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INDONESIA
Jurnal Farmasi Klinik Indonesia
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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Terapi Farmakologi Nyeri pada Amyotrophic Lateral Sclerosis Indira D. Mahdayana; Hanik B. Hidayati
Indonesian Journal of Clinical Pharmacy Vol 9, No 4 (2020)
Publisher : Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15416/ijcp.2020.9.4.327

Abstract

Amyotrophic lateral sclerosis (ALS) merupakan penyakit neurodegeneratif fatal yang memengaruhi motor neuron. Nyeri merupakan gangguan sensoris yang dapat timbul pada ALS dan gejala yang seringkali diremehkan dan diabaikan pada pasien dengan ALS. Sampai saat ini, terapi nyeri hanya didasarkan pada pengalaman klinisi dan belum terdapat tata laksana nyeri yang terstandarisasi untuk pasien ALS. Oleh karena itu, tinjauan pustaka ini bertujuan untuk membahas gambaran klinis dan tata laksana nyeri pada ALS. Penelusuran referensi dilakukan melalui database PubMed dan Google Scholar dengan menggunakan kata kunci “Amyotrophic Lateral Sclerosis”, “pain”, “pharmacology”, dan “therapy”. Hasil penelusuran menunjukkan bahwa terdapat beberapa gambaran klinis nyeri pada ALS, seperti kram, spastisitas dan nyeri muskuloskeletal, sehingga tata laksana nyeri pada ALS harus didasarkan pada penyebab utama timbulnya nyeri. Terbatasnya evidence terkait terapi nyeri pada ALS menyebabkan pemberian terapi tidak dilakukan berdasarkan pendekatan sistematis, sehingga dibutuhkan studi lebih lanjut terkait efikasi dari terapi nyeri ALS.Kata kunci: Amyotrophic lateral sclerosis, farmakologi, nyeri, terapi  Pharmacology Therapy for Pain in Amyotrophic Lateral SclerosisAbstractThe cause of motor neurons is amyotrophic lateral sclerosis (ALS), a fatal neurodegenerative disease with the potential to cause a frequently ignored sensory disorder called pain. Furthermore, pain therapy today is usually based on the clinician’s experience while standardized pain management for ALS patients is unused. Therefore, this literature review aimed to explore ALS clinical features and pain management. The database investigation was performed on PubMed and Google Scholar using the keywords “Amyotrophic Lateral Sclerosis”, “pain”, “pharmacology”, and “therapy”. The results showed the presence of several pain clinical features in ALS, including cramps, spasticity and musculoskeletal pain, and therefore the need for ALS pain supervision to be based on the major cause. However, there were limited evidence reported investigating the effectiveness of drug therapy for this pain, and further research is required to discover efficient and safe pain treatment agents.Keywords: Amyotrophic lateral sclerosis, pain, pharmacology, therapy
Laporan Kasus: Perbaikan Kadar Prolaktin pada Makroadenoma Hipofisis dengan Terapi Bromokriptin dan EETA Ni Putu A. D. Gayatri; Hanik B. Hidayati
Indonesian Journal of Clinical Pharmacy Vol 9, No 3 (2020)
Publisher : Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15416/ijcp.2020.9.3.237

