Drug Eruption Ppt

8/17/2019 Drug Eruption Ppt

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DRUG

ERUPTION

Presentator : DISKY SANJAYA MUKTI

WINDA ADELIA LUBIS JESSICA VEDHAMANI MURTY

FAUZA AULIA JUNIART SIHTAN!

Pembimbing : dr. Dwidr. Dini


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DEFINISI

Er"#s$ o%at a&er'$ ata" a&&er'$( )r"'

er"#t$on a)a&a* rea+s$ a&er'$ #a)a+"&$t ata")aera* ,"+o+"tan -an' ter.a)$ se%a'a$ a+$%at#e,%er$an o%at )en'an (ara s$ste,$+/


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Jen$s0.en$s o%at -an' #a&$n' ser$n' ,en-e%a+an

er"#s$ o%at a&er'$:golongan antimikroba -a$t" se+$tar 48,3!,

golongan anti in"ama#i non #teroid se+$tar$%,&!


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EPIDEMIL!I$ns$)ens er"#s$ o%at a&er'$ ,en(a#a$ 12334 )ar$

tota& 15/513 #as$en )er,ato&o'$ se&a,aseta*"n/

Er"#s$ o%at a&er'$ ter.a)$ #a)a 1064 #as$en-an' )$ra7at )$ r",a* sa+$t2 teta#$ *an-a 14-an' %era+$%at 8ata&/

Ins$)ens er"#s$ o%at a&er'$ #a)a Ne'ara%er+e,%an' %er+$sar antara 94 64


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Non imunologis

Efek samping farmakologis Bibir kering akibat antihistamin

Efek samping farmakologis sekunder Thrush akibat pemakaian antibiotik

Toksisitas obat Hepatotoksisitas akibat methotrexate

Overdosis obat Kejang akibat kelebihan pemakaian

lidokain

Intoleransi Tinitus akibat pemakaian aspirin


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Common drugs Eruption

Ampicillin,penicillin,

phenylbutazone,sulpho-namides, gold, genta-mycin, cephalosporins,

barbit-

urates,thia-

zides

1- Morbilliform(exanthematous(: • the most commonpattern

•Lesions are symmetric,

with confluenterythematous maculesand papules that sparethe palms and soles

• It typically developswithin 2 weeks after theonset of therapy


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ACI ,aspirin!"#AI$s,bloodproducts,cephalosporins,cetirizine, de%tran, infli%imab,inhaled steroids, opiates,penicillin, radiologic contrastmaterial, ranitidine, tetra-

cycline, vaccines, zidovudine

2- Urticaria:•&he 2nd mostcommon eruption

•'ccurs as smallwheals that may

coalesce or havecyclical or gyrateforms

•Lesions appear

within ()h of intakeand resolve rapidlywhen the drug iswithdrawn


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Aspirin,cephalosporins,cytoto%ics,heparin

3- Purpura:•Can occur alone or asa component of

vasculitis


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*old,AC inhibitors,

thiazides, bismuth,barbiturates, griseofulvine,

metro-

nidazole

- Pit!riasis rosea-

li"e:•ruption is similar to+

• Itching is severe notresponding toantihist-amines

•

&here is no tendencyof spontaneousremission


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Allopurinol,sulphonamides,anticon

vulsants, aspirin, barbiturates,captopril, cefo%itin, chlorouine,chlorpro-

mazine,

cimetidine,griseofulvin,

lithium,

nitrofurantoin

#$

Er!throderma.It is a scalingerythematousdermatitisinvolving /01 ormore of thecutaneous

surface


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FAKTR RESIK Jen$s +e&a,$n )an "s$a

Fa+tor 'enet$+Pa.anan o%at se%e&",n-a

R$7a-at #en-a+$t -an' )$,$&$+$

Cara ,as"+ o%at


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DIA!NSISAna,nes$s ;LD CART< )an 'e.a&a #en-erta

&a$nn-a

;Jen$s R"a, #r$,er ata" se+"n)er2 &o+as$2)$str$%"s$2 "+"ran2 .",&a*<

B$o#s$ +"&$t

Pe,er$+saan *$sto#ato&o'$ )an $,"no=oresens$)$re+ +arena )a#at )$&$*at )ar$ a)an-a eos$no>&)an e)e,a .ar$n'an/

