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Jurnal Farmasi Klinik Indonesia

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Published by Universitas Padjadjaran

ISSN : 23375701 EISSN : 2337 5701 DOI : -

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Indonesian Journal of Clinical Pharmacy (IJCP) is a scientific publication on all aspect of clinical pharmacy. It published 4 times a year by Clinical Pharmacy Master Program Universitas Padjadjaran to provide a forum for clinicians, pharmacists, and other healthcare professionals to share best practice, encouraging networking and a more collaborative approach in patient care. Indonesian Journal of Clinical Pharmacy is intended to feature quality research articles in clinical pharmacy to become scientific guide in fields related to clinical pharmacy. It is a peer-reviewed journal and publishes original research articles, review articles, case reports, commentaries, and brief research communications on all aspects of Clinical Pharmacy. It is also a media for publicizing meetings and news relating to advances in Clinical Pharmacy in the regions.

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Evaluasi Nilai Antigen Squamous Cell Carcinoma Pasien Kanker Serviks Sel Skuamosa Stadium II BâIII B yang Menerima Kemoterapi Bleomisin, OncovinÂ®, Mitomisin, dan Cisplatin Noviyani, Rini; Suwiyoga, Ketut; Puspa, Intan; Budiana, Nyoman; Tunas, Ketut
Indonesian Journal of Clinical Pharmacy Vol 4, No 2 (2015)
Publisher : Indonesian Journal of Clinical Pharmacy

Kemoterapi Bleomisin, OncovinÂ®, Mitomisin, dan Cisplatin (BOMP) merupakan salah satu tatalaksana terapi untuk kanker serviks. Penelitian ini bertujuan mengevaluasi respons kemoterapi regimen BOMP pada pasien kanker serviks sel skuamosa stadium IIBâIIIB dengan antigen SCC. Pada penelitian potong lintang prospective ini diperoleh 12 pasien kanker serviks yang memenuhi kriteria inklusi yang diambil dengan metode consecutive sampling. Pemeriksaan kadar antigen SCC dilakukan dengan cara mengambil darah pasien sebelum kemoterapi BOMP seri pertama dan sesudah kemoterapi BOMP seri ketiga kemudian diperiksa dengan alat ARCHITECT SCC assay. Data dianalisis menggunakan paired test dengan interval kepercayaan 95%. Terdapat penurunan rerata nilai antigen SCC pada penderita kanker serviks tipe sel skuamosa setelah tiga seri kemoterapi BOMP meskipun penurunan tersebut tidak bermakna secara statistik (p>0,05). Perbedaan yang tidak bermakna secara statistik ini mungkin disebabkan kurangnya jumlah pasien yang digunakan. Hasil penelitian ini dapat digunakan oleh dokter sebagai pertimbangan untuk melanjutkan kemoterapi BOMP hingga seri keenam sesuai dengan prosedur yang diberlakukan dengan pemantauan rutin terhadap kondisi pasien khususnya nilai antigen SCC untuk untuk memprediksi prognosis dan respons kemoterapi.Kata kunci: Antigen SCC, BOMP, kanker serviks sel skuamosa, kemoterapi, stadium IIBâIIIBEvaluation of Squamous Cell Carcinoma Antigen Value in Stadium IIBâIIIB Squamous Cell Cervical Cancer Patients which Receiving Bleomycin, OncovinÂ®, Mitomycin, and Cisplatin ChemotherapyBleomycin, OncovinÂ®, mitomycin, and cisplatin (BOMP) chemotherapy is one of the management of cervical cancer therapy. The aim of this study was to evaluate the response to BOMP chemotherapy regimens in patients squamous cell cervical cancer stage IIB-IIIB using SCC antigen. In this prospective cross sectional study was obtained 12 cervical cancer patients who met the inclusion criteria, which is taken by using consecutive sampling method. Examination of SCC antigen levels was conducted by taking a patientâs blood before the first series and after the third series of BOMP chemotherapy, then further examined by ARCHITECT SCC assay. Data were analyzed using paired test with 95% confidence intervals. Statistical analysis showed that there were a decrease in the average value of SCC antigen in patients with squamous cell cervical cancer types after 3 series of BOMP chemotherapy although this reduction was not statistically significant (p>0.05). The differences are not statistically significant is probably due to insufficient number of patients used in this study. The doctor may consider to continue chemotherapy until the sixth series in accordance with the procedures by routine monitoring of the patientâs condition, especially SCC antigen values for predicting the prognosis and response of chemotherapy.Key words: BOMP, chemotherapy, SCC antigen, squamous cell of cervical cancer, stadium IIBâIIIB

