Kaskade Dan Terapinya

8/18/2019 Kaskade Dan Terapinya

1/30

COASS OBGIN PERIODE 7SEPTEMBER – 15 NOVEMBER 2015

KASKADE PEMBULUH DARAHDAN TERAPINYA


2/30

Hemos!s"s !#!$!% me&!'"sme !$!m"!%()(% #!$!m me'*!!s" +e,#!,!%!'-

Ke"&! +em)($(% #!,!% me'*!$!m"&e,(s!&!'. m!&! %emos!s"s )e&e,/!#e'*!' e+! ('(& me'*%e'"&!'+e,#!,!%!' e,se)( me$!$(" )e)e,!+!me&!'"sme se+e," s+!sme !s&($!,.+em)e'(&!' s(m)! +$!e$e #!'&o!*($!s"-


3/30


4/30


5/30

T,om)os"See$!% e#e,! +em)($(% #!,!%. ,om)os" me$e&! +!#!

/!,"'*!' "&! s()e'#oe$ !'* e,)(&!- M"&,o:),"$s()e'#oe$ me'*"&! m($"me, ; !'* $e)"% )es!,. !'*)e,"&!!' #e'*!' &om+$e&s I) mem),!' ,om)os"- D")!2?1@ me'*"&! &o$!*e' #!' me'*%e'"&!',!'s$o&!s"- A&"!s" ,om)os" &em(#"!' #"!+!" me$!$("*$"&o+,oe"' II)9III! ="'e*,"' >II)?@ !'* me'*"&!:),"'o*e' ('(& me'*%!s"$&!' !*,e*!s" ,om)os"-Kom+$e&s ,ese+o, II)9III! /(*! mem)e'(& em+!+e'*"&!!' se&('#e, #e'*!' ; !'* me'e)!)&!'!#%es" $e)"% $!'/(-

!&o, o' ;"$$e),!'# =;@ mem)!


6/30


7/30


8/30

K!s&!#e Ko!*($!s" Pem)e&(!' #!,!% me$")!&!' s(!( s"sem * &em(#"!'

me'*!&"4&!' s(!( &!s&!#e +,oe"' +,e&(,so, !'* )e,s",&($!s"=e'"m6e'"m 4!&o, &o!*($!s"@ me$!$(" +,oeo$"s"s !'*mem('!& +!#! +em)e'(&!' %,om)"' %,om)"' me'*()!%:),"'o*e' +$!sm! me'/!#" :),"'- "),"' me,!'*&!+ !*,e*!,om)os" +!#! em+!6em+! e#e,! !s&($!, #!' me,()!%s(m)! ,om)os" +,"me, !'* "#!& s!)"$ me'/!#" s(m)!

%emos!"& !&%", !'* +!#! #!' s!)"$- Ko!*($!s" #"+e,&",!&!' #"e(s&!' se!,! "' "o o$e% 4!&o,

/!,"'*!'. !'* #"em(&!' +!#! +e,m(&!!' /!,"'*!'+e,"!s&($!,. e,"&! +!#! 4!&o, &o!*($!s" VII- H!$ "'"me'*!&"4&!' 4!&o, VII !'* &em(#"!' me'*!&"4&!' 4!&o, I8#!' 8- A&"!s" 4!&o, 8 me'e)!)&!' #"%!s"$&!''! se/(m$!%&e"$ %,om)"' !'* me'*!m+$":&!s" +,oses &o!*($!s" #e'*!'

me'*!&"4&!' &o4!&o, V #!' VIII- !$(, !m+$$":&!s" !'*me$")!&!' 4!&o, VIII #!' I8 "'" mem+e,!%!'&!' +e,!'#om"'!' ('(& mem+e,&(! +em)e'(&!' 4!&o, 8 !&"4- T,om)"' /(*! me'*!&"4&!' 4!&o, I8. !'* me'"'*&!&!'+,o#(&s" 4!&o, I8 !&"4- !&o, &o!*($!s" VIII e,"&! +!#! ;#!$!m +$!sm!- !&o, "'" #"s"'es"s #" #!$!m %!" o$e% %e+!os"-


