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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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Articles 540 Documents
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Efek Proteksi Profilaksis Isoniazid terhadap Infeksi Tuberkulosis pada Pasien HIV di Rumah Sakit Pengayoman Cipinang Nurfitri Bustamam; Indra Setiawan
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.2021.10.2.100

Abstract

Tuberkulosis (TB) merupakan infeksi oportunistik yang menjadi penyebab utama kematian pada pasien human immunodeficiency virus (HIV). Oleh karenanya, perlu upaya pencegahan infeksi TB melalui pemberian profilaksis isoniazid (INH) kepada pasien HIV. Penelitian ini bertujuan untuk memberikan gambaran karakteristik pasien yang mendapat profilaksis INH dan hasil pemberian profilaksis tersebut di RS Pengayoman Cipinang. Metode penelitian yang digunakan adalah desain kohort retrospektif pada pasien HIV yang mulai mendapat profilaksis INH pada tahun 2018–2019. Data diambil dari Ikhtisar Perawatan HIV. Hasil penelitian menunjukkan sebanyak 46 dari 57 (80,7%) subjek mendapat profilaksis INH lengkap, sementara subjek lainnya ada yang mengalami alergi, loss of follow up, pindah, atau meninggal. Subjek mulai mendapat profilaksis INH setelah 3 (0–13) tahun dikonfirmasi terinfeksi HIV.  Berdasarkan karakteristiknya, subjek yang mendapat profilaksis INH lengkap sebagian besar adalah laki-laki, berusia 36 (24–54) tahun, berpendidikan Sekolah Menengah Atas (SMA), dan belum menikah. Status kesehatan dan riwayat pengobatan subjek beragam. Sebanyak 71,1% subjek mendapat regimen antiretroviral fixed-dosed combination, 87% dengan adherence ≥95%, 39% stadium klinis III, 52,2%  dengan viral load detected, 15,2% mempunyai riwayat infeksi TB, dan 93,5% tidak mendapat profilaksis kotrimoksasol. Hasil observasi selama setahun menunjukkan tidak ada subjek dengan profilaksis INH lengkap yang terinfeksi TB. Dapat disimpulkan profilaksis INH efektif melindungi subjek dari infeksi TB.Kata kunci: Pasien human immunodeficiency virus, profilaksis isoniazid, tuberkulosis   The Protective Effect of Isoniazid Prophylactic Therapy against Tuberculosis Infection in HIV Patients at Pengayoman Cipinang Hospital AbstractTuberculosis (TB) is the most opportunistic infection and the leading cause of death in human immunodeficiency virus (HIV) patients. Consequently, TB infection must be prevented by providing these patients with isoniazid prophylactic therapy (IPT). This study, therefore, aimed to describe the characteristics of patients administered IPT and the results of this therapy at Pengayoman Cipinang Hospital, using a retrospective cohort design in HIV patients first administered IPT between 2018 and 2019. Data was collected through a review of medical records and a total of 57 participants were selected for the study. According to the results, 46 subjects (80.7%) received complete IPT, while others either experienced allergies, failed to follow-up, moved, or died. The subjects all began IPT after 3 (0 to 13) years of confirmed HIV infection, and based on the respondent characteristics, the majority of subjects administered complete IPT were unmarried men, aged 36 (24–54) years, and with high school education. However, the health status and treatment history of the subjects varied. A total of 71.1% of the subjects received a fixed-dose combination antiretroviral regimen, 87% received with adherence ≥95%, 39% with clinical stage III, 52.2% with viral load detected, 15.2% had a history of TB infection, while 93.5% did not receive cotrimoxazole prophylaxis. Observations for a year showed none of the subjects with complete IPT were infected with TB. Therefore, IPT was concluded to be effective in protecting HIV patients from TB infection.    Keywords: Isoniazid prophylactic therapy, human immunodeficiency virus patients, tuberculosis 
Profil Proteinuria dan Tekanan Darah pada Pasien Preeklampsia Berat yang menggunakan Antihipertensi Nurmainah Nurmainah; Firda M. Hadad; Mohamad Andrie
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.2021.10.2.79

