Lithium Klp 4 helna adelia

8/9/2019 Lithium Klp 4 helna adelia

1/29

OTHER DRUGS

(LITHIUM)

S1 REGULER KELAS B

KELOMPOK 4

1. Ayu Lestari 11.01.01.0552. Eli Suarti 11.01.01.060

3. Hela A!elia Gustia 11.01.01.065

4. Kuria Maila Sari 11.01.01.0"0

5. M. A!a# $irliasya% 11.01.01.0"5


2/29

LithiumLit%iu# is a al&ali #etal t%at is a!#iistere! as

a #''(alet )ati' *Li+, -'r t%e treat#et '-

i/'lar !is'r!er. t%e Uite! States 'rally

a!#iistere! )ar'ate a! )itrate salts '-

lit%iu# are a(ailale. %ile lit%iu# is still use!

as a /ri#ary treat#et -'r i/'lar !is'r!ers

(al/r'i) a)i! la#'triie 'r )ara#ae/ie

#ay e use! -'r s'#e susets '- t%e !isease.


3/29

%era/euti) a! 'i) 7')etrati'%e eeral t%era/euti) rae -'r lit%iu# is

0.681.5 ##'l9L. Be)ause lit%iu# is a

#''(alet )ati' t%e t%era/euti) rae

e/resse! i #E:9L is i!eti)al t' t%ese

(alues *i.e.0.681.5 #E:9L,.


4/29

%era/euti) a! 'i) 7')etrati'$'r i!i(i!uals ;it% a)ute #aia a #ii#u# lit%iu#

)')etrati' '- 0.< ##'l9L is usually

re)'##e!e!. %e usual !esire! rae -'r t%ese

i!i(i!uals is 0.


5/29

%era/euti) a! 'i) 7')etrati'$'r l'=ter# #aitea)e use t%e usual

!esire! rae is 0.680.< ##'l9L. - /atiets !'

't res/'! t' t%ese le(els !uri

#aitea)e treat#et '))asi'al use '-

lit%iu# )')etrati's e:ual t' 0.>81 ##'l9L

is re:uire! a! i s'#e )ases )')etrati's

as %i% as 181.2 ##'l9L are e)essary t' ai

a a!e:uate 'ut)'#e.


6/29

FIGURE 17-1 Lithium ion serumconcentration/time curve after

a single 900-mg oral dose oflit%iu# )ar'ate *24.4 ##'l 'r#E: '- lit%iu# i', ra/i!=release)a/sules. Mai#u# seru#)')etrati's '))ur 283 %'ursa-ter t%e !'se is i(e. A-ter t%e

/ea& )')etrati' is a)%ie(e! t%e!istriuti' /%ase lasts -'r 6810%'urs -'ll';e! y t%e eli#iati'/%ase. /atiets ;it% ''! real-u)ti' *)reatiie )leara)e ?


7/29

At lit%iu# seru# )')etrati's ;it%i t%e u//er

e! '- t%e t%era/euti) rae *1.281.5 ##'l9L, t%e

-'ll';i a!(erse ee)ts )a e 'te! i /atiets

!e)rease! #e#'ry a! )')etrati' !r';siess

Ce %a! tre#'r ;ea&ess la)& '- )''r!iati'

ausea !iarr%ea ('#iti 'r -atiue.1210At )')etrati's @ust a'(e t%e t%era/euti) rae

*1.583 ##'l9L, )'-usi' i!!iess aitati'

slurre! s/ee)% let%ary la)&'uts ataia

!ysart%ria ysta#us lurre! (isi' tiitus

(erti' %y/erreDeia %y/ert'ia )'arse %a!

tre#'rs a! #us)le -as)i)ulati's #ay '))ur i

/atiets.


8/29

- )')etrati's e)ee! ##'l9L se(ere t'i)ity

'))urs ;it% )%'re'at%et'sis seiures irre(ersile

rai !a#ae arr%yt%#ias %y/'tesi'

res/irat'ry a! )ar!i'(as)ular )'#/li)ati's

stu/'r )'#a a! !eat%

Be)ause '- t%is a! t%e se(ere t'i) si!e ee)ts

lit%iu# )')etrati's a'(e 3.584 ##'l9L #ay

re:uire %e#'!ialysis t' re#'(e t%e !ru as

:ui)&ly as /'ssile


9/29

EFFE!" #F $I"E%"E "!%!E" %&$ #&$I!I#&"

#& LI!'IU( )'%R(%#*I&E!I"

eli#iati' %al-=li-e '- 24 %'urs ('lu#e '-

!istriuti' e:ual t' 0.> L9& a! )leara)e '-

20 #L9#i -'r lit%iu#.

uri a a)ute #ai) /%ase lit%iu#

)leara)e )a i)rease y as #u)% as 50F

;%i)% /r'!u)es a %al-=li-e t%at is a'ut 192 t%e

'r#al (alue.


