FARMAKOTERAPI ANTIHIPERTENSI

( PERAN FARMASIS )

Abdul Kadir Jaelani., S.Si., Apt., SpFRS

Instalasi Farmasi Rumah Sakit Daerah Bangil
1

Epidemiologi
15 % BP TINGGI

Tak terkontrol

Tx

Usia
Ras
Pendidikan
dll

Kerusakan pembuluh darah

BP Di turunkan

Di turunkan secara farmakologis

Kerusakan pembuluh darah

menurun

Tunggal
Mekanisme
Tempat kerja
Toksisitas / ESO

Kombina
si
RASIONAL

BP menurun

Toksisitas / ESO rendah Kerusakan organ rendah

4

Classification & Management

Pengukuran berulang terhadap BP

Sebab jarang ditemukan

HIPERTENSI

10 15 %

Asimptomatik

Akibat sering terlihat

Classification

Management

10

Lifestyle

11

TREATMENT
NONPHARMACOLOGIC
THERAPY

All patients with prehypertension and hypertension should

be prescribed lifestyle modifications, including :
(1) weight reduction if overweight
(2) adoption of the Dietary Approaches to Stop Hypertension
eating plan
(3) dietary sodium restriction ideally to 1.5 g/day (3.8 g/day
sodium chloride)
(4) regular aerobic physical activity
(5) moderate alcohol consumption (two or fewer drinks per day)
(6) smoking cessation.

Lifestyle modification alone is appropriate therapy for patients

with prehypertension. Patients diagnosed with stage 1 or 2
hypertension should be placed on lifestyle modifications and drug
therapy concurrently.

12

13

14

15

16

17

18

19

20

21

22

Monitoring & Evaluation

BP evaluated 2 to 4 weeks after initiating or

making changes.
Once goals BP values are obtained, every 3
to 6 months, assuming no signs or
symptoms of acute target-organ disease.
More frequent evaluations are required in
patients with a history of poor control,
nonadherence, progressive target-organ
damage, or symptoms of adverse drug
effects.
23

Monitoring & Evaluation

Monitoring for adverse drug effects should

typically occur 2 to 4 weeks after starting a
new agent or dose increases, and then
every 6 to 12 months in stable patients.

Patients should be questioned periodically

about changes in their general health
perception, energy level, physical
functioning, and overall satisfaction with
treatment.
24

Resistant Hypertension

25

THE ROLE OF WARD

PHARMACIST IN HOSPITAL
Yahaya Hassan, Pharm.D
Professor of Clinical Pharmacy
School of Pharmaceutical Sciences
Universiti Sains Malaysia
Penang,Malaysia

26

Drug Related Problems

Identify potential or actual drug

related problems
Resolve actual drug related problems
Prevent potential drug related
problems

27

WARDS PHARMACIST INTERVENTIONS

SCORING SYSTEM

0-1 no effect to negative effect

1 minor significance, any improved
standard of care
2 significant, improve standard of
care or optimize therapy
3 very significant, prevent major
toxicity and/or end organ damage
4 potentially life saving

28

Evaluated each drug

Indication?
Yes
Effective?
Yes
Adverse effect?
No
Is cost an issue?

No

No

Yes

Yes

Discontinue and evaluate

Dose, initiate additional
or alternative agent
Dose, substitute with
less toxic alternative
Use generic, substitute
with less costly agent

29

Evaluate entire drug

regimen
Duplicate therapy?

Yes

Discontinue and
evaluate

Drug interactions?
Yes

Change drug, dose,

schedule, or preparation

Can regimen be
simplified?

30

Evaluate adherence

Can the patient or

caregiver administer
medications as
prescribed?

Provide written and

verbal instructions
Consider adherence aid
(medication dispenser
tablet splitter, spacer,
computerized/electronic
reminder systems)
Other educational
materials (videos, books)
Home health evaluation

31

IMPLIKASI TERAPEUTIK
Tx antihipertensi

Tidak pada penyebab khusus

Pada gangguan terhadap

Mekanisme fisiologi normal
yg mengatur tekanan darah

Tdk ada keluhan

Tdk memberikan
kesembuhan langsung

Mencegah kerusakan organ

dan kematian
di masa yg akan datang
32

PERAN FARMASIS
KRITIS

PROBLEM SOLVING

KOMUNIKATIF

RATIO = BENEFIT / RISK

33

PROBLEM TERAPI ANTIHIPERTENSI

1.
2.
3.
4.
5.
6.
7.

Pengobatan jangka panjang

Tidak menghilangkan gejala penyakit
Terapi tidak konsisten
Poli farmasi
Efek samping jangka panjang
Efek toksik jangka panjang
Terapi individual

KEPATUHAN
34

KESIMPULAN
1. Meningkatkan efektifitas terapi.
2. Menurunkan eso dan toksisitas.
3. Meningkatkan kepatuhan

KRITIS
BENEFIT

TROUBELSOLVING

KOMUNIKATIF

RISK
35

36

37