Abstract

Preeklampsia berat sering terjadi pada ibu hamil. Pengobatan preeklampsia berat dapat dilakukan dengan pemberian antihipertensi untuk mencegah penyakit serebrovaskular dan kematian. Penelitian ini bertujuan untuk mendeskripsikan profil penurunan proteinuria, tekanan darah, dan penggunaan antihipertensi pada pasien preeklampsia berat di Instalasi Rawat Inap RSUD dr. Soedarso Pontianak. Metode penelitian yang digunakan adalah observasional dengan rancangan penelitian potong lintang. Pengumpulan data dilakukan secara retrospektif dari rekam medis pasien preeklampsia berat rawat inap selama periode Januari–Desember 2018. Penelitian ini dilakukan selama bulan Oktober–Desember 2019 di RSUD dr. Soedarso Pontianak. Sampel yang memenuhi kriteria inklusi dalam penelitian ini sebanyak 62 pasien. Hasil penelitian menunjukkan bahwa 32,27% pasien mengalami penurunan nilai proteinuria dengan rata-rata penurunan sebesar dipstik (+)1 sedangkan nilai proteinuria dipstik yang tetap terdapat pada 67,73% pasien dengan mayoritas pasien memiliki nilai proteinuria dipstik (+)3. Penurunan rata-rata tekanan darah sistolik/diastolik (TDS/TDD) pada pasien preeklampsia berat sebesar 28,58/17,69 mmHg. Antihipertensi yang digunakan yaitu nifedipin (14,52%), metildopa (8,06%), furosemid (1,61%). Penggunaan antihipertensi kombinasi paling banyak digunakan adalah kombinasi nifedipin dan metildopa sebanyak 40,32%. Simpulan penelitian ini adalah terdapat penurunan tekanan darah dan proteinuria pada pasien preeklampsia berat yang menggunakan antihipertensi.Walaupun demikian, beberapa pasien preeklampsia berat masih memiliki kadar proteinurianya dalam kondisi tetap. Antihipertensi yang paling banyak digunakan pada pasien preeklampsia berat di Instalasi Rawat Inap RSUD dr. Soedarso Pontianak yaitu kombinasi nifedipin dan metildopa.Kata kunci: Antihipertensi, preeklampsia berat, proteinuria, tekanan darah  Proteinuria and Blood Pressure Profiles in Severe Preeclampsia Patients using Antihypertensive MedicationAbstractPreeclampsia is a common occurrence among pregnant women, and in severe cases, the condition is treated using antihypertensive medication to prevent cerebrovascular disease, as well as death. This study, therefore, aimed to describe the proteinuria levels, blood pressure, and antihypertensive profile of patients with severe preeclampsia at Dr. Soedarso General Hospital, Pontianak, using a descriptive observation method with a cross-sectional design. The study was conducted from October–December 2019, however, data were collected retrospectively, based on inpatients with severe preeclampsia medical records from January to December 2018, and a total of 62 participants were selected based on the inclusion, as well as exclusion criteria. According to the results, 32,27% of the respondents experienced a reduction in proteinuria levels, with an average of proteinuria dipstick (+)1, while 67,73% experienced constant proteinuria levels, with most patients having proteinuria dipstick (+)3. Furthermore, the average systolic/diastolic blood pressure (SBP/DBP) reduction in patients with severe preeclampsia was 28,58/17,69 mmHg. The antihypertensive used were nifedipine (14,52%), methyldopa (8,06%), and furosemide (1,61%), alone or in combination, however combination medication, for instance, nifedipine + methyldopa (40,32%), was most prevalent. In conclusion, patients with severe preeclampsia experienced reductions in blood pressure and proteinuria levels after treatment with antihypertensive medication, however, several patients experienced constant proteinuria levels. Also, the most commonly used antihypertensive was discovered to be a combination of nifedipine and methyldopa.Keywords: Antihypertensive medication, blood pressure, proteinuria, severe preeclampsia 
Efek Ekstrak Angkak dalam Menghambat Proliferasi Sel Kanker Prostat dan Payudara Vesara A. Gatera; Tiana Milanda
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.2021.10.2.119