10/29

et .. )%il!re >812 years '- ae a(erae eli#iati' %al-=

li-e e:uals 1< %'urs ('lu#e '- !istriuti' is 0.> L9&

a! )leara)e e:uals 40 #L9#i -'r t%e i'.

Be)ause l'#erular Cltrati' a! )reatiie )leara)e

!e)rease ;it% ae lit%iu# )leara)e )a e !e)rease!

i el!erly /atiets /r'!u)i %al-=li(es u/ t' 36 %'urs.

Be)ause '- t%e )ir)a!ia r%yt%# '- l'#erular Cltrati'

lit%iu# )leara)e is a'ut 30F %i%er !uri !ayti#e

%'urs.


11/29

Real ys-u)ti'Be)ause lit%iu# is eli#iate! al#'st e)lusi(ely

y t%e &i!ey real !ys-u)ti' is t%e #'st

i#/'rtat !isease state t%at ae)ts lit%iu#

/%ar#a)'&ieti)s. Lit%iu# )leara)e rate

!e)reases i /r'/'rti' t' )reatiie )leara)e.

a!ults t%e lit%iu# )leara)e9)reatiie

)leara)e rati' is 20F ut !uri a #ai)

/%ase i)reases t' a'ut 30F


12/29

Real ys-u)ti'%is relati's%i/ et;ee real -u)ti' a!

lit%iu# )leara)e ;ill -'r# t%e asis -'r iitial

!'sae )'#/utati' later i t%is )%a/ter.

Be)ause '- t%e !e)rease i )leara)e t%e

a(erae lit%iu# %al-=li-e is 40850 %'urs i real

-ailure /atiets.


13/29

S'!iu# 9 Hy!rati'%e real )leara)e '- lit%iu# -'r a /atiet is iDue)e! y t%e

state '- s'!iu# ala)e a! Dui! %y!rati' i t%at i!i(i!ual.

Lit%iu# is reas're! i t%e /r'i#al tuule '- t%e e/%r' (ia

t%e sa#e #e)%ais#s use! t' #aitai s'!iu# ala)e. %e

a /atiet is i eati(e s'!iu# ala)e t%e &i!ey i)reases

s'!iu# reas'r/ti' as a )'#/esat'ry #aeu(er a! lit%iu#

reas'r/ti' i)reases as a result.


14/29

S'!iu# 9 Hy!rati'%e &i!ey als' i)reases s'!iu#

reas'r/ti' ;%e a /atiet e)'#es

!e%y!rate! a! aai lit%iu# reas'r/ti'

i)reases.

't% )ases i)rease! lit%iu# reas'r/ti'

lea!s t' !e)rease! lit%iu# )leara)e.


15/29

A)ute Maiauri /eri'!s '- a)ute #aia lit%iu#

)leara)e )a e i)rease! y as #u)% as

50F


16/29

Prea)y 9 La)tati'Lit%iu# is eerally 't use! i t%e Crst tri#ester !ue

t' /'ssile terat'ei) ee)ts ' t%e -etus.

ue t' i)rease! l'#erular Cltrati' lit%iu# )leara)e

#ay e i)rease! i /reat ;'#e es/e)ially !uri

t%e t%ir! tri#ester. Lit%iu# )r'sses t%e /la)eta a!

%u#a #il& )')etrati's are 308100F t%at '-

)')urret seru# )')etrati's


17/29

ialysis 9 He#'Cltrati'Lit%iu# is re#'(e! -r'# t%e '!y y %e#'!ialysis

/erit'eal !ialysis a! arteri'(e'us

%e#'!iaCltrati' ;it% )leara)e (alues '- 30850

#L9#i 13815 #L9#i a! 21 #L9#i res/e)ti(ely.

%e sie(i )'e)iet -'r lit%iu# !uri

%e#'Cltrati' is 0.>0. Re/la)e#et !'ses '- lit%iu#

!uri !ialysis 'r %e#'Cltrati' s%'ul! e

!eter#ie! usi seru# )')etrati' #'it'ri.


18/29

ru tera)ti'sMay !iureti)s %a(e !ru itera)ti's ;it% lit%iu#.

