International Journal of Pharmacy Teaching & Practices (IJPTP)

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: [email protected] ISSN: 1986-8111

Vol 5, Issue 3

Supplement

2014

International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.

1020

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


1021

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


1022

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


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



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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


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 Ramatillah

2, Aprilita Rinayanti Eff

2

1Pharmacist Professional Program Student, Faculty of Pharmacy UTA'45 Jakarta 2Lecturer Pharmacy in Pharmacy Faculty University of 17 August 1945 Jakarta

(UTA’45 Jakarta)

Email : [email protected]

ABSTRACT

Ischialgia is pain sensation from lower back, pain from butt area, stiffness on lower

back6. 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 recover

8.

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.

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


1027

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.


1028

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


1029

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


1030

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.


1031

THE MONITORING OF DRUG THERAPY FOR CRF (Chronic Renal Failure)

PATIENT IN Dr. MINTOHARDJO, INDONESIAN NAVY MILITARY HOSPITAL

Ardiansyah1, Diana Laila Ramatillah

2, Aprilita Rinayanti

2


(UTA’45 Jakarta)


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

mailto:[email protected]


1032

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 ( 22-

23 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


1033

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


1034

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.


1035

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


1036

DIABETES MELLITUS TYPE II, and CHRONIC RENAL FAILURE

Arie Setiabudi Latif1, Diana Laila Ramatillah


2


(UTA’45 Jakarta)


ABSTRACT

Diabetes mellitus type 2 – formerly known as insulin-dependent diabetes mellitus (non-

insulin-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


1037

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,obesity-

related 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.


1038

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


1039

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

15 16 17 18 19 20 21 22 23 24 25 Nilai

Leukos

it

*

124

00

*

159

00

*

145

00

*

190

00

*

193

00

*

198

00

*

120

00

*

164

00

*

190

00

840

0

5000-

10000

Hb

*

11,6

*

11,4

*

11,7

*

11,7

*

10,1

*

9,9

*

6,6

*

10,8

*

5,5

Pria :

14-18

Ureum

*

192

*

14

1

*

232

*

198

*

215

17-43

mg/dl

Albumi

n

*

2,

7

*

2,6

3,5-

5,2

Protein

*

3,

6

*

5,5

6,6-

8,8


1040

Kreatin

in

*

4

*

3,

5

*

4,6

0,9-

1,3

GDS

*

204

*

18

8

*

304

*

276

*

169

*

178

80-

125

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


1041

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.


1042

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.

http://emedicine.medscape.com/


1043

DRUG RELATED PROBLEMS ASSOCIATED OF TREATMENT UROLITHIASIS

DISEASE PATIENT IN PGI CIKINI HOSPITAL

Bioty Wong1, Diana Laila Ramatillah


2

1Pharmacist Professional Program Student, Faculty of Pharmacy UTA'45 Jakarta

2Lecturer Pharmacy in Pharmacy Faculty University of 17 August 1945 Jakarta (UTA’45

Jakarta)

Email:[email protected]

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


1044

formation of organic substances 10

. Organic substances were surrounded by precipitated

minerals1. 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 vomit

1.

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


1045

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


1046

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


1047

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


1048

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.


1049

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.


1050

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 Eff

2


(UTA’45 Jakarta)


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 (complex-



1051

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).


1052

C. EXAMINATION OF VITAL SIGN

Date Of

Examination

Blood

Pressure

(120/80

mmHg)

Pulse

(60-

100x/menit)

circulation of

breath (14-

18x/menit)

body

temperature

(36-37⁰C)

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

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

(Tablet, 500 mg)

30-40

mg/kg/day

1000 1750 mg

1750

2000 mg

2000

Etambutol

(Tablet, 400 mg)

25 mg/kg/day 800 1200 mg

1200

1600 mg

1600

2000 mg

Kanamisin

(Vial, 1000 mg)

15-20

mg/kg/day

500 750 mg 1000

mg 1000 mg

500

Levofloksasin 750 mg day 750 mg 750 mg 750-1000 mg


1053

(Kaplet, 250 mg)

Sikloserin

(Kapsul, 250 mg)

15-20

mg/kg/day

500 mg 750 mg 750-1000 mg

Etionamid

(Tablet, 250 mg)

