F1000Research2021,7:1837Lastupdated: 13 April 2021

JOURNAL OF PHARMACY

A Case Study Of Ischemic Stroke With Complementary

Disease Of Hypertension and Cholesterol
HendraRamadani
Dizky S. PululawaIrma
Putri I.Salwa DewaAyupuspitaDewi
Papeo Zulkarnain Marhaba Fadrianza Sahir
Fairus Saskia Djibran Sarah Safira

Received 06 April 2021

V2 Received in revised form 12 April 2021
Accepted 13 April 2021

Abstract
Stroke is a disorder that occurs in the brain that includes defects in blood vessels involving
neurons, blood vessel cells, and matrix components. where stroke can be divided into 2, namely
ischemic stroke (87%) and hemorrhagic stroke (13%). The risk factors for stroke are age, low
birth weight, race, and genetic factors. Hypertension is generally defined as a persistent increase
in arterial blood pressure (BP). While cholesterol is to increase total lipid levels there by
increasing the risk of several cardiovascular diseases. The purpose of this study was to analyze
case studies related to ischemic stroke and other comorbidities in order to find the right solution
in therapeutic treatment of patients. The method used in this research is literature study using
Dipiro Book Edition 11 and journals made in the form of SOAP (Subjective, Objective,
Assessment, Planning). Based on the results of the research that has been done, found a
treatment solution for patients with ischemic stroke, including through Pharmacology and Non
Pharmacology therapy. Pharmacological therapies used in patients are Aspilet, Diazepam,
haloperidol, clobazam, a combination of amlodipine and candesartan and atorvastatin, which is
used in the treatment of ischemic stroke accompanied by other comorbidities, namely
hypertension and cholesterol. While the non-pharmacological therapy used is monitoring and
control of patient drug use is carried out, avoiding smoking and drinking alcohol, reducing stress
and a salt diet.

Keywords
Ischemic Stroke, Hypertension, Cholesterol, Pharmacological Therapy, Non

Pharmacologica Therapy

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F1000Research2021,7:1837Lastupdated: 13 April 2021

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 modifiable, less well documented i.e. Migraine,
REVISED Amendments from Version 1
Metabolic syndrome, Drug and alcohol abuse,
Change in this journal are the addition of
therapeutic pharmacology from patients and Inflammation and Infection, Elevated Lp(a),
consultation, information and education of Homocysteinemia, and Sleep-disordered breathing
the drug in patients
[6].
Preliminary Hypertension is a common disease that is simply
Stroke is a disorder that occurs in the brain that defined as persistently elevated arterial blood
includes defects in blood vessels which are pressure (BP). Although elevated BP was
further defined as a broader defect involving perceived to be “essential” for adequate perfusion
neurons, vascular cells, and matrix components, of vital organs during the early and middle 1900s,
which are collectively referred to as it is now identified as one of the most significant
neurovascular units. Stroke is divided into 2, risk factors for cardiovascular (CV) disease.
namely ischemic stroke (87%) and hemorrhagic Increasing awareness and diagnosis of
stroke (13%) [7]. hypertension, and improving control of BP with
The prevalence of stroke in Indonesia in 2018 appropriate treatment are considered critical public
was 10.9% and increased by 3.9% in the last five health initiatives to reduce CV morbidity and
years. A total of 10.9 per 1,000 Indonesians mortality [7].
suffered strokes in 2018. This figure decreased Lipid abnormalities increase the risk of coronary,
from the previous five years, 12.10 per 1,000 cerebrovascular, and peripheral vascular arterial
inhabitants and increased compared to 2007, disease collectively known as atherosclerotic
which was 8.3 per 1,000 inhabitants [19]. cardiovascular disease (ASCVD). The ASCVD-
Risk factors from stroke are divided into several risk assessment evaluates a 10- year
such as Nonmodifiable risk factors or risk atherosclerotic cardiovascular disease incident.
markers, namely Age, Low birth weight, Race, Developing a first ASCVD event is defined as
and Genetic factors. Modifiable, well nonfatal myocardial infarction or coronary heart
documented namely Cigarette smoking, disease (CHD) death, or fatal or nonfatal stroke,
Hypertension, Diabetes, Asymptomatic carotid over a 10-year period. Premature coronary
stenosis, Dyslipidemia, Atrial fibrillation, Sickle atherosclerosis is the most common and significant
cell disease, Poor diet, Obesity, Physical consequence of dyslipidemia [7].
inactivity, and cardiac Other diseases (coronary One method that can be used to cure stroke with
heart disease, heart failure, PAD). Potentially hypertesni and cholesterol is to eliminate

