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dr. Zulkarnain R. MSi

Dep. Farmakologi & Terapeutik,Fakultas Kedokteran

Universitas Sumatera

Utara

13 Oktober 2014, KK!F"M#$, FK USU

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U&'"& (#&$#R)*" dan $OK*

penderita Dokter

keluhan

keluhan

gejala

penyakit

gejala

OBAT

OBAT

OBAT

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diarrheadiarrhea

anti!

mi+robialaents

feverfever

anxietyanxiety

coughcough

insomniainsomnia

etc,etc,etc,etcetc,etcetcetc

cryingcrying dyspneadyspnea

anti!

mi+robialaents

anti!

mi+robialaents

anti!

mi+robialaents

anti!

mi+robialaents

anti!

mi+robialaents

+i-ro

-enem

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Sakit ke-ala

Sakit ii

isulan

&eri /aid

Rematik

'out

(onstan

oltaren

Femina

)ra-anelebre

&ovalin

DangerousDangerous

Doctor ?Doctor ?

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Sakitii

"sammeenamat

PegalPegal

LinuLinu

NyeriNyeribisulbisul

NyeriNyerihaidhaid

&eridada

etc,etc,etc,etcetc,etcetcetc

Sakit ?Sakit ? SakitSakitin-partuin-partu

"sammeenamat"sam

meenamat

"sammeenamat"sam

meenamat

"sammeenamat"sam

meenamat

"sammeenamat

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pakah !" ?pakah !" ?

#eluhan sama,#eluhan sama,

Diagnosa sama,Diagnosa sama,

" " " " " " " " " " diterapi dengan obat" " " " " " " " " " diterapi dengan obatyang sama?yang sama?

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$ational prescription %&'(,)**+

(atient re+eivea--ro-riate medi+ines

a++ordin to t/eir+lini+al needs

at an a--ro-riatedosae,

administration duration

and in a 5at/at en+ouraes

t/e -atient +om-lian+eand

at t/e lo5est +ost

to t/e +ommunit

"--ro-riate -atient( Tepat Pasien )

"--ro-riate indi+ation( Tepat ndikasi )

"--ro-riate dru( Tepat O!at )

"--ro-riate dosae,administration duratio

(Tepat dosis, "ara & lama pem!erian)

"--ro-riate inormation( Tepat n#ormation )

"--ro-riate +ost

( Tepat !iaya )

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#asus Laki-laki, 32 tahun, datang ke dokter dengan keluahan batuk,

berdahak warna hijau, mual, demam dan pegal linu. Dari pemeriksaan tensi 130/! mm"g, nadi 112 #/menit reguler,

rhon$hi kering %&', didiagnosa $(N.'/0/S, diberi resep(

) .odein 0ab %12

) Levofloxacin 0ab %)+

) Parasetamol 0ab %)+) *etaph+l * ab %10'

) albutamol ab %30'

) ntasida +rup %1'

) 3etil Prednisolon 0ab %12

) *anitidin ab %20'

) entolin 2,! ml %3'

) ierron ab %10'

) erote$ nh. %1'

dakah +ang irrasional, aneh ataulucu

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&hat is a P-Drug?

- a drug that is read+ or a$tion

- a drug +ou are going to use regularl+

and with whi$h +ou be$ome amiliar.

- a drug o irst $hoi$e or a $ommon $onditionNot a drug for an individual patienthe 4-drug $on$ept in$lude(

- the name o the drug

- the dosage orm- the dosage s$hedule

- the duration o treatment

#or a#or aspe"i$"spe"i$"

"onditio"onditio

nn

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Sele+tin our (6ersonal7drus

%uidelines #or sele"ting Pdrugs'tep i ' De$ne the diagnosis

tep ii ' pe"i#y the therapeuti" o!je"ti*e

tep iii' Make an inventor oe8e+tive

rou- o drus

tep i*' +hoose an ee"ti*e groupa""ording to "riteria

tep *' +hoose a Pdrug

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$)"'&OS)S

F"9S# ORR#* )&S#UR#

F"9S#"SSUM(*)O&

:

)M"')&"*)O&

$#F#&S)#*%#R"(;

)RR"*)O&"9)*;:

