Tinjauan Kasus Preeklamsia

Amalia Refina Pratiwi Rahmita Bimasari

Tiara Bianca Putri Hidayat
Fianny Rezka Sjahjadi Hafizhatul Hilma
Holy Amalia Ningtyas Aulia Rahmi
Hanny Tri Gustia Eureka Fadillah Susanti
Lathifah Hanum Fajri Aprila Haspiza
Muhammad Redha Ilahi Nova Wahyuni
Fauziah Sirahtul Aini Rika Putri
Cici Anggraini Oldetapia Najwa Miladi Hasri
Syarifah Fadhlira H Luthfi Ariza Lubis
Siti Inelza Ramadhani Ardilla Maizulfiani
 KASUS

•
 PATOFISIOLOGI
Pada preeklampsia ada dua tahap perubahan yang mendasari patogenesianya
Preeklamsia Ringan Preeklamsia Berat
(PER) (PEB)
PEB
 Tinjauan Farmakoterapi

•
Pemilihan
Farmakoterapi
untuk
Preeklamsia
Berat
 Penatalaksanaan Preeklamsia
Pengelolaan preeklamsia berat mencakup

Pencegahan Pengelolaan
Kejang Cairan
Penderita preeklamsia berat harus
segera masuk rumah sakit untuk
rawat inap dan dianjurkan tidur miring
ke kiri (POGI, 2005
Pelayanan
Pengobatan supportif
terhadap
Hipertensi penyulit organ
yang terlibat
Penanganan Preeklamsia Ringan
Penanganan Preeklamsia Berat
• Dimulai dengan memberikan magnesium sulfat untuk
mencegah kejang dengan rute Pemberian IV
• Pemberian dimulai dengan memberikan 4 gram dosis
dan diikuti dengan infusa 1-3 g/jam secara IV dengan
menggunakan infus terkontrol
Penanganan Preeklamsia Ringan
Pengelolaan cairan pada preeklamsia bertujuan
untuk mencegah terjadinya edema paru dan oliguria.
Diuretikum diberikan jika terjadi edema paru dan payah
jantung. Diuretikum yang dipakai adalah furosemid.
Penatalaksanaan Hipertensi Pada pasien
preeklampsia

Tujuan terapi adalah untuk menurunkan tekanan sistolik sampai

140-155 mmHg dan tekanan diastolik sampai 90-105 mmHg.
Untuk menghindari terjadinya hipotensi, tekanan darah harus
diturunkan secraa perlahan-lahan (Wagner, 2004).
Rekomendasi terapi hipertensi ringan Rekomendasi terapi hipertensi berat
dalam kehamilan (JNC VII, 2003 dalam kehamilan

● obat lini pertama adalah ● Adapun obat lini pertama

metildopa, obat lini kedua
adalah Labetalol, nifedipin
dan klonidin
adalah hidralazin.
● Lini kedua lebatalol dan
nifedipin.
● Indikasi khusus untuk pasien
yang tidak dapat diberi obat
lini pertama dan lini kedua
digunakan diazoxide dan
sodium nitopurusside.
Kondisi awal pasien masuk ke rumah sakit ini
adalah kondisi dimana pasien harus
mendapatkan obat antihipertensi yang
memberikan kerja yang cepat,

.Dalam buku Farmaklogi Ricahrd A. Harvey edisi

4, nicardipin merupakan salah satu obat anti
hipertensi yang mampu bekerja cepat untuk
menurunkan tekanan darah

mekanisme kerjanya adalah menghambat kanal

kalsium
 ANALISIS DRP
DRUG THERAPY ASSESSMENT WORKSHEET
(DTAW)
No Problem Assessment Presence of drug- comment
related problem
1 Correlation between •Are thre drug without a 1. A problem exists • magnesium
drug therapy problem medical indication 2. More information sulfat 40% = anti
and medical problems needed for kejang
•Are any medication determination
unindetilled (are any 3. No problem exists or an • klonidin
intervention is non
unlabeled or re any prior needed
(catapres),
to admission/ clinic visit- captopril =
unknown ) antihipertensi

•Are thre untreated •Hidroklorthiazid

medical condition? Do (HCT) = diuretic
they require drug therapy?
No Problem Assessment Presence of drug- comment
related problem
2 Appropriate drug • What is the comparative 1. A problem exists •Hidroklorthiazid
selection efficacy of the chosen 2. More information (HCT) KI
medications? needed for terhadap ibu
determination hamil
•What is the relative safety 3. No problem exists or an
intervention is non needed
of the chosen medication? •Klonidin dan
captopril dapat
•Has the therapy been menyebabkan
tallored to this individual hipotensi
patient?
No Problem Assessment Presence of drug- comment
related problem
3 Drug regimen • Are the prescribed dose and dosing 1. A problem exists • Dosis MgSO4
frequency appropriate-whitin the 2. More information terlalu besar
usual therapeutic range and or needed for
modified for patient factor? determination • MgSO4 im
3. No problem exists or an digant menjadi iv
intervention is non needed
• Is pm use appropriate for those agar efek terapi
medication either prescribed or taken cepat didapat
that way?