Abstract

Kanker payudara dan prostat masih menjadi kasus prevalensi tertinggi hingga saat ini, untuk itu diperlukan beberapa alternatif terapi yang berasal dari bahan alam dengan efek samping yang relatif rendah. Salah satu bahan alam yang memiliki aktivitas sitotoksisitas adalah angkak yang merupakan hasil fermentasi dari jamur Monascus pada medium beras, namun potensinya belum optimal diteliti terutama pada kanker payudara dan prostat. Penelitian ini bertujuan untuk menguji sitotoksisitas ekstrak etanol, etil asetat, dan n-heksan dari angkak terhadap lini sel kanker prostat DU145, lini sel kanker payudara MDA-MB-231 dan menentukan golongan senyawa yang diduga memiliki aktivitas sitotoksik. Penelitian ini menggunakan metode 3-4,5-di-methylthiazol-2-y1-5-(3-carboxymethoxyphenyl)-2-(sulfophenyl)-2H-tetrazolium (MTS). Berdasarkan hasil penelitian, diketahui bahwa ekstrak n-heksan memiliki sitotoksisitas terbaik dengan nilai IC50 138,900 μg/mL pada lini sel DU145 dan 192,623 μg/mL pada lini sel MDA-MB-231, sedangkan pada ekstrak etanol dan etil asetat memiliki tingkat sitotoksik yang rendah dengan masing-masing nilai IC50 yaitu 649,426 μg/mL pada lini sel DU145, di luar rentang konsentrasi uji pada sel lini MDA-MB-231 dan 207,916 μg/mL pada lini sel DU145 dan 259,408 μg/mL pada lini sel MDA-MB-231. Disimpulkan bahwa ekstrak n-heksan angkak memiliki aktivitas sitotoksisitas terbaik, kemampuan tersebut diduga berasal dari senyawa flavonoid dan kuinon.Kata kunci: Angkak, kanker prostat, Monascus, sitotoksisitas The Effect of Angkak Extract in Inhibiting Cell Proliferation of Prostate and Breast CancerAbstractProstate cancer attacks the prostate gland in the male reproductive system. However, angkak, a product of fermentation from Monascus mushrooms on rice medium, exhibits potent anticancer activity. This study, therefore, aims to examine the cytotoxicity of ethanol, ethyl, and n-hexane extracts from angkak against DU145 prostate, as well as MDA-MB-231 breast cancer cells line, and determine the class of compounds with cytotoxic activity. The cytotoxic assay was performed using the 3-4,5-di-methylthiazol-2-y1)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium (MTS) method. According to the results,  the n-hexane extract of angkak exhibited the most impressive cytotoxicity at IC50 138,900 μg/mL in DU145 cell, and 192,623 μg/mL, in MDA-MB-231 cell line. Meanwhile, the ethanol and ethyl acetate extracts exhibited low cytotoxic levels with  IC50 649,426 μg/mL and 207,916 μg/mL, respectively, in DU145 cell line, as well as unidentified results and 259,408 μg/mL, respectively, in MDA-MB-231 cell line. Therefore, angkak n-hexane extract was concluded to exhibit the best cytotoxicity activity, with the potential compounds having this activity derived from flavonoid and quinone compounds.      Keywords: Angkak, prostate cancer, Monascus, cytotoxicity
Potensi Tanaman Herbal Antidiabetes untuk Minuman Obat: Sebuah Literatur Review Yulin Prisdiany; Irma M. Puspitasari; Norisca A. Putriana; Mas Rizky A. A. Syamsunarno
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.2021.10.2.144