15-20

mg/kg/day

500 mg 750 mg 750-1000 mg

PAS

(Granula, 4 gr)

150 mg/kg/day 8 g 8 g 8 g

F. LINE TREATMENT For TBC6

Category I

Weight The intensive phase of each day for

56 days

The advanced stages, 3 times

a week for 16 weeks

INH, rifimpisin, etambutol,

pirazinamid

Rifampisin, INH

30-37 kg 2 tablet 4 FDC 2 tablet 4 FDC



≥71 kg 5 tablet 4 FDC 5 tablet 4 FDC

Category II

Weight 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




≥71 kg 5 tablet 4 FDC 5 tablet 4 FDC


1054

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

02/03/2

014

03/0

3/20

14

04/03

/2001

4

05/0

3/20

14

06/03

/2014

Leukosit 5 ~ 10 Ribu/mm3 14,29 16,88

Hitung Jenis

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


1055

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

Elektrolt

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 7,37

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


1056

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

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


1057

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


1058

BRONCHOPNEUMONIA IN PULMONARY DISEASE WARD

Delius Wonda, Diana Laila Ramatillah2, Aprilita Rinayanti Eff

2


(UTA’45 Jakarta)


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


1059

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 beri-

beri 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


1060

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 REFERENCE VALUE 18/3 19/3

HEMATOLOGY

Erythrocyte

Sedimentation Rate

< 20 mm/hour 28 28

Routine Hematology

Hemoglobin

13 – 18 g/Dl

11,6

Hematocrit 40 – 52% 34

Erythrocytes 4.3 – 6.0 million/μ L 3,8

Leukocyte 4,800 – 10, 800/ μ L 17200

Platelet 150,000 – 400,000/ μL 347000

MCV 80 – 96 fl 88

MCH 27 – 32 pg 30

MCHC 32 – 36 g/Dl 34

Total Bilirubin

Direct Bilirubin

Indirect Bilirubin

Fosfatase

< 1,5 mg/dL

<0,3 mg/dL

<1,1 mg/dL

56-119

1,92

0,86

1,06

85

SGOT < 35 U/L 54

SGPT

y-GT

< 40 U/L

8-61 U/L

33

50

Total Protein 6-8,5 g/dL 6,5

Albumin 3,5-5,0 g/dL 4,0

Globulin 2,5 – 3,5 g/dL 2,5

Total Cholesterol < 200 mg/dL 147


1061

Triglyserida < 160 mg/dL 66

HDL Cholesterol >35 mg/dL 54

LDL Cholesterol <100 mg/dL 80

Urea 20 – 50 mg/dL 62 61

Creatinine 0.5 – 1,5 mg/dL 1,7 2,2

Uric Acid 3.5 – 7.4 mg/dL

Fasting Blood Glucose 70 - 100 mg/dL

Blood Glucose (2 hours

PP)

<140 mg/dL 117 118

Sodium 135 – 147 mmol/L 131 137

Potassium 3,5 – 5,0 mmol/L 3,5 3,7

Clorida 95 – 105 mmol/L 97 97

URINALYSIS

Complete Urine

Ph

PCO2

PO2

Bicarbonate

Bases Excess

Saturation

4,6 – 8,0

33-44 mmHg

71-104 mmHg

22-29 mmol/L

(-2)-3 mmol/L

94-98 %

7,483

23,1

126,4

17,5

-4,3

96,5

5,5

Specific Gravity 1010 – 1030 1015

Protein Negatif -/Negatif

Glucose Negatif -/Negatif

Bilirubin Negatif -/ Negatif

Nitrite Negatif -/ Negatif

Ketones Negatif -/ Negatif

Urobilinogen Negatif – Positif 1 Negatif

Erythrocytes < 2 LPB 0-1-0

Leukocyte < 5/LPB 2-2-2

Cylinder Negatif/LPK -/Negatif

Cristal Negatif -/Negatif

Epithelial Positif +/Positif 1

Others Negatif -/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.


1062

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


1063

� 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


1064

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.