Abstract

Hiperprolaktinemia merupakan salah satu gejala klinis yang umum terjadi pada kasus makroadenoma hipofisis. Hiperprolaktinemia yang terjadi pada makroadenoma hipofisis dapat disebabkan oleh adanya penekanan massa tumor terhadap infundibulum (pituitary stalk) atau pun adanya sekresi hormon oleh tumor. Penelitian ini bertujuan untuk membahas pengaruh pemberian terapi bromokriptin dan operasi Endoscopic Endonasal Transsphenoidal Approach (EETA) terhadap perbaikan kadar hormon prolaktin dan kondisi klinis pada kasus makroadenoma hipofisis dengan hiperprolaktinemia. Dalam laporan kasus ini, dilaporkan bahwa seorang remaja pria usia 17 tahun datang dengan hilangnya penglihatan mata kanan, nyeri kepala, sulit menelan, dan ginekomasti. Pemeriksaan Magnetic Resonance Imaging (MRI) otak dengan kontras didapatkan adanya lesi ekstra aksial supratentorial di intrasellar yang meluas hingga suprasellar. Pada pemeriksaan laboratorium didapatkan adanya hiperprolaktinemia 198,10 ng/mL (nilai referensi 2,1–17,1 ng/mL). Hiperprolaktinemia yang terjadi pada kasus ini dapat disebabkan oleh tumor hipofisis yang mensekresi prolaktin (prolaktinoma) dan/atau akibat dari pendesakan massa tumor terhadap infundibulum. Berdasarkan hasil anamnesis, pemeriksaan fisik, pemeriksaan laboratorium dan penunjang, pasien didiagnosis mengalami makroadenoma hipofisis. Kami mempresentasikan kasus perbaikan kondisi klinis dan total penurunan kadar prolaktin sebesar 79,70% (pre pengobatan 198,10 ng/mL, post pengobatan 40,20 ng/mL) pada pasien dengan makroadenoma hipofisis yang disertai hiperprolaktinemia setelah dilakukan pemberian terapi bromokriptin 2,5 mg per hari selama 14 hari masa perawatan di rumah sakit dan tindakan operasi EETA.Kata kunci: Bromokriptin, ginekomasti, hiperprolaktinemia, makroadenoma hipofisisA Case Report: Prolactin Levels Improvement in Pituitary Macroadenoma with Bromocriptine Therapy and EETAAbstractHyperprolactinemia is one of the common clinical symptoms of pituitary macroadenoma. Hyperprolactinemia that occurs in pituitary macroadenoma can be caused by the suppression of the tumor mass against the infundibulum (pituitary stalk) or due to hormone secretion by the tumor. This study aims to discuss the effect of bromocriptine therapy and Endoscopic Endonasal Transsphenoidal Approach (EETA) surgery on prolactin level and clinical conditions in pituitary macroadenoma with hyperprolactinemia. This case report presents a seventeen years old boy with loss of right eye vision, headache, swallowing difficulty, and gynecomastia. Brain Magnetic Resonance Imaging (MRI) scan with contrast media found an extra-axial supratentorial lesions extending to the suprasellar. Also, based on laboratory examination, hyperprolactinemia was found with prolactin level of 198.10 ng/mL (reference value 2.1–17.1 ng/mL). Hyperprolactinemia that occurred in this case was found to be caused by a prolactin-secreting pituitary tumor (prolactinoma) towards the infundibulum. Based on the anamnesis, physical examination, laboratory test, and MRI, the patient was diagnosed of pituitary macroadenoma. An improvement was also observed in clinical conditions, where prolactin levels decreased by 79.70% (pre and post treatment 198.10 ng/mL and 40.20 ng/mL, respectively) after 2.5 mg bromocriptine therapy administration for 14 days and EETA surgery therapy.Keywords: Bromocriptine, gynecomastia, hyperprolactinemia, pituitary macroadenoma
Studi Pola Pemberian Artemisinin-Based Combination Therapy pada Pasien Malaria di RSUD Supiori Papua Sandra J. Parambang; Didik Hasmono; Jenggo Suwarko
Indonesian Journal of Clinical Pharmacy Vol 10, No 1 (2021)
Publisher : Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15416/ijcp.2021.10.1.30

Abstract

Malaria merupakan salah satu penyakit dengan prevalensi tinggi di Indonesia. Data Riset Kesehatan Dasar (Riskesdas) tahun 2018 menunjukkan prevalensi populasi malaria berdasarkan riwayat pemeriksaan darah tertinggi di Indonesia pada tahun 2013–2018 yaitu di Provinsi Papua. Tujuan penelitian adalah mengetahui pola pemberian dan ketepatan terapi Artemisinin based combination therapy (ACT) di RSUD Supiori, Papua. Penelitian ini merupakan penelitian deskriptif dengan pengambilan data secara retrospektif yaitu melakukan penelusuran terapi melalui rekam medis pasien dan dokumen pencatatan yang lain. Penelitian dilakukan pada periode Januari–Agustus 2019 terhadap 1.636 orang dan 71 pasien dinyatakan positif malaria. Seluruh pasien (100%) diterapi dengan Dyhidroartemisinin-piperaquin (DHP). Kasus malaria falciparum ditemukan pada 33 orang (46,48%), dan hampir seluruhnya (96,97%) diterapi dengan DHP+Primakuin. Kasus malaria vivax ditemukan pada 33 orang (46,48%), yang seluruhnya (100%) diterapi dengan DHP+Primakuin. Kasus malaria mix ditemukan pada 5 orang (7,04%), sebanyak 4 orang (80,00%) diterapi dengan DHP+Primakuin dan 1 orang (20,00%) diterapi dengan Artesunate dilanjutkan dengan DHP+Primakuin.Pola pemberian terapi malaria di RSUD Supiori pada periode Januari–Agustus 2019 telah sesuai pedoman tatalaksana malaria. Kata kunci: Artemisinin-based combination therapy (ACT), malaria, pola pemberian terapi  Study of Artemisinin-Based Combination Therapy Patterns in Malaria Patients at Supiori Hospital, Papua AbstractMalaria is a disease with high prevalence in Indonesia. According to the Basic Health Research data (Riskesdas) 2018, the province with the highest prevalence of malaria based on the results of blood tests in Indonesia was Papua. The research aims to determine the accuracy of Artemisinin-based combination therapy (ACT) pattern at Supiori Hospital, Papua. Furthermore, a descriptive study and data collection were conducted retrospectively by tracking the treatment history recorded in the patient medical records and other documents. The study was conducted between January–August 2019 and out of 1.636 patients, 71 tested positive for malaria. All patients (100%) were treated with Dyhidroartemisinin-piperaquine (DHP). Falciparum malaria cases were found in 33 people (46.48%), and almost all (96.97%) were treated with DHP+Primaquine. Vivax malaria cases were found in 33 people (46.48%), all of whom (100%) were treated with DHP+Primaquine. Also, mixed malaria cases were found in 5 people (7.04%), 4 people (80.00%) were treated with DHP+Primaquine and 1 person (20.00%) was treated with Artesunate followed by DHP+Primaquine. Furthermore, the pattern of providing malaria therapy at Supiori Hospital in the period January to August 2019 followed the malaria guidelines.Keywords: Artemisinin-based combination therapy (ACT), malaria, pattern of therapy
Acute Toxicity Test of Amomum Cardamomum (Kapulaga) Seed Extract didn’t Alter the Hepatic Trasaminase Enzyme in Rat Ratih D. Yudhani; Riza N. Pesik; Sarah Azzahro; Adliah F. Anisa; Rizka Hendriyani
Indonesian Journal of Clinical Pharmacy Vol 9, No 4 (2020)
Publisher : Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15416/ijcp.2020.9.4.288

