pressure more than other drugs. Extrapyramidal symptoms most often occur in phenothiazine, butirofenon, and tiosantin and including pseudoparkinsonisme, akathisia, distonia, and dyskinesia tardif. Anticholinergic medications may be given to cause blood dyscrasias (blood cell disorders).
Side effects and adverse reactions klozapin (clorazin) is a Teru sustained tachycardia, with the added pulse 10-15 times / min, hypotension (9%), and hypertension (4%). Cardiovascular effects can be reduced with a low initial dose and gradually increased dosage. Constipation, nausea, abdominal discomfort, headache, vomiting, and diarrhea is sometimes reported, as well as incontinence and urinary retention are rarely reported.
Side effects and adverse reactions klozapin (clorazin) is a Teru sustained tachycardia, with the added pulse 10-15 times / min, hypotension (9%), and hypertension (4%). Cardiovascular effects can be reduced with a low initial dose and gradually increased dosage. Constipation, nausea, abdominal discomfort, headache, vomiting, and diarrhea is sometimes reported, as well as incontinence and urinary retention are rarely reported.
Drug Interactions
Clients who take anticonvulsant should not be taking phenothiazines aliphatic and tiosantin because these groups of drugs lower seizure threshold. If one or two groups of antipsychotics are given, then it may take anticonvulsant in higher doses to prevent seizures.
Klozapin berinteraksidengan alcohol, hypnotics, sedatives, narcotics, and sedative effects of benzodiazepines so that the strengthening of antipsychotics. Antropin against EPS and strengthen the effect of antipsychotics. use of antihypertensives may cause additive hypotensive effects.
Antipsychotics should not be supplied with antipsychotic or antidepressant drugs other than with the intent to control psychotic behavior in certain individuals are refractory to drug therapy. Usually if an antipsychotic is ineffective, then the other one drug prescribed. The person concerned should not drink alcohol or other CNS suppressant (such as narcotic analgesics) together with antipsychotics because of the possibility of additive depressant effects. It has been reported that caffeine can inhibit the absorption of antipsychotics. geriartik client may require a lower dose yanh to reduce the occurrence of side effects.
During a stop antipsychotics, drug dosage should be reduced gradually to avoid sudden relapse of psychotic symptoms.
antipsychotics can alter glucose levels.
Klozapin berinteraksidengan alcohol, hypnotics, sedatives, narcotics, and sedative effects of benzodiazepines so that the strengthening of antipsychotics. Antropin against EPS and strengthen the effect of antipsychotics. use of antihypertensives may cause additive hypotensive effects.
Antipsychotics should not be supplied with antipsychotic or antidepressant drugs other than with the intent to control psychotic behavior in certain individuals are refractory to drug therapy. Usually if an antipsychotic is ineffective, then the other one drug prescribed. The person concerned should not drink alcohol or other CNS suppressant (such as narcotic analgesics) together with antipsychotics because of the possibility of additive depressant effects. It has been reported that caffeine can inhibit the absorption of antipsychotics. geriartik client may require a lower dose yanh to reduce the occurrence of side effects.
During a stop antipsychotics, drug dosage should be reduced gradually to avoid sudden relapse of psychotic symptoms.
antipsychotics can alter glucose levels.
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Local anesthesia or local pain substance is a drug on the local use of a reversible obstructive channeling of nerve impulses to the CNS and thereby eliminate or reduce pain, itching - itching, hot or cold. Many other compounds also have the power of such work, but the effect is not reversible and causes permanent damage to nerve cells.
The first local anesthetic was cocaine, an alkaloid obtained from the leaves of a plant reeds in the Andes (Peru).
The first local anesthetic was cocaine, an alkaloid obtained from the leaves of a plant reeds in the Andes (Peru).
REQUIREMENTS
There are several criteria that must be met for a type of drug used as a local anastetikum, among others:
1. Not stimulate tissue
2. Does not cause permanent damage to the nervous system
3. Low systemic toxicity
4. Effective with the road or the use of local injection of the membrane lender
5. Starting work as short as possible, but survived long enough
6. Soluble in water and produce a stable solution, there are also sterilization
2. Does not cause permanent damage to the nervous system
3. Low systemic toxicity
4. Effective with the road or the use of local injection of the membrane lender
5. Starting work as short as possible, but survived long enough
6. Soluble in water and produce a stable solution, there are also sterilization
Classification of local anesthetics
The basic structure of local anstetika generally consist of three parts, namely a hydrophilic-amino group (secondary or tertiary) which is connected by an ester bond (alcohol) or amide with an aromatic group-lipofil. The longer the alcohol group, the greater their power anastetiknya, but also increases toxicity.
Anastetika local chemical can be classified into several groups as follows:
Anastetika local chemical can be classified into several groups as follows:
a. -Ester compound: cocaine and ester-PABA (benzocaine, procaine, oksibuprokain, tetrakain)
b. -Amide compounds: lidocaine and prilokain, mepivakain, bupivacaine, and cinchokain
c. Other: phenol, benzialkohol and etilklorida
All of the above drugs except cocaine is sintetris natural.
b. -Amide compounds: lidocaine and prilokain, mepivakain, bupivacaine, and cinchokain
c. Other: phenol, benzialkohol and etilklorida
All of the above drugs except cocaine is sintetris natural.
