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8/9/2019 Case Kelompok 1 Uin (Rsko)
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PRECEPTOR:
DR. ADHI WIBOWO NURHIDAYAT, SPKJ, MPH
COMPILED BY:DEBY ARIANDINY 108103000024
DISCA ARIELLA RUCITA 108103000042
FARIDA NUR AINI 10810300003
LELIANA SALEH 108103000008
M. IHSAN SASRANIN!RAT 10810300001"
Case Reportopioid dependent
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Main complaints
Patients come to the Methadone maintenance
program for his own desire to break away
from dependence putau use.
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Disease History Now
In !!! "class high school#
Patients started high school education.
In addition to schools$ the patient was also working part%time at his uncle&s restaurant field.
Patients were first tried cigarettes$ opioid$ ben'odia'epam$
methamphetamine$ mari(uana$ and alcohol. )ut not
necessarily the amount of usage and dosage of the substance
used.
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Disease History Now
In *++* "class , high school#
Patients began to routinely use *++ thousand packets
opioid *%, times a day with burning using lead then
inhaled.
-ometimes$ patients using mari(uana rolled *%, by way of
sucked.
hen patient hanging out with his friends$ patients often
consume alcohol in an amount not necessarily.
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Disease History Now
In *++/$ the patient tried abstance and can last for /
months.
0rom *++1 to *++! $ the patient only uses putaualone. Putau used as much as half a gram $ *%, times
a day by means of in(ected through a 2ein.
During the drug use$ the patient had e3perienced
sakau or o2erdose$ but forget how many times and
when.
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Disease History Now
In *++4$ the patiente3perienced 2isual
hallucinations such as
seeing a large black shadow
and auditory hallucinations
in the form of hearing his
friends who had died asked
her to do something.
Patients do not ha2e
delusions.
In *++$ the patient tried
to replace putau with
-ubute3. Patients get
-ubute3 prescription from
Pasar Rebo Hospital.
Patients using -ubute3 4
mg per day by way of oral
or in(ectable for year
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Disease History Now
In *+$ the patient began to follow Methadone
maintenance program in R-56. Patients wishing to
escape from dependence putau because it was tiredof his routine$ many of his friends who died with
HI7% positi2e and want to return to normal
acti2ities. 0irst time using methadone$ patients
e3periencing body aches and intolerable
drowsiness.
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Disease History Now
Howe2er$ now they do not feel it. 8he dose of
methadone that is used when the patient is 4/
mg per day. 8he dose for the patient because it
felt enough not to cause withdrawal. Patients
ha2e not dared to lower the dose of methadonefor fear of re% use putau.
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Disease History Now
9arly Methadone maintenance programs$ e3amination of
HI7 patients and is said to be HI7 positi2e with CD: test
results *,: cells ; ul. 8hen$ the patients followed for
year of antiretro2iral treatment and dismiss.
Patients often e3perience thrush. 8he patient had a
history of fungus on the tongue$ tooth loss patients and
there are some that date$ all of the patient&s hands and
feet nails color black.
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Disease History Now
8he patient had a history of skin arising rolled in the
back of both hands on the area until the elbow and
the back of both legs up to the knee$ but now li2es
(ust colored black scar. 0riends in the work place a
lot of patients who died of drug use with HI7%
positi2e .
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=I09 -9>?
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?sage History Psychoacti2e -ubstances
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Psychosocial -tressors
. Parents B none
*. 6ther 0amily B the first child of four siblings
,. 0riend B none
:. 6ccupation B none
/. 0inancial B none
1. Marriage B unmarried patients with HI7 disease
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R9=
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A, 57T, 51 J, 48 R, 45 T, 42 W, 39
S, 53
E, 28M,
25
T, 21 A, 12J, 31
Aenogram
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PH@-IC
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PH@-IC
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Diagnosis Psychiatric
Aeneral Description
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Intellectual function
=e2el of education B
intellectual functioning in
accordance with the
education and intelligence
Concentration B good
6rientation B
place B good
time B good
people B good
Memory B
immediate B good
-hort%term B good
medium term B good =ong%term good
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Diagnosis Psychiatric
Mind
Processes and forms of thought
B coherent
8he contents of thought B either
Impulse Control B Aood
power 2alue
Power of social 2alues B good
8est power 2alue B good
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=aboratory 93amination Result
*
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Resume
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organic mentaldisorders can be
ruled out.
