Case Kelompok 1 Uin (Rsko)

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    PRECEPTOR:

    DR. ADHI WIBOWO NURHIDAYAT, SPKJ, MPH

    COMPILED BY:DEBY ARIANDINY 108103000024

    DISCA ARIELLA RUCITA 108103000042

    FARIDA NUR AINI 10810300003

    LELIANA SALEH 108103000008

    M. IHSAN SASRANIN!RAT 10810300001"

    Case Reportopioid dependent

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    Main complaints

    Patients come to the Methadone maintenance

    program for his own desire to break away

    from dependence putau use.

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    Disease History Now

    In !!! "class high school#

    Patients started high school education.

    In addition to schools$ the patient was also working part%time at his uncle&s restaurant field.

    Patients were first tried cigarettes$ opioid$ ben'odia'epam$

    methamphetamine$ mari(uana$ and alcohol. )ut not

    necessarily the amount of usage and dosage of the substance

    used.

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    Disease History Now

    In *++* "class , high school#

    Patients began to routinely use *++ thousand packets

    opioid *%, times a day with burning using lead then

    inhaled.

    -ometimes$ patients using mari(uana rolled *%, by way of

    sucked.

    hen patient hanging out with his friends$ patients often

    consume alcohol in an amount not necessarily.

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    Disease History Now

    In *++/$ the patient tried abstance and can last for /

    months.

    0rom *++1 to *++! $ the patient only uses putaualone. Putau used as much as half a gram $ *%, times

    a day by means of in(ected through a 2ein.

    During the drug use$ the patient had e3perienced

    sakau or o2erdose$ but forget how many times and

    when.

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    Disease History Now

    In *++4$ the patiente3perienced 2isual

    hallucinations such as

    seeing a large black shadow

    and auditory hallucinations

    in the form of hearing his

    friends who had died asked

    her to do something.

    Patients do not ha2e

    delusions.

    In *++$ the patient tried

    to replace putau with

    -ubute3. Patients get

    -ubute3 prescription from

    Pasar Rebo Hospital.

    Patients using -ubute3 4

    mg per day by way of oral

    or in(ectable for year

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    Disease History Now

    In *+$ the patient began to follow Methadone

    maintenance program in R-56. Patients wishing to

    escape from dependence putau because it was tiredof his routine$ many of his friends who died with

    HI7% positi2e and want to return to normal

    acti2ities. 0irst time using methadone$ patients

    e3periencing body aches and intolerable

    drowsiness.

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    Disease History Now

    Howe2er$ now they do not feel it. 8he dose of

    methadone that is used when the patient is 4/

    mg per day. 8he dose for the patient because it

    felt enough not to cause withdrawal. Patients

    ha2e not dared to lower the dose of methadonefor fear of re% use putau.

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    Disease History Now

    9arly Methadone maintenance programs$ e3amination of

    HI7 patients and is said to be HI7 positi2e with CD: test

    results *,: cells ; ul. 8hen$ the patients followed for

    year of antiretro2iral treatment and dismiss.

    Patients often e3perience thrush. 8he patient had a

    history of fungus on the tongue$ tooth loss patients and

    there are some that date$ all of the patient&s hands and

    feet nails color black.

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    Disease History Now

    8he patient had a history of skin arising rolled in the

    back of both hands on the area until the elbow and

    the back of both legs up to the knee$ but now li2es

    (ust colored black scar. 0riends in the work place a

    lot of patients who died of drug use with HI7%

    positi2e .

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    =I09 -9>?

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    ?sage History Psychoacti2e -ubstances

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    Psychosocial -tressors

    . Parents B none

    *. 6ther 0amily B the first child of four siblings

    ,. 0riend B none

    :. 6ccupation B none

    /. 0inancial B none

    1. Marriage B unmarried patients with HI7 disease

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    R9=

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    A, 57T, 51 J, 48 R, 45 T, 42 W, 39

    S, 53

    E, 28M,

    25

    T, 21 A, 12J, 31

    Aenogram

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    PH@-IC

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    PH@-IC

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    Diagnosis Psychiatric

    Aeneral Description

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    Intellectual function

    =e2el of education B

    intellectual functioning in

    accordance with the

    education and intelligence

    Concentration B good

    6rientation B

    place B good

    time B good

    people B good

    Memory B

    immediate B good

    -hort%term B good

    medium term B good =ong%term good

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    Diagnosis Psychiatric

    Mind

    Processes and forms of thought

    B coherent

    8he contents of thought B either

    Impulse Control B Aood

    power 2alue

    Power of social 2alues B good

    8est power 2alue B good

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    =aboratory 93amination Result

    *

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    Resume

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    organic mentaldisorders can be

    ruled out.