Abstract

Kapulaga (Amomum Cardamomum), one of Indonesia’s herbs is commonly used in comunity as a spices or remidies, and the seed is becoming the most papular part. The prior evidence showed that kapulaga had many biological properties such as  antibacterial, antifungal and has been proven to reduce blood glucose and artherogenic parameter. Those previous studies promote the development of kapulaga as standardized herbal remidies. The utilization of herbal medicine especially in clinical setting must be supported by safety and effectiveness evidence, including toxicity test. Hepar was one of the target organs in the toxicity test, caused its role in the metabolism of most drugs. The aim of this study is to determine the safety profile of kapulaga seed extract through acute toxicity test in Winstar rats based on hepatic transaminase enzyme (SGOT and SGPT) level. Toxicity test was guided by the OECD 420 Fixed Dose Procedure. Preliminary test using 300 mg/kg BW dose and followed by high single dose (2000 mg/kg BW) of Kapulaga The main test was conducted by dividing the rat into control and treatment groups, 5 rats in each group. Based on preeliminary test, the treatment group was given 2000 mg/kg BW in a single dose of kapulaga seed extract. In days 14th, blood from orbita vein was taken, then SGOT and SGPT were assessed by enzymatic-photometric method. Independent sample t-test were used to analyze SGOT and SGPT’s data. The mean of SGOT in control and treatment groups were 116.92±22.35 and 98.02±16.38 (p = 0.17), whilts SGPT were 58.72±8.79 and 47.64±7.30 (p = 0.06). Both of them were not statistically different. The maximum dose of Kapulaga seed extract (2000 mg/kgBW) was not toxic due to it didn’t alter the hepatic transaminase enzyme (SGOT and SGPT) in rat. 
Glycemic Control and Its Factor in Type 2 Diabetic Patients in Jakarta Maifitrianti Maifitrianti; Nora Wulandari; Muthoh Haro; Sifah F. Lestari; Anisa Fitriani
Indonesian Journal of Clinical Pharmacy Vol 9, No 3 (2020)
Publisher : Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15416/ijcp.2020.9.3.198