• Is the route/dosage form/mode of

administrasion appropriate,
considering efficacy, safety,
convenience, patient limitation , and
remigen complexity?

• Is the length of crouse of

No Problem Assessment Presence of drug- comment
related problem

4 Therapeutic • Are there any therapeutic 1. A problem exists Tidak ada

duplication duplication? 2. More information duplikasi terapi
needed for
determination
3. No problem exists or an
intervention is non
needed
No Problem Assessment Presence of drug- comment
related problem

5 Drug allergy or • Is the patient allecgic to 1. A problem exists Tidak adanya

intolerance or intolerance of any 2. More information riwayat alergi
cemical (or chemically needed for pada rekam
related medications) determination medis pasien
currently being taken? 3. No problem exists or an
intervention is non
needed
• Is the pateient using any
method to alert health
care providers of the
allergy/intolerance?
No Problem Assessment Presence of drug- comment
related problem

6 • Are there any medical 1. A problem exists Belum ada

problem that may be drug 2. More information penggunaan
induced? What is the the needed for sebelumnya
that the problem is determination
related? 3. No problem exists or an
intervention is non
needed
No Problem Assessment Presence of drug- comment
related problem

7 Interaction •Are there drug-drug 1. A problem exists • Captopril +

drug-drug, interaction? Are they 2. More information klonidine =
drug-disease, drug- clinically significant? needed for memyebabkanhi
nutrient and drug- determination potensi
laboratory test •Are any medication 3. No problem exists or an
intervention is non
contraindicated given needed
• HCT KI
patient characteristic and terhadap ibu
current/past disease hamil
states?

•Are there drug-nutrient

interactions? Are they
clinically significant?
No Problem Assessment Presence of drug- comment
related problem

8 Social or recreational • Is patient current use of 1. A problem exists Tidak diketahui

drug use social drugs problematic? 2. More information riwayat
needed for penggunaan obat
• Could the sudden determination pasien
decrease or 3. No problem exists or an
intervention is non
discontinuation of social needed
drugs be related to patient
symtoms?
•

•
•

•
•

•
Pharmacotherape Recommendation Monitoring Desired Monitoring
utic Goal s for therapy Parameter Endpoint(s) Frequency
Mencegah MgSO4 Kejang Tidak terjadi 2 kali sehari
terjadinya kejang kejang
Menurunkan tekan Nicardipin iv Tekanan Darah TD Normal 2 kali sehari
darah
Mengontrol Methyldopa Tekanan Darah TD Normal 2 kali sehari
tekanan darah
Mengurangi Furosemid Udem Tidak ada udem Setiap hari
terjadinya udem
Rencana Pemantauan Efek Samping
Rencana Edukasi Pasien
Rencana Edukasi Pasien
 Daftar Pustaka
1. American College of Obstetricians and Gynecologists - Task Force on Hypertension in
Pregnancy. 2013. Hypertension in Pregnancy. Washington DC: ACOG.
2. Burke. S, Ananth (2013). Spiral Artery Remodelling in Preeklampsia Revisited ; 62p 1013-
1014.
3. Chestnut, David H. Chestnut’s Obstetric Anesthesia: Principles and Practice 5 th ed.
Philadelphia (USA): Elsevier; 2015, p. 521, 532-533, 2056-2062
4. Cunningham F.G, Leveno Kenneth J, Bloom Steven L (2014). Hypertensive Disorders in
William Obstetrics 24th Edition. McGraw Hill Education. 762-768
5. Dorniak-wall T, Grivell R.M et al (2013). The Role of L-Arginineee in the prevention and
treatment of pre-eclampsia: a systematic review of randomized trials. 230-235.
6. Ekambaram P (2011). HSP70 Expression and its Role in Preeclamptic Stress.Indian J.
Biochem.Biophys.48 : 243- 255.
 Thanks!

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