Sejarah Farmasi Islam

Peradaban Islam dikenal sebagai perintis dalam bidang farmasi. Para ilmuwan Muslim di era kejayaan Islam sudah berhasil menguasai riset ilimiah mengenai komposisi, dosis, penggunaan, dan efek dari obat-obatan sederhana dan campuran.  Selain menguasai bidang farmasi, masyarakat Muslim pun tercatat sebagai peradaban pertama yang memiliki apotek atau toko obat.

Sharif Kaf al-Ghazal dalam tulisannya bertajuk The valuable contributions of Al-Razi (Rhazes) in the history of pharmacy during the Middle Ages, mengungkapkan, apotek pertama di dunia berdiri di kota Baghdad pada tahun 754 M. Saat itu, Baghdad sudah menjadi ibukota Kekhalifahan Abbasiyah. ''Apotek pertama di Baghdad didirikan oleh para apoteker Muslim,'' ungkap al-Ghazal.

Jauh sebelum peradaban Barat mengenal apotek, masyarakat Islam lebih dulu menguasainya.  Sejarah mencatat, apoteker pertama di Eropa baru muncul pada akhir abad ke-14, bernama Geoffrey Chaucer (1342-1400). Ia dikenal sebagai apoteker asal Inggris. Apotek mulai menyebar di Eropa setelah  pada abad ke-15 hingga ke-19 M, praktisi apoteker mulai berkembang di benua itu.

''Umat Islam-lah yang mendirikan warung pengobatan pertama,'' papar Howard R Turner dalam bukunya bertajuk  Science in Medievel Islam .  Philip K Hitti dalam bukunya yang terkenal bertajuk  History of Arab, juga mengakui bahawa peradaban Islamlah yang pertama kali mendirikan apotek.

''Selain itu, peradaban Islam juga merupakan pendiri sekolah farmasi pertama,'' ungkap K Hitti. Ia juga membuktikan bahwa umat Muslim di era kekhalifahan sebagai pencipta pharmacopoeia yang pertama. Perkembangan ilmu farmasi yang begitu cepat, membuat apotek atau toko-toko obat tumbuh menjamur di kota-kota Islam.

Hampir di setiap rumah sakit besar di kota-kota Islam dilengkapi dengan apotek atau instalasi farmakologi. Apotek-apotek itu dikelola oleh apoteker yang menguasai ilmu peracikan obat. ''Kaum Muslimin menyumbang begitu banyak hal terhadap perkembangan apotek atau obat,'' ungkap Howard R Turner dalam bukunya bertajuk  Science in Medievel Islam .

Di era kejayaan Islam, toko-toko obat bermunculan bak jamur di musim hujan. Toko obat yang banyak jumlahnya tak cuma hadir di kota Baghdad - kota metropolis dunia di era kejayaan Abbasiyah - namun juga di kota-kota Islam lainnya. Para ahli farmasi ketika itu sudah mulai mendirikan apotek sendiri. Mereka menggunakan keahlian yang dimilikinya untuk meracik, menyimpan, serta menjaga aneka obat-obatan.

Pemerintah Muslim pun turun mendukung pembangunan di bidang farmasi. Rumah sakit milik pemerintah yang ketika itu memberikan perawatan kesehatan secara cuma-cuma bagi rakyatnya juga mendirikan laboratorium untuk meracik dan memproduksi aneka obat-obatan dalam skala besar.Keamanan obat-obatan yang dijual di apotek swasta dan pemerintah diawasi secara ketat. Secara periodik, pemerintah melalui pejabat dari Al-Muhtasib - semacam badan pengawas obat-obatan - mengawasi dan memeriksa seluruh toko obat dan apotek. Para pengawas dari Al-Muhtasib secara teliti mengukur akurasi berat dan ukuran kemurnian dari obat yang digunakan.

Pengawasan yang amat ketat itu dilakukan untuk mencegah penggunaan bahan-bahan yang berbahaya dalam obat dan sirup. Semua itu dilakukan semata-mata untuk melindungi masyarakat dari bahaya obat-obatan yang tak sesuai dengan aturan. Pengawasan obat-obatan yang dilakukan secara ketat dan teliti yang telah diterapkan di era kekhalifahan Islam.

Perkembangan  ilmu botani dan kimia telah mendorong umat Muslim untuk mengembangkan farmasi.  Pada masa itu, ilmuwan Muslim seperti  Muhammad ibnu Zakariya al-Razi (865-915 M) alias Razes turut mengembangkan pengobatan dengan menggunakan obat-obatan.  Selain itu, dokter dan ahli farmasi Muslim lainnya  Abu al-Qasim al-Zahrawi alias Abulcasis (936-1013 M) juga tercatat sebagai saintis perintis dalam bidang distiliasi dan sublimasi.

Tak cuma itu, Sabur ibnu Sahl (wafat 869 M), juga tercatat sebagai dokter pertama yang mencetuskan  pharmacopoedia. Ia telah menjelaskan beragam jenis obat-obatan  untuk mengobati penyakit. Saintis Muslim lainnya yang turut menopang tumbuhnya aoptek di era Islam adalah  al-Biruni (973-1050 M). Sang ilmuwan legendaris Islam itu telah menulis buku farmakologi yang sangat berharga bertajuk  Kitab al-Saydalah ( Buku tentang Obat-obatan).

Dalam kitabnya itu, al-Biruni menjelaskan secara detail pengetahuan mengenai peralatan untuk pembuatan oba-obatan, peran farmasi, fungsi serta tugas apoteker. Ia juga menjelaskan tentang apotek. Ilmuwan Muslim lainnya, Ibnu Sina  alias Avicenna juga menulis tak kurang dari 700 persiapan pembuatan obat, peralatannya, kegunaan dan khasiat obat -obatan tersebut.  Kontribusi Ibnu Sina dalam bidang farmasi itu dituliskannya dalam bukunya yang sangat monumental  Canon of Medicine.

Ilmuwan Muslim lainnya yang turut menopang berdiri serta berkembangnya apotek di dunia Islam adalah al-Maridini dan Ibnu al-Wafid (1008-1074). Kedua karya ilmuwan Muslim itu  telah dicetak dalam bahasa Latin lebih dari 50 kali. Kitab yang ditulis keduanya diterjemahkan ke dalam bahasa Latin berjudul   De Medicinis universalibus et particularibus dan   Medicamentis simplicibus.

"Kaum Muslimin telah menyumbang banyak hal dalam bidang farmasi dan pengaruhnya sangat luar biasa terhadap Barat," papar Turner. Menurut Turner, para sarjana Muslim di zaman kejayaan telah memperkenalkan sederet obat herbal yang terbukti berkhasiat untuk kesehatan, seperti, adas manis, kayu manis, cengkeh, kamper, sulfur, serta merkuri sebagai unsur atau bahan racikan obat-obatan.

Menurut K Hitti, kemajuan peradaban Islam dalam farmasi dan apotek ditopang oleh banyaknya buku dalam bidang farmakologi yang ditulis ilmuwan Muslim. K Hitti mencatat, buku farmakologi pertama di dunia Islam ditulis oleh  Jabir bin Hayyan.  Selain itu, ada pula karya  al-Razi, Ibnu Sina, Tabari dan d Majusi. ''al-Razi dan Ibnu Sina adalah dua dokter yang paling terkemuka di zamannya,'' ujar K Hitti.

Sejak dulu, apotek yang dikelola apoteker merupakan bagian yang tak terpisahkan dari  institusi rumah sakit. Hal itu sama halnya dengan  farmasi dan farmakologi yang juga merupakan bagian yang tak terpisahkan dari ilmu kedokteran. Dunia farmasi profesional secara resmi terpisah dari ilmu kedokteran di era kekuasaan Kekhalifahan Abbasiyah.

Terpisahnya farmasi dari kedokteran pada abad ke-8 M, membuat farmakolog menjadi profesi yang independen dan farmakologi sebagai ilmu yang berdiri sendiri. Menurut Howard R Turner, praktisi seperti herbalis, kolektor, penjual tumbuhan, rempah-rempah untuk obat-obatan, penjual dan pembuat sirup, kosmetik, air aromatik, serta apoteker merupakan profesi yang menopang geliat farmasi di dunia Islam. heri ruslan


Ilmuwan Muslim Penopang Apotek

* Abu Jafar Al-Ghafiqi (wafat 1165 M)
Ilmuwan Muslim yang satu ini juga turut memberi kontribusi dalam pengembangan farmakologi dan farmasi. Sumbangan Al-Ghafiqi untuk memajukan ilmu tentang komposisi, dosis, meracik dan menyimpan obat-obatan dituliskannya dalam kitab Al-Jami Al-Adwiyyah Al-Mufradah. Risalah itu memaparkan tentang pendekatan dalam metodelogi, eksperimen, serta observasi dalam farmakologi dan farmasi.

* Sabur Ibnu Sahl (wafat 869 M)
Ibnu Sahal adalah dokter pertama yang mempelopori pharmacopoeia. Kontribusinya dalam bidang farmakologi dan farmasi juga terbilang mata besar. Dia menjelaskan beragam jenis obat-obatan. Sumbangannya untuk pengembangan farmakologi dan farmasi dituangkannya dalam kitab Al-Aqrabadhin.

* Yuhanna Ibnu Masawayh (777 M - 857 M)
Orang Barat menyebutnya Mesue. Ibnu Masawayh merupakan anak seorang apoteker. Kontribusinya juga terbilang penting dalam pengembangan farmasi dan farmakologi. Dalam kitab yang ditulisnya, Ibnu Masawayh membuat daftar sekitar 30 macam aromatik.Salah satu karya Ibnu Masawayh yang terkenal adalah kitab Al-Mushajjar Al-Kabir. Kitab ini merupakan semacam ensiklopedia yang berisi daftar penyakit berikut pengobatannya melalui obat-obatan serta diet.