It works
Anatetika local flavor with a resulting loss of road some way. For example, by way of temporarily avoiding the formation and transmission of nerve impulses through cell edges. Central mechanism of action is located in the cell membrane. As well as alcohol and barbital, anastetika local forwarding inhibit impulses by way of reducing nerve cell membrane permeability to ions-sodium, which is necessary for proper nerve function. This was due to competition with calcium ions, which are adjacent to the sodium channels in the membrane of neurons. At the same time, due to the decline rate of depolarization, the threshold of sensitivity to electrical stimulation gradually increased, so that finally happened losing the local flavor is reversible.
SECURITIES - OTHER SECURITIES
In addition to the efficacy of local anastetika anatetikanya still has a number of other effects, al disrupt the function of all organs where there is conduction / transmission of multiple impulses.
1. Pressing SSP
2. Pressing the cardiovascular system
3. Vasodilatation
2. Pressing the cardiovascular system
3. Vasodilatation
FAMAKOKINETIK
Resorpsinya of skin and mucus membranes can take place very quickly and well, for example on cocaine, lidocaine, and tetrakain prilokain. Any progress with the rapid distribution to all organs and tissues. Conversely, procaine resorption in bad skin, so it is not useful in local stocks. The speed and duration of labor power is determined by lipofilitas, pKa, degree of binding to proteins and the degree vasodilatasinya.
The structure of local anestetika drug has a direct effect on the therapeutic effect. Everything has a hydrophobic group (an aromatic) related through an alkyl chain to the relatively hydrophilic group (tertiary amine).
Local anestetika onset speed is determined by:
a. drug levels and their potentialLocal anestetika onset speed is determined by:
b. the number of drug binding by proteins and binding of drugs to the local network
c. speed metabolism
d. drug injection site tissue perfusion.
Giving vasoconstrictor (epinephrine) + local anestetika to reduce local blood flow and reduce systemic absorption. Vasoconstrictor should not be used in areas with little collateral circulation and on the fingers or toes and penis. Group ester (procaine, tetrakain) hydrolyzed rapidly into inactive products by plasma cholinesterase and liver esterase. Bupivacaine extensively bound to plasma proteins.
Pharmacodynamic
Onset, intensity, and duration of nerve blockade is determined by the size and anatomical location of nerve. Na + channel is important in muscle cells that can be excited like heart. The effect of cardiac Na + channels is the basis of local anestetika therapy in the treatment of certain arrhythmias (usually used lidocaine). Local Anestetika generally less effective in infected tissue than normal tissue, usually because of local infection resulting in metabolic acidosis, and lower the pH.
SIDE EFFECTS
The side effects are a result of the effect of depression on the CNS and the effects of cardio-depresifnya (suppressing the function of the heart) with symptoms of inhibition of respiration and blood circulation. Local Anastetika can also lead to reactions that often form hipersensitasi exantema, urticaria, and allergic until sometimes bronchopasme anafilaktis shock which can be deadly. Famous in this regard is the ester group substances and tetrakain procaine, which therefore is not used anymore in local stocks. Hipersensitasi reaction was caused by PABA (para-amino-benzoic acid) is formed through hydrolysis. This can negate the effects of PABA antibakteril of sulfonamides, which based on competitive antagonism by PABA, therefore, therapy with a sulfa should not be combined with the use of these esters.
USE
A. By Parenatal
Local Anastetika seering times used in surgery for which general anesthesia is not necessary or desirable. Type of local anatesia the most widely used as an injection is as follows:
• Infiltration anesthesia• Conduction anesthesia
• Spinal anesthesia (intrathecal)
• epidural anesthesia
• Surface Anatesia
B. How to use other oral
Local Anastetika used as a solution to pain in the mouth or suction tablets (sore throat) are also in the form of eye-drops to measure the intraocular pressure or remove foreign objects, as well as ointments for itching or pain in burns and anti-pill-drop hemorrhoids.
Ester compounds often cause allergic skin reactions, then you should dugunakan-amide, a compound which is more rarely result in hipersensitasi.
Ester compounds often cause allergic skin reactions, then you should dugunakan-amide, a compound which is more rarely result in hipersensitasi.
SUBSTANCE - PARENT SUBSTANCE
A. ESTER COMPOUNDS
• Cocaine: benzoylmetilekgonin
• benzocaine: anestesin, etilaminoobenzoat, * benzomid, * Rako.
• procaine: novocaine, etokain, * gerovital (drAslan)
• Lidocaine: lignokain, xylocaine, * EMLA
• Mepivakain: scandicaine, * estradurin
B. Amide COMPOUNDS
• Cinchokain: dibukain, * proctosedyl, * scheriproct
• Artikain: carticaine, * ultracain
C. OTHER
• Etilklorida: kloretan, kloretil
• Phenol: carbolic acid, acidum carbolicum, * calamine lotion
• Benzialkohol
• Artikain: carticaine, * ultracain
C. OTHER
• Etilklorida: kloretan, kloretil
• Phenol: carbolic acid, acidum carbolicum, * calamine lotion
• Benzialkohol
GENERAL Anaesthetics
Anastetika common are drugs that can cause anesthesia or narkosa (Yunan = no, aesthesis = feeling), which is a state of general depression of the central pelpagai in the CNS that is reversible, in which all feelings and consciousness are done, so a bit like a fainting fit.
