Dr. Eka Musridharta, SpS Data Pribadi Tempat/Tgl Lahir : Jakarta, 1 Mei 1975 Alamat : Bulu Perindu Raya Blok N-3 Pondok Bambu, 13430 +68551075488 [email protected]Pendidikan Pendidikan Dokter Umum FKUI, Lulus 2009 Pendidikan Dokter Spesialis Neurologi FKUI, lulus 2006 Pendidikan Konsultan Intensive Care FKUI, Lulus 2009 Jabatan Staff Medik Departemen Neurologi RSCM Konsultan Neurofisiologi RS. Pusat Pertamina Konsultan Neurofisiologi RS. Menteng Mitra Afia
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O Acetaminophen is generally considered to be a weak inhibitor of the synthesis of prostaglandins (PGs).
O Acetaminophen also decreases PG concentrations in vivo, but, unlike the selective COX-2 inhibitors, acetaminophen does not suppress the inflammation of rheumatoid arthritis.
O Acetaminophen is a weak inhibitor of PG synthesis of COX-1 and COX-2 in broken cell systems, but, by contrast, therapeutic concentrations of acetaminophen inhibit PG synthesis in intact cells in vitro when the levels of the substrate arachidonic acid are low (less than about 5 μmol/L).
Graham, Garry G.; Scott, Kieran F. Am J of Therapeutics: 2005.12 - Issue 1: 46-55
Acetaminophen
O COX-3, a splice variant of COX-1, has been
suggested to be the site of action of
paracetamol.
O There is considerable evidence that the
analgesic effect of paracetamol is central
and is due to activation of descending
serotonergic pathways, but its primary site of
action may still be inhibition of PG synthesis.
Graham, Garry G.; Scott, Kieran F. Am J of Therapeutics: 2005.12 - Issue 1: 46-55
Acetaminophen and Clinical Settings
37
Acetaminophen Penetrates Readily Into the CSF of Children After I.V
Administration
O The children, aged 3 months to 12 years, who were undergoing surgery in the lower body using spinal anesthesia were given a single IV inject of paracet (15 mg/kg).
O CSF and venous blood samples were obtained between 5 min and 5 hours after injection.
O Paracetamol concentrations were determined by using a fluorescence polarization immunoassay.
Elina Kumpulainen, BMa,b, et al. Published online April 2, 2007PEDIATRICS Vol. 119 No. 4 April 2007, pp. 766-771 (doi:10.1542/peds.2006-3378)
Results
O Acetaminophen was detected in CSF from the earliest sample at 5 minutes, although in this sample acetaminophen concent was below the limit of quantification of 1.0 mg/L.
O Subsequent CSF acetaminophen concentr ranged between 1.3 and 18 mg/L (median: 7.2 mg/L), plasma concentr ranged between 2.4 and 33 mg/L, and CSF/plasma ratios ranged between 0.06 and 2.0.
O The highest CSF acetaminophen concentr was detected at 57 minutes.
Study Conclusions
O Acetaminophen permeates readily into the
CSF of children.
O This fast and extensive transfer enables the
rapid central analgesic and antipyretic
action of IV acetaminophen.
Summary• Hyperthermia may caused of increased O2 Consumption and
metabolism rate and may be detrimental to a critically ill
patient
• Occurs in up to 70% of all neurologically-injuries patients
• Hyperthermia poor outcome in brain injury.
• The modalities of treatment of hyperthermia are
pharmacological therapy, surface cooling and intravascular
cooling.
• Acetaminophen intravenous is the choice of drug if the
patient is unable to take oral or rectal and NSAIDs are