Download - 2014 p drug
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dr. Zulkarnain R. MSi
Dep. Farmakologi & Terapeutik,Fakultas Kedokteran
Universitas Sumatera
Utara
13 Oktober 2014, KK!F"M#$, FK USU
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U&'"& (#&$#R)*" dan $OK*
penderita Dokter
keluhan
keluhan
gejala
penyakit
gejala
OBAT
OBAT
OBAT
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diarrheadiarrhea
anti!
mi+robialaents
feverfever
anxietyanxiety
coughcough
insomniainsomnia
etc,etc,etc,etcetc,etcetcetc
cryingcrying dyspneadyspnea
anti!
mi+robialaents
anti!
mi+robialaents
anti!
mi+robialaents
anti!
mi+robialaents
anti!
mi+robialaents
+i-ro
-enem
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Sakit ke-ala
Sakit ii
isulan
&eri /aid
Rematik
'out
(onstan
oltaren
Femina
)ra-anelebre
&ovalin
DangerousDangerous
Doctor ?Doctor ?
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Sakitii
"sammeenamat
PegalPegal
LinuLinu
NyeriNyeribisulbisul
NyeriNyerihaidhaid
&eridada
etc,etc,etc,etcetc,etcetcetc
Sakit ?Sakit ? SakitSakitin-partuin-partu
"sammeenamat"sam
meenamat
"sammeenamat"sam
meenamat
"sammeenamat"sam
meenamat
"sammeenamat
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pakah !" ?pakah !" ?
#eluhan sama,#eluhan sama,
Diagnosa sama,Diagnosa sama,
" " " " " " " " " " diterapi dengan obat" " " " " " " " " " diterapi dengan obatyang sama?yang sama?
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$ational prescription %&'(,)**+
(atient re+eivea--ro-riate medi+ines
a++ordin to t/eir+lini+al needs
at an a--ro-riatedosae,
administration duration
and in a 5at/at en+ouraes
t/e -atient +om-lian+eand
at t/e lo5est +ost
to t/e +ommunit
"--ro-riate -atient( Tepat Pasien )
"--ro-riate indi+ation( Tepat ndikasi )
"--ro-riate dru( Tepat O!at )
"--ro-riate dosae,administration duratio
(Tepat dosis, "ara & lama pem!erian)
"--ro-riate inormation( Tepat n#ormation )
"--ro-riate +ost
( Tepat !iaya )
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#asus Laki-laki, 32 tahun, datang ke dokter dengan keluahan batuk,
berdahak warna hijau, mual, demam dan pegal linu. Dari pemeriksaan tensi 130/! mm"g, nadi 112 #/menit reguler,
rhon$hi kering %&', didiagnosa $(N.'/0/S, diberi resep(
) .odein 0ab %12
) Levofloxacin 0ab %)+
) Parasetamol 0ab %)+) *etaph+l * ab %10'
) albutamol ab %30'
) ntasida +rup %1'
) 3etil Prednisolon 0ab %12
) *anitidin ab %20'
) entolin 2,! ml %3'
) ierron ab %10'
) erote$ nh. %1'
dakah +ang irrasional, aneh ataulucu
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&hat is a P-Drug?
- a drug that is read+ or a$tion
- a drug +ou are going to use regularl+
and with whi$h +ou be$ome amiliar.