Personalized Medicine Terapi Digoksin pada Individu dengan Polimorfisme Gen MDR Sutrisna, Em
Indonesian Journal of Clinical Pharmacy Vol 4, No 2 (2015)
Publisher : Indonesian Journal of Clinical Pharmacy

Digoksin merupakan salah satu obat digitalis. Pemakaian yang luas untuk gagal jantung dan aritmia (supraventrikuler) memerlukan pengawasan yang cukup ketat karena obat tersebut merupakan obat dengan indeks terapi sempit. Digoksin merupakan substrat P-glikoprotein (P-gp) yang dikode oleh multi drugs resistance-1 (MDR1). Gen MDR-1 terletak di kromosom 7q21.1. Gen tersebut mengandung 28 exon yang mengkode protein dari 1280 asam amino. Gen ini memegang peranan penting dalam absorbsi, distribusi, dan eliminasi beberapa obat. Polimorfisme gen MDR1C3435T terjadi pada exon 26. Terdapat tiga tipe gen MDR1C3435T yaitu MDR1C3435T CC, MDR1C3435T CT dan MDR1C3435T TT. Polimorfisme ini akan memengaruhi pembentukan PGP dan ini berpengaruh pada profil kinetika digoksin. Perubahan profil kinetika ini menyebabkan perubahan kadar digoksin dalam darah. Metode yang digunakan dalam review ini adalah penelusuran data berbasis pubmed, medline, dan embase dengan kata kunci MDR, digoxin. Terdapat beberapa studi yang berbeda mengenai pengaruh polimorfisme MDR1C3435T terhadap kadar digoksin dalam darah. Peningkatan kadar digoksin dalam darah akibat polimorfisme gen MDR1C3435T akan berisiko terjadinya intoksikasi digitalis. Pengobatan digoksin dalam jangka panjang atau dosis besar seyogyanya mulai mempertimbangkan profil genetika pasien. Distribusi polimorfisme MDR1C3435T penduduk suku Jawa adalah TT (0,10), CT (0,52), dan CC(0, 38).Kata kunci: Digoksin, MDR1C3435T, polimorfisme, P-gpÂ Personalized Medicine Digoxin Theraphy in Individuals with MDR Gene PolymorphismDigoxin is one of digitalis drugs. Wider applicability to heart failure and arrhythmias (supraventricular) requires fairly strict scrutiny because of its narrow therapeutic index. Digoxin is a substrate of P-glycoprotein (P-gp) encoded by multi drugs resistance-1 (MDR1). MDR-1 gen located on chromosome 7q21.1. This gene contains 28 exons that encoded a protein of 1280 amino acids. This gene plays an important role in the absorption, distribution and elimination of many drugs. MDR1C3435T polymorphism occurs in exon 26. There are three types of MDR1C3435T gene namely MDR1C3435T CC, MDR1C3435T CT and MDR1C3435T TT. These polymorphisms will affect to the formation of P-gp and consequently to change the kinetic profile of digoxin. The change of kinetic profile causes changes in the digoxin blood levels. The method used in this review is data search based on pubmed, medline, and embase with keywords MDR and digoxin. There are several different studies of the influence of polymorphisms MDR1C3435T on blood digoxin levels. Increased levels of digoxin in the blood due to polymorphism of MDR1C3435T will be at risk of digitalis intoxication. Long-term digoxin treatment or large dose should consider the patientâs genetic profile. Distribution of polymorphism of MDR1C3435T in Javanese population is approximately TT (0,10), CT (0,52), and CC(0, 38).Key words: Digoxin, MDR1C3435T , polymorphism, P-gp

Hubungan Persepsi terhadap Perilaku Swamedikasi Antibiotik: Studi Observasional melalui Pendekatan Teori Health Belief Model Insany, Annisa N.; Destiani, Dika P.; Sani, Anwar; Pradipta, Ivan S.; Sabdaningtyas, Lilik
Indonesian Journal of Clinical Pharmacy Vol 4, No 2 (2015)
Publisher : Indonesian Journal of Clinical Pharmacy

