farmakoterapi antihipertensi

8/18/2019 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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farmakoterapi antihipertensi

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