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modifiable risk factors. Therefore,
comprehensive guidance and management is
needed for people with hypertensive stroke and
cholesterol so as to prevent serious impacts that
can have a serious impact on the health of
sufferers and affect the quality of life of sufferers
in the family and community environment.
Methods
The method used in this journal is by using the
SOAP method equipped with IEC, in the SOAP
method, S as a subject containing patient
information notes, O as an object containing a
physical examination of the patient, A as an
assessment containing studies and assessments
based on findings and observation of the patient's
condition and P as a plan which contains plans to
overcome patient problems. KIE
(communication, information and education)
contains a form of counseling that will be given
to patients. The patient data used were obtained
by cross sectional from the patient's medical
record file.
Study case
Mr. D, a 38 year old man, address Bandung,
was admitted to the hospital with the main
complaint of stroke, with the patient's initial
clinical condition, namely the general condition
of the rero, consciousness of Compos Mentis
(CM), blood pressure 130/90 mmHg, pulse 104x /
minute, respiration 24x / minute, temperature 37⸰C
and dependence on diazepam.
At the initial inspection Mr. D obtained lab data,
namely Hb: 13.8, Leukocytes: 12,900, Hematocrit:
43, Platelets: 291,000, GDS: 94. With a history of
patient drug consumption, namely Diazepam,
Haloperidol and drugs from psychiatric and
neurological disorders. In addition, Mr.D has a
history of previous diseases, namely Hipertension,
Cholesterol and Stroke with a family history of
Hypertension. After being admitted to the hospital,
the patient was diagnosed with a stroke with
anxiety. Furthermore, the CT scan results showed
that the patient had cerebral cephalic atrophy,
cerebral infarction in the subcortial parietal area
and right temporalis in the cortical area which
indicated that the patient had an ischemic stroke.
Subject
Patients Experiencing anxiety disorders and
Difficulty speaking, spoken words are not to your
liking or speech disorders.
Object
a. Physical Examination :
Rero condition and awareness compos mentis
(CM).
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b. Supporting Examination :

Table 1. Lab Data Result

Examination Normal Value Result Per date

07-4 08-4

Hematology
Hemoglobin 13,0 – 16,0 13,8

Leukocyte 4000 – 10000 12900

Hematocrit 40 – 50 43

Platelets 150000-440000 29100

0

Clinical Chemistry
Gds <140 94 83

Ureum 20 – 40 21

Creatinine 0,8 – 1,3 1,0

Tg <150 155

Total <200 248

Cholesterol
HDL Cholesterol >40 38

LDL Cholesterol <100 179

c. Holistic Diagnostics :  Concern : the patient has psychiatric disorders

Personal Aspects and dependence on diazepam.
 Reason for arrival : Experiencing the main Clinical aspects
complaint of stroke accompanied by anxiety  Ischemic Stroke
disorders  Hypertension

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  Cholesterol  Body Mass Index, including obesity group
Internal Risk Aspects  Race
 Age factor  Taking drugs such as diazepam
 Genetic factor

Assesment

Table 2. Assesment Pharmacological Therapy

Medicine Indication Dosage Drug side effect
Name

Ranitidine duodenal ulcer Oral: 2 x 150 mg. Tachycardia (rare), agitation, visual
Injection: twice a disturbances, alopecia, interstitial nephritis
day (rare)
Citicolin Ischemic Stroke 500 mg, three times Vertigo, muscle weakness, apnea,
a day nephrotoxicity. Occasionally vasomotor
disorders, speech and vision disorders,
confusion, neurotoxicity and psychosis.
Coditam Relieve severe Three times a day Dyspepsia, sore throat, fatigue,
pain palpitations, and visual disturbances

Sucralfat Duodenal ulcer 10 cc, 1-2 hour Constiption,Headache, Dry mouth, Dizzy,
before eating Diarrhea, Insomnia, Bloated, Nausea or
vomiting.

