Vol 5, Issue 3
Supplement
2014
International Journal of Pharmacy
Teaching & Practices (IJPTP)
Clinical Case Reports - September, 2014
Published by: DRUNPP Association of Sarajevo, Bosnia & Herzegovinia
www.iomcworld.com/ijptp
email: ijourptp@gmail.com
ISSN: 1986-8111
International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
EDITORIAL BOARD
Editor-in-Chief
Dr. Syed Wasif Gillani
Associate Prof. Dr. Azmi Sarriff
Editorial Assistant
Dr. Mostafa Nejati
Executive Editors
Prof. Dr. Syed Azhar Syed Sulaiman
Dr. Waffa Mohamed El-Anor Ahmed Rashed
Prof. Dr. Mark Raymond
Mr. Robert Hougland
Advisory Board Members
Dr. Mensurak Kudumovic
Dr. Jasmin Musanovic
Dr. Monica Gaidhane
Assoc.Prof. Dr. Mok.T Chong
Dr. Syed Tajuddin Syed Hassan
Dr. Sumeet Dwivedi
Dr. Dibyajyoti saha
EDITORIAL ADDRESS: KA311, KEYANGANG, BANDAR SUNWAY, SELANGOR, MALAYSIA
PUBLISHED BY: DRUNPP, SARAJEVO, BOLNICKA BB. VOLUME 5, ISSUE 3, SUPP I, 2014
ISSN: 1986-8111,
INDEXED ON: EBSCO PUBLISHING (EP)USA, INDEX COPERNICUS (IC) POLAND
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Table of Contents
1.
ISCHIALGIA AND LUNG TUMOR IN MINTOHARDJO HOSPITAL ............................................................ 1026
2.
THE MONITORING OF DRUG THERAPY FOR CRF (Chronic Renal Failure) PATIENT IN Dr. MINTOHARDJO,
INDONESIAN NAVY MILITARY HOSPITAL.............................................................................................. 1031
3.
DIABETES MELLITUS TYPE II, and CHRONIC RENAL FAILURE ............................................................... 1036
4.
DRUG RELATED PROBLEMS ASSOCIATED OF TREATMENT UROLITHIASIS DISEASE PATIENT IN PGI CIKINI
HOSPITAL ............................................................................................................................................. 1043
5.
STUDY OF PULMONARY DISEASES WARD PULMONARY TB BTA (+) LLKB (The lesion Area new cases) on
OAT kat II.............................................................................................................................................. 1050
6.
BRONCHOPNEUMONIA IN PULMONARY DISEASE WARD.................................................................... 1058
7.
DRUG RELATED PROBLEMS IN THE TREATMENT OF GUILLAIN-BARRE SYNDROM DISEASE, ANTI
PHOSPOLIPID SYNDROME AND DIABETES MELLITUS TYPE 2 ............................................................... 1065
8.
STUDY IN DISEASE WARD CHRONIC RENAL FAILURE AND TYPE II DIABETES MELLITUS ...................... 1076
9.
COMBINED DRUG RELATED PROBLEMS IN THE TREATMENT OF TUBERCULOSIS (TB) AND PLEURAL
EFFUSION SINISTRA .............................................................................................................................. 1081
10. DRUG RELATED PROBLEMS IN TREATMENT HEMODIALYSIS ON CHRONIC RENAL FAILURE ............... 1086
11. RELATED DRUG PROBLEM IN THE TREATMENT OF VERTIGO DISEASE AND HYPERTENSION IN PGI CIKINI
HOSPITAL ............................................................................................................................................. 1091
12. DRUG RELATED PROBLEM TREATMENT OF FEMORAL NECK FRACTURES IN MINTOHARJO HOSPITAL 1095
13. PHYSIOTHERAPY STUDY ISCHIALGIA .................................................................................................... 1100
14. TREATMENT OF THE CHRONIC KIDNEY DISEASE (CKD) PATIENT IN THE PGI HOSPITAL CIKINI JAKARTA
............................................................................................................................................................. 1105
15. DRUG RELATED PROBLEMS ASSOCIATED AND TREATMENT FOR CERVICAL CANCER IN INTERNAL
MEDICINE WARD IN PGI CIKINI HOSPITAL ........................................................................................... 1120
16. DRUG RELATED PROBLEMS IN ACUTE GASTROENTERITIS (GEA) AND CORONARY ARTERY DESEASE
(CAD) .................................................................................................................................................... 1124
17. PERIODIC PARALYSIS OF HYPOKALEMIA FAMILIAL IN GENERAL CARE WARD OF GATOT SUBROTO
HOSPITAL JAKARTA INDONESIA ........................................................................................................... 1130
18. PANCREATIC TUMOR DISEASE ............................................................................................................. 1136
19. PNEUMONIA AND MELENA PATIENT IN PULMONARY DISEASE WARD AT GATOTSOEBROTO ARMY
HOSPITAL JAKARTA INDONESIA ........................................................................................................... 1142
20. COMBINED DRUG RELATED PROBLEMS IN DISEASE TREATMENT FOR DYSPEPSIA IN INTERNAL MEDICINE
WARD IN PGI CIKINI HOSPITAL............................................................................................................. 1149
21. CHRONIC OBSTRUCTION PULMONARY DISEASE (COPD) ..................................................................... 1153
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22. CASE STUDY OF CKD (CHRONIC RENAL DISEASE) IN PGI CIKINI HOSPITAL .......................................... 1156
23. STUDY OF DRUG RELATED PROBLEMS (DRPS) ASSOCIATED WITH THE PATIENT TREATMENT MILIARY
TUBERCULOSIS (TB) AT INTERNAL MEDICINE WARDS PGI CIKINI HOSPITAL ....................................... 1161
24. ABSTRACT............................................................................................................................................. 1161
25. DRUG RELATED PROBLEM ON DISESASE THERAPY MANAGEMENT COMPLICATIONS STROKE WITH FEW
COMPLICATIONS TYPE II DIABETES, HYPERLIPIDEMIA AND HYPERTENSION ....................................... 1168
26. ABSTRACT............................................................................................................................................. 1168
27. A CASE STUDY CHRONIC KIDNEY DISEASE STAGE V ON HEMODIALYSIS ............................................. 1174
28. CKD (CHRONIC KIDNEY DISEASE) AND ANEMIA ................................................................................... 1181
29. DRUG RELATED PROBLEMS ASSOCIATED WITH THE TREATMENT FOR TUBERCULOSIS (TB) IN
PERSAHABATAN HOSPITAL .................................................................................................................. 1186
30. DRUG RELATED PROBLEMS IN THE COMBINATION OF TREATMENT OF TYPE 2 DIABETES MELLITUS AND
CAD (CORONARY ARTERY DISEASE)/CORONARY ARTERY DISEASE ...................................................... 1189
31. DRUG RELATED PROBLEMS IN TYPE II DIABETES MELLITUS ............................................................... 1194
32. DRUG RELATED PROBLEMS IN REGIMEN OF DOSE FOR TUBERCULOSIS (TB) PATIENT AT INTERNAL
WARD RSUP HOSPITAL ......................................................................................................................... 1199
33. DRUG RELATED PROBLEMS IN HIV-AIDS PATIENT ............................................................................... 1204
34. DRUG RELATED PROBLEMS ASSOCIATED WITH THE TREATMENT FOR CHRONIC KIDNEY DISEASE (CAD)
STAGE III WITH DIABETES MELLITUS (DM) TYPE II ............................................................................... 1209
35. DRP ASSOCIATED WITH TREATMENT OF MELENA DISEASE WITH D.M TYPE II AND PARKINSON HISTORY
............................................................................................................................................................. 1215
36. TUBERCULOSIS DISEASE AT CIKINI HOSPITAL ...................................................................................... 1221
37. DRUG RELATED PROBLEMS IN STROKE NON HEMOROGIK DISEASE ................................................... 1225
38. DRUG RELATED PROBLEMS IN TREATMENT OF BRAIN TUMOR DISEASE ACCOMPANIED TB ............. 1229
39. COMBINED DRUG RELATED PROBLEMS IN TREATMENT MENINGITIS TUBERCULOSA, HEMIPARESIS THE
RIGHT, PULMONARY TUBERCULOSIS, PNEUMONIA, VASCULITIS, AND ENCEPHALITIS, IN PGI CIKINI
HOSPITAL, CENTRAL JAKARTA. ............................................................................................................. 1235
40. THE EVALUATION OF DRUG RELATED PROBLEMS (DRPs) ASSOCIATED WITH THE TREATMANT FOR
ACUTE EXACERBATION OF COPD IN GATOT SOEBROTO HOSPITAL ..................................................... 1250
41. DRUG RELATED PROBLEM ON THE TREATMENT A SIMPLE FEVER SEIZURE ........................................ 1258
42. DRUG RELATED PROBLEMS ON DISEASE MANAGEMENT OF DYSPEPSIA IN GERIATRIC PATIENT IN THE
INTERNAL MEDICINE WARD PGI CIKINI HOSPITAL ............................................................................... 1263
43. DRPs (DRUG RELATED PROBLEMS) ASSOCIATED WITH TREATMENT TO FEBRILE OBSTRUCTION PATIENT
IN PGI CIKINI HOSPITAL ........................................................................................................................ 1267
44. BRONKIEKTASIS (BE) AT LUNG INFECTION WARD RSUP HOSPITAL .................................................... 1271
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45. DRUG RELATED PROBLEMS PNEUMONIA DISEASE .............................................................................. 1276
46. DRUG RELATED PROBLEMS IN ASCITES PATIENT ................................................................................. 1281
47. DRUG RELATED PROBLEMS (DRPs) ASSOCIATED WITH THE TREATMENT FOR TUBERCULOSIS DISEASE IN
PERSAHABATAN JAKARTA HOSPITAL ................................................................................................... 1287
48. TREATMENT ASSOCIATED WITH OF PATIENT CHRONIC HEART FAILURE (CHF) DISEASE IN CIKINI
JAKARTA HOSPITAL .............................................................................................................................. 1293
49. INAPROPRIATE DRUGS FOR PNEUMONIA & BRONCHIOLITIC PATIENT AT PEDIATRIC WARD RSPAD
HOSPITAL ............................................................................................................................................. 1299
50. STUDY OF CHRONIC RENAL FAILURE DISEASE IN THE WARD OF DISEASE IN PGI CIKINI HOSPITAL .... 1304
51. STUDY IN DISEASES WARD TYPHOID FEVER......................................................................................... 1309
52. DRUG RELATED PROBLEMS ASSOCIATED WITH TREATMENT TO HEMORRHAGIC STROKE PATIENT IN
PGI CIKINI HOSPITAL ............................................................................................................................ 1313
53. TREATMENT MEDICINE TO PATIENT ACUTE LOW BACK PAIN,DISPEPSIA AND POST INFECTION BUILDING
OF ORIF AT PGI CIKINI HOSPITAL ......................................................................................................... 1319
54. DRUG RELATED PROBLEM AMONG RIGHT EMPYEMA PULMUNARY, TUBERCULOSIS WITH THE TYPE 2
DIABETES MELLITUS IN GATOT SUBROTO HOSPITAL .......................................................................... 1324
55. DRUG RELATED PROBLEMS ASSOCIATED WITH THE TREATMENT FOR CONGESTIVE HEART FAILURE
(CHF) IN PGI CIKINI HOSPITAL JAKARTA ............................................................................................... 1329
56. EVALUATION OF TREATMENT ANGINA PECTORIS DISEASE AT GATOT SOEBROTO ARMY HOSPITAL . 1333
57. DRUG RELATED PROBLEMS ON TYPE II DIABETES MELLITUS DISEASE TREATMENT IN MINTOHARDJO
HOSPITAL ............................................................................................................................................. 1337
58. EVALUATION OF TREATMENT SEIZURES, CEREBRAL TOXOPLASMOSIS, ORAL CANDIDIASIS, HEMIPARESE
DEXTRA, SUSPECTED OF PULMONARY TUBERCULOSIS, PULMONARY PNEUMONIA, HYPOKALEMIA,
HYPONATREMIA AND PATIENTS ON HIV / AIDS IN FLOOR GENERAL MAINTENANCE IV ARMY HOSPITAL
EDUCATION GATOT SUBROTO JAKARTA .............................................................................................. 1347
59. CASE STUDY IN HOSPITAL K OF DISEASE NON HEMORRHAGIC STROKE (SNH) POST. HEAD TRAUMA 1356
60. DRUG RELATED PROBLEM ASSOCIATED IN TREATMENT OF HNP (HERNIATED NUCLEUS PULPOSUS)
DISEASE IN MINTOHARDJO NAVY HOSPITAL ...................................................................................... 1361
61. DRUG RELATED PROBLEM ASSOCIATED IN TREATMENT CHRONIC KIDNEY FAILURE DISEASE ............ 1365
62. DRUG RELATED PROBLEMS ON URINE RETENTION DISEASE IN PGI CIKINI HOSPITAL ........................ 1370
63. DRUG RELATED PROBLEMS WITH THE TREATMENT FOR DIABETES MELLITUS (TYPE II DM) IN
PERSAHABATAN HOSPITAL .................................................................................................................. 1373
64. DRUG RELATED PROBLEM ASSOCIATED WITH TREATMENT FOR NASOPHARYNX CANCER PATIENT IN
PGI CIKINI HOSPITAL ............................................................................................................................ 1379
65. HAS NOT TREATED WITH ARV YET ON GATOT SUBROTO ARMY HOSPITAL ........................................ 1384
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66. DRUG RELATED PROBLEM IN THERAPY CHRONIC KIDNEY DISEASE (CKD) IN INTERNAL MEDICINE WARD
Dr. MINTOHARDJO NAVY HOSPITAL .................................................................................................... 1399
67. DRUG RELATED PROBLEMS ASSOCIATED WITH TREATMENT ON ACUTE GASTROENTERITIS DISEASE IN
MINTOHARDJO HOSPITAL .................................................................................................................... 1406
68. CASE STUDY OF DISEASE IN PGI CIKINI HOSPITAL JAKARTA MASSIVE ASCITES ................................... 1409
69. DRUG RELATED PROBLEMS ON NON-HEMORRHAGIC STROKE AND DIABETES MELLITUS DISEASE
TREATMENT IN MINTOHARDJO HOSPITAL......................................................................................... 1417
70. DRUG RELATED PROBLEM ASSOCIATED WITH TREATMENT FOR STROKE HEMORRHAGIC PATIENT IN
MINTOHARDJO HOSPITAL .................................................................................................................... 1423
71. DRUG RELATED PROBLEM ASSOCIATED WITH TREATMENT FOR DIABETES MELLITUS KETOACIDOSIS
PATIENT IN GATOT SOEBROTO ARMY HOSPITAL ................................................................................ 1427
72. TREATMENT EVALUATION ON PATIENTS WITH IHD (ISCHEMIC HEART DISEASE) AT ARMY HOSPITAL
“GATOT SOEBROTO” ............................................................................................................................ 1433
73. DRUG RELATED PROBLEM ASSOCIATED WITH TREATMENT FOR TUBERCULOSIS (TB) PATIENT IN
PERSAHABATAN HOSPITAL JAKARTA ................................................................................................... 1437
74. EVALUATION OF DRUG RELATED PROBLEMS (DRPs) ASSOCIATED WITH THE TREATMENT FOR
PULMONARY TUBERCULOSIS WITH HYPOALBUMINEMIA AND CIRRHOSIS IN GATOT SUBROTO
HOSPITAL ............................................................................................................................................. 1442
75. DRUG RELATED PROBLEM ASSOCIATED WITH TREATMENT FOR DYSPEPSIA PATIENT IN MINTOHARDJO
HOSPITAL ............................................................................................................................................. 1448
76. DRUG RELATED PROBLEM IN CORONARY ARTERY DISEASE TREATMENT AMONG PATIENTS IN PGI CIKINI
HOSPITAL ............................................................................................................................................. 1453
77. ANEMIA GRAVIS, HYPOKALEMIA, HEMATOSKEZIA DISEASE ................................................................ 1457
78. DRUG RELATED PROBLEM TREATMENT OF PNEUMONIA IN PATIENTS TREATED IN THE LUNG GATOT
SOEBROTO ARMY HOSPITAL ................................................................................................................ 1461
79. DRUG RELATED PROBLEM ASSOCIATED WITH TREATMENT FOR UPPER RESPIRATORY INFECTIONS AND
DIABETES MELITUS TYPE II PATIENT IN MINTOHARDJO JAKARTA HOSPITAL ...................................... 1468
80. DRUG RELATED PROBLEM ASSOCIATED WITH TREATMENT PLEURAL EFFUSION TUBERCULOSIS PATIENT
IN PGI CIKINI HOSPITAL ........................................................................................................................ 1472
81. DRUG RELATED PROBLEMS (DRPs) ASSOCIATED WITH TREATMENT FOR COLIC RENAL PATIENT IN PGI
CIKINI HOSPITAL ................................................................................................................................... 1477
82. DRUG RELATED PROBLEM ASSOCIATED WITH THE TREATMENT FOR HYPERCOAGULATE IN PGI CIKINI
HOSPITAL ............................................................................................................................................. 1482
83. DRUG RELATED PROBLEM ASSOCIATED WITH TREATMENT FOR TUBERCULOSIS (TBC) PATIENT IN
PERSAHABATAN HOSPITAL .................................................................................................................. 1487
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84. DRUG RELATED PROBLEM ASSOCIATED WITH TREATMENT FOR CONGESTIVE HEART FAILURE PATIENT
IN MINTOHARDJO HOSPITAL ............................................................................................................... 1491
85. DRUG RELATED PROBLEM ASSOCIATED WITH TREATMENT FOR ATELECTATION AND PNEUMONIA
PATIENT IN PERSAHABATAN HOSPITAL ............................................................................................... 1497
86. DISEASE TYPE II DIABETES MELLITUS (DM) AND HYPERTENSION IN GENERAL HOSPITAL CENTER
PERSAHABATAN JAKARTA .................................................................................................................... 1501
87. DRUG RELATED PROBLEM (DRPs) ASSOSIATED WITH TREATMENT OF DIABETES MELLITUS TYPE 2
DISEASE AT PERSAHABATAN HOSPITAL ............................................................................................... 1507
88. DRUG RELATED PROBLEM ASSOCIATED WITH THE TREATMENT FOR HYPERTENSIVE DISEASE IN
MINTOHARJO HOSPITAL ...................................................................................................................... 1511
89. CASE REPORT: DRUG RELATED PROBLEM ASSOCIATED WITH TREATMENT FOR URETHRAL STRICTURE
PATIENT IN MINTOHARDJO NAVY HOSPITAL ....................................................................................... 1515
90. DRUG RELATED PROBLEMS ASSOCIATED WITH TREATMENT FOR ACUTE RESPIRATORY INFECTION
PATIENT IN PGI CIKINI HOSPITAL ......................................................................................................... 1519
91. DRUG RELATED PROBLEM ASSOCIATED WITH TREATMENT FOR LUNG TUBERCULOSIS PATIENT IN
PERSAHABATAN HOSPITAL .................................................................................................................. 1523
92. DRUG RELATED PROBLEM ASSOCIATED WITH TREATMENT FOR HEMORRHAGIC STROKE PATIENT IN
GATOT SOEBROTO HOSPITAL .............................................................................................................. 1528
93. GENERAL STUDY CARE WARDS GERIATRIC .......................................................................................... 1533
94. DRUG RELATED PROBLEM ASSOCIATED WITH THE TREATMENT FOR CHRONIC KIDNEY DISEASE AT THE
INTERNAL DISEASE IN PGI CIKINI HOSPITAL ......................................................................................... 1538
95. DRUG RELATED PROBLEM ASSOCIATED WITH TREATMENT FOR PULMONARY TUBERCULOSIS PATIENT
IN PERSAHABATAN HOSPITAL .............................................................................................................. 1544
96. DRUG RELATED PROBLEM ASSOCIATED WITH THE TREATMENT FOR BENIGN PROSTATE HYPERPLASIA IN
MINTOHARJO HOSPITAL ...................................................................................................................... 1549
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ISCHIALGIA AND LUNG TUMOR IN MINTOHARDJO HOSPITAL
Agnes Anggraeny Para’pak1 , Diana Laila Ramatillah2, Aprilita Rinayanti Eff2
1
Pharmacist Professional Program Student, Faculty of Pharmacy UTA'45 Jakarta
Lecturer Pharmacy in Pharmacy Faculty University of 17 August 1945 Jakarta
(UTA’45 Jakarta)
2
Email : Anggraenyagnes@yahoo.com
ABSTRACT
Ischialgia is pain sensation from lower back, pain from butt area, stiffness on lower
back . Pain sensation radiating or as a sense of shock, which is perceived from the buttocks
radiating to the thigh, calf and even up to the foot depending which part of the nervous is
wedge6. Lung tumors are one type of tumor that grows in the lungs is difficult to recover8.
Lungs tumor is caused by cells that divide and grow uncontrollable in lungs8. Mr.MI
patients, aged 23 years, entered the Dr. Mintohardjo hospital on 10 June 2014 with a chief
complaint of low back pain radiating to the left leg up since a month ago. Therapy for the
treatment of hospitalized namely ceftriaxone, ringer lactate, ketorolac, CTM, paracetamol,
Taxotere (docetaxel), Platinol (cisplatin), and zonal (Epherison HCL). Based on the results
of their clinical practice in TNI AL Dr.Mintohardjo hospital on room Salawati it can be
concluded that the presence of Drug Related Problems (DRP) in the form of drug
interactions, but did not receive needed medications and side effects from used drug.
6
Keyword : Ischialgia And Lung Tumor Hospital Navy Dr.Mintohardjo
INTRODUCTION
Ischialgia is the symptom of sensation pain from nerve ischiadicus stimulation6. In
this situation arises pain and tingling along the nerve branches which pressure6. Dictionary
Mahar Priguna Mardjono and Sidhartha (1978) defines ischialgia as pain stems in the
lumbosacral area radiating to the buttocks and then to the posterolateral part of the upper
limbs, the lateral part of the lower leg, as well as the lateral part of foot6.
Lung cancer is a malignant tumor derived from primary lung or airway epithelial
bronkus8. The occurrence of cancer is characterized by abnormal cell growth, unlimited,
and destroy tissue cells normal8. Malignant process in the bronchial epithelium is preceded
by pre cancer8. The first change that occurred during the so-called precancerous squamous
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
metaplasia is characterized by changes in the shape epitel8. Like most other cancers, the
cause of lung cancer is definitely not known, but prolonged exposure to inhalation of a
substance that is carcinogenic is a major causative factor in addition to other factors such as
the immune, genetic, etc8.
PERCENTAGE CASE
Mr. MI 23 years old, came to Dr.Mintohardjo hospital on June 10, 2014 with a
primary complaint of pain in the waist, spread to the left leg since a month ago. Patients
admitted to hospital on June 11, 2014 and June 24, 2014 came out with a doctor's note that
outpatient chemotherapy and subsequent action. Patients with a history of ulcer disease and
have had surgery on the left breast tumor, the left neck. Currently patients diagnosed with
the disease ischialghia.
