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G.M.

Aman
Drug administration
(Cara Penggunaan Obat)
• Systemic (enteral, parenteral)

• Topical

• Transdermal
Tujuan pemakaian obat untuk kulit

• Perawatan (sistemik, topikal)

• Pengobatan (sistemik, topikal)


Bentuk Obat Topikal
• Powder
• Lotion
• Cair
• Krim
• Gel
• Patch
• Salep
Skin Aging
(Penuaan Kulit)
• Natural/ chronological aging

• Environmental and photoaging


Anti-aging treatment strategies
To prevent / pencegahan
• Dryness use Moisturizers
• Fine line & wrinkles use vitamin (Retinol,
Tocopherol, Ascorbic acid, Niacinamide, beta
Carotene), Antioxidant, AHA
• Photodamage use Sunscreen (tabir surya)
• Erythema and swelling caused by sunburn use
Thocopheryl phosphate Complex
• Age spots & hyperpigmentation use Arbutin,
Ascorbic acid, Niacinamide.
Protect Skin From Radiation
• Topical (sunscreen cream)
. Zinc oxide, Titanium oxide
. PABA 5% in alcohol, Benzophenon 3%
• Systemic drug
. Beta carotene
. Antihistamin (pada Solar urticaria)
Obat yang berefek pada kulit
• Antioxidant
• Vitamin
• Antiinfeksi:
 antibiotika
 antifungal
 antiviral (herpes, varicela)
• Antialergy
OBAT SISTEMIK
(Anti-aging Benefit)
• Vitamin A (retinol)
• Alpha Hydroxy acid (AHA)
• Alpha lipoic acid (ALA)
• Vitamin C (ascorbic acid)
• Vitamin E (tocopherol)
• Niacinamide
• Beta carotene & carotenoid
• Coenzyme Q10
Optimum Dose
Nutrient average daily optimum
intake level
----------------------------------------------------------------
Vit C 58 mg 500 mg
Vit E 9,3 mg 100 mg
B Carotene 1,9 mg 7 mg
Co-enyme Q10 10 mg 60 mg
Flavonoid 140 mg 250 mg
Vitamin A (retinol)
• Antioksidan, menghambat lipid
peroxidation
• Stimulasi sintesis kolagen
• Photoprotection
• Mempercepat penyembuhan pada
photodamage
Alpha Hydroxy acid
• Increase epidermal desquamation by
increase keratin synthesis
• Stimulate production of Collagen
• Improvement of the line and wrinkles
Alpha lipoic acid (ALA)
• Dipecah di dalam sel menjadi dihydrofolic
acid, yang berfungsi sebagai antioksidan
• Membantu recycling antioksidan Vitamin E
dan vitamin C
• Antiinflamasi
• Bekerja pada mitochondria meningkatkan
pbt energi (ATP)
• Bayam, brokoli, kentang
Vitamin C (Ascorbic Acid)
• Membrane antioxidant
• Stimulasi sintesis kolagen
• Menstimulasi pembentukan barrier lipid
• Regenerate vitamin E
• Memperbaiki keadaan hiperpigmentasi
• Photoprotection
Vitamin E (tocopherol)
• Membrane antioxidant
• Bekerja memproteksi vitamin A,
Carotenoid dan Polyunsaturated Fatty
Acid (PUFA)
• Photoprotection terutama kalau
dikombinasi dengan vitamin C
Niacinamide
• Memperbaiki keadaan hiperpigmentasi
• Mengurangi red spot
• Meningkatkan fungsi barrier kulit
Beta Carotene & Carotenoid
• Antioxidant
• Lutein, Lycopene
• Free radical scavengers
Coenzyme Q10
• Membrane antioxidant
• Memproteksi sel dari oxidative damage
yang disebabkan sinar ultra violet (UV)
• Regenerate tocopherol
• Sangat penting untuk Jantung & Otak
Local Drug Administration
• Topically – outer layer of the skin
– Most act on the skin but are not absorbed (soften,
disinfect or lubricate).
– Few contain enzymes to remove superficial debris
(skin ulcerations)
– Others treat skin infections

• Transdermally – through a patch


– Readily absorbed with systemic effects
– Patches – gradual release, reducing toxicity effects
– Fewer adverse reactions
– Eg. Nitroglycerin (Cardiac Pts) and Scopolamine
(nausea)
Skin Biology
• Epidermis:
– Outermost layer
• Dermis:
– Contains small capillaries,
glands, nerve fibres & hair
follicles
• Subcutaneous
(Hypodermia):
– Arterioles, fat, collagen,
fibroblasts
Routes Of Drug
• Must have to penetrate cutaneous layer to exert
effects.
• Percutaneous absorption involves:
– Dissolution of drug in its vehicle
– Diffusion of drug from vehicle to surface of skin
– Penetration through skin layers

• NB: Passage is slowest in the stratum corneum


Factors that
effect
cutaneous
Diffusion
Diffusion through absorption
through
channels between hair
epidermal cells follicles