Simvastatin Relieve pain 10 mg, twice a day Drowsiness, Headache, Constipation,

5 mg tablet Clumsiness or balance disorders. Impaired
appetite, Fatigue, Vomiting, and Cough.

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Haloperidol Skizofrenia 5-15 mg/ day Less sedative, less antimuscarinic and
hypotensive symptoms. Photosensitization
and pigmentation are rare. Extrapyramidal
symptoms especially dystonia and
akathisia are more frequent, especially in
thyrotoxic patients.
Amlodipine Hypertension, 5 mg, once a day Abdominal pain, nausea, palpitations,
where the flushing, edema, sleep disturbances,
patient's blood headache, dizziness, fatigue;
pressure lab
results reach 130 /
90-180 / 90
Aspilet Ischemic Strore Once a day Stomach pain, headache, drowsiness,
bronchospasm, impaired kidney function,
gastrointestinal bleeding, and other
bleeding such as the subconjunctiva.
Mannitol Cerebral edema Three times a day Fever, chills, headache, runny nose.
Urinating more frequently. Dizziness or
blurred vision. Nausea or vomiting.

Pantoprazole Duodenal ulcer Twice a day Increased triglycerides

Micardis Hypertension, 80 mg, once a day Dizziness or lightheadedness, especially

Telmisartan where the after waking up. Symptoms of the flu, such
patient's blood as weakness and coughing. Impaired
pressure lab kidney function; Indigestion, such as
results reach 130 / nausea, stomach pain, and diarrhea
90-180 / 90
Lanzoprazole Duodenal ulcer 30 mg, once a day reported alopecia, paresthesia, bruising,
purpura, petechiae, fatigue, vertigo,
hallucinations, confusion; rare:
gynecomastia, impotence.

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 Diazepam Anxiety disorders Oral: 2-3 x 2-5 mg/ Drowsiness, muscle weakness, ataxia,
day. paradoxical reactions to aggression, mental
Injection: disorders, amnesia, dependence,
respiratory depression, lightheadedness the
5-10 mg (iv/om)
next day, confusion. Sometimes occurs:
headache, vertigo, hypotension, changes in
salivation, gastrointestinal disorders, rash,
visual disturbances, changes in libido,
urinary retention, also reported blood
disorders and jaundice, on intravenous
injection occurs: pain, thrombophlebitis
and rarely apnea or hypotension
Granisetron Nausea and 1-2 mg, twica a day Constipation, headache, skin rash,
vomiting temporary increase in liver enzymes, and
hypersensitivity reactions

Candesartan Hypertension 8 mg, once a day Hypotension can occur in patients with
high renin levels such as hypovolemia,
heart failure, renovascular hypertension
and cirrhosis of the liver. Renal
insufficiency, dizziness, headache,
diarrhea, decreased hb, rash, abnormal
taste sentation
Atorvastatin Cholesterol 10 mg/day Transient myositis, headaches, changes in
renal function and gastrointestinal effects
(gastric pain, nausea and vomiting),
changes in liver function tests, paraesthesia
and gastrointestinal effects including
abdominal pain, flatulence, constipation,
diarrhea, nausea and vomiting. Skin rash
and hiersensitivity as well as effects on
muscles.

Planning outpatient process.