* Abu Hasan Ali bin Sahl Rabban at- Tabari
At-Tabari lahir pada tahun 808 M. Pada usia 30 tahun, dia dipanggil oleh Khalifah Al-Mutasim ke Samarra untuk menjadi dokter istana. Salah satu sumbangan At-Tabari dalam bidang farmakologi adalah dengan menulis sejumlah kitab. Salah satunya yang terkenal adalah Paradise of Wisdom. Dalam kitab ini dibahas mengenai pengobatan menggunakan binatang dan organ-organ burung. Dia juga memperkenalkan sejumlah obat serta cara pembuatannya.

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Obat Tradisional Yang Sangat Bermanfaat Dan Mengatasi Penyakit

Obat tradisional adalah obat-obatan yang diolah secara tradisional dan diwariskan secara turun-temurun. Umumnya obat tradisional dibuat berdasarkan resep nenek moyang, adat-istiadat, kepercayaan, atau kebiasaan setempat. Menurut penelitian masa kini, obat tradisional memang bermanfaat bagi kesehatan, dan kini digencarkan penggunaannya karena lebih mudah dijangkau masyarakat, baik harga maupun ketersediaannya.
Beberapa jenis obat tradisional diperkirakan dapat membantu tubuh memerangi infeksi. Khasiat lainnya dikatakan membantu pencernaan, menenangkan saraf, berfungsi sebagai obat pencahar, atau membantu menormalkan kelenjar. Pengolahannya bisa dilakukan dalam banyak cara, seperti seduhan, godokan, larutan, dan kompresan.
Banyak orang beranggapan bahwa obat tradisional pada saat ini lebih banyak digunakan karena dianggap tidak terlalu menyebabkab efek samping dan bisa diterima oleh tubuh. Ada yang berpendapat bahwa herba tradisional dan obat rakyat lebih aman daripada obat-obat farmasi modern. Apakah anggapan demikian tepat? Apakah obat tradisional memang benar-benar bebas risiko
Apakah Obat Tradisional Tanpa Risiko?
Sekalipun obat tradisional mungkin secara luas dianggap aman, disarankan untuk waspada. Jangan longgarkan kewaspadaan Anda hanya karena suatu produk berlabelkan "natural". Fakta yang tidak menyenangkan ialah bahwa beberapa herba bahkan bisa sangat berbahaya. Dan ironisnya beberapa orang tidak memandang herba atau obat tradisional sebagaimana mestinya. Senyawa kimia dalam obat tradisional atau herba dapat mengubah detak jantung, tekanan darah, dan kadar glukosa. Maka, orang yang memiliki problem jantung, tekanan darah tinggi, atau kelainan gula darah seperti diabetes harus sangat waspada.
Meski demikian, efek sampingan obat tradisional biasanya terbatas pada reaksi tipe alergi. Misalnya sakit kepala, pusing, mual, atau ruam. Beberapa pengobatan tradisional atau herba kemungkinan bisa menimbulkan "krisis penyembuhan" dengan menghasilkan gejala seperti flu atau gejala lainnya. Orang yang mengkonsumsi obat tradisional mungkin tampak menjadi lebih parah sebelum menjadi lebih baik. Secara umum dikatakan bahwa reaksi ini disebabkan oleh pembuangan limbah racun dari tubuh selama tahap-tahap awal terapi herbal.
Dalam berbagai cara, obat tradisional dapat mempengaruhi obat-obat resep farmasi modern. Misalnya, obat tradisional dapat meningkatkan atau mengurangi efek obat, membuat obat itu lebih cepat keluar dari tubuh daripada biasanya karena ada yang berfungsi sebagai detoks, atau meningkatkan risiko efek samping dari obat farmasi modern. Jika Anda memilih untuk mengobati sendiri dengan obat tradisional, sebaiknya Anda mempertimbangkan beberapa risiko seperti bahwa Anda mungkin tidak benar-benar tahu apa penyebab problem kesehatan Anda. Lalu pengobatan yang Anda lakukan secara sendiri mungkin menyembuhkan penyakit ringan, tetapi memperburuk problem kesehatan lainnya, seperti tekanan darah tinggi. Bahkan beberapa pengobatan sendiri bisa jadi mungkin bertolak belakang dengan obat yang diresepkan dokter. Seperti semua produk kesehatan, obat tradisional hendaknya digunakan dengan kewaspadaan, pengetahuan dan, keseimbangan.
Resep Obat Tradisional
Beberapa resep berikut ini bermanfaat untuk menangani masalah kesehatan dan telah diwariskan secara turun-temurun kepada beberapa generasi. Ternyata tidaklah sulit mencari bahan-bahan yang dibutuhkan dan meramunya menjadi obat yang bermanfaat.

Batuk
Resep: Air jeruk nipis dicampur dengan madu.
Fakta: Jeruk nipis mengandung vitamin C yang dapat memperbaiki ketahanan tubuh untuk melawan flu. Juga berfungsi sebagai antiseptik yang mampu membuang racun dalam tubuh.

Madu yang juga berfungsi sebagai antiseptik dan mampu menambah tenaga untuk mengalahkan penyakit.

Sakit Kepala
Resep: Minum rebusan air dari jahe, sereh dan ketumbar.
Fakta: Jahe, sereh dan ketumbar mengandung minyak atsiri yang akan memperlancar peredaran darah juga berfungsi sebagai analgetik untuk mengurangi sakit di kepala.

Kolesterol dan Diabetes
Resep: Rebus daun salam bersama laos lalu minum air rebusan tersebut.
Fakta: Daun salam mengandung flavonoid dan tanin sebagai zat yang mampu menurunkankan kolesterol. Dapat pula menurunkan kadar gula dalam darah.

Laos mengandung minyak atsiri untuk membantu memperlancar sirkulasi darah dan proses pengeluaran sisa metabolisme termasuk kolesterol yang berlebih.

Hipertensi
Resep: Konsumsi daun seledri secara teratur.
Fakta: Seledri mengandung phthalide yang mampu untuk mengendurkan otot arteri sehingga menurunkan tekanan darah bagi penderita hipertensi dan juga mengurangi produksi hormon stres.

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Makanan Berlemak Ternyata Menambah Nafsu Makan

Sebuah penelitian yang dilakukan Exercise and Health Sciences di Loughborough University mengamati bahwa latihan rutin mempengaruhi pelepasan hormon tertentu yang mempengaruhi napsu makan makan seseorang. Jika Anda berlatih dengan tujuan menurunkan berat badan, Anda pasti merasakan penurunan nafsu makan.

Namun pada kasus tertentu, latihan yang dilakukan secara berlebihan juga bisa mengakibatkan hilangnya nafsu makan yang dapat memicu anoreksia. Anoreksia adalah gangguan berupa hilangnya napsu makan, sehingga tubuh tidak mendapatkan asupan gizi yang cukup dan kehilangan banyak energi. 95 persen penderita anoreksia adalah perempuan yang memasuki masa puber seperti remaja dan perempuan dewasa yang terobsesi ingin menurunkan berat badan secara instan.

Meski dikategorikan penyakit ringan, namun jika berlangsung dalam waktu lama, penyakit ini bisa menyebabkan kematian.

Dua Hormon Pengendali Napsu Makan

Ada berbagai hormon yang berperan dalam mengendalikan nafsu makan. Dua yang paling berperan adalah hromon grehlin dan Peptide YY atau disingkat PYY, yang berperang mengurangi rasa lapar.

Saat Anda mengasup protein, tubuh akan melepaskan hormon PYY untuk menurunkan rasa lapar. Inilah mengapa diet tinggi protein kerap dianjurkan jika Anda ingin menurunkan berat badan. Hormon PYY juga dilepaskan tubuh saat Anda berlatih. Tak hanya hormon PYY, peneliti juga menemukan bahwa glukagon juga berperan dalam mengendalikan rasa lapar, baik di saat dan setelah latihan.

Glukagon adalah hormon yang dilepaskan tubuh saat gula darah mulai turun. Proses ini memicu pelepasan gula yang ada dalam sel-sel lemak, serta membantu memecah sel-sel lemak itu sendiri. Inilah alasan mengapa glukagon turut berperan penting dalam proses diet Anda.

Selama ini kita sering membicarakan tentang efek ‘Afterburn’, namun masih banyak orang di luar sana yang belum benar-benar memahami konsep dari efek ‘afterburn’yang sebenarnya. Afterburn merujuk pada fakta bahwa tubuh masih tetap membakar lemak setelah latihan. Proses afterburn juga tidak terlepas dari peran hormon glukagon yang membantu pelepasan gula dari cadangan energi yang tersimpan yaitu lemak.

Namun, latihan dengan tujuan menurunkan nafsu makan bukanlah satu-satunya jawaban bagi setiap orang. Mengingat setiap orang memiliki respon yang berbeda terhadap latihan yang dilakukan. Satu hal yang berhasil disimpulkan oleh tim peneliti adalah, bahwa latihan yang Anda lakukan adalah cara yang baik untuk memaksimalkan kinerja kedua hormon tersebut dalam mengendalikan nafsu makan.

Makin Banyak Lemak Makin Tinggi Napsu Makan

Berbanding terbalik dengan efek latihan yang bisa menekan nafsu makan, obesitas atau seseorang yang memiliki kelebihan berat badan akibat tingginya kadar lemak tubuh sangat berisiko mengalami peningkatan nafsu makan.

