KASUS 1.

Diagnosis
Ny.AB 56 th tanpa riwayat penyakit
sebelumnya. BMI nya 26 kg/m2
dan memiliki riwayat keluarga
Diabetes Type 2. Tekanan
darahnya (diukur 2 kali) 132/84.
Dengan melihat tekanan darahnya
maka Ny.AB termasuk kategori:
1. Normal
2. Prehypertensive
3. Stage 1 Hypertension
4. Stage 2 Hypertension
KASUS 1 .Terapi
Terapi awal apa yg sebaiknya diberikan pada
Ny.AB?
1. Enalapril 5 mg PO daily
2. Hydrochlorothiazide 25 mg PO daily
3. Belum perlu terapi
4. Modifikasi gaya hidup termasuk
penurunan berat badan dan
perencanaan makan
Kasus 1. Goal of therapy
Apa tujuan terapi terhadap Ny.AB?
1. Goal BP < 140/90
2. Goal BP < 130/80
3. Meningkatkan kualitas hidup pasien
4. Mencegah timbulnya hipertensi
Kasus 1. 5 tahun kemudian
Ny.AB, saat ini 61 th, kembali ke RS dan
tekanan darahnya terukur 146/92.
Termasuk kategori apa tekanan darah
Ny.AB saat ini?
1. Normal
2. Prehypertensive
3. Stage 1 Hypertension
4. Stage 2 Hypertension
Kasus 1. 5 tahun kemudian
Ny.AB, saat ini 61 th, kembali ke RS dan
tekanan darahnya terukur 146/92.
Apa yang seharusnya dilakukan?
1. Enalapril 5 mg PO daily
2. Hydrochlorothiazide 25 mg PO daily
3. Belum perlu terapi obat
4. Meningkatkan modifikasi gaya hidup
termasuk penurunan berat badan dan
perencanaan makan.
Kasus 2. Goal terapi
Tn.CD 50 th dg DM tipe 2 terkontrol.
Hasil pengukuran tekanan darah
pd saat yg sama 162/98 dan
158/96. Ia didiagnosa
Hypertension Stage 2. Apa tujuan
terapi untuk Tn.CD?
1. Goal BP <140/90
2. Goal BP <130/80
3. Memperlambat progres kerusakan
ginjal dg menurunkan BP hingga
<125/80
4. Meningkatkan kualitas hidup pasien
Kasus 2. Terapi
Apa terapi awal yg sebaiknya diberikan pada
Tn.CD?
1. Merubah gaya hidup selama 6 bulan
2. Hydrochlorothiazide 25 mg PO daily
3. Enalapril 10 mg PO daily
4. Enalapril / Hydrochlorothiazide 5/12.5
mg PO daily
KASUS 3
• Ny.IN 42 th merasakan pusing kepala
bagian belakang, jantung berdebar lebih
cepat dan sering berkeringat. Setelah
periksa ke dokter, hasil pemeriksaan
tekanan darah : 150/95 mmHg. Ny.IN
memiliki riwayat asma sejak kecil, dimana
obat yang digunakan jika terjadi serangan
adalah Ventolin inhaler.
KASUS 3
1. Berdasar JNC 7, termasuk kategori
apakah Ny.IN?
2. Pilihan obat apakah yang sebaiknya
digunakan? Berapa dosisnya?
3. Berapa target tekanan darah yang harus
dicapai?
4. Monitoring apa sajakah yang perlu
dilakukan utk NY.IN?
KASUS 4
• Ny. AN, 24 tahun yang
memiliki riwayat keluarga
hipertensi, diresepkan
kontrasepsi oral. 6 bulan
kemudian dia mengalami
peningkatan tekanan
darah menjadi 148/96.
• Bagaimana mengelola
pasien tersebut?
 KASUS 5

• Wanita 23 th hamil 8 minggu

tekanan darah 118/82. Pada saat
usia kehamilan 24 minggu
mengalami kenaikan tekanan
darah menjadi 148/96. Hasil
pemeriksaan urinalysis dalam
batas normal.
• Apa akibatnya jika terjadi
peningkatan tekanan darah pd masa
kehamilan?
 • Bagaimana terapi utk pasien tsb?

Kasus

• Tn B, 62 tahun dengan tinggi badan 170 cm dan berat

badan 90 kg melakukan pemeriksaan rutin di Poliklinik.
Tn B mempunyai riwayat hipertensi. Hasil pemeriksaan
kadar glukosa darah puasa 192 mg/dL, HbA1c 9,6%,
total cholesterol 202 mg/dL, low-density lipoprotein
(LDL) 140 mg/dL, high-density lipoprotein (HDL) 30
mg/dL and triglyceride 190 mg/dL. Vital sign : tekanan
darah 154/96 mmHg, heart rate 82 beats/menit, dan
respiratory rate 18 kali/menit.Terapi yang diberikan
Propranolol 40 mg, 2 kali sehari dan Fenofibrate 160 mg,
 sekali sehari.