The risk factor for ischemic stroke in this patient is
Patients should avoid smoking, alcohol consumption
the consumption of drugs, especially the
as well as multiplication of eating vegetables and
consumption of diazepam, therefore it is
fruits, avoid consumption of fatty foods and a diet
necessary to talk about the use of drugs given to
consuming salt.
patients by families and health workers during the
Patients are advised to control to find out whether
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 the disease has improved or if there are side
effects or dangerous interactions due to the drugs
given.
Patients also have to routinely go to the Internal
Medicine Polyclinic for cholesterol so that total
cholesterol levels can be controlled
complications do not occur as well as routine
blood pressure checks.
And finally, always get closer to God Almighty by
performing worship according to the patient's
beliefs and beliefs. And stay confident in living
life and don't feel burdened by current illnesses
Discussion
Stroke is a disorder that occurs in the brain that
includes defects in blood vessels which are
further defined as a broader defect involving
neurons, vascular cells, and matrix components,
which are collectively referred to
neurovascular units. Stroke is divided into 2,
namely ischemic stroke (87%) and hemorrhagic
stroke (13%) [7]. Stroke is classified into
ischemic stroke and hemorrhagic stroke.
Approximately 83% of all strokes are ischemic
strokes, and approximately 51% of strokes are
caused by arterial thrombosis, which is the
formation of blood clots in the cerebral arteries
due to atherosclerosis [16].
The purpose of this study was to analyze case
studies related to ischemic stroke and other
comorbidities in order to find the right solution in
therapeutic treatment of patients. From the patient's
data named Mr. D a 38 year old man, was
diagnosed with stroke. Where the initial condition
is normal consciousness, speaking clearly but not
according to what is being discussed. From the CT
and
scan results, the results were cephalic atrophy and
cerebral infarction in the subcortial parietalis and
right temporalis in the cortical area, so that this
patient was diagnosed with ischemic stroke. When
cerebral blood flow decreases by less than 10 ml /
100 grams of brain tissue, an ischemic nucleus is
formed. This ischemic core area will soon become
irreversible necrotic and the cells die (cerebral
infarction) [16].
The trigger for stroke is due to the patient's
history of experiencing anxiety so that the patient
has experienced dependence on the drug
Diazepam, where diazepam works by affecting
chemicals in the brain so that it has a calming
as
effect for several hours. Stroke occurs when part of
the brain experiences a lack of blood flow
(ischemic) [20].
In addition, one of the triggers for ischemic stroke
is the presence of high levels of leukocytes. Based
on the patient's lab data, there was a very high
patient leukocyte result. Leukocytes can cause
occlusion in the brain circulation. Decreased
perfusion pressure can trap circulating leukocytes
and form contact with capillary endothelium [10].
Based on the results of the patient's lab data, it
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was found that the patient's total cholesterol level known that there is a history of hypertension, so
exceeded the normal limit of 248 mg / dL, the that the patient is diagnosed with hypertension.
patient's LDL cholesterol was very high, 179 mg / Judging also from the results of the patient's lab
dL, and the patient's HDL cholesterol was 38 mg / data, there is a high patient blood pressure, which
dL. Based on these data, the patient was is an average of 150/90 mmHg which includes
diagnosed with cholesterol. Ischemic stroke has stage 1 hypertension [6]. Hypertension makes
many risk factors. One of them is dyslipidemia, blood vessels easily closed by plaque. The arteries
which is an increase in cholesterol and in the brain that are blocked by plaques can cause
triglyceride levels and a decrease in HDL reduced oxygen intake to the brain or commonly
cholesterol [1]. called a stroke [11].
Based on the patient's family history, it is
Table 3. Classification of Blood Pressure in Adults (Age ≥18 Years) [6]
Systolic Blood Diastolic Blood
Classification pressure (mm Hg) Pressure (mm Hg)
Normal < 120 <80
Prehypertensionb 120-139 80-89
Stage 1hypertension 140-159 90-99
Stage 2 hypertension ≥160 ≥100