Abstract

Jumlah kasus dan prevalensi diabetes terus meningkat selama beberapa dekade terakhir. Pada tahun 2012, diabetes menyebabkan 1,5 juta kematian. Seiring berkembangnya pengetahuan, saat ini tanaman herbal lebih banyak digunakan sebagai bahan obat. Salah satu sediaan yang saat ini sedang banyak dikembangkan adalah sediaan minuman herbal. Minuman herbal kaya akan senyawa bioaktif alami. Bukti ilmiah menunjukkan bahwa senyawa bioaktif ini memberikan banyak efek biologis, seperti antioksidan, antibakteri, antidiabetes, dan lain-lain. Salah satu permasalahan yang berkaitan dengan penggunaan tanaman herbal adalah kurangnya penelitian atau pengujian secara ilmiah yang menunjukkan khasiat dari tanaman obat yang digunakan. Artikel ini memberikan gambaran secara ilmiah tentang tanaman herbal yang sudah terbukti memiliki khasiat antidiabetes yang dapat dimanfaatkan untuk pengembangan minuman obat herbal. Pencarian literatur melalui basis data elektronik PubMed pada bulan April 2020 dengan kata kunci “herbal tea” dan “antidiabetic” memperoleh total 30 artikel yang dapat ditelaah lebih lanjut. Sebanyak 12 artikel tentang uji in vitro, 16 artikel tentang uji in vivo, dan 2 artikel tentang uji klinik. Terdapat 35 jenis tanaman herbal di seluruh dunia yang terbukti dapat memberikan aktivitas antidiabetes. Bagian morfologi tanaman yang paling sering digunakan yaitu bagian daun. Mekanisme in vitro dari tanaman herbal dalam memberikan aktivitas antidiabetes adalah dengan menghambat aktivitas enzim α-Amylase dan α-Glucosidase. Pada uji in vivo dan uji klinik, semua tanaman herbal yang digunakan pada penelitian mempunyai aktivitas dalam membantu menurunkan kadar glukosa darah dan dapat dimanfaatkan sebagai minuman obat herbal.Kata kunci: Antidiabetes, minuman herbal, tanaman herbal The Potential of Antidiabetic Herbal Plants for Medicinal Drinks: A Literature ReviewAbstractOver the past few decades, an increase has occurred in the occurrence and prevalence of diabetes, with 1.5 million deaths recorded in 2012 alone. Currently, more herbal plants are being used as medicines including medicinal drinks, and these are rich in natural bioactive compounds. According to scientific evidence, these bioactive compounds provide many biological effects, for instance, antioxidant, antibacterial, and antidiabetic activities. However, one problem related to the use of herbal medicine is the inadequate research or scientific evidence of the plants’ efficacy. This article, therefore, provides a scientific description of medicinal plants proven to exhibit antidiabetic properties and suitable for developing medicinal drinks. A literature search conducted across the PubMed electronic database in April 2020, using the keywords “herbal tea” and “antidiabetic” obtained a total of 30 articles, and of these publications, 12 were in vitro studies, 16 were pre-clinical studies, while 2 clinical trials. Across the world, 35 types of herbal plants have been proven to exhibit antidiabetic activity, with the leaves being the most commonly used part. The in vitro mechanism of herbal plants in exhibiting this antidiabetic activity is through inhibition of α-Amylase and α-Glucosidase enzyme activity. In addition, pre-clinical and clinical trials showed each plant in this study was able to reduce blood glucose levels and were suitable for developing medicinal drinks.Keywords: Antidiabetic, herbal plants, medicinal drinks
Respon Terapi Community Acquired Pneumonia pada Geriatri: Tinjauan Kasus di Intensive Care Unit Widyati Widyati; I Wayan Suryajaya; Arroyani A. Dilaga; Nidaul Hasanah; Renni Simorangkir; Rizky Hidayaturahmah
Indonesian Journal of Clinical Pharmacy Vol 10, No 3 (2021)
Publisher : Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15416/ijcp.2021.10.3.209

Abstract

Pneumonia komunitas adalah salah satu masalah yang semakin meningkat di populasi lanjut usia. Berbagai faktor yang terkait dengan penuaan, seperti komorbiditas, status gizi dan disfungsi menelan telah terlibat dalam peningkatan Community Acquired Pneumonia (CAP) pada populasi yang lebih tua. Streptococcus pneumoniae masih merupakan patogen yang paling umum di antara geriatri, meskipun patogen multiple drug resistance (MDR) juga seringkali menginfeksi geriatri, khususnya pada pneumonia berat. Strategi terapi antibiotik empirik pada pasien CAP berat adalah antibiotik spektrum luas atau kombinasi β-laktam dan fluorokuinolon, atau β-laktam dan makrolida. Laporan kasus ini memaparkan dua kasus CAP pada geriatri yang mewakili dua golongan terapi yang berbeda dengan hasil yang sangat berbeda pula. Kombinasi cefoperazon sulbaktam-makrolida tidak memberikan respon terapi yang baik hingga hari ke-7, sehingga makrolida diganti dengan amikacin dan diteruskan selama 3 hari. Di lain pihak, kombinasi cefoperazon sulbaktam-levofloksasin memberikan hasil yang baik dengan durasi terapi 9 hari. Pemilihan antibiotik dengan penetrasi yang baik ke paru sangat penting untuk mendapatkan efektivitas terapi. Resistensi azitromisin dapat menjadi salah satu penyebab utama terapi tidak efektif, namun karena efek pleiotropic yang dimiliki azitromisin, azitromisin direkomendasikan untuk tetap diberikan. Pemberian kombinasi cefoperazon/sulbaktam-levofloksasin dan cefoperazon/sulbaktam-amikasin pada kedua kasus ini efektif. Manfaat dari laporan kasus ini adalah terapi CAP pada lansia memerlukan kombinasi antibiotik baik dengan fluorokuinolon maupun aminoglikosida. Azitromisin pada kedua kasus di atas menunjukkan resistensi dan tidak dapat difungsikan sebagai antibiotik kedua pada kombinasi. Kata kunci: Antibiotik, CAP, geriatri, pneumonia  Therapeutic Response of Community Acquired Pneumonia in Geriatrics: A Case Series from Intensive Care UnitAbstractCommunity acquired pneumonia (CAP) is a common major growing challenge to elderly populations. Several aging factors, including comorbidities, nutritional status and digestive dysfunctions have been associated with increasing CAP among older persons. Furthermore, Streptococcus pneumoniae remains the most predominant pathogen in geriatrics, although multiple drug resistance (MDR) species regularly occur, particularly in severe pneumonia. Broad-spectrum antibiotics or a combination of β-lactam and fluorokuinolones, or β-lactams and macrolides serve as a promising therapy mainly in critical CAP patients. This study describes two geriatric CAP cases representing two separate treatments with widely varied results. The combination of cefoperazone sulbactam-azithromycin did not generate suitable clinical response until 7 days. As a consequence, the macrolides were replaced with amikacin and continued for 3 days. Meanwhile, the cefoperazone sulbactam-levofloxacin samples significantly improved the clinical conditions under 9 days. The selection of antibiotics with sufficient lung penetration is important in providing the effective therapy. Conversely, azithromycin resistance potentially instigates ineffectiveness, but is also recommended due to its pleiotropic effects. The benefit of this case study shows that CAP treatment among older population requires a blend of antibiotics with either a fluorokuinolone or an aminoglycoside. In both instances, azitromisin is believed to demonstrate high resistance, therefore, it is incapable in functioning as a second antibiotic component.Keywords: Antibiotic, CAP, geriatric, pneumonia
Pharmacy staffing and workload in RSGM Unpad using Workload Indicators of Staffing Needs (WISN) method Faisal Kuswandani; Dwintha Lestari; Felisha F. Balafif
Indonesian Journal of Clinical Pharmacy Vol 10, No 3 (2021)
Publisher : Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15416/ijcp.2021.10.3.198

