farmakoterapi case study

8/10/2019 Farmakoterapi case study

1/35

Sheppriola Vonia1011014025

Kelas D


2/35

Kasus 1 (current therapeutic, 1995)


3/35

, 92 tahunDiagnosis : - Ischemic Heart Disease

- Congestive Heart Failure with Atrial

Fibrilation

- NIDDM

- Hypertension

- Anxiety

- Constipation

Obat yang diberikan :

1. Digoxin 9. Paracetamol

2. Isosorbid Dinitrat 10. Tolbutamid

3. Aspirin 11. Furosemid

4. Cimetidin 12.Metformin Rosiglitazon

5. Metoclopropamid 13.Captopril

6. Metamucil 14. Verapamil

7. Nitrazepam 15. Diltiazem

8. Salbutamol 16. Aldacton


4/35

Digoxin

Concomitant use Calcium-channel blocking agents canhave additive negative effects on AV conduction

(Diltiazem, Verapamil)

Serum digoxin concentrations may increase by about 15-

30% when captopril and digoxin are used concomitantlyfor CHF (Captopril)

Loop or Thiazide diuretics makes hypokalaemia,increases the toxicity of digoxin (Furosemide)

Metoclopramidereduce GI absorption of digoxin(resulting in low plasma digoxin concentrations),

especially when administered at the same time as

digoxin, so Should be spaced as far apart as possible


5/35

Sebelum makan

Spironolactone (Aldactone) increasedserum concentrations of digoxin; possible

toxicity


6/35


7/35

ISDN

Isosorbide dinitrate: Organic nitrates;vasodilating agents.

Brands:BiDil(combination), Dilatrate,

Imdur, Ismo, Isordil, Monoket; alsoavailable generically

Generic Name:Isosorbide Dinitrate

Chemical Name:D-Glucitol-1,4:3,6-dianhydrodinitrate

Molecular Formula:C6H8N2O8

AHFS DRUG INFORMATION ESSENTIALS


8/35

1. Indikasi: terapi dan preventif anginapektoris, CHF

2. KI: hipersensitifitas berat, infark jantung

akut, kegagalan sirkulasi akut.3. Interaksi: Disopyramide.

4. Administrasi: sublingual, intrabukal dan

oral


9/35


10/35

Dosage: Maximum 40 mg of isosorbide

dinitrate (Dilatrate-SR)it have tocontrolled

Dosage for Geriatri


11/35

Indication: Atrial Fibrillation/Flutter

An alternative or adjunct to oralanticoagulation for reduction of the

incidence of thromboembolic episodes inselected patients with chronic atrial

fibrillation.

Aspirin


12/35


13/35

Dosage

60 years of age and no other risk factors:325 mg daily --- AF

Food delays the absorption of aspirin butdoes not affect the overall amount

absorbed.


14/35

Drug Interaction

ACE inhibitorsreduced BPPossible attenuation of hemodynamic actions of ACE

inhibitors in patients with CHF Reduced hyponatremic

effect of ACE inhibitorsmonitor BP

Aspirin may reduce the diuretic effect of bumetanide,furosemide, and piretanide, and the combination of

aspirin and furosemide may increase the risk of acute

renal failure and salicylate toxicity.

Although some studies have found that metoclopramideincreases the rate of aspirin absorption, others have

found no change, and the clinical efficacy of aspirin

seems unaltered---No action needed.


15/35

Metformin

Maintenance dosage generally should notbe titrated to the maximum recommended

for younger adults;limited data suggest

reducing initial dosage by approximately33% in geriatric patients


16/35

For the fixed combination withrosiglitazone, maximum daily dosage is 2

g of metformin hydrochloride and 8 mg of

rosiglitazone


17/35


18/35

Cimetidine

Severe (Clcr< 30 mL/minute)Oral:300 mg every 12 hours.

Accumulation may occur; use lowest frequency of dosing

compatible with adequate response.