LINE TREATMENT FOR LUNG TUMOR4
First line
Cisplatine / vinorelbine, cisplatin / gemcitabine, cisplatine / paclitaxel, carboplantin
/ gemcitabine (chemotherapy early stage, given the combination of the 2 drugs)
Second line
Docetaxel (Taxotere), pemetrexed, erlotinib and platinol (advanced stage that failed
previously treated with chemotherapy, administered with a single dose)
TREATMENT MANAGEMENT ISCHIALGIA1
1. Drugs: analgesics, NSAIDs, muscle relaxan, etc.
2. Program medical rehabilitation
a. Physical therapy: diathermy, electrotherapy, lumbar traction, manipulation
therapy, exercise.
b. Occupational Therapy: Teach proper body mechanic
c. Orthotic prosthetic: the provision of a lumbar corset, walkers
d. Advice

Avoid a lot of over bending.
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
Avoid frequent heavy lifting.

Immediately break if have pain when walking or standing.

When sitting for long try disila foot alternately right and left, or use a small
seat for both legs rested.

When sweeping and mopping the floor use a broom handle or mop long so
that when sweeping or mopping the back does not bend.

If you want to take things on the floor, keep your back straight and bend
your knees to reach the goods.
3. Operation: Performed in severe cases or where the debilitating drugs and medical
rehabilitation programs do not help.
EVALUATION CLINIC2,3
The use of ceftriaxone injection is to overcome bacterial infections. Ketorolac for
the treatment of short-term post-surgical pain, paracetamol is used when necessary as an
analgesic and antipyretic. Mefenamic acid for mild or moderate pain, CTM to treat
symptoms of allergies. As for chemotherapy drugs given Taxotere (docetaxel) for the
treatment of lung cancer and a subsequent treatment failure when treated with previously
chemotherapy. Platinol (cisplatin) for the treatment of lung cancer. Zonal (epherison HCL)
for the symptomatic treatment of the circumstances related to musculuskoletal cramp
(muscle cramp).
DOSAGE AND METHOD OF USE
In the case of patients treated with injectable ceftriaxone 1 g administered for 7 days
2x1, 2x1 ketorolac 10 mg for 7 days, paracetamol 500 mg if necessary, mefenamic acid 500
mg for 7 days 2x1, 1x1 CTM 4 mg for 1 day on day three Taxotere (docetaxel) 20 mg,
Platinol (cisplatin) 10 ml, given on the eighth day as chemotherapy drugs and zonal 5 mg
administered on day 14.
RESULTS OF LABORATORY TESTS5
Results from laboratory tests on 12 June 2014 showed a decrease in the value of
urea 14 mg / dl (17-43 mg / dl) and impaired creatinine 0.7 mg / dl (0.9 -1.3 mg / dl), which
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indicates a decrease kidney function. On 18 June 2014 showed a decrease in the value of
leukocytes 4,700 u / l (5,000-10,000 U / l), hemoglobin 13.4 g / dl (14-48 g / dl), which is
caused by the use of chemotherapy drugs, and a decrease in creatinine values 0 , 8 mg / dl
(0.9-1.3 mg / dl), which indicates a decrease in kidney function.
DRUG RELATED PROBLEM
1.
Drug Interactions7
Mefenamic acid and ketorolac were equally increase the anticoagulant effect, used of
this drug should be monitored7.
2.
REQUIRES DRUG BUT DID NOT GET IT2
After chemo, patients complained a nausea but did not get anti-nausea drugs. Patients
who had chemotherapy should be given ondacetron to treat nausea after chemo2.
3.
DRUG SIDE EFFECTS3
Mefenamic acid and ketorolac have the same side effects that can irritate the stomach,
so that the necessary medication proton pump inhibitors such as omeprazole to
prevent an increase in gastric acid and stress ulcer3.
CONCLUSION
Based on the results of monitoring drug therapy in internal medicine wards at the
TNI AL Dr.Mintohardjo Hospital, then be concluded that the presence of Drug Related
Problems (DRP) in the form of drug interaction, but did not necessesary drug and drug side
effects. Results from laboratory tests showed a decrease in serum creatinine and serum
urea, indicates a decrease in renal function and impairment of leukocytes, hemoglobin,
creatinine, which is caused by the side effects of chemotherapy drugs.
REFERENCES
1. Anggriani. W. 2010. Physiotherapy Management In Ischialgia. Dr.Ramelan Hospital
Surabaya. Muhammadiyah University. Surakarta
2. BPOM. RI. 2008. Indonesian National Drug Information. Komperpom. Jakarta
3. Galileopharma. 2008. BNF Edition 56. Alexandria University
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4. Islamuddin. 2009. Systemic Therapy of Lung Carcinoma. Section of Internal Medicine.
Faculty of medicine. Andalas University. Field
5. Ministry of Health. RI. 2011. Guidelines For Clinical Data Interpretation. Jakarta
6. Markam. S. 1982. Neurology. Publisher. PT. EGC. Jakarta
7. Medscape. Drug Interactions. 2014
8. Siregar. L. 2006. Lung Cancer. University of North Sumatra.
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THE MONITORING OF DRUG THERAPY FOR CRF (Chronic Renal Failure)
PATIENT IN Dr. MINTOHARDJO, INDONESIAN NAVY MILITARY HOSPITAL
Ardiansyah1, Diana Laila Ramatillah2, Aprilita Rinayanti2
1
Pharmacist Professional Program Student, Faculty of Pharmacy UTA'45 Jakarta
Lecturer Pharmacy in Pharmacy Faculty University of 17 August 1945 Jakarta
(UTA’45 Jakarta)
Email : chunca.ardiansyah7@gmail.com
2
ABSTRACT
CRF (Chronic Renal Failure) is defined as abnormality of renal function which is marked
by the presence of protein in the urine (proteinuria) and the decline of renal function for 3
or more than 3 months which progressive to terminal renal failure1. Mrs. LD, 32 years old,
entered Dr. Mintohardjo hospital on June 22, 2014 with diagnosis CRF (Chronic Renal
Failure). Medical therapy for 5 days are Lasix injection, valsartan 80 mg, Amlodipine 10
mg, Cefoperazon 1 g, Dextrometorphan, Sodium bicarbonate, Folic acid, Aminoral,
Isosorbide Dinitrat 10 mg, Hydrochorthiazide 25 mg, and Lasix tablet. Based on the results
of clinical work practice in internal disease ward of Dr. Mitohardjo hospital, we can
conclude that DRP (Drug Related Problem) was high dosing and drug interaction.
Keywords: Chronic Renal Failure, Internal disease, Dr. Mintohardjo hospital
INTRODUCTION
Chronic renal disease is pathophysiological process with various etiology, it caused
progressive decline of renal function, and generally, it will be chronic renal failure in the
end. Chronic renal failure (CRF) is the decline of renal function which happen continuously
but slowly, it reversible because of the decline of glomerular filtration rate5. If renal could
not function well, there will be a cumulation of substances of metabolism residue inside the
body, so it caused toxic effects4. Chronic renal disease can expand so fast, in 2 – 3 months,
or slowly, in 30 – 40 years4.
End-stage renal failure is condition where the renal function of patient has declined,
which is measured by Klirens Kreatinin (KK) is not more than 15 ml/minute. Patient of
end-stage renal failure needs special therapy which is called renal replacement therapy6.
Renal replacement therapy consists of hemodialysis, peritoneal dialysis and renal
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
transplant6. From some of replacement therapies above, Hemodialysis is the most applied in
Indonesia.
Based on The United States Renal Data System (USRDS) in 2009 end-stage renal
failure often found and its prevalence is about 10-13 %. In USA, the amount is 25 million
people, and in Indonesia is about 12,5 % or 18 million people7. According to the data of
Indonesian Renal Registry (IRR), total patients of end-stage renal failure which take
hemodialysis in Indonesia from 2007-2012 are 1885, 1936, 4707, 5184, 6951 and 91618.
Data of some research center in Indonesia, report that the cause of end-stage renal failure
who takes dialysis is glomerulonefritis (36,4%), obstruction and infection renal disease
(24,4%), diabetic renal disease (19,9%), hypertension (9,1%) and the other causes (5,2%)
PERCENTAGE OF CASES
Mrs. LD, 32 years old, entered Dr. Mintohardjo hospital on June 22, 2014 with diagnosis
CRF (Chronic Renal Failure) and Dyspepsia. Her complaint is she has limp for two days
before entering the hospital, dizzy a day before entering the hospital, nausea when eating,
defecate three times a day, it liquid ad black, low back pain and her right foot is limp when
she is walking. Results of laboratory tests showed that serum creatinine of patient was
increase and glomerular filtration rate is 13,30 ml/minute which indicate that the patient
suffer renal failure disease (dialysis).
CLINIC EVALUATION
The use of Lasix (furosemide) for edema heart, kidney and liver, valsartan and amlodipine
for hypertension therapy, cafoperazon as antibiotics because based on laboratory tests
result, leukocyte of patient has increase which indicate that there is infection,
dextrometorphan symptomatic therapy for non productive cough, folic acid for anemia and
renal failure, aminoral (keto acid) for chronic renal isufficiency, isosorbide dinitrat for
treatment nad prevention angina pectoris, hydroclhorthiazide for hypertension.
DOSE AND DIRECTION10,11.
In this case, patient was treated with lasix injection, 2x1 ampoule a day for two days ( 2223 June), valsartan 1x80 mg in 5 days (22-25 June), amlodipine 1x10 mg in 5 days (22-26
June), cefoperazon injection 2x1 g in 5 days (22-26 Juni), dextrometorpan 3x15 mg in 5
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
days (22-26 June), sodium bicarbonate 3x500mg in 5 days (22-26 June) , folic acid 3x1 in 5
days (22-26 June), aminoral (keto acid) 3x2 in 3 days (22,25 and 26 June) , Isosorbide
Dinitrat 2x10mg in 3 days (23,24,dan 25 June), and hydrochorthiazide 1x25 mg in 5
days(22-26 June).
THE RESULT OF LABORATORY TEST
The result of hematology examination on 22 June 2014 showed the increasing of leukocyte,
it was 14.700/µL (5.000 – 10.000/ µL) it indicate that there was an infection, the increasing
of ureum, it was 90 mg/dl (17 – 43 mg/dl) and creatinine 6,2 mg/dl (0,6 – 1,1 mg/dl)
showed the decline of renal function. The decline of erythrocytes 3,59 million/ µL (4,2 –
5,4 million/ µL),hemoglobin 10,3 g/dl (12 – 14 g/dl) and hematocrit 31 % (37 – 42 %)
indicated that it was anemia.
GUIDE LINE OF CRF THERAPY10
LINE I
Antihypertention (ACE-Inhibitor) to decrease hypertention mitraglomerular and hypertofi
glomerular.
LINE 2
Diuretics to remove the excess fluid in the body.
According to National Kidney Foundation (NKF) Kidney Disease Outcome Quality
Initiative (K/000/) Guidelines Update in 2002, the definition of chronic renal disease are11:
a. Renal decay> 3 months, it is like as renal structure disorder, with or without the
decline of glomerular filtration rate which is marked by: pathology disorder, and
there is indication of renal decay, it could be blood or urine disorder, or radiology
disorder11.
b. Glomerular filtration rate <60 ml/minute/1,73m2 for >3 months, with or without
renal decay11.
DRUG RELATED PROBLEMS(DRPs)11
1. Too high dose
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
The dose is too high in the distribution of valsartan it was 80 mg in a day. According to
BNF in 57th edition, 2009, if the glomerular filtration rate less than 20 ml/minute so the
distribution of valsartan begin with 40 mg, once a day.
2. Drug interaction
HCT and Lasix (Furosemid)
It has similar indication. Giving in the same time can caused hypokalemia, so that it
needs addition of KSR tablet.
CONCLUSION
Based on the results of clinical work practice in internal disease ward of Dr. Mintohardjo
hospital, we can conclude that the results of laboratory tests showed that serum creatinine
of patient was increase and glomerular filtration rate is 13,30 ml/minute which indicate that
the patient suffered renal failure disease (dialysis) and there is DRP (drug related problem)
it means the drug distribution with too high dose and there is drug interaction also.
BIBLIOGRAPHY
1. Putu,et al. 2007. Evaluasi penggunaan ACE Inhibitor pada Pasien Gagal Ginjal Kronik
di RSUP DrSardjito Yogyakarta. Pharmacy Faculty of Gajah Madah University
2. Bonner GF. 2006. Gastrointestinal evaluation related to the pelvic floor. London
3. Djojodiningrat, dkk.2006. Dispepsia fungsional. Buku ajar ilmu penyakit dalam. Edisi
ke-4. Ilmu Penyakit Dalam. Medical Faculty of Indonesia University.
4. Suwitra, K. 2009.Penyakit Ginjal Kronik. Interna Publishing.
5. Sekarwana N. 2011. Kompendium Nefrologi Anak. IDAI. Jakarta
6. Sharif, S. 2014.Asupan Protein, Status Gizi Pada Pasien Gagal Ginjal Tahap Akhir
yang Menjalani Hemodialisis Reguler. Medical Faculty of Hasanuddin University.
7. Suhardjono.2009. Penyakit Ginjal Kronik Adalah Suatu Wabah Baru (Global
Epidemic) Di seluruh Dunia. Annual Meeting of Association of Indonesian
Nephrology.
8. PERNEFRI. 2012. Report of Indonesian Renal Registry5th. Association of Indonesian
Nephrology.
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
9. Prodjosudjadi, dkk.2009. End-Stage Renal Disease In Indonesia. Treatment velopment.
10. Faradilla.N. 2009.Gagal Ginjal Kronik (GGK). Medical Faculty of Riau University.
11. Burns, A. 2009. Renal Drug Handbook third edition. UK
12. BNF.2009. British National Formulary. BMJ Group. UK
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
DIABETES MELLITUS TYPE II, and CHRONIC RENAL FAILURE
Arie Setiabudi Latif1, Diana Laila Ramatillah2, Aprilita Rinayanti Eff2
1
Pharmacist Professional Program Student, Faculty of Pharmacy UTA'45 Jakarta
2
Lecturer Pharmacy in Pharmacy Faculty University of 17 August 1945 Jakarta
(UTA’45 Jakarta)
Email : Daengexe@gmail.com
ABSTRACT
Diabetes mellitus type 2 – formerly known as insulin-dependent diabetes mellitus (noninsulin-dependent diabetes mellitus-NIDDM) or adult-onset diabetes is a metabolic
disorder characterized by high blood glucose levels in the context of insulin resistanceand
relative insulin deficiency Caused GGK. 1 the most common are diabetes
andhypertension5.Mr. DS patient, age 38 years old, Dr. MINTOHARDJO RSAL Hospital
entered on June 15, 2014 with type II diabetes mellitus and with diagnosed of chronic renal
failure. Therapy treatment for 18 days of Intravenous Nefrosteril: RL 12 tpm, tpm, 12
Maltos Lasix Injection 2 x 2,3x6 ui, Novorapid Cefriaxone 2x1, Cefoperazone, Oral 2x1
folic acid 3x1, 3x1, CaCo3 Prorenal 3x1, 1x2, Bicnat 3x1 Cardace, Ranitidine, 2x1 Letonal
1x100 mg, Ondansetron,Omeprazole 3 x 1 2x1, Uripas 3x1, 4x1 Syr Season gr/day. Based
on the results of the practice of the clinician in the island of sangeang RSAL
Dr.MINTOHARDJO Hospital then can be drawn the conclusion that the existence of DRP
(DrugRelated Problem), in the form of indication without drugs, and drug interactions
(drug interaction).
Keywords: Diabetes Mellitus Type II, Chronic Renal Failure (GGK),
RSAL Dr. MINTOHARDJO
INTRODUCTION
Diabetes Mellitus is a disease in which levels of glucose (a simple sugar) in the blood is
high because the body cannot use insulin or release is adekuat. Blood sugar levels vary
throughout the day. Blood sugar will rise after a meal and returned to normal within 2
hours. Normal blood sugar levels tend to increase in a lightweight but progressive after the
age of 50 years, especially in people who are not active. 2
Classification:
1. type 1 Diabetes, which includes medical condition where cells was associated
with
Ketoacidosis to beta in the pancreas caused or cause autoimmunity, and idiopathic in
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
nature. Diabetes mellitus with pathogenesis of cystic fibrosis, such as clear
ormitochondrial deficiency, is not included in this classification.
2. type 2 Diabetes, which is caused by a deficiency of insulin secretion, often
accompanied by insulin resistance syndrome.
DIABETES TYPE 2
Diabetes mellitus type 2 (language of the United Kingdom: adult-onset diabetes,obesityrelated diabetes, a non-insulin-dependent diabetes mellitus, NIDDM) is a typeof diabetes
mellitus that occurred not due to the ratio of insulin in the blood circulation, rather it is a
metabolic disorder caused by mutations in many genes,including those that express the β
cell dysfunction, impaired secretion of the hormone insulin, resistance of the cells to insulin
which is caused by a malfunction of the GLUT10with the hormon resistin that causes cell
cofactors network, especially in the liverbecome less sensitive to insulin and glucose
absorption RBP4 that suppress musclestriated but by increasing the secretion by the liver
blood sugar. The common gene mutation on chromo some 19 that is the most populous of
chromo somes that are found in humans 4.
Chronic renal failure (GGK) is defined as keabnormalan kidney function arecharacterized
by the presence of protein in the urine (proteinuria) and decreased kidney function for 3
months or more progressive to Terminal renal failure. The most commoncause of GGK is
diabetic and hypertension. 8
CASE OF PERCENTAGE
Mr. DS. patient age 38 years old in RSAL Dr. MINTOHARDJO Hospital on June 15,
2014. with a diagnosed of type II diabetes mellitus and chronic kidney Failure. A patient
come in with complaints of sore feet, can't sleep, body swelling, urination are few.
Laboratory examination results showed high levels of leukocytes indicates a high rate of
infection, ureum indicates CKD, the high levels of albumin and protein indicates CKD, the
high levels of creatinin indicates CKD, high blood sugar levels during indicate diabetes
mellitus.
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
LINE TREATMENT OF DIABETES TYPE II.
The first line Sulfonurea group (increase insulin secretion), for example, glibenclamide,
glipizide, gliclazide, gliquidone, glimepiride, a sulfonylurea first used clinically are
tolbutamide and chlorpropamide.
Line two biguanide groups (increase glucose utilization in peripheral tissues and making
glukogan and inhibits gluconeogenesis), for example, Metformin.
Line three classes Alpha-glucosidase inhibitors, consisting of acarbose and voglibose; is
the enzyme alpha-glucosidase inhibitors (works by inhibiting the absorption of
carbohydrates from the intestine). 14
LINE TREATMENT OF CHRONIC RENAL FAILURE (CKD)
The first line antihypertensives (ACEI) to reduce glomerular hypertrophy and
hypertension intraglomerulus.
The second line Diuretics
The third line antidiabetes.13
CLINICAL EVALUATION
The use of Laxis to hypertension, edema, caused the failure of the heart and kidney disease,
Novorapid for therapy of diabetes mellitus type 1 and 2, Cefriaxone forinfection of the
respiratory tract, ENT, sepsis, meningitis. Bones, joints, Cefaperacone,genital tract
infections to breath, the genital tract, urinary tract, skin and mucosa,endometritis, folic acid
folic acid supplements to CaCo3, in order to prevent vitamin D deficiency, especially in
circumstances where the need for vitamin and calcium increases,chronic renal Insufficiency
for prorenal in association with a low calorie diet high inretention terkompensasi or not
terkompensasi.Cardace for additional therapy, hipetension a diuretic with or without
cardiac glycosides. To reduce the risk of myocardial infarction, stroke, death or the need for
KV Transmyocardial in diabetes patients,Ranitidine to eliminate symptoms of inability to
digest the sense of hot and sour on thesolar plexus, stomach ulcer and duodenal ulcer.
Letonal for essential hypertension,edem result: congestive heart pains, liver cirrhosis with
or without asites, nefrotiksyndrome, hiperaldosteronisme primary, ondansetron for nausea
1038
International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
and vomiting aftersurgery, Easter keoterapi omeprazole for the treatment of active duodenal
ulcer short-term, gastroesofageal reflux disease, the State of hipersekresi patologik, Uripas
fordysuria, syr Season for peptikum ulcer and chronic gastritis.
DOSAGE AND USING2 4 .5
In the case of patient with treated (Ivs) Nefrosteril: RL 12 tpm for 6 days (12-17 June2014),
(Iv) Maltos 12 tpm subs 12 days (September 18 – June 29, 2014), (injection)Lasix
(Furosemid) 2 x 2 for 12 days (date 12-June 23, 2014), 6 3 x Novorapid ui for 11days (date
of 13-June 23, 2014), Cefriaxone 2 x 1 for 2 days (12-13 June20114)Cefoperazone, 2 x 1
for 11 days (date of 13-June 23, 2014), Folic Acid (Oral) 3 x 1 for 6 days (12-17 June
2014), CaCo3 3 x 1 for 6 days (12-17 June 2014), Prorenal 3 x 1 for 6 days (12-17 June
2014), Cardace (ramipril) 1 x 2 for 6 days (12-17 June2014), Bicnat 3 x 1 for 6 days (12-17
June 2014)Ranitidine, for 2 days (June 18-June 19, 2014), Letonal (Spironolactone) 1 x 1
(morning) for 12 days (date 12-June 23,2014), Ondansetron 3 x 1 for 3 days (date of June
18-20, 2014), Omeprazole 2 x 1 for 5 days (19-23 June 2014), Urispas (Flavoksat Hcl) 3 x
1 for 7 days (12-18 June 2014),Season Syr 4 x 1 gr/day for 2 days (on 20 and 23 June
2014).
Results Of Laboratory Examination
Parame
ter
Tanggal pemeriksaan
Hb
15
*
124
00
*
11,6
Ureum
*
192
Leukos
it
Albumi
n
Protein
16
*
14
1
*
2,
7
*
3,
6
17
*
159
00
*
11,4
18
*
145
00
*
11,7
19
*
190
00
*
11,7
*
232
*
198
20
*
193
00
*
10,1
21
*
198
00
*
9,9
22
*
120
00
*
6,6
23
*
164
00
*
10,8
24
*
190
00
25
Nilai
840
0
*
5,5
500010000
Pria :
14-18
*
215
17-43
mg/dl
*
2,6
3,55,2
*
5,5
6,68,8
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
Kreatin
in
*
4
GDS
*
204
*
3,
5
*
18
8
*
4,6
0,91,3
*
304
*
276
*
169
*
178
80125
Description:
1. High levels of leukocytes indicates an infection. 12
2. Low Hb levels indicates CKD. 12
3. High levels of ureum indicates CKD. 12
4. the low levels of albumin and protein indicates CKD. 12
5. High levels of Creatinin indicates CKD. 12
6. the high blood sugar levels during indicate Diabetes mellitus 12
DRUG RELATED PROBLEM 4 .5
Drug Interactions
a. Urispas + Lasix (furosemid)
Effect: very nefrotoksik
Recommendation: stop using urispas (Flavoksat Hcl), because of the risk of nefrotoksik
b. Cefriaxone + lasix (furosemid)
Effect: increases the risk of nefrotoksit
Recommendation: replace the medicine cefriaxone with another drug that is still in a
group that does not give effect nefrotoksitas, in this case replaced with cefoperazone
c. Cardace (Ramipril) + Novorapid (insulin aspart)
Effect: increases the effect of novorapid
Recommendation: monitor blood glucose levels, the effect of this hipoglikemi it
is expected to lower the GDS that haven't been normal.
d. Cardace (Ramipril) + furosemid (lasix)
Effects: acute onset of hypotension and risky gagl kidney
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
Recommendation: stop the use of ramipril for the antihipertensi the ACEi risk
nefrotoksik.
e. Cardace (Ramipril) + calcium carbonate (CaCo3) + Sodium bicarbonate (Bicnat)
Effects: calcium carbonate and bicnat can decrease the effect of ramipril.