Contoh Kasus
R.T. is a 60-year-old HD patient who has had ESRD for 10 years. His HD access is
a left arteriovenous fistula. He has a history of hypertension, CAD, mild CHF, type
2 diabetes mellitus, and a seizure disorder. Medications: Epoetin 14,000 units 3
times/week at dialysis; multivitamin (Nephrocaps) once daily; atorvastatin 20 mg/day;
insulin; calcium acetate 2 tablets 3 times/day with meals; phenytoin 300 mg/day;
and intravenous iron 100 mg/month. Laboratory values:immunoassay
Hemoglobinfor 10.2 g/dL;
(iPTH) 800 pcg/mL; Na 140 mEq/L; K 4.9 mEq/L; Cr 7.0 mg/dL; PTH calcium 9
mg/dL; albumin 2.5 g/dL; and phosphorus 7.8 mg/dL. Serum ferritin is 200
ng/mL, and transferrin saturation is 32%. The RBC indices are normal. His WBC
is normal. He is afebrile. Which one of the following is most likely contributing
to relative epoetin resistance in this patient?
A. Iron deficiency.
B.Hyperparathyroidism.
C. Phenytoin therapy.
 D.Infection.

 In addition to diet modification and emphasizing adherence, which

one of the following is the best approach to managing this
patient’s hyperparathyroidism and renal osteodystrophy?
A. Increase calcium acetate.
B.Change calcium acetate to sevelamer and add cinacalcet.
C. Hold calcium acetate and add intravenous vitamin D analog.
D.Add intravenous vitamin D analog.

Contoh Kasus
H.D. is a 48-year-old African American man admitted to the intensive care unit after an acute
myocardial infarction. He has a medical history/social history of type 2 diabetes mellitus,
hypertension, and tobacco use. Current medications include metformin 500 mg orally 2
times/day, lisinopril 20 mg/day, nicotine patch14 mg/day applied each morning, and
naproxen 500 mg/day orally. Before admission, his kidney function was normal (SCr 1.0 mg/dL);
however, during the past 24 hours, his kidney function has declined (BUN 20 mg/dL, SCr
2.1 mg/dL). His urine shows muddy casts. He has been anuric for 6 hours. His
current BP is 110/70 mm Hg. He has edema and pulmonary congestion. Which
one of the following is the best assessment of H.D.’s kidney function?
A. 26.2 mL/minute (CrCl using the Cockcroft-Gault equation).
B. 44 mL/minute/1.73m2 (glomerular filtration rate [GFR] using abbreviated MDRD study
equation).
C. 23.1 mL/minute/70 kg (CrCl using the Brater equation).
D. Assumed CrCl less than 10 mL/minute.
Which one of the following represents the most likely cause of impaired kidney
function in this patient?
A. Prerenal.
B.Intrinsic.
C. Postrenal.
D.Functional.
Which of the following medications is best to discontinue at this time?
A. Lisinopril.
B.Naproxen.
C. Metformin and lisinopril.
D.Metformin, naproxen, and lisinopril.
Which one of the following interventions is most appropriate at this time?
A. Add intravenous 0.9% NaCl.
B.Add hydrochlorothiazide.
C. Add furosemide.
D.Add fluid restriction.
Contoh Kasus
P.P. is a 55-year-old male patient with a history of hypertension and
newly diagnosed type 2 diabetes mellitus. He denies alcohol use but
does smoke cigarettes (1 pack/day). His medications include
atenolol 50 mg/day and a multivitamin. At your pharmacy, his BP
is 149/92 mm Hg. A
24- hour urine collection reveals 0.4 g of albumin. A recent
SCr
is 1.9 mg/dL. His eGFR is 50 mL/minute. Which one of
the following is the best answer in terms of staging of
kidney disease?
A. Stage 2.
B.Stage 3.
C. Stage 4.
D.Stage 5.
Assuming that nonpharmacologic approaches have been
maximized, which one of the following actions is best for P.P. to
limit the progression of his kidney disease?
A. Add nifedipine.
B.Add diltiazem.
C. Add enalapril.
D.Increase atenolol.
Enalapril was added to this patient’s regimen. Two weeks later,
he presents back to his physician. His BP is 139/89 mm Hg. A
repeat SCr is 2.3 mg/dL, and the serum K is 5.2 mEq/L. Which
one of the following is the best recommendation for this
patient?
A. Change enalapril to Cardizem CD. Monitor BP, SCr, and K in 2
weeks.
B.Add chlorthalidone 50 mg/day. Monitor BP, SCr, and K in 2 weeks.
C. Change enalapril to valsartan.
D.Increase atenolol.