Evaluation Of Drug Related Problems (DRP) In Patients With Diabetes
Mellitus Internal Medicine Ward EVALUATION OF DRUG RELATED PROBLEMS (DRPs) IN PATIENTS OF DIABETES MELLITUS ON THE WARD INTERNAL MEDICINE INPATIENT INSTALLATION ON THE ISLAND OF SELAYAR NAVY HOSPITAL MINTOHARDJO Dr. JAKARTA Astinapati Sampe Bua1), Ayu Ashari2), Desi Irma Rinding3), Dewi Sri Utami4), Endang Rahayu5), Erviyani Batmar6), Fras Korompis8), Hernianti7), Monalisa Karinda9), Nadhirah10), Neltji Aifa Batilmurik11), Surianti12), dan Windy Fitriani Sumarauw13) 1-13)
Faculty of Pharmacy, Pharmacist Program, University of August 17, 1945
Jakarta, Indonesia. Internal Medicine, Dr. Mintohardjo RSAL, Jakarta.
ABSTRACT Diabetes mellitus (DM) the DM type 2 in particular is one of a number of degenerative diseases is increasing from year to year in Indonesia. DM type 2 can be controlled through the four pillars of the treatment DM. Restrained DM indicated with normal blood sugar levels is an indicator in the diagnosis of DM. the general objective of this research is to know the amount and percentage of the Drug Related Problems in RSAL Dr. Mintohardjo. The research is descriptive, data retrieval was performed by a prospective patient criteria 7 patients with was diagnosed of DM and undergone hospitalization in Ward internal medicine Dr. Mintohardjo RSAL.. Data taken in February 2014. Identification of Drug Related Problems (DRP) related to improper drug selection was done through discussion with clinicians. The results showed that some Drug Related Problems (DRPs) in patients who were diagnosed DM. to reduce the incidence of Drug Related Problems (DRPs) in DM patients on the ward of disease in required an increase in the role of active licensed as well as cooperation among medical personnel in providing health care services and monitoring drug therapy. Keyword (s) : DM (Diabetes Melitus), RSAL Dr.Mintohardjo
INTRODUCTION Diabetes mellitus is a metabolic disorder that is the result
of a failure of the pancreas to
secreting insulin (the hormone that is
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responsibel for the utilization of
glucose) is adekuat. A common result is the onset of hyperglycemia. Diabetes mellitus is a group of heterogeneous disorder characterized by abnormalities in blood glucose levels or Hyperglycemia-induced insulin deficiency or insulin not working due to adekuat (Brunner, 2002). Diabetes mellitus was also defined as a chronic disease that a result of insufficient pancreas produce insulin or the body is unable to use insulin effectively (WHO, 2006). The world Health Organization (WHO) estimates more than 180 million people in the world suffer from DM. This figure was expected to continue to increase and by 2030 will be the 2nd time. An estimated 1.1 million people died due to the DM in 2005 (WHO, 2008). Diabetes mellitus (DM) is a chronic disease that until now has not yet curable. The term DM can cause fear for the individual who is miserable (diabetisi), ongoing anxiety and eventually leading to depression. Depression felt by diabetisi can be moodiness, hopelessness, lack of berdayaan, recurring thoughts about death, especially with complications that continue to diabetes. This is in accordance with the explanation of the Golden a doctorate from Johns Hopkins HOSPITAL in Baltimore, Maryland, to the effect that that has been getting mainly diabetis treatment will increase the risk of the occurrence of symptoms of
depression (McWright, 2008).
In order to improve the rational use of drugs, especially the important role has licensed in identifying and solving problems related to drug use or Drug Related Problems (DRPs) which are both potential and actual. Drug Related Problems is a problem arising in the use of drugs or drug therapies that are actual or potential can affect patient therapy outcame, increasing maintenance costs and can impede the achievement of a therapeutic purposes (Van, 2008). The emergence of Drug related Problems (DRPs) was usually triggered by the increasing number of drug types and consumed the patient (polypharmacy) to tackle various diseases suffered [4]. The Minessota Pharmaceutical Care Project has identified the presence of 5533 Drug Related Problems (DRPs) on common patient 9399 (not just elderly patients). The results showed more than 1,400 patients experienced more than one category of Drug Related Problems (DRPs) for the duration of the treatment. This research aims to know the number and percentage of patients on the drug selection DM in the ward of disease In RSAL Dr. Mintohardjo, Jakarta. Parameter selection of inappropriate medications include: medications that the patient is not an acceptable remedy is most appropriate (there
Evaluation Of Drug Related Problems (DRP) In Patients With Diabetes
Mellitus Internal Medicine Ward are other drugs that are more effective), patients receiving a combination of drugs that the drug contraindication was not required, its used for patients, the drug was not safe for the patient's condition, the shape of the material was not appropriate, a drug that was used the most appropriate remedy in such cases not effective. RESEARCH METHODOLOGY The research is descriptive. data retrieval in a prospective done on 7 patients with criteria of patients older than 50 years and undergone hospitalization in Ward section of internal medicine Dr. Mintohardjo RSAL. Data taken in the time period i.e. April May 2014. Patient treatment data retrieval done through medical record cards, note cards, dispensing by nurses, data collected were: 1. General Data of patients such as sex, weight, aged. 2. history of previous disease. 3. endured patient Complaint during hospitalized 4. Diagnosis 5. inspection results either physical or laboratory the patient during the treatment. 6. treatment given patients during hospitalized. Identification of Drug Related Problems (DRPs) related to improper drug selection was done through discussion with clinical. And than data analysis done for descriptive.