- a drug o irst $hoi$e or a $ommon $onditionNot a drug for an individual patienthe 4-drug $on$ept in$lude(
- the name o the drug
- the dosage orm- the dosage s$hedule
- the duration o treatment
#or a#or aspe"i$"spe"i$"
"onditio"onditio
nn
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Sele+tin our (6ersonal7drus
%uidelines #or sele"ting Pdrugs'tep i ' De$ne the diagnosis
tep ii ' pe"i#y the therapeuti" o!je"ti*e
tep iii' Make an inventor oe8e+tive
rou- o drus
tep i*' +hoose an ee"ti*e groupa""ording to "riteria
tep *' +hoose a Pdrug
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$)"'&OS)S
F"9S# ORR#* )&S#UR#
F"9S#"SSUM(*)O&
:
)M"')&"*)O&
$#F#&S)#*%#R"(;
)RR"*)O&"9)*;:
"$#RS# R#"*)O&S )&R#"S#$
-+/+A O/0
O1 2T3 DA%/OT+ TOO
-T31O4%3 +5/TF+ O16+5/TF+7 A1%485/T
-D14% /D4T10 FA+TAT/% 6+5/TF+7 8A%/ATO/- PAT5/T9 P15415
-8O15 D14% 45D T3A/ /55D5D
DO+TO1 '-P1D5-P1OFT-%/O1A/+5
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Standard o-eratin-ro+edure 6SO(7
-Anamnesis-Pemeriksaan-Diagnosis
tentukan -roblema utamapenderita yang
merupakan sasaran pengo!atan-Pemilihan o!at-Pengo!atan-5*aluasi
(#$OM"& (#&'O"*"&
(#$OM"& $)"'&OS)S
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Step )" Define the patient4 problem
Laki-laki, 32 tahun, datang ke dokter dengankeluahan batuk, berdahak 5arna hi6au, mual,demamdan pegal linu.
Dari pemeriksaan tensi 130/! mm"g, nadi ))7#/menit reguler, ronchi kering %&', didiagnosa$(N.'/0/S.
pakah problema utama pada pasien ini) Yang dapat mematikan ) 5eluhan +ang tak mengenakkan %batuk, demam') akikardi) /nfeksi
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(enunaan "&*))O*)K" anrasional
SO(
)&F#KS)
"&*))O*)K"
$OS)S (#M#R)"&
#"9U"S)
KU9*URS#&S)*))*;
*#S*
#$U"*#$'U#SS
*%#R"(;
kekebalan kumaneek sam-in/ara
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3anifestation of /nfection
Local /nflammation
initial and sometimes
inal response
6hat is obser7ed) wound margins
) e#udates
) sensations) skin temperature
Systemic /nflammation
atigue,
malaise,
anore#ia,
m+algia,
arthralgia, and
e7er
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ntimicrobial Policies8 .lassification
8irst-$hoi$e antimi$robials %non-restricted use' 9sed b+ all pres$ribers without appro7al b+ senior pres$ribers ae, ee$ti7e, reasonabl+ pri$ed antimi$robials
$estricted use 8or more serious $lini$al $onditions under $ertain $onditions
Less sae, more e#pensi7e, newer antimi$robials :onditions $ould in$lude the ollowing( pe$ii$ ine$tions known to be sensiti7e to the antimi$robial
medi$ine ater $ulture and sensiti7it+ testing ;mpiri$al treatment or suspe$ted lie-threatening ine$tions
pending the result o $ulture and sensiti7it+
:ounter-signature b+ a senior ph+si$ian appro7ed b+ D: *eser7e antimi$robials %very restricted use' 8or lie-threatening ine$tions known to be resistant to other
antimi$robials ppro7al needed b+ the D: or mi$robiologist
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Step 78 Specify the therapeutic ob6ective
Laki-laki, 32 tahun, dengan keluahan batuk, berdahak
warna hijau, mual, demam dan pegal linu, takikardi
ron$hi kering %&', didiagnosa $(N.'/0/S.
4roblema utama infeksi
6hat will be +our therapeuti$ obje$ti7e) Redakan batuk?
) Turunkan suhu tubuh
) Redakan takikardi?
) Enyahkan kuman patogen ANTIBIOTIK.