Pe,er$+saan &a%orator$",

Dara* &en'+a# ;at-#$(a& &-,#*o(-tos$s2ne"tro#*$&$a2 eos$no#*$&$a< serta LFT )an RFT/

Pe,er$+saan ".$ te,#e& )an ".$ #ro?o+as$


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PENATALAKSANAANPe,%er$an +ort$+ostero$) -an' ser$n'

)$'"na+an a)a&a* #re)n$son/

Dos$s stan)ar "nt"+ oran' )e7asa a)a&a* 6@ 9 ,' sa,#a$ @ 9 ,' se*ar$ ;"rt$+ar$a2er$te,a2 )er,at$t$s ,e)$+a,entosa2 #"r#"ra2er$te,a no)os",2 )an e+sante,a >+st",<

Ant$*$sta,$n -an' %ers$8at se)at$8 )a#at ."'a)$%er$+an .$+a ter)a#at rasa'ata&/


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Pen'o%atan to#$+a& ter'ant"n' #a)a+ea)aan +e&a$nan +"&$t a#a+a* +er$n' ata"%asa*/

J$+a +er$n' )a#at )$%er$+an %e)a+ sa&$s$&at 14)$ta,%a* o%at ant$#r"r$t"s se#ert$ ,ento&094 "nt"+ ,en'"ran'$ rasa 'ata&

J$+a %asa* +o,#res )en'an &ar"tan asa,sa&$s$&at 94


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PR!NSISEr"#s$ +"&$t +arena o%at a+an ,en-e,%"* %$&a

o%at #en-e%a%n-a )a#at )$+eta*"$ )an se'era)$s$n'+$r+an/

S$n)ro, Ste?en Jo*nsons ,e,$&$+$ an'+a,orta&$tas )$%a7a* 4 se)an'+an to@$(

e#$)er,a& ne(ro&-s$s ;TEN< ,en(a#a$ 1064)an +e%an-a+an #as$en ,en$n''a& a+$%atse#s$s/


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STATUS RAN! SAKITNo,or RM :/G/13/5

Nama '.Danil

U,"r 6 ta*"n Jen$s Ke&a,$n La+$0&a+$

Stat"s Per+a7$nan Men$+a*

Pe+er.aan W$ras7asta

S"+" Ja7a

A'a,a Is&a,

A&a,at J&/ Se$ Brantas No/ 6


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ANAMNESIS PENYAKITKe&"*an "ta,a : Ber(a+ +e,era*an )$se&"r"* t"%"*Ha& $n$ )$a&a,$ s )a&a, 9 ,$n''" $n$/ Ber(a+ +e,era*an )$serta$)en'an rasa 'ata& )an n-er$ )$.",#a$ )$ se&"r"* t"%"*/ A7a&n-a%er(a+ *an-a ,"n("& )$ )aera* tan'an )an +a+$2 +e,")$an,en-e%ar +e )aera* %a)an )an ,en'ena$ )aera* 7a.a*/ Men"r"ts2 %er(a+ t$,%"& sete&a* os ,en'+ons",s$ o%at0o%atan -an'

)$#ero&e* )ar$ +&$n$+ atas $n)$+as$ +ontro& #ost o#eras$ *ern$a$n'"$na&$s/ Ber(a+ +e,era*an ,"n("& 9 .a, sete&a* os,en'+ons",s$ o%at/

R$7a-at a&er'$ o%at se%e&",n-a t$)a+ )$.",#a$2 r$7a-at a&er'$,a+anan se%e&",n-a t$)a+ )$.",#a$2 r$7a-at +e&"ar'a )en'an+e&"*an -an' sa,a t$)a+ )$.",#a$/

R$7a-at #en-a+$t '"&a t$)a+ )$.",#a$2 r$7a-at #en-a+$t *$#ertens$t$)a+ )$.",#a$/

RPT : Hern$a In'"$na&$s

RP : C$#ro=o@a($n


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(N('NE)I) U'U' ORG(N

Jantung Sesak apas! "#ngina $ektoris! "

Edema! "$alpitasi! "

%ain"lain! "

Saluran $ernafasan Batuk"batuk! "

&ahak ! "

#sma' bronkitis! "

%ain"lain! "Saluran $en(ernaan afsu

)akan!ormal

Keluhan )enelan! "

Keluhan $erut! "

$enurunan BB! "

Keluhan

&efekasi! "

%ain"lain! "

Saluran *rogenital Sakit B#K! "

)engandung batu! "

Haid! "

B#K tersendat! "

Keadaan urin! "

%ain"lain!"