Diffusion
through Diffusion
Transcellular
sebaceous through
Diffusion
ducts sweat ducts
Factors affecting absorption
• Nature of skin:
– With a skin lesion 80% can penetrate, with intact skin only
1% (hydrocortisone)
– Hydration improves this rate (occulsive dressings)
– Thin layer of stratum corneum (infant & elderly)
• Nature of drug:
– Active drug concentration, composition, physiochemical
properties and base vehicle
– Lipid soluble more effective than water soluble (20% fat)
Topical Anti-infectives
• Include antibiotic, antifungal and antiviral
drugs.
• Antibiotic:
– Exert a local bactericidal (killing) or bacteriostatic
(retarding growth) effect.
• Bacitracin, Gentamicin (G-myticin), Erythromycin
(Emgel) and neomycin are good examples
• Bacitracin (Baciguent) inhibits cell wall synthesis
– Prevention of superficial infections in wounds,
skin abrasions and minor burns
• Antifungal:
– Local inhibitory effect
• Amphotercin B (Fungizone) used for myotic infections
• Miconazole (Micatin), Ciclopirox (Loprox), econazole
(Spectazole) used for tinea pedis (athlete’s foot); tinea
corporis (ringworm)
• Clioquinol used for eczema and athletes' foot
• Antiviral:
– Acyclovir (Zovirax) and Penciclovir (Denavir) the
only available antiviral topical preparations
– Acyclovir used for initial presentation of genital
herpes and herpes simplex in immunocomprised
pts
– Penciclovir used for cold sores in adults
Adverse reactions to Anti-infectives
• Usually mild but relatively common
• Present as skin rash, itching, dermatitis,
irritation and redness
• Hypersensitive reactions
• Prolong use may lead to a ‘Super-sized’
infection
Contraindications
• Hypersensitive pts
• Be cautious in pts with extensive burns or
trophic ulceration
– Nephrotoxicity
Penicilin, Streptomycin,
chloramphenicol, Sulphonamide

lebih baik jangan diberikan topical


Antialergi/antihistamin
• Topical
• Sistemik

• First generation / konventional AH1


• Second generation
First generation
• Diphenhydramine
• Promethazine
• Pheniramine
• Chlorpheniramine
• chlorcyclizine
Second generation
• Astemizol
• Terfenadine
• Loratadine
• Cetirizine
• Levocobastin
• acrivastin
First generation Second generation
• Sedasi Non sedasi
• Atropin like effect No atropin like effect
• Tolerance Rare
• Interaction with Interaction with
- alkohol - ketokonazol
- depresant - macrolide AB
Antihistamine

Dianjurkan tidak memakai topical


Topical Corticosteroids
• Potency dependant upon drug concentration, vehicle
and area of application
• Exert localised anti-inflammatory response
(reduction in oedema, irritation, vascular perfusion
and pain)
• Psoriasis, dermatitis, rashes, eczema, 1st & 2nd degree
burns
• Adverse reactions = irritation, dryness, secondary
infections
Contraindications
• Pts with known hypersensitivity
• For use on face & groin (only high potency)
• Not for ophthalmic use (induce glaucoma)
• Category C for pregancy

• Eg: Hydrocortisone (Cort-Dome)


Evidence base therapy

Pada severe eczema sistemik


corticosteroid lebih efektif
daripada topical
Topical tidak efektif pada
• Severe Eczema.
Pemberian Corticosteroid tidak efektif dan
efek samping lebih besar
• Dermatosis Bulosa.
Pemberian Corticosteroid topical tidak efektif
o.k. penetrasi kurang baik
• Psoriasis.
Pemberian Metothrexate topical tidak efektif
o.k. penetrasi yang kurang, sehingga
pemberian sistemik lebih baik.
• Pemberian Antihistamin topical juga tidak
tidak efektif ok penetrasi sulit
• Pemberian Corticosteroid topical, sama
sulitnya dengan Antihistamin, ok sulit
penetrasi dan menyebabkan vasokonstriksi
Efek Samping Pemberian Topical
• Contact dermatitis
* Antihistamin
* Local Anaesthetic (Kecuali Lignocaine)
* Antibiotic (Streptomycin, Penicillin)
* Corticosteroid
Beberapa Disinfectant
• Disinfectant alat : Hipochlorite, Spiritus,
Alkohol, Povidine-Iodine
• Disinfectant tangan : Cuci dengan sabun,
Chlorhexidine, Alkohol+Chlorhexidine
• Disinfectant kulit sebelum operasi : Alkohol +
Povidone-Iodine, Alkohol + Chlorhexidine
• Disinfeksi kulit sebelum injeksi : 70% Ethyl
Alkohol, Isopropyl Alkohol
Mekanisme Kerja Antiseptik
• Alkohol (Ethyl, Isopropyl) :
* presipitasi protein
*70% lebih efektif daripada 100%. Yang
100% presitasi protein lapisan luar mikro-
ba shg alkohol sukar masuk mikroba. Yang
70% menurunkan tahanan permukaan sel
mikroba shg mudah masuk dan mempresi-
pitasi protein sel mikroba
• Hexachlorophane :
*bakterisidal
*untuk profilaksis infeksi (dlm sabun,
emulsi atau powder
*hati-hati penggunaannya ok dapat
diabsorbsi oleh kulit dan toksik thd
CNS
• Hydrogen Peroksida (H2O2)
*antimikrobial yg digunakan membersihkan
luka. H2O2 akan mengeluarkan O2 waktu
membersihkan luka, mengeluarkan sisa
kotoran pada luka
• Chlorhexidine :
*broad spektrum disinfektan
*untuk kulit sebelum operasi, tindakan
obstetrik, dan juga untuk alat operasi
TERIMAKASIH

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