a. Patient condition damage, chronic lung disease, polycythemia

In the hematology lab data, it was explained and shock and to a decrease in hct levels can be
that the patient's hemoglobin level was normal, indicators of anemia[15].
namely 13.8, where the normal value range was Platelet result data also shows that the patient
13.0-16.0. Hemoglobin data can explain the has normal levels, namely 291,000 with a
conditions experienced by patients if they are normal range of 150,000-440,000. That
exposed to anemia. Furthermore, the platelets still have a good working function,
hematocrit test, which results in the patient namely forming a mechanical plug which is a
having a normal value, namely 43 with a normal hemostatic response to vascular
normal range of 40-50. Hematocrit data shows injury[15].
the percentage of collar blood cells to total Then the patient leukocyte data showed that
blood volume, where an increased hematocrit the patient had excess leukocyte levels than
level can occur in erythrocytosis, dehydration, normal levels, namely 12,900 with normal
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levels of 4,000-10,000. Where this can be
caused by a disease experienced by the patient,
one of which is an ischemic stroke. Which
patients with upper quartile leukocyte levels (>
8,2x109) / L) have a higher risk of ischemic
stroke[23]. In Poland, where there is a
significant relationship between increased
leukocytes and mortality in acute stroke
patients[14].
For clinical chemistry result, it was explained
that the patient's creatinine level was normal,
namely 1.0 with a normal value range of 0.8-
1.3. Creatinine levels can explain the patient's
kidney condition, where if there is an increase
in creatinine levels, it indicates impaired kidney
function due to impaired kidney function
caused by nephritis, blockage urinary tract,
muscle disease or acute dehydration[23].
The GDS data result, showed that the patient
had normal levels, namely 94 and 83 where the
normal value range was <140. Current blood
glucose levels is the value of the measured
glucose results at 2 hours after eating. Score
that will determine whether sufferers stay
diabetes mellitus or not, if blood glucose levels
timing is more than 200 mg / dl then sufferers
are diagnosed as sufferers diabetes mellitus[2].
The urea data result, also showed normal
levels, namely 21 with a range of 20-40. Urea
levels indicate whether the patient's kidney is
experiencing acute renal failure or not by
seeing an increase in urea levels[3].
Triglycerides, HDL, LDL and total cholesterol
data result, showed that the patient had
hyperlipidemia, which was shown by the
patient's HDL level, which was 38, which was
less than the patient's normal level, which was>
40, accompanied by an increase in triglyceride
levels, 155 which exceeded normal levels,
namely < 150, LDL level from normal level is
179 with normal value <100 and total
cholesterol level is 248 with normal value
<200. The value of LDL, triglycerides and
total cholesterol increases can occur in
coronary artery disease or congenital
hyperlipidemia. [23].
b. Treatment Goals
The goals of treatment of acute stroke are to
reduce the ongoing neurologic injury and
decrease mortality and long-term disability,
prevent complications secondary to immobility
and neurologic dysfunction, and prevent stroke
recurrence.Primary prevention of stroke is
reviewed elsewhere [6].
c. Pharmacological and Non-
pharmacological Medicine
1. Non-pharmacological therapy

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The management of non-pharmacological bad fats are too excess. Therefore, if a patient
therapy in Mr.D is reducing cigarette has an ischemic stroke, it is highly
consumption, avoiding foods that contain lots recommended to carry out non-
of salt or fat. The high salt content can worsen pharmacological therapy by avoiding foods
the blockage in the arteries which contain fat, containing salt and high fat [12].
the fat will not be digested by the body if the 2. Pharmacological Therapy

Figure 1. Guidline therapy of Stroke Ischemic [6].

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Figure 2. Guidline therapy of Hyperlipidemia [6]