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Step 18 9erify the suitability ofyour P - drug
1re the a$ti7e substan$e and dosage ormsuitable
:ffective< ndi$ation%drug reall+ needed
:on7enien$e %eas+ to handle' Safety < ide-ee$ts, $ontraindi$ation %high risk groups, other diseases' ntera$tion %drugs, ood, al$ohol'
.ost < t is alwa+s an important $riterion. lwa+s look at the total $ost otreatment rather than the $ost per unit
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(ertimbanan dalammenentukan obat -ili/an
:fficacy %khasiat' /ndikasi
Safety %keamanan' :fek samping0olerability,Suitability #ontra indikasi
.ost, Price %harga' #etersediaan
Pri"e, al:ays look at the total "ost o# treatment rather than the "ost per
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%o5 to sele+t t/ea--ro-riate dru
;. 23O 8anual
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the concept of selecting P-drug
give values to the worst drug irst,
) the drug we 5ould never prescribe
) gi7e it a 7alue a$$ording to the $riteria morin %=3'
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Tempat in#eksiTempat in#eksi
Tipe in#eksiTipe in#eksium!er in#eksium!er in#eksi
P:$0/3N;N P:3/L/'NN0//(0/#
=eadaan klinis pasien=eadaan klinis pasien
Faktor o!atFaktor o!at>>
anti!iotikanti!iotikensiti*itas kuman terhadapensiti*itas kuman terhadap
anti!iotikanti!iotik
a+teria b Site o
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a+teria b Site o)ne+tion
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the concept of selecting P-drug
5ould never prescribe ascending on the values or the better drugs $(N.'/0/Swith P$(D
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S*#(S rame5orkmm3g, nadi ;;< C>menit reguler, ron"hi kering (), didiagnosa RO&%)*)S
AndansetronAndansetron
$amipril$amipril
@i$ardis %@i$ardis %telmisartantelmisartan'':lopidogrel:lopidogrel
spiletspilet
?operten %?operten %lisinoprillisinopril
mlodipinmlodipin@elo#i$am@elo#i$am
E ter!aik, termurah, tersedia di pasaran
; ter!uruk, termahal, tak tersedia
ntibiotics :ff Saf Suit Price 0otal
@AB:LL? 3 C C C )+
;?@:? C 1 C 2 11
@;*A?DEAL 1 3 C 3 11
A8LAB:? C 3 3 3 )1
L;A8LAB:? C 2 3 1 10
;*:F:L? 2 3 C C )1:A*@ABEAL 2 2 C C 12
*8@4:? 1 2 C C 11
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$osaereimen
+on"entration
*s time in-lasma +on"entration
*s time insite o
ine+tion
"ntibioti+e8e+t vs time
+on"entration*s time intissue and
otherbod =uids
(/arma+oloi+or toi+oloi+
e8e+t
Relations/i- bet5een (Kand ($
-/arma+odnami+s-/arma+okineti+s
A!sorptionProtein !indingDistri!utionBiotrans#ormation5C"retion
+raig 2A. Pharma"okineti">pharma"odynami" parameters'
1ationale #or anti!a"terial dosing o# mi"e and men. +lin n#e"t Dis.
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($ -arameters -redi+tiveo out+ome
4arameter$orrelating
with ei$a$+0=3/.
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#asus Laki-laki, 32 tahun, datang ke dokter dengan keluahan batuk,
berdahak warna hijau, mual, demamdan pegal linu. Dari pemeriksaan tensi 130/! mm"g, nadi 112 #/menit reguler,
rhon$hi kering %&', didiagnosa $(N.'/0/S, diberi resep(
) .odein 0ab %12
) Levofloxacin 0ab %)+
) Parasetamol 0ab %)+) *etaph+l * ab %10'
) albutamol ab %30'
) ntasida +rup %1'
) 3etil Prednisolon 0ab %12
) *anitidin ab %20') entolin 2,! ml %3'
) ierron ab %10'
) erote$ nh. %1'
ntibiotik +ang $S/(NL
moxicillin IDosis dan $ara pemberian
> x +22 mg ==7 x )222 mg
5alau dari uji kepekaan
din+atakan levofloxacinpaling sensiti, maka dosis dan
$ara pemberiann+a
+ x >22 mg 7 x )222 mg
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Ste- 4< >rite a-res+ri-tion
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Ste- ?< 'ive inormation,instru+tion and 5arnin
1.Effects of the drug:- wh+ the drug is needed- whi$h s+mptoms will disappear, whi$h will not- when the ee$t is e#pe$ted to start- what will happen i the drug is not taken $orre$tl+
2.Side-effects:- what side ee$t will o$$ur- how to re$ogniGe them- how long, how serious- what a$tion to take
3.nstructions:- how and when the drug should be taken- how long the treatment should $ontinue- how long the drug should be stored- what to do with the let-o7er drug