Abstract

Poor glycemic control is a primary risk factor for the progression of complications. This study aimed to determine the status of glycemic control and associated factors among type 2 Diabetes Mellitus (DM) patients at primary health care of Cakung District, Kebon Jeruk District and Rawa Bunga Village, Jakarta. This study was conducted from July to August 2019, and adopted a cross-sectional design. The respondents' data included sex, age, occupation, education, long suffered with diabetes, diagnosed chronic disease, antidiabetic and other regular drugs were obtained through a questionnaire. Measurement of glycated haemoglobin A1c level was carried out in a standardized laboratory in Jakarta. A total of 126 respondents met the inclusions and exclusion criteria, of which 70.6% were female. The mean age of patients was 61.46±9.086 years (35–85 years). HbA1c level was measured, and the results showed that 45.2% of respondents had good glycemic control (<7% of HbA1c level), while 54.8% had poor control (≥7% of HbA1c level). On the bivariate analysis, the number of antidiabetics was significantly associated with glycemic control (p<0.05). The poor glycemic control was significantly higher in patients with polytherapy (72.6%) antidiabetic compared to single antidiabetic (37.5%) (p=0.01). These findings highlighted the need for proper management of patients with polytherapy, in order to prevent the complication of type 2 DM.Keywords: Glycemic control, Jakarta, primary health care, type 2 diabetes mellitus Kontrol Gikemik dan Faktor yang Berhubungan pada Pasien dengan Diabetes Melitus Tipe 2 di JakartaAbstrakKontrol glikemik yang buruk merupakan faktor risiko utama terjadinya komplikasi pada pasien diabetes melitus (DM). Penelitian ini bertujuan untuk mengetahui kontrol glikemik dan faktor yang berhubungan pada pasien DM tipe 2 di Puskesmas Kecamatan Cakung, Kecamatan Kebon Jeruk dan Kelurahan Rawa Bunga, Jakarta. Penelitian dilakukan pada bulan Juli–Agustus 2019. Desain penelitian yang digunakan adalah cross-sectional. Data responden antara lain jenis kelamin, umur, pekerjaan, pendidikan, lama menderita penyakit DM, penyakit kronis lain yang diderita, obat DM dan obat rutin lain yang digunakan didapatkan melalui instrumen kuisioner. Pengukuran kadar HbA1c dilakukan di laboratorium yang terstandarisasi di Jakarta. Sebanyak 126 responden memenuhi kriteria inklusi dan eksklusi terlibat dalam penelitian ini, dan sebanyak 70,6% adalah berjenis kelamin perempuan. Usia rata-rata pasien adalah 61,46±9,086 tahun (35–85 tahun). Hasil penelitian menunjukkan bahwa 45,2% responden memiliki kontrol glikemik yang baik (<7 level HbA1c), sedangkan 54,8% responden memiliki kontrol glikemik yang buruk (≥7 level HbA1c). Hasil uji bivariat menunjukkan bahwa jumlah antidiabetes yang digunakan berhubungan dengan kontrol glikemik. Kontrol glikemik yang buruk secara signifikan lebih tinggi ditemukan pada pasien dengan politerapi (72,6%) dibandingkan pada pasien dengan terapi tunggal antidiabetes (37,5%) (p=0,01). Temuan ini menyoroti perlunya manajemen yang tepat pada pasien dengan politerapi untuk mencegah komplikasi DM tipe 2.Kata kunci: Diabetes melitus tipe 2, Jakarta, kontrol glikemik, puskesmas
Hubungan Derajat Celah Langit-Langit dengan Keadaan Telinga Tengah Berdasarkan Timpanogram pada Pasien Celah Langit-Langit Shinta F. Boesoirie; Nur A. Aroeman; Dicki Nursyafri; Vesara A. Gatera
Indonesian Journal of Clinical Pharmacy Vol 10, No 2 (2021)
Publisher : Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15416/ijcp.2021.10.2.110