9/30

D!$!m /!$(, &$!s"& !'* #"4o,m($!s"&!' ('(& me'/e$!s&!' %!s"$+e'*(/"!' &o!*($!s" se!,! "' ",o. +e'e(s!' /!$(, e,se)(meme,$(&!' ,e!&s" &o'!& !'!,! 4!&o, 8II. &!$"&,e"'. #!' &"'"'o*e')e,)e,! mo$e&($ "'**" =HM;K@ !'* me'e)!)&!' !&"!s" 4!&o,8I- ;!$!(+(' #em"&"!'. "#!& !#!'! +e,#!,!%!' !)'o,m!$ +!#!"'#""#(6"'#""#( #e'*!' #e:s"e's" %e,e#"e, 4!&o,64!&o, &o'!&e,se)( me'('/(&&!' )!%

!&o, 8 !&"4 )e,s!m! #e'*!' &o4!&o, V +!#! +e,m(&!!' 4os4o$"+"##!' &!$s"(m. me'*()!% +,o,om)"' me'/!#" %,om)"'- T,om)"'me'*%"#,o$"s"s :),"'o*e'. me$e+!s&!' :),"'o+e+"#! A #!' B ('(&

mem)e'(& :),"' mo'ome,- "),"' mo'ome, "'" )e,"&!!' se!,!s+o'!' me$!$(" "&!!' %#,o*e' ('(& mem)e'(& s(!( :),"'+o$"me, !'* $o'**!, #!' "#!& $!,(- !&o, 8III /(*! #"!&"4&!' o$e%%,om)"' )e,s!m! #e'*!' &!$s"(m- !&o, 8III !&"4 me's!)"$&!'+o$"me, :),"' #e'*!' +em)e'(&!' "&!!' s"$!'* !'* e,"&!se!,! &o!$e'-


10/30

Ke,/! O)!As!m ,!'e&s!m! Me,(+!&!' !*e' !'":),"'o$""&- As!m ,!'e&s!m!

)e&e,/! #e'*!' !,! mem)$o& "&!!' +$!sm"'o*e' #!'+$!sm"' e,%!#!+ :),"' "'%")"s" e,%!#!+ +$!sm"' "'"s!'*! e,)!!s +!#! "'*&! e,e'(- As!m ,!'e&s!m!

se!,! &om+e""4 me'*%!m)! !&"!s" +$!sm"'o*e'=me$!$(" me'*"&! #om!"' &,"'*$e@. se%"'**! me'*(,!'*"&o'e,s" +$!sm"'o*e' me'/!#" +$!sm"' =:),"'o$"s"'@. e'"m!'* me'#e*,!#!s" +em)e&(!' :),"'. :),"'o*e'. #!'+,oe"' +$!sm! $!"''!. e,m!s(& 4!&o,64!&o,+,o&o!*($!' V #!' VIII- As!m ,!'e&s!m! /(*! $!'*s('*me'*%!m)! !&""!s +$!sm"'. e!+" #os"s !'* $e)"%"'**" #"+e,$(&!' #!,"+!#! !'* #")((%&!' ('(&me'*(,!'*" +em)e'(&!' +$!sm"'-


11/30

V"!m"' K P!#! o,!'* 'o,m!$ "!m"' K "#!& mem+('!" !&""!s4!,m!&o#"'!m"&. e!+" +!#! +e'#e,"! #e:s"e's" "!m"' K."!m"' "'" )e,*('! ('(& me'"'*&!&!' )"os"'es"s )e)e,!+!4!&o, +em)e&(!' #!,!% !'* )e,$!'*s('* #" %!" !"(+,o,om)"'. 4!&o, VII =+,o&o'e,"'@. 4!,&o, I8 =4!&o, C%,"sm!s@#!' 4!&o, 8 =4!&o, S(!,@ !'* )e,$!'*s('* #" %!"- Se)!*!"

%emos!"&. "!m"' K meme,$(&!'

