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TUGAS FARMAKOLOGI

(Case challenge)

 NAMA : SITI RAHMAH

 NIM : G1A113026

Dosen pembimbing :

!" Anggelia #$spasa!i

M%DICAL FACULT& U'I%RSIT& OF AM*I

+,-./+,-0

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Case s1$2 3

• Ms Jones, 49 years of age, presents !t" sy#pto#at!$ anae#!a after %e!ng on

&'a( ant!)p(ate(et t"erapy *asp!r!n an& t!$agre(or+ for 1 #ont"s for a non)STseg#ent e(e-at!on a$'te $oronary syn&ro#e, "!$" as treate& $onser-at!-e(y.

S"e $o#p(a!ns of fre/'ent nose%(ee&s an& "ea-y per!o&s. A gastros$opy s"os

#!(& eros!-e gastr!t!s.

• Ho o'(& yo' re-!e "er ant!p(ate(et t"erapy to %a(an$e "er r!s of %(ee&!ng

an& t"e r!s of a re$'rrent $oronary e-ent es$r!%e rat!ona( e-!&en$e %ase&

a4aban : case 3

S!n&ro# ant'ng oroner a't: sta%!( Ang!na ata' Non)ST)seg#en e(e-as! MI :

!g'naan &a(a# o#%!nas! &engan asp!r!n 'nt' #eng'rang! r!s!o ea&!an ata'

sere%ro-as'(ar pa&a pas!en &engan non)ST)seg#en e(e-as! *NST5+ s!n&ro#

oroner a't *AS NST5+, ter#as' ang!na t!&a sta%!( &an non)ST)seg#en e(e-as!

MI *NST5MI+. !g'naan pa&a pas!en yang #en&apat peraatan #e&!s ata'

&engan !nter-ens! oroner *#!sa(nya 7I &engan ata' tanpa stent!ng arter! oroner,

A8G+. 7engg'naan anga panang yang &!reo#en&as!an o(e" A7 se%aga!a(ternat!f 'nt' asp!r!n pa&a pas!en &engan ang!na t!&a sta%!( ata' NST5MI,

ter#as' #erea yang #ena(an! A8G, yang a(erg! ter"a&ap asp!r!n.

!reo#en&as!an o(e" A AHA &an &oter (a!n se%aga! ta#%a"an 'nt' terap!

a't &engan "epar!n &an asp!r!n pa&a pas!en &engan NST5 AS yang &!e(o(a

se$ara #e&!s &an pa&a #erea yang #ena(an! 7I yang t!&a %er!s!o t!ngg! 'nt' 

 pen&ara"an.

Terapi antiplatelet dual-obat (aspirin dan clopidogrel atau prasugrel) yang direkomendasikan oleh ACC / AHA untuk pasien dengan pasti atau mungkin

 NSTE! pada mereka yang memilih pendekatan in"asi#$ ulai pengobatan sedini

mungkin sebelum atau pada saat %C! dan terus untuk & ' bulan idealnya ' tahun

 pada pasien yang tidak berisiko tinggi untuk pendarahan$

ese!#%angan potens! #anfaat &ar! pretreat#ent &engan $(op!&ogre( pa&a pas!en

yang #ena(an! 7I ter"a&ap pen!ngatan r!s!o pen&ara"an se"ar'snya A8G

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&ar'rat &!%'t'"an. 7eng"ent!an se#entara terap! ;)10 "ar! se%e('# A8G &an

#e#'(a! terap! &a(a# "'%'ngannya &engan asp!r!n sete(a" prose&'r terse%'t,

7a&a pas!en yang #ena(an! 7I &engan ontra!n&!as! #'t(a 'nt' asp!r!n, A7

#enyataan %a"a pretreat#ent &engan $(op!&ogre( &an ata' !n"!%!tor G7 II%

IIIa)reseptor a&a(a" (aya.

Sete(a" !#p(antas! %are)#eta( stent arter! oroner pa&a pas!en &engan r!s!o ren&a"

'nt' per&ara"an, A AHA saat !n! #enyaranan pengg'naan &a(a# o#%!nas!

&engan asp!r!n 'nt'

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7as!en yang #ena(an! A8G yang a(erg! ter"a&ap asp!r!n: A7 #ereo#en&as!an

!n!s!as! (oa&!ng &os!s 300 #g $(op!&ogre( 6 a# sete(a" prose&'r, &!!'t! o(e" ?; #g

sea(! se"ar!, ter's tanpa %atas.

Sete(a" !#p(antas! stent %are)#eta(: ?; #g sea(! se"ar! &engan asp!r!n 'nt' n t"e ay to t"e "osp!ta(, "!s

$"est pa!n !ntens!f!e& an& "e as g!-en !ntra-eno's *I+ %o('s #orp"!ne.

