TUGAS STUDI KASUS

Diajukkan untuk Memenuhi Tugas Mata Kuliah Farmasi Klinik

Semester VII Fakultas Farmasi Universitas Padjadjaran

Disusun oleh
Indah A. Sagita

260110110041

Putu Listynelia W. A.

260110110048

Anzari Muhammad

260110110087

Andini Faramitha

260110110089

Armydha Iga P.

260110110105

FAKULTAS FARMASI
UNIVERSITAS PADJADARAN
JATINANGOR
2014

CLINICAL PHARMACY EXAMINATION

ST, a 64-year-old patient, has heart failure (HF), which is being controlled with
digoxin (Lanoxin), furosemide (Lasix), and a low-sodium diet. She is taking
potassium chloride (KCl ) 20 mEq perday orally. Three days ago, ST had flulike
symptoms such as anorexia, lethargy, and diarrhea. Her fluid and food intake was
diminished. She refused to take the KCl and stated that the drug makes her sick.
She has been taking the digoxin and furosemide daily.
The nurses assessment during the home visit yesterday includes poor skin turgor,
poor muscle tone, irregular pulse rate, and decreased bowel sounds. The nurse
obtained a blood sample for serum electrolytes; results indicated potassium (K)
2.9 mEq/L, sodium (Na) 137 mEq/L, and chloride (Cl) 96 mEq/L.
This morning she was admitted at emergency department because when she was
taking a bath she felt something uncomfortable in her chest, like 3 years ago
when she was diagnosed myocardial infarction.
Her vital signs are blood pressure 174/94 mmHg, pulse 56 beats/minute irregular
and respirations 30/minute.

Create pharmaceutical care plan for that patient with the SOAP method !

Note.
Pharmaceutical care plan include subjective, objective, problem medis, current
therapy, Drug related problems (DRPs) and drug monitoring.

Penyelesaian:
Pasien: Ny. ST (64 tahun)

SUBJECTIVE

- Anorexia
- Lethargy
- Diarrhea
- KCl membuat
rasa tidak
nyaman
- Riwayat
Penyakit
Dahulu : Infark
Miokardial
(Sakit dada)

OBJECTIVE

ASSESSMENT

PROBLEM
MEDIS

- Tekanan darah - Poor skin turgor - Gagal

174/94 mmHg
jantung
- Poor muscle
- Denyut 56
tone
- Infak
ketuk/menit
miokardium
- Irregular pulse
- Pernapasan
rate
30/menit
- Decreased bowel
- Kadar Kalium sounds
(K) 2.9
mEq/L, Kadar
Natrium (Na)
137 mEq/L
Kadar klorida
(Cl) 96 mEq/L

TERAPI

- Digoxin
(Lanoxin)
- Furosemide
(Lasix)
- KCl 20
mEq
perhari
- Diet rendah
natrium

DRP

Interaksi obat:
Digoksin
Furosemid.
Meskipun diuretik
dan digitalis
glikosida sering
dan cukup tepat
jika digunakan
bersama, namun
diuretik dapat
menyebabkan
hipokalemia dan
hipomagnesia,
dimana hal ini
dapat
mepengaruhi
(meningkatkan)
efek digoksin
digitalis pada
pasien aritmia.
Gejala dari efek
interaksi kedua
obat tersebut yaitu
detak jantung
melambat, diare,

SUGES
FOLLOW

Nonfarmakolo
Perbanyak
air mineral
minuman
elektrolit

Farmakolo

Pemberian
digoksin da
furosemide
dengan inte
waktu (terla
di bawah)

anoreksia dan
poor muscle tone.
Efek samping.
- Efek samping
digoksin antara
lain
ketidakteratura
n denyut
jantung,
penurunan
suara perut,
anoreksia,
letargi dan
diare.
- Efek samping
furosemide
adalah poor
skin turgor
(dehidrasi).

Pharmaceutical Plan:

Time

Drug

Route

05.30 am
07.30 am
12.00 pm
02.00 pm
19.00 pm
21.00 pm

1 Tablet Digoxin 0,25 mg

Makan pagi
Makan siang
KCL mEq
Makn malam
1 Tablet Furosemide 40 mg

Oral
Oral
Oral

Monitoring therapy by Nurse:

One Week Result
Monitoring

Hypertension
Blood pressure Monitoring

Getting Worse
Target Therapy

Sistol : <130
mmHg
Diastol : 80 90
mmHg

Drug side effect :

1. Drug Interaction :

Hypokalemia and
hypochloremia

Pottasium : 3.65.5 mEq/L

slow heart rate, diarrhea,

anorexia , poor muscle tone

Chlor : 98-108
mEq/L

2. Digoxin Side Effect :

No diarrhea

irregular pulse rate

decreased bowel sounds

irregular heart beat

anorexia

Normal
tone

muscle

Lethargy

Normal

pulse

Increase apetite
Normal heartbeat

(insert
Checklist)

Getting Worse
(Insert Checklist)

rate

Diarhea

3. Furosemid Side Effect

Poor
skin
Dehydration

Turgor

Normal
turgor

skin

Pharmaceutical Care Plan :

Time
05.00 am
08.00 am
01.00 pm
02.00 pm
06.00 pm

Drug
1 Tablet Digoxin 0,25 mg
Makan pagi
1 Tablet Aldazide (Spironolactone 25 mg dan Tiabutazide 2,5 mg
Makan siang

Route
Oral

1 Tablet Aldazide (Spironolactone 25 mg dan Tiabutazide 2,5 mg

Oral

KCL 10 mEq
Makan malam
1 Tablet Aldazide (Spironolactone 25 mg dan Tiabutazide 2,5 mg

Oral

Oral

Oral