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Penulis Topik: Obat Pereda Sakit dan Penurun Panas  (Dibaca 54415 kali)

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Offline Idad

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Re: Obat Pereda Sakit dan Penurun Panas
« Jawab #75 pada: Januari 29, 2011, 04:21:03 PM »
pasti praktisi yang menganjurkan penggunaan ibuprofen di antara NSAID lainnya sudah mempertimbangkan risk and benefit, termasuk efek sampingnya terhadap mukosa saluran cerna. kalo semua melihat ke risk aja ga ada obat demam yang aman untuk anak.
m.., berarti selama :
1. Orang itu tidak ada gangguan lambung
2. Dosisnya dalam batas wajar

maka tidak masalah menggunakan Ibuprofen
bgitu ya Om?

Oia Om, mau tanya juga, Kalau misalnya ada pasien, dia kena gangguan Liver + Ginjal yang berarti. Na kan itu berarti kita harus hati2 menggunakan obat2an kan, terutama yang ada kontra indikasi penderita gangguan hati dan ginjal. Untuk obat2an, kan banyak yang KI terhadap itu. Jika kita menemui pasien ini, apa sebaiknya yang kita lakukan jika memang dia benar2 butuh obat  (misal, kena Gout dan harus dikasi Sulfynpyrazone, atau perlu Kortiko, padahal Kortiko ada efek retensi Na nya)?
Visit My Site ! ! !
Download Soal Matematika SMA ZyuProject



Offline syx

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Re: Obat Pereda Sakit dan Penurun Panas
« Jawab #76 pada: Januari 31, 2011, 10:27:24 PM »
yg pasti musti selektif dalam pemilihan obatnya. pertama mencari obat alternatif yang aman untuk kondisi tertentu, misalnya allopurinol untuk gout. kedua mempertimbangkan risk-and-benefit dari obat yang akan digunakan, apakah obat akan meringankan gejala ato malah memperberat penyakit dalam tubuh.

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Re: Obat Pereda Sakit dan Penurun Panas
« Jawab #77 pada: Februari 01, 2011, 10:11:46 PM »
All Nonsteroidal Anti-Inflammatory Drugs Have Cardiovascular Risks

January 21, 2011 — New data showing nonsteroidal anti-inflammatory drugs (NSAIDs) have cardiovascular risks are putting the well-known pain relievers back in the headlines. Investigators evaluating available evidence report they have found little to suggest that any of the investigated options are safe.

Regulatory agencies have already pointed to cardiovascular signals with NSAIDs, but these concerns are based mainly on observational evidence. This new study provides a comprehensive analysis of all randomized controlled trials of the drugs.

During an interview with Medscape Medical News, senior investigator Peter Jüni, MD, from the University of Bern in Switzerland, said his team expected to see an increased risk but was surprised by the magnitude of the signal. "We never thought we'd see 2- and 4-fold increased risks," he said. "The doses were admittedly high," he pointed out, "however, this is clearly clinically relevant."

Several earlier meta-analyses were unable to resolve the debate over risk because they failed to include all randomized evidence in 1 study. This new network meta-analysis, published online January 11 in BMJ, includes all available evidence.

The team led by Sven Trelle, MD, also at the University of Bern, included 31 trials and 116,429 patients taking naproxen, ibuprofen, diclofenac, celecoxib, etoricoxib, lumiracoxib, rofecoxib, or placebo.

Investigators saw an increase in myocardial infarctions, stroke, and cardiovascular death in patients taking all of these NSAIDs. Not surprisingly, rofecoxib was associated with the highest risk for myocardial infarction, with a rate ratio of 2.12. The drug's manufacturer, Merck, voluntarily withdrew the product marketed as Vioxx  in 2004 because of concerns over cardiotoxicity.

Lumiracoxib had the next highest rate of myocardial infarction in the current study. Ibuprofen was associated with the highest risk for stroke with a rate ratio of 3.36 followed by diclofenac at 2.86. Etoricoxib was linked to the highest rate of cardiovascular death at 4.07 followed by diclofenac at 3.98.

Dr. Jüni recommends that physicians take special care in evaluating patients prone to cardiovascular events. Those who require treatment should take the lowest possible dose for the shortest period.

Dr. Jüni says he would like to see black box warnings added to drug packaging for the products still available on the market.

