farmakoterapi antihipertensi
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Abdul Kadir Jaelani., S.Si., Apt., SpFRS
Instalasi Farmasi Rumah Sakit Daerah Bangil
FARMAKOTERAPI ANTIHIPERTENSI
( PERAN FARMASIS )
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EpidemiologiEpidemiologi
15 % B !I"##I !$siaRas
dllendidikan
!ak terk&ntr&l Kerusakan pembuluh darah
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B Di turunkan
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Classification & ManagementClassification & Managementengukuran berulang terhadap B /I R! "SI Asimpt&matik
Sebab arang ditemukan Akibat sering terlihat10 15 %
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ClassificationClassification
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ManagementManagement
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LifestyleLifestyle
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TREATMENTNONPHARMACOLOGIC THERAPY
All patients 3ith preh4pertensi&n and h4pertensi&n sh&uldbe pres'ribed li(est4le m&di 'ati&ns, in'luding 6
718 3eight redu'ti&n i( &9er3eight7:8 ad&pti&n &( the Dietar4 Appr&a'hes t& St&p /4pertensi&n
eating plan7;8 dietar4 s&dium restri'ti&n ideall4 t& 1.5 g-da4 7;.< g-da4s&dium 'hl&ride8
7=8 regular aer&bi' ph4si'al a'ti9it4758 m&derate al'&h&l '&nsumpti&n 7t3& &r (e3er drinks per da487>8 sm&king 'essati&n.
*i(est4le m&di 'ati&n al&ne is appr&priate therap4 (&r patients3ith preh4pertensi&n. atients diagn&sed 3ith stage 1 &r :h4pertensi&n sh&uld be pla'ed &n li(est4le m&di 'at i&ns and drugtherap4 '&n'urrentl4.
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Monito ing & E!al"ation
B e9aluated : t& = 3eeks a(ter initiating &rmaking 'hanges.)n'e g&als B 9alues are &btained, e9er4 ;t& > m&nths, assuming n& signs &rs4mpt&ms &( a'ute target?&rgan disease.+&re (re@uent e9aluati&ns are re@uired inpatients 3ith a hist&r4 &( p&&r '&ntr&l,
n&nadheren'e, pr&gressi9e target?&rgandamage, &r s4mpt&ms &( ad9erse druge e'ts.
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Monito ing & E!al"ation
+&nit&ring (&r ad9erse drug e e'ts sh&uldt4pi'all4 &''ur : t& = 3eeks a(ter starting ane3 agent &r d&se in'reases, and then
e9er4 > t& 1: m&nths in stable patients.
atients sh&uld be @uesti&ned peri&di'all4ab&ut 'hanges in their general healthper'epti&n, energ4 le9el, ph4si'al(un'ti&ning, and &9erall satis(a'ti&n 3ithtreatment.
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Resistant Hypertension
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:>
#$E % LE ' ()%*#$E % LE ' ()%*
+$)%M)C,-# ,. $ -+,#)L+$)%M)C,-# ,. $ -+,#)L aha4a /assan, harm.D aha4a /assan, harm.D
r&(ess&r &( Clini'al harma'4r&(ess&r &( Clini'al harma'4
S'h&&l &( harma'euti'al S'ien'esS'h&&l &( harma'euti'al S'ien'es
ni9ersiti Sains +ala4siani9ersiti Sains +ala4siaenang,+ala4siaenang,+ala4sia
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* "g %elated + o/lems* "g %elated + o/lems
Identi(4 p&tential &r a'tual drugIdenti(4 p&tential &r a'tual drugrelated pr&blemsrelated pr&blemsRes&l9e a'tual drug related pr&blemsRes&l9e a'tual drug related pr&blems
re9ent p&tential drug relatedre9ent p&tential drug relatedpr&blemspr&blems
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()%* - +$)%M)C,-# ,.#E% E.#, .-()%* - +$)%M)C,-# ,.#E% E.#, .--C %,. - -#EM-C %,. - -#EM
0?1 n& e e't t& negati9e e e't0?1 n& e e't t& negati9e e e't1 min&r signi 'an'e, an4 impr&9ed1 min&r signi 'an'e, an4 impr&9ed
standard &( 'arestandard &( 'are
: signi 'ant, impr&9e standard &(: signi 'ant, impr&9e standard &('are &r &ptimi e therap4'are &r &ptimi e therap4
; 9er4 signi 'ant, pre9ent ma &r; 9er4 signi 'ant, pre9ent ma &r
t&$i'it4 and-&r end &rgan damaget&$i'it4 and-&r end &rgan damage= p&tentiall4 li(e sa9ing= p&tentiall4 li(e sa9ing
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Evaluated each drug
Indi'ati&nE
e'ti9eE
Ad9erse e e'tE
Is '&st an issueE
Dis'&ntinue and e9aluate
D&se, initiate additi&nal&r alternati9e agent
D&se, substitute 3ithless t&$i' alternati9e
se generi', substitute3ith less '&stl4 agent
"&
es
es
es
es
"&
"&
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Evaluate entire drug
regimenDu licate thera !"
Drug interacti#n$"
%an regimen &e$im li'ed"
Di$c#ntinue andevaluate
%hange drug d#$e$chedule #r re arati#n
e$
e$
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9aluate adheren'e
%an the atient #r
caregiver admini$termedicati#n$ a$re$cri&ed"
Pr#vide *ritten andver&al in$tructi#n$%#n$ider adherence aid(medicati#n di$ en$erta&let $ litter $ acerc#m uteri+ed,electr#nicreminder $!$tem$)Other educati#nalmaterial$ (vide#$ #-$)H#me health evaluati#n
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,M+L, )-, #E%)+E #,,M+L, )-, #E%)+E #, !$ antihipertensi !idak pada pen4ebab khusus
ada gangguan terhadap+ekanisme si&l&gi n&rmal4g mengatur tekanan darah
!dk ada keluhan !dk memberikan
kesembuhan langsung +en'egah kerusakan &rgandan kematian
di masa 4g akan datang
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+E%). ')%M)-,-+E%). ')%M)-,-
KRI!ISR)B* + S)* I"#
K)+ "IKA!IF
RA!I) G B " FI! - RISK
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+% LEM #E%)+, ).#,$,+E%#E.-,+% LEM #E%)+, ).#,$,+E%#E.-,
1.1. eng&batan angka pan angeng&batan angka pan ang:.:. !idak menghilangkan ge ala pen4akit !idak menghilangkan ge ala pen4akit;.;. !erapi tidak k&nsisten !erapi tidak k&nsisten=.=. &li (armasi&li (armasi5.5. (ek samping angka pan ang(ek samping angka pan ang>.>. (ek t&ksik angka pan ang(ek t&ksik angka pan angH.H. !erapi indi9idual !erapi indi9idual
K A! /A"
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E-,M+ L).E-,M+ L).
1. +eningkatkan e(ekti tas terapi.1. +eningkatkan e(ekti tas terapi.:. +enurunkan es& dan t&ksisitas.:. +enurunkan es& dan t&ksisitas.
;. +eningkatkan kepatuhan;. +eningkatkan kepatuhan
KRI!IS
!R) B *S)* I"#
K)+ "IKA!IF RISK
B " FI!
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