Abstract

Introduction : One of the challenges in the health facility is the balance between the number of staff and workloads to achieve quality, effectiveness and efficiency. Developing countries that have limited resources and budgets finds out difficult to achieve it. This study aims to analyze the workload at Pharmacy RSGM Unpad using the Workload Indicators of Staffing Needs (WISN) from the World Health Organization (WHO). Methodology: The study employed descriptive cross-sectional design and the Workload Indicator of Staffing Needs (WISN) methodology. Conducted in May 2020. We utilized observations, discussion and interviews to obtain information from staff; document review from hospital's records in 2019. Results :  Available work time in a year were 97440 minutes. As a result, the staffing needed  the Inpatient-outpatient department in Pharmacy RSGM Unpad were 4 people and in the logistic-purchasing department in Pharmacy RSGM Unpad were 2 people. The WISN ratio was obtained at 1.17 (> 1) which means the workload and number of staff at Pharmacy RSGM Unpad were not appropriate (overstaff). Conclusion : Based on the analysis using the WISN method, the number of staff in the Pharmacy RSGM Unpad is overstaff the existing workload. The Pharmacy RSGM Unpad can redistribute staff and develop pharmaceutical satellites to increase effectiveness and efficiency.
Peran Gen TNFRSF11B sebagai Pemicu Osteoporosis Sekunder pada Pasien Artritis Reumatoid Nur A. Ali; Dika P. Destiani; Riezki Amalia
Indonesian Journal of Clinical Pharmacy Vol 10, No 3 (2021)
Publisher : Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15416/ijcp.2021.10.3.234

