Sheppriola Vonia

1011014025
Kelas D
Kasus 1 (current therapeutic, 1995)
,92tahun
Diagnosis: -IschemicHeartDisease
-CongestiveHeartFailurewithAtrial
Fibrilation
-NIDDM
-Hypertension
-Anxiety
-Constipation
Obatyangdiberikan:
1. Digoxin 9.Paracetamol
2. IsosorbidDinitrat 10.Tolbutamid
3. Aspirin 11.Furosemid
4. Cimetidin 12.Metformin+Rosiglitazon
5. Metoclopropamid 13.Captopril
6. Metamucil 14.Verapamil
7. Nitrazepam 15.Diltiazem
8. Salbutamol 16.Aldacton
Digoxin
Concomitant use Calcium-channel blocking agents can
have additive negative effects on AV conduction
(Diltiazem, Verapamil)
Serum digoxin concentrations may increase by about 15-
30% when captopril and digoxin are used concomitantly
for CHF (Captopril)
Loop or Thiazide diuretics makes hypokalaemia,
increases the toxicity of digoxin (Furosemide)
Metoclopramide reduce GI absorption of digoxin
(resulting in low plasma digoxin concentrations),
especially when administered at the same time as
digoxin, so Should be spaced as far apart as possible





Sebelum makan
Spironolactone (Aldactone) increased
serum concentrations of digoxin; possible
toxicity

Dosage
Geriatric Patients 70 years of age: For
maintenance dosage, generally initiate at
125 mcg once daily orally (digoxin tablets).
ISDN
Isosorbide dinitrate: Organic nitrates;
vasodilating agents.
Brands: BiDil

(combination), Dilatrate

,
Imdur

, Ismo

, Isordil

, Monoket

; also
available generically
Generic Name: Isosorbide Dinitrate
Chemical Name: D-Glucitol-1,4:3,6-
dianhydrodinitrate
Molecular Formula: C
6
H
8
N
2
O
8

AHFS DRUG INFORMATION ESSENTIALS
1. Indikasi: terapi dan preventif angina
pektoris, CHF
2. KI: hipersensitifitas berat, infark jantung
akut, kegagalan sirkulasi akut.
3. Interaksi: Disopyramide.
4. Administrasi: sublingual, intrabukal dan
oral
Adverse effect
Effects on the blood. Haemolysis
occurred in 2 patients with G6PD
deficiency during treatment with isosorbide
dinitrate.
Headache
Hypersensitivity.
Nitrate tolerance.
Oedema.
Martindale, 1317
Dosage: Maximum 40 mg of isosorbide
dinitrate (Dilatrate

-SR) it have to
controlled

Dosage for Geriatri
Indication: Atrial Fibrillation/Flutter


An alternative or adjunct to oral
anticoagulation for reduction of the
incidence of thromboembolic episodes in
selected patients with chronic atrial
fibrillation.


Aspirin
Serious GI toxicity (e.g., bleeding,
ulceration, perforation) can occur with or
without warning symptoms.Increased risk
in those with a history of GI bleeding or
ulceration, geriatric patients, those
receiving an anticoagulant, receiving
prolonged therapy, taking multiple NSAIAs
concomitantly, and consuming 3 alcohol-
containing beverages daily
Warning
Dosage
60 years of age and no other risk factors:
325 mg daily --- AF

Food delays the absorption of aspirin but
does not affect the overall amount
absorbed.
Drug Interaction
ACE inhibitors reduced BP
Possible attenuation of hemodynamic actions of ACE
inhibitors in patients with CHF Reduced hyponatremic
effect of ACE inhibitors monitor BP
Aspirin may reduce the diuretic effect of bumetanide,
furosemide, and piretanide, and the combination of
aspirin and furosemide may increase the risk of acute
renal failure and salicylate toxicity.
Although some studies have found that metoclopramide
increases the rate of aspirin absorption, others have
found no change, and the clinical efficacy of aspirin
seems unaltered---No action needed.

