Drug Therapy

Problem

Ika Mustikaningtias, M.Sc., Apt.

Laboratorium Farmakologi dan Farmasi Klinik
Jurusan Farmasi FIKes
Universitas Jenderal Soedirman
Definition
• A drug therapy problem is any undesirable event
experienced by a patient that involves, or is suspected
to involve, drug therapy, and that interferes with
achieving the desired goals of therapy and requires
professional judgment to resolve.
• If not resolved, drug therapy problems have clinical
consequences. As clinical patient problems, drug
therapy problems require professional (clinical)
judgment to resolve. The characteristics of requiring
professional judgment place drug therapy problems at
par with other clinical problems in medicine, dentistry,
and nursing.
• Drug therapy problems are the clinical domain of
the pharmaceutical care practitioner. The purpose of
identifying drug therapy problems is to help patients achieve
their goals of therapy and realize the best possible outcomes from
drug therapy.
• The identification of drug therapy problems is the focus of the
assessment and represents the key decisions made in that step of
the patient care process. Although drug therapy problem
identification is technically part of the assessment process, it
represents the truly unique contribution made by pharmaceutical
care practitioners. Therefore, a separate discussion has been
devoted to describing drug therapy problems so that you can learn
to identify, resolve, and most importantly, prevent drug therapy
problems in your practice.
• Drug therapy problems are a consequence of a patient's drug-
related needs that have gone unmet. They are central
to pharmaceutical care practice.
Drug Related Problem
Drug needed for untreated indication

Wrong drug being taken

Too little dose of the correct drug

Too much dose of the correct drug

Adverse drug reaction present

Drug-drug/food/lab interaction

Not receiving the prescribed drug

Drug use without valid indication

Five Patient Needs for Drug Therapy
Every drug has an appropriate
indication
Drug therapy is effective

Drug therapy is safe

Patients can comply with drug
therapy
No untreated indications are present
Drug Related Problem Drug Therapy Problem
Drug needed for untreated Needs additional therapy
indication
Wrong drug being taken Wrong drug

Too little dose of the correct drug Dose too low

Too much dose of the correct drug Dose too high

Adverse drug reaction present Adverse drug

reaction
Drug-drug/food/lab interaction

Not receiving the prescribed drug Inappropriate compliance

Drug use without valid indication Unnecessary drug therapy

 Etiology of Drug Therapy Problem
(Strand et.al., 1998)
Drug Therapy
Patient need Problem
Appropriate indication Needs additional
therapy
Wrong drug
Effectiveness
Dose too low

Safety Dose too high

Adverse drug reaction
Compliance
Inappropriate
compliance
No untreated Unnecessary drug
indications therapy
 Need Problem Cause
Appropriate Unnecessary 1. No medical indication
indication drug therapy
2. Addiction/recreational drug
3. Non drug therapy more
appropriate
4. Duplicate therapy
5. Treating avoidable ADR
 Need Problem Cause
Effectiveness Wrong drug 1. Dosage form appropriate
2. Contraindication present
3. Drug not indicated for
condition
4. More effective drug available
 Need Problem Cause

Effectiveness Dose too low 1. Wrong dose

2. Frequency inappropriate

3. Duration inappropriate

4. Incorrect storage

5. Incorrect administration

6. Drug interaction
 Need Problem Cause

Safety Adverse 1. Unsafe drug for patient

drug
reaction 2. Allergic reaction

3. Incorrect administration

4. Drug interaction

5. Dose changed too fast

6. Undesirable effect
 Need Problem Cause

Safety Dose too 1. Wrong dose

high
2. Frequency inappropriate

3. Dose inappropriate

4. Drug interaction
 Need Problem Cause

Compliance Inappropriat 1. Drug not available

e
compliance 2. Patient can’t afford drug

3. Patient can’t swallow/take

4. Patient doesn’t understand

5. Patient prefers not to take

Kasus 1
• Pasien EM 26 tahun BB 50 kg, TB 155 cm masuk rumah
sakit dengan eluhan sesak sejak 1 minggu yg lalu,
kadang-kadang batuk mual muntah, serak, dengan KU
lemah. Pasien memiliki riwayat TB, sekaang sedang
menjalani pengobatan. Diagnosis pasien ini adalah
suspect laryngitis TB, new case TB pengobatan fase
intensif, transaminitis DIH. Pasien MRS tgl 5 Sep 2018,
KRS 10 Sep 2018. tentukan DTP yang terjadi pada
pasien beserta plan pengatasannya
LATIHAN KASUS DTP
• RK (24 tahun, BB : 50 kg, TB : 155 cm), mengeluhkan bersin-bersin setelah
membersihkan rumah. Pasien juga mengeluh hidungnya gatal, berair dengan
sekret cair, dan hidungnya tersumbat. Bahkan kadang-kadang rasa gatal dan
berair juga dirasakannya pada mata. Kejadian ini sudah sering dirasakan
pasien terutama ketika beres-beres rumah, oleh karena itu pasien akhirnya
memutuskan untuk memeriksakan diri ke RS. Dari pemeriksaan didapatkan
hasil TD : 110/80 mmHg, T : 37,2 oC, RR : 20 x/mnt, HR : 80 x/mnt. Selain itu
terdapat lingkaran gelap di sekitar mata, pembengkakan selaput mukosa
hidung (+), eosinofil : 400 µl, Ig E : 3,5 kU/l. Pasien sedang hamil 3 bulan
anak pertamanya. Pasien tidak mempunyai riwayat asma atau penyakit yang
lain.
• Diagnosis : Rhitinis Alergi
• Resep yang didapat pasien : Loratadin 1x10 mg dan Ipratropium bromide 3x
20 mcg
• Lakukan analisis pada kasus tersebut !