Of all the NSAIDs, naproxen seemed least harmful in this study. The finding is in agreement with recommendations made by regulatory agencies when rofecoxib was first removed from the market and physicians were evaluating alternatives.

"I think we should reserve our final judgment on naproxen until after we've completed the overall safety study," Dr. Jüni said. His team is currently studying the gastrointestinal safety of the drug and weighing the benefits and risks from that perspective.

"With naproxen, we tend to need a proton pump inhibitor to protect the stomach," Dr. Jüni added. "This is far from ideal."

No Clear Link Between Specificity and Risk

In an interesting twist, investigators found no clear relation between specificity of cyclooxygenase-2 inhibitors and risk for cardiovascular events. This finding contrasts with previous claims that increased selectivity for cyclooxygenase-2 inhibitors is associated with cardiovascular risk.

Several mechanisms have been proposed, but the hypothesis of an imbalance between prostacyclin and thromboxane A2 leading to an increased risk for thrombotic events is the most well known.

The researchers suggest the lack of a clear association between specificity of cyclooxygenase-2 inhibitors and cardiovascular risk implies that other mechanisms should be considered. "Multiple effects most probably contribute to the increased risk of cardiovascular events, including differential effects on prostacyclin and thromboxane A2 synthesis, endothelial function, nitric oxide production, blood pressure, volume retention, and other renal effects," they note.

Millions of Patients Taking NSAIDs

In an accompanying editorial, Wayne Ray, PhD, from Vanderbilt in Nashville, Tennessee, pointed out that millions of patients with chronic musculoskeletal symptoms are long-term NSAID users.

In the United States, an estimated 5% of all visits to a physician are related to prescriptions of anti-inflammatories, and they are among the most commonly used medications.

"Given that both mechanistic and clinical data suggest that individual NSAIDs may have different cardiovascular risk profiles," Dr. Ray noted, "a natural question is, 'Which NSAID is safest for patients with high cardiovascular risk?'"

He points out the ongoing PRECISION trial, otherwise known as the Prospective Randomized Evaluation of Celecoxib Integrated Safety versus Ibuprofen Or Naproxen, will eventually provide more information on the relative cardiovascular safety of these options. "Until these results become available, naproxen seems to be the best choice with regard to cardiovascular safety."

Dr. Ray says the controversy and confusion about the cardiovascular safety of these products provides an important lesson. "Drugs for symptomatic relief must be evaluated with regard to the target symptoms as well as less frequent yet serious adverse effects. NSAIDs are not an ideal treatment with respect to efficacy or safety. Perhaps it is time for a larger more systematic evaluation of a broader range of alternatives."

This study was funded by the Swiss National Science Foundation. The researchers have disclosed no relevant financial relationships. Editorialist Dr. Wayne Ray has received funding from Pfizer. He served as an expert for the State of Texas in a lawsuit filed against Merck. Dr. Ray also works as an expert for an insurance company.

BMJ. 2011;342:c7086.

Offline Astrawinata G

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Re: Obat Pereda Sakit dan Penurun Panas
« Jawab #78 pada: Februari 04, 2011, 01:01:58 AM »
mau nanya , apakah setiap molekul prostaglandin akan menempati reseptornya sendiri? seperti PGF-alfa dsbg...kalau iya, bisa ga ya kita ciptakan obat yang khusus menghalangi menempelnya PG pemicu nyeri ini ke reseptornya? biar lebih selektif dan efek samping lebih sedikit ???
Best Regards,


Astrawinata G

Offline Idad

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Re: Obat Pereda Sakit dan Penurun Panas
« Jawab #79 pada: Februari 04, 2011, 09:59:37 PM »
yg pasti musti selektif dalam pemilihan obatnya. pertama mencari obat alternatif yang aman untuk kondisi tertentu, misalnya allopurinol untuk gout. kedua mempertimbangkan risk-and-benefit dari obat yang akan digunakan, apakah obat akan meringankan gejala ato malah memperberat penyakit dalam tubuh.
M.., gtu y, ok mksi banyak Om..,


Kutip
"With naproxen, we tend to need a proton pump inhibitor to protect the stomach," Dr. Jüni added. "This is far from ideal."
Hm, bukannya Proton Pump Inhibitor itu mahal y Om, klo alternatif untuk inin apa ya Om?

mau nanya , apakah setiap molekul prostaglandin akan menempati reseptornya sendiri? seperti PGF-alfa dsbg...kalau iya, bisa ga ya kita ciptakan obat yang khusus menghalangi menempelnya PG pemicu nyeri ini ke reseptornya? biar lebih selektif dan efek samping lebih sedikit ???
menarik2, gimana om syx?