Recommendation: the effect of ramipril therapy is inhibited by the presence of CaCo3
/bicnat, where bicnat is more necessary and CaCo3 in CKD patients. Results
ofmonitoring of blood pressure is also normal, so not needed antihipertensi again.
(ISOFarmakoterapi)
f. Cardace (Ramipril) + insulin aspart (Novorapid)
Effects: rapimril enhances the effect of Novorapid
Recommendation: it is recommended, however, because ramipril has been stopped,then
the maintenance of blood sugar insulin aspart work to help should use oralantidiabet
drugs.
CONCLUSION
Based on the results of the practice of the internal medicine, patient in RSAL Dr.
MINTOHARDJO Hospital then pull on theconclusion that the existence of DRP (Drug
Related Problem) is the presence of multipledrug interactions that occur are Lasix
(furosemid) + letonal (spironolactone), Cefriaxone+ lasix (furosemid), Cardace (Ramipril) +
Novorapid (insulin aspart), Cardace (Ramipril) + furosemid (lasix), Cardace (Ramipril) +
calcium carbonate (CaCo3) + Sodiumbicarbonate (Bicnat), Cardace (Ramipril) + insulin
aspart (Novorapid), urispas + Lasix(Furosemid)
REFERENCES
1. anonymous. 2008. Iso farmakoterapi. PT.ISFI Publishing: London.
2. anonymous. (2013) .ISO (information Drug spesialiten Indonesia). Volume 48.Jakarta:
Indonesia Pharmaceutical Degree Bond.
3. Dipiro JT ., et all, 2006. Pharmacotherapy Handbook Sixth Edition Appleton
and lange: Newyork.
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
4. National
Kidney
Foundation.
2005.
K/DOQI
Clinical
Practice
Guidelines
forCardiovascular Disease in Dialysis Patients. New York.
5. Galileopharma. 2008, BNF edition 56, Alexandria University.
6. Suwitra, k. 2009. Chronic Kidney Disease. International Publishing.
7. Suhardjono. 2009. Chronic kidneydisease isa new plague (global epidemic)throughout
the world. Society Of Nephrology Annual Meeting Indonesia.
8. Prodjosudjadi dkk., 2009. EndStage Renal Disease In Indonesia. VelopmentTreatment.
9. BPOM.2008.nationaldrug Informatorium Indonesia (IONI). Jakarta: Sagung Seto.
10. Burns, a. 2009. Renal Drug Handbook third edition. New York: Oxford
11. http://emedicine.medscape.com
12. A.Y. Sutedjo, SKM. PocketBook ToKnow TheDisease ThroughThe LaboratoryExamin
ation Result.
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
DRUG RELATED PROBLEMS ASSOCIATED OF TREATMENT UROLITHIASIS
DISEASE PATIENT IN PGI CIKINI HOSPITAL
Bioty Wong1, Diana Laila Ramatillah2, Aprilita Rinayanti Eff2
1
2
Pharmacist Professional Program Student, Faculty of Pharmacy UTA'45 Jakarta
Lecturer Pharmacy in Pharmacy Faculty University of 17 August 1945 Jakarta (UTA’45
Jakarta)
Email:bioty89@gmail.com
ABSTRACT
Urolithiasis was a disease that occurs in hospital wards of PGI Cikini. Urolithiasis can be
occur anywhere in the urinary system1. Urolithiasis is a mineral efflorescence surrounding
the organic substance consisting of calcium salts (oxalate and phosphate) or magnesium
phosphate and uric acid 1. Case presentation: IS was a 41-year-old man admitted to the
wards for internal medicine. Patients diagnosed with urolithiasis. reclinical evaluation: in
this case need to be considered in this case study is the use of drugs that can cause
unwanted interactions in patients.
Keywords: Urolithiasis, RS PGI Cikini, Interactions
INTRODUCTION
In developed countries the disease is common upper urinary tract stones. This is due
to the influence of nutritional status and daily activities of the patient9. In the United States
5-10% of the population suffer from this disease, while in the entire world, there are an
average of 1-12% of people who suffer urinary tract stones9. This disease is one of the three
most prevalent diseases of urology in addition to urinary tract infections and prostate
enlargement benigna9.
Urolithiasis is a disease that occurs in the disease in hospital wards PGI Cikini.
Urolithiasis can occur anywhere in the urinary system1. Urolithiasis can be caused of a
mineral efflorescence surrounding the organic substance consisting of calcium salts
(oxalate and phosphate) or magnesium phosphate and uric acid 1.
Kidney stones can remain asymptomatic until it came out into the ureter and / or obstructed
urine flow, when the potential for kidney damage is acute10. This infection will increase the
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
formation of organic substances
10
. Organic substances were surrounded by precipitated
1
minerals . This mineral deposition (due to infection) will increase the alkalinity of urine
and lead to precipitation of calcium phosphate and magnesium ammonium fosfat1. Other
factors associated with stone formation were antacid consumption in the long term, too
much vitamin D, and calcium carbonate 1.
The main symptom is an acute kidney stone or renal colic pain1. Location of pain depends
on the stone locations
10
. If the stone is in the renal pelvis, causing pain and pain is
hydronephrosis is not sharp, fixed, and is felt in the area of costovertebra corner1. If a stone
dropped into the ureter, the patient will experience severe pain, colic, and taste like
stabbed1. This pain is intermittent and caused by spasm (spasm) of the ureter and the
ureteral wall anoxia pressed by the stone. This pain spreads to the suprapubic area, external
genitalia, and lap1. Colicky pain may be accompanied by nausea and vomit1.
CASE PRESENTATION
IS was a 41-year-old man admitted to the wards for internal medicine. Patients
diagnosed with urolithiasis. Hospitalized patients PGI Cikini June 7, 2014, he was a new
patient in the PGI Cikini’s hospital. The patient cannot urinate 2 days ago, no urine during
straining, nausea, vomiting (+), fever (-), packed (-) before admission. History of present
illness 1 week ago when urinating out the stone, small stones mixed with blood urine. The
patient has a past medical history of drug allergy that causes the skin to blister genitals,
unknown type of medicine because at the time it was taking some kind of medication.
Clinical chemistry examination was increased alanine aminotransferase 64 U/L, urea at 96
mg/dL, creatinine 11.4 mg /dL and decreased sodium is 130 mEq / L and calcium of 8.4
mg/dL. While on hematological examination increased in erythrocyte sedimentation rate 69
mm / h, 12.3 10 ^ 3μL leukocytes, neutrophils segment of 81%, 9% monocytes, MCHC
37.9 g / dL and decreased in erythrocytes 4.16 10 ^ 6μL, hematocrit 34%, reticulocyte 7
permil, and neutrophils rods 0%.
GUIDELINE FOR UROLIHIASIS MEDICATION6,8,9,11
a. Conservative therapy
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
Most ureteral stones have a diameter of <5 mm. As mentioned earlier, ureteral
stones <5 mm can come out spontaneously. Therapy aims to reduce pain, facilitate the
flow of urine by giving diuretics, such as:
1. Drink so diuresis 2 liters / day
2.
NSAIDs
Time limit is 6 weeks of conservative therapy. In addition to the size of the stone is
another requirement for the observation of the severity of the patient's complaints, the
presence or absence of infection and obstruction. The presence of recurrent colic or UTI
cause observation is not an option. So also with the presence of obstruction, especially
in certain patients (eg single kidney, kidney transplantation and decreased kidney
function) there is no tolerance for obstruction. Such patients should be done
immediately intervene.
b. ESWL (Extracorporeal Shockwave Lithotripsy)
With ESWL most patients do not need to be sedated, given only antidote to pain.
The patient will lie on a tool and will be subject to shock waves to break the stone Even
in last generation ESWL patients can be operated from a separate room. So, once the
location of the kidney is found, the doctor simply pressed a button and ESWL in the
operating room to move. Supine position of the patient himself could fit the position or
face down kidney stones. Kidney stones that have been broken will come out with the
urine. Usually patients do not need to be treated and can go home. ESWL is a kidney
stone crushing equipment using shock waves between 15-22 kilowatts. Although almost
all types and sizes of kidney stones can be solved by ESWL, still have to be reviewed
the effectiveness and efficiency of this tool. ESWL is only suitable to crush kidney
stones with a size less than 3 cm and located in the kidney or urinary tract between the
kidney and bladder (unless blocked by the pelvic bone). Another thing to consider is
whether the type of stone can be solved by ESWL or not. Hard rock (eg calcium oxalate
monohydrate) broke hard times and need some action. ESWL should not be used by
people with high blood pressure, diabetes, blood clotting disorders and kidney function,
pregnant women and children, as well as excess body weight (obesity).
c. Endourology
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
Endourology action is minimally invasive techniques to remove urinary tract stones
which consisted of breaking stones, and then remove it from the urinary tract through the
instrument that is inserted directly into the urinary tract. The device is inserted through
the urethra or through a small incision in the skin (percutaneous). The process of
breaking rocks can be done mechanically, by means of hydraulic energy, the energy of
sound waves, or with laser energy.
d. Open Surgery
Clinics that do not have adequate facilities for the actions of endourology,
laparoscopy, or ESWL, stone retrieval was performed through open surgery. The open
surgery include: pielolitotomi or nephrolithotomy to pick up stones in the bile duct, and
for stones in the ureter ureterolitotomi. Not infrequently the patient should undergo
nephrectomy or taking action kidneys because kidneys are not functioning and contains
pus (pyonephrosis), the cortex already very thin, or may warp due to urinary tract stones
that cause obstruction or chronic infection.
e. installation Stent
Although not a primary treatment option, ureteric stenting sometimes play an
important role as an additional measure in the treatment of ureteral stones. For example,
in patients with sepsis is accompanied by signs of obstruction, stent use was necessary.
Also on ureteral stones attached (impacted).
f. Prevention of Recurrence After kidney stones removed
Prevention is done is based on the content of the elements which make up urinary
stones obtained from stone analysis. In general, prevention of this form:
1. Avoid dehydration by drinking enough and sought production of as much as 2-3
liters of urine per day.
2. Diet to reduce the levels of the substances the rock-forming components.
3. Daily activities are quite
Some diets are recommended to reduce the recurrence is:
a. Low protein, because the protein will stimulate urinary calcium excretion and cause the
urine to become more acidic atmosphere.
b. low oxalate
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
c. Low salt, because it will spur the emergence natriuresis, hipercalsiuri
d. Low purine.
e. Low calcium diet is not recommended except in patients suffering from type II
absorptive Hipercalsiuri.
CLINICAL EVALUATION 3,7
Broadced (Ceftriaxone disodium) was used for urinary tract infections, Tramadol
(Tramadol HCl) for the treatment of acute and chronic pain, postoperative pain. Rantin
(Ranitidine HCl) used for hyperacidity, gastritis, peptic ulcer, chronic duodenitis,
pathological hypersecretion. Flagyl (Metonidazole) used for the prevention of postoperative
infections caused by anaerobic bacteria, especially Bacteroides species, and anaerobic
streptococci. Harnal (Tamsulosin HCl) used for symptoms of lower urinary tract disorders
associated with benign prostatic hyperplasia. Spasmium (Alverine citrate and
Chlordiazepokside) indicated for spasm pain / spasm, peptic ulcer. Sodium bicarbonate is
used to. Infusion of 0.9% NaCl is used to maintain electrolyte balance. NS infusion is used
to treat metabolic alkalosis due to fluid loss and mild sodium depletion.
DOSAGE AND DIRECTION3,7
For ten days in hospital care PGI Cikni Mr. IS getting 9 types of treatment. Patients
get Broadced (Ceftriaxone disodium) 2 grams for 10 days with a dose of 1 x 2 grams a day.
Tramadol (Tramadol HCl) ampoules administered for 10 days. On the first day until the
sixth day, the eighth day up to day 10 tramadol given at a dose of 3 x 1 day. On the seventh
day was given a dose of 1 x 1 a day. Rantin (Ranitidine HCl) ampoules in getting patients
for 3 days ie on day eight to ten with a daily dose of 2 x 1. Flagyl (Metronidazole)
suppository was given for 3 days ie on day eight to ten at a dose of 3 x 1 day. Harnal
(Tamsulosin HCl) 0.4 mg was given for 6 days from day five to ten with a daily dose of 1x
1. Spasmium (Alverine citrate and Chlordiazepokside) given for 6 days. Day five was given
at a dose of 1 x 1 a day. On day six to ten at a dose of 3 x 1 day. Sodium bicarbonate
capsules given for 6 days with dosi days to five 1 x 1 and on day six to ten 3 x 2 a day.
Infusion of 0.9% NaCl was given 6 days diving on the first day with a dose of 1x1, on the
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
second day up to six at a dose of 2 x 1 day. NS infusion was given for 4 days, on seventh
day to tenth day.
DRUG RELATED PROBLEMS (DRPS)2,3,4,7
1. Drug Related Problem 1 (Drug Interaction)
a. Drug interaction 1
Spasmium and tramadol both increase sedation. Potential for interaction, monitoring
should be done.
Doctor’s Note: Tramadol is given to relieve acute or chronic pain or severe
postoperative pain due to kidney stones
Spasmium given to treat spasms of pain / spasm, peptic ulcer.
Pharmacist Intervention: Perform monitoring of the use of drugs that can interact.
Leave a space of drug use during 2 hours
b. Drug Interaction 2
Flagyl increases levels of harnal by affecting hepatic/intestinal enzyme CYP3A4
metabolism. Potential for interaction, Monitoring should be performed. Dose
reduction may be needed for coadministered drugs that are predominantly
metabolized by CYP3A
Doctor’s Note: Flagil used for urethritis and vaginitis, amubiasis, anaerobic
infections. Harnal given for symptoms of lower urinary tract disorders.
Intervention pharmacists: Advise the patient to give space around 2 hour to drugs
that interact with each other.
2. Drug Related Problem 2
On the seventh day ( June 13, 2014) patients require tramadol for pain suffered 3
times a day, but the patient was given once a day.
CONCLUSION
After the assessment of the patient's treatment, it can be concluded that patients diagnosed
urolithiasis. For drugs that interact give space 2 hours in the offering. Do rigorously
monitoring for drug-drug interaction.
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
REFERENCES
1. Baradero, Mary,dkk.2005.Klien Gangguan Ginjal. Jakarta:Buku Kedokteran EKG.
2. Baxter, K. 2008. Stockley’s Drug Interaction Eight Edition. London.
3. BPOM.2008.Informatorium Obat Nasional Indonesia (IONI).Jakarta: Sagung Seto
4. Burns, A. 2009. Renal Drug Handbook third edition. New York : Oxford
5. Doenges, Marilynn.E,dkk. 2000. Rencana Asuhan Keperawatan edisi 3. Jakarta:Buku
Kedoktran EGC.
6. Hayes, Peter C. 2005.Buku Saku Diagnosis dan Terapi. Jakarta:Buku Kedokteran EGC.
7. MIMS. 2009. MIMS Indonesia Petunjuk Konsultasi. Edisi 9. Jakarta. PT. Bhuana Ilmu
Populer
8. Nugroho, Ditto. 2009. Batu ginjal. Jakarta: Buku Kedokteran EGC.
9. Perhimpunan Dokter Spesialis Penyakit Dalam Indonesia. 2006. Buku Ajar Ilmu
Penyakit Dalam. Jilid I. Edisi IV. Pusat Penerbitan Departemen Ilmu Penyakit Dalam
FKUI. Jakarta.
10. Sabiston, C. Sabiston. 2005. Buku Ajar Bedah.Jakarta:Salemba Medika.
11. Tiselius HG, Ackerman D, Alken P, dkk. Guidelines on urolithiasis.
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
STUDY OF PULMONARY DISEASES WARD PULMONARY TB BTA (+) LLKB
(The lesion Area new cases) on OAT kat II.
Junaedi, Chandra, Diana Laila Ramatillah2, Aprilita Rinayanti Eff2
1
Pharmacist Professional Program Student, Faculty of Pharmacy UTA'45 Jakarta
Lecturer Pharmacy in Pharmacy Faculty University of 17 August 1945 Jakarta
(UTA’45 Jakarta)
2
Email : budhajulai33@gmail.com
ABSTRACT
Tuberculosis (TB) is a disease caused by infection with Mycobacterium complex
tuberculosis1. Mycobacterium Tuberculosis rod-shaped, straight or slightly curved, not
capsule and spores. Tuberculosis (TB) disease of a lung to date is still a public health
problem1. Patient Mr. AH, age 37 years, 3 months, 7 days, W: 42 Kg, it was the friendship
on 02 Mach 2014 with the diagnosis of pulmonary TB BTA (+) LLBK (Broad new cases of
Lesion) on OAT category II. Therapy treatment for treated is. IV FD NaCl 0.9%,
Streptomycin Injeksi, Paracetamol, and OAT category II drugs (INH, Rifampin,
ETHAMBUTOL and Streptomycin, pirazinamid). Based on the results of the practice of
the Clerk's Ward on pulmonary disease clinic at the Friendship was then be drawn the
conclusion that the existence of the DRP (Drug Related Problem) is there a medicine
without any indication, the failure of patients in receiving medications and conditions that
need to be taken care of.
Keywords: Tuberculosis, BTA (+) LLKB, Pulmonary Disease
A. INTRODUCTION
Tuberculosis (TB) is a disease that it is caused by infection with Mycobacterium
tuberculosis kompleks1. Microbe Tuberculosis rod-shaped, straight or slightly curved, not
spores or not capsules1. These bacteria-sized width of 0.3 – 0.6 mm long and 1-4 mm. Wall
microbe is very complex, consisting of a layer of fat is quite high (60%)1. The main
constituent of the cell wall Microbe tuberculosis were micolat, wax complex (complex1050
International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
wexes), thehalosa dimikolat called the cord factor and microbe sulfo lipids that play a role
in virulensi6.
The world's TUBERCULOSIS report by the WHO in 2006, that Indonesia as the
largest contributions number, three in the world after india and China with the number of
new cases is about 539.000 people per year. According to Notoatmodjo (2003) in addition
to the factor of environmental sanitation of houses, pulmonary TB disease occurrence is
also very concerned with the behavior and the amount of family income because most
patients with TB is a poor level of education rendah2. For examination of pulmonary
TUBERCULOSIS checked 3 specimens sputum within 2 days6. Based on the guidelines of
the national TB program, the diagnosis of pulmonary TB in adults is enforced with the
discovery of TB germs (BTA) 6. Whereas such checks photo thoracic, culture and
sensitivity test can be used as a support in diagnosis in accordance with the indications and
not justified in diagnosing TB6.
B. RESERVED
Patient Mr. AH, age 37 years, 3 months, 7 days, W: 42 Kg, it was the friendship on
02 Mach 2014 with the diagnosis of pulmonary TB BTA (+) LLBK (Broad new cases of
Lesion) on OAT category II. Friendship was signed on 2 March 2014. The patient came in
with the complaint that shortness of breath increased severe since 2 month SMRS. The
patient complained of shortness of breath during the 5 days of SMRS, claustrophobic not
reads ngik, shortness is felt throughout the day, shortness of breath, chest pain right side,
pain relapse during nighttime, losing weight and coughing at night.
The patients had previously received treatment for lung OAT category I at the
clinic, where patients had healed cause stopping his own treatment of OAT, OAT resistance
for category so I substituted OAT and category II. After treatment of OAT category II 5
days in diagnosis MDR TB patients (Multi Drug Resistant).
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
C. EXAMINATION OF VITAL SIGN
Date Of
Examination
Blood
Pressure
(120/80
mmHg)
Pulse
circulation of
breath (1418x/menit)
body
temperature
2/3/2014
126/87 mmHg
108 x / menit
28.4 x / menit
36.8 ⁰C
3/3/2014
110/70 mmHg
90 x / menit
24 x / menit
36 ⁰C
4/3/2014
120/80 mmHg
88 x / menit
22 x / menit
36 ⁰C
5/3/2014
110/70 mmHg
84 x / menit
22 x / menit
36,7⁰C
6/3/2014
110/70 mmHg
84 x / menit
22 x / menit
36⁰C
(60100x/menit)
(36-37⁰C)
D. CLINICAL EVALUATION
Patient was given the drug OAT category II (Rifampin, Etambutol, INH, and
Pirazinamid) and injek Streptomycin for tuberculosis treatment. Patient to on paracetamol
to reduce short of breath and gave oxygen therapy 2 Lpm.