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Definition:
Migraine (Yun. Hemikrania = sebalah head pain; hemi = half, Cranium = skull) is a disease characterized by severe pain attacks from one side (unilateral) head with a pulse at the temples who come regularly, usually accompanied by gastrointestinal disturbances just as nausea and vomiting .
Theories. There are a number of theories are the most important migraine would Teteng
a. Theory neurovaskulerTheories. There are a number of theories are the most important migraine would Teteng
In certain circumstances, such as stress, occurs adrenergis nerve hyperactivity, which releases NA and 5HT exaggerated by the strong vasoconstriction. The result is a shortage of local blood supply in the brain (intracranial) and the resulting lack of oxygen.
b. Platelet aggregation theory
All of serotonin in the blood is transported by trombosit.pelat-plate is clotted blood under the influence of inductors such as adrenaline (stress) and tyramin (cheese) in people who are sensitive. In this aggregation process, serotonin is released into the blood, which makes other platelets more sensitive to these inductors.
c. The theory of "spreading pression" classical untukmigran
This study shows that classical migraine likely caused by a "cortical spreading depression", which is a gelombong-depolarization of neurons and glia-cells (tissue-tissue from the nervous system), which gradually spread throughout the skin surface of the brain (cortex .)
The factors generating the attack
There are a number of factors that can trigger an attack migraian, that for every patient must be determined individually.
a. Physical and mental stress, for example, are too tired, busy or lack of sleep, and excessive emotion and tension, making child-renal noradrenaline release.There are a number of factors that can trigger an attack migraian, that for every patient must be determined individually.
b. Diets containing vaso-active amines, which means that can lead to vaso-constriction, such as cheese tyramin in cooking (especially French cheeses from brie, camembert), red wine (wine) and feniletilamin in chocolate.
c. Allergens, ie substances that can cause allergic reactions, such as odors (gasoline, tar, asphalt) and fragrances (perfumes, especially muskus), as well as strong sunlight (glare) and sudden temperature changes.
d. Hormonal changes. Since long suspected that there is a certain link between sex hormones and migraine.
• The period of menstruation.
• During the birth-control pills to swallow
• gynecological disorders
• During pregnancy
e. Hypoglycemia
c. Allergens, ie substances that can cause allergic reactions, such as odors (gasoline, tar, asphalt) and fragrances (perfumes, especially muskus), as well as strong sunlight (glare) and sudden temperature changes.
d. Hormonal changes. Since long suspected that there is a certain link between sex hormones and migraine.
• The period of menstruation.
• During the birth-control pills to swallow
• gynecological disorders
• During pregnancy
e. Hypoglycemia
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Definition:
Hipnotika or sleeping pills (Yun: hypnos = sleep) are the substances in therapeutic doses designation increases the desire for sleep physiology and facilitate or cause sleep. Usually this drug is given at night. When the substances are given in the day ii in higher doses randah for calming purposes, then called sedativa (Obata reliever medication).
Hipnotika / sedativa, as well as anti-psikotika (neuroleptika), included in psikoleptika group that includes medications that suppress or inhibit certain functions of the CNS.
Sedativa function decrease of activity, reduce tension.
Hipnotika / sedativa, as well as anti-psikotika (neuroleptika), included in psikoleptika group that includes medications that suppress or inhibit certain functions of the CNS.
Sedativa function decrease of activity, reduce tension.
users.
Hipnotika causing drowsiness (drowsiness), accelerate the natural sleep of the properties it resembles EEG.
Differences sedativa-traquilizers
Sedativa-hipnotika efficacious suppress CNS. When used in increasing doses, a sedativum, for example denobarbital, will cause the effect of successive differences, sleep, and general anesthesia (anesthesia).
Tranquillizers, also called ataraktika or anxiolitika, especially benzodiazepines substances, can depress the central nervous system with sedative and hypnotic properties, and in addition it also empowered anxiolitis, antikonvulsif and muscle relaxation.
Tranquillizers, also called ataraktika or anxiolitika, especially benzodiazepines substances, can depress the central nervous system with sedative and hypnotic properties, and in addition it also empowered anxiolitis, antikonvulsif and muscle relaxation.
Classification
Hipnotika can be divided into several groups, namely compounds barbiturates and benzodiazepines, medicines and other Obata, and medications obsolete.
1. Barbiturates
Barbital used as relief medication for daytime ang lower doses than the dose as a sleeping pill, which is 0.5 to 1 / 6 time. For example, phenobarbital in doses of 15-30 mg works as sedativum and 100 mg or more as a sleeping pill.
2. Benzodiazepines
In essence, all benzodiazepines have the power of compound mentioned above, namely efficacy anksiolitis, sedative hypnotic, antikonvulsif, muscle relaxation and power.