Tingginya perilaku swamedikasi antibiotik dapat meningkatkan peluang penggunaan antibiotik yang tidak rasional sehingga berdampak pada peningkatan resistensi antibiotik. Perubahan perilaku swamedikasi antibiotik diperlukan untuk menurunkan penggunaan antibiotik yang irasional. Penelitian ini bertujuan untuk mengetahui hubungan persepsi masyarakat terhadap praktik swamedikasi antibiotik yang bermanfaat untuk mengembangkan model intervensi dalam rangka menurunkan praktik swamedikasi antibiotik (SMA). Studi observasional analitik dilakukan pada bulan NovemberâDesember 2014 kepada masyarakat yang berkunjung ke fasilitas kesehatan primer di Kota Bandung. Wawancara terstruktur dengan menggunakan kuesioner tervalidasi dilakukan untuk melihat variabel perilaku swamedikasi serta variabel persepsi ancaman, keuntungan, hambatan, dan kemamampuan bertindak berdasarkan teori perubahan perilaku health belief model (HBM). Wawancara dilakukan terhadap 506 responden dewasa yang diambil secara acak di 43 puskesmas dan 8 apotek. Data yang diperoleh dianalisis dengan menggunakan statistik deskriptif dan regresi logistik (CI 95%, Î±=5%).Validitas kuesioner dinyatakan dengan koefisien korelasi >0,3 dan nilai reabilitas alpha-cronbach sebesar 0,719. Terdapat 29,45% responden yang melakukan swamedikasi antibiotik selama 6 bulan terakhir. Tidak terdapat hubungan signifikan antara variabel HBM (persepsi ancaman, keuntungan, hambatan, dan kemampuan bertindak) dengan perilaku swamedikasi antibiotik (p>0,05). Persepsi ancaman, keuntungan, hambatan, dan kemauan bertindak berdasarkan teori HBM menunjukkan hubungan yang lemah terhadap perilaku swamedikasi antibiotik. Mudahnya akses dalam membeli antibiotik secara bebas diduga menjadi faktor dalam perilaku SMA sehingga regulasi yang ketat diperlukan sebagai dasar intervensi dalam menurunkan perilaku SMA.Kata kunci: Antibiotik, health belief model, swamedikasiAssociation between Perceived Value and Self-Medication with Antibiotics: An Observational Study Based on Health Belief Model TheoryHigh prevalence of self medication with antibiotics can increase the probability of irrational use of antibiotics which may lead antibiotics resistance. Thus, shifting of behavior is required to minimize the irrational use of antibiotics. This study was aimed to determine the association between public perceivedvalue and self-medication with antibiotics which can be used to develop an intervention model in order to reduce the practice of self-medication with antibiotics. An observational study was conducted during the period of NovemberâDecember 2014.The subjects were patients who visit primary health care facilities in Bandung. A structured-interview that has been validated was used to investigate the association between perceived value and self-medication behavior based on the Health Belief Model theory (perceived susceptibility, benefits, barrier, and cues to action). Approximately 506 respondents were drawn randomly from 43 community healthcare centers and 8 pharmacies. Data was analyzed by using descriptive statistics and logistic regression (CI 95%, Î± = 5%). Validity and reliability of the questionnaire were shown with a correlation coefficient of >0.3 and a cronbach-alpha value of 0.719, respectively. We found that 29.45% of respondents practiced self-medication with antibiotics over the last six months. Additionally, there was no significant association between the perceived susceptibility, benefits, barrier, and cues to action with self-medication behavior (p>0.05). Easiness to access antibiotics without prescription was presumed as a factor that contribute to self-medication with antibiotics, therefore strict regulation in antibiotics use is very needed as a basic intervention to decrease self-medication with antibiotic.Key words: Antibiotics, health belief model, self-medication

Ganoderma lucidum Polysaccharide Peptide (GLPP) for the Cancer Treatment Rasjidi, Imam; Susanto, Christine
Indonesian Journal of Clinical Pharmacy Vol 4, No 2 (2015)
Publisher : Indonesian Journal of Clinical Pharmacy

