LITERATUR REVIEW

JURNAL 1
International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-
1552.

DRUG RELATED PROBLEMS IN TREATMENT HEMODIALYSIS ON CHRONIC

RENAL FAILURE

Esther Jeniaty1, Diana Laila Ramatillah2, Aprilita Rinayanti Eff2 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 : oktavianafarmasi@yahoo.co.id

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 final. 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 terminal. 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.

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. .

CLINICAL EVALUATION

Drug Related Problems (DRPs)

1. Drug selection

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

bisoprolol,valsartan and clonidine. 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 ARB.

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 problems.

b) Bisoprolol and clonidin Cardioselektiv use of beta blockers and centrally acting alpha
agonists may lead to rebound hypertension and there is potential for interaksi. Pharmacist
advice: To avoid interaction and rebound hypertension need to be monitoring the use of both
drugs.

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 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

JURNAL 2
International Journal of Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-
1552.

DRUG RELATED PROBLEM TREATMENT OF FEMORAL NECK FRACTURES

IN MINTOHARJO HOSPITAL

Fitriany JR1, Diana Laila Ramatillah2, Aprilita Rinayanti Eff2 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 : ranhiejr@gmail.com

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 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 shortterm 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 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 1119 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.

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 510 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 antipain 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, 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

JURNAL 3

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

DRUG RELATED PROBLEMS ASSOCIATED AND TREATMENT FOR

CERVICAL CANCER IN INTERNAL MEDICINE WARD IN PGI CIKINI
HOSPITAL

Hendra Rahman1, Diana Laila Ramatilla2, Aprilita Rinayanti Eff2

1Pharmacist Professional Program Student, Faculty of Pharmacy UTA'45 Jakarta 2Lectuter

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

Email : Hendrarahman.sfarm@yahoo.co.id

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 . Cervical cancer at an early stage does not show
typical symptoms, even without symptoms. In later stages, the symptoms of cervical cancer
include: bleeding post coitus, abnormal vaginal discharge, bleeding after menopause, and
abnormal discharge (yellowish, odorless and mixed blood) . 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.

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 . Spasmium (Alverin Citrate 30 mg and Klordiazepoksida HCl 5 mg) for pain
spasms / seizures . Ketorolac is used as the management of acute pain is severe short-term
(<5 days) . ketoprofen used for rheumatoid arthritis, osteoarthritis, spondylitis, and acute
articular disorder, fibrosis, cervical spondylitis, low back pain, painful musculoskeletal
conditions .

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 DIAGNOSIS

EXAMINATION NORMAL VALUE 23/6

Hemoglobin 12-16 g / Dl 9.7

Hematocrit 37-47% 28

Erythrocytes 4.3-6 million / mL

Leukocyte 4800-10800 / mL 20,700

Platelets 150.000-400.000/μL 592,000

FULL URINISASI dated 06.28.2014

Specific gravity 1015-1025 1,010

Color Yellow Yellow

Clarity Clear Clear

Leukocyte esterase Negative Negative

Nitrite Negative Negative

Blood Negative Negative

pH 4.8 - 7.4 6.0

Proteins Negative Negative

Glucose Negative Negative

Bilirubin Negative Negative

Urobilinogen <0.2 <0.2

Ketones Negative Negative

From the above data it can be concluded that an increase in platelet levels are where normal
values while the platelet 150.000-400.000/μL on clinical laboratory results showed 592,000 /
ML. Supported by the value which the normal value 4800-10800 leukocytes / mL and the
results of clinical laboratory 20,700 / uL and it can be concluded that the patient had cervical
cancer.

DRUG RELATED PROBLEM

Improper drug selection is Keterolac use an anti-inflammatory non-steroidal heterocyclic

acetic acid derivative that is used as an analgesic which is supposed to opiate analgesics has
experienced pain scale (VAS) 9.

CONCLUSION
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.

