Tesis

Evaluasi Penggunaan Obat Pada Pasien Stroke Yang Dirawat di RSUP Prof. Dr. R. D. Kandou Manado = Evaluation of Drug Therapy in Stroke Inpatients at the Prof.Dr.R.D.Kandou Manado Hospital.

Latar belakang : Stroke selalu menempati urutan pertama jumlah penderita rawat inap di pusat-pusat pelayanan neurologi di Indonesia. Keragaman faktor risiko dan penyakit penyerta menyebabkan farmakoterapi pasien stroke menjadi kompleks, bervariasi, dan dapat menimbulkan masalah terkait obat seperti ketepatan indikasi, polifarmasi, interaksi, dan efek samping obat. Tujuan Penelitian observasional retrospektif ini dilakukan untuk mengevaluasi penggunaan obat pada pasien stroke rawat inap di RSUP Prof. Dr. R.D. Kandou Manado pada periode bulan Juli – Desember 2013 dalam hal ketepatan indikasi, dosis, lama penggunaan, efek samping, dan kemungkinan interaksi obat. Metode: Semua pasien stroke rawat inap pada periode bulan Juli – Desember 2013 yang rekam mediknya dapat ditelusuri dievaluasi pengobatannya. Ketepatan indikasi, dosis, lama penggunaan, efek samping, dan kemungkinan interaksi obat dinilai berdasarkan standar pelayanan medik RSUP Prof. Dr. R.D. Kandou, berbagai literatur dan buku teks. Hasil: Dari 127 pengobatan kasus stroke yang dapat dievaluasi, terdapat 762 penggunaan obat yang 61,5% di antaranya tepat indikasi, 35,2% kurang tepat indikasi, dan 3,30% tidak tepat indikasi. Dari penggunaan obat yang tepat indikasi, 89,6% di antaranya tepat dosis, 10,2% dosis subterapi, 0,20% dosis berlebih, 59,5% tepat lama penggunaan, 9,60% tidak tepat lama penggunaan dan 30,9% tidak dapat dinilai lama penggunaannya. Didapatkan 68,3% penggunaan ranitidin dengan indikasi kurang tepat. Frekuensi terbanyak (28,3%) jumlah jenis obat yang dipakai ialah 5 jenis. Interaksi antar obat potensial didapatkan pada 33 kasus (4,30%) dan kemungkinan kejadian efek samping obat didapatkan dua kasus (2,62%). Didapatkan 21,6% kasus stroke iskemik yang tidak mendapat terapi aspirin. Kesimpulan : Ketepatan indikasipenggunaan obatpada pasien stroke rawat inap di RSUP Prof.Dr.R.D. Kandou Manado masih perlu ditingkatkan. Ketidak tepatan indikasi ini berkaitan dengan penggunaan obat yang bukti ilmiahnya masih kurang atauindikasinyakurangtepat.
Kata kunci : evaluasi penggunaan obat, stroke, ranitidin, aspirin, RSUP Kandou Manado.


Background : Stroke is the most common disorder in patients hospitalized in Indonesia neurology centers. Various risk factors and comorbidities in patients with stroke may lead to a complex drug therapy that result in drug-related problems such as the inappropriateness of indications, polypharmacy, interactions, and adverse reactions. Aim: This retrospective observational study was performed to evaluate drug therapy in stroke patients hospitalized at the Prof. Dr. R.D. Kandou Manado Hospital within the period of July - December 2013 in terms of the appropriateness of the indications, dosages, duration of use, potential drug interactions and adverse drug reactions. Methods: Drug therapy in stroke patients hospitalized within the period of JulyDecember 2013 and had traceable medical records were evaluated. The appropriateness of the indications, dosages, duration of use, potential drug interactions and adverse drug reactions were determined based on the Prof. Dr. R. D. Kandou Manado Hospital medical services standard, literature and text books. Results: Of the 127 evaluable stroke cases, there were 762 drug utilization, with 61.5%, 35.2%, and 3.30% of them given for appropriate, less appropriate, and not appropriate indications, respectively. Among drugs given for appropriate indications, 89.6%, 10.2.%, and 0.20% were given at appropriate, under, and over doses, respectively, while 59.5%, 9.60%, and 30.9% were given with appropriate, less appropriate, and undetermined duration of therapy, respectively. Less appropriate indication for using ranitidine was 68.3%. The number of drug most oftenly given to the patients was 5 (28.3%). The percentage of potential drug interactions and possible adverse drug reactions were 4.30% and 2.62%, respectively. Among patients with ischaemic stroke, 21.6% were not treated with aspirin. Conclusion: The appropriateness of indication of drug therapy in stroke patients hospitalized at the Prof. Dr. R. D. Kandou Manado Hospital needs to be improved. Inappropriate drug therapy was related to the use of drugs lacking the scientific evidence, or given without clear indications.
Keywords: drug therapy evaluation, stroke, aspirin, ranitidine, Prof. Dr. R. D. Kandou Manado Hospital.