Ganoderma lucidum mushroom (also known as Ling Zhi in China, Mannetake /Reishi in Japan) has been widely used for thousands of years to prevent and treat various diseases, such as heart disease, diabetes mellitus, viral infection, and cancer. Polysaccharides from Ganoderma lucidum has been extensively investigated for free radical scavenging activity. Both in vivo and in vitro studies suggest that G. lucidum have anti-tumor effects, which mediated by its immunomodulatory, anti-angiogenesis, and cytotoxiceffects. Ganoderma lucidum polysaccharide peptide (GLPP) which extracted from Ganoderma lucidum mycelium tissue culture, give the best quality of Î²-D-Glucans bioactive compounds. These biologically active glucans interact with receptors on the surface of immune cells such as macrophage and natural killer cell (NK cell) to induce immunomodulatory and tumoricidal effects. However, many studies still need to answer those mechanisms.Key words: Anti-tumor effects, Î²-Glucan, Ganoderma lucidum, GLPP, immunomodulatory activityGanoderma lucidum Polysaccharide Peptide (GLPP)untuk Terapi KankerJamur Ganoderma lucidum (dikenal juga dengan nama Ling Zhi di China, atau disebut sebagai Mannetake/Reishi di Jepang) telah dimanfaatkan secara luas selama ribuan tahun untuk mencegah dan mengobati beragam penyakit, seperti penyakit jantung, diabetes melitus, infeksi virus, bahkan kanker. Polisakarida dari Ganoderma lucidum telah banyak diteliti untuk aktivitas radikal bebasnya. Baik studi in vivo maupun in vitro menyatakan G. lucidum memiliki efek anti tumor, yang dimediasi oleh aktivitas imunomodulator, anti-angiogenesi, dan sitotoksik. Ganoderma lucidum polysaccharide peptide (GLPP) yang diekstrak dari kultur jaringan miselium Ganoderma lucidum memberikan kualitas terbaik dari senyawa bioaktif Î²-D-glucans. Senyawa bioaktif glukans ini yang berinteraksi dengan reseptor di permukaan sel-sel imun, seperti makrofag dan NK cell yang dipercaya memberikan efek imunomodulator dan tumorisidal. Meskipun masih diperlukan banyak studi lanjutan untuk menjawab mekanisme dari GLPP.Kata kunci: Anti-tumor, Î²-Glucan, GLPP, Ganoderma lucidum, imunomodulator

Evaluasi Penggunaan Antibiotik pada Pasien Bedah di Suatu Rumah Sakit Swasta di Bandung Zazuli, Zulfan; Sukandar, Elin Y.; Lisni, Ida
Indonesian Journal of Clinical Pharmacy Vol 4, No 2 (2015)
Publisher : Indonesian Journal of Clinical Pharmacy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15416/ijcp.2015.4.2.87

Pemberian antibiotik prabedah dan pascabedah telah digunakan secara luas untuk menghindari dan menangani infeksi pada daerah pembedahan. Penggunaan antibiotik harus dievaluasi melalui program evaluasi penggunaan obat (EPO) untukÂ menjamin penggunaan obat yang rasional. EPO antibiotik ini dilakukan berdasarkan pada kriteria penggunaan obat yang telah ditetapkan menggunakan studi data retrospektif dari bulan September sampai dengan November tahun 2009 untuk seluruh pasien bedah di salah satu rumah sakit swasta di Bandung. Telah dilakukan pemberian antibiotik sebanyak 1290 dosis yang terdiri atas pemberian antibiotik prabedah sebanyak 94 dosis danÂ pemberian antibiotik pascabedah sebanyak 1196 dosis. Telah terjadi ketidaktepatan penggunaan antibiotik yang terdiri atas ketidaktepatan indikasi sebesar 0,39%, dosis berlebih dan dosis kurang pada pemberian antibiotik pascabedah berturut-turut sebesar 2,26% dan 0,50%, ketidaktepatan waktu pemberian antibiotik prabedah sebesar 22,34%, interaksi obat sebesar 1,78% yang terdiri atas 0,46% interaksi farmakokinetik dan 1,31% interaksi farmakodinamik, serta duplikasi antibiotik sebesar 0,46%. Dapat disimpulkan bahwa terjadi beberapa ketidaktepatan penggunaan antibiotik. Ketidaktepatan yang paling besar terjadi pada ketidaktepatan waktu pemberian antibiotik prabedah. Dibutuhkan peran serta apoteker rumah sakit sebagai bagian dari upaya peningkatan ketepatan penggunaan antibiotik pada pasien bedah.Kata kunci: Antibiotik, evaluasi penggunaan obat, pembedahan, studi retrospektifÂ Antibiotic Use Evaluation in Surgery Patients at a Private Hospital in BandungAntibiotic administrations in presurgery and postsurgery are widely used to avoid and to treat surgical site infections. In order to ensure the rational use of this drug, the use of antibiotic should be evaluated through drug use evaluation (DUE) programme. In this research, the DUE programme had been carried out based on predetermined criteria using restrospective data study from September until November 2009 to all surgery patients at a private hospital in Bandung. This research showed that 1290 doses antibiotic had been given to patients to treat surgical site infections, which were consist of 94 doses presurgery antibiotic and 1196 doses postsurgery antibiotics. This study showed the presence of inappropriate antibiotic uses that consists of 0.39% inappropriate indications; 2.26% overdoses and 0.50% subtherapy doses; 22.34% inappopriate administration timings of presurgery antibiotic; 1.78% drug interactions which 0.46% are pharmacokinetic drug interactions and 1.31% are pharmacodynamic drug interactions; and 0.46% antibiotic duplications. It can be concluded that there is some inappropriate use of antibiotics. The greatest inappropriateness is inappopriate administration timings of presurgery antibiotic. The role of the hospital pharmacist is needed as part of efforts to increse the appropriateness use of antibiotics in surgical patients.Key words: Antibiotic, drug use evaluation, restrospective study, surgery