Usage (2). Substances that are relatively powerful hypnotic sedative properties from other properties, mainly used in sleeping pills. Another use is as spasmolitikum (substance release spasms), for example on tetanus (especially klonazepam and diazepam), and as a premedication prior to differentiation (especially midazolam), where the nature anestetisnya useful.
The advantage of these drugs compared with barbital and other sleeping pills are not or almost not impede-REM sleep. However, benzodiazepines when used for only a few weeks, by many experts considered a relatively safe sleeping pills, and is the first choice hipnotika.
Pharmacokinetics. Thanks to the nature lipofilnya, resorpinya going well in the gut (80-90%) and fast, while the maximum concentration in plasma is reached within 0.5 to 2 hours.
Usage (2). Substances that are relatively powerful hypnotic sedative properties from other properties, mainly used in sleeping pills. Another use is as spasmolitikum (substance release spasms), for example on tetanus (especially klonazepam and diazepam), and as a premedication prior to differentiation (especially midazolam), where the nature anestetisnya useful.
The advantage of these drugs compared with barbital and other sleeping pills are not or almost not impede-REM sleep. However, benzodiazepines when used for only a few weeks, by many experts considered a relatively safe sleeping pills, and is the first choice hipnotika.
Pharmacokinetics. Thanks to the nature lipofilnya, resorpinya going well in the gut (80-90%) and fast, while the maximum concentration in plasma is reached within 0.5 to 2 hours.
Classification of benzodiazepine
Based on the speed of metabolism can be distinguished three groups, ie substances long-acting, short-acting substances, and substances ultra short-acting.
a. Medications Long-acting: such klordiazepoksida, diazepam, nitrazepam, and flurazepam, with respective t ½ 50-30 (-200), 20-54 (42-120), 18-34 and (47-100) hours.
b. Drug-drug short-acting: oksazepam (t1 / 2: 5-15 hours), lorazepam (12-16), lormelam (Dormonoct, 12-16), and zopiclon (5 hours). These drugs are metabolized without producing metabolites that have long working aktid. The drug is fit for use as a sleeping pill because it does not berkumulasi during use repeatedly and rarely cause-effect residual (hangover)
c. Drugs ultra-short acting: triazolam (t1 / 2: 1.5 to 5.5 hours), midazolam (Dormicum, 2.1 to 3.5), and estazolam. The risk of the effects of abstinence and rebound-insomnia greater on these medications, so you should not be used longer than 2 weeks.
b. Drug-drug short-acting: oksazepam (t1 / 2: 5-15 hours), lorazepam (12-16), lormelam (Dormonoct, 12-16), and zopiclon (5 hours). These drugs are metabolized without producing metabolites that have long working aktid. The drug is fit for use as a sleeping pill because it does not berkumulasi during use repeatedly and rarely cause-effect residual (hangover)
c. Drugs ultra-short acting: triazolam (t1 / 2: 1.5 to 5.5 hours), midazolam (Dormicum, 2.1 to 3.5), and estazolam. The risk of the effects of abstinence and rebound-insomnia greater on these medications, so you should not be used longer than 2 weeks.
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Analgesics or pain medication are substances that reduce or block the pain without losing consciousness (the difference with general anestetika).
Definitions.Pain is a sensory and emotional feeling of not feeling and relating to (the threat) of tissue damage. Pain is a personal feeling and pain tolerance threshold varies for each person limit for the temperature is constant pain, which is at 44-45oC.
The pain in most cases only a gejela, which serves to protect the protect the body. Pain should be considered as an indication of the danger of a disruption in the network, such as inflammation (Rema, gout), infectious microorganisms, or muscle spasms. Pain caused by mechanical stimulation, chemical or physical (heat, electricity), can cause damage to the network. These stimuli trigger the release of certain substances, called mediators of pain.
Mediataor pain now also called autocoida and comprising, among others, histamine, serotamin, bradyinin, leukotrienes, and prostaglandin2. Bradykinin is a polypeptide (amino acid sequences) that is formed from plasma proteins. Prostaglandin-like structure with fatty acids and are formed from amino arachidonat. According to estimates of these substances increase the sensitivity of the tips of sensory nerves for pain stimulation.
Seagai-defined pain threshold level (level) Diman pain is felt for the first time. Thus, the low intensity of stimulation when a person feels pain. For each person the pain threshold is constant.
Fever. In general, fever is also a symptom and not a separate disease. Now, experts bersependapat that fever is a useful countered reaction of the body against infection. At temperatures above 37oC lymphocytes and macrophages become more active. When the temperature exceeds 40-41oC, then place the critical situations that could be fatal, because no longer restrained by the body.
The pain in most cases only a gejela, which serves to protect the protect the body. Pain should be considered as an indication of the danger of a disruption in the network, such as inflammation (Rema, gout), infectious microorganisms, or muscle spasms. Pain caused by mechanical stimulation, chemical or physical (heat, electricity), can cause damage to the network. These stimuli trigger the release of certain substances, called mediators of pain.
