FARMAKOTERAPI ANTIHIPERTENSI
( PERAN FARMASIS )
Abdul Kadir Jaelani., S.Si., Apt., SpFRS
Instalasi Farmasi Rumah Sakit Daerah Bangil
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Epidemiologi
15 % BP TINGGI
Tak terkontrol
Tx
Usia
Ras
Pendidikan
dll
Kerusakan pembuluh darah
BP Di turunkan
Di turunkan secara farmakologis
Kerusakan pembuluh darah
menurun
Tunggal
Mekanisme
Tempat kerja
Toksisitas / ESO
Kombina
si
RASIONAL
BP menurun
Toksisitas / ESO rendah Kerusakan organ rendah
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Classification & Management
Pengukuran berulang terhadap BP
Sebab jarang ditemukan
HIPERTENSI
10 15 %
Asimptomatik
Akibat sering terlihat
Classification
Management
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Lifestyle
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TREATMENT
NONPHARMACOLOGIC
THERAPY
All patients with prehypertension and hypertension should
be prescribed lifestyle modifications, including :
(1) weight reduction if overweight
(2) adoption of the Dietary Approaches to Stop Hypertension
eating plan
(3) dietary sodium restriction ideally to 1.5 g/day (3.8 g/day
sodium chloride)
(4) regular aerobic physical activity
(5) moderate alcohol consumption (two or fewer drinks per day)
(6) smoking cessation.
Lifestyle modification alone is appropriate therapy for patients
with prehypertension. Patients diagnosed with stage 1 or 2
hypertension should be placed on lifestyle modifications and drug
therapy concurrently.
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Monitoring & Evaluation
BP evaluated 2 to 4 weeks after initiating or
making changes.
Once goals BP values are obtained, every 3
to 6 months, assuming no signs or
symptoms of acute target-organ disease.
More frequent evaluations are required in
patients with a history of poor control,
nonadherence, progressive target-organ
damage, or symptoms of adverse drug
effects.
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Monitoring & Evaluation
Monitoring for adverse drug effects should
typically occur 2 to 4 weeks after starting a
new agent or dose increases, and then
every 6 to 12 months in stable patients.
Patients should be questioned periodically
about changes in their general health
perception, energy level, physical
functioning, and overall satisfaction with
treatment.
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Resistant Hypertension
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THE ROLE OF WARD
PHARMACIST IN HOSPITAL
Yahaya Hassan, Pharm.D
Professor of Clinical Pharmacy
School of Pharmaceutical Sciences
Universiti Sains Malaysia
Penang,Malaysia
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Drug Related Problems
Identify potential or actual drug
related problems
Resolve actual drug related problems
Prevent potential drug related
problems
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WARDS PHARMACIST INTERVENTIONS
SCORING SYSTEM
0-1 no effect to negative effect
1 minor significance, any improved
standard of care
2 significant, improve standard of
care or optimize therapy
3 very significant, prevent major
toxicity and/or end organ damage
4 potentially life saving
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Evaluated each drug
Indication?
Yes
Effective?
Yes
Adverse effect?
No
Is cost an issue?
No
No
Yes
Yes
Discontinue and evaluate
Dose, initiate additional
or alternative agent
Dose, substitute with
less toxic alternative
Use generic, substitute
with less costly agent
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Evaluate entire drug
regimen
Duplicate therapy?
Yes
Discontinue and
evaluate
Drug interactions?
Yes
Change drug, dose,
schedule, or preparation
Can regimen be
simplified?
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Evaluate adherence
Can the patient or
caregiver administer
medications as
prescribed?
Provide written and
verbal instructions
Consider adherence aid
(medication dispenser
tablet splitter, spacer,
computerized/electronic
reminder systems)
Other educational
materials (videos, books)
Home health evaluation
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IMPLIKASI TERAPEUTIK
Tx antihipertensi
Tidak pada penyebab khusus
Pada gangguan terhadap
Mekanisme fisiologi normal
yg mengatur tekanan darah
Tdk ada keluhan
Tdk memberikan
kesembuhan langsung
Mencegah kerusakan organ
dan kematian
di masa yg akan datang
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PERAN FARMASIS
KRITIS
PROBLEM SOLVING
KOMUNIKATIF
RATIO = BENEFIT / RISK
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PROBLEM TERAPI ANTIHIPERTENSI
1.
2.
3.
4.
5.
6.
7.
Pengobatan jangka panjang
Tidak menghilangkan gejala penyakit
Terapi tidak konsisten
Poli farmasi
Efek samping jangka panjang
Efek toksik jangka panjang
Terapi individual
KEPATUHAN
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KESIMPULAN
1. Meningkatkan efektifitas terapi.
2. Menurunkan eso dan toksisitas.
3. Meningkatkan kepatuhan
KRITIS
BENEFIT
TROUBELSOLVING
KOMUNIKATIF
RISK
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