Pada 2010 tim peneliti dari University College London mengungkap bahwa lemak berlebih dalam tubuh dapat menghalangi pelepasan hormon yang mengendalikan nafsu makan. Inilah yang menjadi jawaban dari pertanyaan, mengapa orang obesitas lebih sulit bertahan dalam program diet mereka daripada mereka yang bertubuh sehat?. Bahkan, saat mereka makan dalam jumlah cukup sekali pun mereka masih merasakan lapar daripada orang sehat yang makan lebih sedikit.

Lemak bisa Membunuh Hormon PYY dan Glukagon

Kita telah ketahui bersama bagaimana peran hormon PYY dan glukagon dalam mengendalikan napsu makan.

“Kita tahu bahwa kedua hormon ini memainkan peran kunci dalam mengendalikan rasa lapar dan berapa banyak yang kita makan. Tapi di sini kami telah menunjukkan bahwa obesitas memiliki pengaruh merugikan terhadap kedua hormon tersebut yang bisa merugikan diet kita. Jika mungkin untuk menambah hormon ini kita mungkin dapat mengembalikan kemampuan alami tubuh untuk mengatur nafsu makan. ” ungkap Dr Rachel Batterham salah satu peneliti dari University College London.

Peningkatan jumlah sel-sel lemak akan mem-blok hormon pengendali nafsu makan dengan cara menghalangi mereka mengirimkan sinyal untuk berhenti makan. Ini berarti Anda akan terus makan bahkan ketika tubuh Anda sebenarnya sudah cukup makan.

Mengendalikan napsu makan bisa menjadi bagian tersulit bagi orang yang sedang menjalankan diet untuk menurunkan berat badan. Oleh karena itu, dengan memahami berbagai faktor lain, seperti peran sistem hormonal tubuh dalam mengendalikan napsu makan, diharapkan Anda memiliki langkah yang lebih efektif untuk mencapai keberhasilan menurunkan berat badan.

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Cara Mencegah Terjadinya Plak Pada Gigi

Kandungan pemanis alami berupa xylitol dan polifenol dalam buah strawberry yang mampu mengurangi kolonisasi streptococcus mutans, yang biasa menghambat aktivitas enzim di dalam mulut. Dengan berkurangnya streptococcus mutans, plak di gigi akan berkurang, serta mencegah terbentuknya plak gigi kembali.

Secara umum, strawberry mengandung nutrisi penting untuk tubuh seperti protein, lemak, karbohidrat dan energi. Selain itu, ada mineral potensial yang terkandung di dalamnya seperti kalsium, fosfor, zat besi, magnesium, potassium, selenium, vitamin C dan juga asam folat,

Strawberry juga terbukti memiliki aktivitas antioksidan dua kali lipat lebih tinggi dibanding anggur merah, lima kali lipat dari apel dan pisang, dan sepuluh kali lipat dari semangka.

Pentingnya menyingkirkan plak di gigi

Plak adalah penyebab utama yang memunculkan aneka penyakit gigi dan mulut seperti karier, calculus, gingivitis, dan periodontitis. Logikanya, jika plak dapat dicegah dan dikurangi, maka penyakit-penyakit seperti disebutkan di atas akan dapat teratasi.

Untuk itulah, mengonsumsi buah strawberry sangat dianjurkan.

Cara yang lebih efektif menghilangkan plak di gigi adalah dengan mengonsumsi jus strawberry. Jus strawberry sendiri rasa asamnya dapat merangsang sekresi saliva dalam jumlah tinggi, sehingga saliva menjadi lebih encer dan viskositasnya jadi lebih rendah.

Menurut para ilmuwan, cara tersebut sefektif mencegah penyakit gigi dan mulut dengan cara mudah dan menyenangkan. Namun perlu diingat, akan lebih efektif bila Anda tidak mencampurkan gula ke dalam jus strawberry, karena strawberry sendiri sudah mengandung gula alami.

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Makanan Yang Tidak Boleh Dimakan Saat Diet

Telah dijelaskan oleh beberapa pakar dan Personal Trainer, bahwa mengimbangi menu makanan dengan latihan akan membantu Anda mendapatkan berat badan dan tubuh yang diidamkan. Oleh karena itu, atur menu makan Anda, jangan pernah terlambat makan, dan hindari beberapa makanan berikut ini:

Jus buah kalengan

Kembalilah ke cara alami, mengonsumsi jus buah yang Anda buat sendiri, dan TANPA TAMBAHAN GULA.

Jus buah kalengan atau yang dikemas di dalam kotak umumnya mendapat tambahan gula dan mengandung pengawet. Sekalipun ada embel-embel vitamin di dalamnya, namun tidak disarankan bagi Anda pelaku diet.

Minuman bersoda

Semua minuman bersoda sekalipun dengan label zero fat tidak disarankan dikonsumsi Anda yang sedang berdiet. Soda tidak akan membantu Anda menurunkan berat badan, dan umumnya membuat perut jadi buncit.

Bila Anda ingin sehat, lebih baik konsumsi air putih saja. Panas atau dingin, tak jadi masalah.

Junk food

Walaupun Anda makan junk food tanpa nasi, tetap saja kandungan kalorinya tinggi. Alhasil, latihan Anda yang seminggu itu sia-sia.

Roti Tawar

Diet masih memperbolehkan Anda mengonsumsi roti. Namun, pastikan roti yang Anda konsumsi bukanlah roti tawar biasa, atau roti dengan segala jenis isi yang menggoda, seperti misalnya roti isi keju, roti cokelat, dan lain sebagainya.

Roti yang disarankan untuk para pelaku diet adalah roti gandum. Di mana roti tersebut banyak seratnya, sedikit gula, dan memberikan rasa kenyang yang lebih lama.

Roti ini baiknya dikonsumsi saat sarapan dan boleh tetap dimakan sebagai camilan di siang hari saat Anda merasa lapar.

Camilan kaya kandungan gula

Hindari aneka camilan yang kaya akan kandungan gula, seperti kue-kue, permen, cokelat, dan lain sebagainya.

Mungkin Anda berpikir sesekali mengonsumsi snack tersebut baik-baik saja. Tetapi, ingatlah bahwa Anda butuh workout lebih juga untuk membakarnya. Apabila Anda tak cukup membakar kalori di tubuh, maka yang terjadi justru kalori bertambah dan bertambah lagi.

Camilan yang disarankan untuk pelaku diet adalah buah. Yang mengandung gula alami dan manisnya cukup serta tidak berlebihan.

Susu whole fat

Tubuh Anda memang membutuhkan kalsium saat sedang diet, tetapi produk susu yang dibutuhkan bukanlah yang whole fat. Lebih baik pilih yang skim sehingga tidak menambah beban Anda membakar lemak yang ada.

Susu kedelai adalah pilihan terbaik bagi para pelaku diet. Selain rasanya yang lezat, susu kedelai juga membantu mengontrol kadar kolesterol dalam tubuh.

Kentang

Katanya boleh dikonsumsi untuk menggantikan nasi? Info tersebut tidak salah, karena kentang kukus memang diperbolehkan dikonsumsi para pelaku diet. Namun sayangnya banyak yang sering salah info, akhirnya kentang goreng atau kentang bakar dengan aneka bumbupun dilahap. Nah, kentang yang diolah dengan cara itu yang sebenarnya tidak disarankan.

Jadi, lebih baik apabila Anda ingin mengonsumsi kentang, olah saja dengan cara merebus atau dikukus.

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Drug Interactions heart

Preliminary

Drug interactions occur when one drug alters the effects of other drugs. Altered drug action can be more or less reactive. Individual reactions vary. Factors that can affect offspring among other properties, liver and kidney function, age (which is the most sensitive babies and people aged over 50 years), presence or absence of a disease, the amount of drug used, duration of treatment, the time between the use of two drugs, and which drugs are used initially. Therefore their effects may not mean anything to anyone but very dangerous for others. The basic thing that should be realized is that the hazard may occur.

Drugs taken through four basic processes in the body. From the mouth, to the stomach medicine, and then to the intestines. Here the drug is absorbed into the bloodstream and spread throughout the body so that it appears the effect. Drugs or dimetabolisis then described by the liver. Finally, a form of medicine that has been described, is excreted in the urine through the kidneys. On drug interactions, a drug other drugs that change in one or more pharmacological processes. This type of interaction is called pharmacokinetic interactions. The other main type of interaction is a pharmacologic interaction. On this type, the effect of a drug will increase (synergism) or reduce the effects of other drugs (antagonism) effects of the second drug.

Classification of Cardiac Drugs and Drug Interactions

The most common heart disorder occurs is angina, cardiac arrhythmias, and withered heart. Pain angina occurs when the heart does not receive enough oxygenated blood. This occurs when blood flow through a coronary artery is blocked, usually due to blockage of that line the inside of the arteries. This unpleasant situation usually occurs when the heart has to work harder, such as the physical fatigue and emotional stress.

Irregular heartbeat is normal heart rhythm disorders. There are many different types of arrhythmias, namely fibrillation, cardiac flutter, palpitation, premature beats, and paroxysmal takhikardia (very fast heart rate).

