RS STIFI BHAKTI PERTIWI

PALEMBANG
RM
INSTALASI FARMASI

Nama : Tn.SyaRi 0 0 3
Nomor RM :
0 0 0 0 0
0
Tanggal lahir / Umur : 1965/55 th BB : 60 kg TB : cm
RPD : Hipertensi sejak 10 tahun yang lalu
MRS : - Diagnosis : CKD stage III,Hipertensi
Merokok : aktif Kopi : 4 gelas/hari Lainnya : - Alergi : -

Diisi oleh Farmasis:

Parameter / Tanggal Nilai Normal Ket
Tanda Vital

Suhu 39oC 37,5oC Demam

Tekanan Darah 140/90 120/80 mmhg Hipertensi stage I

Lemas
Pusing
Keluhan

Keringat dingin
Mual
Nafsu makan menurun

Hasil
Nilai Normal
Laboratorium
TD 140/90 mmhg 120/80 mmhg Hipertensi stage I
Laboraturium

Crsr 1,5 mg/dl 64 mg/dl

Crcl 47,22 ml/menit >80 ml/menit

Terapi
Aturan pakai
(Nama obat, kekuatan)
Amlodipine 5 mg 3 X 1 tab
Paracetamol 500 mg 3 X 1 tab
Domperidone 10 mg 3 X 1 tab pc
Oral/ Parenteral

Captopril 12,5 mg 2X1

Paracetamol 500 mg 3 X 1 Prn
Domperidone 10 mg 3 X 1 ac

BB : Berat Badan; TB : Tinggi Badan; MRS: Masuk Rumah Sakit. RPD : Riwayat Penyakit Dahulu
 RS STIFI BHAKTI PERTIWI
PALEMBANG RM
INSTALASI FARMASI
Nama : Tn.SyaRi Nomor RM : 0 0 0 0 0 0 3
0

Tanggal lahir / Umur : 1965/ 55 th BB : 60 kg TB : - cm

PEMANTAUAN TERAPI OBAT

Diisi oleh Farmasis
Asuhan Kefarmasian
Planning/
Tgl Monitoring/
Subjektif Objektif Assessment
KIE/
(Disertai literature)
26 Keluhan Chronic Kidney  Pada kasus hipertensi dengan  Disarankan Amlodipine diganti
Nov lemas, Disease Stage III, CRD,dokter meresepkan dengan golongan ACEI seperti
emb pusing, amlodipine 5 mg(gol ccb) , captopril. ACEI mengurangi
er
Hipertensi pada terapinya pasien aldosteron dan meningkatkan
2020
keringat TD 140/90, Crsr dianjurkan menggunakan kadar kalium dalam serum
dingin, 1.5mg/dl, Clcr 47,22 golongan ACEI/ARB ( Dipiro)
mual, mg/menit,Suhu 39oC  Paracetamol diberikan hanya  Captopril diberikan 2x sehari
nafsu jika demam bila suhu tubuh 12,5 mg (Pionas 2015)
makan normal bisa dihentikan maka  Untuk mengatasi tidak rutin
Amlodipine 5 mg aturan pakai obat prn (jika menggunakan obat,maka perlu
menurun perlu) dilakukan pemantauan juga
Paracetamol 500 mg
Domperidone 10 mg  Pemberian obat domperidone perlu dilakukan pengecekan
sebaiknya diberikan saat tekanan darah secara rutin.
sebelum makan
 Pada riwayat terdahulu pasien ffffffffffffffffffffffffffffffffffffffffffffff
tidak rutin menggunakan obat ffffffffffffffffffffffffffffffffffffffffffffff
 Tidak ada interaksi ffffffffflllMMMMMMMMMMMMM
MMMMMMMMMMMMMMMMM
MMMMMMMMMMMMMMMMM
MMMMMMMMMMMMlllllllllllllllll
llllllllllllllllllllllllllllllllllllllllllllllllllllllll
lllllllllllllllllllffffffffffffffffffffffffffffff
ffffffffffffffffffffffffffffffffffffffffffffff
fffffllllllllllllllllllllllllllllllllllllllllllllllllll
lllllllllllllllllllllllllllllllllllllllllllllfffffffff
ffffffffffffffffffffffffffllllllllllllllllllllllll
llllllllllllllllllllllllllllllllllllllllllllllllllllllll
lllllllllllllllffffffffffffffffffffffffffffffffff
fllllllllllllllllllllllllllllllllllllllllllllllllllllll
lllllllllllllllllllllllllllllllllllllllllffffffffffff
fffffffffffffffffffffffllllllllllllllllllllllllllll
llllllllllllllllllllllllllllllllllllllllllllllllllllllll
lllllllllllffffffffffffffffffffffffffffffffffflll
llllllllllllllllllllllllllllllllllllllllllllllllllllllll
llllllllllllllllllllllllllllllllllllffffffffffffffff
ffffffffffffffffffffffffffffffffffffffffffffff
ffffffffffffffffffffffffffffffffffffflllllllllll
llllllllllllllllffffffffkkllf