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 Figure 3. Guidline therapy of Hypertension [6]. .
The management of pharmacological therapy is
the first line therapy used for the treatment of
ischemic stroke, namely the use of antiplatelet
drugs such as 80 mg aspirin. Antiplatelet therapy
is the cornerstone of antithrombotic therapy for
secondary prevention of ischemic stroke and
should be used in noncardioembolic strokes. The
three drugs currently in use, namely aspirin,
clopidogrel, and dipiridamole with slow-release
with aspirin (ERDP-ASA), are first-line
antiplatelet agents approved by the American
College of Chest Physicians (ACCP) [5]. Based
on research, as many as 69% of stroke patients get
antiplatelet therapy as a prevention of recurrent
stroke, with 58% type of antiplatelet that is aspilet,
this result is lower when compared to the use of
antiplatelet in Australia as much as 84.4% of
ischemic stroke patients get antiplatelet therapy as
a prevention of recurrent stroke [22], while in the
United Kingdom the use of antiplatelet as much as
75% [19].Guideline issued by the Indonesian
Society of Neurologists (PERDOSSI) recommends
the administration of antiplatelet therapy up to 9
months after the incident [18].
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The results of the statistics test in the study,
showed a significant association between the
administration of antiplatelet therapy to the
incidence of recurrent stroke with a value of p =
0.000. Patients who did not get antiplatelet
therapy were 6,755 times more likely to have
repeated strokes than patients who received
antiplatelet therapy [13].
To overcome the side effects of antiplatelet
drugs, IV injection of pantoprazole 40 mg / day is
used. Selection of pantropazole compared to
other PPI-class drugs because pantoprazole has
no interaction with drugs that have been
prescribed. Pantoprazole is a PPI (Proton Pumb
Inhibitor) class drug recommended by the FDA
(Food and Drug Administration) for the treatment
and prevention of gastric ulcers due to repeated
use of NSAIDs (gastropathy) in patients
undergoing long-term NSAID therapy. This drug
works by irreversibly inhibiting H +, K +,
ATPase. Pantoprazole was chosen because it has
the potential to inhibit all phases of gastric acid
secretion. With repeated daily doses there will be
a progressive inhibitory effect of acid secretion
[5].
Antihypertensive therapy given to ischemic
stroke patients is a combination of drugs such as
amlodipine 5 mg and candesartan 8 mg.
Antihypertensive therapy given to ischemic
stroke patients can be in the form of single
therapy (monotherapy) or combination therapy of
two, three or even four antihypertensives. The
most frequent combination therapy is amlodipine
and candesartan for 2 combinations. This
combination is considered appropriate because the
combination selection comes from different drug
classes, namely Angiotensin Receptor Blocker 25
(ARB), Calcium Channel Blocker (CCB) [4].
From several studies, combination therapy 2
most widely used drugs are Amlodipine and
Candesartan as much as 31.58%. In general, 44
patients (32.1%) those receiving hypertension
treatment have controlled blood pressure in
accordance with WHO guidelines. The data
showed patients who received more combination
treatments controlled their blood pressure. This
was experienced in patients receiving
ACEI+diuretics (30.8%). While patients who
received monotherapy treatment with controlled
blood pressure were patients who received CCB
(61.1 %) and ACEI (27.8 %) [8].
Cholesterol therapy given to patients is in the
form of a statin drug, namely atorvastatin 10 mg.
Atorvastatin works to reduce LDL cholesterol and
triglyceride levels, and increase HDL levels. This
effect of atorvastatin therapy has a close
association to reduce the risk of stroke, heart
attack, or other complications of heart disease who
also suffer from type 2 diabetes mellitus and
coronary heart disease [24].
The results of statistical tests in the study,
showed a significant association between the
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administration of antidislipidemia therapy such as such as hearing sounds, seeing strange things.
statins, with the incidence of recurrent stroke Haloperidol is effective in patients with symptoms
with p = 0.011. Patients who did not use dominant rowdy, restless, hyperactive and
antidislipidemia therapy had a 2,925 times risk of sleepless due to hallucinations[14].
recurrent stroke compared to patients who used
Conclusion
antidislipidemia therapy and dutifully used it or
dutifully took antidislipidemia therapy. The Based on the case studies that have been done,
incidence of recurrent stroke in patients who do the patient is on behalf of Mr. D is advised to

not use antidislipidemia therapy is 54%, while the undergo Pharmacology and Non Pharmacology

incidence of recurrent stroke using therapy. Pharmacological therapy is given in the

antidislipidemia therapy and obedient use it, the form of the drug Aspilet as the first line in the

incidence of recurrent stroke decreases to prevention of ischemic stroke, a combination of