Abstract

Celah langit-langit dan bibir sering terjadi akibat kegagalan penyatuan langit-langit dan bibir selama masa perkembangan janin. Sekitar 90% penderita celah langit-langit akan mengalami gangguan telinga tengah dan menimbulkan gangguan pendengaran. Kelainan telinga tengah pada penderita celah langit-langit pada derajat 2 umumnya terjadi pada obstruksi fungsional pada tuba eustakius sehingga terjadi kegagalan otot palatal untuk membuka tuba eustakius. Penelitian ini bertujuan untuk mengeksplorasi hubungan derajat celah langit-langit dengan keadaan telinga tengah pada pasien dengan celah langit-langit. Penelitian ini merupakan penelitian analitik observasional dengan rancangan potong lintang. Subjek penelitian adalah penderita celah langit-langit yang datang berobat ke poliklinik bedah mulut di YPPCBL Bandung dan poliklinik Telinga, Hidung, Tenggorok-Bedah Kepala dan Leher (THT-KL) pada tahun 2018 di Rumah Sakit Dr. Hasan Sadikin Bandung sebanyak 30 subjek. Data penelitian didapatkan dari anamnesis, pemeriksaan fisik THT-KL dan pemeriksaan timpanometri untuk mengetahui keadaan telinga tengah subjek penelitian. Data yang terkumpul dilakukan analisis data menggunakan uji regresi linear melalui nilai p≤0,05 untuk melihat derajat hubungannya. Keadaan telinga tengah di kedua sisi memberikan gambaran semakin bertambah derajat celah langit-langit maka timpanogram lebih banyak tipe B diikuti dengan jumlah penderita celah abnormalnya. Dari 30 subjek penelitian, didapatkan sebanyak 20% pada derajat 3 dan 66,7% pada derajat 4 memiliki timpanogram tipe B di telinga kanan, sedangkan pada telinga kiri, didapatkan 6,7% pada derajat 2 memiliki tipmanogram tipe As, 20% pada derajat 3 dan 66,7% pada derajat 4 memiliki timpanogram tipe B. Disimpulkan bahwa terdapat hubungan yang bermakna antara derajat celah langit-langit dengan keadaan telinga tengah berdasarkan timpanogram.Kata kunci: Celah langit-langit, derajat celah langit-langit, keadaan telinga tengah, timpanogram The Correlation Between the Cleft Palate Severity and the Middle Ear Condition Based on the Tympanogram in Cleft Palate PatientsAbstractCleft lip and palate (CLP) are congenital anomalies caused by the failure of palate and lip fusion during fetal development which is influenced by numerous factors. Approximately 90% of CLP patients develop middle ear disorders leading to loss of hearing. Middle-ear disorders in cleft palate patients starting from grade 2, are bound to cause functional obstruction in the eustachian tube, due to the palatal muscle’s failure to open the eustachian tube. This study, therefore, aimed to investigate the association between the cleft palate severity and the middle ear condition in these patients, using an analytic-observational method with a cross-sectional design. The study subjects were 30 cleft palate patients admitted to the oral surgery polyclinic at YPPCBL Bandung and ORL-HNS Polyclinic Dr. Hasan Sadikin General Hospital. Data were collected retrospectively from medical records, while ORL-HNS physical examination and tympanometry examination were performed to determine the middle ear condition. Subsequently, a regression analysis was conducted to determine the degree of association. According to the results, an increase in the cleft palate severity increases the prevalence of type-B tympanogram, with an increasing number of CLP patients. Among the study subjects, about 20% of grade 3 and 66.7% of grade 4 had type-B tympanogram in the right ear, while in the left ear, 6.7% of grade 2 had type-As tympanogram, and 20% of grade 3, as well as 66.7% of grade 4, had type-B tympanogram. Therefore, the cleft palate severity is significantly correlated with the middle ear condition, based on the tympanogram.   Keywords: Cleft palate, cleft palate severity, middle ear condition, tympanogram
Evaluasi Kuantitatif Penggunaan Antibiotik di Ruang Perawatan Airlangga dan Peta Kuman RSUD Kanjuruhan Malang Periode Juli-Desember 2018 Wirda Anggraini; Hajar Sugihantoro; Firda Ludfiyah
Indonesian Journal of Clinical Pharmacy Vol 10, No 2 (2021)
Publisher : Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15416/ijcp.2021.10.2.90