E. TUBERCULOSIS DRUGS AND MULTI DRUG RESISTANT7
Name
Doses
Pirazinamid
30-40
(Tablet, 500 mg)
mg/kg/day
Etambutol
1000
1750 mg
1750
2000 mg
2000
25 mg/kg/day 800
1200 mg
1200
1600 mg
1600
2000 mg
Kanamisin
15-20
500
(Vial, 1000 mg)
mg/kg/day
750 mg 1000 500
mg 1000 mg
Levofloksasin
750 mg day
750 mg
750 mg
(Tablet, 400 mg)
750-1000 mg
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
(Kaplet, 250 mg)
Sikloserin
15-20
(Kapsul, 250 mg)
mg/kg/day
Etionamid
15-20
(Tablet, 250 mg)
mg/kg/day
PAS
150 mg/kg/day
500 mg
750 mg
750-1000 mg
500 mg
750 mg
750-1000 mg
8g
8g
8g
(Granula, 4 gr)
F. LINE TREATMENT For TBC6
Category I
Weight
The intensive phase of each day for
56 days
INH, rifimpisin, etambutol,
pirazinamid
2 tablet 4 FDC
3 tablet 4 FDC
4 tablet 4 FDC
5 tablet 4 FDC
The advanced stages, 3 times
a week for 16 weeks
Rifampisin, INH
The intensive phase of each day for
56 days
The advanced stages, 3 times
a week for 20 weeks
INH, Rifimpisin, Etambutol,
Pirazinamid, dan Injek Sereptomisin
Rifampisin, INH, Etambutol
30-37 kg
2 tablet 4 FDC
2 tablet 4 FDC
38-54 kg
3 tablet 4 FDC
3 tablet 4 FDC
55-70 kg
4 tablet 4 FDC
4 tablet 4 FDC
≥71 kg
5 tablet 4 FDC
5 tablet 4 FDC
30-37 kg
38-54 kg
55-70 kg
≥71 kg
2 tablet 4 FDC
3 tablet 4 FDC
4 tablet 4 FDC
5 tablet 4 FDC
Category II
Weight
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
G. DOSAGE and MODE were USED3,4,5
The Name Of
Drug
Dose
Medicinal
indication
Usage
Common Dose
O2
2 Lpm
Short of breath
Inhalasi
2 Lpm
Parasetamol
3 x 500 mg
Analgetik
Oral
3-4 x 500 mg/day
Setreptomicin
1 x 750 mg
TBC
Injeksi
750mg /day
NaCl 0,9%
500 cc
Elektrolit
Injeksi
2 x/24 hour
4 FDC
1 x 3 tablet
TBC
Oral
3 tablet 4 FDC
H. THE VALUE OF LABORATORY
Table 1. The results of laboratory Examination
No. Lab : 140308-1796
No. Med Rec. 02-10-27-42
Name : Mr. A H
No
The name of
the test
Normal
Value
Units
Inspection Results
Leukosit
5 ~ 10
Ribu/mm3
14,29
16,88
Netrofil
50 ~ 70
%
74,1
77,3
Limposit
25 ~ 40
%
95
73
Monosit
2~8
%
7,9
6,1
Eosinofil
2~4
%
8,2
8,7
Basofil
0~1
%
0,3
0,6
Eristrosit
4,5 ~ 6,5
Juta/uL
5,18
5,98
02/03/2
014
03/0
3/20
14
04/03
/2001
4
05/0
3/20
14
06/03
/2014
Hitung Jenis
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
Hemoglobin
13,0 ~ 18,0
g/dL
13,3
13,1
Hematrokrit
40 ~ 52
%
38
43
MCV
80 ~ 100
fL
73,7
77,9
MCH
26 ~ 34
Pg
25,7
24,0
MCHC
32 ~ 36
%
34,8
80,8
RDW-CV
11,5 ~ 14,5
%
17,0
16,20
Trombosit
150 ~ 440
Ribu/mm3
559
585
Na
135 ~ 145
Mmol/L
142,0
K
3.5 ~ 5.5
Mmol/L
4,20
Cl
98 ~ 109
Mmol/L
99
Ur
20 ~ 40
Mg/dL
18
Keratinin
0,6 ~ 1,6
Mg/dL
0,9
pH
7,34 ~ 7,44
PCO2
35 ~ 45
mmHg
43,3
PO2
85 ~ 95
mmHg
113,8
HCO3
22 ~ 26
Mmol/L
26,0
TCO2
23 ~ 27
Mmol/L
26,3
Std HCO3
2,5 ~ 26
Mmol/k
24,2
Saturasi O2
96 ~ 97
%
98,1
GDS
< 180
Mg/dL
98
Elektrolt
7,37
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
Laju Endap
Darah
0 ~ 10
Mm
85
Protein
6~8
g/dL
8,2
Albumin
3,4 ~ 5
g/dL
3,9
Globulin
1,3 ~ 2,7
g/dL
4,3
Ast (SGOT)
0 ~ 37
u/L
25
Alt (SGPT)
0 ~ 40
u/L
4
I. DRUG RELATED PROBLEM
1. failed to receive medication
Patients failed to receive oral Paracetamol at 08.00 am on March 3,
2014. Suggestion to nurses and nurse's records list check performed periodically
and always cultivating the habit of giving information to his first patient-related
properties that are associated.
2. Condition to be note
The condition that need to be considered in these patient, in which
patient experience decreased in appetite so it should be given the addition of
vitamins to increase his appetite so it can improve the condition of the patient's
body in the face of illness and always check the function SGOT/SGPT patient at
regular intervals.
J. CONCLUSION
Based on the results of the practice in the Clerk's Ward on pulmonary
disease conclusion that the existence of DRPs (Drug Related Problems) is a
condition that needs to be noted and the patient's role in the failure to receive the
drug.
REFERENCES
1. PDPI, 2013. Pedoman diagnosis dan penatalaksanaan Tuberkulosis . Jakarta
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
2. Herryanto, 2004, Riwayat pengobatan penderita TB paru Jurnal Kesehatan vol 3,
Bandung.
3. BPOM. 2008. Informatorium Obat Nasional Indonesia (IONI). Jakarta : Sagung Seto
4. Burns, Dr. Aine. 2009. Renal Drug Handbook third edition. New York : Oxford
5. Galileopharma. 2008, BNF edition 56, Alexandria University
6. Djojodibroto, Dr. R. Darmanto, Sp. P, FCCP. 2009. Respirologi (Respiratory
Medicine). Jakarta : EGC.
7. Nawas, Aarifin. 2014. Penatalaksanaan TB MDR dan Setrategi DOTS plus: Jakarta
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BRONCHOPNEUMONIA IN PULMONARY DISEASE WARD
Delius Wonda, Diana Laila Ramatillah2, Aprilita Rinayanti Eff2
1
Pharmacist Professional Program Student, Faculty of Pharmacy UTA'45 Jakarta
2
Lecturer Pharmacy in Pharmacy Faculty University of 17 August 1945 Jakarta
(UTA’45 Jakarta)
Email : dianalailaramatillah@gmail.com
ABSTRACT
In clinical, pneumonia is defined as an inflammation of lung caused of microorganisms
(bacteria, viruses, fungi, parasites)3. Pneumonia caused by Mycobacterium tuberculosis not
including while the lung inflammation caused by nonmikroorganisme (chemicals, radiation,
toxic material aspirations, drugs etc.) is called pneumonitis3. Mr. SY patients was 75 years
old and hospitalize at Gatot Subroto Army Hospital on 18 March 2014 with diagnosis is
bronchiectasis and bronchial asthma. Therapy treatment during hospitalized that is
Neurobion, furosemide, ceftriaxon, digoxin, ISDN, aspilet, allupurinol, nitrokaf, methyl
prednisolone, Ventolin. Based on the results of clinical practice in pulmonary disease ward
at Gatot Subroto Army Hospital, so can be concluded that presence of DRP (Drug Related
Problem) is happen drug interaction between furosemide interactions with digoxin and
aspirin with digoxin.
Key Word : Broncopneumonia, Pulmonary Disease, Gatot Subroto Army Hospital
INTRODUCTION
In clinical, pneumonia is defined as an inflammation of lung caused of
microorganisms (bacteria, viruses, fungi, parasites)3. Pneumonia caused by Mycobacterium
tuberculosis not including while the lung inflammation caused by nonmikroorganisme
(chemicals, radiation, toxic material aspirations, drugs etc.) is called pneumonitis3.
Streptococcus pneumoniae causes inflammatory exudate in large amount take a part
to helping bacteria invade through the pores that exist within alveoli until destroyed by
septum that separates lobes of the lungs2.
The origin of the pneumonia was the damage caused by the entry of particles
attacker in lower respiratory tract. The entryway frequent happen is inhalation of small
particles, but aspirations particles infection that larger in oropharyngeal spreads from
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
distant infection focus or spread directly from surrounding tissues used as an entrance by
agents causing pneumonia4.
These particles can cause lung damage because they contain ingredients that can
cause an infection, disseminated through the air (water borne) when the infectious agent is
still active, and stay active while suspended in the air and then enter to tissue, and this
particles can cause infection. Combination of these conditions may help to explain why
pneumonia is less common happen and why some are more at risk than at other locations4.
CASE PRESENTATION
Mr. SY patients was 75 years old and hospitalize at Gatot Subroto Army Hospital
on 18 March 2014. Patients present with shortness of breath ± 1 week of cough with
phlegm, coughing, shortness of breath, sputum colored black. Ever seek treatment earlier
but no change. Past medical history of asthma last relapse was last week, Diabetes mellitus,
hypertension and stroke. The result of hematology laboratory tests that is ESR values has
increased 28 mm/hour, hemoglobin has decreased 11.6 g/dL, hematocrit has decreased
34%, erythrocytes has decreased 3.8 million/μL, leukocyte has increased 17200/μL, urea
has increased 62 mg/dL, creatinine has increased 1.7 mg/dL.
CLINICAL EVALUATION
Neurobion used for treatment of deficiency Vitamin B1, B6 and B12 such as beriberi and polineuritis. Furosemide used as a treatment of edema accompanying congestive
heart failure, cirrhosis of the liver and kidney disorders including nephrotic syndrome,
treatment of hypertension, either given alone or combination with antihypertensive drugs,
furosemide is very useful for situations that require a strong diuretic. Ceftriaxon used as
antibiotics due to bacterial infection. Digoxin used to treatment of acute congestive heart
failure and chronic and paroxysmal supraventricular tachycardia. ISDN used to prevent
chest pain caused by angina and heart failure left. Aspilet used to treatment and prevention
of angina pectoris and myocardial infarction. Allupurinol used to gout and hyperuricemia.
Nitrokaf used as a long-term prevention and treatment of angina pectoris. Methyl
prednisolone used as adrenocortical insufficiency acute and chronic primary. Ventolin used
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
as treatment and prevention of asthma attacks. Routine management of chronic
bronchospasm that does not respond to conventional therapy; Acute severe asthma (status
asthmaticus).
DOSAGE AND DIRECTION
Therapeutic treatment given for 3 days that is Neurobion 5000 is administered
Intravena on days 2 and 3, furosemide administered orally on day 1 to day 3, ceftriaxon
given intravena on day 2 and day 3, digoxin administered orally on day 2 and day 3, ISDN
administered orally on day 2, aspilet administered orally on day 2, allupurinol administered
orally on day 2, nitrokaf-R administered orally on day 2, methyl prednisolone given
intravena on day 2, ventolin inhalation is given on day 2.
DATA LABORATORY VALUE
TIPE OF CHECK UP
HEMATOLOGY
REFERENCE VALUE
18/3
19/3
Erythrocyte
Sedimentation Rate
Routine Hematology
Hemoglobin
Hematocrit
Erythrocytes
Leukocyte
Platelet
MCV
MCH
MCHC
Total Bilirubin
Direct Bilirubin
Indirect Bilirubin
Fosfatase
SGOT
SGPT
y-GT
Total Protein
Albumin
Globulin
Total Cholesterol
< 20 mm/hour
28
28
13 – 18 g/Dl
40 – 52%
4.3 – 6.0 million/μ L
4,800 – 10, 800/ μ L
150,000 – 400,000/ μL
80 – 96 fl
27 – 32 pg
32 – 36 g/Dl
< 1,5 mg/dL
<0,3 mg/dL
<1,1 mg/dL
56-119
< 35 U/L
< 40 U/L
8-61 U/L
6-8,5 g/dL
3,5-5,0 g/dL
2,5 – 3,5 g/dL
< 200 mg/dL
11,6
34
3,8
17200
347000
88
30
34
1,92
0,86
1,06
85
54
33
50
6,5
4,0
2,5
147
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
Triglyserida
HDL Cholesterol
LDL Cholesterol
Urea
Creatinine
Uric Acid
Fasting Blood Glucose
Blood Glucose (2 hours
PP)
Sodium
Potassium
Clorida
URINALYSIS
Complete Urine
Ph
PCO2
PO2
Bicarbonate
Bases Excess
Saturation
Specific Gravity
Protein
Glucose
Bilirubin
Nitrite
Ketones
Urobilinogen
Erythrocytes
Leukocyte
Cylinder
Cristal
Epithelial
Others
< 160 mg/dL
>35 mg/dL
<100 mg/dL
20 – 50 mg/dL
0.5 – 1,5 mg/dL
3.5 – 7.4 mg/dL
70 - 100 mg/dL
<140 mg/dL
62
1,7
66
54
80
61
2,2
117
118
135 – 147 mmol/L
3,5 – 5,0 mmol/L
95 – 105 mmol/L
131
3,5
97
137
3,7
97
4,6 – 8,0
33-44 mmHg
71-104 mmHg
22-29 mmol/L
(-2)-3 mmol/L
94-98 %
1010 – 1030
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif – Positif 1
< 2 LPB
< 5/LPB
Negatif/LPK
Negatif
Positif
Negatif
7,483
23,1
126,4
17,5
-4,3
96,5
5,5
1015
-/Negatif
-/Negatif
-/ Negatif
-/ Negatif
-/ Negatif
Negatif
0-1-0
2-2-2
-/Negatif
-/Negatif
+/Positif 1
-/Negatif
GUIDELINE OF PNEUMONIA
Treatment consists of antibiotics and supportive treatment. Administration of
antibiotic in patients with pneumonia should be based on the data of microorganisms and
susceptibility test results, but for some reason that is3 :
1. Severe disease can be life-threatening.
2. Bacteria pathogens that can be isolated is not necessarily the cause of pneumonia.
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
3. Results of bacterial culture takes time
Therefore, in patients with pneumonia can be administered empirical therapy. In general,
the selection of antibiotics based on bacteria that cause pneumonia can be seen as follows3 :
Penisilin sensitif Streptococcus pneumonia (PSSP)
� Group Penicillin
� Trimethoprim-sulfamethoxazole (TMP-SMZ)
� Macrolides
Penisilin resisten Streptococcus pneumoniae (PRSP)
� Betalaktam high oral doses (for outpatient)
� Sefotaxime, Ceftriaxone high doses
� New macrolides high doses
� respiratory Fluoroquinolone
Pseudomonas aeruginosa
� Aminoglycoside
� Seftazidime, Sefoperason, Cefepim
� Ticarsilin, Piperacillin
� Carbapenem : Meropenem, Imipenem
� Ciprofloxacin, Levofloxacin
Methicillin resistent Staphylococcus aureus (MRSA)
� Vancomysin
� Teikoplanin
� Linezolid
Hemophilus influenzae
� TMP-SMZ
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� Azitromysin
� Cefalosporin genes 2 or 3
� Respiratory Fluoroquinolone
Legionella
� Macrolides
� Fluoroquinolone
� Rifampin
Mycoplasma pneumoniae
� Doxycycline
� Macrolides
� Fluoroquinolone
Chlamydia pneumoniae
� Doxycycline
� Macrolides
� Fluoroquinolone
DRUG RELATED PROBLEMS (DRPs)
1. Interactions happened between digoxin and furosemide that is furosemide increases
effect of digoxin through pharmacodynamic synergism interactions that cause
hypokalemia.
2. When aspirin is given together with digoxin will increase levels of digoxin so that need
to dose adjustment or doing special tests to take a second these drugs. If the are used
need to be monitored closely and given the distance of at least 2 hours.
CONCLUSION
Based on a review of the patient's disease can be concluded that between giving
together digoxin and furosemide will cause furosemide can increase digoxin effects by
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pharmacodynamic synergism. When used simultaneously aspirin and digoxin will increase
digoxin levels should be monitored closely and should be spaced at least 2 hours of
administration of the drug.
REFERENCES
1. AHFS drug information 2004. McEvoy GK, ed. Methotrexate. Bethesda, MD:
American Society of Health-System Pharmacists; 2003:1082-9).
2. Dipiro, Joseph T., et. al., 2008, Pharmacotherapy: A Pathophysiologic Approach 7th
Edition, McGraw Hill, New York.
3. PDPI, 2003. Pneuomonia Komuniti Pedoman Diagnosa dan Penatalaksanaan di
Indonesia. Jakarta.
4. Syamsuddin, 2013. Farmako terapi gangguan saluran pernafasan. Salemba medika.
Jakarta.
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DRUG RELATED PROBLEMS IN THE TREATMENT OF GUILLAIN-BARRE
SYNDROM DISEASE, ANTI PHOSPOLIPID SYNDROME AND DIABETES
MELLITUS TYPE 2
Dessy Karina L, Diana Laila Ramatillah2, Aprilita Rinayanti Eff2
Pharmacist Professional Program Student, Faculty of Pharmacy UTA'45 Jakarta
2
Lecturer Pharmacy in Pharmacy Faculty University of 17 August 1945 Jakarta
(UTA’45 Jakarta)
1
Email : dkl_niez@yahoo.com
ABSTRACT
Guillain Barre Syndrome and Anti Phospolipid Syndrome is an autoimmune condition and
its prevalence is very small at 2-3 cases in 100,000 people for a year and one of the patients
with this condition are treated in PGI Cikini hospital. Guillain-Barré syndrome is an
inflammatory disorder of nerve (nerves outside the brain and spinal cord) are attacked by its
own immune system. GBS is characterized by progressive muscle weakness and rapid. It
affects the nerves that signal muscles to contract and may impair the ability to walk, write,
breathe, talk, etc. Early symptoms are decreased sensation in the lower limbs which
developed into numbness and tingling. Can also occur severe back pain and leg weakness
in hands simultaneously, muscle pain, cramps, and shortness of breath. GBS symptoms
vary widely and in some cases can occur up to a total paralysis of respiratory muscles. APS
is a thrombophilic disorder in which antibodies are produced to various phospholipids.
Clinical manifestations in patients with APS is because phospholipids are an integral part of
the platelet and endothelial cell surface membrane, then the anti-phospholipid antibodies
will have a significant effect on platelets and vascular endothelial mechanism by inhibiting
the production of endothelial protasiklin, generating procoagulant effect on platelets, as
well as a decrease in fibrinolysis. Meanwhile other diagnosis of diabetes mellitus is a state
dysfunction and impaired glucose metabolism occurs in the form of impaired fasting
glucose and impaired glucose tolerance eventually occurs with type 2 diabetes mellitus.
Keywords: Guillain Barre Syndrome, diabetes type 2, PGI Cikini Hospital
1. Preliminary
Guillain Barre syndrome is an autoimmune disease that causes inflammation and
damage to myelin (fatty material, composed of fat and protein that forms a protective
sheath around some kind of peripheral nerve fibers). GBS is considered a rare disorder
with an incidence of about 2-3 cases in 100,000 people for a year
1
Symptoms of this
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disease is early weakness and numbness in the legs that quickly spread cause paralysis
(2). GBS is mediated by postinfectious. Cellular and humoral immune mechanisms may
play a role in its development. Most patients reported infectious disease in the weeks
before the onset of GBS. Many infectious agents are identified is expected to induce the
production of antibodies that cross-react with specific gangliosides and glycolipids,
such as GM1 and GD1b are distributed throughout the myelin in the peripheral nervous
system. GBS is a disease that usually occurs one or two weeks after a viral infection
such as sore throat, bronchitis, or the flu, after vaccination or surgical procedures.
Weakness and numbness in the legs are the first symptoms. These sensations can
quickly spread, eventually paralyzing the entire body 2.
Guillain-Barre may be triggered by 2 :
a. Campylobacter infection, the type of bacteria that is commonly found in food,
especially poultry
b. Operation
c. Epstein Barr Virus
d. Hodgkin's disease
e. Mononucleosis
f. HIV
g. Rabies or influenza immunization (rare)
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Guillain-Barre syndrome (GBS) Guidline 3
In 1986 the disease was introduced by Hughes Harris and Gharavi, Anti Phospolipid
Syndrome is a thrombophilic disorder in which antibodies are produced to various
phospholipids4. APS can be caused by lupus anticoagulant (LA) and anticardiolipin
antibodies (ACA), also called antiphospholipid antibodies5. Clinical manifestations in
patients with APS is because phospholipids are an integral part of the platelet and
endothelial cell surface membrane, then the anti-phospholipid antibodies will have a
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significant effect on platelets and vascular endothelial mechanism by inhibiting the
production of endothelial protasiklin, generating procoagulant effect on platelets, as well as
a decrease in fibrinolysis.
Guideline Antiphospolipid Syndrome 6
Diabetes mellitus is caused by glukotoksistas relative insulin deficiency results in
pancreatic
cell dysfunction and impaired glucose metabolism occurs in the form of
impaired fasting glucose impaired glucose tolerance and type 2 diabetes eventually
occurred7. It is essential in the management of Diabetes mellitus type 2 is a lifestyle change
that is a good diet and regular exercise. With or without pharmacologic therapy, a balanced
diet and exercise regularly (if not contraindicated) should still be carried out8
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Guidline Hyperglicemic Type 2 9
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2. Case Presentation
a. Patient Identity:
Patient Name
: EM
No
: Medical Records: 187 455
Dependents
: Alone
b. Anamnesis
Main Complaint: Limp
History of present disease: Weakness, defecate rather liquid, decreased appetite,
tingling and weakness in the hands, feet, and lips since 1 month ago.
Past medical history: The patient was known to have the same complaint with the
diagnosis of GBS, diabetes type 2, as well as from the APS in 2012 and had been
treated for 4 months in the Cikini hospital. Patients taking Metformin 500mg 2x
daily during and Simarc 1x2tab once every 2 days.
Family Disease History: None
c. General Examination:
Examination Vital sign: BP: 120/80, pulse: 74x/menit, R: 20x/menit, T: 36.5
d.
Clinical examination
Table 1. Examination Clinical Chemistry
No
Parameters
Clinical chemistry
1 Natrium
2 Kalium
3 Kalsium
4 Gula Darah Sewaktu
Value
Reference value
141 mEq/L
3,5 mEq/L
6,2 mg/dl *
186 mg/dl *
135-147
3,5-5,0
8,5-10,0
< 150 mg/dl
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e.
Examination During Treatment
Table 2. Examination Lab
2
June
2014
Parameters
1
Albumin
3,4 g/dl
2
Ferritin
0,84
*mg/ml
3
SGPT
26 u/L
4
Kreatinin
0,6 mg/dl
Glukosa darah
jam 06.00
Glukosa darah
jam 18.00
Glukosa darah
jam 24.00
Glukosa darah
jam 11.00
Glukosa darah
jam 16.00
Glukosa darah
jam 06.00
Glukosa darah
jam 11.00
Glukosa darah
jam 16.00
133
mg/dl
70-150
96 mg/dl
70-150
116mg/dl
70-150
6
7
8
9
10
11
12
13
Ureum
14
Natrium
15
Kalium
3 June
2014
5
June
2014
No
5
22-May14
29May14
21May-14
3,3
g/dl
6 June
2014
Reference value
3,4-4,8
Premenopouse :
6,9-282,5
Post : 14,0-233,1
Laki2 :
18-30 tahun :
18,7-323
31-60 tahun :
16,4-293,9
0-35
0,7
mg/dl
0,6-1,1
129
mg/dl
131
mg/dl
70-150
70-150
114
mg/dl
73
mg/dl
118
mg/dl
100
mg/dl
83
mg/dl
167 *
mg/dl
21
mg/dl
137
meq/L
4,2
meq/L
70-150
70-150
70-150
10-50
135-147
3,5-5,5
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16
Kalsium
17
Anti H. Pyllori
Kualitatif
8,4
*mg/dl
8,8-10,0
Positif
Positif
3. Clinical Evaluation
GBS is the main therapy to prevent and manage complications and provide
supportive care until symptoms begin to improve2. Mrs. EM treated with injection of
Methycobal for complaints peripheral neuropathy10. As is known Mrs. EM complain
circumstances tingling in hands, feet and lips. In the laboratory results are known Mrs.