• >n arr!-a( at t"e "osp!ta(, "e as g!-en a (oa&!ng &ose of asp!r!n. H!s #e&!$a(

"!story as 'nre#ara%(e !t" no "!story of &!a%etes, "ypertens!on,

"yper(!p!&e#!a, or s#o!ng. He as not ta!ng any #e&!$at!ons or re$reat!ona(

&r'gs. 7"ys!$a( e@a#!nat!on, (a%oratory tests, an& an e(e$tro$ar&!ogra# *5G+

ere perfor#e&, an& t"e res'(ts are s'##ar!Be& !n Ta%(e 1.

Evaluation Result

Physical examinationVital signs

  • Blood pressure

  • Heart rate

  • Respiratory rate

105/65 mm Hg

62 beats/min

14 breaths/minLung auscultation Clear

Cardiac auscultation Normal S1 and S2

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 Jugular vein No distentionECG!"segment 3 to 6 mm elevation in

leads II, III, aV, and V5 

thro!gh V6 

La#oratory$hite #lood cell count 1",300 #ells/mm3 Creatinine 2$5 mg/d%!roponin ! 0$04 ng/m%

Case -

• T"e pat!ent as taen for e#ergent $oronary ang!ograp"y on t"e %as!s of "!s test

res'(ts. Cnfra$t!onate& "epar!n *CDH+ as !n!t!ate&, an& ang!ograp"y as

 perfor#e&. Ang!ograp"y re-ea(e& $o#p(ete o$$('s!on !n "!s #!& r!g"t $oronary

artery *RA+ an& 30E stenos!s !n "!s (eft anter!or &es$en&!ng $oronary artery

*FA+. 7r!#ary per$'taneo's $oronary !nter-ent!on *7I+ as a $(ear 

!n&!$at!on.

• At t"e t!#e of 7I, "!$" a&&!t!ona( ant!t"ro#%ot!$ t"erapy *or t"erap!es+ o'(&

 %e appropr!ate for 5& es$r!%e rat!ona( e-!&en$e %ase&

a. 7ras'gre( or t!$agre(or

 %. (op!&ogre(

$. G(y$oprote!n *G7+ II%IIIa re$eptor antagon!st

&. (op!&ogre( p('s a G7 II%IIIa re$eptor antagon!st

e. 7ras'gre( or t!$agre(or p('s a G7 II%IIIa re$eptor antagon!st

ase 1 ont!n'e&: 7r!#ary 7I

• At t"e t!#e of 7I, pras'gre( as !n!t!ate&, per 5&s $"o!$e, at a (oa&!ng &ose of 

60 #g an& a%$!@!#a% at 0.2;)#gg I %o('s fo((oe& %y 0.12; gg#!n. A

&r'g)e('t!ng stent *5S+ as &ep(oye& !n "!s RA, !t" e@$e((ent ang!ograp"!$

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res'(ts. After 4 "o'rs of %e& rest, I t"erap!es ere &!s$ont!n'e&. He as

&!s$"arge& after 4 "o'rs per "osp!ta( proto$o(.

Ho o'(& yo' #anage 5&s ant!t"ro#%ot!$ t"erapy after pr!#ary 7I es$r!%erat!ona( e-!&en$e %ase&

a. In!t!ate a (o)#o(e$'(ar)e!g"t "epar!n *FMH+

 %. In!t!ate &ose)a&'ste& arfar!n

$. In!t!ate anot"er (oa&!ng &ose of pras'gre( fo((oe& %y a #a!ntenan$e &ose

&. In!t!ate a #a!ntenan$e &ose of pras'gre(

• In "!$" s!t'at!on o'(& pras'gre( not "a-e %een a goo& $"o!$e for 5&

es$r!%e rat!ona( e-!&en$e %ase&

a. If "e "a& &!a%etes

 %. If "e !s on a &!et

$. If "e "a& a #o&erate %(ee&!ng r!s 

Case .

." A ne%orn #a(e as &!agnose& !t" se-ere "e#op"!(!a A * 1E+ at %!rt". T"e

 pat!ent "as not "a& a s!gn!f!$ant %(ee&!ng ep!so&e. T"e #ot"er !n&!$ates a $o's!n

"a& "e#op"!(!a an& "a& pro%(e#s !t" !n"!%!t!on after %e!ng treate& !t" fa$tor 

III. T"e parents ant t"e pat!ent to 'n&ergo $!r$'#$!s!on.

Ho o'(& yo' treat t"!s pat!ent es$r!%e rat!ona( e-!&en$e %ase&• 7ostpone t"e s'rgery 'nt!( t"e pat!ent !s o(&er 

• Treat !t" re$o#%!nant fa$tor III *rDIII+ pr!or to s'rgery

• G!-e fa$tor IIa pr!or to "!s $!r$'#$!s!on

• If "e "a& a "!story of stroe

a4aban : case

'omo! - an .

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