Wilting occurs when the heart fails to pump blood the heart immediately after blood entry. This causes blood to accumulate in the lungs so that the breath will be short and to accumulation of fluid in body tissues. Cardiac drugs are grouped into 6 sections, namely:

1. Angina drug

Angina drug reduces angina pain by improving blood supply and oxygen to the heart. Name angina drug patent (generic name in parentheses):

Ø Cardilate (eritritil tetranitrate)

Ø Duotrate (pentaerythritol tetranitrate)

Ø Isordil (isosorbida dinitrate)

Ø Nitro-BID (Nitroglycerin)

Ø Nitro-Dur (nitroglycerin, transmukosal)

Ø Persantine (dipiridamol)

2. Antiaritmika

 This drug normalize irregular heartbeat. Antiaritmika name drug patent (generic name in parentheses):

Ø Quinidex Extentabs (kinidin)

Ø Procan (prokainamida)

Ø Norpace (disopiramida)

3. Beta Blocker Heart Drug

 Beta blockers are drugs that a lot of heart function. In addition to eliminating the pain of angina and normalize the heart rate, the drug is also effective menurunksn blood pressure. Beta blockers are also used for other purposes such as to prevent migraine headaches. Names of beta blockers medicines patent (generic name in parentheses):

Ø Blocadren (timolol)

Ø Corgard (nadolol)

Ø Inderal (propranolol)

Ø Lopressor (metoprolol)

Ø Tenormin (atenolol)

Ø Visken (pindolol)

4. Cardiovascular Drugs Calcium Blocker

Calcium blocking drugs is the latest development of cardiovascular medicine. This drug can reduce angina pain that can not be addressed with other drugs. Verapamil is effective against certain types of cardiac arrhythmias. Name of calcium blocking drug patent (generic name in parentheses):

Ø Calan (verapamil)

Ø Cardizem (diltiazem)

Ø Isoptin (verapamil)

Ø Procardia (nifedipine)

5. Heart drug Digitalis

 Similar drug digitalis increase the power and efficiency of the heart and is used to treat heart wither and normalize irregular heartbeat. Name of the heart drug digitalis patent (generic name in parentheses):

Ø Crystodigin (digitoksin)

Ø Digifortis (digitalis)

Ø Lanoxin (digoxin)

Ø Purodigin (digitoksin)

6. Diuretics

 Diuretics remove excess body fluids and is often used to treat heart wither. Name drug patent diuretic (generic name in parentheses):

Ø Aldactone (spironolactone)

Ø Anhydron (siklotiazida)

Ø Aquatag (benztiazida)

Ø Aquatensin (metiklotiazida)

Ø Lasix (furosemide)

Ø Midamor (amiloride)

Ø Naqua (triklormetiazida)

Ø Zaroxolyn (metolazon)

Heart Drug Interactions

· Drug interactions angina / antiaritmika

Angina drug / antiaritmika - Beta Blocker

This combination can cause blood pressure to drop too low. As a result: postural hypotension with symptoms: dizziness, weakness, fainting, severe decrease in blood pressure which can lead to seizures or shock. Drug given beta blockers in angina, to normalize heart rate and to lower high blood pressure.

Angina drug / antiaritmika - Diuretics

This combination can cause blood pressure to drop too low. As a result: dizziness, weakness, fainting, severe decrease in blood pressure which can lead to seizures or shock. Diuretics remove excess fluid from the body and is used to treat high blood pressure and heart withered.

Angina drug / antiaritmika - high blood pressure medicine

This combination can cause blood pressure to drop too low. As a result: dizziness, weakness, fainting, severe decrease in blood pressure which can lead to seizures or shock. High blood pressure medications are used to lower high blood pressure.

Angina drug - Alcohol (beer, liquor, wine, etc.)

This combination can cause blood press down too low. As a result: postural hypotension with accompanying symptoms: dizziness, weakness, fainting, severe decrease in blood pressure which can lead to seizures or shock. This interaction can be minimized by reducing alcohol consumption.

Angina drug - vasodilators

This combination can cause blood pressure to drop too low. consequently; postural hypotension with accompanying symptoms: dizziness, weakness, fainting, severe decrease in blood pressure which can lead to seizures or shock. Vasodilators dilate blood vessels and is used to treat circulatory disorders, such as arteriosclerosis (hardening of the arteries).

Antiaritmika - Antidepressants (type cyclic)

This combination can cause adverse effects on the heart. As a result: the possibility of cardiac arrhythmias. Antidepressants are used to reduce mental depression and improve mood. Note: antidepressants trazadon (Desyrel) do not interact.

Disopiramida - Phenytoin

Disopiramida effects can be reduced. As a result: irregular heartbeat that can not be controlled. Phenytoin is used to control seizures in disorders such as epilepsy.

Prokainamida - Antacids

Prokainamida effect can be increased. As a result: too many prokainamida can lower blood pressure, heart clogging (reduces nerve transmission required for irregular heartbeat) or has a very irregular heartbeat called ventricular fibrillation dangerous.

Kinidin - Antacids

Effects can kinidin msningkat. As a result: too many kinidin can lower blood pressure, heart clogging (megganggu nerve transmission required for irregular heartbeat), or has a very irregular heartbeat called ventricular fibrillation dangerous.

Kinidin - Anticoagulants

Anticoagulant effect can be increased. Anticoagulants are used to thin the blood and prevent clotting. As a result: increased risk of bleeding. Reported symptoms such as bruising or bleeding in the body, stool black.

Kinidin - Barbiturates

Kinidin effect can be increased. As a result: irregular heartbeat that can not be controlled. Barbiturate used as a sedative or sleeping pills.

Kinidin - Digoxin (Lanoxin)

Effects of digoxin may increase. Digoxin is used to treat heart rate and to normalize irregular heartbeat. As a result: possible adverse effects akibt too much digoxin. Al reported symptoms of nausea, vision problems, headaches, lethargic, no appetite, confusion, bradycardia or tachycardia, cardiac arrhythmias.

 Kinidin - Phenytoin

Kinidin effects can be reduced. As a result: irregular heartbeat that can not be controlled. Phenytoin is used to mngendalikan seizures in disorders such as epilepsy.

· Beta blockers heart drug interactions

Beta blockers - Alcohol

This combination can cause blood pressure to drop too low. As a result: postural hypotension with accompanying symptoms: dizziness, weakness, fainting; severe drop in blood pressure which can lead to seizures or shock. This interaction can be minimized by reducing alcohol consumption.

Beta blockers - Amphetamines

Effects of beta blockers resisted. As a result: disorders treated with beta blockers can not be controlled. This combination can also be paradoxical increase in blood pressure dangerous with symptoms such as fever, headache, visual disturbances,. Amphetamines are used as a slimming pill (not recommended), to address behavior problems in children and for narcolepsy.

Beta blockers - drugs angina / antiaritmika

This combination can cause blood pressure to drop too low. As a result: postural hypotension with accompanying symptoms: dizziness, weakness, fainting; severe drop in blood pressure which can lead to seizures or shock.

Beta blockers - Antacids

Effects of beta blockers can be reduced. As a result: the condition can not be handled properly controlled.

Beta blockers - Antidepressants (Janis MAO)

This combination can cause a significant rise in blood pressure. Al reported symptoms irregular heartbeat, fever, headache, visual disturbances. Imao antidepressants are useful to reduce mental depression and improve mood is not used much anymore since developed type of cyclic antidepressants such as Elavil and Sinequan.

Beta blockers - Antidepressants (type cyclic)

Eek beta blockers can be reduced. As a result: a heart condition that could not be handled properly controlled. Antidepressants are used to reduce mental depression and improve mood.

Beta blockers - antipsychotics

This combination can cause blood pressure to drop too low and the effect of beta blockers may increase. Symptoms of low blood pressure are reported al dizziness, weakness, fainting. Akkibat reported symptoms of beta blockers is too much: bradycardia, fatigue, heart arrhythmia, breathing berdengik as in asthma or breathing difficulties. Antipsychotics is a major trankulansia used to treat severe mental disorders like schizophrenia. Generally, a class of phenothiazine antipsychotics.

Beta blockers - medicines Asthma

Effect of theophylline on asthma will be resisted. Asthma medication is used to open the airways in the lungs and make breathing asthma patients. As a result: the bronchial tract can not open wide enough to cope with an asthma attack.

Beta blockers - Barbiturates

Effects of beta blockers can be reduced. As a result: conditions treated by beta blockers can not be controlled.

Beta blockers - Preparations flu / cough lozenges containing nasal

Effects of beta blockers may be resisted. As a result: conditions treated by beta blockers can not be controlled. Medicinal preparations containing nasal decongestant Idung can be absorbed into the bloodstream and can cause interactions.

Beta blockers - drugs diabetes

This combination may increase or reduce the effects of diabetes drugs. As a result: if the effects of diabetes drugs increased, blood sugar levels can drop too low. symptoms of hypoglycemia were reported, which will be more apparent on physical activity or sport: sweating, anxiety, fainting, fatigue, confusion, cardiac arrhythmias, takhikardia, bleary, and vision problems. If the effects of diabetes drugs reduced blood sugar levels will remain too high. Reported symptoms of hyperglycemia: extreme thirst, urine output much, weight loss, hunger, lethargy, drowsiness and bleary-eyed. Heart medication beta blockers used for angina, normalize irregular heartbeats and help lower blood pressure.

Beta blockers - slimming pills (drug-free) containing phenylpropanolamine

Effects of beta blockers may be resisted. As a result: conditions treated by beta blockers tk can be well controlled. Phenylpropanolamine is a nasal decongestant that is a major component in the counter slimming pills due to side effects which can suppress appetite.

Beta blockers - vasodilators

This combination can cause blood pressure to drop too low. As a result: postural hypotension with accompanying symptoms: dizziness, weakness, fainting; severe drop in blood pressure that would cause seizures or shock. Vasodilators dilate blood vessels and is used to treat disorders caused by poor blood circulation, such arterioskerosis.

· Digitalis Drug Interactions

Digitalis group - Amphetamines

This combination can lead to cardiac arrhythmias. Amphetamines are used as a slimming pill (not recommended), to address behavior problems in children, and to markolepsi.

