hipertensi fater,id,en

1. Case
Hypertensi
on
GROUP : I (ONE)
C-S1 PHARMACEUTICAL 2020
Translated from Indonesian to English - www.onlinedoctranslator.com

2. 1. Rezkiyah A. D. M. Hulungo (821420088)
2. Devina A. P. Pakaya (821420091)
3. Sity Nur Rahayu Maloho (821420095)
4. Nur Fadillah Venny Rasyid (821420096)
5. Latifa Goni (821420104)
6. Kerin Vivian Kujiman (821420116)
7. Ninda Aulia Latama Poetri (821429121)
GROUP1

3. Hypertension is increase pressure blood systolic more big from 140 mmHg and or
diastolic more big from 90 mmHg at two time measurement with hose time 5
minute in state enough rest (calm). Hypertension defined by the Joint National
Committee on Detection, Evaluation and Treatment of High Blood Pressure as
pressure which more high from 140/90 mmHg
DEFINITION

4. According to Nair & Peate (2015), reason hypertension primary not yet is known by clear, but
there is a number of factor risk which could cause hypertension which already is known
progress that is: obesity, stress, cigarette, consumption alcohol, intake sodium excessive could
cause retention fluid, history family. Whereas hypertension secondary could occur because
factor that is : disease renal, syndrome Cushing, contraception orally, coarc tation (narrowing)
aorta.
ETIOLOGY OF HYPERTENSION

5. On hypertension, because existence various disturbance genetics and risk environment, so occur
disturbance neuro hormonal that is system nerve center and system renin-angiotensin aldosterone, as
well as happening inflammation and resistance insulin. Resistance insulin and disturbance neuro
hormonal cause vasoconstriction systemic and enhancement resistance peripheral. Inflammation
cause disturbance kidney which accompanied disturbance system renin-angiotensin-aldosterone
(RAA) the cause retention salt and water in kidney, so that occur enhancement volume blood.
Enhancement resistance peripheral and volume blood is two reason main happening hypertension
(Asikin et al, 2016).
PATHOPHYSIOLOGY

6. Mrs. RN aged 56 Year go to RS Dunda Limboto on date 20 January 2022, with
complaint painful heartburn, weak and dizzy and diagnosed painful I. Then doctor
do inspection ,obtained rate hemoglobin 14.2 g/dl, hematocrit 40.7%, erythrocytes
5.17/mm, leukocytes 10.8/mm, platelets 297/mm, MCV 78.8 fL, MCH 27.5pg,
MCHC 34.9 gr/dl, segment neutrophil 56%, Lymphocytes 38%,cellothers 6% rate
sugar blood when 85 mg/dl, cholesterol a total of 209 mg/dl, cholesterol HDL 56
mg/dl, cholesterol LDL 123 mg/dl, triglycerides 150 mg/dl. So that doctor give
therapy in the form of sucralfate syrup, and captopril 25 mg and seen from results
the examination also doctor recommend to patient for intake care stay During 4 day
and doctor give ondansentron injection, simvastatin, anstrain injection, and
omeprazole
CASE

7. Name Patient: Mrs. RN
Age : 56 Year
Complaint : Ulcer heartburn, dizzy, weak
History use drug : sucralfate syrup 3 x 1 Cth captopril 25 mg 3 x 1 tab, amlodipine 5 mg 1 x 1 tab,
injection ondansentron 3 x 1, injection omeprazole 2 x 1 and anstrain 3 x 1
SUBJECTIVE

8. Blood Routine Results Normal Value
Hemoglobin 14.2 g/dl 12-16 gr/dl
haemotocrit 40.70% 44-65
Erythrocytes 5.17 10⁶/mm 3.5 - 5.5 million
Leukocytes 10.8 10ᶟ/mm 5-10 thousand
Platelets 297 10ᶟ/mm 150 – 450 Thousand
OBJECTIVE
Information
Normal
Normal
Abnormal
Abnormal
Normal

