Kuliah 7

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Mahasiswa mampu menjelaskan cara penggunaan
obat dengan alat khusus
1. Penggunaaan insulin
2. Penggunaan berbagai macam inhaler.

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http://www.asthma.org.uk/News/being-shown-the-right-way-to-use-an-inhaler-by-their-pharmacist-can-
help-people-manage-their-asthma

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Medication Usage
 Difficulties associated with
inhalers
 Complicated regimens
 Fears about, or actual side
effects
 Cost
 Distance to pharmacies
© Global Initiative for Asthma
Non-Medication Factors
 Misunderstanding/lack of
information
 Fears about side-effects
 Inappropriate expectations
 Underestimation of severity
 Attitudes toward ill health
 Cultural factors
 Poor communication
 Estimate Comparative Daily Dosages for
Inhaled Glucocorticosteroids by Age
Drug Low Daily Dose (g) Medium Daily Dose (g) High Daily Dose (g)
> 5 y Age < 5 y > 5 y Age <5y > 5 y Age < 5 y
Beclomethasone 200-500 100-200 >500-1000 >200-400 >1000 >400

Budesonide 200-600 100-200 600-1000 >200-400 >1000 >400

Budesonide-Neb 250-500 500-1000 >1000

Inhalation Suspension

Ciclesonide 80 – 160 80-160 >160-320 >160-320 >320-1280 >320

Flunisolide 500-1000 500-750 >1000-2000 >750-1250 >2000 >1250

Fluticasone 100-250 100-200 >250-500 >200-500 >500 >500

Mometasone furoate 200-400 100-200 > 400-800 >200-400 >800-1200 >400

Triamcinolone acetonide 400-1000 400-800 >1000-2000 >800-1200 >2000 >1200

© Global Initiative for Asthma
 NEBULIZER
 INHALER
 Metered-dose aaerosol.
 Dry-powder inhaler,

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  This is an electrical device that sends medicine
directly into mouth by tube or, in children, by
clear mask.
 It require no hand-breath coordination.
Simply put in the prescribed amount of
medicine, take the tube in your mouth (or
place the mask over the child's nose and
mouth) and breathe normally until the
medicine is gone.
(http://www.aafa.org/display.cfm?id=8&sub=17&cont=167)
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www.summitmedicalgroup.com
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asthmaready.org

rationalpreparedness.blogspot.com

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www.pediatricsupplier.com

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www.mountainside-medical.com

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conemaugh.kramesonline.
com

www.cfece.org

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 Convenient and easy to use.
 Dispense medicine directly to the place where it is
needed, greatly reducing side effects as compared
with medicines taken as pills or tablets.
 Deliver medicine to the troubled site quickly,
without need for absorption, digestion and
circulation.
 Deliver both long-lasting anti-inflammatory
benefits or short-acting, quick-relief
bronchodilation when needed.
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 As with adults, children with asthma may
need more than one inhaler.
 In order to run, swim and play with others, a
child with asthma may need one inhaler for
constant anti-inflammatory treatment and
another, containing different medicine, for
bronchodilation when a child is involved in
physical activity.

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 This sends a measured dose of medicine into
the mouth using a small amount of
pressurized gas.
 Sometimes a "spacer" is placed between the
drug reservoir and mouth to control the
amount inhale.

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 Aerosols fell out of favor a few years ago when
the common propellant chlorofluorocarbon
(CFC), a gas that depletes the atmosphere's
ozone layer, was banned throughout the
world.

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 Fluticasone
 Flixotide (flutikason propionate50 μg , 125 μg
/dosis) Inhalasi aerosol
▪ Puff (dalam resep)
 Dewasa dan anak > 16 tahun: 100-250 μg, 2 kali
sehariAnak 4-16 tahun; 50-100 μg, 2 kali sehari.

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 A popular alternative to aerosols.
 No propellant.
 Because it has no propellant, it depends on
the force of inhalation to get medicine to your
lungs.

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 Children, people with severe asthma, and
people suffering acute attacks may be unable
to produce enough airflow to use dry-powder
inhalers successfully.

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 The dry-powder inhalers are currently the most
common inhalers.
 Almost anyone with asthma (more than 90
percent of all asthma patients) is usually able to
inhale enough air to make the inhalers operate
properly.

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 However, infants and toddlers, and anyone
unable to manage the minimum hand-breath
coordination needed for effective use, should not
use this method.
 It also excludes anyone who, for any reason, is
not responsible enough to use the inhaler as it is
prescribed.

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 People with severe asthma, especially if
confined to bed, may benefit more from the
closed nebulizer system that provides
constant airflow and uses smaller particles
that get down to the airways more efficiently.