    0ormula Diagnosis

    A#$%$ Ithe patient had no history of

    head in(ury due to an accident.6n physical e3amination

    found no common medicalconditions that affect brain

    function.

    the patient&s routine use of inhaled putau

    since *++* and in(ected since *++1.Initially$ patients using *++ thousand putauuse *%, times per day and last use as much as

    half a gram putau$ *%, times per day.If the patient discontinue the use of putauwill feel withdrawal symptoms so that the

    patient continues to use putau.

    dependence ofthe opioid

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    0ormula Diagnosiss

    A#$%$ II

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    0ormula Diagnosiss

    A#$%$ III

    0riends in the working en2ironment of patients who died of drug use

    with HI7 positi2e and often e3changing syringes.

    Patients said doctors R-56 declared HI& '($%)%*+ patients with CD:

    results *,: sl ; ul.

    0rom the results of a physical e3amination found a blackish colored

    crusting

    A#$%$ I&

    patients ha2ing marital problems$ namely the desire to ha2e

    a life partner but has a positi2e HI7 disease.

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    0ormula Diagnosiss

    A#$%$ &

    )ased on the Alobal

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    92aluation Multia3ial

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    Problem =ist

    6rganobiologisB HI7%positi2e

    PsychologyB not married

    9n2ironmental and socio%economicB no

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    Management

    Initial doseB 3 */ mg Metadone

    8he current doseB 3 4/ mg Metadone

    Methadone is an opioid substitution

    therapy that are agonists. the initialphase$ a gi2en dose of methadone is *+%

    :+ mg per day.

    In patients$ the initialdosing phase is */ mg

    In order to reach the threshold 2alue of

    methadone in the blood$ plus or minus theinitial dose of /%+ mg for ,%*: hours.8o achie2e longer considered adeGuate doseincrease or decrease the dosage until thedeto3ification opioida continued with

    methadone maintenance therapy.

    Now$ the dose gi2ento the patient is a

    maintenance dose.

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    Prompts e3amination

    0ollow%up CD: e2ery 1 months.

    Patients only been checked once the outcome CD:

    *,: cells ; ul. CD: cell count monitoring to monitor

    the se2erity of HI7%induced immune damage. 8o

    that end$ there should be periodic inspection CD:

    le2els.

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    6piate dependence

    Define

    6pioid dependence is a cluster of physiological$ beha2ioral$

    and cogniti2e symptoms$ which together indicates repeated

    and continuing use of opioid drugs$ despite significantproblems related to such use.

    Drug dependence$ in general$ has also been defined by the

    orld Health 6rgani'ation "H6# as a syndrome in whichthe use of a drug or class of drugs takes on a much higher

    priority for a gi2en person than other beha2iors that once

    had a higher 2alue.

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    6pioid

    MorphineHeroin "diacetylmorphine#

    Hydromorphone

    "dihydromorphinone#

    63ymorphone

    "dihydrohydro3ymorphinone#

    =e2orphanol

    Methadone

    Meperidine "pethidine#

    Pethadol 0entanyl

    Codeine

    Hydrocodone

    "dihydrocodeinone#

    Drocode "dihydrocodeine#63ycodone

    "dihydrohydro3ycodeinone#

    Propo3yphene)uprenorphine

    Penta'ocine

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    Neuropharmocology

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    Heroin

    P(7/+6 H+6(%P(7/+6 H+6(% B5# T6B5# T6

    H+6(%H+6(%

    ,1

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    -ign for using Heroin

    9uphoria

    Drowsiness

    Impaired mental functioning

    -lowed down respirationConstricted pupils

    Nausea

    ,

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    ,4

    -hort%term 9ffects

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    ,!

    =ong%term 9ffects

    Collapsed 2eins$ infection of heart lining and 2al2es$

    abscesses$ cellulites$ and li2er disease

    Pulmonary complications$ including 2arious types of

    pneumonia

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    D-M%I7%8R Diagnostic Criteria for 6pioid

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    D-M I7 8R Diagnostic Criteria for 6pioidithdrawal

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    Mangement

    6bser2ation of 2ital sign

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    6pioid substitute

    6pioid deto3ificationmethadone "< daily dosage of *+ to 4+ mg$ up to

    *+ mg #

    =e2omethadyl "=

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    H- I-(/+%5%+5 &%6-$

    HI7 is a 2irus that attacks the

    human immune system and

    can cause

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    H- I-(/+%5%+5 &%6-$

    HI7 are mainly in human body fluids. 0luids that contain

    HI7 are potentially blood$ semen$ 2aginal fluids and breast

    milk. HI7 transmission can occur through a 2ariety of

    ways$ namelyB

    se3ual contact$

    contact with infectious blood or secretions$

    mother to child during pregnancy$

    labor and

    breastfeed

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    Pathogenesis

    Classified as ha2ing HI7 retro2irus RN< genetic

    material. hen the 2irus into the patient&s body

    "the host cell#$ the 2iral RN< is con2erted into DN