Mediataor pain now also called autocoida and comprising, among others, histamine, serotamin, bradyinin, leukotrienes, and prostaglandin2. Bradykinin is a polypeptide (amino acid sequences) that is formed from plasma proteins. Prostaglandin-like structure with fatty acids and are formed from amino arachidonat. According to estimates of these substances increase the sensitivity of the tips of sensory nerves for pain stimulation.
Seagai-defined pain threshold level (level) Diman pain is felt for the first time. Thus, the low intensity of stimulation when a person feels pain. For each person the pain threshold is constant.
Fever. In general, fever is also a symptom and not a separate disease. Now, experts bersependapat that fever is a useful countered reaction of the body against infection. At temperatures above 37oC lymphocytes and macrophages become more active. When the temperature exceeds 40-41oC, then place the critical situations that could be fatal, because no longer restrained by the body.
Classification
On the basis of work farmakologisnya, analgesics were divided into two major groups, namely:
a. Peripheral analgesic (non-narcotic), which consists of drugs that are not central narcotic and does not work.
b. Special narcotic analgesic used to block the intense pain, as in fractura and cancer. These drugs are discussed in Chapter 23, Drugs.
Handling pain
Based on the occurrence, the pain can be combated in several ways, namely:
a. Hinder the formation of stimulating the peripheral pain receptors to the peripheral analgesic
b. Impede the distribution of stimuli in sensory nerves, for example with local anestetika.
c. Blockade of CNS pain centers with central analgesics (narcotics) or with the general anestetika.
b. Impede the distribution of stimuli in sensory nerves, for example with local anestetika.
c. Blockade of CNS pain centers with central analgesics (narcotics) or with the general anestetika.
In the treatment of pain with analgesics, psychological factors also play a part as already described above, for example, individual patience and power to block the pain. These medications below can be used according to type of pain.
Mild pain can be treated with medication peripheral, such as paracetamol, asetosal, mefenaminat, propifenazon, or aminofenazon, as well as pain with fever. For the pain is to be added kofein or codeine. Pain is accompanied pembengkakanatau due to trauma (falls, kicks, collisions) should be treated with a analgetikum anti-inflammatory, such as aminofenazon and NSAIDs (mefenaminat, nifluminat). Pain is a great need to be tackled with morphine or other opiates.
Pain in cancer is generally treated by a four-story scheme that is providing:
1. Drug peripheral (non-opioid) per oral or rectal: paracetamol, asetosal.Mild pain can be treated with medication peripheral, such as paracetamol, asetosal, mefenaminat, propifenazon, or aminofenazon, as well as pain with fever. For the pain is to be added kofein or codeine. Pain is accompanied pembengkakanatau due to trauma (falls, kicks, collisions) should be treated with a analgetikum anti-inflammatory, such as aminofenazon and NSAIDs (mefenaminat, nifluminat). Pain is a great need to be tackled with morphine or other opiates.
Pain in cancer is generally treated by a four-story scheme that is providing:
2. Peripheral drug with codeine, or tramadol
3. Central Drugs (opioids) as oral or rectal
4. Parenteral opioid medication.
To strengthen analgetikum effects can be added co-analgetikum, like psikofarmaka (amitriptyline, lovepromazin) or prednisone.
PERIPHERAL analgesics
Chemically, peripheral analgesics can be divided into several groups, namely:
a. Paracetamol;
b. Salicylates: asetosal, salisilamida, and benorilat;
c. Prostaglandin inhibitors (NSAID's): ibuprofen (Arthrifen), and others;
d. Derivative-derivative antranilat: mefenaminat, niflumat acid glafenin, floktafenin;
e. Derivative-derivative pirazolinon: aminofenazon, isopropilaminofenazon, and metamizol;
f. Other: benzidamin (Tantum).
b. Salicylates: asetosal, salisilamida, and benorilat;
c. Prostaglandin inhibitors (NSAID's): ibuprofen (Arthrifen), and others;
d. Derivative-derivative antranilat: mefenaminat, niflumat acid glafenin, floktafenin;
e. Derivative-derivative pirazolinon: aminofenazon, isopropilaminofenazon, and metamizol;
f. Other: benzidamin (Tantum).
CO-analgesic efficacy is a drug and its main indications are not dispel the pain, ie, NSAIDs (non-steroidal anti inflammatoryDrugs), antidepresiva trisiklis (amitriptyline), and anti-epileptika (carbamazepine, valproic). These drugs are used alone or combined with other analgesics in certain circumstances, such as in pain due to inflammation and neuropathy.
Side effects
The most common are gastrointestinal disorders (b, c, e), damage to blood (a, b, d, and e), liver and kidney damage (a, c), as well as allergic skin reactions. These side effects occur mainly on the use of old or in high doses. Therefore, continuous use of analgesics is not recommended.
Intraksi. Most analgesics strengthen antikoagulansia effect, unless the setamol and glafenin: Both of these drugs in normal doses can be combined safely to wakyu maximum of two weeks.
Intraksi. Most analgesics strengthen antikoagulansia effect, unless the setamol and glafenin: Both of these drugs in normal doses can be combined safely to wakyu maximum of two weeks.