0ormula Diagnosis
A#$%$ Ithe patient had no history of
head in(ury due to an accident.6n physical e3amination
found no common medicalconditions that affect brain
function.
the patient&s routine use of inhaled putau
since *++* and in(ected since *++1.Initially$ patients using *++ thousand putauuse *%, times per day and last use as much as
half a gram putau$ *%, times per day.If the patient discontinue the use of putauwill feel withdrawal symptoms so that the
patient continues to use putau.
dependence ofthe opioid
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0ormula Diagnosiss
A#$%$ II
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0ormula Diagnosiss
A#$%$ III
0riends in the working en2ironment of patients who died of drug use
with HI7 positi2e and often e3changing syringes.
Patients said doctors R-56 declared HI& '($%)%*+ patients with CD:
results *,: sl ; ul.
0rom the results of a physical e3amination found a blackish colored
crusting
A#$%$ I&
patients ha2ing marital problems$ namely the desire to ha2e
a life partner but has a positi2e HI7 disease.
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0ormula Diagnosiss
A#$%$ &
)ased on the Alobal
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92aluation Multia3ial
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Problem =ist
6rganobiologisB HI7%positi2e
PsychologyB not married
9n2ironmental and socio%economicB no
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Management
Initial doseB 3 */ mg Metadone
8he current doseB 3 4/ mg Metadone
Methadone is an opioid substitution
therapy that are agonists. the initialphase$ a gi2en dose of methadone is *+%
:+ mg per day.
In patients$ the initialdosing phase is */ mg
In order to reach the threshold 2alue of
methadone in the blood$ plus or minus theinitial dose of /%+ mg for ,%*: hours.8o achie2e longer considered adeGuate doseincrease or decrease the dosage until thedeto3ification opioida continued with
methadone maintenance therapy.
Now$ the dose gi2ento the patient is a
maintenance dose.
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Prompts e3amination
0ollow%up CD: e2ery 1 months.
Patients only been checked once the outcome CD:
*,: cells ; ul. CD: cell count monitoring to monitor
the se2erity of HI7%induced immune damage. 8o
that end$ there should be periodic inspection CD:
le2els.
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6piate dependence
Define
6pioid dependence is a cluster of physiological$ beha2ioral$
and cogniti2e symptoms$ which together indicates repeated
and continuing use of opioid drugs$ despite significantproblems related to such use.
Drug dependence$ in general$ has also been defined by the
orld Health 6rgani'ation "H6# as a syndrome in whichthe use of a drug or class of drugs takes on a much higher
priority for a gi2en person than other beha2iors that once
had a higher 2alue.
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6pioid
MorphineHeroin "diacetylmorphine#
Hydromorphone
"dihydromorphinone#
63ymorphone
"dihydrohydro3ymorphinone#
=e2orphanol
Methadone
Meperidine "pethidine#
Pethadol 0entanyl
Codeine
Hydrocodone
"dihydrocodeinone#
Drocode "dihydrocodeine#63ycodone
"dihydrohydro3ycodeinone#
Propo3yphene)uprenorphine
Penta'ocine
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Neuropharmocology
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Heroin
P(7/+6 H+6(%P(7/+6 H+6(% B5# T6B5# T6
H+6(%H+6(%
,1
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-ign for using Heroin
9uphoria
Drowsiness
Impaired mental functioning
-lowed down respirationConstricted pupils
Nausea
,
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,4
-hort%term 9ffects
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,!
=ong%term 9ffects
Collapsed 2eins$ infection of heart lining and 2al2es$
abscesses$ cellulites$ and li2er disease
Pulmonary complications$ including 2arious types of
pneumonia
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D-M%I7%8R Diagnostic Criteria for 6pioid
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D-M I7 8R Diagnostic Criteria for 6pioidithdrawal
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Mangement
6bser2ation of 2ital sign
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6pioid substitute
6pioid deto3ificationmethadone "< daily dosage of *+ to 4+ mg$ up to
*+ mg #
=e2omethadyl "=
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H- I-(/+%5%+5 &%6-$
HI7 is a 2irus that attacks the
human immune system and
can cause
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H- I-(/+%5%+5 &%6-$
HI7 are mainly in human body fluids. 0luids that contain
HI7 are potentially blood$ semen$ 2aginal fluids and breast
milk. HI7 transmission can occur through a 2ariety of
ways$ namelyB
se3ual contact$
contact with infectious blood or secretions$
mother to child during pregnancy$
labor and
breastfeed
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Pathogenesis
Classified as ha2ing HI7 retro2irus RN< genetic
material. hen the 2irus into the patient&s body
"the host cell#$ the 2iral RN< is con2erted into DN