Antagonis Reseptor Arginine Vasopressin: Harapan Baru dalam Penanganan Hiponatremia pada Pasien Gagal Jantung Saepudin, Saepudin
Indonesian Journal of Clinical Pharmacy Vol 4, No 2 (2015)
Publisher : Indonesian Journal of Clinical Pharmacy

Pasien gagal jantung merupakan salah satu kelompok pasien yang memiliki risiko tinggi mengalami hiponatremia. Selain masalah diagnosis, permasalahan terapi juga banyak dijumpai dalam penanganan hiponatremia. Di tengah minimnya hasil uji klinis terapi konvensional untuk penanganan hiponatremia, hasil uji klinis obat-obat golongan antagonis reseptor arginine vasopressin atau yang dikenal dengan golongan vaptan membawa harapan baru untuk penanganan hiponatremia pada pasien gagal jantung. Tulisan ini merupakan hasil telaah pustaka terhadap artikel-artikel hasil penelitian dan pengkajian yang relevan yang ditelusuri dengan menggunakan kata kunci heart failure, hyponatremia, argininevasopressin, arginine-vasopressin receptor antagonist dan vaptan. Hasil uji klinis golongan vaptan pada pasien gagal jantung menunjukkan bahwa obat-obat tersebut secara efektif meningkatkan kadar natrium dalam darah dengan efek samping ringan yang umumnya dapat ditoleransi. Berdasarkan hasil uji klinis, conivaptan dan tolvaptan disetujui oleh Food and Drug Administration di Amerika untuk digunakan dalam penanganan hiponatremia pada pasien gagal jantung. Namun, banyak pakar mengajukan pertanyaan kritis terhadap hasil uji klinis obat-obat golongan vaptan ini dan masih meragukan penggunaannya untuk penanganan hiponatremia. Tulisan ini mengulas secara ringkas tentang hiponatremia pada pasien gagal jantung dan peran hormon arginine vasopressin (AVP), aspek farmakologi dan hasil uji klinis beberapa obat golongan vaptan, serta beberapa pertanyaan yang masih tersisa dari hasil uji klinis obat-obat tersebut.Kata kunci: Antagonis arginine vasopressin, arginine vasopressin, gagal jantung, hiponatremia, vaptanArginine-Vasopressin Receptor Antagonists: A New Hope for Treatment of Hyponatremia in Patients with Heart FailureHyponatremia is an important problem in patients with heart failure. It has also been known as a predictor both of short and long-term clinical outcome of heart failure patients. While evidences of clinical efficacy and safety of conventional options for treatment of hyponatremia resulted from clinical trials are very limited, several clinical trials have been conducted to evaluate the efficacy and safety of arginine vasopressin antagonists or also known as vaptan group. This paper reviews hyponatremia in patients with heart failure and the important roles of arginine vasopressin in its development, pharmacological aspects and clinical trials outcomes of some vaptans and several questions emerged from those clinical trials. Relevant research papers, reviews, and website information have been searched and included in this review using keyword of heart failure, hyponatremia, arginine-vasopressin, arginine-vasopressin receptor antagonist and vaptan. Generally, clinical trials have highlighted the efficacy and safety of vaptan groups in the management of hypervolemic hyponatremia in patients with heart failure. ThoseÂ drugs can effectively increase serum sodium level with tolerable adverse reactions. Based on those clinical data two drugs of vaptan group, conivaptan and tolvaptan, have been approved by Food and Drug Administration in The United States to be used for the treatment of euvolemic and hypervolemic hyponatremia. However, many experts are still hesitant to recommend vaptans as treatment of choice for hyponatremia due to the lack of patients-focused outcomes measurements.Keywords: Arginine vasopressin antagonist, heart failure, hyponatremia, vaptan