Abstract

Artritis reumatoid (AR) adalah kelainan autoimun sistemik yang menyebabkan peradangan luas dan persisten pada lapisan sendi sinovial. Pasien dengan AR memiliki risiko lebih besar terkena osteoporosis sekunder. Osteoporosis (OP) sekunder adalah komplikasi umum dari radang sendi seperti AR. Prevalensi OP sekunder pada pasien AR di berbagai belahan dunia dilaporkan antara 22% hingga 36%. Beberapa polimorfisme genetik dapat memengaruhi timbulnya penyakit osteoporosis. Proses remodeling tulang erat kaitannya dengan receptor activator nuclear factor-κB ligand (RANKL)/RANK dan osteoprotegerin (OPG). RANK/ RANKL/OPG adalah memiliki peran penting dalam osteoklastogenesis, karena OPG mampu menghambat diferensiasi dan aktivasi osteoklas. Kajian pustaka ini membahas mengenai hubungan polimorfisme gen TNFRSF11B yang mengkode protein OPG dengan risiko osteoporosis sekunder pada penderita AR. Metode yang digunakan pada kajian pustaka ini adalah dengan penelusuran artikel penelitian dan artikel review dari Pubmed, Cochrane Library, dan Medline dengan kata kunci “TNFRSF11B polymorphism”, “osteoprotegerin polymorphism”, “rheumatoid arthritis”, dan “secondary osteoporosis”. Sebagai hasil kajian pustaka, didapatkan beberapa simpulan berbeda dari studi pengaruh polimorfisme gen TNFRSF11B terhadap OP sekunder pada AR. Gen TNFRSF11B memiliki beberapa polimorfisme yang erat kaitannya dengan remodeling tulang, di antaranya adalah C950T, G1181C, A163G, T245G dan rs4876869.Kata kunci: Artritis reumatoid, osteoporosis sekunder, polimorfisme, TNFRSF11B The Roles of TNFRSF11B Genes as a Trigger for Secondary Osteoporosis in Rheumatoid Arthritis CasesAbstractRheumatoid arthritis (RA) is an autoimmune disorder responsible for widespread and persistent inflammation of the synovial joint lining. Hence, victims are prone to greater risk of developing secondary osteoporosis (OP), a common complication of arthritis. The global prevalence of secondary OP among RA patients is estimated between 22-36%, although certain genetic polymorphisms pose a possible influence. Also, bone remodeling is closely related to the receptor activator nuclear factor-κB ligand (RANKL)/RANK and osteoprotegerin (OPG). The variables play a significant role in osteoclastogenesis, due to the ability of OPG to inhibit osteoclast differentiation and activation. This literature review discusses the relationship of TNFRSF11B gene polymorphisms that encode OPG protein with the risk of developing secondary osteoporosis in RA patients. The research method encompassed exploring similar articles from Pubmed, Cochrane Library, and Medline, using particular keywords, such as “TNFRSF11B polymorphism”, “osteoprotegerin polymorphism”, “rheumatoid arthritis” and “secondary osteoporosis”. Several distinct conclusions were obtained after analyzing the effects of TNFRSF11B gene polymorphisms on secondary OP in RA cases. Furthermore, the TNFRSF11B gene showed various polymorphisms closely related to bone remodeling, including C950T, G1181C, A163G, T245G and rs4876869.Keywords: Polymorphism, rheumatoid arthritis, secondary osteoporosis, TNFRSF11B
The Beyond-Use Date Perception of Drugs in North Jakarta, Indonesia Fonny Cokro; Sherly T. Arrang; Jonathan A. N. Solang; Pangestuning Sekarsari
Indonesian Journal of Clinical Pharmacy Vol 10, No 3 (2021)
Publisher : Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15416/ijcp.2021.10.3.172

Abstract

Beyond-Use Date (BUD) refers to the unsafe period of drug consumption and is calculated from the moment of opening the primary package. Meanwhile, Indonesia has no current related data, in terms of public awareness. Therefore, this research aims to assess the BUD perception of North Jakarta communities and pharmacists’ roles in providing the relevant information. The data collection process employed a semi-structural interview across 6 districts in the research location between September-November 2019, followed by data transcription and thematic development. Based on 60 informants recruited by purposive sampling, three themes were obtained, including residual drug storage, pharmacists’ contributions, and BUD awareness. Furthermore, about 97% of the respondents were completely unaware of the subject matter, while 100% denied having any form of sensitization from pharmacists. The perception of 50% were based on the expiration date labelled on the medications. In summary, North Jakarta community’s views were possibly influenced by very poor BUD knowledge. Therefore, the role of pharmacists in educating patients and communities appears very essential.Keywords: Drug-compounding, drug-stabilities, perception, pharmacists Persepsi mengenai Beyond-Use Date Obat pada Masyarakat Jakarta Utara, IndonesiaAbstrakBeyond-Use Date (BUD) merupakan waktu ketika sediaan obat tidak dapat digunakan lagi dan dihitung berdasarkan waktu pembukaan kemasan primer sediaan. Sampai dengan saat ini, tidak terdapat data tentang pemahaman masyarakat Indonesia mengenai BUD. Penelitian ini bertujuan untuk melihat persepsi masyarakat Jakarta Utara mengenai BUD, serta mengetahui peran apoteker dalam menyediakan informasi BUD. Data mengenai persepsi BUD diperoleh dari wawancara semi terstruktur yang dilakukan di 6 kecamatan yang terletak di Jakarta Utara pada September–November 2019, dan diikuti oleh proses transkripsi dan pengembangan tema. Dari 60 informan yang direkrut secara purposive sampling, didapatkan tiga tema yaitu penyimpanan sisa obat racikan, kontribusi apoteker terkait BUD, dan pengenalan terhadap BUD. Mayoritas informan (97%) tidak mengetahui tentang BUD, dan semua informan (100%) tidak pernah menerima informasi BUD dari apoteker. Sebagian dari informan memiliki persepsi bahwa BUD sama dengan masa kadaluarsa yang ada di kemasan pabrik. Kami menyimpulkan bahwa persepsi masyakat Jakarta Utara mengenai BUD dapat disebabkan oleh pengetahuan tentang BUD yang rendah, dan peran apoteker dalam menginformasikan dan mengedukasi pasien dan masyarakat mengenai BUD sangat diperlukan. Kata kunci: Apoteker, obat racikan, persepsi, stabilitas obat
Implikasi Polimorfisme Gen CYP2A6 terhadap Penyakit Kardiovaskular Preiffer A. Prasojo; Christine Patramurti
Indonesian Journal of Clinical Pharmacy Vol 10, No 3 (2021)
Publisher : Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15416/ijcp.2021.10.3.217