1065

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 Eff

2


(UTA’45 Jakarta)


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



1066

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)


1067

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


1068

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


1069

Guidline Hyperglicemic Type 2 9


1070

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 Value Reference value

Clinical chemistry

1 Natrium 141 mEq/L 135-147

2 Kalium 3,5 mEq/L 3,5-5,0

3 Kalsium 6,2 mg/dl * 8,5-10,0

4 Gula Darah Sewaktu 186 mg/dl * < 150 mg/dl


1071

e. Examination During Treatment

Table 2. Examination Lab

No Parameters 21-

May-14

22-May-

14

29-

May-

14

2

June

2014

3 June

2014

5

June

2014

6 June

2014 Reference value

1 Albumin 3,4 g/dl

3,3

g/dl 3,4-4,8

2 Ferritin 0,84

*mg/ml

Premenopouse :

6,9-282,5

Post : 14,0-233,1

Laki2 :

18-30 tahun :

18,7-323

31-60 tahun :

16,4-293,9

3 SGPT

26 u/L

0-35

4 Kreatinin

0,6 mg/dl

0,7

mg/dl 0,6-1,1

5 Glukosa darah

jam 06.00

133

mg/dl 70-150

6 Glukosa darah

jam 18.00 96 mg/dl

70-150

7 Glukosa darah

jam 24.00 116mg/dl

70-150

8 Glukosa darah

jam 11.00

129

mg/dl 70-150

9 Glukosa darah

jam 16.00

131

mg/dl 70-150

10 Glukosa darah

jam 06.00

114

mg/dl

100

mg/dl 70-150

11 Glukosa darah

jam 11.00

73

mg/dl

83

mg/dl 70-150

12 Glukosa darah

jam 16.00

118

mg/dl

167 *

mg/dl 70-150

13 Ureum

21

mg/dl 10-50

14 Natrium

137

meq/L 135-147

15 Kalium

4,2

meq/L 3,5-5,5


1072

16 Kalsium

8,4

*mg/dl 8,8-10,0

17 Anti H. Pyllori

Kualitatif 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. Simarc-

2 (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


1073

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.


1074

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.

http://www.bmj.com/content/bmj/340/bmj.c2541/F3.large.jpg


1075

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-globulin-

overview . Retrieved date of July 6, 2014.

14. Medscape, 2014 d. Drug Interaction. http://reference.medscape.com/drug-

interactionchecker . Retrieved July 9, 2014 date.

http://translate.google.com/translate?hl=en&prev=_t&sl=id&tl=en&u=http://guidelines.diabetes.ca/Browse/Chapter13

http://translate.google.com/translate?hl=en&prev=_t&sl=id&tl=en&u=https://www.mims.com/INDONESIA/drug/info/%2520Methycobal/

http://translate.google.com/translate?hl=en&prev=_t&sl=id&tl=en&u=https://www.mims.com/INDONESIA/drug/info/%2520Methycobal/

http://translate.google.com/translate?hl=en&prev=_t&sl=id&tl=en&u=https://www.mims.com/INDONESIA/drug/info/%2520Provelyn/%3Ftype%3Dbrief

http://translate.google.com/translate?hl=en&prev=_t&sl=id&tl=en&u=https://www.mims.com/INDONESIA/drug/info/%2520Provelyn/%3Ftype%3Dbrief

http://translate.google.com/translate?hl=en&prev=_t&sl=id&tl=en&u=http://www.webmd.com/cancer/tc/immune-globulin-overview

http://translate.google.com/translate?hl=en&prev=_t&sl=id&tl=en&u=http://www.webmd.com/cancer/tc/immune-globulin-overview

http://translate.google.com/translate?hl=en&prev=_t&sl=id&tl=en&u=http://reference.medscape.com/drug-interactionchecker

http://translate.google.com/translate?hl=en&prev=_t&sl=id&tl=en&u=http://reference.medscape.com/drug-interactionchecker


1076

STUDY IN DISEASE WARD CHRONIC RENAL FAILURE AND TYPE II

DIABETES MELLITUS

Deviyanti1, Diana Laila Ramatillah

2, Aprilita rinayanti Eff

2

1Student of Pharmacist Program, Faculty of Pharmacy UTA'45 Jakarta

2Lecturer of Faculty of Pharmacy UTA’45 Jakarta

[email protected]

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 end-

stage 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


1077

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


1078

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


1079

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.


1080

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.


