Evaluasi Penggunaan Obat Antihipertensi pada Pasien Stroke Iskemik di Rumah Sakit Stroke Nasional Bukittinggi
Abstract
Obat antihipertensi menjadi salah satu obat yang paling banyak diresepkan pada pasien stroke iskemik. Penatalaksanaan hipertensi yang tidak tepat pada kedaruratan neurovaskular akut dapat meningkatkan risiko kerusakan otak dan saraf. Penggunaan obat antihipertensi harus dievaluasi melalui program evaluasi penggunaan obat (EPO) untuk menjamin penggunaan obat yang rasional. Penelitian ini bertujuan untuk mengkaji kerasionalan/ketepatan penggunaan obat antihipertensi pada pasien stroke iskemik meliputi tepat indikasi, tepat obat, tepat regimen dosis dan tepat pasien. Penelitian ini merupakan penelitian deskriptif retrospektif dengan menggunakan data rekam medis 150 pasien stroke iskemik. Kriteria inklusi penelitian yaitu semua pasien stroke iskemik nonkardioemboli dan tanpa komplikasi yang menerima terapi antihipertensi di Instalasi Rawat Inap (IRNA) Rumah Sakit Stroke Nasional (RSSN) Bukittinggi pada tahun 2016. Evaluasi ketepatan dilakukan secara deskriptif dengan membandingkan data penelitian terhadap literatur. Hasil penelitian menunjukkan ketepatan penggunaan obat antihipertensi yaitu 100% tepat indikasi; 84% tepat obat; 96% tepat dosis; 98% tepat frekuensi; dan 100% tepat pasien. Jenis ketidaktepatan yang paling sering ditemui adalah ketidaktepatan kombinasi obat serta ketidaksesuaian pemilihan obat dengan stage hipertensi yang diderita pasien. Dibutuhkan peran apoteker rumah sakit sebagai bagian dari upaya peningkatan ketepatan penggunaan obat pada pasien stroke.
Kata kunci: Antihipertensi, evaluasi penggunaan obat, stroke iskemik, tepat dosis, tepat indikasi, tepat
obat
Evaluation of Antihypertensive Drug Use on Ischemic Stroke Patients at National Stroke Hospital Bukittinggi
Abstract
Antihypertensive drugs are the most widely prescribed drug for ischemic stroke patients. Inappropriate management of hypertension in acute neurovascular emergencies may increase the risk of brain and nerve damage. Use of antihypertensive drugs should be evaluated through a drug use evaluation program to ensure rational use of drugs. This study aimed to examine the rationale for the use of antihypertensive drugs in patients with ischemic stroke including indications, drugs, dosage regimens and patients. This research was a retrospective descriptive study using medical record data of 150 ischemic stroke patients who met the inclusion criteria, i.e. all non-cardioembolic and uncomplicated ischemic stroke patients receiving antihypertensive therapy in Inpatient Care (IRNA of National Stroke Hospital Bukittinggi (RSSN) in 2016. The evaluation of accuracy was done descriptively by comparing the research data with the literature. The results showed that 100% of medication use was precisely indicated; 84% precise medication; 96% right dose; 98% exact frequency; and 100% precise patient. Inappropriate drug selection compared to the stage of hypertension and incorrect drug combinations were the most common types of inappropriate medications found in this study inaccuracies. It takes the role of hospital pharmacists as part of efforts to improve the accuracy of drug use in stroke patients.
Keywords: Antihypertensive, correct dose, drugs use evaluation, ischemic stroke, precise indication, proper drug
Keywords
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Caplan LR. Stroke: A clinical approach, 4th Edition. Boston: Elsevier; 2009.
Saseen JJ, Maclaughlin JM. In: Dipiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM (Ed). Pharmacotherapy: A pathophysiology approach, 7th Edition. New York: McGraw Hill Company; 2008.
Sepriani R, Wahyuni FS, Almahdy A, Armal K. Indication accuracy of alprazolam use in stroke patients of Neurology Ward of National Stroke Hospital Bukittinggi - Indonesia. J Sains Farm Klin. 2014;1(1);95–100. doi: 10.29208/jsfk.2014.1.1.17
Hassan Y, Aziz NA, Al-Jabi SW, Looi I, Zyoud SH. Evaluation of antihypertensive therapy among ischemic stroke survivors: Impact of ischemic heart disease. J Cardiovasc Pharmacol Ther. 2010;15(3):282–8. doi: 10.1177/1074248410368049
Departemen Kesehatan RI. Laporan hasil riset kesehatan dasar (Riskesdas) Indonesia. Jakarta: Kemeterian Kesehatan Republik Indonesia; 2013.