9. Results Inspection Laboratory
Blood complete Results Normal Value
MCV 78.8 fL 80-100 fL
MCH 27.5 pg 26 -36 pg
MCHC 34.9 g/dL 32 - 35
Information
Abnormal
Normal
Normal

10. Results Inspection Laboratory
Routine Blood Results Normal Value
Neutrophil 56% 50 - 70%
Lymphocytes 38.00% 20 - 40%
Other gels 6% 1-8%
Information
Normal
Normal
Normal

11. Results inspection Laboratory
Chemical Results Normal Value
When blood sugar 85 mg/dL 70-150 mg/dL
Total cholesterol 209 mg/dL <200 mg/dL
HDL Cholesterol 56 mg/dL >55 mg/dL
LDL Cholesterol 123 mg/dL <150 mg/dL
Triglycerides 150 mg/dL <150 mg/dL
Information
Normal
Abnormal
Normal
Normal
Normal

12. HISTORY OF DRUG USE
No Date
Name of drug used
Information
Anstrain Amlodipine Captopril Sucralfate Omeprazole Sinvastatin Ondansentron
1. 21/01/2022
✔ ✔ ✔ ✔ ✔ ✔ ✔
2. 22/01/2022
✔ ✔ ✔
3. 23/01/2022
✔ ✔ ✔ ✔ ✔ ✔
4. 24/01/2022
✔ ✔ ✔ ✔ ✔

13. Assessment
Name
Drug
Indication (Literature)
Indication on
case
Dose Literature Dose On Case Effect Side
Antrain
Injection
Sick tooth. Sick head.
Arthralgia (painful joints).
Neuralgia (painful nerve)
For resolve painful
1 g given 4 times a day, or 2.5 g
given 2 times a day through
injection intravenous (vessels
blood) or intramuscular (through
muscle). Customize dose based on
level severity disease. Maximum : 5
g /day
given by 3 x 1 a
day
Inflammation of the
stomach or sicko
epigastric (gastritis) or
heartburn. Hyperhidrosis
(sweat too much)
Retention fluid and salt in
body.
Mechanism work drug NSAID that is hinder synthesis prostaglandins with obstacle on enzyme
cyclooxygenase so that conversion sour arachidonic Becomes PGE2 disturbed (Sharif, Amir, 2009)

14. Amlodipin
e 5 mg
Amlodipine used for help treat
pressure blood tall
(hypertension).With lower
pressure blood. This drug also
could used for help treat
painful chest (angina)
pectoris).
For lower
pressure blood
Adults: 5–10 mg a
day.
Children 6–17
years: 2.5–5 mg a
day.
Condition:
Angina pectoris
Adults: 5–10 mg a
day.
1 x 1 tab a day
A number of effect side which
can occur after consuming
amlodipine is:
Dizzy, appearance of floating,
drowsiness, or sick head
Swollen on feet, warm and hot
taste in face, neck, or chest
(flushing), stomachache or
nauseous
Tired unusual
Mechanism work from Calcium Chanel Blocker (CCB) that is, relaxation heart and muscle plain with hinder
channel calcium which sensitive to voltage, so that reduce entry calcium extracellular to in cell (Dipiro,
2015).

15. Ondansentron
Injection
indication of
ondansentron that
is for nauseous
and vomit
consequence
chemotherapy
and radio
therapy,
prevention
nauseous and
vomit post
operation.
To treat
nausea and
vomiting
Dose nauseous and vomit
consequence chemotherapy which is
very
emetogenic 8 mg by intravenous
quick before chemotherapy, then
next with intravenous
1mg/hour During 24 hours or 2-8 mg
each 2-4 hours then next
with 8 mg orally each 12 hours
During 5 day. Chemotherapy which
not enough emetogenic 8 mg
intravenous
quick before chemotherapy or 8 mg
orally each 1-2 hours before
chemotherapy, next with 8 mg
orally each 12 hours During 5 day.
Dosage given 3 x
1 a day
Effect side ondansetron
which analyzed in
study this is
sick head, constipation,
and diarrhea (Agustina,
2014)
Ondansetron including group drug antagonist serotonin 5-HT3, which work with hinder by selective
serotonin 5-hydroxytryptamine (5HT3) bond on the receptor which there is at CTZM (chemoreceptors
trigger zone) on channel digest. Serotonin substance which will released if ondansetron injection.