Offline riandono

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Re: Obat Pereda Sakit dan Penurun Panas
« Jawab #80 pada: Februari 05, 2011, 02:08:28 PM »
@idad
Proton pump inhibitor kayaknya ngga mahal2 amat deh, udah banyak yg generik: omeprazole, lansoprazole

Offline Idad

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Re: Obat Pereda Sakit dan Penurun Panas
« Jawab #81 pada: Februari 05, 2011, 08:38:10 PM »
@idad
Proton pump inhibitor kayaknya ngga mahal2 amat deh, udah banyak yg generik: omeprazole, lansoprazole
oya, wh, sepertinya sy harus update info lagi..,,
ok2, mksi bang rian..,


Offline syx

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Re: Obat Pereda Sakit dan Penurun Panas
« Jawab #82 pada: Maret 17, 2011, 10:14:35 PM »
semoga tidak bikin para cowo takut minum obat analgesik-antipiretik, khususnya NSAID:

Regular NSAID Use Linked to Erectile Dysfunction

March 7, 2011 — Regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with erectile dysfunction (ED), according to the results of a prospective cohort study reported online February 21 and in the April print issue of the Journal of Urology.

"This study is a great example of how we work to understand the safety and effectiveness of what we recommend for our patients," said senior author Steven J. Jacobsen, MD, PhD, an epidemiologist and director of research for Kaiser Permanente Southern California in San Diego, in a news release.

"We went into this study thinking we would find the opposite effect: that NSAIDs would have a protective effect because they protect against heart disease, which is also linked to ED. The next step is to dive a bit deeper to understand the underlying physiology of what might be happening with these drugs."

Beginning in 2002, the California Men's Health Study enrolled a large, ethnically diverse cohort of male members of the Kaiser Permanente managed care plans who were 45 to 69 years old. A questionnaire evaluated ED, and automated pharmacy data and self-reported use allowed evaluation of NSAID exposure.

NSAID use was present in 47.4% of the 80,966 participants, and moderate or severe ED was reported in 29.3%. NSAID use and ED correlated strongly with age. Regular NSAID use increased from 34.5% in men aged 45 to 49 years to 54.7% in men aged 60 to 69 years, and ED increased from 13% to 42% in these age groups.

Without adjustment for potentially confounding variables, the odds ratio (OR) for the association of NSAIDs and ED was 2.40 (95% confidence interval [CI], 2.27 - 2.53). A positive association persisted after adjustment for age, race/ethnicity, smoking status, diabetes mellitus, hypertension, hyperlipidemia, peripheral vascular disease, coronary artery disease, and body mass index (adjusted OR, 1.38). A positive association also was evident when a stricter definition of NSAID exposure was used.

"There are many proven benefits of non steroidals in preventing heart disease and for other conditions," Dr. Jacobsen said. "People shouldn't stop taking them based on this observational study. However, if a man is taking this class of drugs and has ED, it's worth a discussion with his doctor."

Limitations of this study include cross-sectional design, potential participation bias, and low original participation rate.

"These data suggest that regular NSAID use is associated with ED even after extensive adjustment for age and potentially confounding factors or comorbidities," the study authors write.

"While this raises the question of the role of inflammation and COX [cyclooxygenase] pathways in ED etiology, we cannot exclude alternative explanations. However, if this is a direct relationship, the current strategy of using NSAIDs for cardiovascular disease protection as well as other common uses of NSAIDs should be weighed against the potential side effects of ED. Studies are needed to elucidate this association in more detail."

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Re: Obat Pereda Sakit dan Penurun Panas
« Jawab #83 pada: September 16, 2011, 12:26:04 AM »
September 6, 2011 — Use of nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) in early pregnancy is linked to twice the risk for miscarriage, according to the results of a nested case-control study reported online September 6 in the Canadian Medical Association Journal.

hati-hati penggunaan NSAID selain aspirin saat hamil muda...

 

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