Digitalis group - Asthma medication (epinephrine group)

This combination can lead to cardiac arrhythmias. Asthma medication is used to open the airways of the lungs and make breathing bronchial asthma.

Digitalis group - Preparations flu / cough lozenges containing nasal

This combination can lead to cardiac arrhythmias. Nasal decongestant preparations can be absorbed into the blood and cause interactions Liran.

Digitalis group - slimming pills (without a prescription) that contain phenylpropanolamine

This combination can lead to cardiac arrhythmias. Phenylpropanolamine is a nasal decongestant that is a major component in the counter slimming pills, because the side effects dapay suppress appetite.

Digitalis group - Diuretics

This combination can be detrimental to the heart. Diuretics remove excess fluid in the body and used the heart rate and high blood pressure. Generally diuretics reduce the body's potassium levels. Lack of potassium causes the heart to become very sensitive to digitalis and increased risk of digitalis toxicity with symptoms: nausea, confusion, visual disturbances, headaches, lack of energy, no appetite, bradycardia, takhikardia, and cardiac arrhythmias.

Digitalis group - Laxatives

This combination can be detrimental to the heart. Laxative reduce body potassium. Lack of potassium causes the heart is very sensitive to digitalis and increased risk of digitalis toxicity with symptoms: nausea, confusion, visual disturbances, headaches, lack of energy, no appetite, bradikardai, takhikardia, and cardiac arrhythmias.

Digitoksin - Barbiturates

Digitoksin effects can be reduced. As a result: a heart condition that can be dealt with digitoksin not well controlled.

Digoxin (Lanoxin) - Antacids

Effects of digoxin may be reduced. As a result: a heart condition that can be dealt with digitoksin not well controlled.

Digoxin (Lanoxin) - methyldopa (Aldomet, Aldoril)

This combination can be detrimental to the heart. Methyldopa is used to treat high blood pressure. Symptoms reported al bradycardia, dizziness, fainting, confusion, and forgetfulness.

Digoxin (Lanoxin) - Antibiotics tetracycline

Digoksi effect can be increased. As a result: adverse side effects can occur from too much digoxin. Al reported symptoms of nausea, confusion, visual disturbances, headaches, lack of energy, no appetite, bradycardia, takhikardia, and cardiac arrhythmias.

Cardiovascular medicine calcium blockers - Beta Blocker

This combination can be detrimental to the heart. If the two drugs are given together, the physician should carefully monitor their effects on patients. Beta blockers used to treat heart problems and high blood pressure.

Calcium blockers - digoxin

Digoksi effect can be increased. As a result: adverse side effects can occur from too much digoxin. Al reported symptoms: nausea, confusion, visual disturbances, headaches, lack of energy, no appetite, bradycardia, takhikardia, and cardiac arrhythmias.

Medicinal plants Heart Disease

 Plants are used by humans for thousands of years for medicinal purposes. In this approach it is stated that, interference with one of the organs will cause an imbalance of other organs. If the balance of the body's problems can not be resolved, then there will be health problems. Treatment performed by healers aims to help the natural healing and restore the health of people in balanced conditions, not only eliminate the symptoms.

 The main principle of treatment with medicinal plants is important to use total plant extracts, not pure or artificial substance isolation of certain specific functions, especially synthetic materials. Constituent chemical diversity in plants can result in extensive activity in the body. The chemical compound will work together so as to eliminate possible side effects and may provide the ability to work in unison. Thus, the amount of compound required relatively little compared pemakaina single compound.

 A number of plants are scattered in nature containing steroid glycosides with 23 or 24 carbon atoms which can strengthen the effect on the heart is weakened.

 In the plants, cardiac glycosides present in seed plants. Commonly found in many parts Apocynaceae and Asclepiadaceae, but also found in some plants Liliaceae, Ranunculaceae, and Euphorbiaceae.

· Apocynaceae tribes, such as: pulasari (Alyxia stellate A)

· Liliaceae tribes, such as: Garlic (Allium sativum L) and onion (Allium cepa L)

· Ranunculaceae tribes, such as black cumin (Nigella sativum)

· Euphorbiaceae tribe, such as: Meniran (Phyllantus niruri L)

Plant Interactions with Cardiovascular Drugs

· Concomitant administration of ergot alkaloids and potentially cause coronary vasospasm may aggravate angina.

· Lisinopril if combined with garlic (can increase the antihypertensive effect)

· Ginseng (aggravate hypertension).

· Increased vasodilator effects and side effects including severe hypotension and myocardial ischemia may occur when used with nifedipine grapefruit.

Cardiovascular Drug Interactions Plants

· Allii nightingale sativa (garlic)

 Aliin mangandung fresh tubers from 0.2 to 1.0%. Aliin or S-allyl-L-Cysteine ​​is a compound soluble in water, and its chemical formula is (-)-5-allyl-L-Cysteine-solfoksida, which can be hydrolyzed by the enzyme activity alisin aliinliase form, ammonia, and acid ketoasetat.

 Aliin hemihidrat compound which is colorless and crystallized in the form of needles with acetone solvent. Molecule has two centers of asymmetry that can have four isomers, two of which were derived from L-Cysteine ​​and D-Cysteine ​​nature. The fourth isomer has to be synthesized and the one that is identical to the natural aliin is (-)-S-allyl-L-Cysteine ​​sulfoxide.

 Alisin unstable and can decompose during distillation or hydrolyzed by water or sodium carbonate to form polysulfide compounds, dialilsulfida, which cause the bad smell of essential oil. Hydrolysis decomposition that can be isolated is already trans compound - and / or cis-ajoen, 2-vinyl-[4H] -1,3-ditiin, 3-vinyl-[4H] -1,2-ditiin, dialiltrisulfida and metal- allyl-trisulfida.

· Allii cepae bulb (onion)

The main components of this bulb is compound oxide-S bond with amino acids, namely zikloaliin (levels up to 2%) and homologous propel-and / or propenyl-of aliin. In the enzymatic dissociation can occur storage form tiosulfinat acid ester, sulfinildisulfida (sepain), di-and polysulfide, and tiopen. The smell of the bulbs was caused by the presence of substances propantial-S-oxide, which causes eye pain and spend a lot of tears.

· Purpureae Folium Digitalis (Digitalis leaves)

 Of the digitalis leaf could have isolated more than 30 types of glycosides kardenolida with levels from 0.15 to 0.4%. Primary glycosides (purpurea glycoside A, purpurea glycoside B, and glukogitaloksin) all have genin at 3 C atoms form linear chains of group 3 digitoksosa sugar and topped with glucose. Active components dry matter of Digitalis purpurea is digitoksin (± 12%), as well as gitoksin, and gitaloksin (± 10%).

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Worms

Worm Disease 

Worm infection is one of the most common diseases spread and infect more than 2 billion people around the world. In general, worms rarely cause serious illness, but it can lead to chronic health problems, which is a very important economic factor. Infection can occur simultaneously by several types of worms at once. It is estimated that more than 60% of children in Indonesia suffer from a worm infection. 

Transmission 

Worm infections generally occur through: 

Mouth

Sores on the skin

Eggs or larvae that exist everywhere on the ground (worm eggs out of the human stomach with feces, if the waste is discharged into the environment then it would make more luas.Contohnya spread if spread in the river, then the worm eggs will contaminate "the river water , food, wind "). Diagnosis: Microscopic examination of eggs or larvae in the feces, urine, blood and tissue. This determination is important because the drugs work mostly depends on the type of worm parasites. 

Symptoms of Worms 

Itching of the anus or feet, diarrhea, constipation, abdominal pain and small bowel obstruction and pancreatic ducts.

Distended abdomen, kelalahan very, decreased appetite, seizures, nausea and vomiting.

Weight loss, pallor and anemia or anemia

Symptoms or complaints may be caused by the toxic effects of substances exchange products worms, intestinal obstruction and bile duct (obstruction) or withdrawal of essential nutrients for the body. Often the symptoms are not so obvious and the only form of gastrointestinal disorders, such as nausea, vomiting, heartburn, diarrhea, convulsions and loss of appetite periodically with (anorexia). 

Prevention 

Common actions that need to be done is to obey hygiene rules firmly and consistently, especially in children. For example precautions taken: 

Wash hands with soap before and after waking up, after defecation and before eating and cut fingernails and do not bite your nails.

Wear footwear.

Not to snack at any place, let alone snacks open

Wash vegetables and fruits before eating the first running water or dip it a few seconds in boiling water, and the meat should be cooked until matah right before eaten.

Clothing and room: give the kids in tight pants to avoid contact between the finger and the rectum, the bedrooms are regularly cleaned.

At the same time, children who suffer from intestinal worms must be treated immediately. However, despite all of the children are taking medication worms, worms do not mean the problem will be completed on the spot

Do not eat anything that has been dropped on the ground without washing thoroughly first.

Thus oral infection most often occurs, can be avoided. In eradicating worm infections common hygiene measures need to be taken which includes housing improvement, social and economic environment. 

Types of worms 

Worms are parasites that humans can be divided into 2 groups, namely: 

Plathelminthes (flatworms). Characteristics: flat shape and does not have a body cavity.

Tapeworms (Cestoda): Taenia, echinococcus, Hymenolepsis, etc.. Echinococcus has a fixed host (dog)

Flatworms (Trematodes): Schistosoma, Fasciola, etc.. Schistosoma infected by its active form (cercariae). Fasciola (liver fluke) specifically found in sheep and pose include an enlarged liver, rarely infect humans. 

Nematode (Roundworm): Oxyuris (Kermi worms), Ascaris (roundworm), Ancylostoma (hookworm), Strongyloides and Trichuris (whipworm). Infection can occur through egg, larva or worm itself, through the mouth or through the skin.