De:s"e's" "- K #!+! e,/!#" !&")! *!'**(!' !)so,)s" "-K.)e,&(,!'*'! )!&e," !'* me's"'es"s V"- K +!#! (s(s #!'+em!&!"!' !'"&o!*($!' e,e'(- P!#! )!" )!,( $!%",%"+o+,o,om)"'em"! #!+! e,/!#" e,(!m! &!,e'! )e$(m!#!'! )!&e," * me's"'es"s "- K


12/30

ANTITROMBOSIT

O)! !'* me'*%!m)! !*,e*!s" ,om)os"

e,%!m)!'! +em)e'(&!' ,om)(s !'* e,(!m!se,"'* #"em(&!' +!#! s"sem !,e,"-

C9 As+","'. S($:'+",!o'. D"+","#!mo$ #!'De&s,!'.

P,os!&s"&$"'. PGI2 #!' T"&$o+"#"'

- Asam Asetil Salisilat:

Mekanisme Kerja 16 * 9 %!,"

Ase"$!s" +,oe"' mem),!' ,om)os" #!' +,oe"'+$!sm! . e,(!m! &e,/! e'"m s"&$oo&s"*e'!se

s"'es"s T,om)o&s!' A2 Pos!&s"&$"'


13/30

SULFINPIRAZON

Mekanisme Kerja Mem+e,+!'/!'*

T"#!& e4e&"4 "'4!,& m"o&!,# !&( +e'#e,"! !'*"'! !&

s!)"$Eek Sam!in":

- G!'**(!' GIT. ,(!m &($". #"s&,!s"! #!,!%. 'e4,""s

"'e,"s"!$ !&(. &o$"& *"'/!$. *!*!$ *"'/!$ !&(

Interaksi :;!,4!,"' e4e& me'"'*&! )e,s!m! S($:'+",!o'

#$sis:

P,ee's" se&('#e, see$!% "'4!,& m"o&!,# !&( 00 m*9%!,"


14/30

#IPIRI#AMOLMekanisme Kerja:Mem+e,&(! &e,/! +e'*%!m)!!' !*,e*!s" !'* #"m"$"&"

!#e'os"' F +,os!*$!'#"' E. #"s!m+"'* "( me'*%!m)!4os4o#"ese,!se ,om)os" +em)e)!s!' me#"!o,,om)os" #"e&!'

Me'*%!m)! !m)"$!' #!' me!)o$"sme !#e'os"' o$e% e,",os"#!' se$ e'#oe$ +em)($(% #!,!%. #e'*!' #em"&"!'me'"'*&!&!' &!#!,'! #!$!m +$!sm!- A#e'os"' me'*%!m)!4('*s" ,om)os" #e'*!' me,!'*s!'* !#e'"$! s"&$!se #!'me,(+!&!' !so#"$!o,-

Mem+e,)es!, e4e& !'"!*,e*!s" P,os!s"&$"'

Dos"s 'o,m!$ 10 me'*!$!m" $(s%"'* #!' s!&" &e+!$!

M!&! #")e," Kom)"'!s" Dos"s #"*('!&!' Ke"$D"+","#!mo$ As+","' I'4!,& m"o&!,# !&( ('(& P,ee's" se&('#e, #!' +!s"e' TIA('(& me'e*!% S,o&eD"+","#!mo$ A'"&o!*($!' O,!$


15/30

Farmak$kinetik:

B"o!!"$!)"$"!s )e,!,"!s"

0 )e,"&!!' #e'*!' P,oe"' P$!sm!

Me'*!$!m" s"&$(s e'e,o %e+!"&

192 16 12 /!m

#$sis:

6 P,o:&$!&s"s !'*&! P!'/!'* K!(+ !'('* )(!!' J00

m*9 %!,"

)e,s!m! ;!,4!,"'

6 Me'e*!% !&"!s" ,om)os" se$!m! o+e,!s" ) +!ss J00 m* #"m($!" 2 %!," se)e$(m o+e,!s"


16/30

#ekstranSe)!*!" +,o:$!&s"s ('(& +!s"e' #e'*!' &ee'#e,('*!'