Abstract

Antibiotik merupakan salah satu obat yang paling banyak dikonsumsi secara luas di tempat layanan kesehatan. Tingginya jumlah penggunaan antibiotik yang tidak tepat dapat mengakibatkan terjadinya resistensi, efek samping dan biaya rumah sakit yang meningkat. Salah satu upaya untuk mengendalikan resistensi antibiotik di rumah sakit adalah pelaksanaan evaluasi penggunaan antiobiotik. Penelitian ini bertujuan untuk mengetahui profil penggunaan antibiotik dan peta kuman, serta melakukan evaluasi kuantitatif. Penelitian ini merupakan penelitian observasional deskriptif menggunakan desain cross-sectional melalui data rekam medik pasien Ruang Perawatan Airlangga bulan Juli–Desember 2018 dan data peta kuman tahun 2018 RSUD Kanjuruhan Malang yang diambil secara retrospektif. Didapatkan 75 sampel rekam medis yang kemudian dianalisis secara kuantitatif menggunakan metode ATC/DDD. Hasil penelitian ini menunjukkan bahwa golongan antibiotik terbanyak yang digunakan adalah golongan Cephalosporin (86%) dengan tiga antibiotik tertinggi adalah Cefoperazone (43,90%), Ceftriaxone (18,29%), dan Cefotaxime (13,41%). Dari hasil analisis kuantitatif penggunaan antibiotik dengan metode ATC/DDD, didapatkan nilai total DDD/100 patient days sebesar 66,44 dengan antibiotik tertinggi adalah Cefoperazone (20,72), dan Ceftriaxone (20,18). Antibiotik yang masuk dalam segmen 90% antara lain Cefoperazone (parenteral) 31,19%, Ceftriaxone (parenteral) 30,37%, Cefotaxime (parenteral) 12,45%, Levofloxacin (parenteral) 5,19%, Levofloxacin (oral) 4,88%, dan Metronidazole (parenteral) 4,73%. Isolat bakteri yang diperoleh dari laboratorium mikrobiologi berjumlah 120 isolat dengan distribusi bakteri gram positif (49,17%) dan bakteri gram negatif (50,83%). Isolat bakteri gram positif terbanyak adalah Staphylococcus aureus (30%) dan bakteri gram negatif terbanyak adalah Escherichia coli (15%) dengan sensitivitas antibiotik terbaik untuk bakteri gram positif adalah Clarithomicyn (81,8%) dan untuk bakteri gram negatif adalah Amikacin (77,8%).Kata kunci: Antibiotik, DDD/100 patient days, DU 90%, peta kuman  A Quantitative Evaluation of the Antibiotic Use in Airlangga Ward and Microorganism Pattern in Kanjuruhan Regional General Hospital Malang, between July and December 2018AbstractAntibiotics are the most widely used class of drugs in health care, however, the abuse of these drugs leads to resistance, side effects, and increased hospital costs. The evaluation of antibiotics use is a possible attempt to control antibiotic resistance in hospitals. Therefore, this study aimed to determine the profile of antibiotic use, microorganism pattern, and perform a quantitative evaluation. Using an observational descriptive method study with a cross-sectional design, data were retrospectively retrieved from medical records of patients admitted in Airlangga Ward between July and December 2018, as well as the microorganism pattern in Kanjuruhan Region General Hospital Malang 2018. A total of 75 medical record samples were obtained and these were further analyzed using the ATC/DDD method. According to the results, the most used antibiotics group was Cephalosporin (86%), particularly Cefoperazone (43.90%), Ceftriaxone (18.29%), and Cefotaxime (13.41%). In addition, the quantitative analysis of antibiotics use showed the total DDD/100 patient days was 66.44 with Cefoperazone (20.72) and Ceftriaxone (20.18). The antibiotics included in the 90% segment were Cefoperazone (parenteral) 31.19%, Ceftriaxone (parenteral) 30.37%, Cefotaxime (parenteral) 12.45%, Levofloxacin (parenteral) 5.19%, Levofloxacin (oral) 4.88%, and Metronidazole (parenteral) 4.73%. Meanwhile, a total of 120 bacterial isolates (49.17% gram-positive and 50.83% gram-negative) were obtained from the microbiology laboratory, with the most prevalent gram-positive and negative isolates being Staphylococcus aureus (30%) and Escherichia coli (15%), respectively. Also, the best antibiotic sensitivity for gram-positive and negative bacteria was recorded for Clarithomicyn (81.8%) and Amikacin (77.8%), respectively.    Keywords: Antibiotics, DDD/100 patient days, DU 90%, microorganism pattern
Reaksi Obat yang Tidak Diharapkan dari Penggunaan Teofilin akibat Interaksi dengan Obat Penghambat Enzim Sitokrom P450 1A2: Laporan Kasus Ulvi N. Rista; Astria Y. Permana
Indonesian Journal of Clinical Pharmacy Vol 10, No 2 (2021)
Publisher : Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15416/ijcp.2021.10.2.127