REFERENCES

1. POM RI, 2008. Indonesian National Drug Information, Jakarta

2. Canavan TP, NR Doshi. Cervical cancer. Am Fam Physician 2000; 61:1369 -76.

3. Dipiro, Joseph T., et. al., 2008, Pharmacotherapy: A pathophysiologic Approach 7 th

Edition, McGraw Hill, New York.

4. Hughes, J, 2008. Pain Management of, from basich to clinical practice

5. Menczer J. The low incidence of cervical cancer in Jewish women: has the puzzle finally
been solved? Isr Med Assoc J 2003; 5:120-3

6. Nurwijaya, H, dkk.2010.Cegah and Cervical Cancer Detection, Surabaya

7. D Turk and Melzack R. Handbook of pain as sessment. Guilford Press, New York, 1992.
 LITERATUR REVIEW

Jurnal Internasional Pengajaran dan Praktisi Farmasi memuat beberapa masalah

terkait dengan obat dan pengobatan pasien di salah satu rumah sakit. Dalam Jurnal
Internasional tersebut saya memilih 3 jurnal yang membahas tentang permasalahan obat
antara lain masalah terkait obat hemodialisis dan hipertensi pada perawatan gagal ginjal,
masalah terkait obat fraktur femoral, dan masalah terkait obat internal pada kanker servik.

Jurnal yang pertama dengan judul “Drug Related Problems in Treatment

Hemodialysis on Chronic Renal Failure” membahas tentang masalah terkait obat
hemodialisis dan hipertensi yang diberikan pada pasien Tn. EH yang berusia 46 tahun yang
didiagnosa mengalami gagal ginjal kronis tahap V dan hipertensi . Pasien EH tiap bulannya
melakukan terapi hemodialysis selama 1 jam 30 menit. Selain itu pasien EH juga diberikan
beberapa obat, antara lain: amlodipin 10mg sekali sehari, klonidin 0,15 mg 3 kali, tiga kali
sehari Captropil 25mg, asam folat sehari 2 tablet, 3 kali sehari CaCO3 500mg, 1 tablet sehari
5000mcg Neorobion, omeperazol 1 kapsul 3 kali sehari, valsartan 10 mg 2 kali sehari dan 1
tablet sehari bisoprolol. Selama pengobatan terdapat masalah yang terkait dengan obat-obat
yang diberikan antara lain adanya seleksi obat yang kurang tepat, adanya interaksi obat yang
seharusnya dihindari dan dosis yang kurang sesuai. Maka untuk menangani hal tersebut
dilakukan penggantian obat dan pengurangan dosis yang diberikan kepada pasien.

Jurnal yang kedua dengan judul “Drug Related Problem Treatment of Femoral Neck
Factures in Mitoharjo Hospital”, membahas tentang masalah terkait obat fraktur femoral yang
diberikan pada pasien Tn. TS yang berusia 49 tahun dengan diagnosis Femur Fractures
Collum. Terapi yang dilakukan untuk Tn. TSterapi adalah injeksi ceftriaxone, injeksi
remopain, injeksi ranitidin, injeksi ketorolak, propranolol injeksi, tab amlodipin, Celexa,
tablet ultracet, tablet cal 95, tablet oscal, tablet alovell, injeksi novalgin , tablet Rantin.
Namun berdasarkan hasil praktik klinis pada perawatan umum di rumah sakit PGI Cikini
disimpulkan bahwa adanya DRP's (Drug Related Problem s) dalam bentuk seleksi obat yang
tidak tepat, indikasi tersebut tidak ditangani sekaligus gagal untuk menerima Obat ranitidine
ineksij, tablet Rantin, dan tablet ultracet. Selain itu gagal menerima pengobatan Pada 14-17
Juni 2014 diberikan tablet Ultracet 3 x1 dan pada tanggal 13 dan 18 Desember, gagal untuk
menerima obat satu kali, Pada tanggal 17 dan 19 Juni 2014 diberikan tablet Rantin 2 x 1
sedangkan pada tanggal 18 Juni 2014 gagal menerima obat satu kali, dan tertanggal 11-16
Juni 2014 2x1 ampulsedangkan suntikan Ranitidin yang diberikan pada 10 Juni 2014 diberi
ampli injeksi Ranitidin 1x1 yang gagal untuk menerima obat satu kali.Kesalahan tersebut
karena perawat tidak mencatat obat-obatan yang diberikan kepada pasien. Dalam menangani
hal tersebut maka disarankan agar perawat selalu memperhatikan apa yang telah diberikan
kepada pasien dan melakukan pemantauan catatan perawat pada daftar buku obat serta
melakukan uji lab yang lebih signifikan agar obat yang diberikan dapat sesuai indikasi.