1081

COMBINED DRUG RELATED PROBLEMS IN THE TREATMENT OF

TUBERCULOSIS (TB) AND PLEURAL EFFUSION SINISTRA

Dewi Masyitha1, Diana Laila Ramatillah


2


2Lecturer Pharmacy in Pharmacy Faculty University of 17 August 1945 Jakarta

(UTA’45 Jakarta)


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



1082

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:


1083

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 Lini 2

1. Categories 1, anti-tuberculosis drugs:

- Isoniazid

- Rifampicin

- Pyrazinamide

- Ethambutol

For 2 months (intensive phase) every day.

The next 4 months (continuation phase) with

Rifampicin and isoniazid 3 times a week.

2. Fixed-dose combination (fixed dose

combination).

This fixed dose combination comprising :

- Four antituberculosis drugs in one tablet, namely

rifampicin 150 mg, isoniazid 75 mg,

pyrazinamide 400 mg and 275 mg ethambutol.

- Three antituberculosis drugs in one tablet,

namely rifampicin 150 mg, isoniazid 75 mg and

400 mg pyrazinamide.

Categories 2 :

- Isoniazid

- Rifampisin

- Pirazinamid

- Etambutol

- Streptomisin

Every day for 2 months and then

with isoniazid, rifampin, and

ethambutol for 5 months 3 times a

week.

- Type any additional medication

(line 2):

- Kanamycin

- Quinolones

- Other drugs are under

investigation, macrolides

- Amoxicillin + clavulanic acid

- 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.


1084

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 Anti-

Tuberculosis 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.


1085

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.

http://www.persity.com/id/perspective/medical-conditions-disease/efusi-fleura


1086

DRUG RELATED PROBLEMS IN TREATMENT HEMODIALYSIS

ON CHRONIC RENAL FAILURE

Esther Jeniaty1, Diana Laila Ramatillah


2


(UTA’45 Jakarta)


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.


1087

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.


1088

Guidelines on the Treatment of Chronic Renal Failure patients Hipertensi5.

CLINICAL EVALUATION

Drug Related Problems (DRPs)

1. Drug selection

5 The use of combinations of antihypertensive drugs: amlodipine, Captropil,

bisoprolol,valsartan and clonidine4.

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

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 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.

.


1089

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


1090

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


1091

RELATED DRUG PROBLEM IN THE TREATMENT OF VERTIGO DISEASE

AND HYPERTENSION IN PGI CIKINI HOSPITAL

Fitriani1, Diana Laila Ramatillah


2


(UTA’45 Jakarta)


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:



1092

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 Results Reference value

glucose during

leukocytes *

LED

hemoglobin *

hematocrit *

erythrocytes

platelets

urea

creatinine *

total cholesterol

AST *

SGPT

sodium

calcium

chloride

HDL Cholesterol

LDL Cholesterol

122

12,600

2

11,5

34

3,91

234

22

12

170

35

29

144

4,5

103

65

98

< 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


1093

The results of examination of the patient's vital signs on 29 April- May 6, 2014 is :

Examination

/ date 29/04 30/04 01/05 02/05 03/05 04/05 05/05 06/05

Blood

tension pulse breathe

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 30-

May 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.


1094

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


1095

DRUG RELATED PROBLEM TREATMENT OF FEMORAL NECK FRACTURES

IN MINTOHARJO HOSPITAL

Fitriany JR1, Diana Laila Ramatillah


2


(UTA’45 Jakarta)


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



1096

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 short-

term 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


1097

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 11-

19 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.


1098

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 5-

10 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 anti-

pain 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,


1099

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.


1100

PHYSIOTHERAPY STUDY ISCHIALGIA

Fitriani1, Diana Laila Ramatillah


2


(UTA’45 Jakarta)


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



1101

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: 37-

42%), 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: 50-

70%), 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:


1102

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 anti-

inflammatory, 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


1103

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.


1104

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.


1105

TREATMENT OF THE CHRONIC KIDNEY DISEASE (CKD) PATIENT IN THE

PGI HOSPITAL CIKINI JAKARTA

Francisca Linawati Moeljono1, Diana Laila Ramatillah


2


(UTA’45 Jakarta)

Email: [email protected]

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.



1106

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.


