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Pharmaceutical Care I. IDENTITAS PASIEN Nama Pasien : Tn. GR Umur : 62 Tahun Berat Badan/Tinggi badan :- kg Tanggal MRS : 31 juli Diagnosa : CHF fc III-IV + PJK OMI (OMI+>30 hari) + CAD 3VDS (3 vessel disease) II. SUBYEKTIF (Saat MRS) 2.1 Keluhan Utama : Sesak ± 2 minggu yang lalu, batuk yang kadang kambuh selama 1 tahun 2.2 Keluhan Tambahan : 2.3 Riwayat Penyakit Dahulu: Diabetes mellitus Jantung 2.4 Riwayat Pengobatan: Pengobatan: ISDN, Noperten (lisinopril), Azitromisin (antibiotik), Bisoprolol (b-blocker), Simvastatin, Furosemid, Nitrokaf (gliseril trinitrat), Spironolacton (antagonis aldosteron),Candesartan (ACEI) 2.5 Riwayat keluarga/Sosial: keluarga/Sosial: 2.6 Alergi Obat :
III. OBYEKTIF 3.1 Tanda Vital Nilai Normal Normal TD (mmHg) Nadi
< 120-80 60 – 100 100
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31/7 130/102 112
1/8 Useful 2/8 Not useful 90/50 115/60 76 72
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3.3 Terapi Pasien RL O2 Lasix pump (furosemid) Dobuject (dobutamine HCL) Digoxin Cedocard (isdn) iv ISDN
31/7
1/8
7 tpm/menit 2L 10mg/jam
√
√
3-5 mcg/kgBB
√
√
2x1 0,5mg/jam 3x5 mg
√ √
√ -
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ASSESMENT Problem Medik dan Drug Related Pr oblem Pasien Problem Medik
CHF fc III-IV
Subjektif/objektif Subjektif: Sesak nafas, batuk Objektif: TD (mmHg): (31/7) 130/102 (1/8) 90/50 (2/8) 115/60 RR (x/menit): (31/7) 40 (1/8) 20 (2/8) 22
Terapi
DRP
-
O2 diberikan untuk pemulihan terjadinya hipoksia (DIH). Mekanisme : O2 meningkatkan tekanan O2 pada arteri dan sebagai You're Reading a Preview akseptor elektron Unlock full access selama with a fosforilasi free trial. oksidatif melalui aktivasi sitokrom c oxidase Download With Free Trial (Drugbank.ca)
O2 2L
Analisis
RL 7 tpm/menit
-
Berfungsi untuk mengembalikan keseimbangan elektrolit
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Lasix pump 10mg/jam
Furosemide Useful merupakan diuretik loop. Mekanisme : menghambat
Plan Monit Monitori Saturasi O pasien
Furosemide dengan Not useful digoxin : Pasien dengan kondisi hipokalemi dapat
Plan : Ditambah KCl 0,5-1 mEq/kg/d
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Furosemide merupakan diuretik loop. Mekanisme : menghambat transporter Na-K-Cl di lengkung Henle, dimana 20% - 25% dari Na yang difiltrasi biasanya diserap kembali. Setelah kelebihan cairan telah diatasi, You're Reading a Preview banyak pasien terapi Unlock full accessmemerlukan with a free trial. diuretik kronis untuk mempertahankan euvolemia (dipiro, Download With Free Trial 2008). Dosis awal: 10-40 mg dapat diulang dalam 1-2 jam (DIH, 2009) Dosis harian: 40-240 mg (DIH, 2009)
Lasix pump 10mg/jam
Da�ar obat
Furosemide dengan digoxin : Pasien dengan kondisi hipokalemi dapat menigkatkan efek digoxin Furosemide dengan dobutamine : menurunkan kadar kalium
Plan : Ditambah KCl 0,5-1 mEq/kg/d (Dosis ma 40 mEq) ( 2009). Monitori Kadar KC
Dobuject 35 mcg/kgBB
up to vote on this title DobutamineSign bekerja Dobutamine dengan sebagai agonis Useful digoxin : dapat Not useful rese ptor β2 meningkatkan kadar adrenergik, obat ini kalium digunakan unutk
Monit Kadar pasien
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Dobuject 35 mcg/kgBB
You're
Da�ar obat
Dobutamine bekerja sebagai agonis rese ptor β2 adrenergik, obat ini digunakan unutk meningkatkan kekuatan kontraksi otot jantung shingga voume dearah yang dipompa meningkat (Dipiro, 2008) Dosis : 80-320 mg 1x Reading a Preview sehari (Dipiro, 2008)
Dobutamine dengan digoxin : dapat meningkatkan kadar kalium
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Digoxin 2x1
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Monit Kadar pasien
Pemberiannya dapat menurunkan risiko hospitalisasi pada With Free Trial pasien dengan dengan laju nadi > 70x/ menit). Pasien juga harus mendapat ACEI (ARB) dan MRA. Dosis awal: 0,25 mg, 1 x/hari pada pasien dengan fungsi ginjal normal. Pada pasien usia lanjut dan
Monitori Kadar Dig
Sign up to vote on this title gangguan fungsi ginjal dosis Useful Not useful diturunkan menjadi 0,125 atau 0,0625 mg, 1 x/hari
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gangguan fungsi ginjal dosis diturunkan menjadi 0,125 atau 0,0625 mg, 1 x/hari (Guidelines GJ, 2015). Cedocard Kombinasi nitrat 0,5mg/jam hydralazine memberikan efek (ISDN ) menguntungkan ISDN 3x5 melampaui tindakan You're Reading a Preview mg hemodinamik mereka mengganggu Unlock full accessdengan with a free trial. proses biokimia terkait dengan tingkat serum lithium Download With Free Trial perkembangan gagal jantung. Guideline Heart Failure Society of America merekomendasikan penambahan hydralazine dan ISDN sebagai bagian dari standar terapi, meskipun terapi sudah dioptimalkan
Plan : Digunak kombina dan hidr karena d meningk hospital pada pas dan sesu pasien y mengala hipotens Monitor Tekanan
up to vote on this title dengan aceiSign (ARB)
dan β blocker) Useful
(Dipiro, 2008). Dosis maksimum: ISDN 20 mg, 3-4
Not useful
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dengan acei (ARB)
dan β blocker)
Sheet Music
Hiperurisemia
Objektif : Kadar asam urat 13,5
You're
(Dipiro, 2008). Dosis maksimum: ISDN 20 mg, 3-4 x/hari (DIH, 2009)
Pasien mengalami kondisi hiperuricemia. Maka pasien membutuhkan obat untuk menurunkan kadaraasam urat Reading Preview tersebut.
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Alopurinol berinteraksi dengan loop diuretic. Penggunaan bersama allopurinol dan loop diuretic dapat meningkatkan kadar allopurinol di dalam darah.
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Plan : Terapi allopur sebany 100mg
Monitor Monito kadar a pasien.
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DAFTAR PUSTAKA
Aberg, J.A., Lacy,C.F, Amstrong, L.L, Goldman, M.P, and Lance, L.L. 2009. Drug Information Handbook , 17th edition. Lexi-Comp for the American Pharmacists. Association Dipiro, J.T., et al . 2008. Pharmacotherapy: A Pathophysiologic Approach, 7th Edition. Mc-Graw Hill. Hal 268
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