Jurnal ketiga dengan judul “Drug Related Problems Associated and Treatment for
Cervical Cancer in internal Medecine Ward in PGI Cikini Hospital” membahas tentang
masalah terkait obat kanker servik yang diberikan kepada Penderita IbuMM yang berusia 39
tahun, dirawat di rumah sakit PGI Cikini pada 23 Juni 2014, didiagnosis menderita kanker
serviks. Saat dirawat di rumah sakit, dia telah menerima injeksi Vitamin K, injeksi Kalnex
(asam traneksamat), Alverin Citrate 30 mg dan Klordiazepoksida HCl 5 mg, Ketorolac.
Namun berdasarkan hasil sekretariat klinis di bangsal K di RS PGI Cikini, ditemukan adanya
DRPs (Drug Related Problem) antara lain pemilihan obat yang tidak benar, penggunaan obat
yang tidak tepat, Ketorolak tidak digunakan sesuai dengan yang ada dan pasien mengalami
nyeri. Dalam menangani hal tersebut dilakukan penggantian obat yang tepat sesuai indikasi.

Dari ketiga jurnal internasional dapat disimpulkan bahwa dalam pengobatan pasien
selalu terjadi DRPs (Drug Related Problem) dengan kesalahan yang sama yaitu pemberian
obat yang tidak tepat, kegagalan pengobatan yang tidak ditangani dan kegagalan menerima
pengobatan karena perawat lalai dalam memantau buku catatan keperawatan. Sehingga
sebagian kesalahan dalam proses pengobatan pasien dilakukan oleh perawat, karena perawat
lah yang memilik tugass untuk memantau pemberian obat yang diresepkan oleh dokter
kepada pasien. Selain itu Perawat juga bertugas mengamati respon tubuh pasien jika obat
yang diberikan tidak sesuai sehingga nantinya dapat ditangani langsung agar obatnya dapat
diganti oleh dokter. Jika perawat lalai dalam melakukan tugas dan fungsinya sebagai perawat
maka keadaan pasien dapat memburuk karena kesalahan dalam pemberian obat yang tidak
sesuai atau kegagalan dalam penerimaan obat yang seharusnya diberikan untuk mengobati
penyakitnya setiap hari sesuai ketentuan resep dokter. Maka dari itu perawat berperan penting
dalam kelancaran pengobatan pasien untuk menuju kesembuhan. Oleh karena itu perawat
diharapkan untuk dapat melaksanakan tugas dan fungsinya sebagai perawat secara optimal
agar tidak terjadi kelalaian yang dapat membahayakan pasien.
Daftar Pustaka
Esther Jeniaty1, Diana Laila Ramatillah2, Aprilita Rinayanti.2014. Drug Related Problems in
Treatment Hemodialysis on Chronic Renal Failure.Jakarta: International Journal of
Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.

Fitriany JR1, Diana Laila Ramatillah2, Aprilita Rinayanti.2014. Drug Related Problem
Treatment of Femoral Neck Factures in Mitoharjo Hospital.Jakarta: International Journal of
Pharmacy Teaching & Practices, Vol5, issue3, Supplement I, 1020-1552.

Hendra Rahman1, Diana Laila Ramatilla2, Aprilita Rinayanti.2014. Drug Related Problems
Associated and Treatment for Cervical Cancer in internal Medecine Ward in PGI Cikini
Hospital. Jakarta: International Journal of Pharmacy Teaching & Practices, Vol5, issue3,
Supplement I, 1020-1552.