1107

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. Drugs Giving method Dose Indications

1. LEVOFLOXACIN PO 1X500mg daily 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


1108

CLINICAL LABORATORY VALUES

Type of examination Result Unit Normal value

Hemoglobin 11,8 g/dL 13,0-16,0

Hematocrit *32 % 40-48

Leukocytes 37600 10^3 µL 5,0-10,0

Platelets 199 10^3 µL 150-450

Reticulocyte *160.000 µg/L 5 – 15

Type of examination Result Unit Normal value

Freezing period 10,11 minutes 10,0 – 16,0

APTT 53,7 second 26,4 – 37,5

PT 14,2 second 11,0 – 14,2

INR 1,2

Fibrinogen 271 mg/dL 180 – 350

Total Protein 5,9 g/dL 6,0 – 8,0

Albumin 2,1 g/dL 3,4 – 4,8

Globulin 3,8 g/dL 1,3 – 3,7

Urea 132 mg/dL 10 – 50

Creatinine 4,1 mg/dL 0,6 – 1,1

Urid acid 6,5 mg/dL < 6,8

Sodium 129 mmol/L 135 - 147

Potassium 3,6 mEq/l 3,5 – 5,0

GUIDELINE PAIN


1109

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


1110

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.


1111

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


1112

DRUG RELATED PROBLEMS OF BLADDER CANCER SUSPECT IN

SURGICAL WARD PGI CIKINI HOSPITAL

Haerul Syam1, Diana Laila Ramatillah


2


2Lecturer Pharmacy in Pharmacy Faculty University of 17 August 1945 Jakarta

(UTA’45 Jakarta)


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 red

8.

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


1113

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 limfogen

2.

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


1114

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 Results

30 – 04 –

2014

Unit Normal

Value

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 (Lee-

White)

Period protombin / INR

Protombin period (PT)

