cpd slide edit 1

7/17/2019 Cpd Slide Edit 1

1/64

MODERATE

PERSISTENTASTHMA

Presented by : Taufq Ramadhan,S.FarmInneke Devi P, S.FarmNur Fitriani Ahdy,S.FarmSitara mi Rara !an"iS.FarmRid!an, S.Farm#ania In"rid, S.Farm

PKPA RS. BETHESDA

PERIODE OKTOBER-NOVEMBER 2014


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$T%INE &PREVA ENSI ASMA

ETIO O!I ASMA

K ASI"IKASI KEPARAHAN ASMAPATO"ISIO O!I ASMA

KAS#S $ %A&ABAN PERTAN'AANCRITICAL APPRAISAL

PRODUCT INFORMATION

1

2(

4)*

+,

DE"INISI ASMA

'

TERAPI ASMA

OUTLINE %#RNA


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A)) ima"e

ad*+ted are *n)y*r tudy +ur+* e

-


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Defni i ASMAPeny / t y n d t nd den n

d ny n 3 s /r n s 5 ds 67r n 5ern 5 s n d n 87

den n d ny symptoms se5ertMEN!I 9 WHEEZE ; NAPAS

TERSEN!A 9 SHORTNESS OF

BREATH ; DADA SESAK 9 CHESTTIGHTNESS d n BAT#K 9 COUGH

!6 b 6 In t t 3 ; 2014


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ETIO%O I a ma

/

K d K 3b6e; A556 ed T>er 5e7t ?s t>e @6 n ? 6 #se= Dr7 s; 201(

"AKTORPASIEN

"AKTORIN!K#N!

AN

ATOPI

DEB# ASAPROKOKPO #SI

B# #BINATAN!


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D#NIA

TAH#N 2012

0

T>e & r6d He 6t> S7r


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1

(

'

2

-

3

/

0

1

4

5

+.,+.(

*.- *.+*.4 *.2

)., )., ).+).4

Persent se 9B:

PREVA ENSI ASMA DIINDONESIA TAH#N 201(

R set Kese> t n D s r 201(; B 6 tb nKe3en/es RI


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4

PATOFISIO%OIa ma
http://var/www/apps/conversion/tmp/scratch_4/PPT%20CPD/ASMA3.mpghttp://var/www/apps/conversion/tmp/scratch_4/PPT%20CPD/ASMA3.mpghttp://var/www/apps/conversion/tmp/scratch_4/PPT%20CPD/ASMA3.mpghttp://var/www/apps/conversion/tmp/scratch_4/PPT%20CPD/ASMA3.mpghttp://var/www/apps/conversion/tmp/scratch_4/PPT%20CPD/ASMA3.mpghttp://var/www/apps/conversion/tmp/scratch_4/PPT%20CPD/ASMA3.mpg


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5

6%ASIFI6ASIa ma


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'(9NH BI; 200+; EC5ert P ne6 Re5 rt ( : !7 de6 nes = r t>e D n s snd Tre t3ent = Ast>3


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''

TERAPIa ma


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'-

FARMA6O%O IS

7 ?/ Re6 e=Med ? t n :

SA;A

9NH BI; 200+; EC5ert P ne6 Re5 rt ( : !7 de6 nes = r t>e D n s snd Tre t3ent = Ast>3


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6AS$S

'3


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KAS#S

1. D t de3 r 5 s enNama : Sdr 6AN*. RM : ((


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'0

1+ 12 1( 1, 12 1( 1 12 1( 20 12 1(

MAS#K I!D6e)uhan utama : e ak na a , ri!ayat

a ma @ B

6e adaran : CMDia"n* i : "a"a) na+a , asthma

attack Ri!ayat +enyakit ke)uar"a : a ma MAS#K RA&AT INAP6e)uhan utama : e ak e8ak 2 min""u )a)u

6e adaran : CMDia"n* i : asthma bronchial, "an""uan +*)a

na+aI tirahat>tidur : tidak ada ke)uhanAktivita : ter"antun" +enuh, tidak t*)eran i

aktivita 9erda arkan +*)ana+a

Se ak dan nyeriSatura i O 2 : 5/Aktivita : mandi dan "anti 9a8u di9antu

+era!at ma a)ah tidak t*)eran i9eraktivita 9e)um terata iPuku) 2'.(( : e ak 9erkuran"Pa ien tidur nyenyak, tidak ter9an"un

