OBAT PADA SARAF PERIFER

OBAT PADA SARAF PERIFERDr.Muhammad Yusuf,SpSAgonis muskarinik : Ach,Ester kolin, alkaloid kolinergikAntagonis Muskarinik : Atropin, skopolamin, Obat adrenergik : Epinefrin,DopaminPenghambat Adrenergik: Bloker, BlokerMuscle Relaksan: Baklofen, Tizanidin, Esperison, Toksin botulinum Neurotropik : Mecobalamin

AtropinMECHANISM OF ACTION Parasympatholytic; menghambat aksi dari asetilkolin di daerah neuroefektor parasimpatik post ganglion meningktakan denyut jantung (HR) in life threatening bradyarrhythmias.INDICATIONS Hemodynamically unstable Bradycardia, Asystole, Bradycardic ( 5 yrs): 0.5 mg/kg twice daily, increase by 0.5 mg/kg/day every week to responseAdverse effects: weakness, drowsiness, lethargy, nausea, diarrheaChronic effects: liver toxicity with dosing near maximum and in women >50 yrsRoute of administration: oral, intravenousTizanidine (Zanaflex)Clonidine (Catapres)Mechanism of action: alpha-2 receptor agonistClinical effects: reduced tone, spasm frequency, and hyperreflexiaDoses: tizanidine initial 4 mg three times daily increase to 36 mg/day; clonidine initial 0.1 mg twice daily increase to 2.4 mg/dayTizanidine (Zanaflex)Clonidine (Catapres)Pediatric dose: tizanidine dose not established; clonidine initial 5-10 mcg/kg/day increase gradually to responseAdverse effects: drowsiness, dizziness, dry mouth, orthostatic hypotensionChronic effects: rebound hypertension with rapid withdrawalRoute of administration: oral, transdermal patch (Clonidine)Other Drugs for SpasticityCyproheptadine (Periactin): limited experienceCannabinoids (Marinol, Cesamet): work in multiple sclerosis; limited information on other usesOrphenadrine (Norflex): short actingGabapentin (Neurontin): possibly helpful in spinal cord injury or multiple sclerosisBotulinum Toxin (Botox, Myobloc)Enters the pre-synaptic terminal and binds to acetylcholineInhibits acetlycholine from entering the synaptic cleftToxin serves as a block at the neuromuscular unctionCan be administered to a specific muscle or group via local injectionBotoxUsed in tx of pts with focal dystonia as found in CVA; CP; TBA;Spinal Cord LesionsUsed to restore volitional motor control thus increasing use of extremities and improving function, mobility and opportunities to participate in meaningful occupationsPrevention of joint contraction and fixationAdverse EffectsTx limited to a few muscles due to potential for toxic effectsEffects of tx are temporary (3-6 months)Eperisone

Eperisone hydrochlorideantispasmodic drug, relaxing both skeletal muscles and vascular smooth muscles, and demonstrates a variety of effects such as reduction of myotonia, improvement of circulation, and suppression of the pain reflex. Indications Spastic paralysis ,improvement of muscular hypertonic symptoms in conditions such as cervical syndrome, periarthritis of the shoulder, lumbago.Dosage and administration In adults, the usual dose of eperisone is 50-150 mg per day, in divided doses after meals. Contraindications hypersensitivity to the drug.Cautions history of hypersensitivity to any medication, or with disorders of liver function Weakness, light-headedness, sleepiness or other symptoms may occur.

Side effects Shock and Anaphylactic reactions: In the event of symptoms such as redness, itching, urticaria, oedema of the face and other parts of the body, dyspnoea etc, Oculo-muco-cutaneous syndrome (Stevens Johnson Syndrome) and Toxic Epidermal Necrolysis: Serious dermatopathy such as oculo-muco-cutaneous syndrome (Stevens-Johnson syndrome) or toxic epidermal necrolysis may occur. , anaemia, rash, pruritus, sleepiness, insomnia, headache, nausea ang vomiting, anorexia, abdominal pain, diarrhoea, constipation, urinary retention or incontinence.MecobalaminIndication & Dosage OralPeripheral neuropathiesAdult: 1500 mcg/day in 3 divided doses.ParenteralPeripheral neuropathiesAdult: 500 mcg daily IM/IV 3 times/wk.ParenteralMegaloblastic anaemia caused by vitamin B12 deficiencyAdult: 500 mcg daily IM/IV 3 times/wk. Maintenance dose: After about 2 mth of therapy, reduce dose to single admin of 500 mcg every 1-3 mth.Adverse Drug Reactions Oral: Anorexia, nausea, vomiting and diarrhoea. Parenteral: Rash, headache, hot sensation, diaphoresis and pain/induration at IM inj site.Potentially Fatal: Anaphylactoid reactions (parenteral).Mechanisme of actionMecobalamin is the neurologically active form of vitamin B12 , a water-soluble vitamin in the body. It is a cofactor in the enzyme methionine synthase, which functions to transfer methyl groups for the regeneration of methionine from homocysteine. In anaemia, it increases erythrocyte production by promoting nucleic acid synthesis in the bone marrow and by promoting maturation and division of erythrocytes.