Abstract

Teofilin merupakan bronkodilator dengan rentang konsentrasi terapetik sempit dan memiliki variabilitas antarindividu secara farmakokinetik. Klirens teofilin dipengaruhi oleh usia, fungsi hati, dan interaksi obat. Kami laporkan sebuah kasus anak usia 2 tahun 8 bulan dengan sepsis disertai gangguan fungsi ginjal dan hati, mengalami reaksi obat yang tidak diharapkan yang diduga efek toksisitas teofilin akibat interaksi obat, yaitu tremor, kejang, gelisah, dan takikardia. Dilakukan pengecekan interaksi obat dengan menggunakan Micromedex® dan penilaian hubungan kausalitas menggunakan Drug Interaction Probability Scale (DIPS). Dari penilaian DIPS, paling mungkin disebabkan oleh interaksi obat teofilin dan siprofloksasin, didukung dengan tanda dan gejala toksisitas hilang setelah teofilin dihentikan. Efek tersebut terjadi karena peningkatan dosis teofilin yang tidak diikuti dengan peningkatan klirens teofilin pada anak. Penyesuaian dosis dan pemantauan kadar teofilin dalam darah diperlukan untuk mencegah efek toksisitas.Kata kunci: Interaksi obat, siprofloksasin, teofilin, toksisitas obat  Adverse Drug Reaction due to the Drug Interaction between Theophylline and a CYP1A2 Drug Inhibitor: Case Report AbstractTheophylline is a bronchodilator with narrow therapeutic concentration, as well as inter-individual pharmacokinetic variability, and the clearance of this drug is influenced by age, liver function, and drug interactions. This study, therefore, reports the case of a 32 month-old child diagnosed with sepsis as well as renal and liver impairment and exhibiting theophylline toxicity symptoms of tremor, seizure, agitation, as well as tachycardia. The drug interaction and causality relationship were assayed using Micromedex® and a Drug Interaction Probability Scale (DIPS), respectively. Based on the DIPS, the most probable cause is the drug interaction of theophylline and ciprofloxacin. Furthermore, all the symptoms disappeared after theophylline was continued. Also, an increase in the theophylline dose did not lead to an increase in the drug’s clearance, therefore, to prevent toxicity, the dosage ought to be adjusted and the drug concentration must be monitored. Keywords: Ciprofloxacin, drug interaction, drug toxicity, theophylline
Sacubitril/Valsartan: The Role of Neprilysin Pathway in Heart Failure Sidhi L. Purwowiyoto; Ferina Angelia; Ananta S. Prawara
Indonesian Journal of Clinical Pharmacy Vol 10, No 2 (2021)
Publisher : Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15416/ijcp.2021.10.2.133

Abstract

Neprilysin (NEP) is an enzyme present in several body cells and is involved in the degradation of natriuretic peptides (NPs), bradykinin (BK), and adrenomedullin (ADM). Furthermore, sacubitril/valsartan (LCZ696), the first agent of Angiotensin Receptor Neprilysin Inhibitor (ARNI), has been developed to inhibit both Renin Angiotensin Aldosterone System (RAAS) and NEP. This study, therefore, aimed to discuss the role of sacubitril/valsartan in inhibiting the progression of heart failure (HF) by influencing the RAAS and NEP pathways. Data on previous articles related to basic theory and clinical trials of ARNI were collected through multiple search engines using the inclusion criteria: articles published in the English language within 2010 to 2020, while additional information on HF guidelines, RAAS, NPs, and ADM were acquired separately. Subsequently, a total of 30 studies were selected and further discussed. According to the results, NEP inhibition leads to a rise in the level of vasodilator agents and is beneficial for HF patients previously prescribed solely RAAS inhibiting agent (Angiotensin Converting Enzyme, ACE-inhibitor and Angiotensin II Receptor Blockers, ARB). In addition, the RAAS, as well as the NEP pathways play a significant role in HF progression and are inhibited by sacubitril/valsartan. Also, clinical trials showed sacubitril/valsartan is superior to ACE-inhibitor and ARB in clinical trials in treating, as well as reducing the morbidity and mortality rates of patients suffering from HF with reduced ejection fraction (HFrEF). Keywords: ARNI, heart failure, neprilysin, sacubitril/valsartan Sacubitril/Valsartan: Peran dari Jalur Neprilisin dalam Gagal JantungAbstrakNeprilisin (NEP) merupakan sebuah enzim yang dapat ditemukan di berbagai sel pada tubuh dan terlibat dalam mendegradasi peptida natriuretik, bradykinin  (BK), dan adrenomedullin (ADM). Sacubitril/valsartan (LCZ696) merupakan agen pertama dari Angiotensin Receptor Neprilysin Inhibitor (ARNI) yang dikembangkan untuk menghambat jalur Renin Angiotensin Aldosterone System (RAAS) dan NEP. Review ini bertujuan untuk membahas peranan dari sacubitril/valsartan dalam menghambat progresi gagal jantung dengan memengaruhi jalur RAAS dan NEP. Pengumpulan data untuk teori dasar dan uji klinis ARNI dalam artikel review ini menggunakan beberapa mesin pencari. Informasi tambahan seperti pedoman-pedoman gagal jantung, RAAS, peptida natriuretik, dan ADM didapatkan secara terpisah. Kriteria inklusi yang digunakan adalah studi harus berbahasa Inggris dan dipublikasikan antara 2010 dan 2020. Sebanyak 30 studi diinklusi dan dibahas lebih lanjut dalam review ini. Hasilnya didapatkan bahwa inhibisi dari NEP menyebabkan terjadinya peningkatan agen-agen vasodilator yang berdampak positif bagi pasien gagal jantung yang sebelumnya direkomendasikan meminum obat yang hanya menghambat RAAS (penghambat Angiotensin Converting Enzyme/ACE dan Angiotensin II Receptor Blockers/ARB). Sacubitril/valsartan menghambat alur RAAS dan NEP yang mana keduanya memainkan peranan penting dalam progresi gagal jantung. Sacubitril/valsartan lebih superior dalam mencapai target pengobatan pasien yaitu mengurangi morbiditas dan mortalitas pasien gagal jantung dengan penurunan fraksi ejeksi dibandingkan dengan penghambat ACE dan ARB pada uji-uji klinis.Kata kunci: ARNI, gagal jantung, neprilisin, sacubitril/valsartan
Atypical Antipsychotic Induced Weight Gain in Schizophrenic Patients Tetie Herlina; Dyah A. Perwitasari; Haafizah Dania; Santi Yuliani; Melisa I. Barliana
Indonesian Journal of Clinical Pharmacy Vol 10, No 1 (2021)
Publisher : Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15416/ijcp.2021.10.1.57