Se ak Aktivita : +a ien men"atakan 9adan)ema dan e ak, mandi dan "anti 9a8uma ih di9antu +era!atPuku) '4.(( : e ak udah 9erkuran", AD%di9antu

Tidur nyenyak

Se ak 9erkuran"Puku) '3.((: e ak , O 2 na a) 9i)a +er)uAktivita : mandi ma ih di9antu +era!atPuku) 2'.(( : k*ndi i umum edan", e ak9erkuran", re +ira i di9antu O 2 na a)Puku) 23.(( : e ak 9erkuran", +a ien tidurnyenyak


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'1

21 12 1( 22 12 1(

Aktivita di9antu e9a"ianSe ak 9erkuran"Pa ien tenan" dan tidur

Se ak 9erkuran", O2di)e+aAktivita mu)ai mandiri


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'4

P r 3eterN 6

1+ 12

20 12

Hem*")*9in '0,1

Hemat*krit 35,3

e7/ s t 21*0

1(*00

Eu in*f) 23,3 Tr*m9* it 3'5(

($reum '','

6reatinin (,15S OT 3',-

S PT 22,1

Natrium '-0,4

6a)ium /,(3

P r 3eterN 6

1+ 12

+CO2 44,5 mmH"+O2 ''-,- mmH"O2 Satura i 5-

HASIABORATORI#M

TIN!!I


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'5

T 6 He rtr te S7>7Res5 r t

ry R te TD

'1>'2 4('2 1('2 14


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OBAT9 r 6

1+ 12 1, 12 1 12 20 12

pa si so ma pa si so ma pa si so ma pa si so ma

Sa)9utam*) 2 m"

' ' ' ' ' ' ' ' ' '

;r*n *)van'/( m"

OBAT95 renter 6 $n> 6 s

1+ 12 1, 12 12 20 12pa si so ma pa si so ma pa si so ma pa si so ma

Amin*+hy))ineIn u

ID

STOP

Ce triaG*ne ' " I D ' ' (4 '2( '(4 '2( '(4 '2(

Ranitidin 2/m">m)

ID

STOP

Methy)+redni *)*ne '2/ m">2 m)

ID

'(4

''4

'(4

''4

'(4

''4

DeGametha *ne3 m" >m)

ID

STOP

DA"TAR PEMBERIAN OBAT


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2'

OBAT21 12 22 12 2( 12

P si so M P si so M P si so M

Sa)9utam*) 2 m" ' ' ' ' ' ' ';r*n *)van

'/( m"

CefGime'(( m"

' ' ' ' '

Methy)Predni *)*n 3

m"

' ' ' ' '

OBAT95 renter 6 $

n> 6 s

21 12 22 12 2( 12pa si so ma pa si so ma pa si so ma

Ce triaG*ne ' " '(4 STOP

Methy)+redni *)*ne '2/m"

'(4 STOP

F)iG*tide (,/ m">2m) C*m9ivent

2,/ m)@Ne9u)i erB

'(0 STOP

OBAT P# AN!

Sa)9utam*) 2 m" @- G ehari' ta9)etB;r*n *)van '/( m" @- G

ehari ta9)etBSeretide Di ku /(>2/( @2 G

ehariB

CefGime '(( m" @2 G ehari' ta9)etBMeti)+redni *)*n 3 m" @2 G

ehari ' ta9)etB


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PERTANJAAN

22

1 ;a"aimana tata)ak ana tera+i +adaa ma kate"*ri moderate-persistent K

2 A+akah tera+i a ma moderate- persistent yan" diterima +a ien udah

e uai den"an guideline K;a"aimana +er9andin"an e ektivita

+en""unaan ICS e?ara intermittent @+rnB dan rutin K

(


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7ALA;AN Tera+i yan" da+at di9erikan +ada +a ienm*derate +er i tent a thma ada)ah 6 Fd se I@SG ABA atau 3en n / t/ nd s s I@S 3en8 d 3ed 73 d se I@S

