peresepan 2013
DESCRIPTION
aktTRANSCRIPT
Mr Good Day, 25 y male, with productive cough for a week
Rales in hemithorax dextra, x ray: infiltrates, sputum: coccus gram +
Dx ? Tx ? Prescription ?
Ms Communi Cation, 72 y female with long standing hypertension
Treatment: nifedipin 3x10 mg Px: BP 170/100 mmHg, pulse 88 x/mnt reg,
cardiomegali, no basal rales. Px ? Tx ? Prescription ?
Mr Best Zer, 45 y male, dysuria & ↑ frequency for 5 days
Costovertebral angle flank pain – dextra Lab ? Dx ? Tx ? prescription
4A Influenza Asma bronkial Bronkitis akut Pneumonia,
bronkopneumonia Tuberkulosis paru tanpa
komplikasi3A Bronkiektasis Tuberkulosis dengan HIV Emfisema paru Abses paru
3B Acute Respiratory Distress
Syndrome (ARDS) SARS Flu burung Status asmatikus (asma
akut berat) Pneumonia aspirasi Efusi pleura masif Penyakit Paru Obstruksi
Kronik (PPOK) eksaserbasi akut
Edema paru
4A Hipertensi esensial3B Syok (septik, hipovolemik,
kardiogenik, neurogenik) Angina pektoris Infark miokard Gagal jantung akut Takikardi: supraventrikular,
ventrikular Fibrilasi ventrikular Atrial flutter Kor pulmonale akut Ensefalopati hipertensi
3A Gagal jantung kronik Fibrilasi atrial Ekstrasistol
supraventrikular, ventrikular Kor pulmonale kronik Hipertensi sekunder Tromboflebitis Limfangitis Limfedema (primer,
sekunder) Insufisiensi vena kronik
4A Kandidiasis mulut Ulkus mulut (aphtosa,
herpes) Gastritis Gastroenteritis (termasuk
kolera, giardiasis) Refluks gastroesofagus Demam tifoid Keracunan makanan Penyakit cacing tambang Strongiloidiasis Askariasis Skistosomiasis Taeniasis Hepatitis A Disentri basiler, disentri
amuba Hemorrhoid grade 1-2
3B Lesi korosif pada esofagus Perdarahan gastrointestinal Botulisme3A Esofagitis refluks Ulkus (gaster, duodenum) Malabsorbsi Hepatitis B Abses hepar amoeba Perlemakan hepar Divertikulosis/divertikulitis Kolitis Irritable Bowel Syndrome Proktitis
4A Infeksi saluran kemih Pielonefritis tanpa
komplikasi
3A Glomerulonefritis akut
(Anak) Glomerulonefritis kronik
4A Infeksi saluran kemih
bagian bawah Anemia defisiensi besi pada
kehamilan
3B Infeksi pada kehamilan:
TORCH, hepatitis B, malaria
4A Diabetes melitus tipe 1 Diabetes melitus tipe 2 Hipoglikemia ringan Malnutrisi energi-protein Defisiensi vitamin Defisiensi mineral Dislipidemia Hiperurisemia Obesitas
3B Ketoasidosis diabetikum Hiperglikemi hiperosmolar Hipoglikemia berat Tirotoksikosis Cushing’s disease Krisis adrenal Sindrom metabolik (3B?)3A Diabetes melitus tipe lain
(intoleransi glukosa akibat penyakit lain atau obat-obatan)
Hipoparatiroid Hipertiroid Goiter
4A Anemia defisiensi besi Limfadenitis Demam dengue, DHF Malaria Leptospirosis Reaksi anafilaktik Tetanus HIV AIDS tanpa komplikasi3B Bakteremia Dengue shock syndrome Sepsis Malaria serebral Rabies
3A Anemia hemolitik Anemia makrositik Limfadenopati Toksoplasmosis AIDS dengan komplikasi Lupus eritematosus
sistemik Polimialgia reumatik Demam reumatik (Anak) Artritis reumatoid Artritis, osteoartritis Osteoporosis Tenosinovitis supuratif
Prescription sheet
Prescribing doctor: Physician's name, degree and address (phone, license no.)