Abstract

Gen CYP2A6 merupakan penyandi enzim CYP2A6. Gen CYP2A6 diketahui memiliki tingkat polimorfisme yang tinggi sehingga menyebabkan terdapatnya variasi bentuk alel baik dalam bentuk aktif maupun alel inaktif. Adanya variasi bentuk alel ini selanjutnya dapat berakibat pada penurunan, peningkatan atau penghilangan aktivitas enzim CYP2A6 yang disandi oleh gen ini. Salah satu substrat spesifik enzim CYP2A6 adalah nikotin, suatu senyawa aktif terdapat dalam rokok. Nikotin diketahui merupakan salah satu faktor risiko penyakit kardiovasakuler, sehingga kehadiran alel inaktif gen CYP2A6 akan menyebabkan penurunan aktivitas enzim CYP2A6 dalam metabolisme nikotin dan lebih lanjut akan meningkatkan risiko penyakit kardiovaskuler. Tujuan dari artikel review ini yaitu untuk mengevaluasi implikasi polimorfisme gen CYP2A6 terhadap penyakit kardiovaskular. Database yang digunakan pada artikel review ini berasal dari PubMed dan Google Scholar yang kemudian dilakukan seleksi dengan menggunakan kriteria inklusi dan eksklusi. Hasil yang diperoleh yaitu terdapat pengaruh polimorfisme gen CYP2A6 terhadap kandungan nikotin dalam darah terutama pada individu dengan gen CYP2A6 yang memiliki aktivitas metabolisme yang lambat atau buruk yang mengakibatkan kadar nikotin dalam darah yang tinggi, yang kemudian mengakibatkan peningkatan pengaktifan sistem saraf simpatis, lipolisis, dan resistensi insulin yang menyebabkan peningkatan kejadian anterosklerosis. Disimpulkan bahwa polimorfisme gen CYP2A6 akan meningkatkan penyakit kardiovaskuler terutama pada perokok, baik aktif maupun pasif.Kata kunci: Atherosklerosis, CYP2A6, penyakit kardiovasuler, polimorfisme The Effects of CYP2A6 Gene Polymorphism on Cardiovascular DiseasesAbstractThe CYP2A6 gene encodes its enzymes and is highly polymorphic, leading to variations in allele forms, both in the active and inactive states. These changes result in a decrease, increase or deletion of enzyme activities. One of the specific substrates is nicotine, an active compound in cigarettes. Nicotine is a major risk factor for cardiovascular diseases, and the inactive alleles tends to decrease its metabolism and expands the threat to infections. Therefore, this study aims to evaluate the effects of CYP2A6gene polymorphism on cardiovascular diseases. Relevant literatures were obtained using PubMed and Google Scholar, while the eventual selection followed the inclusion and exclusion criteria. Based on this review, the CYP2A6 gene polymorphism, both in increased, decreased or deleted alleles, was known to significantly influence nicotine metabolism and its blood levels. Species categorized as slow or poor metabolizers, tend to decrease the nicotine metabolism, but result in greater nicotine blood levels. This outcome subsequently accelerated the activation of the sympathetic nervous system, lipolysis, and insulin resistance, to trigger atherosclerosis. In summary, CYP2A6 gene polymorphism is known to increase cardiovascular diseases, particularly among active or passive smokers.  Keywords: Atherosclerosis, cardiovascular disease, CYP2A6, polymorphism
Penggunaan dan Resistensi Antibiotik di Instalasi Rawat Intensif Rumah Sakit Umum Daerah di Bali: Studi Ekologikal selama 3 Tahun Herleeyana Meriyani; Dwi A. Sanjaya; Ni Wayan Sutariani; RR. Asih Juanita; Nyoman B. Siada
Indonesian Journal of Clinical Pharmacy Vol 10, No 3 (2021)
Publisher : Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15416/ijcp.2021.10.3.180