PT Patients

PT Control

H 20

L 7,3

5,8

L 3,38

L 24

13

H 2

H 13

L 1

L 47

27

H 10

213

L 70

L 21,6

L 30,8

3

11 – 12

H 14,3

12,8

1,2

mm/ja

m

g/dL

10^3μL

10^6μL

%

Permil

%

%

%

%

%

%

10^3μL

fL

pg

g/dL

Menit

Menit

Detik

Detik

0 – 10

13,0 – 16,0

5,0 – 10,0

4,50 – 5,50

40 – 48

5 – 15

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


1115

INR

Examination Results

01 – 05 –

2014

Unit Normal

Value

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

H 43

L 7,3

8,1

L 3,52

L 25

12

H 2

H 15

L 0

L 49

24

H 10

210

L 70

L 21,3

L 30,4

mm/ja

m

g/dL

10^3μL

10^6μL

%

Permil

%

%

%

%

%

%

10^3μL

fL

pg

g/dL

0 – 10

13,0 – 16,0

5,0 – 10,0

4,50 – 5,50

40 – 48

5 – 15

0 – 1

1 – 3

2 – 6

50 – 70

20 – 40

2 – 8

150 – 450

81 – 92

27,0 – 32,0

32,0 – 37,0

Examination Results

02 – 05 –

2014

Unit Normal

Value

Complete Peripheral

Blood

Erythrocyte

sedimentation rate

Hemoglobin

Leukocytes

Erythrocytes

Hematocrit

Retikolosit

Calculate Type

Leukocytes

Basophils

Eosinophils

Neutrophils Trunk

Neutrophils Segment

H 23

L 9,6

8,1

L 4,17

L 30

L 7

1

H 12

L 0

65

L 14

8

237

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

0 – 1

1 – 3

2 – 6

50 – 70

20 – 40

2 – 8

150 – 450


1116

Lymphocytes

Monocytes

Platelets

MCV

MCH

MCHC

L 72

L 23

32,1

10^3μL

fL

pg

g/dL

81 – 92

27,0 – 32,0

32,0 – 37,0

Examination Results

01 – 05 –

2014

Unit Normal

Value

Complete urinalysis

Density

Color

Clarity

Leukocyte esterase

Nitrite

Blood

pH

Proteins

Glucose

Bilirubin

Urobilinogen

Ketones

Sediment

Leukocytes

Erythrocytes

Epithelial

Cylinder

Bacteria

L 1,010

Yellow

Clear

Negatif

Negatif

Negatif

7,0

Negatif

Negatif

Negatif

0,2

Negatif

1

0

0

0

H 2362

g/mL

/LPB

/LPB

/LPB

/LPK

/LPB

1,015 – 1,025

Yellow

Clear

Negatif

Negatif

Negatif

4,8 – 7,4

Negatif

Negatif

Negatif

< 0,2

Negatif

0 – 2

0 – 3

0 – 1

0 – 1

< 5

Table 2. Examination of blood pressure

Date Blood Pressure

Systole and Diastole

at

04.00

at

12.00

at

20.00

30 april 2014 S - - 130

D - - 70

01 may 2014 S 130 130 150

D 80 80 100

02 may 2014 S 130 176 120

D 80 93 58

03 may 2014 S 153 140 140

D 80 90 90


1117

04 may 2014 S 140 140 150

D 80 80 80

05 may 2014 S 120 160 160

D 90 110 90

06 may 2014 S 140 120 120

D 90 80 80

07 may 2014 S 110 110 110

D 80 70 70

08 may 2014 S 110 110 100

D 80 80 80

Table 3. Laboratory of Chemical clinic

Examination Results

02 – 05 –

2014

Unit Normal Value

Sodium, Potassium

Sodium (Na) blood

Potassium (K)

blood

Calcium (Ca)

142

4,1

8,4

mEq/L

mEq/L

mg/dl

135 – 147

3,5 – 10,3

0,8 – 10,3

Examination Results

03 – 05 –

2014

Unit Normal Value

Sodium, Potassium

Sodium (Na) blood

Potassium (K)

blood

Calcium (Ca)

142

3,8

8,4

mEq/L

mEq/L

mg/dl

135 – 147

3,5 – 10,3

0,8 – 10,3

Table 4. Profile Dispensing

Name of

Medication

Date

30/4 1/5 2/5 3/5 4/5 5/5 6/5 7/5 8/5

Ceftriaxone 1

gram

- - 2 x 1 2 x 1 2 x 1 2 x 1 2 x 1 2 x 1 2 x 1

Torasic 30 mg - - 2 x 1 2 x 1 2 x 1 2 x 1 2 x 1 2 x 1 2 x 1

Vomizole 2 x 1

flc

- - 2 x 1 2 x 1 2 x 1 2 x 1 2 x 1 2 x 1 2 x 1


1118

Kalnex 500 mg - - 3 x 1 3 x 1 3 x 1 3 x 1 3 x 1 3 x 1 3 x 1

Vit. K 2 x 1 amp - - 2 x 1 2 x 1 2 x 1 2 x 1 2 x 1 2 x

1

2 x 1

Cernevit 1 x 1

amp

- - 1 x 1 1 x 1 1 x 1 1 x 1 1 x 1 1 x

1

1 x 1

Urecolin 2 x 1

tab

- - - 2 x 1 2 x 1 2 x 1 2 x 1 2 x

1

2 x 1

Angioten 25 mg - - - 1 x 1 1 x 1 1 x 1 1 x 1 1 x

1

1 x 1

Folic iberet 3 x 1

tab

- - - 3 x 1 3 x 1 3 x 1 3 x 1 3 x

1

3 x 1

Infusion

tutofusin

- - 2 btl 2 btl 2 btl 2 btl 2 btl 2 btl 2 btl

Infusion asering - - 1 btl 1 btl 1 btl 1 btl 1btl 1 btl 1btl

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


1119

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.


1120

DRUG RELATED PROBLEMS ASSOCIATED AND TREATMENT FOR

CERVICAL CANCER IN INTERNAL MEDICINE WARD IN PGI CIKINI

HOSPITAL

Hendra Rahman1, Diana Laila Ramatilla


2

1Pharmacist Professional Program Student, Faculty of Pharmacy UTA'45 Jakarta 2Lectuter Pharmacy in Pharmacy Faculty University of 17 August 1945 Jakarta

(UTA ’45 Jakarta)


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



1121

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 1. Ketorolac is used as the management of acute pain is

severe short-term (<5 days) 1.

ketoprofen used for rheumatoid arthritis, osteoarthritis,

spondylitis, and acute articular disorder, fibrosis, cervical spondylitis, low back pain,

painful musculoskeletal conditions 3.


1122

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 DIAGjava.lang.StackOverflowError

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International Journal of Pharmacy Teaching & Practices (IJPTP)

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