PARENT substances
1. Paracetamol: acetaminophen, Panadol, Tylenol, Tempra, * Nipe.
-Asentanilida derivatives are metabolites of fenasetin, who was formerly widely used as analgeticiu, but in 1978.
Side effects often occur, including hypersensitivity reactions and blood disorders. Overdose can cause, among others, nausea, vomiting, and anorexia.
Women hamildapat use paracetamol safely, also during lactation although mencapi breast milk.
Dosage: for oral pain and fever 2-3 dd 0.5 to 1 g, maximum 4 g / day, the chronic use maksimum2, 5 g / day. Children: 4-6 dd 10 mg / kg, the average age of 60 mg 3-12 months, 1-4 years 120-180 mg, 180 mg 4-6 years, 7-12 years 240-360 mg, 4-6 a day. Rectal 20 mg / kg each time, adult 4 dd 0.5 to 1 g, children aged 3-12 months 120 mg dd 2-3, 1-4 years 240 mg dd 2-3, 4-6 years 4 dd 240 mg, 7-12 years 2-3 dd 0.5 g.
2. Acetylsalicylic acid (FI): asetosal, Aspirin, Cafenol, Naspro.
Asetosal is the oldest anti-pain (1899!), Which until now the most widely used around the world.
Side effects The most common form of gastric mucosal irritation with risk of peptic ulcers and bleeding cryptic (occult). The reason is the nature of asetosal acid, which can be reduced through a combination with a antasidum (MgO, aluminiumhidroksida, CaCO3) or calcium salts (carbasalat, ascal).
Pregnant women are advised not to use asetosal in high doses, especially in the last quarter and before labor, because of long gestation and birth can be extended, as well as increased bleeding tendencies.
Dose: oral pain and fever in 4 dd 0.5 to 1 g pc, maximum 4 g daily, children up to 1 year 10 mg / kg 3-4 times a day from 0.1 to 2 yrs 4-6 dd, above 12 4 yrs dd320-500 mg, maximum 2 g / hari.Rektal 4 dd 0.5 to 1 g of adult, children up to 2 yrs 2 dd 20mg/kg, over 2 yrs 3 dd 20 mg / kg pc
* The forms that dissolve asetosal:
Karbasalatkalsium (Ascal) is the calcium salt of asetosal, in which crystal water is replaced by urea (1951).
Iysin-asetosal are compounds that are after the break in the form of soluble ammonia acid lysine (Iysine) and asetosal, which is then hydrolyzed into salisiat. Combination (1620 mg) with metoklo-pramida (10 mg) is recommended for migraine (Migrafin).
a. Diflunisal (Diflonid, Dolocid) is a derivative-difluorfenil (1980) with the efficacy and side effects are more or less the same.
Dose: for pain and at the beginning Rema 0.5 to 1 g, followed by 2dd
0.25 to 0.5 g, maximum 1.5 g / day.
b. Beneroliat (Bentum, benortan) is an ester asetosal with paracetamol (1972).
Dose: maximum 4 dd 0.5 to 1 g.
c. Salisilamida (FI) (salamid, * Neozep, * Refagan) is devirat-salicylate with weaker properties in all areas of effect is less reliable. This substance is often used of digestive hemorrhage rarely arise in the appeal vague asetosal. In overdose can occur hypotension, CNS depression, and respiratory cessation. Its use has been deemed obsolete.
Dosage: 3-4 dd 0.5 g.
d. Natriumsalisilat (FI) (* Nephrolit, Enterosalicy) is weaker than asetosa properties. Sampignya more or less the same effect, but did not inhibit platelet clumping.
Dosage: 4-6 ss 1 to 1.5 g, maximum 12 g / day.
3. Aminofenazon: aminopyrin (FI), amidopyrin, pyriamdom.
Devirat-pirazolinon this (1887) berkasiat anlgetis, antipiretis, and anti-inflammatory. The side effects of the blood (agranulocytosis and leukopenia) are often fatal, this drug has been since the 1980's banned its circulation in many countries.
Pregnancy and lactation. All drugs of pirazolinon group should not be used during pregnancy and lactation.
Dosage: 300-600 mg 3 dd, maximum 3 g / day.
a. Isopropilaminofenazon (* pehazon) is devirat-aminopirin with the same efficacy. In addition, these substances are also vulnerable to high doses of sedative and hypnotic. Toksitasnya otherwise lighter.
Dose: oral, rectal or iv 3dd 400 mg for 1 week, then 600 mg / day.
b. Fenazon (FI) (antipirin) is a compound-parent of the drugs mentioned above without anti-inflammatory properties (1884).
c. Propifenazon (isopropilantipirin, * saridon, migraine) is devirat fenazon (1951)
Dosage: 150-300 mg 1-3 dd, generally combined with other analgenitika.
4. Fenibutazon: Butazolidin, * New Skelan, * Pehazonlforte.Obat is specifically used for certain types of arthritis, such as deviratnya oksifenilbutazon.
Serious side effects, among other things, blood and stomach, so that in many Western countries has been withdrawn from circulation since the late 1980s.