Metformin
Maintenance dosage generally should not
be titrated to the maximum recommended
for younger adults;

limited data suggest
reducing initial dosage by approximately
33% in geriatric patients
For the fixed combination with
rosiglitazone, maximum daily dosage is 2
g of metformin hydrochloride and 8 mg of
rosiglitazone

Cimetidine
Severe (Cl
cr
< 30 mL/minute)
Oral: 300 mg every 12 hours.
Accumulation may occur; use lowest frequency of dosing
compatible with adequate response.
Increase frequency to every 8 hours or more frequently
(with caution) if required.
Presence of hepatic impairment may require further
dosage reduction.


Pelunak feses
Tolbutamid
Antidiabetic agent; sulfonylurea
Oral: Initially, 1-2 g daily
Rumus Cockcroft - Gault
CrCl (ml/menit) = 140 umur (th) X BB (kg)
72 X SrCr ( mg/dl )
CrCl (ml/menit ) = 0,85 X CrCl ()
Kasus 2 (Current Therapeutic 1995)
,83tahun
Diagnosis: -MildMemoryDisorders
-Falls
-Hypertension
-CongestiveHeartFailure
-Osteoartritis
-Angina

Obatyangdiberikan:
1. Furosemid 6.Paracetamol
2. KCL 7.Nitrazepam
3. Digoxin 8.Prochlorperazin
4. Vorapamil 9.Dothiepin
5. Tenoxicam 10.Laxativeagent

Furosemide
A sulfonamide, loop-type diuretic and
antihypertensive agent
Indication: antiHypertension
KCl
Indication: replacement pottasium
because of the adverse effect of
furosemide using (hypokalemia)
Digoxin
indication: CHF and angina
Verapamil
Chalcium chanel blocker
This drug is antihypertension agent
Tenoxincam
This uses as antiinflamation drug (NSAID)
The indication is for osteoartritis patient
Paracetamol, Prochlorperazin, Dothiepin,
Laxative agent, Nitrazepam tidak perlu
digunakan karena tidak tepat indikasi.

Paracetamol: untuk demam, (pasien tidak

demam)
Proclorperazin, nitrazepam: sebagai
antipsychotic and antiemetic agent (pasien
tidak mengalami ganguan kejiwaan)
Laxative aget: untuk konstipasi (pasien tidak
mengalaminya)

Kasus 3 (RSUP Dr. Sardjito)
,70tahun
Diagnosis: -IschemicHeartDisease
-Hiperkolesterolemia
-Hiperurikemia
-AnxietyDepression
-Katarak

Obatyangdiberikan:
1. ISDN 6.Aurorix
2. Digoxin 7.Frixitas
3. Furosemid 8.TriaminE
4. KCL 9.FarmabecC
5. Amiodaron 10.Catalineeyedrop

Indikasi Obat
ISDN dan digoxin: CHF
Aurorik:gejaladepresi
Amiodaron:takikardia
Furosemid:antihipertensi
KCl:mengatasiefeksampinghipokalemiadari
furosemid
Triamin:penurunpanasdanmengobatiflu
Frixitas (alprazolam): anxiolitic
Farmabex C: memenuhi kebutuhan vitmin dalam
tubuh
Catalineeyedrop:katarak

Ischemic Heart Disease diobati dengan
merekomendasikan nitrogliserin atau
amlodipin
Hiperkolesterolemia diobati dengan
merekomendasikan obat atrovastatin yang
juga baik untuk IHD
Anxiety Depression diobati dengan Frixitas
dan Aurorik
Katarak diobati dengan Cataline eye drop
Farmabec C tetap digunakan tujuannya:
sebagai suplemen vitamin untuk orang tua
saja
ISDN dan digoxin tidak lagi digunakan,
karena ia bukan terapi utuk pasien ISD
tetapi CHF begitu juga dengan
penggunaan amiodaron
Furosemid dan KCl tidak lagi digunakan
karena: akan memperparah hiperurikemia
pasien, di samping itu pasien tidak
mengalami hipertensi atau pun udem
Pasien tidak demam maupun flu, maka
tidak perlu digunakan triamin E
Lekas Sehat

TTD.
SHEPPRIOLA VONIA
(Im proud to be a PHARMACIST)