Abstract

Atypical antipsychotics are widely prescribed and have the potential to cause weight gain, which may result in the development of metabolic syndrome. Also, it is important to monitor the use of atypical antipsychotic for metabolic disturbance. The purpose of this study is to determine the side effects of atypical antipsychotics in increasing body weight in schizophrenia patients after 4 weeks of use. Furthermore, a retrospective design was conducted and data were collected based on consecutive sampling in 80 adult psychiatric inpatients (20 women and 60 men) with initial diagnoses of schizophrenia and with the same daily nutrition. The patients were hospitalized from January to March 2019, within the term (over 4 weeks) of initiation atypical antipsychotic. The patient body weight was collected before and 4 weeks after the treatment of atypical antipsychotic. The results showed that patients (20 women and 60 men) receiving atypical antipsychotic had a mean age of 35.6 years and a percentage of 70% women and 56% men had a weight gain of 1–5 kg over 4 weeks. The mean weight observed among our subjects increased from 57.55±10.743 kg to 59.83±12.205 kg after initiating treatment (p=0.001). However, the dual combination of atypical antipsychotics risperidone and clozapine are the most widely atypical antipsychotic used with a percentage equal to 91.25%, 3.75% clozapine, and 5% risperidone. Furthermore, it can be concluded that atypical antipsychotics use for at least 4 weeks can cause weight gain in schizophrenic patients. Pharmacist and doctors are recommended to monitor the metabolic side effects due to the atypical antipsychotic use. Keywords: Atypical antipsycotic, schizophrenia, weight gain  Antipsikotik Atipikal Menginduksi Peningkatan Berat Badan pada Pasien Skizofrenia AbstrakAntipsikotik atipikal banyak diresepkan dan berpotensi menyebabkan kenaikan berat badan yang dapat menyebabkan sindrom metabolik. Ada kebutuhan klinis yang mendesak untuk memantau penggunaan antipsikotik atipikal terhadap gangguan metabolisme. Penelitian ini bertujuan untuk mengetahui efek samping antipsikotik atipikal dalam meningkatkan berat badan pada pasien skizofrenia setelah pemakaian 4 minggu. Melalui desain retrospektif, data dikumpulkan dengan consecutive sampling pada 80 pasien rawat inap psikiatri dewasa (20 wanita dan 60 pria) dengan diagnosis awal skizofrenia dan dengan pengaturan nutrisi harian yang sama. Pasien dirawat di rumah sakit sejak Januari 2019 sampai dengan Maret 2019, dalam jangka menengah (lebih dari 4 minggu) pemberian antipsikotik atipikal. Data berat badan pasien dicatat sebelum dan 4 minggu sesudah pemakaian antipsikotik atipikal. Pasien (20 wanita dan 60 pria) yang menerima antipsikotik atipikal memiliki usia rata-rata 35,6 tahun, semua pasien dengan persentase 70% wanita dan 56% pria memiliki kenaikan berat badan 1–5 kg selama periode 4 minggu. Berat rata-rata yang diamati di antara subyek meningkat dari 57,55±10,743 kg menjadi 59,83±12,205 kg setelah memulai pengobatan (p=0,001). Antipsikotik atipikal yang paling banyak digunakan adalah kombinasi antipsikotik atipikal risperidon clozapin dengan persentase sebesar 91,25%, clozapin 3,75%, risperidon 5%. Kami menyimpulkan bahwa penggunaan antipsikotik atipikal selama setidaknya 4 minggu dapat menyebabkan penambahan berat badan pada pasien skizofrenia. Apoteker dan dokter direkomendasikan untuk memantau efek samping metabolik akibat penggunaan antipsikotik atipikal.Kata kunci: Antipsikotik atipikal, peningkatan berat badan, skizofrenia

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