&om+$"&!s" ,om)oem)o$" =e- +!#!

Mekanisme Kerja:

6 Me'*%!m)! !*,e*!s" ,om)os"

6 V!so#"$!!s"

Eek Sam!in":

$(s%"'*. s!&" &e+!$!. '!(se!. m('!%.*e$"s!%. em!s.%"+oe's". ,ee&s !&"&!,#"!


17/30

TROMBOLITIK:

Ke,/! Me$!,(&!' T,om)(s !'* s(#!% e,)e'(&

D"*('!&!' +!#! s!! ,om)(s s(#!% e,)e'(&- O)! "'")e&e,/! #e'*!' !,! )e,#"4(s" &e #!$!m )e&(!' #!,!% #!'me'*!&"4&!' +$!sm"'o*e' !'* #"*('!&!' ('(&me'*%!'(,&!' *(m+!$!'6*(m+!$!' +!#! &o'#"s" se+e,",om)os"s e'!. em)o$" +!,(. ,om)os"s ,e"'!. /(*!

"'4!,& m"o&!,#- Indikasi:

6 I'4!,& m"o&!,# !&(

6T,om)os"s Ve'!

6 6 Em)o$" P!,(6 6 T,om)oem)o$" A,e,"

6 Me$!,(&!' )e&(!' #!,!% +!#! &!(+ /!'('* )(!!' #!'

&!ee, Ve'!


18/30

STREPTOKINASE:

Mekanisme Kerja:

Me'*!&"4!s" +$!sm"'o*e' #e'*!' !,! "#!& $!'*s('*!"(

De'*!' )e,*!)('* e,$e)"% #($( #e'*!' +$!sm"'o*e'('(& mem)e'(& &om+$e&s !&"!o,me'*&!!$"s"s +e,()!%!' +$!sm"'o*e' )e)!s me'/!#"+$!sm"'-

Um(m'! P!se"' mem"$"&" !'")o#" e,%!#!+S,e+o&"'!se !&")! e,"'4e&s" S,e+o&o&(s

#$sis : 1 /(! IU "#!& e4e&"4 "#!& #"*('!&!'-

Kinetik: )"4!s"& !se e+! 1161 me'". $!m)! 2me'"


19/30

ANTIKOA'ULAN

Me'e*!% +em)e&(!' #!,!%

me'*%!m)! +em)e'(&!' !!(me'*%!m)! 4('*s" )e)e,!+! 4!&o,+em)e&(!' #!,!%-

U'(& me'e*!% e,)e'(& #!' me$(!s'!

,om)(s #!' em)o$". /(*! me'e*!% )e&('!#!,!% "' ",o +!#! +eme,"&s!!'$!)o,!o,"(m 9 ,!'4(s"-

A'"&o!*($!' O,!$ #!' He+!,"' me'*%!m)!

+em)e'(&!' fbrin se)!*!" +e'e*!%!'('(& me'*(,!'*" "'s"#e' tromboemboli e,(!m! +!#! e'!


20/30

(*! )e,m!'4!! Pe'*o)!!' ,om)os"s !,e," &!,e'!mem+e'*!,(%" +em)e'(&!' :),"' !'* #"+e,$(&!'('(& mem+e,!%!'&!' *(m+!$!' ,om)os"-

ANTIKOAGULAN DIKELOMPOKAN

*+ ,e!arin: A'"&o!*($!' !'* )e&e,/! $!'*s('*

(+ Antik$a"lan $ral: A'"&o!*($!' !'* )e&e,/! "#!&$!'*s('*

A- Derivat 4 –Hidroksikumarin D"&(mo,!$. ;!,4!,"'

B- De,"! Indan-1,3-dion A'"s"'#"o'

- Antik$a"lan .ekerja men"ikat i$n Kalsim=4!&o, +em)e&(!' #!,!%@


21/30

*+ ,EPARINHe+!,"' s!(6s!('! !'"&o!*($!' #")e,"&!'