Chiu EHH, Tan TY, Chang KC, Liou CW. Risk factors for ischemic stroke: Electrocardiographic findings. Acta Neurol Taiwan. 2006;15:232–6.
Perhimpunan Dokter Spesialis Saraf Indonesia (PERDOSSI). Guideline stroke. Jakarta: PERDOSSI; 2011.
Mudhaliar RM, Dungavath S, Yiragamreddy PR, Venkataramana B. Drug use evaluation and appropriateness of medication used in stroke patients. World J Pharm Med Res. 2016:2(5):168–74
Celin AT, Seuma J, Ramesh A. Assessment of drug related problems in stroke patients admitted to a South Indian Tertiary Care Teaching Hospital. Indian J Pharm Pract. 2012;5:28–33.
Weber MA, Schiffrin EL, White WB, Mann S, Lindholm LH, Kenerson JG, et al. Clinical practice guidelines for the management of hypertension in the community: A statement by the American Society of Hypertension and the International Society of Hypertension. J Clin Hypertens 2014;16(1):14–26. doi: 10.1111/jch.12237
Sumawa PMR, Wullur AC, Yamlean PVY. Evaluasi kerasionalan penggunaan obat antihipertensi pada pasien hipertensi rawat inap di RSUP Prof. DR. R.D. Kandou Manado Periode Januari–Juni 2014. Pharmacon. 2015:4(3);126–3.
Yanes LL, Reckelhoff JF. Postmenopausal hypertension. Am J Hypertens. 2011;24(7):740–9. doi: 10.1038/ajh.2011.71
Kumar V, Abbas AK, Fausto N. Hypertensive vascular disease. In: Robbins and Cotran pathologic basis of disease, 7th Edition. Philadelpia: Elsevier Saunders; 2005.
Appelros P, Stegmayr B, Terént A. Sex differences in stroke epidemiology: A systematic review. Stroke. 2009;40(4):1082–90. doi: 10.1161/STROKEAHA.108.540781
Martin J. Hypertension guidelines: Revisiting the JNC 7 recommendations. J Lancaster General Hospital. 2008;3(3):91–9
Hemphill JC, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015;46(7):2032–60. doi: 10.1161/STR.0000000000000069
Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M, et al. 2013 ESH/ESC practice guidelines for the management of arterial hypertension: The task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC). J Hypertension. 2013;31(7):1281–357. doi: 10.1097/01.hjh.0000431740.32696.cc.
Jeffers BW, Robbins J, Bhambri R, Wajsbrot DA. Systematic review on the efficacy of amlodipine in the treatment of patients with hypertension with concomitant diabetes mellitus and/or renal dysfunction, when compared with other classes of antihypertensive medication. Am J Ther. 2015;22(5):322–41. doi: 10.1097/MJT.0000000000000202.
James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence‑based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8). J Am Med Assoc. 2014;311(5):507–20. doi: 10.1001/jama.2013.284427
Mallat SG. What is a preferred angiotensin II receptor blocker-based combination therapy for blood pressure control in hypertensive patient with diabetic and non-diabetic renal impairment. Cardiovasc Diabetol. 2012;11:32. doi:10.118 6/1475-2840-11-32.
Faramitha A, Prihartanto B, Destiani DP. Cost minimization analysis of antihypertensive therapy with captopril-hydrochlorothiazide and amlodipine-hydrochlorothiazide in one of hospitals in Bandung. Indones J Clin Pharm 2017;6(3):220–30. doi: 10.15416/ijcp.2017.6.3.220
Johnston A, Stafylas P, Strergiou GS. Effectiveness, safety and cost of drugs substitution in hypertention. Br J Clin Pharmacol. 2010;70(3):320–34. doi: 10.1111/j.1365-2125.2010.03681.x.
Fialová D, Topinková E, Gambassi G, Finne-Soveri H, Jónsson PV, et al. Potentially inappropriate medication use among elderly home care patients in Europe. J Am Med Assoc. 2005;293(11):1348–58. doi: 10.1 001/jama.293.11.1348
Association of Physicians of India. Indian guidelines on hypertension (I.G.H) - III. 2013. J Assoc Physicians India. 2013;61(2):6–36.
DOI: https://doi.org/10.15416/ijcp.2018.7.2.99
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