"$#RS# R#"*)O&S )&R#"S#$

-+/+A O/0

O1 2T3 DA%/OT+ TOO

-T31O4%3 +5/TF+ O16+5/TF+7 A1%485/T

-D14% /D4T10 FA+TAT/% 6+5/TF+7 8A%/ATO/- PAT5/T9 P15415

-8O15 D14% 45D T3A/ /55D5D

DO+TO1 '-P1D5-P1OFT-%/O1A/+5

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Standard o-eratin-ro+edure 6SO(7

-Anamnesis-Pemeriksaan-Diagnosis

tentukan -roblema utamapenderita yang

merupakan sasaran pengo!atan-Pemilihan o!at-Pengo!atan-5*aluasi

(#$OM"& (#&'O"*"&

(#$OM"& $)"'&OS)S

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Step )" Define the patient4 problem

Laki-laki, 32 tahun, datang ke dokter dengankeluahan batuk, berdahak 5arna hi6au, mual,demamdan pegal linu.

Dari pemeriksaan tensi 130/! mm"g, nadi ))7#/menit reguler, ronchi kering %&', didiagnosa$(N.'/0/S.

pakah problema utama pada pasien ini) Yang dapat mematikan ) 5eluhan +ang tak mengenakkan %batuk, demam') akikardi) /nfeksi

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(enunaan "&*))O*)K" anrasional

SO(

)&F#KS)

"&*))O*)K"

$OS)S (#M#R)"&

#"9U"S)

KU9*URS#&S)*))*;

*#S*

#$U"*#$'U#SS

*%#R"(;

kekebalan kumaneek sam-in/ara

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3anifestation of /nfection

Local /nflammation

initial and sometimes

inal response

6hat is obser7ed) wound margins

) e#udates

) sensations) skin temperature

Systemic /nflammation

atigue,

malaise,

anore#ia,

m+algia,

arthralgia, and

e7er

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ntimicrobial Policies8 .lassification

8irst-$hoi$e antimi$robials %non-restricted use' 9sed b+ all pres$ribers without appro7al b+ senior pres$ribers ae, ee$ti7e, reasonabl+ pri$ed antimi$robials

$estricted use 8or more serious $lini$al $onditions under $ertain $onditions

Less sae, more e#pensi7e, newer antimi$robials :onditions $ould in$lude the ollowing( pe$ii$ ine$tions known to be sensiti7e to the antimi$robial

medi$ine ater $ulture and sensiti7it+ testing ;mpiri$al treatment or suspe$ted lie-threatening ine$tions

pending the result o $ulture and sensiti7it+

:ounter-signature b+ a senior ph+si$ian appro7ed b+ D: *eser7e antimi$robials %very restricted use' 8or lie-threatening ine$tions known to be resistant to other

antimi$robials ppro7al needed b+ the D: or mi$robiologist

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Step 78 Specify the therapeutic ob6ective

Laki-laki, 32 tahun, dengan keluahan batuk, berdahak

warna hijau, mual, demam dan pegal linu, takikardi

ron$hi kering %&', didiagnosa $(N.'/0/S.

4roblema utama infeksi

6hat will be +our therapeuti$ obje$ti7e) Redakan batuk?

) Turunkan suhu tubuh

) Redakan takikardi?

) Enyahkan kuman patogen ANTIBIOTIK.

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Step 18 9erify the suitability ofyour P - drug

1re the a$ti7e substan$e and dosage ormsuitable

:ffective< ndi$ation%drug reall+ needed

:on7enien$e %eas+ to handle' Safety < ide-ee$ts, $ontraindi$ation %high risk groups, other diseases' ntera$tion %drugs, ood, al$ohol'

.ost < t is alwa+s an important $riterion. lwa+s look at the total $ost otreatment rather than the $ost per unit

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(ertimbanan dalammenentukan obat -ili/an

:fficacy %khasiat' /ndikasi

Safety %keamanan' :fek samping0olerability,Suitability #ontra indikasi

.ost, Price %harga' #etersediaan

Pri"e, al:ays look at the total "ost o# treatment rather than the "ost per

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%o5 to sele+t t/ea--ro-riate dru