9seb ? ntr 66er d n SABA

9seb quic !"#i"$ 9NH BI; 200+; EC5ert P ne6 Re5 rt ( : !7 de6 nes = r t>e D n s s

nd Tre t3ent = Ast>3

1

6*m9ina i ter 5 ABA d n I@S6eb > e=e/t = da)am menin"katkanun" i +aru, mem+er9aiki symptoms

dan +er9aikan da)am rekuen i+en""unaan SA;A sebagai quick

reliever d b nd n / n den n I@S

den n d s s y n 6eb > t n9D7?> r3e;".M.; "t% ;

2010


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23

DOSIS n A?t n Bet 2 A n st @Sa)meter*)B /( m?">inha)a iASMA : 2 G ehari ' inha)a i$ntuk k*ntr*) a ma, %A;A haru di"unakanda)am k*m9ina i den"an inha)a i k*rtik* ter*iddan 9ukan e9a"ai m*n*tera+i


9Dr7 In= r3 t n H ndb /2014; ed s 2(


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2/



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20

2 Tera+i yan" di9erikan +ada +a ien BE #M e uaiden"an !7 de6 nes = r t>e D n s s nd

Tre t3ent = Ast>3 9N HBI;200+KETEPATAN

OBATOb t 7nt7/ ter 5 s3

y n d ber / n 5 d / s7s

Men7r7t !7 de6 nes = rt>e D n s s nd

Tre t3ent = Ast>39N HBI;200+

Sa)9utam*) ta9)et 2 m"@- G ehari ' ta9)etB

P!"$"!!"' optio( :%*! d* e ICS %A;A atauMedium d* e ICS @k*ntr*)B

A#t"!(&ti)" optio( *%*! d* e ICS %euk*trienRe?e+t*r Anta"*ni t>Te* in> i)eut*n @k*ntr*)B

;r*n *)van ta9)et '/( m"@- G ehari ta9)etB

F)iG*tide (,/ m">2 m) C*m9ivent 2,/ m) Ne9u)i er @3

G ehariBMethy)+redni *)*ne '2/ m">2

m)@2 G ehariB

Short Acting B2 Agonist@SA;AB e9a"ai quick reliever

Methy)+redni *)*ne 3 m"@2 G ehariB

Seretide Di ku /(>2/( m?"


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21

K d K 3b6e; A556 ed T>er 5e7t ?s t>e @6 n ? 6 #se= Dr7 s; 201(6*m9ina i )*! d* e ICS %A;A )e9ih 9aik da)ammenin"katkan un" i +aru di9andin"kan %A;A

te*f)in sustained release9Ad ?> ;M.; "t% ;200,


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24

KETEPATANDOSIS

Re 3en d s s 7nt7/ ter 5 s3y n d ber / n 5 d / s7s

Men7r7t !7 de6 nes = r t>eD n s s nd Tre t3ent =

Ast>3 9N HBI;200+

Seretide di ku /(>2/( m?"@2 G ehariB

Sa)meter*) /( m?">inha)a i '((m?"

F)uti?a *ne +r*+i*nate 2/( m?"

/(( m?"

%A;A @Sa)meter*)B mak ima)'(( m?"

%*! d* e ICS '((e D n s snd Tre t3ent = Ast>3

D s s ter6 67t n


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25

( Dai)y ICS )e9ih un""u) dari+ada intermitent ICS +ada 9e9era+aindikat*r e+erti un" i +aru, +eradan"an a)uran udara, dan+en""unaan k*ntr*) dan re)iever a ma

9@> 7> n B"; "t ; 201(


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O$T%INE 7$RNA%

-(


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O7t6 ne re=erens


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CRITICA% APPRAISA%

-2


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Criti?a) a++rai a)


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Be= re ?*m+)etin" thi ?he?k)i t,?*n ider:

'. I the +a+er a y temati? revie! *r

meta


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An 6 s s PI@OP s en P 576 s

Pa ien de!a a dan anak u ia 2 tahun,)aki


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Section 1: Internal validity

'.'

The tudy addre e a ?)ear)y defned re ear?hque ti*n. Je Q Can t ay Q

N* Q[i] The research question and inclusion criteria should be established before the review isconducted. To score a yes for this factor there must be reference to a protocol, ethicsapproval, or pre-determined/a priori published research ob ectives.


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'.2

At )ea t t!* +e*+)e h*u)d e)e?t tudieand eGtra?t data.

[i] !t least two people should select papers and e"tract data. There should bea consensus procedure to resolve any differences.