As for the types of worms that infect humans are: 

Pinworms, pinworms spread is more common in cold regions. The female pinworm measuring 8-13 mm x 0:44 mm with a long tail and pointy looking male pinworms measuring 2-5 mm with a circular tail. Berrkisar worm life cycle between 2 weeks to 2 months. Pinworm transmission and transmission is affected by dust from hand to mouth. Diseases caused by pinworms known Enterobiasis. That places the inflammation around the rectum and the vagina girls inflammation. The introduction is through examination of the skin around the anus.

Bracelet worms, roundworms, similar to worms tanahpanjang 10-30 cm, small intestine dironggo life. This worm landed on the dog, the eggs can be removed with the feces of infected children when playing in the dust and be ingested by humans through food terkontamonasi. The eggs will hatch in the intestine, and then develop into larvae penetrate the intestinal wall and into the lungs. After adult roundworms will inhabit the human gut and invade the food there so that causes people to suffer malnutrition because food intake is absorbed by roundworms. Moreover cause intestinal blockage and inflammation of the appendix or pancreatic lobe. The introduction is through a fecal examination, where the worms and eggs with a real egg obvious. 

Whip worms, whip-like shape, 3-5 cm long. Infection occurs through the egg in water and food. Spreading occurs when swallowing whipworm eggs. In children whipworm can be found throughout the colon and rektum.Gejala per4mukaan that may occur in this disease is anemia. As a result, the children flocked cause inflammation of acute appendicitis or peritonitis. There are no worms in stool, only eggs that can be recognized by the microscope. 

Mine worm, this worm length between 6-12 mm. Has 4 teeth were similar, 90% of these infections are caused by N. Americanus. Hookworm eggs out along with feces, within 1 1.5 days the eggs will hatch into larvae called rhabditiform larvae. Three days later the larvae turn into filariform larvae that can penetrate the skin lareva feet and into the human body. In the human body, following the moves of hookworm bloodstream, heart, lungs, throat, and swallowed kemudiaan into the intestine. In the intestine, the larvae become adult worms are ready to suck the blood of so dangerous because it can cause anemia in humans. The symptoms are itching in the legs and cough with increasing temperature. 

Thread worms, worm infection worms live in the soil, infection occurs through the larvae penetrate the foot. The symptoms are intense itching in the anal area and inflammation of the skin. The introduction of the infection can be identified and thread worm larvae feces that do not contain eggs. The introduction can be recognized from larvanyha in the stool, which does not contain eggs. 

Ribbon worm, this worm length 60 cm in T. Solium and 2 m in T. Saginata found in beef liver. Consequently dangerous penetrate the intestinal wall, blood circulation and to other organs such as the brain, liver and lung. Transmission occurs by eating meat that has not been cooked long enough and still contain worm eggs. After hatching, the larvae grow into worms in the gut cavity. The introduction can be recognized from the eggs and ruasnya (3 cm long, 1 cm wide) are present in the feces. 

Breeding Worms 

Community widespread worms in the stomach easily. As an illustration, an adult female roundworm can produce 200,000 eggs per day. If there are five in the belly of the tail, they can produce a million eggs a day. Only egg size in units of microns (1 micron is one thousandth of a millimeter). So small, the eggs can only be seen with a microscope. 

Type Worm Disease 

Ascariasis: Mebendazole, pyrantel, Albendazole, piperazine. Ascaris lumbricoides (roundworm) 10-15 cm in length and usually reside in the small intestine. Transmission occurs through food by infected eggs and larvae that develop in the small intestine. The larvae penetrate the intestinal wall, through the heart and then to the lungs. After reaching the throat, then swallowed and breeding larvae into adult worms in the small intestine. Treatment: Mebendazole, Albendazole and pyrantel is the drug of first choice. Kur often have to be repeated with a second chair, because not all worms or eggs can be destroyed. 

Oxyuriasis: Mebendazole, pyrantel, Albendazole, piperazine. Enterobius vermicularis (formerly called oxyuris) or worms that are common in Kermi coecum, cause itching around the anus and severe convulsions in children. Sometimes these infections cause inflammation of the lobe acute appendicitis (appendicitis). Transmission in young children is often the case with the auto-reinfection, ie, through the eggs attached to the fingers while scratching the anal area, which felt very itchy and thus allowing secondary infections. The cause is the female worms are 8-13 mm in length, which is in between the hours of 8-9 nights out of the anus to lay eggs on the skin around the anus. Kermi worm infection is an infection of worms that is the only transmission takes place from person to person, so that all family members should be treated simultaneously as well, although they do not show any symptoms. The cause is the new female worms lay their eggs between 3-6 weeks after infeksi.Terapi: Mebendazole, Albendazole and pyrantel no lethal eggs so after 2 weeks of worms that hatched should be turned off by the second chair. Piperazine is the second choice drug. 

Taeniasis: Praziquantel, niclosamide. The most common tapeworm Taenia solium there is, T. Saginata there is lots of pork / beef, fish also. Transmission occurs by eating meat that is not cooked long enough and still contain larvae. Taenia difficult to eradicate, because the fist (scolenya) a relatively small embedded into the intestinal mucous membrane to terkenan no cure. Worms parts (segments) that come into contact with drugs and had been turned off, removed from the scolex which then makes new segments (regeneration). Segments and their eggs can be recognized in the stool, but scolexnya usually digested by the nodes usus.Terapi: the first choice drug Praziquantel and niclosamide. 

Ancylostomiasis: Mebendazole, Albendazole. There are 2 types of worms that Necator americanis Mine are mainly found in the United States and Ancylostoma duodenale are found in tropical / subtropical and length of approximately 10 mm. Transmission occurs by the larvae enter the broken skin on the feet and cause local reactions. Having entered the vein, the larvae to the lungs and bronchi ultimately to the gastrointestinal tract. Hookworm is also associate themselves with the intestinal mucosa and suck blood host to serious anemia. Treatment is directed at two objectives, namely improve blood picture (nutritious foods and iron compounds) and eradicate the worm. Mebendazole and pyrantel worm medicine is the first choice as well as to eradicate roundworm infection when mixed. 

Strongyloidiasis: tiabendazol, Ivermectin, Albendazole. Strongyloides stercooralis (thread worms) found in the tropics and subtropics. Transmission through the thread-shaped larvae penetrate the skin. The larvae can be recognized in the stool, which does not contain eggs. Since the auto-reinfection occurs, the worms can survive for decades in the mucosa of the upper small intestine. In this place, the worms cause inflammation and damage. Typical symptoms are intense itching (urticaria) on the rear, which is temporary, also stomach upsets and respiratory irritation (cough) due to migration of worms. Treatment: Tiabendazol and Ivermectin is the drug of first choice for thread worms. Albendazole is also effective. 

Trichiuriasis: Mebendazole, pyrantel, Albendazol.Trichiuris trichiura (whipworm) in the state are generally hot and humid climates. Contained in coecum (appendectomy) and settles in the ileum and colon mucosa, with causing damage and inflammation. Eggs are excreted in feces and used for diagnosis. Eggs can be grown in the ground. Transmission occurs through infected food and water. Symptoms in young children can lead to acute appendicitis. Due to blood loss anemia may also occur. Treatment is done effectively with Mebendazole, pyrantel, and Albendazole. 

Filariasis: Dietilkarbamazin (DEC) and Hetrazan. Wucheria bancrofti (filarial worm) is a family of filarial nematodes, which cause tropical diseases elephantiasis (elephantiasis). Inflammation of the lymph vessels to the blockage followed by adult worms (8-10 cm in length). As a result, hypertrophy of these tissues, especially in the legs that can grow up to 30 cm diameter. Transmission to humans occurs through the mosquito Culex fatigans, which stung by night. Treatment: Dietilkarbamazin especially when administered at an early time, sometimes requiring surgery to repair a lymph drainage and remove excess tissue. 

Schistosomiasis: Praziquantel. Schistosoma haematobium (flatworms) are not segmented worms and schistosomiasis are the cause of the disease is transmitted by a type of carrier snail larvae. Once developed, the parasites penetrate human skin and enter the blood circulation. Transmission occurs by cercariae, typical forms are released into the water by which the host (snail) which then penetrate human skin or mucous membranes. Sexual cycle occurs in humans with the formation of eggs excreted in feces or urine. In the water, out of the eggs and larvae infect snails, which produced tens of thousands of cercariae. Treatment: Medication is the first choice for all types of schistosomiasis Praziquantel that attack humans. 

Helminthic 

Anthelmintics or worming (Greek = anti = opponent, helmins = worm) is a drug that can destroy worms in humans and animals. 

Many antelmintika have efficacy against 1 or 2 types of worms. Only a few drugs that have efficacy against more types of worms (broad spectrum), eg: Mebendazole. 

Various Kinds of Drugs Worms 

Mebendazole: tiabendazol, albendazole.

very effective against pinworms, bracelets, ribbon, whip and mine.

Widely used as monotherapy for the treatment of mass deworming, also in mixed infections 2 or more worms. Working as vermicid, larvacid and ovicid.

Mechanism of action: counteraction revenue and accelerate the use of glucose (glycogen) in the worm.

Dosage: Children and adults alike, the Oxyuriasis single dose of 100 mg at breakfast time. In the roundworm infection, mining, thread, ribbon and whip 2 dd 100 mg for 3 days, if necessary, be repeated after 3 weeks.

2. Piperazine: Upixon 

Oxyuris and highly effective against Ascaris.

Worms paralyzed and then removed from the body by the intestinal peristalsis, as well as efficacious laksan weak.

Widely used because it is effective and inexpensive, but in many western countries since 1984 is not used anymore because of side effects, especially neurotoxicity.