;. 23O 8anual

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the concept of selecting P-drug

give values to the worst drug irst,

) the drug we 5ould never prescribe

) gi7e it a 7alue a$$ording to the $riteria morin %=3'

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Tempat in#eksiTempat in#eksi

Tipe in#eksiTipe in#eksium!er in#eksium!er in#eksi

P:$0/3N;N P:3/L/'NN0//(0/#

=eadaan klinis pasien=eadaan klinis pasien

Faktor o!atFaktor o!at>>

anti!iotikanti!iotikensiti*itas kuman terhadapensiti*itas kuman terhadap

anti!iotikanti!iotik

a+teria b Site o

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a+teria b Site o)ne+tion

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the concept of selecting P-drug

5ould never prescribe ascending on the values or the better drugs $(N.'/0/Swith P$(D

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S*#(S rame5orkmm3g, nadi ;;< C>menit reguler, ron"hi kering (), didiagnosa RO&%)*)S

AndansetronAndansetron

$amipril$amipril

@i$ardis %@i$ardis %telmisartantelmisartan'':lopidogrel:lopidogrel

spiletspilet

?operten %?operten %lisinoprillisinopril

mlodipinmlodipin@elo#i$am@elo#i$am

E ter!aik, termurah, tersedia di pasaran

; ter!uruk, termahal, tak tersedia

ntibiotics :ff Saf Suit Price 0otal

@AB:LL? 3 C C C )+

;?@:? C 1 C 2 11

@;*A?DEAL 1 3 C 3 11

A8LAB:? C 3 3 3 )1

L;A8LAB:? C 2 3 1 10

;*:F:L? 2 3 C C )1:A*@ABEAL 2 2 C C 12

*8@4:? 1 2 C C 11

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$osaereimen

+on"entration

*s time in-lasma +on"entration

*s time insite o

ine+tion

"ntibioti+e8e+t vs time

+on"entration*s time intissue and

otherbod =uids

(/arma+oloi+or toi+oloi+

e8e+t

Relations/i- bet5een (Kand ($

-/arma+odnami+s-/arma+okineti+s

A!sorptionProtein !indingDistri!utionBiotrans#ormation5C"retion

+raig 2A. Pharma"okineti">pharma"odynami" parameters'

1ationale #or anti!a"terial dosing o# mi"e and men. +lin n#e"t Dis.

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($ -arameters -redi+tiveo out+ome

4arameter$orrelating

with ei$a$+0=3/.

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#asus Laki-laki, 32 tahun, datang ke dokter dengan keluahan batuk,

berdahak warna hijau, mual, demamdan pegal linu. Dari pemeriksaan tensi 130/! mm"g, nadi 112 #/menit reguler,

rhon$hi kering %&', didiagnosa $(N.'/0/S, diberi resep(

) .odein 0ab %12

) Levofloxacin 0ab %)+

) Parasetamol 0ab %)+) *etaph+l * ab %10'

) albutamol ab %30'

) ntasida +rup %1'

) 3etil Prednisolon 0ab %12

) *anitidin ab %20') entolin 2,! ml %3'

) ierron ab %10'

) erote$ nh. %1'

ntibiotik +ang $S/(NL

moxicillin IDosis dan $ara pemberian

> x +22 mg ==7 x )222 mg

5alau dari uji kepekaan

din+atakan levofloxacinpaling sensiti, maka dosis dan

$ara pemberiann+a

+ x >22 mg 7 x )222 mg

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Ste- 4< >rite a-res+ri-tion

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Ste- ?< 'ive inormation,instru+tion and 5arnin

1.Effects of the drug:- wh+ the drug is needed- whi$h s+mptoms will disappear, whi$h will not- when the ee$t is e#pe$ted to start- what will happen i the drug is not taken $orre$tl+

2.Side-effects:- what side ee$t will o$$ur- how to re$ogniGe them- how long, how serious- what a$tion to take

3.nstructions:- how and when the drug should be taken- how long the treatment should $ontinue- how long the drug should be stored- what to do with the let-o7er drug

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Ste- ?< 'ive inormation,instru+tion and 5arnin

!."arnings:

- when the drug should not be taken

- what is the ma#imum dose

- ull treatment $ourse should be taken

#.$uture consu%tation:- when to $ome ba$k %or not'