Sterilitas Instrumen Pakai Ulang di Ruang Penyimpanan Unit Luka Bakar (ULB) Salah Satu Rumah Sakit di Kota Bandung Kurniawansyah, Insan S.; Warya, Sohadi; Rahayu, Hegandari S.; Putri, Dionice L. Y.
Indonesian Journal of Clinical Pharmacy Vol 4, No 2 (2015)
Publisher : Indonesian Journal of Clinical Pharmacy

apabila sterilitasnya tidak terjaga. Proses penyimpanan dan perlakuan terhadap instrumen pakai ulang adalah faktor utama dalam menjaga sterilitas instrumen. Prevalensi infeksi nosokomial di ruang unit luka bakar (ULB) salah satu rumah sakit di Kota Bandung ternyata cukup tinggi sehingga dilakukan penelitian mengenai sterilitas instrumen pakai ulang yang disimpan di ruangan tersebut. Penelitian ini bertujuan untuk dapat menekan angka kejadian infeksi nosokomial, yang salah satunya disebabkan oleh tidak sterilnya instrumen pakai ulang yang digunakan di ruang penyimpanan ULB yang akhirnya dapat menjamin keamanan atau keselamatan pasien. Metode penelitian yang digunakan adalah observasional laboratorik dengan tahapan yaitu penyiapan alat, bahan dan ruangan, pengujian sampel penelitian, dan analisis data. Hasil penelitian menunjukkan bahwa ruang penyimpanan ULB berpengaruh secara signifikan terhadap sterilitas instrumen pakai ulang, ruang CSSD 15,47 kali lebih steril dibanding ruang ULB. Adapun pengaruh lama penyimpanan terhadap sterilitas instrumen pakai ulang diketahui bahwa semakin lama waktu penyimpanan maka sterilitas instrumen semakin berkurang. Pihak rumah sakit diharapkan melakukan penyimpanan dan penggunaan instrumen di ULB tidak lebih dari tujuh hari sebagai usaha dalam mengurangi kejadian infeksi nosokomial di rumah sakit.Kata kunci: Infeksi nosokomial, instrumen pakai ulang, uji sterilitas, unit luka bakar (ULB)The Reusable Instrument Sterilities Stored in the Burn Care Unit at a Hospital in BandungReusable instruments may be a vector for the transmission of nosocomial infections if found contaminated or the sterility are not maintained. The process of storage and treatment towards the reusable instruments are the crucial factors to ensure the sterility of the reusable instruments. The prevalence of nosocomial in the Burns Unit (BU) at a Hospital in Bandung reveals outstanding values and thus has been chosen for this research. This research aimed to suppress the incidence of nosocomial infections, one of which is caused by not sterile of reusable instruments in the storage space BU which can get patient safety ultimately. The laboratory observational was used for this research with steps are preparing tools, materials and test room, sample test, and data analysis. The results found that the storage area in BU had a significant effect on the sterility of the instruments and it was deduced that the CSSD was 15.47 times more sterile than Burns Unit. Time of storage also affected the sterility of the instruments as it was found that the longer the storage time, the possibility of the reusable instruments remaining sterile are decreased. The hospital is expected to keep the instrument in ULB not more than seven days to efforts in reducing the incidence of nosocomial infections in hospitals.Key words: Burns unit (BU), nosocomial infection, reusable instrument, sterility test

Permasalahan Terkait Obat (Drug Related Problems/DRPs) pada Penatalaksanaan Penyakit Ginjal Kronis dengan Penyulit Penyakit Arteri Koroner Furqani, Winda H.; Zazuli, Zulfan; Nadhif, Nabilah; Saidah, Siti; Abdulah, Rizky; Lestari, Keri
Indonesian Journal of Clinical Pharmacy Vol 4, No 2 (2015)
Publisher : Indonesian Journal of Clinical Pharmacy