 Medicines that are not available in inhalable

form, continue to depend on pills or
injections.
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 Children five years old and up adjust easily to
dry-powder inhalers, but they need careful
instruction and watching to be certain they
use them correctly.
 (Infants can use inhaled anti-inflammatory
medicines by using nebulizers with masks.)

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 Budesonide
 Pulmicort (budesonide 100 μg, 200 μg, 400 μg /
dosis)Inhalasi aerosol 200 μg, 2 kali sehari.
 Serbuk inhalasi: 200-1600 μg / hari dalam dosis
terbagi anak: 200-800 μg/ hari dalam dosis
terbagi.

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 Turbuhaler
 Swinghaler
 Accuhaler
 Handihaler

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•Open
•Slide
•Inhale
•Close

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HOW TO USE SWINGHALER

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Capsule-Based Inhaler
Komponen-komponen
handihaler :
1. Dust cap (penutup)
2. Mouthpiece
3. Base (bagian dasar)
4. Piercing button
(tombol).
5. Center chamber
(tempat untuk
memasukkan obat).

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 A spacer is a large plastic or metal container,
with a mouthpiece at one end and a hole for
the aerosol inhaler at the other.
 Make inhaler easier to use and reduce the risk
of side effects.
 Spacers only work with an aerosol inhaler.
 Medicine is forced into the spacer, which then
squeeze as inhale the medicine quickly.

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 Brand names : Volumatic, Nebuhaler,
AeroChamber and Able Spacer

www.asthma.org.uk/knowledge-bank-treatment-and-medicines-spacers
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 Wash spacer once a month - leave it to drip-
dry as this helps to prevent the medicines
sticking to the sides
 Spacers should be replaced at least every year,
especially if you use them daily

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 Make sure that the spacer you have been
given fits your inhaler
 Put one puff of your inhaler into the spacer
and breathe in deeply through the
mouthpiece.
 Hold your breath for ten seconds (or for as
long as is comfortable) then breathe out
slowly.

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 It is best to take at least two deeply held
breaths for each puff of your inhaler.
 If you find it difficult to take deep breaths,
breathing in and out of the mouthpiece
several times is just as good.
 Repeat the step above for each dose/puff
needed

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 www.lrc.ky.gov

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 www.cpnonline.org

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SIDE EFFECT OF INHALATION
Esp. THROUGH THE MOUTH

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 Because the powder passes through your
mouth on the way to your lungs, and because
the particles are large, much of each dose (up
to 90 percent) will deposit in your mouth or
throat leaving a bad taste and perhaps
irritating your tongue or throat.

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 In adults who use their inhalers only as
prescribed, side effects are usually minor.
 Minimize this by rinsing your mouth after
inhaling.

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 May also swallow some of the medicine that
remains after rinsing.
 This may cause minor stomach upset or
"heartburn," which can do long-term damage.
If it occurs, be sure to tell your doctor so it can
be treated.

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 May also swallow some of the medicine that
remains after rinsing.
 This may cause minor stomach upset or
"heartburn," which can do long-term damage.
If it occurs, be sure to tell your doctor so it can
be treated.

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 Once absorbed in stomach, swallowed asthma
drugs are quickly eliminated from your body,
so they don't have the widespread side effects
of drugs taken as pills.

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 People with severe asthma who take larger
doses of anti-inflammatory medicines may
have more serious side effects.
 A common one is a mouth or throat infection
with yeast, called oral thrush, which appears
as a white coating on the lining of the mouth
and throat. This is easily treated.

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 Mature women who, because of severe
asthma, take large doses of anti-inflammatory
drugs may have a more serious side effect.
 These drugs can accelerate osteoporosis (a
bone disease) after menopause.

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 This can be checked by measuring bone
density and, if osteoporosis is present, it can
be treated with drugs that stimulate bone
formation.

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 There is evidence that even low-dose, inhaled
corticosteroids may temporarily delay a child's
growth before puberty, slightly more in boys
than in girls.
 Furthermore, the long-term benefits of these
drugs greatly outweigh any minor effect on
growth.

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 Untreated asthma, in contrast, does cause
reduction in final height.

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 There is newer evidence that anti-
inflammatory medicines taken by dry-power
inhaler may cause tooth erosion in children by
changing the mouth's chemical environment.
 They also reduce the production of saliva,
affecting the mouth's natural way of
maintaining its chemical balance.

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 To offset these side effects, some dentists
recommend rinsing with a fluoride
mouthwash and chewing sugarless gum to
stimulate salivation after inhaling medicine.

 They recommend against brushing, because

the action of brushing large-particle powder
against young teeth may weaken already
damaged enamel.
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 Tetes Mata
 Tetes Telinga
 Enema
 Tetes Hidung
 Vaginal Douche
 Vaginal Tab
 Suppositoria

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