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Ste- ?< 'ive inormation,instru+tion and 5arnin
!."arnings:
- when the drug should not be taken
- what is the ma#imum dose
- ull treatment $ourse should be taken
#.$uture consu%tation:- when to $ome ba$k %or not'
- when to $ome ba$k earlier
- what inormation the do$tor will need then
&.E'er(thing c%ear?- sk the patient whether e7er+thing is understood
- sk the patient to repeat the most important inormation
- sk whether the patient has an+ more Huestion
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Ste- @< Monitor 6and sto-A7t/e treatment
6as the treatment ee$ti7ea. Fes, and disease $ured
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Sele+tin our (6ersonal7drus
%uidelines #or sele"ting Pdrugs'tep i ' De$ne the diagnosis
tep ii ' pe"i#y the therapeuti"
o!je"ti*etep iii' 8ake an in*entory o# ee"ti*e
group o# drugs
tep i*' +hoose an ee"ti*e groupa""ording to "riteria
tep *' +hoose a Pdrug
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s 4-Drug the same e7er+where
4-Drug is dier - rom $ountr+ to $ountr+
- rom $ompan+ to $ompan+
- rom area to area;;?(
- rom do$tor to do$tor
230 JJJbecause varying in:= availability and cost of drugs= dierent country formularies and essential
drug list medi"al "ultures and inter retation
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Discharge 3edication ;uidelines forthe Secondary Prevention of .9
Disorders8
.oronary rtery Disease(
1. spirin2. Jtatin/"mK
ie sim'astatin ator'astatin pra'astatin/
Target 0*0 1 mgd%3. eta lo$ker i @
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Discharge 3edication ;uidelines forthe Secondary Prevention of .9
Disorders8
'eart @ailure %;8 > C!'
1. :; nhibitor %titrated to ma#imiGedosage'
2. eta lo$ker %initiated and titrated as
outpatient when patient is eu7olemi$'3. pironola$tone %:lass , "8'
C. %Digo#in, diureti$s or s+mptoms'
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Discharge 3edication ;uidelines forthe Secondary Prevention of .9
Disorders8
trial @ibrillation
1. 6ararin 4atients older than M! +o
4atients with stru$tural heart disease
itrate to ?* 2.0 ) 3.0 All medications should be prescribed at time
of discharge unless a contraindication existsand is documented
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:stimated enefit to the'eart @ailure Patient Population
++2 readmissions are preventedper+ear
A 7,>B2,222 are sa7ed based on a7oidedreadmissions
11) lives are saved per year
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:stimated enefit to the.D Patient Population
>12 readmissions are preventedper+ear
ignii$ant $ost sa7ings
>12 lives are saved per +ear
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;ou Manae;ou Manae>/at ;ou Measure>/at ;ou Measure
$o &ot Measure$o &ot Measure
>/at ;ou >ill &ot>/at ;ou >ill &ot
ManaeManae
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Pertimbangan dalammenentukan analgetik pilihan
nalgesic :fficacy Safety.ontra-
indication .ostvailability
formulaSumscore
4ara$etamol 3 C C C C )*
buproen 3 2 2 C C 1!
@elo#i$am 3 1 1 2 C 11
:ele$o#ib 3 1 1 1 C 10
:odeine 2 3 3 3 C 1!@orphine C 0 3 1 2 10
@ the :orst, eCpensi*eK LLL.K E the !est, "heapest
akilaki, < tahun, M)"9')". tensi
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Pertimbangan dalammenentukan obat pilihan
;rup drug%analgesic
:fficacy Safety.ontra-
indication .ostvailability formula
Sumscore
4ara$etamol 0 C C C 0 12
buproen 2 3 C C 0 13
Di$loena$ 3 3 C 3 C 1N
:ele$o#ib 1 1 C 0 0 M
:odeine 3 3 C 3 0 13@orphine C 0 C 1 C 13
@ the :orst, eCpensi*eK LLL.K E the !est, "heapest
4"ok (
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S0:PS frame5ork8n example of ho5 to select a P-drug for a ptlaki2, 32 tahun, 220/)+2mm"g, nadi 120 #/mnt, naaspendek, wajah hitam, e#tremitas dingin, 4 paru bawah
melemah
problema utama( diastoli$ h+pertension
$RU'B #8 Sa e
Suit (ri+e
"vail
Al#a!lo"ker E ; < < ;
A+5inhi!itor < ? E ? E
A1B ; E ? ; ?
+a +hannelBlo"ker
? < ; E E
E ter!aik, termurah, tersedia di pasaran; ter!uruk, termahal, tak tersedia