EM ferritin levels below normal. Low ferritin levels indicate that the concentration of
iron in the body is low. Giving Sangobion caps to prevent anemia due to iron deficiency
and other minerals that contribute to the formation of blood cells. Mrs. EM using
metformin as monotherapy in controlling blood sugar levels and can be said to be
successful in controlling sugar levels seen in the laboratory results of blood sugar at a
time. Metformin monotherapy is rarely accompanied by hypoglycemia and metformin
can be used safely without causing hypoglycemia in prediabetes. Non glikemik effect of
metformin is important not cause weight gain or cause a little weight decrease7. Simarc2 (Warfarin-Na) is indicated for the state of thrombosis caused by APS syndrome with
Warfarin dose of 5-15 mg, the dose was increased by INR to be achieved (2.5 - 3.5) (10).
Provelyn (Pregabalin) is indicated in the neuropathic pain state11. At the starting dose
for nerve pain 75mg 2x a day and if well tolerated may be increased to 150mg after an
interval of 3-7 days, a maximum of 300 mg in the next week12. However, doctors
prescribe the use of 1x 50mg Provelyn only possibility is based on the severity of pain
experienced. Mrs. EM treated with lansoprazole and Inpepsa syrup for gastritis
treatment they experienced. Lansoprazole is a class of drugs for the treatment of ulcers
proton pump inhibitor which works by inhibiting the enzyme and produce energy to
remove HCl from the gastric parietal cell canaliculi while inpepsa works by forming a
layer of the stomach. Ondancentron given as an anti emetic treatment experienced
patients. Gammaraas (Plasma Immune globulin IV (human) 5%) is indicated to
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decrease the ability of the immune system attack body tissues in some cases disease
autoimmune13.
The next treatment is the administration of CaCO 3 in patients with the hope to
increase the value of low calcium on laboratory examination. Giving Laxadin and lacto
B is indicated to help the state of constipation that may be caused by the side effects of
the use Ondancentron and Inpepsa.
4. Drug Related Problems
Drug Interactions14
a. S ucralfate + lansoprazole
Sucralfat decrease levels of lansoprazole by inhibition of absorption GI
Suggestion: Separate multiple drug use for at least 30 minutes
b. Omeprazole + Warfarin
Omeprazole will reduce of Warfarin levels through the hepatic enzyme CYP1A2
Suggestion: Monitor usage and separate use of at least 2 hours.
c. DRP did not receive the drug
1. On 27 May 2014 Lacto B Patients should drink as much as 3 times a day but
only drink twice a day
2. On 28 May 2014 The patient should drink as much Sangobion caps 3x1 a day
but just taking 1 x 1 a day with record TAO
3. On the 29th May, 2014 (Thursday) the patient should drink only Simarc as
much 1x1tab, but the patient drink 1x2 tab. Whereas the dose of 1x1 tab on
Monday and Thursday
4. On 30 May 2014 Patients with Dyspepsia, doctor prescribed Inpepsa 3x1
tablespoon but just drink as much as 1x 1 a day.
5. On 31 May, 2014 and June 1, 2014 Patients should receive as much
lansoprazole 2x1 amp but just accept 1x1 amp.
6. On June 5, 2014 Patients should receive as much Methycobal 2x1 amp but only
received 1x1 amp whit the records TAO.
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7. On June 5, 2014 patients not taking prescribed Laxadin syr 2x1 tbsp with a
record OTM (os does not drink).
Suggestion: There should be more participation of pharmacists to ensure that
patients taking the drug according to the prescription as well as the role that should
be in addition to preventing potential DRP also solve the actual DRP.
5. Conclusion
Based on the practice of clinical work at the Cikini hospital with Patients Mrs.EM
suffering from GBS disease or APS. There is a record for drugs that interaction with
each other are spaced for 2 hours in the offering. Do strictly monitoring for drug
interaction and identification as well as the signing of the DRP Subscribe by local
pharmacists, especially in terms of the number of occurrences found DRP patients not
receiving the drug.
6. References
1. Muscular Dystropy Canada, 2007. Guillain-Barre Syndrome (GBS), Journal of
Muscular Dystropy Canada: Canada.
2. Inawati, 2013. Guillain-Barre Syndrome (GBS), Faculty of Medicine, University of
Wijaya Kusuma Surabaya.
3. BMJ, 2013. Guillain-Barre syndrome http://www.bmj.com/content/340/bmj.c2541
4. Levine et al, 2002. Antiphospholipid syndrome The. N Engl J Med. Retrieved July
8, 2014 date.
5. Saigal et al, 2010. Antiphospholipid Antibody Syndrome. Vol 58: 1 76-183.
Retrieved July 8, 2014 date.
6. The BMJ Diagnosis and management of the antiphospholipid syndrome in 2010
http://www.bmj.com/content/bmj/340/bmj.c2541/F3.large.jpg .
7. Arifin Augusta, 2011. Guide therapy Diabetes Mellitus Type 2 Current. Faculty of
Medicine, Section of Endocrinology and Metabolism UNPAD: Bandung.
8. American Diabetes Association, 2008. Standards of medical care in diabetes.
Journal of the American Diabetes Association: Diabetes Care S12-54.
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9. Canadian diabetes association 2013 pharmacologic Management of Type 2 Diabetes
http://guidelines.diabetes.ca/Browse/Chapter13
10. MIMS,2014.
Methycobal.
https://www.mims.com/INDONESIA/drug/info/
Methycobal / accessed date July 6, 2014.
11. Effendy, 2009. Antiphospholipid antibody syndrome Hematologic and Management
Aspects. Textbook of Medicine in volume II edisis V. Retrieved July 12, 2014 date.
12. MIMS, 2014b. Provelyn. https://www.mims.com/INDONESIA/drug/info/ Provelyn
/? type = brief . Retrieved date of July 6, 2014.
13. MIMS, 2014c. Gammaraas. http://www.webmd.com/cancer/tc/immune-globulinoverview . Retrieved date of July 6, 2014.
14. Medscape,
2014
d.
Drug
Interaction.
http://reference.medscape.com/drug-
interactionchecker . Retrieved July 9, 2014 date.
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STUDY IN DISEASE WARD CHRONIC RENAL FAILURE AND TYPE II
DIABETES MELLITUS
1
Deviyanti , Diana Laila Ramatillah2, Aprilita rinayanti Eff2
1
Student of Pharmacist Program, Faculty of Pharmacy UTA'45 Jakarta
2
Lecturer of Faculty of Pharmacy UTA’45 Jakarta
Deviyantipalallo@yahoo.com
ABSTRACT
Chronic Renal Failure (CRF) is defined as a renal function abnormality characterized by
the presence of protein in the urine (proteinuria) and kidney function decline for 3 months
or more to progressive renal failure Terminal1. Causes of chronic renal failure is the most
common are diabetes and hypertension1. Patient Mrs. LS, aged 59 year old, entered the PGI
Cikini hospital on May 4, 2014 with a diagnosis of chronic renal failure and diabetes
mellitus type II. Therapy treatment for 9 days amlodipine 5 mg, lapibal 500 mcg, folic acid
1 mg, 30 mg gliquidone, captopril 12.5 mg and 1 g NaCl capsule. Based on the results of
their clinical practice in internal medicine wards in PGI Cikini hospital it can be concluded
that the presence of DRP (Drug Related Problems) form without drugs and indications of
improper drug selection.
Keywords: Chronic Renal Failure, Diabetes Mellitus Type II, Internal Medicine
INTRODUCTION
Chronic kidney disease is a pathophysiological process with diverse etiologies,
which resulted in a progressive decline in renal function, and generally end up with kidney
failure2. Chronic Renal Failure (CRF) is a global health problem with an increase in the
incidence, prevalence and morbidity3. According to data from the United States Renal Data
System (USRDS) 2009 end stage renal failure (GGTA) is common and the prevalence is
about 10-13%3. In the United States the number reached 25 million people, and an
estimated 12.5% in Indonesia or about 18 million people4. In Indonesia, the number of
patients with chronic kidney disease (CKD) increases rapidly with the incidence of endstage renal failure patients (GGTA) undergoing hemodialysis from 2002 to 2006 is 2077,
2039, 2594, 3556, and 43445. Data from several research centers spread throughout
Indonesia reported that the cause of end stage renal failure undergoing dialysis was
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glomerulonephritis (36.4%), kidney disease obstruction and infection (24.4%), diabetic
kidney disease (19.9%), hypertension (9.1 %), other reasons (5.2%)5.
Chronic renal failure is often associated with diabetes or hypertension is a serious
health problem and a public health problem in the world economy6. The number of patients
with chronic renal failure is increasing in the world, about 20-30% of patients with renal
impairment requiring renal replacement therapy6. Diabetes and hypertension are the two
most common causes and is associated with a high risk of death from cardiovascular
disease6.
Report of The United States Renal Date System (USRDS) in 2007 showed an
increase in population of patients with chronic renal failure in the United States compared
to previous years, where the prevalence of chronic renal failure patients reached 1,569
people per million population7. In Indonesia, the number of patients with kidney failure this
time is high, reaching 300,000 people but not all patients can be handled by the medical
personnel, only about 25,000 of those patients who can be treated, it means there is 80% of
patients with treatment untouched at all8. Treatment for patients with end stage chronic
renal failure, dialysis is done with therapy such as hemodialysis or kidney transplant which
aims to maintain the quality of life of patients 9.
CASE PERSENTATION
Patient Mrs. LS aged 59 year old, entered PGI Cikini hospital on May 4, 2014.
Patient was diagnosed with chronic renal failure and diabetes mellitus type II. Patient
present with a limp ± 11 hours before of hospital admission, mild headache, tingling of
fingers and swollen. Results of laboratory tests showed serum creatinine of patient has
increased and Glomerular Filtration Rate (LFG) calculation results in getting results 30.08
ml/min which indicates patient suffering from kidney failure 3 degrees.
CLINICAL EVALUATION
The use of amlodipine and captopril for the treatment of hypertension. Lapibal
(mecobalamin derivative of cyanocobalamin) for the treatment of peripheral neuropathy
and anemia. Folic acid as a therapeutic option to increase hemoglobin with values above
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11.5 g/dL for hemoglobin values between 10 g/dL - 11 g/dL of blood transfusion. The use
gliquidon for therapeutic treatment of type II diabetes mellitus, where as saline for the
treatment of hyponatremia and as therapy for anemia.
DOSAGE AND METHOD ARE USED10.11
In the case of patient treated with amlodipine 5 mg administered 5 mg 1x a day for 9 days,
lapibal 500 mcg given 2 x 500 mcg a day for 9 days, folic acid 5 mg administered 1 x 2
tablets a day for 9 days, 30 mg given 2 gliquidone x 30 mg a day for 9 days, captopril 12.5
mg given 2 x 1 tablet for 9 days and 1 g NaCl capsules given 3 x 1 g for 6 days later on the
7th day lowered the dose to 500 mg given 3 x 500 mg for 3 days.
DIAGNOSIS LABORATORIES VALUE12
Hematological examination results on May 4, 2014 showed adecrease in hemoglobin value
of 10.2 g/dL (12-14 g/dL) which indicated the occurrence of anemia, leukocyte 3.0 10
^3μL (5-10 10 ^3μL) and hematocrit 27% (37-43%) decreased that indicated of infection.
Creatinine value increased at 2.3 mg/dL (0.6 to 1.1 mg/dL) that it showed a decrease in
renal function, blood sodium decreased that indicated the occurrence of hyperkalemia and
blood sugar increated at 245 mg/dL (70 - 150 mg/dL), which indicated the presence of
diabetes mellitus.
DIAGNOSIS OF BLOOD GLUCOSE
Blood glucose test results on May 5, 2014 at three time the examination is at 06.00 pm (260
mg/dL), 11:00 pm (240 mg/dL) and 17:00 pm (234 mg/dL) increased from the normal
value of 70 -150 mg/dL, it indicated the presence of diabetes mellitus.
DRUG RELATED PROBLEM 10.11
1. Untreated Indication
Patient required antibiotic therapy for infection but did not get it. Patient also require
anti-inflammatory therapy for inflammation but did not get it.
2. Improper Drug Selection
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Election gliquidon therapy for type II diabetes mellitus in patient with chronic renal
failure are not recommended by the BNF edition 57, 2009.
CONCLUSION
Based on the results of their clinical practice at internal medicine ward PGI Cikini hospital
then pull in the conclusion that the results of laboratory tests showed serum creatinine value
and outcomes of patient experienced an increase in Glomerular Filtration Rate (GFR)
calculation in getting 30.08 ml/min which indicates that the patient has had the disease 3
degrees of renal failure and the DRP (Drug Related Problem) in the form of indications that
are not addressed and the presence of improper drug selection.
REFERENCES
1. Putu, et al., 2007.Evaluation of Use of ACE Inhibitors in Chronic Renal Failure
Patients at Dr Sardjito.Faculty of Pharmacy, University of Gajah Mada.
2. Suwitra, K. 2009.Chronic Kidney Disease.Interna Publishing.
3. National Kidney Foundation., 2005.K / DOQI Clinical Practice Guidelines for
Cardiovascular Disease in Dialysis Patients.New York.
4. Suhardjono.2009.Chronic Kidney Disease adal h an outbreak of a new (global
epidemic) throughout the world.Indonesian Society of Nephrology Annual Meeting.
5. Prodjosudjadi, dkk.2009.End-Stage Renal Disease in Indonesia.Treatment velopment.
6. Reikes, ST, 2000, Trends in endstage renal disease: epidemiology, morbidity and
mortality.Postgrad Med;108 (1): 124-142.
7. Warlianawati., 2007.Perceptions of Patients Against Nurses Role in Meeting the
Spiritual Needs in Chronic Renal Disease Patients on Hemodialysis Unit at the
hospital.PKU Muhammadiyah Yogyakarta : Patient Characteristics and Quality of Life
Patients Undergoing Chronic Renal Failure Hemodialysis Therapy.Faculty of Nursing
University of North Sumatra.
8. Aguwina, et al., 2012.Patient Characteristics and Quality of Life Patients Undergoing
Chronic Renal Failure Hemodialysis Therapy.Faculty of Nursing University of North
Sumatra.
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9. Brunner & Suddarth., 2002.Textbook of Medical Surgical Nursing.Jakarta: EGC.
10. Burns, A., 2009.R Enal Drug Handbook third edition.UK.
11. BNF., 2009.British National Formulary.BMJ Group.UK.
12. Sutedjo, AY., 2007.Disease Handbook Know Through Laboratory examination
results.Amara Books.Yogyakarta.
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COMBINED DRUG RELATED PROBLEMS IN THE TREATMENT OF
TUBERCULOSIS (TB) AND PLEURAL EFFUSION SINISTRA
Dewi Masyitha1, Diana Laila Ramatillah2, Aprilita Rinayanti Eff2
1
Pharmacist Professional Program Student, Faculty of Pharmacy UTA'45 Jakarta
2
Lecturer Pharmacy in Pharmacy Faculty University of 17 August 1945 Jakarta
(UTA’45 Jakarta)
Email : yusrandewi7@gmail.com
ABSTRACT
Tuberculosis is a common disease and often occurs in internal medicine ward at PGI Cikini
Hospital. Classification of tuberculosis there are 2, namely pulmonary tuberculosis and
pleural effusion paru.7 extract also known as fluid in the chest is a medical condition
characterized by an increase in excess fluid between the two layers pleura8. Case
presentation: RM is a 30-year-old man hospitalized in internal medicine wards. Patients
diagnosed with tuberculosis and the left pleural effusion.Clinical evaluation: basically,
there are two interventions were found during the assessment of the patient's treatment, the
first patient did not receive the drug, and both isoniazid and rifampin as the combination of
anti-tuberculosis drugs that cause an interaction.
Keywords: Tuberculosis, Pleural Effusion, PGI Cikini Hospital
INTRODUCTION
Tuberculosis is a disease caused by the bacteria mycobacterium tuberculosis systemic
so it can be on all the organs of the body with the highest location in the lungs which is
usually the site of infection primer.6
Tuberculosis is an important public health problem in the world. In 1992 the World
Health Organization (WHO) has declared tuberculosis a Global Emergency. WHO report of
2004 states that there are 8.8 million cases with pulmonary tuberculosis showed clinical
symptoms include asymptomatic stage, the typical symptoms of pulmonary TB, then
stagnation and regression, eksaserbase worsening, symptoms recur and become chronic. On
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physical examination can be found among other signs mark infiltrates (dim, bronkhi bases,
bronhial), withdrawal signs of lung and mediastinum, secret canals and bronkhi breath,
breath sounds amforik due kafitas directly related to bronkus.7
Pleural effusion is a medical condition characterized by an increase in excess fluid
between the two layers of the pleura is a sac pleura.10 consisting of two layers covering the
lungs and chest wall, and separates it from the structures disekitarnya.10 There are two types
of pleural effusion: transudative pleural effusions are caused by fluid leaking into the
pleural cavity caused by low protein concentrations or high blood pressure, such as the state
of the left heart failure or cirrhosis of the liver, whereas other forms of exudative pleural
effusions are often the result of inflammation of the pleura, in circumstances such as
pneumonia and tuberculosis that causes the blood vessels become more permeable allowing
fluid to leak out and assembled between two layers pleura.2
CASE PRESENTATION
RM is a 30-year-old man was treated in the wards for internal medicine. Patients
diagnosed with tuberculosis and the left pleural effusion. Patients hospitalized PGI Cikini
dated March 30, 2014. Konsisi current patients is decreased. Patients feel shortness of
breath, coughing, weight decreased dramatically, fever, night sweats one week before
admission. Upon entering the hospital, the patient feels weak, fever, cough increasingly
become heavy, uncomfortable sleeping position.
The results of laboratory examinations of patients before treatment was given on
March 30, 2014 is for hematocrit, MCV, neutrophils rods, lymphocytes, sodium, calcium
and albumin lower than the normal value, while for the erythrocyte sedimentation rate,
erythrocytes, platelets and monocytes is higher than normal.
The results of laboratory examinations of patients after treatment given date May 6,
2014 is as follows, for MCV, neutrophils rods, lymphocytes and albumin value is still
lower than normal, while the erythrocyte sedimentation rate, erythrocytes, platelets, and
monocytes are still higher than normal values.
Based on the examination of the thorax was found: Lung looks right upper pulmonary
infiltrates and left, still looks hide left hemothorax. Ultrasound examination of the thorax:
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Looks effusion fleura pretty much left with a maximum of 6.4 cm into. Conclusion The
results: pulmonary tuberculosis effusion fleura duplex and the left.
As for the therapeutic treatment of patients on April 30, 2014 through to May 9,
2014 is as follows ceftriaxone as antibiotic, OBH as cough syrup, paracetamol as drug
fever, robumin used for albumin deficiency, rifampicin, isoniazid, pyrazinamide,
ethambutol is a combination of drugs for diseases tuberculosis, vitamin B complex, and
Lasix is used for edema.4, 5 Alloy tuberculosis treatment regimen used consisted of main
and auxiliary are as follows: 5
Lini 1
1. Categories 1, anti-tuberculosis drugs:
- Isoniazid
- Rifampicin
- Pyrazinamide
- Ethambutol
Lini 2
Categories 2 :
- Isoniazid
- Rifampisin
- Pirazinamid
- Etambutol
- Streptomisin
For 2 months (intensive phase) every day. Every day for 2 months and then
The next 4 months (continuation phase) with with isoniazid, rifampin, and
Rifampicin and isoniazid 3 times a week.
ethambutol for 5 months 3 times a
week.
2.
Fixed-dose
combination
(fixed
dose
combination).
- Type any additional medication
This fixed dose combination comprising :
(line 2):
- Four antituberculosis drugs in one tablet, namely - Kanamycin
rifampicin 150 mg, isoniazid 75 mg, - Quinolones
pyrazinamide 400 mg and 275 mg ethambutol.
- Other drugs are under
- Three antituberculosis drugs in one tablet,
investigation, macrolides
namely rifampicin 150 mg, isoniazid 75 mg and - Amoxicillin + clavulanic acid
400 mg pyrazinamide.
- Derivatives rifampicin and INH
CLINICAL EVALUATION
3.1 Drug Related Problem 1
Paracetamol is an antipyretic drug that is used as a fever. On May 5, 2014 the patient
complained of body heat or fever, but not given the drug to reduce fever of the patient.
Pharmacist Advice: best use of antipyretic drugs still given by the rules of the use of prn
(prorenata) ie if necessary or if the patient's fever.
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Pharmacist interventions: suggested to patients to get plenty of rest and eat foods that
contain protein, low fat, contains fiber, low-salt diet and the consumption of drinking 2
liters/day.
3.2 Drug Related Problem 2
Isoniazid and rifampin is a combination of 4 types of Anti Tuberculosis Drugs (OAT) is
used to treat tuberculosis early phase of 2 months and 4 months of continuation phase.
Concomitant use of both types of OAT can cause significant interaction, which increases
the toxicity of isoniazid rifampin by increasing metabolism.
Pharmacist Advice: a combination of both types of Anti-Tuberculosis Drugs is still given to
patients for the treatment of the initial phase and continuation phase and avoid the use of
fixed-dose combination drug.
Intervention pharmacists: advise the patient to use the distance separating the two AntiTuberculosis drugs, to use rifampin sebaikknya morning and to isoniazid is used at night.
CONCLUSION
On May 5, 2014 the patient complained of body heat or fever, but not given the drug
to reduce fever of these patients, the use of antipyretic drugs should still be given to the
rules of use 3x daily or prn (prorenata) if the patient is febrile. Isoniazid and rifampin is anti
tuberculosis drugs as initial treatment phase and follow-up phase, because concurrent use of
isoniazid with rifampicin can cause significant interaction, the user should be given the
distance, which is used for rifampin and isoniazid morning used at night and avoid the use
of drug-dose combinations fixed. In patients advised to get plenty of rest and eat foods that
contain protein, low fat, contains fiber, low-salt diet and drink consumption 2 liters/day.
REFERENCES
1.
Baxter, K. (ed). 2008. “Stockley’s Drug Interaction”. Eight Edition. Pharmaceutical
Press, London and Chicago
2.
Bramardianto, 2014. “Penyebab, gejala dan pengobatan efusi pleura”. Jakarta
3.
Guyton & Hall. 2007. “Buku Ajar Fisiologi Kedokteran”. Edisi 11.Jakarta : EGC.
4.
Joint formulary comite, 2009 “Brithist National Formulary” BMJ Grop. London.
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
5.
Konsensus TB Paru. 2013. “Pedoman Diagnosis dan penatalaksanaan TB di
Indonesia”. ISFI. Jakarta
6.
Mansjoer, A. 2000. “Kapita selekta kedokteran”. Edisi II. Jakarta : Media Aesculapius,
FKUI.
7.
Perhimpunan dokter paru indonesia, 2014. “Klasifikasi Tuberkulosis”. Jakarta
8.
Pudjo, Astowo. 2014. “perspective medical conditions disease efusi fleura. Jakarta
9.