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Sendi dan Tulang Sakit $inggang! "

Keluhan $ersendian! "

Keterbatasan +erak! "

%ain"lain! "

Endokrin Haus,$olidipsi! "

$oliuri! "

$olifagi! "

+ugup! "

$erubahan suara! "

%ain"lain! "

Saraf $usat Sakit Kepala! " Ho-ong! "

%ain"lain! "

&arah dan $embuluh

&arah

$u(at!"

$ete(hiae! "

$erdarahan! "

$urpura! "

%ain"lain! "

Sirkulasi $erifer .laudi(atio Intermitten! " %ain"lain! "

ANAMNESIS FAMILI: /i0a-at Keluarga dengan keluhan -ang sama disangkal


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PE'ERI*)((N +I)I* DI(GNO)TI*

Keadaan *mum Keadaan $en-akit

Sensorium ! .ompos )entis $an(aran 1ajah ! lemas

Tekanan darah ! 234,54 mmHg Sikap $aksa ! "

adi ! 64 x,i' reg,irreg'

t,v! (ukup

/efleks 7isiologis ! 8

$ernafasan ! 34 x,i /efleks $atologis ! "

Temperatur ! 96:5;.

STATUS PRESENS:


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Anemia


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EPALA:)ata !konjungtiva palpebra pu(at


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T$%RA& DEPAN

Inspeksi

Bentuk ! Simetris 7usiformis

$ergerakan ! Tidak ada ketinggalan bernapas

%ain"lain ! makulopapulo eritematous

Palpasi

-eri tekan !


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'ANTUN(

Batas atas jantung ! I.S II %).S

Batas kiri jantung ! ICS V2 9 (, ,e)$a& LMCSBatas kanan jantung ! I.S ? %$S&

#uskultasi$aru

Suara pernafasan ! ?esikuler

Suara tambahan ! "

Jantung

)2 A )3' $3 A $2' T2 A T3' #3 A #2' desah sistolis


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T$%RA& #ELAAN(

Inspeksi ! simetris fusiformis

lain"lain! makulopapulo eritematous

$alpasi ! S7 kanan @ S7' kesan! normal

$erkusi ! Sonor

#uskultasi !

Suara pernafasan ! ?esikuler Suara tambahan ! "

A#D%MEN

Inspeksi

Bentuk ! Simetris+erakan %ambung,*sus ! "

?ena Kolateral ! "

.aput )edusae ! "

$alpasi

&inding #bdomen ! soepel' H,%,/ tidak teraba


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LIMFA

$embesaran !


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AN((%TA (ERA ATAS AN((%TA (ERA#A-A$

Kiri Kanan

Edema " "&eformitas sendi " #rteri 7emoralis 8 8

%okasi " #rteri Tibialis $osterior 8 8

Jari Tabuh " #rteri &orsalis $edis 8 8

Tremor *jung Jari " /efleks K$/ 88 88

Telapak tangan sembab " /efleks #$/ 88 88

Sianosis " /efleks 7isiologis 8 8Eritema palmaris " /efleks $atologis ! " "

%ain"lain )akuloa ulo

%ain"lain )akuloa ulo

)akuloa ulo


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&arah Kemih Tinja

Hb

Eritrosit

%eukosit

Trombosit

Ht

eutrofil

%imfosit

)onositEosinofil

Basofil

26'g ,dl

6'4x246 ,mm9

C9'55x249 ,mm9

CCDx249,mm9

CD'>

56'D

23'>

C'96'C

4

Kesan leukositosis' eosinofilia

1arna! "

$rotein! "

/eduksi! "

Bilirubin! "

*robilinogen! "Sedimen

Eritrosit! "

%eukosit! "

Epitel! "

Silinder! "

1arna! "

Konsistensi! "

Eritrosit! "

%eukosit! "

#moeba,Kista! "Telur .a(ing

#s(aris! "

#nk-lostoma! "

T: Tri(hiura! "

Kremi! "

Pemeriksaan La.oratorium Rutin


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RESUMEelu"an utama: Eritema +eneralisata

