SEKUNDER
3.128
Indonesia, negara dengan beban TB-MDR
Kasus TB di kab. Jember mencapai
kasus (Dinkes Jawa Timur, 2016)
sebanyak 6.800 kasus baru setiap tahunnya
. 2015 (WHO, 2016)
. 1
TB-MDR
merupakan resistensi mikroorganisme terhadap rifampisin dan
isoniazid
(V. Singh, 2013).
DRP
(Drug Related Problems) LAMA PENGOBATAN PASIEN TB_MDR
18-24 bulan (Kemenkes RI, 2014)
3
Bagaimanakah profil problema obat aktual pada
RUMUSAN MASALAH pasien TB-MDR di RS Paru Jember?
Problema Obat
5
Populasi penelitian adalah pasien dewasa yang terdiagnosis TB-MDR dan dirawat di Instalasi Rawat Jalan dan Instalasi Rawat Inap Rumah Sakit Paru Jember
Sampel penelitian adalah pasien dewasa dengan diagnosis TB-MDR yang sesuai dengan kriteria inklusi di Instalasi Rawat Jalan &
Rawat Inap (IRNA) Rumah Sakit Paru Jember pada bulan Januari 2016 - Desember 2018
Mencari dan mengumpulkan data e-RMK pasien dewasa TB-MDR yang memenuhi kriteria inklusi mulai Januari 2016 - Desember
2018 melalui sumber informasi Rumah Sakit Paru Jember
Mengidentifikasikan dan mengklasifikasikan problema melalui form DRP berdasarkan PCNE 2017 v.8.02
6
Analisis data sesuai PCNE 2017 v.8.02
Pasien dewasa yang terdiagnosis
TB-MDR dengan atau tanpa
komplikasi dan atau penyakit
penyerta pada bulan Januari
2016- Desember 2018 di Rawat
• Rawat Jalan & Rawat Jalan dan Instalasi Rawat Inap
E-RMK (Rekam Medis Inap Rumah Sakit Paru (IRNA) Rumah Sakit Paru Jember
Penelitian observational
Elektronik) pasien dewasa Jember dan memiliki RM lengkap meliputi
secara retrospektif dengan
TB-MDR dan Form PCNE • bulan Januari –Maret jenis OAT, kombinasi OAT, lama
analisis deskriptif
2017 2019. terapi, regimen dosis.
.
50
45
40
35
Jumlah Pasien
30 25
25 22
perempuan; 18
43% 20
14
laki-laki; 15 11 12
57% 10
5
0
15-24 25-34 35-44 45-54 55-64 > 65
Rentang Umur Pasien (tahun)
Laki – laki memiliki mobolitas lebih tinggi dibanding Pada usia 45-64 tahun terjadi penurunan imunitas tubuh
perempuan (WHO, 2013) (Garcia et al., 2008)
8
KARAKTERISTIK PASIEN
52
pasien baru 10 3 0 2 0
46% 0
pernah OAT
54%
9
KOMORBID & KOMPLIKASI YANG
MENYERTAI PASIEN
Dipsnea 21
Jenis Komplikasi
Hipoalbumin 9
Jenis-jenis Komorbid
Hemoptosis 12
HT Malaise 4
5
mual muntah 18
DM 24
0 5 10 15 20 25
0 5 10 15 20 25 30 Jumlah Pasien TB-MDR
Jumlah Pasien TB-MDR
10
Klasifikasi Kode Domain Utama Frekuensi Total
Efektivitas Pengobatan
P1 0
Keamanan Pengobatan
Jenis P2 156
(ESO) 159
Problema
Permasalahan lainnya
P3 (Menolak terapi OAT- 3
MDR)
C1 Pemilihan obat 0
C2 Bentuk sediaan obat 0
Pasien DRP C3 Pemilihan dosis 0
29% Durasi pengobatan
C4 0
Penyebab C5 Dispensing 0 159
Proses penggunaan
Pasien tanpa C6 0
DRP obat
71% C7 Terkait pasien 3
Sebab lain (Efek
C8 156
samping obat)
Status DRP tidak
O0 23
diketahui
Pada penelitian ini terdapat 102 pasien O1
Permasalahan
29
sesuai inklusi , 30 pasien mengalami
terselesaikan
Status
Permasalahan 159
problema OAT Problema
O2 terselesaikan sebagian 58
Permasalahan tidak
O3 49
terselesaikan
P2 Keamanan
Pengobatan
P2.1 Efek samping obat 156 98 Pirazinamid menyebabkan
(ESO) hiperurisemia (66 kasus)
Kanamisin menyebabkan gangguan
pendengaran (17 kasus), hipokalemia
(40 kasus), gangguan fungsi ginjal
(10 kasus)
Sikloserin menyebabkan gangguan
psikotik (4 kasus)
Etionamid, Levofloxacin, Pirazinamid,