Je Q Can t ay QN* Q



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'.- A ?*m+rehen ive )iterature ear?h i

?arried *ut. Je Q Can t ay Q N* Q D*e n*ta++)y #



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'.

3

The auth*r ?)ear)y tate i *r h*! they

)imited their revie! 9y +u9)i?ati*n ty+e.

[i] The authors should state whether or not they e"cluded any reports $from the

systematic review%, based on their publication status or lan&ua&e. 'f searchin&sources that contains both &rey and non-&rey literature, must specify that theywere searchin& for both.

Je Q N*

Q



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Chara?teri ti? * eG?)uded tudie


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'./ The in?)uded and eG?)uded tudie are)i ted.

[i] ! list of included and e"cluded studies should be provided. (imitin& thee"cluded studies to references is acceptable.

Je Q N*Q



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'.0 The ?hara?teri ti? * the in?)uded tudie are+r*vided. Je Q N*Q



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'.1 The ?ientif? qua)ity * the in?)uded tudiei a e ed and d*?umented.

Je Q N*

Q


S i 1 I l lidi


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'.4 The ?ientif? qua)ity * the in?)uded

tudie !a a e ed a++r*+riate)y. Je Q Can t ay Q

N* Q


S i 1 I l lidi


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'.

5

A++r*+riate meth*d are u ed t* ?*m9ine

the individua) tudy fndin" .

Je Q Can t ay QN*

Q" r t>e 5 6ed res76ts; test s> 76d be d ne t ens7re

t>e st7d es Fere ? 3b n b6e; t ssess t>e r> 3 ene ty 9 .e.; @> -s 7 red test = r > 3 ene ty;

+ . I= >eter ene ty eC sts r nd 3 e e?ts 3 de6s> 76d be 7sed nd r t>e ?6 n ? 6 55r 5r teness =

? 3b n n s> 76d be t /en nt ? ns der t n


S ti 1 I t l lidit


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'.'

(

The )ike)ih**d * +u9)i?ati*n 9ia i

a e ed.[i] !n assessment of publication bias should include a combination of &raphical aids$e.&., funnel plot, other available tests% and/or statistical tests $e.&., )&&erre&ression test, *ed&es-+l en%. $ Note core 0ant say1 if there were fewer than

23 included studies%.

Je Q Can t ay QN* Q


S ti 1 I t l lidit


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'.'

'

C*n i?t * intere t are

de?)ared.[i] 4otential sources of support should be clearly ac nowled&ed in both thesystematic review and the included studies.

Je Q N*Q



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2.' Lhat i y*ur *vera)) a e ment * the

meth*d*)*"i?a) qua)ity * thi revie!K[i] 5ate the overall methodolo&ical quality of the study, usin& the followin& as a&uide High quality $66% 7a ority of criteria met. (ittle or no ris of bias..Acceptable $6% 7ost criteria met. ome flaws in the study with an associatedris of bias. Low quality $-% )ither most criteria not met, or si&nificant flawsrelatin& to ey aspects of study desi&n. Reject $3% tudy is irrelevant to 89 orwron& study type.

*i&h quality $66% # !cceptable $6% #(ow quality $-% #'rrelevant/ wron& type : re ect $3% #

Section 2: verall A!!e!!"ent # $he Study


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2.2

Are the re u)t * thi tudy dire?t)ya++)i?a9)e t* the +atient "r*u+ tar"eted 9ythi "uide)ineK

Je Q N*Q

Section 2: verall A!!e!!"ent # $he Study


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/'

PROD$CTINFORMATIO

N

S 6b7 3 6


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S 6b7t 3 6

/2

Ind / s Br n?> s5 s36*ntraIndika i

Hi+er en iti terhada+ a)9utam*), adrenergic amines ,atau 9ahan da)am *rmu)a i

D* i Neb76 Jer : (,/ m) maG '(m">23 8amMDI : '4(m?" 2 G em+r*t me)a)ui mu)ut 3


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S 6b7t 3 6

/-

Pre n n?y @Farmak*kinetik

On et: 2/ menit @#ent*)in HFAB, (,/


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Met>y65redn s 6 ne

/3

Ind / s Ant n 3 s t 7 37n s75ress n6*ntraIndika i

Hi+er en iti terhada+ methy)+redni *)*n, intrathe?a)admini trati*n, +remature in ant, IM. Admini trati*nin idi*+athi? thr*m9*?yt*+enia.