Dose: Rema attack or gout in oral and rectal 200 mg 2-3 dd.
5. Glafenin: Glaphen, Glifanan.
Glafanin is a devirat-4-aminokinolin (such as Rema drug chloroquine), which bound to the acid antranilat (1965).
Side effects such as gastrointestinal disturbances, drowsiness, and using. Even more serious is anafilaktis reaction, liver damage, and animea hemolitis, which sometimes fatal.
Dose: start 400 mg, then 200 mg dd 3-4, maximum 1 g daily.
Floktaferin is CF 3 derivatives with more or less the same efficacy, but less toxic and also more rarely cause allergic reactions. In the liver, these substances are converted into acid floktafeninat.
Dosage: 200-400 mg beginning, then 4-6 dd
Mefenaminat acid (Ponstan) is derival-antinilat with properties analgetis, antipiretis, and anti-inflammatory that is good enough. This drug is also used as medicine Rema. Floktafenin similar side effects.
Dose: 500 mg beginning of the beginning, then 250 mg dd 3-4 pc
6. Tramadol: Tramal, Theradol.
Analgetikum opiates (1977) does not suppress breathing and practically does not affect the cardiovascular system and gastrointestinal motility. The drug is used for pain and paracetamol-codeine NSAISS less effective or can not be used.
Tramadol is not recommended during pregnancy and lactation.
Dose: children 1-14 years old: 3-4 dd 1-2 mg / kg. Above 14 years 50-100 mg dd 3-4, maximum 400 mg daily.
-Asentanilida derivatives are metabolites of fenasetin, who was formerly widely used as analgeticiu, but in 1978.
Side effects often occur, including hypersensitivity reactions and blood disorders. Overdose can cause, among others, nausea, vomiting, and anorexia.
Women hamildapat use paracetamol safely, also during lactation although mencapi breast milk.
Dosage: for oral pain and fever 2-3 dd 0.5 to 1 g, maximum 4 g / day, the chronic use maksimum2, 5 g / day. Children: 4-6 dd 10 mg / kg, the average age of 60 mg 3-12 months, 1-4 years 120-180 mg, 180 mg 4-6 years, 7-12 years 240-360 mg, 4-6 a day. Rectal 20 mg / kg each time, adult 4 dd 0.5 to 1 g, children aged 3-12 months 120 mg dd 2-3, 1-4 years 240 mg dd 2-3, 4-6 years 4 dd 240 mg, 7-12 years 2-3 dd 0.5 g.
2. Acetylsalicylic acid (FI): asetosal, Aspirin, Cafenol, Naspro.
Asetosal is the oldest anti-pain (1899!), Which until now the most widely used around the world.
Side effects The most common form of gastric mucosal irritation with risk of peptic ulcers and bleeding cryptic (occult). The reason is the nature of asetosal acid, which can be reduced through a combination with a antasidum (MgO, aluminiumhidroksida, CaCO3) or calcium salts (carbasalat, ascal).
Pregnant women are advised not to use asetosal in high doses, especially in the last quarter and before labor, because of long gestation and birth can be extended, as well as increased bleeding tendencies.
Dose: oral pain and fever in 4 dd 0.5 to 1 g pc, maximum 4 g daily, children up to 1 year 10 mg / kg 3-4 times a day from 0.1 to 2 yrs 4-6 dd, above 12 4 yrs dd320-500 mg, maximum 2 g / hari.Rektal 4 dd 0.5 to 1 g of adult, children up to 2 yrs 2 dd 20mg/kg, over 2 yrs 3 dd 20 mg / kg pc
* The forms that dissolve asetosal:
Karbasalatkalsium (Ascal) is the calcium salt of asetosal, in which crystal water is replaced by urea (1951).
Iysin-asetosal are compounds that are after the break in the form of soluble ammonia acid lysine (Iysine) and asetosal, which is then hydrolyzed into salisiat. Combination (1620 mg) with metoklo-pramida (10 mg) is recommended for migraine (Migrafin).
a. Diflunisal (Diflonid, Dolocid) is a derivative-difluorfenil (1980) with the efficacy and side effects are more or less the same.
Dose: for pain and at the beginning Rema 0.5 to 1 g, followed by 2dd
0.25 to 0.5 g, maximum 1.5 g / day.
b. Beneroliat (Bentum, benortan) is an ester asetosal with paracetamol (1972).
Dose: maximum 4 dd 0.5 to 1 g.
c. Salisilamida (FI) (salamid, * Neozep, * Refagan) is devirat-salicylate with weaker properties in all areas of effect is less reliable. This substance is often used of digestive hemorrhage rarely arise in the appeal vague asetosal. In overdose can occur hypotension, CNS depression, and respiratory cessation. Its use has been deemed obsolete.
Dosage: 3-4 dd 0.5 g.
d. Natriumsalisilat (FI) (* Nephrolit, Enterosalicy) is weaker than asetosa properties. Sampignya more or less the same effect, but did not inhibit platelet clumping.
Dosage: 4-6 ss 1 to 1.5 g, maximum 12 g / day.