Telaa":Hal ini dialami o:s F 2 minggu S)/S: Keluhan mun(ul F 2 jamsetelah os mengkonsumsi obat -ang diperoleh dari klinik atasindikasi kontrol post operasi hernia inguinalis: +atal


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ST#T*S $/ESES

Keadaan *mum ! Baik,Sedang,Buruk

Keadaan $en-akit ! /ingan , Sedang , Berat

Keadaan +iGi ! Kurang,ormal,Berlebih

$E)E/IKS##

7ISIK

*eala:E)e,a #ae%era;<Er$te,a %ers+"a,a )$ se&"r"* 7a.a*;<

T1ora2:Ma+"&a ;


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%#BO/#TO/I*)

/*TI

DARA$ :

Hb ! 26'g ,dlEritrosit !6'4x246 ,mm9

%eukosit !C9'55x249 ,mm9

Trombosit ! CCDx249,mm9

Ht ! CD'>

URIN ! " TIN'A : /


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&I#+OSIS B#&I+

&rug eruption

*rtikaria

Stevens Johnson S-ndrome

&I#+OSIS

SE)ET#/#

&rug Eruption8 $ost Operasi Hernia Inguinalis &extra

$E#T#%#KS###

#ktivitas ! tirah baring

&iet )II

Tindakan suportif ! I?7& a.l 4' 34 gtt,i


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2: &arah /utin' &iftel >: RFT

3: 7oto Thoraks 6: Biopsi

9: Skin $ri(k Test

C: LFT (SGOT,SGPT,Bilirubin total, direct)

Ren!ana Pen0a0akan Diagnostik ) Tindakan Lan0utan

FLLW UP


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FLLW UP

Tgl ) O ( P

Tera#$ D$a'nost$+9G9119

Ben'+a+)$se&"r"* t"%"*;


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6a#il lab tgl %5/%$/$%< :

H%:932')&Er$tros$t:32@93 &

W%(: 43,52%3 &P&ate&et: G@96 &Ht:G24MCV:5238LMCH:152G #'MCHC: 62G ')LPCT:/1 4

RDW0CV :9/RDW0SD : 6/ne"tro>&:532G4&$,8os$t:9124,onos$t:6264eos$no>&:324%aso#*$&:24Meta%o&$s,e +ar%o*$)rat!&"+osa )ara* ;se7a+t"


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FLLW UPTgl ) O ( P

Tera#$ D$a'nost$+

99119

Ben'+a+)$se&"r"*t"%"*;oratadine

%2%

9/R Fotot*ora+s

1/Ce+ RFT2LFT2 A&%

6/K"&t"r #"s

FLLW UP


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FLLW UPTgl ) O ( P

Tera#$ D$a'nost$+

199119

Ben'+a

+)$se&"r"* t"%"*;


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FLLW UPTgl ) O ( P

Tera#$ D$a'nost$+

119

119

Ben'+a+)$se&"r"* t"%"*;oratadine %2%-(A0

" )o?t U derm" *omre# Nal

,&!/ 4 am#elama %<menit adal@ka o#toera#i

" +@#;om reamdiole#kan $2#e1ari adal@ka


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*imia *linik tanggal $$/%$/%<

S!T : 1G2 U&S!PT : 32 U&A&+/ Pos#atase : G92 U&

Tota& B$&$r"%$n :26 ,')&D$re(t %$&$r"%$n :29 ,')&A&%",$n : 62 ,')&Ure", : 62 ,')&Creat$n$n : 256 ,')&

Ur$( a($): 2 ,')&

DISKUSI


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DISKUSITE%RI ASUS

Etiologi

)enurut penelitian andha' +upta Hashmi


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TE%RI ASUS

Pemeriksaan Penun0ang

• $emeriksaan laboratorium

$emeriksaan ini men(akup perhitungan darah lengkap


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KESIMPULANSeoran' #as$en &a+$0&a+$2 "s$a 6 ta*"n )$)$a'nos$s )en'an)r"' er"#s$on$n8e+s$ se+"n)er/

Tata&a+sana #a)a #as$en:

Tira1 baring

Diet 'II I9+D Nal ,&! $ gtt/i

In. Ranitidin


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TERIMA KASIH


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Drug Eruption Ppt

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