Smeltzer, S.C & Bare,B.G.2003. “Buku Ajar Keperawatan Medikal Bedah” Brunner
& Suddart. Edisi 8. Jakarta: EGC.
10. Tjokronegoro,A & Utama, H.2004. “Rencana Asuhan Keperawatan”. Edisi III. Jakarta
: EGC.
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DRUG RELATED PROBLEMS IN TREATMENT HEMODIALYSIS
ON CHRONIC RENAL FAILURE
Esther Jeniaty1, Diana Laila Ramatillah2, Aprilita Rinayanti Eff2
1
Pharmacist Professional Program Student, Faculty of Pharmacy UTA'45 Jakarta
Lecturer Pharmacy in Pharmacy Faculty University of 17 August 1945 Jakarta
(UTA’45 Jakarta)
2
Email : oktavianafarmasi@yahoo.co.id
ABSTRACT
Chronic renal failure is one disease that is common and often occurs in medicine
ward in PGI Cikini Hospital. Chronic Renal Failure consists of 5 stages, ie stage 1,stage
2,stage 3,stage 4and stage 5. Percentage of cases: Tn. EH is a 46-year-old man hospitalized
in internal medicine wards. Patients diagnosed with Chronic Renal Failure Stage V and
hypertension urgency. Clinical evaluation: Basically, there are two interventions were
found during the assessment of treatment the patient is the first use of a combination of 5
different Valsartan Antihypertensive, Captropil, bisoprolol and amlodipine and the second
is the interaction between calcium carbonate and bisoprolol causes a decrease in the effect
of bisoprolol.
Keywords: Chronic Renal Failure, antihypertensive, PGI Cikini
INTRODUCTION
Chronic kidney disease (CKD) is the inability of the kidneys to maintain the body's
balance and integrity appear gradually before dropping to phase decline stage renal final3.
Chronic kidney disease is a problem in the field of nephrology with a fairly high
incidence, etiology broad and complex, often with no complaints or clinical symptoms but
had entered the terminal stage and referred to as kidney disease terminal3.
Chronic renal failure occurs after kidney or channel experience a variety of diseases that
damage the kidney nephrons. Where the disease is more common in the renal parenchyma,
nevertheless abstraction lesions in the urinary tract can also cause chronic renal failure can
be divided into several 3.
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CASE PRESENTATION
EH is a 46-year-old man hospitalized in internal medicine wards. Patients diagnosed
with chronic kidney disease. Patients hospitalized PGI Cikini 13th June 2014, with past
history of CKD On Hd, Hypertension, and Heart. The patient's condition on admission
decreased, where patients feel weak for 30 minutes while the patient is on hemodialysis and
hemodialysis patients in the stop asking. Hemodialysis performed salama 1 hour 30
minutes. The patient feels tightness, heaviness in the chest radiating to the neck or left arm
when hemodialysis. Patient's blood pressure had risen so Captropil patients given 25 mg,
0.15 mg clonidine, but when taking Captropil, patients experience headache, dry cough. At
the time of entering the ED patients had productive cough with blood, and the patient
experienced severe chest tightness. Laboratory findings were as follows: for the erythrocyte
sedimentation rate, reticulocyte and creatinine higher than normal values, whereas
hemoglobin, leukocytes and erythrocytes is lower than normal values.
The results of examination of the blood pressure on admission was 220 mm Hg
systolic blood pressure and diastolic blood pressure 120 mm Hg indicates that the patient
had hypertension hypertensive urgency is without damage or complications minimum and
target organs. Blood pressure was lowered within 24 hours to the extent of requiring
parenteral therapy. Initial target blood pressure 160/110 mmHg within hours or days with
conventional oral therapy.
The treatment given for patients treated in the hospital is as follows: amlodipine
10mg once daily, 0.15 mg clonidine 3 times, three times a day Captropil 25mg, folic acid a
day 2 tablets, 3 times a day CaCO3 500mg, 1 tablet a day 5000mcg neorobion ,
omeperazole 1 capsule 3 times daily, valsartan 10 mg 2 times a day and 1 tablet daily
bisoprolol.
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Guidelines on the Treatment of Chronic Renal Failure patients Hipertensi5.
Management of Hypertension in CRF handling without diabetes is
recommended in adult patients with CRF and without Diabetes Urine albumin
excretion ≤ 30 mg / 24 hours (or satara) blood pressure ≥ 140 mmHg constant
systolic / diastolic ≥ 90 mmHg treated with blood pressure lowering drugs to
maintain blood pressure ≤ 140 mmHg constant ≤ 90 mm Hg systole and
diastole.
It is recommended that non-diabetic adult patients with CRF and urinary
albumin excretion 30-300 / 24 hours (or equivalent) that constantly blood
pressure> 130 mmHg systolic or> 80 mmHg diastolic were treated with drugs
to maintain blood pressure ≤ 130 mmHg constant systole or ≤ 80 mm Hg
diastolic.
Suggested non-diabetic adult patients with CRF and urine excretion> 300 mg
per 24 hours (or equivalent) is constant blood pressure> 130 mmHg systolic or>
80 mmHg diastolic were treated with blood pressure lowering drugs to maintain
blood pressure to maintain blood pressure konstn ≤ ≤ 130 mmHg systolic and
80 mmHg diastolic
It is recommended to use an ARB or ACE inhibitor in non-diabetic adult
patients with CRF and excretion of urine albumin 30-300 mg / 24 hours (or
equivalent) in the treatment with blood pressure lowering drugs.
Recommended that the use of ARBs or ACE inhibitors in non-diabetic adult
patients with CRF and urine albumin excretion ≥ 300mg/24 hours
(or
equivalent) who were treated with blood pressure medications.
.
CLINICAL EVALUATION
Drug Related Problems (DRPs)
1. Drug selection
5 The use of combinations of antihypertensive drugs: amlodipine, Captropil,
bisoprolol,valsartan and clonidine4.
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Pharmacist
Advice:
Avoid
concurrent
use
of
Ace-inhibitors
and
ARBs.
Intervention pharmacists: first choice hypertension and CRF is Ace-I, if the patient is
unable to tolerate, then another alternative is ARB4.
2. Drug Interactions
a) Bisoprolol and calsium carbonat
Significant interaction occurred between kalcium carbonate and calcium carbonate
bisoprolol which lowers the effect or efficacy of bisoprolol by inhibiting the
absorption of GI7.
Pharmacist advice: separate the two drugs with a distance of 2 hours
3 drug related problems7.
b) Bisoprolol and clonidin
Cardioselektiv use of beta blockers and centrally acting alpha agonists may lead to
rebound
hypertension
and
there
is
potential
for
interaksi1.
Pharmacist advice: To avoid interaction and rebound hypertension need to be
monitoring the use of both drugs1.
3. Dose regimen
Valsartan dose used by patients Tn.E H 80 mg twice daily for treating hypertension, but
the dose is not in accordance with the guidelines, treatment of hypertension and CKD
the dose should be lowered to 40 mg once a daily8.
Recommendation : doctors should be submitted to the lowered dose of valsartan.
CONCLUSION
After the assessment of the patient's treatment, it can be concluded that there are
five kinds of antihypertensive drugs with their respective functions that have been in use
from the group of patients that is Captropil Ace Inhibitor, Valsartan is an ARB class of
antihypertensive, beta-blocker bisoprolol of classes, class mlodipin is antihipertesi calcium
blockers chanal and the antihypertensive clonidine group of central α-2 agonists. The safest
hypertension medication for kidney patients is if ACEI not tolerated by the patient replaced
with ARB.4 Interaction between calcium carbonate and bisoprolol so in its use must be in
jailed 2 hours. The use of bisoprolol and clonidine can cause rebound hypertension while
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
the sudden cessation of clonidine can cause rebound hipertensi1.Valsartan as
antihypertensive drugs, the dose should be given 80 mg twice daily lowered to 40 mg in
patients with Chronic Kidney Disease (CKD) on hemodialysis8.
REFERENCES
1. Baxter, K. 2008. Stockley's Drug Interaction Eight Edition. London
2. Joint Formulary Commite. 2009. British National Formulary. London
3. Saputra Ahmad. 2012. Gagal Ginjal Kronik. Jakarta
4. Badan Pom RI. 2008. Informatorium Obat Nasional Indonesia. Jakarta
5. K/DOQI. 2004. Clinical Practice Guadline on Hipertension and Antihypertensive Agent
in Chronic Kidney disease. Am J Kidney Dis. MA,USE.
6. 2003 World Health Organization (WHO) / International Society of Hypertension
Statement on Management of Hypertension. J Hypertens 2003;21:1983-1992.
7. Medscape. Drug Interactions. 2014
8. Caroline Ashley and Aileen Currie. 2009. The Renal Drug Handbook Third Edition.
Radcliffe Publishing Ltd 18 Marcham Road, Abingdon, Oxon OX14 1AA. United
Kingdom
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RELATED DRUG PROBLEM IN THE TREATMENT OF VERTIGO DISEASE
AND HYPERTENSION IN PGI CIKINI HOSPITAL
Fitriani1, Diana Laila Ramatillah2, Aprilita Rinayanti Eff2
1
Pharmacist Professional Program Student, Faculty of Pharmacy UTA'45 Jakarta
Lecturer Pharmacy in Pharmacy Faculty University of 17 August 1945 Jakarta
(UTA’45 Jakarta)
2
Email : fitriani_08_91@yahoo.com
Abstract
Vertigo is any movement or sense of movement of the patient's body or objects around the
patient is concerned with balance system disorders (equilibrium)5. One factor is
hypertension systemic causes of vertigo2.
Patient Ms. YT is a female patient aged 53 years old was hospitalized at PGI Cikini on
April 29, 2014, the patient was diagnosed with vertigo and hypertension. Therapy treatment
for 8 days ie RL 20 TPM, Ranitidine 2x1, 2x1 g Ceftriaxone, Ondancetron 3x1, 3x1
Antacids, Valsartan 1x1, 3x1 Ibuprofen, Betahistin M 2x1, 3x1 Dramamin, Decolax 2x1,
3x1 Myonal. Based on the results of their clinical practice in internal medicine wards in
hospitals PGI Cikini it can be concluded that the presence of DRP (Drug Related Problem)
a drug interaction.
Keywords: Vertigo, Hypertension, RS PGI Cikini
1. Introduction
Vertigo is the sensation of movement or sense of motion of the body such as rotation
(twisting) without an actual sensation of rotation, can spin around or body that rotates
complaints most often encountered in practice8. Vertigo comes from the Latin "vertere"
ie turning 8. Vertigo included in balance disorders
manifested
as
headache,
dizziness, staggering, a sense of the world such as flying or somersaulting 8,5. Vertigo is
not a disease, but a symptom In short it can be said that the orientation space (spatial
orientation) we depend on three things, namely7:
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1. Input stronger sensation (sensation adequate input) through three of our five senses
are: sight, taste balance of the body, and sensibility.
2. Integration in the center (central integration)
3. Responses suitable motor (the motor proper response)
If the information received through the eyes does not match the information from the
labyrinth, then there will be Factors causing vertigo7.vertigo is caused by central
disorders associated with central nervous system disorders (serebrim cerebellar
cortex, brain stem or related to the vestibular system / otologik, in addition to the
factor of psychological / psychiatric and systemic factors such as aritmi heart,
hypertension, hypotension, congestive heart failure, anemia, hypoglycemia 2,6.
2. Case Presentation
Patient Ms. YT is a 53-year-old admitted to the ward's disease internist PGI Cikini
Hospital, was diagnosed with vertigo and hypertension, patient admitted to hospital
since April 29, 2014 Patient with complaints of fever since two weeks before entering
the hospital with chills, dizziness, nausea, and abdominal pain.
Results of laboratory tests on the patient April 29, 2014 were:
examination
glucose during
leukocytes *
LED
hemoglobin *
hematocrit *
erythrocytes
platelets
urea
creatinine *
total cholesterol
AST *
SGPT
sodium
calcium
chloride
HDL Cholesterol
LDL Cholesterol
Results
122
12,600
2
11,5
34
3,91
234
22
12
170
35
29
144
4,5
103
65
98
Reference value
< 200 mg%
5,000-10,000/uL
0-15 mm/hour
12-16 a/dL
38-46%
3,6-5,2 million/mm3
150-400 thousand/mm3
17-43 mg/dl
0,6-1 mg/dl
<200 mg/dl
<31u/L
<31u/L
134-146 mmol/l
3,4-4,5 mmol/l
96-108 mmol/l
>65 mg/dl
<150 mg/dl
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The results of examination of the patient's vital signs on 29 April- May 6, 2014 is :
Examination
/ date
Blood
tension
pulse
breathe
29/04
30/04
01/05
02/05
03/05
04/05
05/05
06/05
160/8
0
80
20
130/8
0
80
20
120/8
0
80
20
130/8
0
80
20
150/8
0
80
20
130/9
0
80
20
130/9
0
80
20
130/9
0
80
20
3. Dosage
In this case the patient on therapy with intravenous fluids: RL 20 TPM for 5 days
(April 29,-May 3, 2014). Drug injection: Ranitidine (Ranitidine HCl) 2x1 25 mg for 4
days (April 29,-May 2, 2014), Ceftriaxone (Ceftriaxone disodium) 2x1g for 4 days
(April 29,-May 2, 2014), Ondancetron (ondancetronHCl) 0.1 3x1 -0.2 mg / kg for 5
days (April 29,-May 3, 2014). Oral medications: Antacids (Aluminum Hydroxide,
Magnesium Hydroxide) 3x1 1-2 g for 8 days (April 29,-May 6, 2014), 1x80 mg
valsartan for 8 days (April 29,-May 6, 2014), 3x1 Ibuprofen 200 mg for 2 days (April
29 to 30), Betahistin M (betahistinemesylat) 2x1 24-48 mg / day for 7 days (April 30May 6, 2014), Dramamin (Dimrnhydrinate) 3x1 50mg for 5 days (02-06 May 2014),
Decolax (Bisacodyl) 2x1 5 mg for 2 days (05-06 May 2014), Myonal (EperisoneHCl)
50mg 3x1 (05-06 May 2014).
4.
Clinical Evaluation 3.4
The use of Ringer lactate infusions to restore electrolyte balance, Ranitidine
(Ranitidine HCl) for antiulkus, Ceftriaxone (Ceftriaxone disodium) to treat respiratory
tract, Ondancetron (OndansetronHCl) for nausea and vomiting, Antacids (Aluminum
Hydroxide, Magnesium Hydroxide) to treat ulcers or interference acid digestion,
Valsartan for Hypertension, Ibuprofen for pain, Betahistinmesylat for treating vertigo,
dizziness, balance disorders in blood circulation. Dramamin (dimenhydrinate) to treat
vertigo, nausea or vomiting. Decolax (Bisacodyl) to overcome constipation. Myonal
(EperisoneHCl) for the symptomatic treatment of musculoskeletal spasm.
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5.
Drug Related Problem1
Of some drugs given drug-drug interaction, namely:
a. Antacids + Ranitidine
Effect: Antacids decrease the bioavailability of ranitidine, have to be careful with this
interaction because both drugs are often used together in the treatment of ulcers.
Recommendation: to prevent interactions using both drugs at intervals of ± 2 hours.
b. Antacids + Ceftriaxone
Effect: lowers the effectiveness of ceftriaxone Antasi
Recommendation: to prevent interactions using both drugs at intervals of ± 2 hours.
6.
Conclusion
Based on the results of clinician practice in internal medicine wards in the hospital in
patient PGI Cikini then the conclusion that the presence of DRP (Drug Related
Problem) in the form of the presence of several drug interactions that occured were
Antacids + Ranitidine and Antacids + Ceftriaxone.
7.
Bibliography
1. Baxter, 2008. K. Stockley’sDrug Interaction Eight Edition. London.
2.
Bashiruddin J. Vertigo Posisi Paroksismal Jinak. Dalam : Arsyad E, Iskandar
3.
N, Editor. Telinga, Hidung Tenggorok Kepala & Leher. 2008. Edisi Keenam.
Jakarta : Balai Penerbit FKUI.
4.
BPOM RI, 2008.“IONI”. SagungSeto Jakarta
5.
ISFI, 2009.“ISO Indonesia Vol. 44”. BerlicoMuliaFarma. Yogyakarta
6.
Joesoef Aboe Amar. 2000. Vertigo. In : Harsono, editor. Kapita Selekta Neurologi.
Yogyakarta: Gadjah Mada University Press
7.
Li JC & Epley J. Benign Paroxysmal Positional Vertigo. [online] 2009 [cited
20th]. Available from: http:// emedicine.medscape.com/article/884261-overview.
8.
Poerwad,
TroboesdanHerjantoPoernomo.
1994.:VertigodalamNeurologiKlinik.
Surabaya: FK UNAIR/RSUD Dr. Soetomo.
9.
Wreksoatmojo BR. Vertigo-Aspek Neurologi. [online] 2009 [cited 2009 May
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DRUG RELATED PROBLEM TREATMENT OF FEMORAL NECK FRACTURES
IN MINTOHARJO HOSPITAL
1
Fitriany JR , Diana Laila Ramatillah2, Aprilita Rinayanti Eff2
1
Pharmacist Professional Program Student, Faculty of Pharmacy UTA'45 Jakarta
Lecturer Pharmacy in Pharmacy Faculty University of 17 August 1945 Jakarta
(UTA’45 Jakarta)
2
Email : ranhiejr@gmail.com
ABSTRACT
A fracture is a break or continuity of bone and cartilage which is generally caused by
trauma, either directly or indirectly. Femoral neck fractures are intracapsular fracture that
occurs in the proximal femur including the femoral collum is starting from the distal
surface of the femoral head to the proximal part of the intertrokanter. 3 femoral neck
fractures often occur at the age of 60 years and more frequently in women, it This is caused
by a combination of bone loss due to aging processes and post-menopausal osteoporosis
which often can also be seen when the shortening of the left leg compared with the right,
the distance between the greater trochanter and the anterior superior iliac spine is shorter
because the trochanter is higher due to a cranial shift of the leg. 5 Patients Mr.. TS, aged 49
years, entered to hospital PGI Cikini on June 10, 2014 with a diagnosis of Femur Fractures
Collum. Therapy treatment for the treated ceftriaxone inj, remopain injection, ranitidine
injection, ketorolac injection, injection propranolol, amlodipine tab, Celexa, tabs, tab
ultracet, cal 95 tabs, tab oscal, alovell tab, novalgin inj, Rantin tab. Based on the results of
their clinical practice on general care in hospitals PGI Cikini it can be concluded that the
presence of DRP's (Drug Related Problem s) in the form of improper drug selection, the
indication is not handled as well as failed to receive the drug ranitidine inj, Rantin tab,
ultracet tab.
Keywords: Collum Fracture Femur, Internal Medicine and PGI Cikini Hospital.
INTRODUCTION
Femoral neck fractures are injuries that are often found in older patients and lead to
increased morbidity and mortality with health status and life expectancy, the incidence of
these fractures also increased. This fracture is a major cause of morbidity in older patients
due to immobile patient in bed. Rehabilitation takes for some months, causing
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immobilization of patients prefer to lie so susceptible to decubitus ulcers and lung
infections. Initial fracture mortality rate is about 10%. When untreated, these fractures
would worsen. 1 Magnetic ResonanceImaging (MRI) has been proven accurate in the
assessment of fracture and if made within 24 hours of injury, but this examination is
expensive. With MRI, fractures usually appear as a fracture line in the cortex surrounded by
a zone of intense edema in the medullary cavity. In a study by Quinn and McCarthy,
findings on MRI 100% sensitive, specific and accurate in identifying femoral neck fractures
4. Most fractures are caused by a sudden force and excessive, which can be a clash, beating,
crushing, bending or falling on his side, twisting or withdrawal when exposed to direct
force on a broken bone can be affected, it is definitely damaged soft tissue 2.
CASE STUDY
Patient Tn.TS, age 49 years was entered to hospital June 10 2014 PGI Cikini
Patients present with complaints of pain in the left groin, after the fall because of a slip and
fall while walking in the sitting position, the more painful when moved. A history of head
injury (-), fainting (-). The general condition of the patient at the time of hospital admission
was looked ill with a blood pressure of 160/108 mmHg, Nadi92 times / min, temperature 38
° C awareness CM. The patient had a history of hypertension.
CLINICAL EVALUATION
Therapy in the management of femoral neck fractures Tn.TS to suffer. Ceftriaxon
given to treat bacterial infections of gram-positive and gram-negative. Remopain
(ketorolac) is used for short-term treatment for post-surgical pain is moderate to severe and
Propranolol for hypertension as well as with Amlodipine for hypertension, angina
prophylaxis. Celexa (levofloxacin) for infection due to microorganisms Ultracet for shortterm therapy for moderate to severe acute pain. Oscal (alfacalcidol) is used for the
improvement of some symptoms (bone pain, bone lesions) while Alovell (Aledronat
sodium) for the treatment of osteoporosis confirmed the findings with low bone mass or by
the presence or history of osteoporotic fracture. Cal 95 is used for the treatment of
osteoporosis due to various reasons. Ranitidine is used for other conditions where gastric
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acid reduction will be beneficial and Novalgin (Metamizole Sodium) for pain relief after
surgery.
DOSAGE AND DIRECTION
Dosage and how to use the drug in these patients on 13th June 2014 Ceftriaxon 2x1
grams used in injection with usual doses in severe infections 2-4 g / day. on the 13th of
June 2014 Remopain (ketorolac) is given 2x1 amp and on 14 June 2014 increased the dose
to 3x1 amp with standard dosing: initial dose, 10 mg, then 10-30 mg every 4-6 hours when
required. On 10 June 2014 given Ranitidine injection ampoules 1x1 failed to receive the
drug one time and date of 11-16 June 2014 2x1 ampoules Ranitidine injection is given at a
dose of common IM / Slow IV injection: 50 mg every 6-8 hours IV infusion: 25 mg / h for
2 hours, 6-8 hours, or for the prophylaxis of stress ulceration 125-250 mcg / kg / h. On 12
June 2014 granted 1x1 Ketorolac injection ampoules with standard dosing: Awal10 mg
dose, then 10-30 mg every 4-6 hours when required. On 11 June 2014 Propranolol was
given at a dose of 1x10 mg prevalent: the initial oral dose of 80 mg, 2 times daily. On 1119 June 2014 1 x Amlodipine 5 mg given with standard dosing: initial dose of 5 mg once
daily; a maximum of 10 mg once daily. On June 14-19, 2014 Celexa (levofloxacin) tablets
given 1 x 500 mg with standard dosing: oral, 250 mg-500 mg once daily for 7-14 days,
depending on the severity of the 14-17 June 2014 penyakit.pada given Ultracet 3 x1 tablet
and on December 13,18 and 19, failed to receive a one-time drug with standard dosing: 1-2
pain relief tablets every 4-6 hours up to 8 tablets a day, patients with creatinine clearance
<30 m / min ≤ 2 tablets every 12 hours . On 13-19 June 2014 awarded Cal 95 1 x 1 tablet
with a usual dose: 1-3 / tabs / day. On May 13-19 given Oscal (alfacalcidol) 1 x1 tablet
with the usual adult dose initially dose of 250 nanograms per day or 2 days, the usual dose
of 0.5-1 mcg per day. On 13 Alovell (Alendronate sodium) is given 1 x 1 tablet with a
usual dose of 10 mg once daily. On 13 given Novalgin (Metamizole sodium) intravenously
at a dose of 1cc usual 500 mg / ml. On 17 and 19 June 2014 given Rantin 2 x 1 tablet while
on the 18th June 2014 failed to receive the drug once.