- when to $ome ba$k earlier

- what inormation the do$tor will need then

&.E'er(thing c%ear?- sk the patient whether e7er+thing is understood

- sk the patient to repeat the most important inormation

- sk whether the patient has an+ more Huestion

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Ste- @< Monitor 6and sto-A7t/e treatment

6as the treatment ee$ti7ea. Fes, and disease $ured

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Sele+tin our (6ersonal7drus

%uidelines #or sele"ting Pdrugs'tep i ' De$ne the diagnosis

tep ii ' pe"i#y the therapeuti"

o!je"ti*etep iii' 8ake an in*entory o# ee"ti*e

group o# drugs

tep i*' +hoose an ee"ti*e groupa""ording to "riteria

tep *' +hoose a Pdrug

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s 4-Drug the same e7er+where

4-Drug is dier - rom $ountr+ to $ountr+

- rom $ompan+ to $ompan+

- rom area to area;;?(

- rom do$tor to do$tor

230 JJJbecause varying in:= availability and cost of drugs= dierent country formularies and essential

drug list medi"al "ultures and inter retation

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Discharge 3edication ;uidelines forthe Secondary Prevention of .9

Disorders8

.oronary rtery Disease(

1. spirin2. Jtatin/"mK

ie sim'astatin ator'astatin pra'astatin/

Target 0*0 1 mgd%3. eta lo$ker i @

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Disorders8

'eart @ailure %;8 > C!'

1. :; nhibitor %titrated to ma#imiGedosage'

2. eta lo$ker %initiated and titrated as

outpatient when patient is eu7olemi$'3. pironola$tone %:lass , "8'

C. %Digo#in, diureti$s or s+mptoms'

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Disorders8

trial @ibrillation

1. 6ararin 4atients older than M! +o

4atients with stru$tural heart disease

itrate to ?* 2.0 ) 3.0 All medications should be prescribed at time

of discharge unless a contraindication existsand is documented

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:stimated enefit to the'eart @ailure Patient Population

++2 readmissions are preventedper+ear

A 7,>B2,222 are sa7ed based on a7oidedreadmissions

11) lives are saved per year

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:stimated enefit to the.D Patient Population

>12 readmissions are preventedper+ear

ignii$ant $ost sa7ings

>12 lives are saved per +ear

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;ou Manae;ou Manae>/at ;ou Measure>/at ;ou Measure

$o &ot Measure$o &ot Measure

>/at ;ou >ill &ot>/at ;ou >ill &ot

ManaeManae

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Pertimbangan dalammenentukan analgetik pilihan

nalgesic :fficacy Safety.ontra-

indication .ostvailability

formulaSumscore

4ara$etamol 3 C C C C )*

buproen 3 2 2 C C 1!

@elo#i$am 3 1 1 2 C 11

:ele$o#ib 3 1 1 1 C 10

:odeine 2 3 3 3 C 1!@orphine C 0 3 1 2 10

@ the :orst, eCpensi*eK LLL.K E the !est, "heapest

akilaki, < tahun, M)"9')". tensi

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Pertimbangan dalammenentukan obat pilihan

;rup drug%analgesic

:fficacy Safety.ontra-

indication .ostvailability formula

Sumscore

4ara$etamol 0 C C C 0 12

buproen 2 3 C C 0 13

Di$loena$ 3 3 C 3 C 1N

:ele$o#ib 1 1 C 0 0 M

:odeine 3 3 C 3 0 13@orphine C 0 C 1 C 13

@ the :orst, eCpensi*eK LLL.K E the !est, "heapest

4"ok (

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S0:PS frame5ork8n example of ho5 to select a P-drug for a ptlaki2, 32 tahun, 220/)+2mm"g, nadi 120 #/mnt, naaspendek, wajah hitam, e#tremitas dingin, 4 paru bawah

melemah

problema utama( diastoli$ h+pertension

$RU'B #8 Sa e

Suit (ri+e

"vail

Al#a!lo"ker E ; < < ;

A+5inhi!itor < ? E ? E

A1B ; E ? ; ?

+a +hannelBlo"ker

? < ; E E

E ter!aik, termurah, tersedia di pasaran; ter!uruk, termahal, tak tersedia

2014 p drug

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