RESULTS AND DISCUSSION
The results showed that the drug problem was not just elections occurred in 13 cases with type and number as shown in table 1. The effectiveness of treatment was determined by the decisions of the selection of drugs. Election of remedies without scientific evidence base a powerful healing process can cause the disease to be slower so lengthening the hospitalization and further add to the cost of treatment. Drug selection can be based on standard hospital treatment available, or therapeutic guidelines developed by professional organizations both local or international. In table 2 were presented a list of improper drug selection because there were other drugs that more effective. From table 2 visible majority election of remedies that are not exs actly about with the used of medications to type 2 diabetes. diabetes drugs the ideal gift was based on the results of the examination of the while blood sugar. A combination that was not required the used of two or more kinds of drugs with therapeutic grade is the same but different classes which were intended to improve the effectiveness of the therapy, but the selection of one the drug more appropriate than drug combianation. The used of should give the ratio of the benefits and risks for patients 3
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drug selection tudak just look at the
benefits of curing disease but should always be accompanied by consideration of the patient's condition. A list of drugs that are not
safe for diabetic patients on the
ward of disease in RSAL Mintohardjo was presented in table 5.
Table 1 The type and amount of Medication Selection Problems were not just in Pasein Diabetes Disease wards In RSAL Mintoharjo. Drug Selection Problem Not appropriate
The number of cases
Percentage
Election of Remedies are not
appropriate
15
Improper Dosage indication
The untreated condition
Dose Regimens
Drug Interactions
61
Total
13
100
Table 2 A list of drugs that are not exact because there are other drugs that more effective in Diabetes patients in the ward of disease in RSAL Mintoharjo A Drug That was Given A more appropriate remedy Folic Acid Maximum dosage of folic acid Amlodipin 5 mg Valsartan 80 mg
The granting of Amlodidpin 5 mg, Valsartan
80 mg of his deed did not need to because the patient's blood pressure to normal
Metformin 500 mg Ranitidine
Metformin works work enhances the effect
of ranitidine
Evaluation Of Drug Related Problems (DRP) In Patients With Diabetes
Mellitus Internal Medicine Ward Catopril 25 mg Allopurinol
For long-term pemekaian the possibility to
interact seriously. Dimonitoring the use of drugs. The risk of interaction can result in anaphylaxis and steven joensen
Valsartan 80 mg Catopril 25 mg
Mutually enhance each toxicity
(interactions farmakodinamik sinergik)
Bisprolol KSR Amlodipin Clopidogrel
Risk Of Hiperkalemia Risk Of Hiperkalemia
Table 3 List of combinations of drugs that were not required in patients on the ward DM disease in RSAL AL Mintoharjo Name drugs combination was A more appropriate remedy given Amlodipin In the case of HT + DM should be Catopril replaced with amlodipin catopril Furosemid Spironolakton
In the case of DM should be a diuretic
selected spironolakton.
The use of insulin noverapid
Actrapid
Actrapid election or Noverapid one of
them was used.
Table 4 A list of drugs that recommendation its used for patients on the ward of disease in DM at RSAL Mintoharjo The Name Of The Drug Contraindications Furosemid
Hiperkalemia
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Amlodipin
Hiperkalemia
Noverapid
Hipokalemi
KSR
Hipokalemia
Ascardia
Bleeding
CONCLUSION Selection of drug problems often becomes a problem for the treatment of patients, so that the necessary servicing Pharmaucetikal care to prevent the occurrence of DRPs (Drud related Problems), to reduce the numbers of Genesis required cooperation between the DRP medical personnel in providing health services.
BIBLIOGRAPHY 1. Brunner dan Suddarth. 2001. Keperawatan Medikal Bedah Edisi 8 Volume 2. Jakarta : Penerbit Buku Kedokteran EGC 2. Cipolle RJ, Strand LM, Morley PC, Pharmaceutical Care Practice, cgraw- Hill, Health Professions Devinision, 1998. 3. McWright, Bogdan. 2008. Panduan Bagi Penderita Diabetes. Prestasi Pusta karaya; Jakarta. 4. Van Mill JWF, Westerlund T, Hersberger KE, Schaefer MA, Drug Related Problem 6
Classification Systems, The
Annals of Pharmacotherapy, 2004, 38, p: 859- 867. 5. Viktil KK, Blix HS, Moger TA, Reikvam A, Polypharmacy as Commonly Defined is An Indicator of limited Value in The Assessment of Drug Related Problems, Br J Clin Pharmacol, 2006, DOI:10.111/j.1365- 2125. 6. WHO, 2008, World Health Organization-Diabetes Facts. (online) (http://www.who.int diakses 27 Juni 2014).
