CASE 7PHARMACEUTICAL CARE

Puspita Octa Sholihah 1408062156

Irfan Imam Taufik 1408062162

Ersi Arviana Ihsan 1408062164

Erlita Nur Arifana 1408062183

Arsy Mulya Dewi 1408062192

Nurul Fatimah H 1408062205

Sonia Suzma Azmi 1408062244

Puput Sri Ardianti 1408062263

Mr Hd, 67 yo, has been consuming ISDN on this year because of his chest pain complaint. This drug firstly bought with doctor’s prescription that combined with β-Blocker. But on these 3 months, he buys those two drugs without any consultation with his doctor. Recently, he felt dizzy, weak, stomachache and bloating. He is coming to your pharmacy and want to buy “sakatonik liver” to increase his stamina and “Kratingdaeng”

VS: BP: 95/70mmHg, HR: 60x/minute, RR: 20x/minute; Hb: 11,7mg/dL

PH: Hyperlipidemia, angina pectoris

DH: ISDN and propanolol, gemfibrozil 2x600mg/day

Lab data: Total Cholesterol: 265; TG: 205; LDL: 100

Habit: likes to consume fried banana

Patient’s Assesment

Name : baby SB

Date and place birth : -

Address : -

Phone : -

Weight: 4,5 kg

Height : -

HR : 30x/minute

BP :

Gender : female

Allergies : penicillin

Medical problem : Chest pain, stomachachae, dizzy, weak, bloating.

Patient History : Hyperlipidemia, Angina PectorisDrugs History : ISDN and Propanolol,

Gemfibrozil 2x600 mg/dayHabit : Likes to consume fried

banana

PRESCRIPTION MEDICATION HISTORY

Name/strength Directions

Start date

Stop date Physician Purpose Effectiven

ess

ISDN - - - - Chest pain

-

Propranolol - - - - Chest pain

-

Non Prescription Medication History

Name/strenght Directions Purpose How often effectiveness

ISDN - Chest pain 3 months -

Propanolol - Chest pain 3 months -

Gemfibrozil - hyperlipidemia

- -

Assessment1. Problem

Subjective : Chest pain, dizzy, weak, stomachache, bloatingObjective :

Vital Signs Value Normal Result

Blood Pressure 95/70 mmHg 120/80 mmHg Hypotension

Heart Rate 60x/minute 60-100x/minute Normal

Respiration rate 20x/minute 16-20x/minute Normal

Laboratory Data Value Normal Result

Haemoglobine 11,7 mg/dl 13-18 mg/dl Anemia

Total Cholesterol 265 mg/dl < 200 mg/dl Hypercholesteremia

Triglyceride 205 mg/dl < 100 mg/dl Hypertriglyceride

LDL 100 mg/dl < 100 mg/dl Hyperlipidemia

Actual and Potential Problem

a. Actual : hypotension

b. Potential : renal disorder, anaphylactic reaction

2. Assessment Clinical Problem :

Chest pain, dizzy, weak, stomachache, bloating, Hypercolesteremia , hyperlipidemia, hypertriglyceride

Diagnosis Pharmaceutical Care:

• Angina Pectoris

Analysis Drug Related Problem (DRPs)Drug therapy problem Cause Present/

Absentnotes

1. Unnecessary drug therapy

• No medical indications• Addiction creational

drug use• Nondrug therapy /more

appropiate• Duplicate therapy• Treating avoidable

adverse reaction

• Absent• Absent

• Absent

• Absent• Absent

2. Wrong drug • Contraindications• Dosage form

inappropiate• Drug not indication for

condition• More effective drug

available dosage to low

• Present• Present• Absent

• Hypotension• Overdose

3. Dosage too low • Frequency inappropiate• Wrong dosage• Incorrect

administration• Drug interaction• Incorrect storage

• Absent• Absent• Absent• Absent• Absent

4. Adverse drug reaction • Allergic reaction• Unsafe drug for patient• Incorrect

administration• Drug interaction• Dosage increased or

decreased too quickly• Undesirable effect

• Absent• Absent• Absent• Absent• Absent

• Absent

Drug therapy problem

Cause Present/ Absent Note

5. Dosage too high • Wrong dose• Frequency

inappropriate• Duration

inappropriate• Drug interaction

• Present• Absent

• Absent

• Gemfibrozil

6. Inappropiate compliance

• Cannot afford drug product

• Cannot swallow or otherwise administer drug

• Does not understand instuctions

• Patient prefers not to take drug

• Absent

• Absent

7. Needs additional drug therapy

• Untreated condition

• Synergistic therapy

• Propilactic therapy

• Absent• Present• Absent

• Antasida for stomache

3. Pharmaceutical Care PlanA. Clinical problem, goal recommendation, and plan of treatment (doses, frequency, and route)

Clinical problem

Goal recommendation

Plan of treatment

Potency Frequency Route

Chest Pain ISDN 2.5 mg May be repeated 5-10 min, not to exceed 3 doses in 15-30

min

sublingual

Dyspepsia Mylanta 5 ml 4x 1 cth/day (2 hr PC and Before Sleep)

Oral

hyperlipidemia

Simvastatin 10 mg 1 x 1 tablet/day before sleep Oral

Anemia Fe Fumarat 150 mg 1 x 1 capsule/ day Oral

B. Monitoringa. monitoring therapeutic effect

Drug / med

Parameter of monitoring

Normal value End point Monitoring frequency

Recommendation

ISDN Chest pain Depend on patient’s physiology condition

Decrease pain

2-10 minutes (DIH)

SublingualNot recommended to combinate with beta blocker inhibited lipid metabolism(medscape.com)

Mylanta - Stomachache

- Bloating

Depend on patient’s physiology condition

Reduce stomachache and bloating

in fasting : 20-60 minutes1 hour after meal : 3 hours(drugs.com)

If necessary

Drug / med

Parameter of monitoring

Normal value End point Monitoring frequency

Recommendation

Simvastatin

Serum lipopotreins

Depend on patient’s

physiology condition

Decreasing of

lipoproteins

2-5 days VLDL

decreases(drug.com)

Before sleeping

Fe Fumarate

Hb Depend on patient’s

physiology condition

Increasing Hb

2-4 weeks Hb value

increases

Life style modification

b. Monitoring ADRDrug Monitoring ADR

ISDN - Severe Hypotension (infrequent)- Pallor - Dizziness- Nausea vomiting- Headache (most common)- Bradycardia- Postural hypotention- WeaknessDIH (edition 17, 2008-2009)

Mylanta - Diarhea- Increasing clearance

Simvastatin - 1-10 % abdominal pain- < 1 % myopathy

Fe Fumarat - constipation

CIE (Counseling, Information, and Education)Drug Dose

sUse Frequency storage Adverse

Effect

ISDN 2.5 mg

sublingual

May be repeated 5-10 min, not to exceed 3 doses in 15-

30 min

Room temperature

hypotension

Mylanta 5 ml oral 4 x 1 cth/day (2 hours PC and before

sleep)

Room temperature

-Diarhea- Increasing clearance

Simvastatin

10 mg oral 1 x 1 tablets/day before sleep

Room temperature

- 1-10 % abdominal pain- < 1 % myopathy

Fe Fumarat

150 mg

oral 1 x 1 capsule/day Room temperature

- constipation

LIFE STYLE MODIFICATION

Drug Contraindication Sakatonic liver composition : Vitamine B1, B2, B6, Vitamine C, Nicotinamide, Ca

Pantothenate, Na Hypophospite, Mn Sulfat, Fe Sulfat

Kratingdaeng : Cafein, Taurin, Inositol , Niacinamide , Pyridoxine HCL, Dexpanthenol, Cianocobalamine

Effect of Calcium : increasing heart work by contriction the artherie and decline supply oxigen to heart muscle with coronary artherie plasma

Effect of Cafein : increasing heart work, increasing gastric acid, increasing tryglyceride

References Drugs.com

Medscape.com

Drug Information Handbook 17th edition

MIMS.com

Pubmed.com