Masalah terkait obat (DRPs) didefinisikan sebagai setiap kondisi dalam penatalaksanaan terapi pasien yang menyebabkan atau berpotensi menyebabkan tidak tercapainya hasil terapi yang optimal. Penelitian ini dilakukan di salah satu rumah sakit di Kota Cimahi pada bulan Mei 2014. Pada penelitian ini dilakukan identifikasi DRPs pada pasien wanita berusia 59 tahun yang didiagnosis penyakit ginjal kronis dengan penyulit penyakit arteri koroner dan gangren di tangan kiri (jari ke-3). Pasien diketahui mempunyai riwayat diabetes melitus sejak dua hingga tiga tahun yang lalu. Melalui kajian DRPs ditemukan permasalahan terkait obat, yaitu adanya terapi obat yang tidak diperlukan (pemberian kalsium polistiren sulfonat), ketidaktepatan pemilihan antibiotik, Ketidaktepatan dosis (pemberian amoksisilin dan kaptopril), dan risiko interaksi obat-obat merugikan (interaksi kaptoprilâfurosemid, kaptoprilâisosorbid dinitrat, dan kaptoprilânatrium bikarbonat). Pasien penyakit ginjal kronis dengan penyulit penyakit arteri koroner menerima terapi obat yang kompleks sehingga meningkatkan risiko terjadinya DRPs. Keterlibatan apoteker klinis di rumah sakit dalam penatalaksanaan penyakit yang kompleks diperlukan untuk mengoptimalkan terapi, meminimalisir risiko DRPs, dan meningkatkan kualitas hidup pasien.Kata kunci: Drug related problems, penyakit ginjal kronis, penyakit arteri koronerDrug Related Problems in the Management of Chronic Kidney Disease with Coronary Artery DiseaseDrug related problems were defined as conditions on patientâs therapy management that caused, or potentially caused unsuccessful therapy. This study was conducted at a hospital in Cimahi City in May 2014. In this study, DRPs were identified on a 59 years old woman who was diagnosed with chronic kidney disease and coronary artery disease with gangrene on the left hand (the third finger). The patient also had a diabetes mellitus for two until three years ago. Drug related problems (DRPs) were found in this patient. Unnecessary drug therapy (administration of calsium polystirene sulfonate), inappropriate choosen antibiotic, inappropriate dosing (administration of amoxicillin and captopril), and risks drug interactions (captoprilâfurosemide, captoprilâisosorbide dinitrate, and captoprilâsodium bicarbonate). Patients with chronic kidney disease and coronary artery disease received complex drug therapy. These condition lead to higer risk of DRPs. The involvement of clinical pharmacist in interdisciplinary team for management of complex diseases was needed to monitor drug therapy to optimizing the therapy, minimalizing the risk of DRPs, and improving patientâs quality of life.Key words: Chronic kidney disease, coronary artery disease, drug related problems

Personalized Medicine Terapi Digoksin pada Individu dengan Polimorfisme Gen MDR Em Sutrisna
Indonesian Journal of Clinical Pharmacy Vol 4, No 2 (2015)
Publisher : Universitas Padjadjaran

Digoksin merupakan salah satu obat digitalis. Pemakaian yang luas untuk gagal jantung dan aritmia (supraventrikuler) memerlukan pengawasan yang cukup ketat karena obat tersebut merupakan obat dengan indeks terapi sempit. Digoksin merupakan substrat P-glikoprotein (P-gp) yang dikode oleh multi drugs resistance-1 (MDR1). Gen MDR-1 terletak di kromosom 7q21.1. Gen tersebut mengandung 28 exon yang mengkode protein dari 1280 asam amino. Gen ini memegang peranan penting dalam absorbsi, distribusi, dan eliminasi beberapa obat. Polimorfisme gen MDR1C3435T terjadi pada exon 26. Terdapat tiga tipe gen MDR1C3435T yaitu MDR1C3435T CC, MDR1C3435T CT dan MDR1C3435T TT. Polimorfisme ini akan memengaruhi pembentukan PGP dan ini berpengaruh pada profil kinetika digoksin. Perubahan profil kinetika ini menyebabkan perubahan kadar digoksin dalam darah. Metode yang digunakan dalam review ini adalah penelusuran data berbasis pubmed, medline, dan embase dengan kata kunci MDR, digoxin. Terdapat beberapa studi yang berbeda mengenai pengaruh polimorfisme MDR1C3435T terhadap kadar digoksin dalam darah. Peningkatan kadar digoksin dalam darah akibat polimorfisme gen MDR1C3435T akan berisiko terjadinya intoksikasi digitalis. Pengobatan digoksin dalam jangka panjang atau dosis besar seyogyanya mulai mempertimbangkan profil genetika pasien. Distribusi polimorfisme MDR1C3435T penduduk suku Jawa adalah TT (0,10), CT (0,52), dan CC(0, 38).Kata kunci: Digoksin, MDR1C3435T, polimorfisme, P-gp Personalized Medicine Digoxin Theraphy in Individuals with MDR Gene PolymorphismDigoxin is one of digitalis drugs. Wider applicability to heart failure and arrhythmias (supraventricular) requires fairly strict scrutiny because of its narrow therapeutic index. Digoxin is a substrate of P-glycoprotein (P-gp) encoded by multi drugs resistance-1 (MDR1). MDR-1 gen located on chromosome 7q21.1. This gene contains 28 exons that encoded a protein of 1280 amino acids. This gene plays an important role in the absorption, distribution and elimination of many drugs. MDR1C3435T polymorphism occurs in exon 26. There are three types of MDR1C3435T gene namely MDR1C3435T CC, MDR1C3435T CT and MDR1C3435T TT. These polymorphisms will affect to the formation of P-gp and consequently to change the kinetic profile of digoxin. The change of kinetic profile causes changes in the digoxin blood levels. The method used in this review is data search based on pubmed, medline, and embase with keywords MDR and digoxin. There are several different studies of the influence of polymorphisms MDR1C3435T on blood digoxin levels. Increased levels of digoxin in the blood due to polymorphism of MDR1C3435T will be at risk of digitalis intoxication. Long-term digoxin treatment or large dose should consider the patient’s genetic profile. Distribution of polymorphism of MDR1C3435T in Javanese population is approximately TT (0,10), CT (0,52), and CC(0, 38).Key words: Digoxin, MDR1C3435T , polymorphism, P-gp