3. Aminofenazon: aminopyrin (FI), amidopyrin, pyriamdom.
Devirat-pirazolinon this (1887) berkasiat anlgetis, antipiretis, and anti-inflammatory. The side effects of the blood (agranulocytosis and leukopenia) are often fatal, this drug has been since the 1980's banned its circulation in many countries.
Pregnancy and lactation. All drugs of pirazolinon group should not be used during pregnancy and lactation.
Dosage: 300-600 mg 3 dd, maximum 3 g / day.
a. Isopropilaminofenazon (* pehazon) is devirat-aminopirin with the same efficacy. In addition, these substances are also vulnerable to high doses of sedative and hypnotic. Toksitasnya otherwise lighter.
Dose: oral, rectal or iv 3dd 400 mg for 1 week, then 600 mg / day.
b. Fenazon (FI) (antipirin) is a compound-parent of the drugs mentioned above without anti-inflammatory properties (1884).
c. Propifenazon (isopropilantipirin, * saridon, migraine) is devirat fenazon (1951)
Dosage: 150-300 mg 1-3 dd, generally combined with other analgenitika.
4. Fenibutazon: Butazolidin, * New Skelan, * Pehazonlforte.Obat is specifically used for certain types of arthritis, such as deviratnya oksifenilbutazon.
Serious side effects, among other things, blood and stomach, so that in many Western countries has been withdrawn from circulation since the late 1980s.
Dose: Rema attack or gout in oral and rectal 200 mg 2-3 dd.
5. Glafenin: Glaphen, Glifanan.
Glafanin is a devirat-4-aminokinolin (such as Rema drug chloroquine), which bound to the acid antranilat (1965).
Side effects such as gastrointestinal disturbances, drowsiness, and using. Even more serious is anafilaktis reaction, liver damage, and animea hemolitis, which sometimes fatal.
Dose: start 400 mg, then 200 mg dd 3-4, maximum 1 g daily.
Floktaferin is CF 3 derivatives with more or less the same efficacy, but less toxic and also more rarely cause allergic reactions. In the liver, these substances are converted into acid floktafeninat.
Dosage: 200-400 mg beginning, then 4-6 dd
Mefenaminat acid (Ponstan) is derival-antinilat with properties analgetis, antipiretis, and anti-inflammatory that is good enough. This drug is also used as medicine Rema. Floktafenin similar side effects.
Dose: 500 mg beginning of the beginning, then 250 mg dd 3-4 pc
6. Tramadol: Tramal, Theradol.
Analgetikum opiates (1977) does not suppress breathing and practically does not affect the cardiovascular system and gastrointestinal motility. The drug is used for pain and paracetamol-codeine NSAISS less effective or can not be used.
Tramadol is not recommended during pregnancy and lactation.
Dose: children 1-14 years old: 3-4 dd 1-2 mg / kg. Above 14 years 50-100 mg dd 3-4, maximum 400 mg daily.
DAFTAR PUSTAKA
1. Katzung g. Bertram.2002.Farmakologi Dasar dan Klinik.Buku 2 Edisi8.Jakarta:Salemba Medika
2. Hay, Drs. Tan dan Raharja, Drs.Kirana.2007.Oboan Tjat-Obat Penting.Jakarta:PT.Elex Media Komputindo
3. Drs. Kirana Rahardja.2002.Obat-Obat Penting.Jakarta:Gramedia
4. Joyce L Kee, Evelyn R Hayes.1994.Farmakologi Pendekatan ProsesKeperawatan.Jakarta:Buku Kedokteran
5. Muh, Ani I.ef.1995.Prinsip Umum dan Dasar Farmakologi cetakanGajah Mada University Press.Yogyakarta
6. Deglin dan Judith Hopfer.2004.Pedoman Obat Untuk Perawat.Jakarta:EGC
2. Hay, Drs. Tan dan Raharja, Drs.Kirana.2007.Oboan Tjat-Obat Penting.Jakarta:PT.Elex Media Komputindo
3. Drs. Kirana Rahardja.2002.Obat-Obat Penting.Jakarta:Gramedia
4. Joyce L Kee, Evelyn R Hayes.1994.Farmakologi Pendekatan ProsesKeperawatan.Jakarta:Buku Kedokteran
5. Muh, Ani I.ef.1995.Prinsip Umum dan Dasar Farmakologi cetakanGajah Mada University Press.Yogyakarta
6. Deglin dan Judith Hopfer.2004.Pedoman Obat Untuk Perawat.Jakarta:EGC
7. Hopfer deglin.judith dan hazard vallerand,April.2004.pedoman obat untuk perawat edisi4.jakarta:EGC
8. http://www.indomedia.com/intisari/1998/mei/trauma.htm
9. http://www.pikiran-rakyat.com/cetak/2005/0205/24/cakrawala/eureka.htm
10. http://zulliesikawati.wordpress.com/2010/05/18/anesthesia-awareness/
8. http://www.indomedia.com/intisari/1998/mei/trauma.htm
9. http://www.pikiran-rakyat.com/cetak/2005/0205/24/cakrawala/eureka.htm
10. http://zulliesikawati.wordpress.com/2010/05/18/anesthesia-awareness/
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