Date of prescription / treatment R/ Prescription drug(s): name of drug, form, number,
dosage Full name of patient (no nicknames) for whom
drug is prescribed, age, body weight
Rational approach to therapeutics Define the patient’s problem Specify the therapeutic objective Selecting therapeutic strategies
Non-pharmacological treatment Pharmacological treatment
Selecting the correct group of drugs Selecting the drug from the chosen group Verifying the suitability of the chosen pharmaceutical
treatment for each patient Prescription writing Giving information, instructions and warnings Monitoring treatment
Variation in dose response
Drug formulation Body weight and age Physiological and pharmacokinetic variables Drug distribution Drug metabolism and excretion Pharmacodynamic variables Disease variables Environmental variables
Geriatric Patients
They experience an increased incidence of adverse drug effects
There is an increased likelihood that the patient will respond atypically to a given drug Enhanced effect Diminished effect Unexpected adverse effect
~ Age-related pharmacokinetic & pharmacodynamic changes, be aware of nonpharmacologic problems
… Geriatric Patients
Age-related : physiologic changes in renal function physiologic changes in liver function changes in the CNS changes in protein binding changes in body composition
…Geriatric Patients
High incidence of adverse effects in the elderly
Drug-drug interactions Multiple chronic diseases require several
medications→ ddi & becomes difficult to manage Visit different providers for care & obtain meds at
different pharmacies Medications considered inappropriate : risk >
benefit
Adverse Drug Reaction
An adverse drug reaction: a drug response that is noxious or unintended and occurs at prophylactic, diagnostic, or therapeutic doses
Adverse Drug Reaction…
Major factors predisposing to adverse effects Extremes of age
Can present atypically in the elderly ex. symptoms from constipation confusion
Intercurrent illness Drug interactions
Direct association: age ~ medication use Strong relationship: number of medication ~ incidence of
adverse reactions Incompatibilities between drugs and intravenous fluids Adverse effects caused by traditional medicines The effect of food on drug absorption
Polypharmacy
The use of multiple medications: 3-5, >9 medications/day The administration of more medications than clinically
indicated Risk factors: increased
increased age increased number of physicians and pharmacies increased number of office/hospital visits decline in health status the influence of pharmaceutical industry advertising
…Polypharmacy
Contributing factor: tx of an adverse effect of one drug w. another medication
Polypharmacy increases the risk of ADR drug interactions medication noncompliance decline in medical status Increase in health care costs
Can be prevented: communication & education
Polypharmacy in geriatric patient Obtain a geriatric drug history If an adverse effect occurs, don’t add a drug. Take
one away Discontinue all drugs deemed unnecessary or of
questionable therapeutic efficacy Identify the overtreated patient Employ nonpharmacologic treatments whenever
feasible
Adherence (compliance) with drug treatment
Patient reasons Disease reasons Doctor reasons The doctor-patient interaction Prescription reasons Pharmacist reasons The health care system
Recommendations
Review the prescription to make sure it is correct. Quiz the patient periodically to see if medication is being
taken correctly Observe the patient Reevaluate the regimen periodically
Spend time explaining the health problem and the reason for the drug.
Establish good rapport with the patient. Explore problems, for example difficulty with reading
the label or getting the prescription filled. Utilize nonchildproof containers if necessary
Recommendations…
Encourage patients to bring their medication to the clinic, so that tablet counts can be done to monitor compliance. Inspect the contents of the patient’s medication bottles
Encourage patients to learn the names of their medicines, and review their regimen with them. Write notes for them.
Keep treatment regimens simple. Consider combination agents when medically (and
financially) appropriate Attempt to treat specific conditions with monotherapy or
groups of disease with the same medication
Compliance
Don’t assume that every patient can remember a complicated medication regimen
Avoid qid and tid regimens if possible
Recommendations…
Communicate with other health care proffessionals, to develop a team approach and to collaborate on helping and advising the patient.
Involve the partner or another family member. Listen to the patient.