+!,e'e,!$ #!' +"$"%!' )"$! #"+e,$(&!' e4e& e+! +!#!

6 Em)o$" +!,(6+!,(.

6 T,om)os"s e'! #!$!m

6 I'4!,& m"o&!,# !&(-

(*! #"*('!&!'

6 Pe'e*!%!' tromboemboli e'! se$!m! o+e,!s"

6 U'(& mem+e,!%!'&!' s",&($!s" ekstrakorporal

se$!m! o+e,!s" /!'('* e,)(&!-

6 He+!,"' /(*! #""'#"&!s"&!' ('(&

meme,$(&!' !'"&o!*($!'-


22/30

,e!arinDos"s e+! s!'*! +e'"'*.D"+e,$(&!' mo'"o,"'* e,(s6me'e,(s- Pem)e,"!' +!,e'e,!$ #!+! me'"m)($&!' 'e," #!'

%em!ome #" !,e! "'4e&s"-He+!,"' mo$e&($ )es!, s($" me'em)(s +$!se'!. "#!&

m!s(& &e ASI ="#!& mem+e'*!,(%" /!'"' #!$!m &!'#('*!'@- Eek sam!in":

6 Pe,#!,!%!'-

6 A$e,*"6 Oseo+o,os"s e,!+" $e)"% #!," )($!'

6 T,om)os"o+e'"!6 R!m)( ,o'o&

6 R!&s" !'!:$!&"& . S%o&KI: Pem"'(m !$&o%o$ &!,e'! me'**!'**( 4('*s" %e+!,-Anta"$nis: He+!,"' !#!$!% P,o!m"' S($4!- Interaksi: e'"$)(!o'. Ko,"&ose,o"#. K$o,!m4e'"&o$ #!+!

me'"'*&!&!' ,es+o' !'"&o!*($!' o,!$-


23/30

ANTIKOA'ULAN ORAL:

Be,*('! ('(&+e'e*!%!' #!' +e'*o)!!' T,om)oem)o$"-Um(m'! #"*('!&!' #!$!m /!'*&! +!'/!'*-

Te,%!#!+ T,om)os"s e'!. e4e& A'"&o!*($!' o,!$ s!m!#e'*!' He+!,"'. e!+"

T,om)oem)o$" !,e,". !'"&o!*($!' o,!$ &(,!'* e4e&"4-

A'"&o!*($!' o,!$ +!#! #!s!,'! me,(+!&!' !'!*o'"s"!m"' K-

Indikasi:Pe'!&" #e'*!' &ee'#e,('*!' "m)($'! T,om)oem)o$".

se+e,"6 I'4!,& m"o&!,#.6 Pe'!&" /!'('* ,em!"&.6 Se,!'*!' "s&em"! se$"'!s.6 T,om)os"s e'!.6 Em)o$" +!,(-


24/30

KUMARIN: %Anta"$nis /it K)

De,"! J6H"#,o&s" &(m!,"' #ikmar$l

Mekanisme Kerja:6 Me'*%!m)! s"s'es"s P,o,om)"' /(*! 4!&o, VII. I8

#!' 8 #!$!m %!" A'"&o!*($!' !& $!'*s('*

6 Me'e*!% 6&!,)o&s"$!s" !s!m G$(!m! me'/!#" +,!!4!&o, +em)e&(!'

Eek Sam!in":

Res"&o +e'#!,!%!' &!#!'*6&!#!'* E&s!em. De,m!""s &!#!'*6&!#!'*

R!m)( ,o'o& &!#!'*6&!#!'*Ne&,os! &($"9&(m!,"' &!#!'*6&!#!'*

'e&,os!


25/30

0ARFARIN

Pem)e,"!' "',! m(s&($!, !!( "',!e'!-

P!s"e' H"+o",o"# !'* #")e,"&!'


