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Drug Related Problems Complication in Hy
Drug Related Problems Complication in Hy
Drug Related Problems Complication in Hy
Abstract
Hypertension is a disease that often occurs in the Ward Internal Medicine Persahabatan Hospital
in Jakarta. Hypertension is widely known as cardiovascular disease. 1 Estimated for hypertension
that it has caused 4.5% of the global burden of disease, and the prevalence is almost as large in
developing countries and in developed countries. 1 Hypertension is one of the major risk factors
for heart problems.1 In addition to causing heart failure, hypertension can lead to kidney failure
and cerebrovascular disease. 1 In most cases, hypertension was detected on physical examination
for reason of certain diseases, so it is often referred to as the "silent killer".2 Unwittingly patients
experienced complications in vital organs such as the heart, brain or kidneys. 2 The population of
the world who have diabetes mellitus tended to increase from year to year, it is due to the
increasing number of population, lifestyle, increasing prevalence of obesity and lack of physical
activity.3 Reports from WHO on diabetes population studies in various countries, the number of
people with diabetes mellitus in 2000 in Indonesia ranks 4th in the number of people with
diabetes mellitus with the prevalence of 8.4 million people, in 2010 the number of people with
diabetes in Indonesia at least be 5 million and 239.9 million people in the world, estimated in
2030 the prevalence of diabetes mellitus in Indonesia increased to 21.3 million. 4 Morbidity and
mortality due to diabetes mellitus in Indonesia tend to fluctuate each year in line with the lifestyle
changes that lead to fast food and fiber carbohydrates. 4
Case Presentation : Ms. SJ 46-years-old woman hospitalized in internal medicine ward. Patient
was diagnosed with the disease complications of hypertension, chronic renal failure and diabetes
type II, and hypoalbuminemia.
Clinical Evaluation : interventions to do that lower the dose of valsartan, treatment of drug
interactions between Askardia with Gliquidone, and not given albumin..
1. Introduction
2. Case Presentation
SJ is a 46-years-old woman hospitalized in internal medicine ward (Internist).
Patient entered Persahabatan Hospital on the 15th of March 2014 in the Emergency
room (ER) with complaints of shortness of breath become heavy, especially when
lying down sleeping, coughing, and throat felt dry, the patient has a history of
diabetes since 2 years ago with only patient taking the drug Metformin. Having
conducted several clinical interventions particularly blood and urine laboratory tests
and in reference to the disease ward Internist with was diagnosed of type II diabetes,
chronic kidney disease (CKD) and hypertension on March 18, 2014. The patient was
diagnosed with hypertension with blood pressure 160/100 mmHg, CKD on dialysis
with serum creatinine 6.5 mg/dl and she have being 2 times a week hemodialysis,
diabetes mellitus type II disease with while blood glucose 198 mg/dl, and diagnosed
hypoalbuminemia with value of albumin 2.7%.
As for drug therapy was given to patient Ms. SJ were Askardia aims to thin the
blood that occurs in patient on March 20th and on March 21th 2014, while for the
drugs treatment of hypertension given valsartan 160 mg once a daily since her first
day in the ward Internist, amlodipine 5 mg once a daily since the first day of the ward
in internist, clonidine 0.15 once daily start on March 22th to March 25nd 2014.
Furosemide 40 mg once a daily starting on March 22th, 2014 to 26nd March. The
treatment of chronic kidney disease (CKD) using CaCO3 drug since the first day of
the disease ward internist and folic acid given on March 18th, 2014 to March 21nd.
Therapy of type II diabetes using insulin medication was given on the March 18th
2014, and March 19nd and 30 mg Gliquidon 1x1 / 2 was granted on March 20th
2014, to March 26nd.