D* i Or 6 : (.''1


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Met>y65redn s 6 ne

//

Pre n n?y @

Farmak*kinetik

On et: ' 2 8am @*ra)B, 3 4 hari @IMB,Dura i: -( -0 8am @POB, ' 3 min""u @IMBPun?ak !aktu +)a ma: Inha)a i, 2


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Seret de D s/7s9S 63eter 6 "67t ? s ne

/0

Ind / s Pen b t n s 35 3 t / 5 d 5 s en s39 nt n 3 s ; SABA

6*ntraIndika i

Hi+er en iti terhada+ a)meter*) dan utika *ne

D* iediaan

/(>'(( m?" /(>2/( m?" /(>/(( m?"

Mekani me

Sa)meter*)

%*n"


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Seret de D s/7s9S 63eter 6 "67t ? s ne

/1

KI Darunavir, * am+renavir, idinavir, i*+inavir,ne)fnavir, rit*navir

Interak i

Seriu amitri+ty)ine, am*Ga+ine, 9*?e+revir,?)*mi+ramineC*9i?i tat, de i+ramine, d* u)e+in, d*Ge+in,

ide)a)i i9Imi+ramine, i *?ar9*Ga id, iva?a t*r,)ine *)id, )* e+ramineMa+r*ti)ine, me *quine, mian erin,n*rtri+ty)ine, +hene) ine, +r*tri+ty)ine,te)a+revir, trany)?y+r*mine

Tra *d*ne, trimi+ramineSi"nifkan

;ude *nide, deGametha *ne, in u)in,)*ratadine, +henyt*in, +redni *ne,

imva tatin, the*+hy))in,

HAR A : R+ '43.555 @PERORAN ANBTer3 s7/ d 6 3 " r376 r 73 N s n 6


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T>e 5>y66 ne

/4

Ind / s Pen b t n e8 6 d n bstr7/s 8 6 n n 5 s

/ b t s3 /r n s t 7 5eny / t 5 r7-5 r7/r n s 6 nny

6*ntraIndika i

Hi+er en iti terhada+ the*+hy))in, atau 9ahan da)am*rmu)a i

D* i Or 6 s 67t n : 3(( 0(( m">hariECtended re6e se : 3(( 0(( m">hariIntr 8am

Mekani me

;r*nk*di)ata i, diure i , CNS dan men timu)a i 8antun"

Interak iSeriu Ci+r* *Ga?in, Ri a9utin, Ri am+inSi"nifkan

;ude *nide, DeGametha *ne, Predni *ne,Predni *)*ne, Methy)+redni *)*ne

E ekam+in"

Takikardi, akit ke+a)a, mua), muntah, trem*r,diure i


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T>e 5>y66 ne

/5

Pre n n?y @

Farmak*kinetik

On et: varia9)eDura i: varia9)ePun?ak !aktu +)a ma: ' 8am POLaktu Paruh E)imina i: 4.1 8amEk re i : urine

Har"a HAR A : R+ 3'2,/ @PERORAN ANBTer3 s7/ d 6 3 " r376 r 73 N s n 6


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"6 C t de 9"67t ? s ne

0(

Ind / s Seb ter 5 5r 6 /s s 5 d s36*ntraIndika i

Hi+er en iti terhada+ uti?a *ne, atau 9ahan da)am*rmu)a i +en"*9atan +rimer tatu a matiku atau

9r*nk* +a me akut

D* i In> 6 s : 44 33( m?">2 G ehariOr 6 : 33( m?">2 G ehari, maG : 44( m?"M der te st>3 : 2/( /(( m?"> 2 G ehari

Mekani me

#a *k*ntrik i dan e9a"ai anti in ama i

Interak i Seriu ny 7nt7/ ser n n s3 /7t9Ke57t7s n Menter Kese> t n N 3 r 1)t >7n 2014

@ 3b


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cpd slide edit 1

Documents

ine preva ensi asmaetio

anti 9a8uma ih di9antu

o 2 na a 9ia eruaktivita

mandi ma ih di9antu

anti 9a8u di9antu era

a ien menatakan 9adanema

eran iaktivita 9erda

ndi i umum edan