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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

Jurnal Farmasi Indonesia Vol. 1 No. 1 Juni 24 - 28

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

Jurnal Farmasi Indonesia Vol. 1 No. 1 Juni 24 - 28

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

Jurnal Farmasi Indonesia Vol. 1 No. 1 Juni 24 - 28

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).