Prednisone 1 mg/kgbb/day; berat 60 kg Prednisone 60 mg/hari Tablet (mg) Hydrocortisone Cortisone Prednisolone Methylprednisolone Triamcinolone Dexamethasone Betamethasone 240

300 60 48 48 9 7.2

Sediaan tab

Vial

Sediaan vial

Ampul

Sediaan ampul

5 mg 4, 8, 16 mg 4 mg 0.25, 0.5, 0.75, 1 mg 0.5 mg

7 strip 24 12 2

125 mg x 2 10 mg x 5ml 40 mg x 10 ml 5mg x 1 ml

4 mg/ml x 3 amp 2 amp

4 mg/ml 5 mg/ml 4 mg/ml

Prednisone tabs 20 mg no. XV 2.ddi 2 tab pagi 1 tab siang Methylprednisolone tab 16 mg no.XXX 2.ddi 2 tab pagi 1 tab siang Dexametasone tab 2mg no.XXV 2.ddi 2 tab pagi 2 tab siang atau Dexametasone tab 1.5 mg no. XXX 2.ddi 4 tab pagi 2 tab siang Betamethasone tab 0.5 mg no. LXXV 5 tab x 3.ddi Komplikasi
komplikasi Osteoporosis Dosis Dimulai dri low dose pred 5 mg/day lebih dari 3 bulan. mekanisme Apoptosis osteoblast, impair absorbs ca, tx - Calcium 1500 mg/day - Vit D2 400 U/day - Thiazide 12.5-25 mg.day (kalo urinaru Intervensi cek: bone density, vit D, 24 jam urinary ca. folo up: @ 3 months. Keterangan tambahan Reversible: pada usia muda Loss 3-10% of bone density/year

AVN

>40 mg pred/day terapi jangka pendek > 20 hari >7.5 mg/day pred >10 mg pred/day

Insulin tolerance hypertension

Intraoseous HT, apoptosis osteoblast. Trombotic oklusi decrease venous outflow from bone decrease arteri perfusiinfarct bone. gluconeogenesis

ca>250 mg/dl) biphosponat e Joint replacement

Xray, bone scan, mri

S n s: pain, limitasi motion in 1 or 2 joint

insulin

Retensi na, cathecolamin, Vascular Smooth muscle

diuretik

Supresi HPA axis

After onset of treatment 5-20 mg pred/day > 3mg adrenal insuf: >20 mg pred/day > 3 mg

Negative feedback, adrenal supres

Tapering off

Diet low cal, low sugar, low fat Cek FBS, berat badan Diet low cal, low fat, low Na Diet high protein, K, Ca Cek BP, berat badan Cek morning plasma cortisol setelah terapi 4 mg. Keadaan maintenance dose: cek plasma cortisol @ 2 bulan

Predileksi Atherosclerosis Predileksi Atherosclerosis, kelainan jantung lainnya. Adrenal isuf: lethargy, weaknes, nausea, anorex, fever, ortho hipo, hypoglycemi, weight loss. Taper off: kurangi 5mg/day untuk pred >20,<40 mg/day. 2.5 mg/day u/ pred 20 mg. 1mg/day u/ pred 10 mg/day. Recovery HPA axis 9 bulan- 1tahun.

Interaksi Obat

Imunologi

> 15 mg pred/day supres tuberculin response. 14 hari oral pred 40 mg/day inhibit tuberculin response.

Accel metab GCs: phenytoin, barbiturate, rifampin Impair absorbs GCs: cholestyramine, colestirol Inhib limfosit, monosit Impair tipe 4 hipersensitivity

Ppd test, anergy panel

Pregnancy dan laktasi Pediatric Early osteoporosis, growth retard >0.75 pred/kgbb/da y >2 mg/kg pred atau >20 mg/hari

Premature, low birth weight Direct effect on impair Ca, phosphor metabl. Decrease GH, inhib bone matrix formation. GH

Pake prednisone ato prednisolone ga cross placenta