Keterangan: satu pasien dapat mengalami lebih dari satu problema obat
12
Kode Problema Obat Frekuensi Obat Penyebab* Keterangan**
Tipe Problema Keamanan PCNE Kejadian
P2 Keamanan Pengobatan
Pengobatan (ESO) P2.1 Efek samping obat 156
Arthalgia 16 Levofloxacin dan Nyeri sendi, linu-linu hilang
atau pirazinamid timbul pada persendian dan
atau hiperurisemia
urine
Gangguan fungsi 16 Kanamisin Gejala yang dialami pasien
pendengaran 1 Kapreomisin yaitu pendengaran menurun
setelah minum OAT, telinga
Kapreomisin merupakan
mendenging (tinnitus)
(Arshad et al., 2007). polipeptida siklik dengan
banyak gugus amino
Gangguan tidur 2 Levofloxacin (Amalia,
- 2015)
Hipokalemia 32 Kanamisin Rentang kadar K :
8 Kapreomisin 2,1-3,4
Aminoglikosida Radikal bebas
Mual muntah 1 Etionamid, Mual muntah setelah
Levofloxacin, minum obat dengan
Menghasilkan peroxynitrite Mengaktifkan NOS Pirazinamid, adanya peningkatan
Etambutol SGOT: 64, kadar
bilirubin total: 1,4,
14
Meloxicam tolerabilitas
lebih baik terhadap
saluran cerna (Azizah,
2013)
14% 18%
55% problema obat aktual
pada pasien TB-MDR
31%
Problema terselesaikan
Problema terselesaikan sebagian
terselesaikan (seluruhnya
37%
Problema tidak terselesaikan maupun sebagian)
Problema tidak diketahui
16
Jumlah pasien TB –MDR yang mengalami problema aktual obat
antituberkulosis sebanyak 30 pasien (29%) dengan total problema 159
kejadian
1
Jenis problema aktual obat antituberkulosis adalah 98% problema efek samping
obat, meliputi arthalgia, hiperurisemia, gangguan fungsi ginjal, gangguan psikotik,
gangguan fungsi pendengaran, gangguan tidur, hipokalemia, mual muntah dan 2%
ketidakpatuhan pengobatan
2
Obat antituberkulosis yang menyebabkan problema aktual adalah pirazinamid
(42%), kanamisin (34%), levofloxacin (11%), kapreomisin (6%), sikloserin
(4%), dan etionamid (1%)
3
Obat antituberkulosis yang menyebabkan efek samping antara lain pirazinamid menyebabkan
hiperurisemia (41%), kanamisin mengakibatkan gangguan fungsi ginjal (6%), gangguan fungsi
pendengaran (20%), dan hipokalemia (10%), kapreomisin menimbulkan gangguan fungsi pendengaran (1%),
dan hipokalemia (5%), sikloserin menyebabkan gangguan psikotik (3%), levofloxacin mengakibatkan
gangguan tidur (1%), dan arthralgia (10%), etionamid menimbulkan mual muntah (1%).
4
Tatalaksana TB-MDR dengan efek samping obat perlu perhatian khusus karena hampir
sepertiga pasien mengalami problema obat sehingga perlu dikaji lebih lanjut.
2
17
TERIMA KASIH
Mekanisme Hipokalemia oleh Mekanisme Nefrotoksik oleh
aminoglikosida (Vijayakumar et al., 2014) aminoglikosida (Lopez-Novoa, 2011)
Sikloserin Kuinolon
glutamic decarboxylase dihambat
N-metil-d-aspartat adenosine
Perubahan perilaku
(NMDA)
Mekanisme Sikloserin menyebabkan stimulasi
depresi (Faizah, 2015).
Gangguan tidur
Kadar Mg turun
cation-dependent integrin
receptors
Kerusakan kolagen II
5 HT 3
antagonis
Stomatch small
intestine
Penurunan gejala
skizofrenia
Golongan pertama dapat 4 jalur dopamin utama di otak yaitu jalur nigrostriatal, jalur
tuberoinfundibular, mesokortikal dan mesolimbik
Albumin
Albumin 3,5 – 5,2 mg/dL
RFT
BUN L : 9,8 – 25,7 mg/dL
P : 8,4 – 20,1 mg/dL
Kreatinin L : = < 1,2 mg/dL
P : = < 0,9 mg/dL
Uric Acid L : 3,4 – 7,0 mg/dL
P : 2,4 – 5,7 mg/dL
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