Increase frequency to every 8 hours or more frequently(with caution) if required.

Presence of hepatic impairment may require further

dosage reduction.


19/35

Metamucil

Pelunak feses


20/35

Tolbutamid

Antidiabetic agent; sulfonylurea

Oral:Initially, 1-2 g daily


21/35

Rumus Cockcroft - Gault

CrCl (ml/menit) = 140umur (th) X BB (kg)

72 X SrCr ( mg/dl )

CrCl (ml/menit ) = 0,85 X CrCl ()


22/35

Kasus 2 (Current Therapeutic 1995)


23/35

, 83 tahunDiagnosis : - Mild Memory Disorders

- Falls

- Hypertension

- Congestive Heart Failure

- Osteoartritis

- Angina


1. Furosemid 6. Paracetamol

2. KCL 7. Nitrazepam

3. Digoxin 8. Prochlorperazin

4. Vorapamil 9. Dothiepin

5. Tenoxicam 10. Laxative agent


24/35

Furosemide

A sulfonamide, loop-type diuretic andantihypertensive agent

Indication: antiHypertension


25/35

KCl

Indication: replacement pottasiumbecause of the adverse effect of

furosemide using (hypokalemia)


26/35

Digoxin

indication: CHF and angina


27/35

Verapamil

Chalcium chanel blocker

This drug is antihypertension agent


28/35

Tenoxincam

This uses as antiinflamation drug (NSAID)

The indication is for osteoartritis patient


29/35

Paracetamol, Prochlorperazin, Dothiepin,Laxative agent, Nitrazepam tidak perlu

digunakan karena tidak tepat indikasi.

Paracetamol: untuk demam, (pasien tidak

demam)Proclorperazin, nitrazepam: sebagaiantipsychotic and antiemetic agent (pasientidak mengalami ganguan kejiwaan)

Laxative aget: untuk konstipasi (pasien tidakmengalaminya)


30/35

Kasus 3 (RSUP Dr. Sardjito)


31/35

, 70 tahunDiagnosis : - Ischemic Heart Disease

- Hiperkolesterolemia

- Hiperurikemia

- Anxiety Depression

- Katarak


1. ISDN 6. Aurorix

2. Digoxin 7. Frixitas

3. Furosemid 8. Triamin E

4. KCL 9. Farmabec C

5. Amiodaron 10. Cataline eye drop


32/35

Indikasi Obat

ISDN dan digoxin: CHF

Aurorik:gejaladepresi

Amiodaron:takikardia

Furosemid:antihipertensi KCl:mengatasiefeksampinghipokalemiadari

furosemid

Triamin:penurunpanasdanmengobatiflu

Frixitas (alprazolam): anxiolitic Farmabex C: memenuhi kebutuhan vitmin dalam

tubuh

Catalineeyedrop:katarak


33/35

Kesimpulan

Ischemic Heart Disease diobati denganmerekomendasikan nitrogliserin atauamlodipin

Hiperkolesterolemiadiobati denganmerekomendasikan obat atrovastatinyang

juga baik untuk IHD

AnxietyDepression diobati dengan Frixitas

dan Aurorik Katarakdiobati dengan Cataline eye drop

Farmabec C tetap digunakan tujuannya:sebagai suplemen vitamin untuk orang tua

saja


34/35

ISDN dan digoxin tidak lagi digunakan,karena ia bukan terapi utuk pasien ISDtetapi CHF begitu juga dengan

penggunaan amiodaron Furosemid dan KCl tidak lagi digunakan

karena: akan memperparah hiperurikemiapasien, di samping itu pasien tidakmengalami hipertensi atau pun udem

Pasien tidak demam maupun flu, makatidak perlu digunakan triamin E


35/35

Lekas Sehat

TTD.SHEPPRIOLA VONIA

(Im proud to be a PHARMACIST)

farmakoterapi case study

Documents