16. Mechanism work from sucralfate is protect mucosa stomach with shape layer on mucosa so
that no tampered with by factors aggressive stomach especially sour stomach (Armstronget
al,1999).
Sucralfate
indications of
sucralfate is that
it can reduce
inflammation and
heal ulcers
(PIONAS, 2015)
To treat heartburn
Sucralfate syrup
(suspension) normal given
with route orally, with dose
given 3 times a day 1 spoon
and 3 times 2 spoon. Dose
sucralfate in
form suspension is 500 mg/5
mL. Dose maximum gift
sucralfate
for mature is 8 g/day
(PIONAS, 2015)
The dose is given
3 x 1 Cth a day
effect side from
sucralfate that is occur
constipation, diarrhea,
nauseous, disturbance
digestion, disturbance
stomach, mouth dry,
rash, reaction
hypersensitivity,
painful back, dizzy,
headache,, vertigo, and
sleepy, formation
bezoar (PIONAS,2015

17. Mechanism work ACE inhibitor like captoprilis with hinder enzyme conver terpeptidyl dipeptidase
which hydraulic angiotensin It angiotensin II and cause inactivation bradykinin, something vasodilator
strong which work with method stimulate release nitric oxide and prostacyclin. Activities hypotension
captoril occur good on obstacle system renin angiotensin or effect stimulation of the kinin-kallikrein
system. Mechanism which second proven that angiotensin receptors bradykinin, lower effect drop
pressure blood (Katzung, 2001)
Captopril
25 mg
Captopril is indicated for the
treatment of moderate and
severe hypertension. Captopril
can
used alone or in combination
with drugs
other antihypertensives,
especially thiazides.
Unresponsive or uncontrollable
cardiac paralysis
with diuretics and digitalis
(Rahardja, 2007)
To lower
blood
pressure
Captopril
(indofarma)
12.5 mg, 25 mg,
50 mg tab
Initial daily dose: 3x 12.5 mg
Increase daily : 3x 25mg
Captopril
(hexpharm)
12.5 mg, 25 mg, 50 mg tab
Initial daily dose: 2x 12.5 mg
Maintenance Dose
A day: 2 x 25 mg
Max dose: 3 x 50mg
(Rahardja,2007)
Dosage given
3 x 1 a day
Effect side from the
captopril often occur is
loss of sense
(sometimes smell),
cough dry, exanthem
(rashes on
skin). The effect could
removed by
indomethacin or
NSAID other (Tjay &
Rahardja, 2007

18. Omeprazole 20
mg
Ulcer stomach and
ulcer duodenum,
ulcer stomach and
the duodenum
related with
NSAIDs, lesson
stomach and
duodenum, regimen
eradication H.
pylori on ulcer
peptic, reflux
esophagitis,
syndrome Zollinger
Ellison (PIONAS,
2015)
To treat
heartburn
Ulcer stomach and ulcer
duodenum (including which
complications therapy
NSAIDs), 20 mg one time a
day during 4 week on ulcer
duodenum or 8 week on
ulcer stomach; on case
which heavy or relapsed
upgrade Becomes 40 mg a
day ; maintenance for ulcer
the duodenum relapsed, 20
mg a day ; prevention
relapsed ulcer duodenum, 10
mg a day and upgrade until
20 mg a day when symptom
appear return (PIONAS,
2015)
Dosage given 2 x
1 day
Effect side which
caused is paraesthesia,
vertigo, alopecia,
gynecomastia,
impotence, stomatitis,
encephalopathy on
disease heart which
critical, hyponatremia,
confused (temporary),
agitation and
hallucination on sick
which heavy,
disturbance vision
reportedon gift
injection dose tall
(PIONAS, 2015)
Mechanism work from omeprazole is could block work from enzyme K + H + ATP ace which will
break K + H +ATP ace so that produce energy which used for Secrete sour HCl from cell parietal
tolumen stomach (Finkel et al., 2009)