29%[13]. Amlodipine and candesartan for hypertension

therapy, Atorvastatin, for cholesterol therapy for
Therapy for patient anxiety disorders is a
patients. However, they are still given other drugs
benzodiazepine class of drugs such as diazepam,
such as dizepam, haloperidol for the treatment of
in which the diazepam drug is controlled the dose
patient anxiety, ranitidine and several other drugs
so as not to overdose. Anxiety treatment with
contained in pharmacology to treat side effects
diazepam and clobazam for patients because both
caused by the consumption of several first-line
drugs have a rapid onset of work to calm the
drugs that are given. Whereas in non-
patient. However, the use of diazepam is not
pharmacological therapy, monitoring and control
recommended for long-term use, so another
of patient drug use is carried out, avoiding
alternative is haloperidol. Haloperidol works by
smoking and drinking alcohol, reducing stress and
restoring the balance of natural chemicals in the
a salt diet.
brain. That way, the mind becomes calmer and
clearer, not nervous, doesn't behave aggressively, Acknowledgements
and there is no desire to hurt others [10].
Thank you to the lecturer in charge of the
Based on research, as many as 16% of patients
Pharmacotherapy II practicum, Ms. Dr. Widy
with paranoid schizophrenia with the most
Susanti Abdulkadir, M.Sc., Apt., Mrs. Endah
treatment is the use of Haloperidol a number of 2
Nurrohwinta Djuwarno, M.Sc., Apt. and Mrs.
uses. Haloperidol is very effective in treating
Dizky Ramadani Putri Papeo, M.S.Farm., Apt. We
positive symptoms in schizophrenic patients,
16 | P a g e
also thank the practicum assistants, especially Approach, Ten Edition: Me Graw-Hill
Companies United State.
Zulkarnain Marhaba who has been willing to be a
reviewer for our journal. Thank you also to 7. Dipiro, J.T., Talbert, R.L., Yee, G.C.,
Matzke, G.R., Wells, B,G., dan Posey, L.M.
colleagues from the C-S1 class of Pharmacy 2018
2020. Pharmacotherapy A Phatophysiologic
who have provided suggestions and input as well Approach, Eleven Edition: Me Graw-Hill
Companies United State.
as support in making this journal. Finally, thank
you profusely to all those who have assisted the 8. Erni Rustiani, Retnosari Andrajati, Liana
Arsyanti. 2014. Analisis Penggunaan Obat
author in completing this journal.
Antihipertensi di Poliklinik Rawat Jalan Rumah
Sakit PMI Bogor: Perbandingan Cost
References
Effectiveness dan Kualitas Hidup Pasien. Jurnal
1. Arifnaldi, Mochamad Syahrizal. 2014.
Ilmu Kefarmasian Indonesia.
Hubungan Kadar Trigliserida Dengan
Kejadian Stroke Di RSUD Sukoharjo.
9. Hanafi, I., et al. 2017. Haloperidol (Route of
Surakarta. Skripsi FK Universitas
Administration) for People with Schizophrenia.
Muhammadiyah.
The Cochrane Database of Systematic Reviews,
2. Astri Abdulmutalib, H, Syahrir, M. Askar.
(10), CD012833. BPOM RI. Cek BPOM.
2014. Analisis Perbandingan Kadar Glukosa
Haloperidol.
Darah Sewaktu Dan Kadar Glukosa Darah
10. Harkitasari, Saktivi. 2015. Penururnan
Puasa Pada Pasien Diabetes Melitus Di Rsud
Jumlah Leukosit Sebagai Prediktor Perbaikan