The results of laboratory tests :
Examination Result Normal
Neutrofil 81.8 % 50-70 %
Limfosit 8.7 % 2-6 %
Monosit 8.4 % 2-4 %
Eosinofil 0.5 % 2-4 %
Eritrosit 2.86 m/uL 3.6-5.8 m/uL
Hemoglobin 8.3 g/dl 12.0-16.0 g/dl
Hematokrit 25 % 35-47 %
RDW-CV 16.3 % 11.5-14.5 %
Ureum 72 mg/dl 20-40 mg/dl
Creatinin 3.9 mg/dl 0.8-1.5 mg/dl
While Blood Glucose 185 mg/dl <140 mg/dl
Albumin 2.7 g/dl 3,8 – 5,1 gr/dl
According to laboratory results that patient had impaired renal function
characterized by decreased hemoglobin and hematocrit and increased urea and
creatinine. Patient experiencing stress or shock was characterized by decreased
eosinophils. Increased Neutrophils, lymphocytes in patient usually caused by an
infection, inflammation and pancreatitis. Patient experiencing blood disorders or
anemia characterized by decreased erythrocyte. Patient experiencing Hyperglycemia
is characterized by elevated blood glucose values while. Patient also experienced a
marked hypoalbuminemia with albumin impairment.
3. Guideline treatment of hypertension and CKD complications Diabetes On HD10
For women :
(50 kg) x (140−46)
( 0 . 85 ) (
CrCL = 72 x (3 .9 mg % )
50(kg)x(140−46 )
( 0 . 85 ) (
CrCL = 72 x(6 .5 mg %)
5. 1 Clinical Evaluation
5.1.1 Drug Related Problem 1
Valsartan dose has used by patient Ms. SJ 160 mg once daily for treating
hypertension, but the dose was not in accordance with the guidelines, treatment of
hypertension and CKD by creatinine clearance On Hemodialysis 8.54 mL / min the
dose should be lowered to 40 mg once a daily.12
Pharmacist’s Intervention : doctors should be submitted to the lowered dose of
valsartan.
5.1.2 Drug Related Problem 2
Patient experiencing hypoalbuminemia but the patient was not getting drugs to
treat hypoalbuminemia.
Pharmacist’s Intervention : suggested giving the drug based diagnostic indication.
5.1.3. Drug Related Problem 3
The concomitant ascardia used with gliquidone can cause interactions that can
lead to an increased effect Gliquidon so can caused hypoglycemia.
Pharmacist’s Intervention : the use Ascardia with Gliquidone are spaced
approximately 2 hours. The intake of food/sugar must remain even though simply
applied should be limited. This is necessary to avoid hypoglycemia.
6. Conclusion
Based on the assessment of the drugs used this patient, it can be concluded that
Valsartan as antihypertensive drug, the dose should be given 160 mg once daily
lowered to 40 mg in patient with Chronic Kidney Disease (CKD) on hemodialysis.
By George R. Bayley in his book Medfacts Pocket Guide Of Drug Interaction that
uses Askardia along with Gliquidon can cause interactions that can lead to increased
Gliquidon effects that can caused hypoglycemia.13 But in practice does not appear to
hypoglycemia. This is because hypoalbuminemia patient not treated so that the drug
concentration in the blood (protein-bound drug/albumin) be increased.13
Bibliography
5. McGuire KD. 2012. Diabetes and the Cardiovascular System. Braunwald’s Heart
Disesase, 9th ed, Elsevier, Philadelphia.USA.
6. Farkouh ME, Fuster V, Rayfield EJ. 2011. Diabetes and Cardiovascular Disease.
Heart’s The Heart, 13th ed, McGraw-Hill, New York.
7. Creager MA, Luscher TF. 2003. Diabetes and Vascular Disease; Patophysiology,
Clinical Consequences, and medical Therapy: Part I. Circulation.
9. Vola BS. 2002. Diabetes Millitus and the Heart Lange: Current Diagnosis and
Treatment in Cardiology, 2th ed, McGraw-Hill, Ney Jersey.
12. Caroline Ashley and Aileen Currie. 2009. The Renal Drug Handbook Third
Edition. Radcliffe Publishing Ltd 18 Marcham Road, Abingdon,
Oxon OX14 1AA. United Kingdom.
13. George R. Bailie, et al. 2004. Medfacts Pocket Guide Of Drug Interactions,
Nephrology Pharmacy Associates, second edition; Bone Care
International.