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    FATE OF BODY MEDICINE

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    RENAL

    is the organ that serves to

    remove urine, which are

    waste products of metabolism

    of the body in liquid form. Renal function is to regulate

    the water balance in the body,regulating the concentration of

    salt in the blood, regulate the

    balance of acid - alkaline blood

    and regulate the excretion of

    waste material and excess salt.

    When renals fail in its function,

    there will be a disruption in water

    balance and metabolism in the

    body. Thus resulting in the buildup

    of harmful substances in the

    blood. (Pearce, 1995)

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    Renal

    excretion

    Is one of the important mechanisms involved in the removal of

    drugs from the workplace. Effects of a single dose of the drug will

    be extended and the concentration of the saturated state (steady

    state) will increase if the process decreases. In patients with renal

    failure there is a decrease in renal blood flow, organ size,

    glomeruler and tubular function. These changes resulted in theelimination of some drugs more slowly. Therefore, dosi drugs in the

    primary excretion by the kidneys should be customized for each

    individual.

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    COMMON CAUSES OF

    RENAL FAILURE

    ALLERGENNEFRON

    HypovolemiaNephrotoxic drugs / Metal-

    metal

    Diabetes Mellitus

    HYPERTENSION

    Pyelonephritis

    (Shargel & Yu, 2005)

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    Excretion decreased

    Drug levels in the blood

    increases

    Toxic Effects

    Bond decreasedplasma

    (Sulistia , 2009:893)

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    Selected drugelimination via

    the liver

    Avoid the use oftetracycline

    group, diuretics,

    aspirin and oralantidiabetic

    Use lower doses

    than normal,especially for

    drugs primarilyeliminated

    through thekidneys

    GENERAL PRINCIPLES OF DRUG USE IN RENAL FAILURE

    (Sulistia , 2009:893)

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    Creatinine clearance can be calculated using

    For Women, The results of the

    above x 0.85

    In patients with acute renal failure, is

    considered

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    Dose adjustments in renal failure is mainly done for the

    maintenance dose using the equation Giusti -Hayton

    G = The correction factor Giustiayton

    = Fraction of drug elimination by the kidneys

    = creatinine clearance in uremia= normal creatinine clearance

    Furthermore, G is used to lower the dose or extend

    the maintenance interval T

    (Sulistia , 2009:893)

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    Decrease maintenance dose with a fixed

    interval T

    = in uremia

    = in normal

    This was done for drugs with a narrow margin of safety, egdigitalis, antiarrhythmics, and anticonvulsants, to avoid large

    fluctuations levels

    (Sulistia , 2009:893)

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    This was done for drugs that work relies on a high level,

    such as aminoglycosides.

    Extension of dose interval with a fixed maintenance dose

    = dosing interval in uremia

    = normal dose interval

    (Sulistia , 2009:893)

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    3. Changes in renal clearance of

    the drug reflected by changes in

    creatinine clearance.

    2. These renal elimination is not

    (especially the metabolic rate

    constants) remains unchanged.

    1. The elimination rate constant

    decreases proportionally when

    kidney function decreases.

    (Shargel & Yu, 2005)

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    There are several methods to estimate the appropriate

    dosage regime for a patient with renal damage. The

    design rules for people with uremia dose based on

    pharmacokinetic changes that occur in connection with

    the condition of uremia.

    (Shargel & Yu, 2005)

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    No dose adjustment isnecessary, if

    Fraction of intact drugexcreted by the

    kidneys (fr) 0:33 andinactive metabolites,

    regardless LFGnya

    In LFG normal value

    0.67, regardless of hisfr

    (Sulistia , 2009:893)

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    CONCLUSION

    There are two general approaches for pharmacokinetics were

    dose adjustments include methods based on drug clearance and

    a method based on the elimination half-life.

    A dosage regime can be designed for patients with kidneyfailure by either lowering the normal dose of the drug and

    keep the frequency of dosing (dosing interval) that is

    constant or by decreasing the frequency of dosing

    (extending the dosing interval) and maintain a constant

    dose.

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