Abstract

Resistensi bakteri yang terjadi di Intensive Care Unit (ICU) disebabkan oleh banyak faktor, salah satunya adalah penggunaan dan pemilihan antibiotik yang tinggi dan selektif. Perlu dilakukan studi tentang tingkat penggunaan antibiotik dan resistensi bakteri terhadap antibiotik di ICU yang dapat menjadi dasar evidence untuk merencanakan program guna mengontrol tingkat penggunaan antibiotik yang berdampak terhadap resistensi bakteri di ICU. Penelitian ini merupakan penelitian ekologikal yang dilakukan di rumah sakit umum daerah di Bali dengan menggunakan data retrospektif selama tahun 2017–2019. Data yang digunakan yaitu data penggunaan antibiotik sistemik (dinyatakan dalam defined daily doses (DDD) per 100 hari rawat), dan data persentase sensitivitas bakteri di ICU. Analisis statistik dilakukan dengan menggunakan korelasi rank Spearman. Segmen penggunaan antibiotik terbanyak ditetapkan menggunakan drug utilization 90% (DU90%) dan kategori fenotipik bakteri ditetapkan berdasarkan Centers for Disease Control and Prevention (CDC). Hasil penelitian menunjukkan terdapat tujuh antibiotik yang masuk dalam segmen DU90%, yaitu levofloksasin, seftriakson, ampisilin, sefotaksim, siprofloksasin, ampisilin-sulbaktam, dan gentamisin. Enam bakteri Gram-negatif terbanyak di ICU yaitu: Acinetobacter baumannii, Enterobacter cloacae, Enterococcus faecalis, Escherichia coli, Klebsiella pneumonia dan Pseudomonas aeruginosa. Terdapat lima bakteri dengan kategori multi drug resistant (MDR) yaitu A. baumannii, E. cloacae, E. coli, K. pneumonia dan P. aeruginosa. Terdapat dua spesies bakteri yang termasuk dalam kategori carbapenem resistant (CR) dan extended-spectrum cephalosporin-resistant (ESCR) yaitu A. Baumannii dan E. cloacae. Hanya bakteri E. coli yang menunjukkan korelasi yang signifikan dengan arah negatif antara penggunaan antibiotik dan persentase sensitivitas bakteri di ICU (r=–0,543; p=0,024). Dapat disimpulkan bahwa semakin tinggi penggunaan antibiotik menyebabkan penurunan sensitivitas bakteri terhadap antibiotik. Kata kunci: Carbapenem resistant, DDD, extended-spectrum cephalosporin-resistant, MDR, resistensi bakteri, studi ekologikal Antibiotic Use and Resistance at Intensive Care Unit of a Regional Public Hospital in Bali: A 3-Year Ecological StudyAbstractAntibiotic resistance at Intensive Care Unit (ICU) has been impacted by several factors, including high utilization and selectivity. The consumption rate and its selective pressure appear very extensive, with regular opportunities for cross-transmissions. In addition, ICU patients are susceptible to carriage acquisition and subsequent infections with high resistant bacteria. Therefore, this study investigates the relationship between the use and resistance of antibiotics in the ICU of a regional public hospital. The results potentially serve as confirmations for planning programs necessary to control ICU-related antibiotic consumption levels. This ecological analysis was also based on inpatient retrospective data from a regional public hospital in Bali from 2017–2019. Subsequently, the amount of intake expressed as daily doses (DDDs) per 100 patient days, and percentage of resistant bacterial isolates were examined using Spearman rank correlation. The largest segment of the antibiotics was determined by drug utilization 90% (DU90%) and the phenotypic class was defined by Centers for Disease Control and Prevention (CDC). Similarly, the most predominantly applied antibiotics were levofloxcacin, ceftriaxone, ampicillin, cefotaxime, ciprofloxacin, ampicillin-sulbactam and gentamycin. Meanwhile, the major gram-negative bacteria were Acinetobacter baumannii, Enterobacter cloacae, Enterococcus faecalis, Escherichia coli, Klebsiella pneumonia and Pseudomonas aeruginosa. Furthermore, 5 multi drug resistant (MDR) bacteria were observed, including A. baumannii, E. cloacae, E. coli, K. pneumonia and P. aeruginosa, while A. baumannii and E. cloacae occurred as carbapenem resistant (CR) and extended-spectrum cephalosporin-resistant (ESCR), respectively. However, only E. coli showed a negative significant correlation between antibiotic utilization and the percentage of ICU bacterial sensitivity (r=–0,543; p=0,024). Therefore, higher consumption of antibiotics decreases its percentage susceptibility. Keywords: Antibiotic resistance, carbapenem resistant, DDD, ecological study, extended-spectrum cephalosporin-resistant, MDR

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