Hubungan Persepsi terhadap Perilaku Swamedikasi Antibiotik: Studi Observasional melalui Pendekatan Teori Health Belief Model Annisa N. Insany; Dika P. Destiani; Anwar Sani; Ivan S. Pradipta; Lilik Sabdaningtyas
Indonesian Journal of Clinical Pharmacy Vol 4, No 2 (2015)
Publisher : Universitas Padjadjaran

Tingginya perilaku swamedikasi antibiotik dapat meningkatkan peluang penggunaan antibiotik yang tidak rasional sehingga berdampak pada peningkatan resistensi antibiotik. Perubahan perilaku swamedikasi antibiotik diperlukan untuk menurunkan penggunaan antibiotik yang irasional. Penelitian ini bertujuan untuk mengetahui hubungan persepsi masyarakat terhadap praktik swamedikasi antibiotik yang bermanfaat untuk mengembangkan model intervensi dalam rangka menurunkan praktik swamedikasi antibiotik (SMA). Studi observasional analitik dilakukan pada bulan November–Desember 2014 kepada masyarakat yang berkunjung ke fasilitas kesehatan primer di Kota Bandung. Wawancara terstruktur dengan menggunakan kuesioner tervalidasi dilakukan untuk melihat variabel perilaku swamedikasi serta variabel persepsi ancaman, keuntungan, hambatan, dan kemamampuan bertindak berdasarkan teori perubahan perilaku health belief model (HBM). Wawancara dilakukan terhadap 506 responden dewasa yang diambil secara acak di 43 puskesmas dan 8 apotek. Data yang diperoleh dianalisis dengan menggunakan statistik deskriptif dan regresi logistik (CI 95%, α=5%).Validitas kuesioner dinyatakan dengan koefisien korelasi >0,3 dan nilai reabilitas alpha-cronbach sebesar 0,719. Terdapat 29,45% responden yang melakukan swamedikasi antibiotik selama 6 bulan terakhir. Tidak terdapat hubungan signifikan antara variabel HBM (persepsi ancaman, keuntungan, hambatan, dan kemampuan bertindak) dengan perilaku swamedikasi antibiotik (p>0,05). Persepsi ancaman, keuntungan, hambatan, dan kemauan bertindak berdasarkan teori HBM menunjukkan hubungan yang lemah terhadap perilaku swamedikasi antibiotik. Mudahnya akses dalam membeli antibiotik secara bebas diduga menjadi faktor dalam perilaku SMA sehingga regulasi yang ketat diperlukan sebagai dasar intervensi dalam menurunkan perilaku SMA.Kata kunci: Antibiotik, health belief model, swamedikasiAssociation between Perceived Value and Self-Medication with Antibiotics: An Observational Study Based on Health Belief Model TheoryHigh prevalence of self medication with antibiotics can increase the probability of irrational use of antibiotics which may lead antibiotics resistance. Thus, shifting of behavior is required to minimize the irrational use of antibiotics. This study was aimed to determine the association between public perceivedvalue and self-medication with antibiotics which can be used to develop an intervention model in order to reduce the practice of self-medication with antibiotics. An observational study was conducted during the period of November–December 2014.The subjects were patients who visit primary health care facilities in Bandung. A structured-interview that has been validated was used to investigate the association between perceived value and self-medication behavior based on the Health Belief Model theory (perceived susceptibility, benefits, barrier, and cues to action). Approximately 506 respondents were drawn randomly from 43 community healthcare centers and 8 pharmacies. Data was analyzed by using descriptive statistics and logistic regression (CI 95%, α = 5%). Validity and reliability of the questionnaire were shown with a correlation coefficient of >0.3 and a cronbach-alpha value of 0.719, respectively. We found that 29.45% of respondents practiced self-medication with antibiotics over the last six months. Additionally, there was no significant association between the perceived susceptibility, benefits, barrier, and cues to action with self-medication behavior (p>0.05). Easiness to access antibiotics without prescription was presumed as a factor that contribute to self-medication with antibiotics, therefore strict regulation in antibiotics use is very needed as a basic intervention to decrease self-medication with antibiotic.Key words: Antibiotics, health belief model, self-medication

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