26/30

ANTIKOA'ULAN PEN'IKAT ION KALSIUM

Natrim Sitrat #!$!m #!,!% !&!' me'*"&! K!$s"(m

me'/!#" &om+$e&s &!$s"(m s",!- B!'!& #"*('!&!'#!$!m #!,!% ('(& ,!'s4(s". &!,e'! "#!& os"&- Te!+"#os"s e,$!$( "'**" +!#! ,!'s4(s" #!,!% s!m+!" 1-J00 m$#!+! me'e)!)&!' #e+,es" /!'('*-

Asam $ksalat #!' sen1a2a $ksalat $!"''! #"*('!&!'('(& !'"&o!*($!' #" $(!, ()(% =in vitro@. se)!) e,$!$(o&s"s ('(& +e'**('!!' in vivo =#" #!$!m ()(%@-

Natrim Edetat me'*"&! K!$s"(m me'/!#" &om+$e&s#!' )e,s"4! se)!*!" A'"&o!*($!'-

U'(& me'*!!s" +e,#!,!%!' !&")! +e'**('!!'!'"&o!*($!' #"*('!&!'

6P,o!m"' S($4!


27/30

Fakt$r Anti3em$4lik %Fakt$r /III) dan 5r1$!re6i!itated anti3em$!3ili6 a6t$r

Ke#(! ! "'" )e,m!'4!! ('(& me'e*!% !!( me'*!!s"

+e,#!,!%!' +!#! +e'#e,"! %emo:$"! A =#e:s"e's" 4!&o, VIII!'*

s"4!'! %e,"#"e,@ #!' +!#! +e'#e,"! !'* #!,!%'!me'*!'#('*

"'%")"o, 4!&o, VIII-

C,o+,e"+"!e# !'"%emo+%"$" 4!o, #"#!+! #!," +$!sm!#o'o,

('**!$ #!' &!! !&!' 4!&o, VIII. :),"'o*e' #!' +,oe"'

+$!sm! $!"'-


28/30

Eek sam!in"

Re!&s" %"+e,se's"""!s . He+!""s ",(s. !'em"! %emo$""&.

%"+e,:),"'o*e'em"!. me'**"*"$ #!' #em!m-

P$s$l$"i

K!#!, 4!&o, !'"%emo:$"& 2060 #!," 'o,m!$ !'* #")e,"&!'IV )"!s!'! #"+e,$(&!' ('(& me'*!!s" +e,#!,!%!' +!#!+e'#e,"! %emo:$"!-

KOMPLEKS FAKTOR I7

Se#"!' me'*!'#('* 4!&o, II. VII. I8 #!' 8. se,! se/(m$!% &e"$

+,oe"' +$!sm! $!"'. #"*('!&!' ('(&

6 +e'*o)!!' %emo:$"! B. !!(

6 )"$! #"+e,$(&!' 4!&o,64!&o, !'* e,#!+! #!$!m se#"!' ('(&

me'e*!% +e,#!,!%!'.

!'*!' #")e,"&!' +!#! +e'#e,"! 'o'%emo:$"!-


29/30

#ESMOPRESIN

Me,(+!&!' !so+,es"' s"'e"& . #!+! me'"'*&!&!' &!#!,

4!&o, VIII #!' ;4 ('(& seme'!,!- Pe'"'*&!!' &!#!,

4!&o,+em)e&(!' e,se)( +!$"'* )es!, e,/!#" 162 /!m #!'

me'e!+ s!m+!"

#e'*!' /!m-


30/30

FIBRINO'EN INSANI

Se#"!' "'" %!'! #"*('!&!' )"$! #!+! #"e'(&!' &!#!,:),"'o*e'

#!$!m #!,!% +e'#e,"!. #!' #!! +em)e&(!' se)e'!,'!-

/ITAMIN K

Se)!*!" Hemos!"&. "!m"' K meme,$(&!'

ASAM AMINOKAPROAT

Pe'*%!m)! )e,s!"'* #!," !&"!o, +$!sm"'o*e' #!'+e'*%!m)! +$!sm"'-

P$!sm"' )e,+e,!' me'*%!'(,&!' :),"'o*e'. :),"' #!' 4!&o,+em)e&(!'

#!,!% $!"'-

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