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CLINICAL LABORATORY EXAMINATION RESULTS
In the laboratory test results dated 10 June 2014 entered patients obtained some
abnormal results include an increase in leukocytes 13,900 mm 3 with a normal value of 510 thousand mm 3, an increase in APTT of 38.4 seconds with a normal value of 26.4 to
37.5 seconds, a decrease in potassium 3.0 mEq / L with a normal value of 3.5-5.0 mEq / L,
and decreased calcium 8.2 mg / dl with normal values of 70-150 mg / dl 4.
DRUG RELATED PROBLEMS (DRP's)
1.
Improper drug selection 7
Of laboratory examination of patients found that higher patient APTT should get antipain patients who are not at risk of bleeding
2.
The indication is not handled 7
Judging from the value of potassium patients were dropped but the patient does not get
the drugs that may increase potassium.
3.
Failed to receive medication
On 14-17 June 2014 given 3 x1 Ultracet tablets and on December 13,18 and 19, failed
to receive the drug once, On 17 and 19 June 2014 given Rantin 2 x 1 tablet while on the
18th June 2014 failed to receive a one-time drug , and dated June 11-16 2014 2x1
ampulsedangkan Ranitidine injection is given on 10 June 2014 was given Ranitidine
injection ampoules 1x1 failed to receive the drug once.
4. Human Error
In the book list is sometimes nurses did not record drug medication that is administered
to the patient. So it is advisable to nurses to always take note of what has been given to
the patient. Do monitoring nurse notes on the book list of drugs.
CONCLUSION
Based on the results of their clinical practice in the treatment of pulmonary PGI
Cikini hospital, it can be concluded that the presence of DRP (Drug Related Problem) The
selection of a drug that is not appropriate because of the patient's laboratory tests found that
higher patient APTT should get anti-pain patients who are not at risk of bleeding,
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
indications of untreated patients seen from potassium values are down, but the patient does
not get the drugs that can increase potassium, failed to receive the drug ranitidine inj,
Rantin ultracet tabs and tab.
REFERENCES
1. Rosenthal RE. Fracture and Dislocation of the Lower Extremity. In: Early Care of the
Injured Patient, ed IV. Toronto, Philadelphia: BC Decker, 2006.
2. Grace PA, Borley NR. Ataglance surgery. 3rd edition New York: McGraw; 2006.p.85
3. Kailis SG, Jellet LB, Chisnal W, Hancox DA. A rational approac h to the interpretati on
blood and urine of pathology tests. Aust J Pharm 1980 (April): 221-30.
4. Rasad, S. Diagnostic Radiology. 2nd edition of Jakarta, Faculty of Medicine Hall
Publishers; 2006.p.31
5. Snell RS. Clinical anatomy for medical students 6th edition Jakarta: EGC; 2004
6. Teaching staff of the Faculty of Medicine Jakarta surgery. Set of lecture surgery.
Jakarta: Center School of Medicine Publisher; 2004.p.484-7.
7. SM.BOH Stein "s Pharmacy practice manual: a guide to the clinical experience. 3rd ed.
2010 Lippincott Williams and Wilkins.
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PHYSIOTHERAPY STUDY ISCHIALGIA
Fitriani1, Diana Laila Ramatillah2, Aprilita Rinayanti Eff2
1
Pharmacist Professional Program Student, Faculty of Pharmacy UTA'45 Jakarta
Lecturer Pharmacy in Pharmacy Faculty University of 17 August 1945 Jakarta
(UTA’45 Jakarta)
2
Email : fitriani_08_91@yahoo.com
ABSTRACT
Ischialgia is a type of pain that is caused by the excitation of nervus ischiadicus1. Medical
dictionary defines ischias as thigh sores or pain in thigh area (nervus ischiadicus)2. The
patient, Ms. SL, age 32, came to RSAL Dr. Mintoharjo on June 9, 2014 with an ischialgia
diagnosis. Therapy for 8 days treatment is IVFD RL 500 ml, ketorolac injection of 3 x 1
ampoules, Dexamethasone injection 3 x 5 mg, Mefenamic Acid 3 x 500 mg, Diazepam 3 x
2 mg. Based on the results of the clinical practice in physiotherapy ward at RSAL
Dr.Mintohardjo, it can be concluded that there is DRPs (Drug Related Problems) such as
drug interactions and conditions that need to be considered.
Keywords: Ischialgia, RSAL Mintohardjo.
INTRODUCTION
Ischialgia is a pain which originates in the thigh lumbosacral area spreading to the
buttock and then to the posterolateral upper limb, the lateral lower leg, as well as the
lateral foot3. Nervus ischiadicus is located between the musculus piriformis and musculus
obturator internus4. For a person who’s actively running, joint that gets a lot of burden is
the hip joint, thus the bloodstream is concentrated in the area4. The bloodstream is
increased to provide oxygen therefore energy production can run smoothly, however the
bloodstream indeed causes swollen4. Swelling is also caused by a buildup of metabolic
waste results (myogelosis)4. Because of musculus piriformis and musculus obturatoris
internus are swollen, as a result nervus ischiadicus will be strangulated4.
Typical complaint is cramping or pain in the buttock or in the area of hamstring
muscles, ischialgia pain in the legs without back pain, and impaired sensory and motor
nerve that suits Nervus ischiadicus distribution5. Patients’ complaint can also be a pain that
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
is getting severe pain when bows, sitting for too long, getting up from sitting, or when
internally rotate the thigh, also pain during micturition / defecation and dyspareunia5. This
occurs because some disease processes such as physical trauma, electrical, infections,
metabolic problems, and autoimun5. Ischialgia increases in frequency of doing so many
activities5.
There are several factors that lead this nerve strangulated, which include:
contraction / inflammation of the muscles in buttocks area, there is calcification of the spine
or circumstances referred to hernia nucleus pulposus (HNP)5. To know the main reason,
physical examination needs to do carefully by a doctor, or additional screening radiology /
X-ray of the spine if necessary5.
CASE PRESENTATION
The patient, Ms. SL, age 32, came to RSAL Dr.Mintohardjo on June 9th 2014. The patient
had pain complaint in the left groin since 3 days ago. Persistent pain and sometimes the
pain spread to waists. The patient also feels nausea without vomiting. The previous 2
months ago, the patient slipped with sitting position. The patient has dyspepsia past history.
The result of laboratory tests showed abnormalities, hematocrit 35% (normal value: 3742%), leukocytes 10,500 / µL (normal value: 5,000-10,000 / µL), LED 45 mm / hours
(normal value: < 20 mm / hour), HDL cholesterol 38 mg / dL (normal value: > 40 mg / dL),
Neutrophils stem 1% (normal value: 2-6%), neutrophils segment 81% (normal value: 5070%), lymphocytes 10% (normal value : 20-40%).
TREATMENT MANAGEMENT ISCHIALGIA6
1.
Drugs: analgesics, NSAIDs, muscle relaxant.
2.
Medical Rehabilitation Program
a. Physical therapy: Diathermy, Electrotherapy, lumbar traction, manipulation
therapy, Exercise.
b. Occupational Therapy: Teaching proper body mechanics.
c. Prosthetic orthotic: Giving lumbar corsets, a walker.
d. Advice:
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.

Avoid much bowing.

Avoid lifting of heavy goods frequently.

Take a break if get a pain when standing or walking.

When sitting for a long time, try to rotate feet alternately right and left, or use a
small seat for both of leg lean on.

When sweeping or mopping floors, use a handle broom or long mop therefore
the back does not bend.

If you want to take things on the floor, keep your back straight, but bend your
knees to reach the goods.

Do back exercising regularly, to strength back muscles thus can sustain the
spine nicely and optimally.
3.
Operation: perform in serious case / when it very disturbs the activities, where the
drugs and medical rehabilitation program do not help.
EVALUATION CLINIC7
The use of RL infusion aims to restore the balance of body fluids. Ketorolac
injection is used for short-term treatment for severe pain, Dexamethasone injection for antiinflammatory, Mefenamic Acid to cope with left groin pain that has experienced before by
the patient, diazepam to relax the muscles and to make the patient relax.
DOSAGE AND HOW TO USE7
In this case the patient is treated with 500 ml RL for 8 days, ketorolac injection is
given 3 x 1 amp for 8 days, Dexamethasone injection is given 3 x 5 mg for 8 days,
Mefenamic Acid is given 3 x 500 mg after meals for 8 days, and Diazepam is given 3 x 2
mg for 8 days.
THE RESULT OF LABORATORY TEST8
The result of laboratory test showed a decrease in hematocrit value of 35% (normal
value: 37-42%) indicates the occurrence of anemia, reduction in lymphocytes of 10%
(normal value: 20-40%) indicates the occurrence of anemia, reduction in HDL cholesterol
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
38 mg / dL (normal value: > 40 mg / dL), reduction in neutrophils stem 1% (normal value:
2-6%), the value of leukocytes is increased 10,500 / µL (normal value: 5,000-10,000 / µL),
the value of LED is increased 45 mm / hour (normal value: < 20 mm / h), and neutrophils
segment is also increased 81% (normal value: 50-70%) that indicates there is an infection /
inflammation.
DRUG RELATED PROBLEM8,9
1.
Drug Interaction9
The patient is given ketorolac injection and mefenamic acid. The two of these can
lead ulcer irritation, and there is an interaction pharmacodynamicly (synergism)
where the ketorolac injection increases the effect of mefenamic acid, therefore the
proton pump inhibitor is recommended to be given which the purpose is to overcome
ulcer irritation and nausea that patient is suffered.
2.
The condition that needs to be considered8
Conditions that need to be considered in this patient where patient gets reduction in
hematocrit and lymphocyte values that indicates the occurrence of anemia, hence it
should be given vitamin blood booster to improve the patient's health.
CONCLUSION
Based on the results of the clinical practice in physiotherapy ward in RSAL
Dr.Mintohardjo, it can be concluded that there is DRPs (Drug Related Problems) in form of
a drug interaction, that requires the patient to get other drugs such as proton pump inhibitor
drugs to reduce stomach irritation that caused by the interaction of the two drugs (ketorolac
injection and mefenamic acid) and later that needs to get attention is the patient's condition
which is anemia that should get the blood booster drug therapy.
REFERENCES
1. Markam, Soemarmo. Neurologi, Jakarta: PT. EGC, 1982.
2. Kamali, A. Kamus Kedokteran, Jakarta: PT. Dian Rakyat, 1983.
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
3. Mardjono M., and Sidharta P. Neurologi Klinis Dasar, Jakarta: PT. Dian Rakyat. 1978.
4. Sabotta. Atlas Anatomi Manusia Bagian 2, Jakarta. 1985.
5. Minaryanti, RN. Karya Tulis Ilmihah Penatalaksanaan Fisioterapi Pada Ischialgia
Dengan Short Wave Diathermy Dan Terapi Latihan Di RSUD Sreagen. Surakarta:
Universitas Muhammadiyah Surakarta. 2009.
6. Anggriani, W. Penatalaksanaan Fisioterapi Pada Ischialgia Dekstra di RS Dr Ramelan
Surabaya. Surakarta: Universitas Muhammadiyah Surakarta. 2010.
7. Agency for Food and Drug Administration. Information Obat Nasional Indonesia
(IONI). Jakarta: Sagung Seto. 2008.
8. Ministry of Health Indonesia. Pedoman Interpretasi Data Klinik, Jakarta. 2011.
9. Medscape. Drug Interaction. 2014.
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TREATMENT OF THE CHRONIC KIDNEY DISEASE (CKD) PATIENT IN THE
PGI HOSPITAL CIKINI JAKARTA
Francisca Linawati Moeljono1, Diana Laila Ramatillah2, Aprilita Rinayanti Eff2
1
Pharmacist Professional Program Student, Faculty of Pharmacy UTA'45 Jakarta
Lecturer Pharmacy in Pharmacy Faculty University of 17 August 1945 Jakarta
(UTA’45 Jakarta)
2
Email: fransiscalina.1987@gmail.com
ABSTRACT
Renal failure is usually divided into two broad categories namely chronic and acute.
Chronic renal failure is a progressive development of renal gagl and slow (usually lasting
several years), whereas acute renal failure occurs within a few days or a few weeks. In both
cases, the kidneys lose their ability to maintain the volume and composition of body fluids
in a state of normal food intake. Although functional disability were similar in both types of
terminal renal failure, but acute renal failure have a typical illustration and will be
discussed separately1. Ny.SS patients, aged 64 years, entered the hospital PGI Cikini on
June 2, 2014 with a diagnosis of CKD (Chronic Kidney Disease). Therapy treatment for the
amlodipine treated, levofloxacin, meropenem, mebo oint (Radix Extract Scullaria),
renxamin (amino acid), sumagesic (paracetamol). Based on the results of their clinical
practice in internal medicine wards in hospitals PGI Cikini it can be deduced that the
presence of DRP (Drug Related Problem) a correlation between drug therapy with clinical
conditions such as drug delivery is not as indicated, the dose is less than the actual drug and
failed to receive treatment .
Keywords
: CKD, Hypertension dan RS PGI Cikini
INTRODUCTION
Chronic kidney disease is a pathophysiological process with diverse etiologies,
resulting in a progressive decline in renal function and generally end up with kidney failure.
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Furthermore, renal failure is a clinical condition characterized by an irreversible decline in
kidney function, to the degree that requires renal replacement therapy which remains, in the
form of dialysis or kidney transplantation2.
Chronic renal failure or end stage renal disease (ERSD) is a progressive disorder of
renal function and the irreversible metabolism and ability tubules maintain fluid and
electrolyte balance, causing uremia, chronic renal failure or end stage renal disease (ERSD)
is a progressive renal dysfunction and the irreversible metabolism and ability tubules
maintain fluid and electrolyte balance, causing uremia3.
Chronic renal failure (CRF) is damage to renal physiology is almost always can not
be recovered, and can be caused by various things. The term uremia has been used as the
name of this state for more than a century, although now we realize that the symptoms of
chronic renal failure was not entirely due to the retention of urea in the blood4.
Chronic renal failure occurs after a variety of diseases that damage the kidney
nephron mass. Most of this disease is a disease of the renal parenchyma diffuse and
bilateral, despite the obstructive lesions of the urinary tract can also lead to chronic renal
failure. At first, some kidney disease primarily affects glomerular (glomerulonephritis),
whereas other species mainly attack tubuls kidney (pyelonephritis or polycystic kidney
disease) or may also interfere with blood perfusion of the renal parenchyma
(Nephrosclerosis). However, when the disease process is not inhibited, then in all cases the
entire nephron eventually destroyed and replaced by scar tissue1.
The criteria for chronic kidney disease are:
1. Kidney damage that occurred during the 3 months or more, such as abnormalities of
structure or function of the kidney, with or without decreased glomerular filtration rate
(LGF), by:
- Pathological abnormalities.
- A sign of kidney damage, including abnormalities in the composition of the blood or
urine, or abnormalities in imaging examination.
2. GFR <60 ml / min / 1.73 m2 were going for 3 months or more, with or without kidney
damage.
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Chronic renal failure was defined as a progressive decline in renal function were
reversible and not caused by different types of diseases. Underlying disease difficult to
recognize when it has severe kidney failure. When the glomerular filtration rate (GFR)
falls below 25-30% of the normal rate, the kidneys may become unable to excrete the
remains of nitrogen, adjust the volume and electrolyte, and secretes hormones6.
CASE PRESENTATION
Patients aged 64 years Ny.SS PGI Cikini hospitalized on 02 June 2014. Patients
present with swelling in the legs, heartburn, pain from tungkak right down, the patient does
not feel nausea or vomiting.
Patients experienced severe infections on the feet with increased white blood cells
and severely injured condition, and patients with impaired renal urea levels high. The
patient had a history of hypertension and CKD..
CLINICAL EVALUATION
The use of amlodipine to treat high blood pressure (hypertension) occurred in patients,
Levofloxacin as a broad spectrum antibiotic, is also used as an antibiotic Meropenem,
Sumagesic used to relieve pain in patients with swollen legs, and mebooint used for foot
ulcers of patients for skin ulcers . Therapeutic treatment is given of the date of June 2 to
June 11 by 2014.
DOSAGE AND USE1
No.
1.
Drugs
LEVOFLOXACIN
Giving method
PO
Dose
1X500mg daily
Indications
Antibiotic
2.
MEROPENEM
PO
3 x 500 mg daily
Antibiotic
3.
AMLODIPIN
PO
1 x 5mg daily
Hypertension
4.
SUMAGESIC
PO
3X1 daily
Painful
5
TRAMADOL
PO
If pain occurs
Painful
6
RENXAMIN
IV
1X1 daily
Electrolit
7
MEBO OINT
Topical
4-5
Wounded
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CLINICAL LABORATORY VALUES
Type of examination
Hemoglobin
Hematocrit
Leukocytes
Platelets
Reticulocyte
Type of examination
Freezing period
APTT
PT
INR
Fibrinogen
Total Protein
Albumin
Globulin
Urea
Creatinine
Urid acid
Sodium
Potassium
Result
11,8
*32
37600
199
*160.000
Result
10,11
53,7
14,2
1,2
271
Unit
g/dL
%
10^3 µL
10^3 µL
µg/L
Unit
minutes
second
second
Normal value
13,0-16,0
40-48
5,0-10,0
150-450
5 – 15
Normal value
10,0 – 16,0
26,4 – 37,5
11,0 – 14,2
mg/dL
180 – 350
5,9
2,1
3,8
132
4,1
6,5
129
3,6
g/dL
g/dL
g/dL
mg/dL
mg/dL
mg/dL
mmol/L
mEq/l
6,0 – 8,0
3,4 – 4,8
1,3 – 3,7
10 – 50
0,6 – 1,1
< 6,8
135 - 147
3,5 – 5,0
GUIDELINE PAIN
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
MANAGEMEN OF TREATMENT CKD (CHRONIC KIDNEY DISEASE)
DRUG RELATED PROBLEM
1. The drug is not suitable indication
The patient was having a medical problem that requires drug therapy but did not
get the medicine according to the indication. Found CKD diagnosis but received no
prescription for CKD indication, but more handlers to infections and hypertension, but
found that the supporting laboratory values refer to CKD.
2. Drugs Interaction
The use of the antibiotic levofloxacin tramadol drug must be in pause time
drinking because It can work to lower analgesic.
3. Administered dose was less
The patient was having a medical problem that requires drug therapy but the
appropriate drug therapy problem is given at a dose below the recommended dose
treatment is justified. Found the use of amlodipine 5 mg once daily with a blood
pressure of 158/80 mmHg or less but not dose increased to 10 mg once daily.
4. Failed receiving treatment
The patient was having a medical problem that requires drug therapy but can not
receive treatment with economic reasons, psychology, sociology, or for reasons of
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
pharmaceutical. Found that the use of antibiotics meropenem administration is not
every day, for economic reasons, should be given 1x 3x or even not given.
5. Missing Right Drug Selection
The use of antibiotics should not directly use the antibiotic meropenem as an
antibiotic if this is the last line of antibiotic resistance occurs. And not scar tissue
culture examination.
CONCLUTION
Based on the results of their clinical practice in internal medicine wards in hospitals
PGI Cikini it can be deduced that the presence of DRP (Drug Related Problem) a
correlation between drug therapy with clinical conditions such as the presence of drug
delivery that are not appropriate indications and dose of drugs given to patients less than
that actually found the use of amlodipine 5 mg once daily with a blood pressure of 158/80
mmHg or less, but the dose was not increased to 10mg once a day and failed to receive
treatment.
ADVICE
Need for additional anticoagulation clinic because the laboratory tests found the
presence of a high APTT values.
REFERENCES
1. A. Price, Sylvia & M. Wilson, Lorraine. 2005. Edisi 6. Vol.2. Gagal Ginjal Kronik.
Patofisiologi Konsep Klinis Proses-proses Penyakit. Jakarta: EGC .
2. Aru W Sudoyo, dkk. 2009. Jilid 3. Edisi V. Penyakit Ginjal Kronik. Buku Ajar Ilmu
Penyakit Dalam. Jakarta : Interna Publishing
3. Doqi
Guidelines.2002.Clinical
Practice
Guidelines
on
Hypertension
and
AntyhipertensionAgents.USA
4. Jay H. Stein, MD. 2001. Panduan Klinik Ilmu Penyakit Dalam. Jakarta : EGC.
5. Smeltzer, Suazanne C. 2001. Edisi 8. Volume 2. Gagal Ginjal Kronik. Buku Ajar
Keperawatan Medikal-Bedah Brunner & Suddarth. Jakarta: EGC.
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
6. Sibuea, W Herdin, dkk. 2005. Penanggulangan Gagal Ginjal Kronik. Ilmu Penyakit
Dalam. Jakarta : Asdi Mahasatya
7. The British Pain Society.2013.Understanding and managing pain:information for
patients, London
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
DRUG RELATED PROBLEMS OF BLADDER CANCER SUSPECT IN
SURGICAL WARD PGI CIKINI HOSPITAL
Haerul Syam1, Diana Laila Ramatillah2, Aprilita Rinayanti Eff2
1
Pharmacist Professional Program Student, Faculty of Pharmacy UTA'45 Jakarta
2
Lecturer Pharmacy in Pharmacy Faculty University of 17 August 1945 Jakarta
(UTA’45 Jakarta)
Email : jeez2708@gmail.com
ABSTRACT
Bladder cancer is one of the common diseases founded in internal disease ward at PGI
Cikini Hospital. Bladder is a hollow organ walls consist of smooth muscles called muscle
detrusol1. In some cases we will get a painless gross hematuria i.e the urine always red8.
Symptoms of bladder cancer such as blood mixed intermittent urination, feeling hot
urination, feeling to urinate, frequent urination, especially at night and on the next phase of
difficult urination, suprapubic pain that is constant, hot body and feel weak, low back pain
due to nerve pressure, pain on one side because hydronefrosis9.
Case presentation: SS is a 64 year old man hospitalized in internal disease wards. Patients
diagnosed with Bladder cancer disease. Preclinical evaluation: In this case must be
considered is the use of drugs which can be interact such as ketorolac may interact with
losartan and vitamin K with ketorolac.