Dose: Ascaris: 75 mg / kg or a single dose of 3 g for 2 days. Oxyuris 65 mg / kg or a single dose of 2.5 g for 7 days. 

4. Levamisole 

Effective against Ascaris, hookworms.

Side effects are rare, which is an allergic reaction (rash), granulocytopenia and other blood disorders 

5. Niclosamide: Yomesan 

Highly effective against tapeworms human / animal

Mechanisms: increased sensitivity to the protease enzyme that worm worm easier to digest.

Almost no side effects, but these drugs are highly toxic, its use must be careful to increase resorption disorders (colitis and bowel injuries).

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Chikungunya fever

Definition
Chikungunya fever is an endemic disease (applicable to the sector in the region or population often). Chikungunya virus was first identified in East Africa in 1952. Chikungunya comes from Shawill based on patient symptoms, which means (body position) twisted or curved, referring to the bent posture of the patient due to severe joint pain (arthralgia). The joint pain in the knees and ankle joints of the hands and feet.


Cause
Chikungunya fever is caused by Chikungunya virus (CHIKV). CHIKV belongs to the family Togaviridae, alphavirus genus, and is transmitted by the mosquito Aedes aegypti.


Modes of Transmission
Chikungunya may be said to be 'brothers' with high fever and dengue denggi as transmitted by the same carrier Aedes aegypti and albopictus. The difference, if denggi dengue virus invade the bloodstream, Chikungunya virus attacks the joints and bones. Aedes mosquito bites a person who would normally have been infected by chikungunya virus and move blood to a healthy other prey.


Symptom
Chikungunya symptoms-the clinical symptoms are very similar to denggi fever. Chikungunya typically starts with a sudden high fever that reached 390 ° C other symptoms such as chills, rash on legs, hands and body no appetite headache, red eyes, photophobia (sensitivity to light) and vomiting.

The main symptoms of Chikungunya disease is the body suddenly felt a fever followed by rheumatic pain in joints. In fact, because one typical symptom is the emergence of a sense of fatigue, pain, pain may also arise in the bones, there are named as bone fever or flu-bone. In some cases also found that infected patients without causing any symptoms at all or silent chikungunya virus.

This disease does not cause death. Pain in the joints will not cause paralysis. After over five days, the fever gradually subsided, feeling pain or pain in the joints and muscles is reduced, and the sufferer will recover to normal. Patients in some time and then can move her body as usual. Although in some cases the pain is still lagging sometimes for days to months. Usually this condition occurs in patients who previously had a history of frequent bone pain and muscle.


Diagnosis
To obtain an accurate diagnosis needs some serologic tests such as obstacle agglutination test (HI), serum neutralization, and IgM capture ELISA. But this is only bermanfaant serology is used for epidemiological and research interests, not useful for practical purposes everyday clinical.


Treatment
Chikungunya fever include? Self Limiting Disease? or illness that resolves on its own. There is no vaccine or specific drug for this disease. Treatment given only symptomatic therapy or eliminate the symptoms of the disease, such as pain relievers or fever as class paracetamol . Should avoid the use of similar drugs aspirin. Antibiotics are not needed in this case. Use of antibiotics to prevent secondary infection is not considered useful. To improve the general condition of the patient is recommended to eat nutritious foods, especially carbohydrates and sufficient protein and drink as much as possible. Expand consume fresh fruit or fresh fruit juice.

Granting immunity-enhancing vitamins may be beneficial for the treatment of disease. In addition to vitamins, foods that contain enough protein and carbohydrates also increase endurance. Endurance is good and adequate rest can accelerate the healing of disease. Also advised to drink lots of fluids to address the need to increase the time of fever.

Prevention
The only way to avoid this disease is to eradicate mosquitoes carrying the virus. This mosquito, happy to live and breed in stagnant water such as a bathtub, flower vases, and also cans or bottles that hold water.

Black and white patterned mosquito is also happy to live in objects such as clothes hanging on the back door. In addition, this mosquito also enjoys place dark and stuffy.

Given the spreading of this disease is the mosquito Aedes aegypti then the best way to break the chain of transmission is to combat the mosquito, as is often suggested in the fight against dengue fever.

Insecticide used to kill mosquitoes is from malathion group, whereas themopos larvae-larvae to turn off.

Malathion is used by way of fumigation, not by spraying into the wall. This is because the Aedes aegypti do not like to rest on the walls, but the hanging objects. However, prevention is cheap and effective way to combat mosquitoes is to drain the clean water reservoirs, bath, flower vases and so on, at least once a week, since mosquitoes are breeding from the egg to mature within a period of 7-10 days .

Yard or gardens around the house must be clean of objects that allow rainwater clean, especially during the rainy season like now. Doors and windows should be open every day, from morning till evening, so that fresh air and sunlight to enter, resulting in the exchange of air and healthy lighting. Thus, creating an ideal environment for the mosquitoes. How to prevent an outbreak of chikungunya is to reduce outbreaks of mosquito ketahap maximum. This includes breeding larvae destroy the nest to stop the life cycle and transmission. There are various ways to protect yourself from mosquito bites, among others:

Individual prevention can be done in a special way as the use of skin ointment (insect repellent) containing the active ingredient DEET or other EPA. The use of long sleeves and long pants are also recommended for certain areas in the state is an increase in cases, bed use mosquito nets and mosquito ambush on casement pairs.

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Drug Interactions

Preliminary
Drug interaction is a change in the effect of a drug due to the use of other drugs (drug-drug interactions) or by food, traditional medicine and other chemical compounds. Significant drug interactions may occur if two or more drugs are used together.
Drug interactions and adverse drug reactions need attention. An American study showed that each year nearly 100,000 people had to be hospitalized or have to stay in hospital for longer than it should, even in cases of death due to interactions and / or side effects of drugs. Patients who were admitted to hospital often receive therapy with polypharmacy (6-10 kinds of drugs) as the subject for more than one doctor, so it is very possible drug interactions mainly affected the severity of illness or age.
Clinically important drug interactions result in increased toxicity when and / or a reduction in drug effectiveness. So keep in mind, especially when it comes to drugs with narrow safety margin (therapeutic index is low), such as cardiac glycosides, anticoagulants and cytostatic drugs. It is also worth noting the drugs commonly used together.
Incidence of hard drug interactions in clinical estimate because:
a. documentation is lacking
b. often escaped notice, due to lack of knowledge of the mechanisms and the possibility of drug interactions. This resulted in drug interactions include increased toxicity seen as idiosyncratic reaction to one drug, while the form of interaction penurunakn effectiveness ascribed the increased severity of illness of patients
c. the incidence or severity of drug interactions are influenced by individual variations, in which certain populations more susceptible such as geriatric patients or severely diseased, and could also be due to differences in metabolic capacity between individuals. In addition, factors specific diseases, especially renal failure or severe liver disease and other factors (large doses, the drug ingested together, chronic administration).

Mechanism Drug Interactions
Interactions are classified by involvement in a process of pharmacokinetics and pharmacodynamics. Pharmacokinetic interaction is characterized by changes in drug plasma levels, area under the curve (AUC), onset of action, half time, etc.. Pharmacokinetic interactions caused by changes in the rate or extent of absorption, distribution, metabolism and excretion. Pharmacodynamic interactions are usually associated with the ability of a drug to alter the effects of other drugs without altering the properties of farmakokinetiknya. Pharmacodynamic interactions include additive (A drug effect = 1, B = 1 effects of drugs, the effects of a combination of both = 2), potentiation (effect A = 0, B = 1 effect, the effect of the combination of A + B = 2), synergism (effect A = 1, the effect of B = 1, the effect of the combination of A + B = 3) and antagonism (effect A = 1, B = 1 effect, the effect of the combination of A + B = 0). Mechanisms involved in the interactions are pharmacodynamic effects of changes in tissues or receptors.

Pharmacokinetic interactions
1. Absorption
The drugs are taken orally bisaanya absorbed from the gastrointestinal tract into the circulatory system. There are many possibilities for drug interactions occur through the gastrointestinal tract. Drug absorption can occur through passive and active transport, where most of the drug is absorbed passively. This process involves the diffusion of the drug from an area with a high concentration to areas with lower levels of medication. On the displacement of the drug active transport against a concentration gradient (ie ion-ion and water-soluble molecules) and this process requires energy. Absorption of active drug transport is faster than in the passive tansport. Drugs in the form of non-terion fat soluble and easily diffuses across the cell membrane, whereas the drug in the form of fat and insoluble terion can not diffuse. Under normal physiological conditions, but the level of absorption is slightly delayed absorption is usually perfect.
When the absorption rate changes, significant drug interactions will occur more easily, especially drugs with short half-life time or when needed peak plasma levels were quick to get the effect. Interaction mechanism due to impaired absorption, among others:
a. Direct interaction
Interaction physically / chemically between drugs within the lumen of the gastrointestinal tract before absorption can interfere with the absorption process. This interaction can be avoided or greatly dikuangi when interacting drugs are given within a period of at least 2 hours.
b. pH changes in gastrointestinal tract
Gastrointestinal fluid alkalis, for example due to antacids, will increase the solubility of drugs that are poorly soluble acid in the gastrointestinal tract, such as aspirin. Thus aspirin accelerated by alkaline dissolution will accelerate absorption. However, the atmosphere alkalis in the gastrointestinal tract reduces the solubility of a drug that is alkaline (eg, tetracycline) in the gastrointestinal fluids, thereby reducing absorption. Decreased gastric acidity by antacids will reduce the destruction of drugs that are not acid resistant thus increasing bioavailabilitasnya.
Ketoconazole is taken by mouth requires a medium acid to dissolve the required amount so as not allows supplied with antacids, anticholinergic drugs, inhibition of H 2, or proton pump inhibitors (eg, omeprazole). If necessary, the drug should be abat-given at least 2 hours after administration of ketoconazole.
c. formation of insoluble complexes or chelate, and adsorsi
The interaction between the antibiotic group fluorokinolon (ciprofloxacin, enoksasin, levofloxacin, lomefloksasin, norfloxacin, ofloxacin and sparfloksasin) and divalent ions and trivalent (eg Ca 2 + ions, Mg 2 + and Al 3 + from antacids and other drugs) can cause a decrease in significant gastrointestinal absorption, bioavailability and therapeutic effect, because formation of complex compounds. This interaction also decreases the activity of fluoroquinolone antibiotics. This interaction effect can be significantly reduced by providing an antacid a few hours before or after administration of fluoroquinolones. If antacids are really needed, adjustment of therapy, such as drug-pbat replacement with H 2 receptor antagonists or proton pump inhibitors do.
Several antidiarrheal medication (containing attapulgite) adsorb other drugs, resulting in lower absorption. Although there is no scientific research, use of these drugs should interval with other drugs as long as possible.
d. drug being bound to the bile acid sequestrant (BAS: bile acid sequestrant)
Cholestyramine and kolestipol can bind to bile acids and prevents reabsorpsinya, consequently bonding can occur with other drugs, especially acidic (eg warfarin). We recommend the use of interval kolestipol with cholestyramine or other drugs as long as possible (minimum 4 hours).
e. changes in gastrointestinal function (acceleration or slow emptying of the stomach, changes vaksularitas or gastroduodenal mucosal permeability, or damage to the intestinal wall mucosa).
Examples of drug interactions on the absorption process can be seen in the following table:

Obat yang dipengaruhi Drugs affected	Obat yang mempengaruhi Drugs that affect	Efek interaksi Interaction effects
Digoksin Digoxin	Metoklopramida Metoclopramide Propantelin Propantelin	Absorpsi digoksin dikurangi Reduced digoxin absorption Absorpsi digoksin ditingkatkan (karena perubahan motilitas usus) Digoxin absorption increased (due to changes in intestinal motility)
Digoksin Digoxin Tiroksin Thyroxine Warfarin Warfarin	Kolestiramin Cholestyramine	Absorpsi dikurangi karena ikatan dengan kolestiramin Reduced absorption due to bonding with cholestyramine
Ketokonazol Ketoconazole	Antasida Antacids Penghambat H 2 Inhibitor of H 2	Absorpsi ketokonazol dikurangi karena disolusi yang berkurang Ketoconazole absorption is reduced due to the reduced dissolution
Penisilamin Penicillamine	Antasida yang mengandung Al 3+ , Mg 2+ , preparat besi, makanan Antacids containing Al 3 +, Mg 2 +, iron preparations, food	Pembentukan khelat penisilamin yang kurang larut menyebabkan berkurangnya absorpsi penislinamin Penicillamine chelate formation which leads to reduced absorption of poorly soluble penislinamin
Penisilin Penicillin	Neomisin Neomycin	Kondisi malabsorpsi yang diinduksi neomisin Neomycin induced malabsorption conditions
Antibiotik kuinolon Quinolone antibiotics	Antasida yg mengandung Al 3+ ,Mg 2+ , Fe 2+ , Zn, susu Antacids that contain Al 3 +, Mg 2 +, Fe 2 +, Zn, milk	Terbentuknya kompleks yang sukar terabsorpsi Complex formation is difficult adsorbed
Tetrasiklin Tetracycline	Antasida yang mengandung Al 3+ , Mg 2+ , Fe 2+ , Zn, susu Antacids containing Al 3 +, Mg 2 +, Fe 2 +, Zn, milk	Terbentuknya kompleks yang sukar terabsorpsi Complex formation is difficult adsorbed

Among the above mechanisms, the most significant is the formation of insoluble complexes, chelate formation or if the drug is bound resin that binds bile acids. There are also some drugs that alter the pH of the gastrointestinal tract (eg, antacids) which resulted in significant changes in drug bioavailability.

.1. Distribution

Once the drug is absorbed into the circulatory system, drugs brought into the workplace where the drug will react with a variety of body tissues and or receptors. During their stay in the bloodstream, the drug can be attached to various blood components, especially protein albumin. Fat-soluble drugs have a high affinity to adipose tissue, so drugs can be stored in the adipose tissue. The low blood flow to the tissue resulting in fatty tissue into depot for fat-soluble drugs. This prolongs the effects of the drug. The drugs are highly lipid soluble groups such as phenothiazines, benzodiazepines and barbiturates.

Number of acidic drugs have an affinity for blood proteins, especially albumin. The drugs have an alkaline affinity binding to α-acid-glycoprotein. Plasma protein binding (PPB: plasma protein binding) expressed as a percent indicating percent bound drug. Albumin-bound drug is pharmacologically inactive, whereas drugs that are not tied, commonly called fractions free, pharmacologically active. When two or more drugs are highly bound to protein is shared sasam, competition binding occurs at the same place, which resulted in a shift in one of the drug binding to the protein, and it finally happened peninggatan free drug levels in the blood. When the drug displaced of proteins by binding with other drugs, there will be increased levels of free drug is distributed through various networks. Albumin levels in patients with drug-free or active form will be higher.

Valproic acid was reported to shift phenytoin of bonds with proteins and also inhibits the metabolism of phenytoin. If patients take both drugs, unbound phenytoin levels will increase significantly, causing more side effects large. Conversely, phenytoin may decrease plasma levels of valproic acid. The second combination drug therapy should be monitored with tight and dosage adjustments made.

Medications that tend to interact on the distribution of the drugs are:

percent protein bound high (over 90%)

bound on the network

has a small volume of distribution

have a low hepatic excretion ratio

have a narrow therapeutic range

has a rapid onset of action

used intravenously.

Drugs that have a high ability to shift to other drugs from protein binding is salicylic acid, phenylbutazone, sulfonamides and nonsteroidal anti-inflammatory.

.2. Metabolism

To produce a systemic effect in the body, the drug must reach the receptor, means the drug must be able to pass through the plasma membrane. For the drug must dissolve fat. Metabolism can change the fat-soluble active compounds into water-soluble compounds that are not active, which will be excreted primarily through the kidneys. Drug metabolism can pass through two phases, namely phase I and II metabolism. In the phase I metabolism, oxidation, demethylation, hydrolysis, etc.. by liver microsomal enzymes that are in the endothelium, produce more drug metabolites water-soluble. In the phase II metabolism, drug reacts with the water-soluble molecules (eg glucuronic acid, sulfate, etc.) into metabolites that are not or less active, which is soluble in water. A compound can pass one or both of the above fasemetabolisme until a water-soluble form. Most of the drug interaction clinically significant result from the phase I metabolism of the phase II.

a. Increased metabolism

Some medications can increase the activity of hepatic enzymes involved in the metabolism of other drugs. For example, phenobarbital increase the metabolism of warfarin thus lowering antikoagulannya activity. In this case the dose of warfarin should be increased, but after discontinued use of phenobarbital dose of warfarin should be reduced to avoid potential toxicity. Can be used as an alternative sedative than barbiturates, benzodiazepines such groups. Phenobarbital also increases the metabolism of other medications such as steroid hormones.

Other barbiturates and drugs such as carbamazepine, phenytoin, and rifampin also cause enzyme induction.

Pyridoxine accelerate decarboxylation of levodopa into its active metabolite, dopamine, in the peripheral tissues. Unlike levodopa, dopamine can not cross the barrier blood brain to provide antiparkinsonian effects. Giving karbidopa (an inhibitor of decarboxylation) together with levodopa, levodopa activity can prevent interference by pyridoxine,

b. Inhibition of metabolism

A drug may also inhibit the metabolism of other drugs, with impacts extend or increase the action of drugs that are affected. For example, allopurinol reduces the production of uric acid by inhibiting the enzyme ksantin oxidase, which metabolizes some potentially toxic drugs such as merkaptopurin and azathioprine. Ksantin oxidase inhibition can significantly enhance the effects of these medications. So if used with allopurinol, merkaptopurin or azathioprine dose should be reduced to 1/3 or ¼ dose usually.

Cimetidine inhibits oxidative metabolic pathways and may increase the action of drugs that are metabolized by this pathway (eg, carbamazepine, phenytoin, theophylline, warfarin and mostly benzodiazepines). Cimetidine did not affect benzodiazein action lorazepam, oksazepam and temazepam, which undergoes glucuronide conjugation. Ranitidine has an effect on oxidative enzymes lower than cimetidine, famotidine and nizatidin while not affect the oxidative metabolic pathway.

Erythromycin reportedly inhibits hepatic metabolism of some drugs such as carbamazepine and theophylline thereby increasing their effect. Fluoroquinolones such as ciprofloxacin drug class also increases the activity of theophylline, presumably through the same mechanism.

3. Excretion

Unless an inhalation anesthetic drugs, most drugs are excreted via bile or urine. Blood enters the kidney along the renal artery, first delivered to the glomeruli tubules, where small molecules that fit through the glomerular membrane (water, salt and some specific drugs) filtered into the tubules. Large molecules such as plasma proteins and blood cells were detained. Blood flow then passes through another part of the renal tubule where active transport to move the drug and its metabolites from blood to tubular filtrate. Tubular cells then perform active and passive transport (by diffusion) for reabsorbing the drug. The interaction can take place due to changes in renal tubules active excretion, changes in pH and changes in renal blood flow.

a. Changes in renal tubules active excretion

b. changes in urine pH

c. Changes in renal blood flow

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