A.

Incident
Since September 13, 2017, Southeast Sulawesi Health Office mentioned already 76
victims of PCC tablets that are mostly teenagers. About 50 children and teenagers were
hospitalized for acting strangely after taking PCC pills, and 26 of them were treated at
Mental Hospital of kendari. There were 4 victims who died, 3 victims died after receiving
treatment in hospital and 1 person died by drowning after consuming PCC Pill.

B. What is PCC Pills?

Paracetamol
Paracetamol or called acetaminophen is included in the type of over-the-counter
painkillers. Paracetamol (acetaminophen) is a non-narcotic analgesic drug by working
inhibiting prostaglandin synthesis especially in the Central Nervous System (CNS).
Paracetamol is used extensively in many countries both in single dosage form as an
antipyretic-analgesic and as well as in combination with other drugs in flu drug
preparations, through prescription or over-the-counter medications. (Lusiana Darsono
2002). Paracetamol is usually used to reduce mild to moderate pain symptoms such as
headache, flu, pain due to menstruation, toothache, to joint pain.

Caffeine (caffeine)
Caffeine or caffeine is a substance found in coffee, tea or cola to raise awareness,
focus, and alert. Hence, when after drinking coffee your sleepiness will be lost or
decreased. Athletes even make caffeine as a stimulant because of its great ability and
caffeine is a stimulant that its use permitted by the association of athletes of the United
States or called the National Collegiate Athletic Association (NCAA). In the medical
world, caffeine is commonly used as a combination of painkiller. In this case, caffeine can
be added together with paracetamol. Caffeine works by stimulating the central nervous
system, heart and muscles in the body. The effect of caffeine is to increase blood pressure
and smooth the flow of urine. However, this effect may not occur in people who already
drink caffeine routine. Caffeine also has rules in its use. The concentration of caffeine
present in the urine should not reach 16mcg / mL. To reach that number, it takes to drink 8
cups of coffee. Thus, in general caffeine is a relatively safe substance for routine
consumption.
Carisoprodol
If paracetamol and caffeine are commonly consumed and relatively safe
substances that are sold freely, it is different with carisoprodol. Carisoprodol is a limited
drug that can only be used by prescription. These drugs include the type of muscle relaxer
or drug that relaxes the muscles that will cut the pain that flows from the nerve to the
brain. Carisoprodol is used together for physical therapy such as muscle and bone, for
example on injury. Due to this effect, this drug is not actually sold freely and should only
be purchased with a doctor's prescription. Carisoprodol may have sedative properties and
may impair the mental and/or physical abilities.

C. The effect of PCC Pills

Biologic Effects
- Cardiovascular, Tachycardia, postural hypotension, and facial flushing.
 - Central Nervous System --Drowsiness and other CNS effects may require
dosage reduction. Also observed: dizziness, vertigo, ataxia, tremor,
agitation, irritability, headache, depressive reactions, syncope, seizures,
and insomnia.
- Gastrointestinal, Nausea, vomiting, hiccup, and epigastric distress.

Additive Effects
Since the effects of carisoprodol and alcohol or carisoprodol and other CNS
depressants or psychotropic drugs may be additive
Idiosyncratic Reactions
On very rare occasions, the first dose of carisoprodol has been followed by
idiosyncratic symptoms appearing within minutes or hours. Symptoms reported
include: extreme weakness, dizziness, ataxia, temporary loss of vision, diplopia,
mydriasis, dysarthria, agitation, euphoria, confusion, disorientation and seizures.
Symptoms usually subside over the course of the next several hours. Supportive
and symptomatic therapy, including hospitalization, may be necessary.
Overdosage
Overdosage of carisoprodol produces CNS depression, and in severe cases
coma. Shock, respiratory depression, seizures and death have also been reported.
The following signs and symptoms may be associated with carisoprodol
overdosage: horizontal and vertical nystagmus, blurred vision, mydriasis, mild
tachycardia and hypotension, respiratory depression, euphoria, CNS stimulation,
muscular incoordination, and/or rigidity, confusion, headache, hallucinations, and
dystonic reactions. The effects of an overdosage of carisoprodol and alcohol or
other CNS depressants or psychotropic agents can be additive even when one of the
drugs has been taken in the usual recommended dosage.

D. How does it easily distribute?

E. PCC Pills Vs Flakka
F. How to prevent