Keywords : Bladder cancer suspect, Internal disease ward, PGI Cikini Hospital
Introduction
Bladder cancer is one of the common diseases founded in internal disease ward at PGI
Cikini Hospital. This cancer is usually a superficial tumor10. These tumors over time can
be held infiltration into the lamina phopria, muscle and perivesika fat which then spread
directly to the network around10. In some cases we will get a painless gross hematuria i.e
the urine always red8. Bladder is a hollow organ walls consist of smooth muscles called
muscle detrusol1. This muscle is composed of the fiber direction such that when contracted
causes the bladder to contract and shrink in volume. In distal part that close to the pelvic
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base (Diafgrama Urogenital) detrusor muscle forming tube and coating posterior urethral1.
Carcinoma of the bladder is still early superficial tumors2. These tumors can hold over time
infiltration into the lamina propria, muscle and fat perivesika which then spread directly
into the surrounding tissue2. Besides, the tumor can spread and hematogenous limfogen2.
The spread to the lymph glands limfogen perivesika, obturator, iliac and common iliac
ekterna, while the most frequent hematogenous spread to the liver, lungs and bones7. Many
factors influence the occurrence of bladder carcinoma include age, bladder carcinoma is
increased in the decade 60's, carcinogens, both derived from exsogen of cigarettes or
chemicals or endogenous metabolism of the results, another cause is suspected due to the
use of analgesics, cytostatic and chronic irritation by stones, sistomiasis or radiation7.
CASE PRESENTATION
SS is a 64-year-old man hospitalized in internal disease wards. Patients diagnosed
with suspected bladder cancer. Patients enter PGI Cikini hospital dated 30 April 2014.
Patient feels weak, hot body and bloody urine before enter hospital. Upon entering the
hospital, the patients feel back pain, fever, feeling tired and bloody urine. Clinical
chemistry examination has decreased calcium of 8.4 mg / dL, whereas in hematologic
examination, urine and parasitological increase in erythrocyte sedimentation rate 20 mm /
h, 2% basophil, eosinophil 13%, 10% monocytes, protombin past 14 , 3 seconds, the
bacteria in the urine 2362 / LPB and experienced a decrease in hemoglobin of 7.3 g / dL,
3.38 10 ^ 6μL erythrocytes, hematocrit 24%, 1% neutrophils rod, segment neutrophils 47%,
MCV 70 fL, MCH 21.6 pg, MCHC 30.8 g / dL, urine specific gravity of 1.010 g / mL.
Drug therapy given to patients include ceftriaxon given on day 3 to day 9 as antibiotics due
to bacterial infection, torasic (ketorolac) was given on day 3 to day 9 are used for short term
treatment of acute moderate to severe pain after surgical procedures, vomizole
(pantoprazole) was given on day 4 to day 9 was used as a pathological hypersecretion that
can not be treated orally, kalnex (tranexamic acid) administered on day 3 to day 9 is used to
prevent bleeding during surgery, vitamin K is given on day 3 to 9 days to be used for
deficiency of vitamin K, urecolin given on day 4 to day 9 for fluid retention before and
after surgery, cernevit given on day 3 to day 9 daily supplement, angioten (losartan) was
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given on day 4 to 9 days to be used for hypertension, tutofusin infusion given on day 3 to
day 9 as fluid and electrolytes before, during and after surgery, Asering infusion given on
day 3 to day 9 was given as a result of dehydration, trauma, acute gastroenteritis and
acidosis.
LABORATORY VALUE
Table 1. Laboratory of Hematology, Urine and Parasitology
Examination
Complete Peripheral
Blood
Erythrocyte
sedimentation rate
Hemoglobin
Leukocytes
Erythrocytes
Hematocrit
Retikolosit
Calculate Type
Leukocytes
Basophils
Eosinophils
Neutrophils Trunk
Neutrophils Segment
Lymphocytes
Monocytes
Platelets
MCV
MCH
MCHC
Bleeding Period (IVY)
Freezing period (LeeWhite)
Period protombin / INR
Protombin period (PT)
PT Patients
PT Control
Results
30 – 04 –
2014
Unit
Normal
Value
H 20
L 7,3
5,8
L 3,38
L 24
13
mm/ja
m
g/dL
10^3μL
10^6μL
%
Permil
0 – 10
13,0 – 16,0
5,0 – 10,0
4,50 – 5,50
40 – 48
5 – 15
H2
H 13
L1
L 47
27
H 10
213
L 70
L 21,6
L 30,8
3
11 – 12
H 14,3
12,8
1,2
%
%
%
%
%
%
10^3μL
fL
pg
g/dL
Menit
Menit
0–1
1–3
2–6
50 – 70
20 – 40
2–8
150 – 450
81 – 92
27,0 – 32,0
32,0 – 37,0
1–6
10 – 16
11,0 – 14,2
Detik
Detik
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
INR
Examination
Complete Peripheral
Blood
Erythrocyte
sedimentation rate
Hemoglobin
Leukocytes
Erythrocytes
Hematocrit
Retikolosit
Calculate Type
Leukocytes
Basophils
Eosinophils
Neutrophils Trunk
Neutrophils Segment
Lymphocytes
Monocytes
Platelets
MCV
MCH
MCHC
Examination
Complete Peripheral
Blood
Erythrocyte
sedimentation rate
Hemoglobin
Leukocytes
Erythrocytes
Hematocrit
Retikolosit
Calculate Type
Leukocytes
Basophils
Eosinophils
Neutrophils Trunk
Neutrophils Segment
Results
01 – 05 –
2014
Unit
Normal
Value
H 43
L 7,3
8,1
L 3,52
L 25
12
mm/ja
m
g/dL
10^3μL
10^6μL
%
Permil
0 – 10
13,0 – 16,0
5,0 – 10,0
4,50 – 5,50
40 – 48
5 – 15
H2
H 15
L0
L 49
24
H 10
210
L 70
L 21,3
L 30,4
%
%
%
%
%
%
10^3μL
fL
pg
g/dL
0–1
1–3
2–6
50 – 70
20 – 40
2–8
150 – 450
81 – 92
27,0 – 32,0
32,0 – 37,0
Results
02 – 05 –
2014
Unit
Normal
Value
H 23
L 9,6
8,1
L 4,17
L 30
L7
mm/ja
m
g/dL
10^3μL
10^6μL
%
Permil
0 – 10
13,0 – 16,0
5,0 – 10,0
4,50 – 5,50
40 – 48
5 – 15
1
H 12
L0
65
L 14
8
237
%
%
%
%
%
%
0–1
1–3
2–6
50 – 70
20 – 40
2–8
150 – 450
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
Lymphocytes
Monocytes
Platelets
MCV
MCH
MCHC
Examination
Complete urinalysis
Density
Color
Clarity
Leukocyte esterase
Nitrite
Blood
pH
Proteins
Glucose
Bilirubin
Urobilinogen
Ketones
Sediment
Leukocytes
Erythrocytes
Epithelial
Cylinder
Bacteria
L 72
L 23
32,1
10^3μL
fL
pg
g/dL
81 – 92
27,0 – 32,0
32,0 – 37,0
Results
01 – 05 –
2014
Unit
Normal
Value
L 1,010
Yellow
Clear
Negatif
Negatif
Negatif
7,0
Negatif
Negatif
Negatif
0,2
Negatif
g/mL
1,015 – 1,025
Yellow
Clear
Negatif
Negatif
Negatif
4,8 – 7,4
Negatif
Negatif
Negatif
< 0,2
Negatif
1
0
0
0
H 2362
/LPB
/LPB
/LPB
/LPK
/LPB
0–2
0–3
0–1
0–1
<5
Table 2. Examination of blood pressure
Date
30 april 2014
01 may 2014
02 may 2014
03 may 2014
Blood Pressure
Systole and Diastole
S
D
S
D
S
D
S
D
at
04.00
130
80
130
80
153
80
at
12.00
130
80
176
93
140
90
at
20.00
130
70
150
100
120
58
140
90
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
S
D
S
D
S
D
S
D
S
D
04 may 2014
05 may 2014
06 may 2014
07 may 2014
08 may 2014
140
80
120
90
140
90
110
80
110
80
140
80
160
110
120
80
110
70
110
80
150
80
160
90
120
80
110
70
100
80
Table 3. Laboratory of Chemical clinic
Examination
Sodium, Potassium
Sodium (Na) blood
Potassium (K)
blood
Calcium (Ca)
Examination
Sodium, Potassium
Sodium (Na) blood
Potassium (K)
blood
Results
02 – 05 –
2014
Unit
Normal Value
142
4,1
mEq/L
mEq/L
135 – 147
3,5 – 10,3
8,4
mg/dl
0,8 – 10,3
Results
03 – 05 –
2014
Unit
Normal Value
142
3,8
mEq/L
mEq/L
135 – 147
3,5 – 10,3
8,4
mg/dl
0,8 – 10,3
Calcium (Ca)
Table 4. Profile Dispensing
Name of
Medication
Ceftriaxone 1
gram
Torasic 30 mg
Vomizole 2 x 1
flc
Date
30/4
-
1/5
-
2/5
2x1
3/5
2x1
4/5
2x1
5/5
2x1
6/5
2x1
7/5
8/5
2x1 2x1
-
-
2x1
2x1
2x1
2x1
2x1
2x1
2x1
-
-
2x1
2x1
2x1
2x1
2x1
2x1
2x1
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
Kalnex 500 mg
-
-
3x1
3x1
3x1
3x1
3x1
3x1
3x1
Vit. K 2 x 1 amp
-
-
2x1
2x1
2x1
2x1
2x1
2x1
Cernevit 1 x 1
amp
Urecolin 2 x 1
tab
Angioten 25 mg
-
-
1x1
1x1
1x1
1x1
1x1
-
-
-
2x1
2x1
2x1
2x1
-
-
-
1x1
1x1
1x1
1x1
Folic iberet 3 x 1
tab
Infusion
tutofusin
Infusion asering
-
-
-
3x1
3x1
3x1
3x1
-
-
2 btl
2 btl
2 btl
2 btl
2 btl
2x
1
1x
1
2x
1
1x
1
3x
1
2 btl
-
-
1 btl
1 btl
1 btl
1 btl
1btl
1 btl
1btl
1x1
2x1
1x1
3x1
2 btl
CLINICAL EVALUATION
Drug Related Problem 1
Ketorolac is NSAIDs which can reduce pain5. The use of ketorolac when administered
concomitantly with losartan then ketorolac which is NSAIDs can reducing the synthesis of
prostaglandins may affect fluid hemostatic and can reduce the antihypertensive effect3,6.
Pharmacist Intervention: When ketorolac is still used in conjunction with losartan, better
the dose of losartan should be increased to optimize treatment.
Drug Related Problem 2
Vitamin K is used for deficiency of vitamin K5. The use of vitamin K when administered
concurrently with ketorolac will cause bleeding and reduced anticoagulants effect3,6.
Pharmacist Intervention: The use of vitamin K with ketorolac should be given a distance of
administration approximately 2 hours.
CONCLUSION
After the assessment of the patient's treatment, it can be concluded that the use of
ketorolac when administered concomitantly with losartan Ketorolac is NSAIDs which can
reduce pain. The use of ketorolac when administered concomitantly with losartan then
ketorolac which is NSAIDs can reducing the synthesis of prostaglandins may affect fluid
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
hemostatic and can reduce the antihypertensive effect. So the dose of losartan should be
increased. The use of vitamin K when administered concurrently with ketorolac will cause
bleeding and reduced anticoagulants effects. So should be given a distance of
administration approximately 2 hours.
REFERENCES
1. Arief M.I. dkk. 2007. “Deteksi sel transisional karsinoma buli-buli dengan tes NMP-22
dan sitologi urine”. JURI.
2. Basuki B Purnomo. 2000. “Dasar-dasar Urology”, Ed I. penerbit CV Sagung Seto.
Jakarta.
3. Baxter, K. 2008. “Stockley’s Drug Interaction”. Eight Edition. Pharmaceutical Press,
London and Chicago.
4. Charles D.Hepler and Richard Segal. 2003. “Preventing Medication Errors and
Inproving Drug Therapy Outcomes”. CRC Press LLC.Boca Raton. Florida.
5. Depkes RI. 2008. “Informatorium Obat Nasional Indonesia”. Dirjen Pengawasan Obat
dan Makanan. Jakarta.
6. Medscape 2014. “Drugs Interaction Checker”.WebMLLC. Rheuters Helth Informaton.
7. Sjamsuhidayat R dan Jong WD. 1997. ”Buku Ajar Ilmu Bedah” . Ed 4.Penerbit Buku
Kedokteran EGC. Jakarta.
8. Tanagho EA dan McAnnch JW.1995. “Smith's General Urologi”. Ed 14. Appleton
Lange Medical Publication.
9. Wein AJ. 1998. “Urology 3” vol Ed 7.: W.B. Saunders. Philadelphia.
10. Wiley, Blackwell. 2009. “Nursing Dianoses Definition and Classification 2009-2011”.
United States of America: Mosby Elsevier.
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
DRUG RELATED PROBLEMS ASSOCIATED AND TREATMENT FOR
CERVICAL CANCER IN INTERNAL MEDICINE WARD IN PGI CIKINI
HOSPITAL
Hendra Rahman1, Diana Laila Ramatilla2, Aprilita Rinayanti Eff2
1
Pharmacist Professional Program Student, Faculty of Pharmacy UTA'45 Jakarta
Lectuter Pharmacy in Pharmacy Faculty University of 17 August 1945 Jakarta
(UTA ’45 Jakarta)
2
Email : Hendrarahman.sfarm@yahoo.co.id
ABSTRACT
Cervical cancer is a cancer that attacks the cervix (mouth of the womb). Cervical cancer
begins in the lining of the cervix. The occurrence of cancer is very slow. First, some normal
cells turn into precancerous cells, then transformed into cancer cells. This change is called
dysplasia and usually detected with a pap smear test 3.6. Pain is a sensory and emotional
experience unpleasant result of actual tissue damage or potensia5. Patients Mrs.MM 39
years old, hospitalized PGI Cikini on June 23th 2014, was diagnosed of cervical cancer.
During hospitalized, she has received Vitamin K injection, Kalnex injection (tranexamic
acid), Alverin Citrate 30 mg and Klordiazepoksida HCl 5 mg, Ketorolac. Based on the
results of clinical secretariat at the ward of K in PGI Cikini hospital, it can be concluded
that the presence of DRPs (Drug Related Problems) is improper drug selection, Improper
use of drugs, Ketorolac is not used in accordance with the existing pain in patients.
Keywords: Cervical Cancer, Pain and RS PGI Cikini
INTRODUCTION
The cervix is the lower part of the uterus (womb). This is sometimes called the
uterine cervix. Body (the top) of the uterus, is where a fetus grows. The cervix connects the
body of the uterus to the vagina (birth canal). Part of the cervix closest to the body of the
uterus is called the endocervix. Following section to the vagina is exocervix (or ectocervix).
Majority of cervical cancers start in the transformation zone. Cervical cancer (also known
as cervical cancer) begins in the cells lining the cervix
7.3.
Cervical cancer at an early stage
does not show typical symptoms, even without symptoms. In later stages, the symptoms of
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
cervical cancer include: bleeding post coitus, abnormal vaginal discharge, bleeding after
menopause, and abnormal discharge (yellowish, odorless and mixed blood) 3.
Two main types of cells lining the cervix are squamous and glandular cells. Most
cervical cancers start in the cells. These cells do not suddenly turn into cancer, and there are
some processes in its path. Normal cells in the cervix gradually changes from pre-cancer to
cancer. Doctors use several terms to describe the pre-cancerous changes, including cervical
intraepithelial neoplastic (CIN), squamous intraepithelial lesions (SIL), and dysplasia 6.
CASE PRESENTATION
Patients Mrs. MM, aged 39 years old came to PGI Cikini Hospital on June 23, 2014.
Patient felt pain in the right side of the waist. From the results of the diagnosis of cervical
cancer patients experience.
Patients are people with cancer of the cervix and had a hysterectomy, 1 year SMRs
(prior to hospital admission) the patient was said to have spread to the bladder occurred
approximately 2 months SMRs patient began to feel pain in the right hip, Patient radiation
recommended in RSCM and now waiting for the schedule . Patients taking anti-pain
medication SMRs ± 1 day, the patient felt a severe pain in the back right waist, nausea,
vomiting, post-micturition bladder is mounted hose from the kidney to the bladder.
EVALUATION CLINIC
The use of vitamin K for the treatment and prevention of bleeding1. Kalnex ampoule
(tranexamic acid) as cervical conization, hereditary angioneurotic edema, abnormal
bleeding after surgery
1.
Spasmium (Alverin Citrate 30 mg and Klordiazepoksida HCl 5
mg) for pain spasms / seizures
severe short-term (<5 days)
1.
1.
Ketorolac is used as the management of acute pain is
ketoprofen used for rheumatoid arthritis, osteoarthritis,
spondylitis, and acute articular disorder, fibrosis, cervical spondylitis, low back pain,
painful musculoskeletal conditions 3.
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
DOSAGE AND METHOD OF USE
Dosage and how to use the drug in patients is the first day of treatment was given
vitamin K on the second day of vitamin K consumption in stop and continued on the third
day to day with a dosage ten 3x1 ampoules, ampoules kalnex given one ampoule at The
first day and stopped on the second day and continued on the third day to day with a dosage
ten 3x1, spasmium in use on the sixth day with 1 tablet and on day seven to ten days at
doses used 3x1 tablet, the first day of RL (Ringer lactate) given concurrently with ketorolac
where RL given IV on day two RL and ketorolac use was discontinued and resumed on the
third day to the fifth day, the sixth day and seventh RL replaced with INS (Sodium
Chloride) and using ketorolac, on the eighth day until RL tenth day of re-use and ketorolac,
the ninth and tenth days of treatment therapies are added to profenid supposs (ketoprofen)
1x1.
CLINICAL DIAGNOSIS
EXAMINATION
NORMAL VALUE
Hemoglobin
12-16 g / Dl
Hematocrit
37-47%
Erythrocytes
4.3-6 million / mL
Leukocyte
4800-10800 / mL
Platelets
150.000-400.000/μL
FULL URINISASI dated 06.28.2014
Specific gravity
1015-1025
Color
Yellow
Clarity
Clear
Leukocyte esterase
Negative
Nitrite
Negative
Blood
Negative
pH
4.8 - 7.4
Proteins
Negative
Glucose
Negative
Bilirubin
Negative
Urobilinogen
<0.2
Ketones
Negative
23/6
9.7
28
20,700
592,000
1,010
Yellow
Clear
Negative
Negative
Negative
6.0
Negative
Negative
Negative
<0.2
Negative
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
From the above data it can be concluded that an increase in platelet levels are where
normal values while the platelet 150.000-400.000/μL on clinical laboratory results showed
592,000 / ML. Supported by the value which the normal value 4800-10800 leukocytes / mL
and the results of clinical laboratory 20,700 / uL and it can be concluded that the patient
had cervical cancer.
DRUG RELATED PROBLEM
Improper drug selection is Keterolac use an anti-inflammatory non-steroidal
heterocyclic acetic acid derivative that is used as an analgesic which is supposed to opiate
analgesics has experienced pain scale (VAS) 9.
CONCLUSION
Based on the results of clinical secretariat at the ward of K in PGI Cikini hospital, it
can be concluded that the presence of DRPs (Drug Related Problems) is improper drug
selection, Improper use of drugs, Ketorolac is not used in accordance with the existing pain
in patients.
REFERENCES
1. POM RI, 2008. Indonesian National Drug Information, Jakarta
2. Canavan TP, NR Doshi. Cervical cancer. Am Fam Physician 2000; 61:1369 -76.
3. Dipiro, Joseph T., et. al., 2008, Pharmacotherapy: A pathophysiologic Approach 7
th
Edition, McGraw Hill, New York.
4. Hughes, J, 2008. Pain Management of, from basich to clinical practice
5. Menczer J. The low incidence of cervical cancer in Jewish women: has the puzzle
finally been solved? Isr Med Assoc J 2003; 5:120-3
6. Nurwijaya, H, dkk.2010.Cegah and Cervical Cancer Detection, Surabaya
7. D Turk and Melzack R. Handbook of pain as sessment. Guilford Press, New York,
1992.
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
DRUG RELATED PROBLEMS IN ACUTE GASTROENTERITIS (GEA) AND
CORONARY ARTERY DESEASE (CAD)
Herna Barung1, Diana Laila Ramatillah2, Aprilita Rinayanti Eff2
1
Pharmacist Professional Program Student, Faculty of Pharmacy UTA'45 Jakarta
Lecturer Pharmacy in Pharmacy Faculty University of 17 August 1945 Jakarta
(UTA’45 Jakarta)
2
Email: herna_barung@yahoo.co.id
ABSTRACT
Definition of acute gastroenteritis are diarrhea initially is a sudden and rapid, within a few
hours up to 7 and 14 days.3,8 First infection is a major cause of acute diarrhea, either by
bacteria, parasites or viruses. Other causes of vaccines and drugs, enteral nutrition followed
by prolonged fasting, chemotherapy, faecal impaction (overlow diarrhea).7 Coronary artery
disease in the desease is narrowing or blockage of the coronary arteries burrows because
the process of atherosclerosis.5 In atherosclerosis fatty occurs on the walls of the coronary
arteries that have occurred since a young age to old age.4
Case presentation: The patient is a 61 year old woman hospitalized in internal medicine
wards. Patients diagnosed with acute gastroenteritis (GEA) and Coronary Artery Disease
(CAD).
Preclinical evaluation: In this case study to consider the use of medications that can cause
such bisoprolol interaction with aspirin and warfarin with aspirin.
Keywords: Acute gastroenteritis and Coronary Artery Disease, PGI Cikini Hospital
INTRODUCTION
Definition of acute gastroenteritis are diarrhea initially is sudden and rapid, within a few
hours up to 7 or 14 days.3,8 First infection is a major cause of acute diarrhea, either by
bacteria, parasites or viruses. Other causes of vaccines and drugs, enteral nutrition followed
by prolonged fasting, chemotherapy, faecal impaction (overlow diarrhea).3
Potential
complications include diarrhea, cardiac dysrhythmia due to loss of fluid and electrolytes
were significantly (especially the loss of potassium), of urine less than 30 ml / hour for 2-3
days in a row, muscle weakness and parastesia. Hypotension and anorexia and sleepy
because blood potassium levels below 3.0 mEq / liter (SI: 3 mmol / L) should be
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International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.
reported.3,8 . Decreased levels of potassium cause cardiac dysrhythmias (atrial and
ventricular tachycardia, ventricular febrilasi and premature ventricular contractions) that
can cause death. Definition Coronary artery disease is a disease in which the coronary
artery narrowing or blockage of the coronary arteries burrows because the process of
atherosclerosis. In the process of atherosclerosis occurring fatty on the walls of the
coronary arteries and coronary arteries that have occurred at a young age to old age. This
process is generally normal in every person.4
CASE PRESENTATION
Mrs. SH is 61 year old woman hospitalized in internal medicine wards. Patients
diagnosed with acute gastroenteritis and coronary artery diseases entered Cikini hospital on
30 April 2014. Patient had nausea, vomiting, hot, watery bowel movements 20 times in 2
days before entering the hospital. The patient had a history of previous disease is CAD.
Patient fever
1125