%iai!e !iureti)s )ause s'!iu# a! ;ater !e/leti'

;%i)% lea!s t' i)rease! s'!iu# reas'r/ti' i t%e

/r'i#al tuule '- t%e &i!ey as a )'#/esat'ry

#e)%ais#. Si)e lit%iu# is reas're! y t%e sa#e

#e)%ais#s as s'!iu# lit%iu# reas'r/ti'

i)reases a! lit%iu# )leara)e !e)reases y40850F

!uri treat#et ;it% t%iai!e !iureti)s.


19/29

ru tera)ti's'ster'i!al atiiDa##at'ry aets *SAs,

als' !e)rease lit%iu# )leara)e a! i)rease

lit%iu# )')etrati's. %e /r'ale

#e)%ais# is a SA=i!u)e! !e)rease i

real l''! D'; (ia i%iiti' '- /r'stala!is.

O- t%ese aets suli!a) a! as/iri a//ear t'

%a(e little 'r ' !ru itera)ti' ;it% lit%iu#.


20/29

ru tera)ti'sAi'tesi=)'(erti ey#e i%iit'rs

*A7Es, a! ai'tesi re)e/t'r l')&ers

*ARBs, %a(e ee re/'rte! t' i%iit t%e

eli#iati' '- lit%iu# y a u!eCe!

#e)%ais#. O- t%e t;' )lasses '- !rus #'re

!')u#etati' eists -'r t%e A7Es ;%ere

lit%iu# seru# )')etrati's %a(e i)rease!

y as #u)% as 2008300F -r'# /retreat#et


21/29

ru tera)ti's%e'/%yllie i)reases t%e lit%iu#

)leara)e9)reatiie )leara)e rati' y as

#u)% as 5


22/29

7leara)e Esti#ate$'r /atiets ;it% a)ute #aia lit%iu#

)leara)e is i)rease! y a'ut 50F a! t%e

)'rres/'!i e:uati' -'r t%ese i!i(i!uals is

7l I 0.432*7r7l,

;%ere 7l is lit%iu# )leara)e i liters /er !aya! 7r7l is )reatiie )leara)e i #illiliters

/er #iute


23/29

7leara)e Esti#ate%is relati's%i/ all';s t%e esti#ati' '- lit%iu#

)leara)e -'r a /atiet ;%i)% )a e use! t' )'#/utea iitial !'se '- t%e !ru. Mat%e#ati)ally t%ee:uati' -'r t%e strai%t lie s%'; i $iure 1"=2

l + 0,.rl;%ere 7l is lit%iu# )leara)e i #l9#i a! 7r7l is

)reatiie )leara)e i #illiliters /er #iute.

$'r !'si /ur/'ses it is #'re use-ul t' %a(e lit%iu#

)leara)e e/resse! i liters /er !ay. %e e:uati')'(erte! t' t%ese uits is

l +0,.rl

;%ere 7l is lit%iu# )leara)e i liters /er !ay a! 7r7l

is )reatiie )leara)e i #illiliters /er #iute.


24/29

FIGURE 17- %e rati' et;ee lit%iu# )leara)e

a! )reatiie )leara)e is 0.2 -'r /atietsre:uiri #aitea)e t%era/y ;it% lit%iu#. %isrelati's%i/ is use! t' esti#ate lit%iu# )leara)e-'r /atiets re:uiri iitial !'si ;it% t%e !ru.


25/29

Stea!y=state 7')etrati' Sele)ti'Lit%iu# seru# )')etrati's are sele)te! ase! ' t%e

/rese)e 'r ase)e '- a)ute #aia a! titrate! t' res/'se

$'r i!i(i!uals ;it% a)ute #aia a #ii#u# lit%iu#

)')etrati' '- 0.< ##'l9L is usually re)'##e!e!. %e

usual !esire! rae -'r t%ese i!i(i!uals is 0.


26/29

Stea!y=state 7')etrati' Sele)ti'$'r l'=ter# #aitea)e use t%e usual

!esire! rae is 0.680.< ##'l9L. - /atiets !'

't res/'! t' t%ese le(els !uri

#aitea)e treat#et '))asi'al use '-

lit%iu# )')etrati's e:ual t' 0.>81 ##'l9L

is re:uire! a! i s'#e )ases )')etrati's

as %i% as 181.2 ##'l9L are e)essary t' ai

a a!e:uate 'ut)'#e.


27/29


28/29

Re-era)eBauer L. A. 2005. Clinical Pharmacokinetics

Handbook. e; J'r& M)= Gra;=Hill


29/29

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Lithium Klp 4 helna adelia