19. Simvastatin
Simvastatin is
used to lower bad
cholesterol
(LDL) and
triglycerides, and
increase the
amount of good
cholesterol
(HDL) in the
blood (Mayo,
2021).
Adult dose 5-40 mg, once
daily, in the evening. Adults
40 mg, once daily in the
evening (Mayo, 2021)
1 x 1 a day
Effect side from
simvastatin that is
constipation, nose
clogged, sneeze, sick
throat, nauseous, sick
stomach, and headache
(Mayo, 2021)
Mechanism work simvastatin in lower rate cholesterol and LDL with method inhibit
enzyme3- hydroxy-3methylglutaroyl- coenzyme A (HMG-CoA) reductase by
competitive (GINA, 2020)

20. Assessment
Drug Drug Related Problems (DRP)
No. Category Information
1. Indications without therapy Yes
2. Therapy without indication No
3. Dose too high Yes
4. Dosage too low No
5. Adverse reactions No
6. Interaction drug No
PCNE Classification scheme for Drug-Related problems V.01, 2006

21. GuidelinesHypertensionDipiro, 2020

22. GuidelinesHypertension with Compelling IndicationsDipiro, 2020

23. GuidelinesUlcus pepticumwith Compelling IndicationsDipiro, 2020

24. PLANNING
Destination Therapy:
1. Prevent Enhancement Pressure Blood
2. Relieve Painful Indigestion
3. Cure Ulcer peptic
4. Increase Quality Life From Patient
Target Therapy:
1. Lower Pressure Blood Until
Reach Less Than 140/90
mmHg
2. Lower rate stomach acid
Therapy Non Pharmacology:
1.Modification lifestyle
2.Decrease weight
3. Diet Sodium
4. Avoid Stress
5. Avoid eat which spicy and sour, caffeine and alcohol

25. PLANNING
Therapy Pharmacology:
1. Continuing to Use Ondansetron tablet 4 mg 3x1
2. Continue Use Captopril and Amlodipine So that to achieve Pressure Normal
Blood
3. Stop Use NSAIDs (Anstrain)
4. Addition Therapy For H. Pylori that is Combination PPI with Antibiotics
(Amoxicillin and metronidazole)
5. Use Sucralfate 1 Hour After Omeprazole

26. PLANNING
1. Conducted inspection pressure blood and cholesterol check by periodically
2. Conducted inspection endoscope for see lesson on mucosa stomach
3. Conducted evaluation use PPI, after use 8 week lowered dose or if necessary
discontinued for prevent hypergastrinemia

27. REFERENCE
Ayuk Lawuningtyas Hariadini, Bambang sidharta, Tamara Gusti Ebtavanny, Eka Putri Minanga. 2020. Hubungan
Tingkat pengetahuan dan ketepatan penggunaan obat simvastatin pada pasien hiperkolestrolemia di apotek kota
malang. Universitas brawijaya malang.
Chan, p. Amarra, M. S., Khor, G. L., (2016). Intake of Added Sugar in Malaysia: a Review. Asia Pacific Jounal of Clinical
Nutrition
DiPiro J.T., Wells B.G., Schwinghammer T.L. and DiPiro C. V. 2015. Pharmacotherapy Handbook, Ninth Edition.,
McGraw Hill Education Companies, Inggris.
DiPiro J.T., Wells B.G., Schwinghammer T.L. and DiPiro C. V. 2020. Pharmacotherapy Handbook, 11 Edition., McGraw
Hill Education Companies, Inggris.
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Katzung, B.G. 2001. Farmakologi Dasar dan Klinik : Reseptor- reseptor Obat dan Farmakodinamik. Penerbit Buku
Kedokteran EGC.

28. Melyana, Afrias Sarotama.2019. Implementasi Peringatan Abnormalitas Tanda-Tanda
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Mayo Clinic (2021). Drugs and Supplements. Simvastatin (Oral Route).
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CA: Brooks/Cole, Cengagr Learning

29. Group 1 C S1- Pharmacy 2020
THANK
YOU