Labuang Baji Provinsi Sulawesi Selatan.
Klinis Penderita Stroke Hemoragik Selama
Jurnal Ilmiah Kesehatan Diagnosis.
Perawatan di Rumah Sakit Umum Pusat
Sanglah Denpasar. Tesis. Denpasar; Pasca
3. D. G. A. Suryawan, I. A. M. S. Arjani, I. G.
Sarjana Ilmu Biomedik
Sudarmanto. 2016. Gambaran Kadar Ureum
Dan Kreatinin Serum Pada Pasien Gagal
11. Jayanti AA. 2015. Hubungan Hipertensi
Ginjal Kronis Yang Menjalani Terapi
dengan Kejadian Stroke di Sulawesi Selatan
Hemodialisis Di Rsud Sanjiwani Gianyar.
Tahun 2013 (Analisis Data Riskesdas 2013).
Mediratory vol. 4. No 2.
Jakarta: Universitas Islam Negeri Syarif
Hidayatullah.
4. Dipiro, J. T., Dipiro, C.V., Wells, B.G., &
Scwinghammer, T.L. 2008. Pharmacoteraphy
12. Junaidi. 2011. Stroke Waspadai
Handbook Seventh Edition. USA : McGraw-
Ancamannya. Yogyakarta : Andi
Hill Company.
13. Karuniawati, H., Ikawati, Z., Gofir, A.,
5. Dipiro, J.T., Talbert, R.L., Yee, G.C.,
2014. Pengaruh Pencegahan Sekunder
Matzke, G.R., Wells, B,G., dan Posey, L.M.
Terhadap Kejadian Stroke Berulang pada
2015. Pharmacotherapy A Phatophysiologic
Pasien Stroke Iskemik di RSUD. DR. Moewardi
Approach, Ninth Edition: Me Graw-Hill
Surakarta. Tesis Univ. Gadjah Mada Jogjakar
Companies United State
14. Kazmierski, R., Guzik, P., Ambrosius, W.,
6. Dipiro, J.T., Talbert, R.L., Yee, G.C.,
Ciesielska A., Moskal, J., Kozubski, W. 2004.
Matzke, G.R., Wells, B,G., dan Posey, L.M.
Predictive value of white blood cell count on
2017. Pharmacotherapy A Phatophysiologic
admission for in-hospital mortality in acute
17 | P a g e
 stroke patients. Clinical Neurology and
Neurosurgery
15. Kemenkes RI. 2011. Pedoman Interpretasi
Data Klinik.
16. Khaira, N.R., A. Nugroho., A. Saputra.
2015. Drug Related Problems Anti Psikotik
pada Pasien Skizofrenia Paranoid Akut di RS
Jiwa X Jakarta. Farmasains
17. Lo E, Dalkara T, Moskowitz M. 2010.
Mechanisms, challenges an opportunities in
stroke. Nat Rev Neurosci 4, 399-414.
18. Misbach, J., Lamsudin, R., Allah, A.,
Basyiruddin, Suroto, Alfa, A.Y., 2011.
Guideline Stroke Perhimpunan Dokter
Indonesia (PERDOSSI).
19. Ramsay, S., Whincup, P., Wannamethee,
S., 2007. Missed opportunities for secondary
prevention of cerebrovascular disease in
elderly British men from 1999 to 2005: a
population-based study. J Public Health Oxf.
20. Riset Kesehatan Dasar (Riskesdas) 2018.
Badan Penelitian dan Pengembangan
Kesehatan Kementerian RI tahun 2018.
21. Siti, Hardianti. 2015. Karakteristik
Penderita Stroke Yang Dirawat Di RSUD Daya
Kota Makssar Periode Januari-Desember
2014. Skripsi. Makassar;FK Universitas
Hasanuddin
22. Sluggett, J.K., Caughey, G.E., Ward, M.B.,
Gilbert, A.L., 2014. Use of secondary stroke
prevention medicines in Australia: national
trends, 2003-2009. Med. J. Aust.
23. Tasya indriani putri. 2016. Hubungan
Kadar Leukosit Dengan Kejadian Mortalitas
Pada Pasien Stroke Iskemik Rawat Inap Di
Rumah Sakit Umum Pusat H. Adam Malik
Tahun 2016. Skripsi. Medan : Universitas
Sumatera Utara
24. Zhao, H. and Z. Guo, 2009. Medicinal
chemistry strategies in follow-on drug
discovery. Drug discovery today
18 | P a g e