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Kajian Interaksi Obat Antihipertensi Pada Pasien Hemodialisis Di Rumah Sakit Umum Yarsi Pontianak Tahun 2017

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Kajian Interaksi Obat Antihipertensi Pada Pasien Hemodialisis Di Rumah Sakit Umum Yarsi Pontianak Tahun 2017 KAJIAN INTERAKSI OBAT ANTIHIPERTENSI PADA PASIEN HEMODIALISIS DI RUMAH SAKIT UMUM YARSI PONTIANAK TAHUN 2017 Salfitri*1, Nurmainah1, Muhammad Akib Yuswar1 1Program Studi Farmasi Fakultas Kedokteran Universitas Tanjungpura Pontianak Jl Prof. Dr. H. Hadari Nawawi, Kota Pontianak, Kalimantan Barat. ABSTRAK Penyakit gagal ginjal kronik (GGK) merupakan penyakit ginjal stadium akhir. Pasien GGK memerlukan terapi pengganti ginjal seperti hemodialisis. Selain hemodialisis, pasien GGK juga diberikan terapi obat secara polifarmasi yang terdiri dari obat antihipertensi dan golongan obat lainnya. Penelitian ini bertujuan untuk mendeskripsikan jenis obat antihipertensi yang sering berinteraksi dan mengkaji interaksi obat berdasarkan mekanisme kerja serta tingkat keparahan pada pasien GGK yang menjalani hemodialisis. Penelitian ini merupakan penelitian observasional dengan rancangan studi potong lintang (cross sectional) yang bersifat deskriptif, pengumpulan data dilakukan secara retrospektif berdasarkan catatan rekam medik pasien. Data peresepan yang didapat pasien GGK sebelum menjalani hemodialisis di analisis menggunakan software drugs.com. Hasil penelitian menunjukkan bahwa dari 32 sampel terdapat kejadian interaksi obat sebesar 37,50%. Obat yang paling sering berinteraksi adalah golongan CCB yaitu amlodipin sebesar 45,83% dan golongan ACEI yaitu kaptopril sebesar 33,33%. Interaksi obat yang terjadi berdasarkan mekanisme kerja obat yaitu farmakodinamik sebesar 79,17%, farmakokinetik sebesar 8,33% dan yang tidak diketahui mekanisme interaksinya sebesar 12,50%. Sedangkan berdasarkan tingkat keparahannya yaitu minor sebesar 29,17%, moderat sebesar 62,50% dan mayor sebesar 8,33%. Kesimpulan dari penelitian ini adalah obat antihipertensi yang paling banyak digunakan yaitu CCB, sedangkan interaksi obat yang sering terjadi yaitu mekanisme kerja farmakodinamik dan tingkat keparahannya moderat. Kata kunci: Gagal ginjal kronik, Hemodialisis, Interaksi obat. Penulis : Salfitri Program Studi Farmasi Fakultas Kedokteran Universitas Tanjungpura Pontianak Jl. Prof. Dr. H. Hadari Nawawi, Kota Pontianak, Kalimantan Barat. Email: [email protected] STUDY OF ANTIHYPERTENSIVE DRUG INTERACTIONS IN HEMODIALYSIS PATIENTS AT YARSI HOSPITAL PONTIANAK IN 2017 Salfitri, Nurmainah, Muhammad Akib Yuswar Department of Pharmacy, Faculty of Medicine, Tanjungpura University Address on Jalam Prof. Dr. H. Hadari Nawawi Pontianak City, West Kalimantan, Indonesia ABSTRACT Chronic Kidney Disease (CKD) is end-stage kidney disease. CKD patients require renal replacement therapy such as hemodialysis. In addition to hemodialysis, CKD patients are also given polypharmaceutical drug therapy consisting of antihypertensive drugs and other classes of drugs. This study aims to describe the types of antihypertensive drugs that often interact and assess drug interactions based on the mechanism of action and the severity of CKD patients undergoing hemodialysis. This study was an observational study with a cross sectional study design that was descriptive. Data collection was carried out retrospectively based on the patient's medical record. Analyzed of drug interaction using drugs.com software. The results showed that out of 32 samples there were 37.50% drug interactions. The most frequently interacting drugs are the CCB group, namely amlodipine by 45.83% and the ACEI group by captopril by 33.33%. Drug interactions that occur based on the mechanism of action of the drug are pharmacodynamics of 79.17%, pharmacokinetics of 8.33% and the unknown interaction mechanism of 12.50%. Whereas based on the severity level that is minor at 29.17%, moderate at 62.50% and major at 8.33%. The conclusion of this study is the most widely used CCB, while frequent drug interactions are pharmacodynamic mechanisms and moderate severity. Keywords: Chronic kidney disease, Hemodialysis, Drug Interaction. PENDAHULUAN Penyakit gagal ginjal kronik (GGK) merupakan penyakit ginjal stadium akhir. Gagal ginjal kronik adalah kegagalan fungsi ginjal untuk mempertahankan metabolisme serta keseimbangan cairan dan elektrolit akibat destruksi struktur ginjal yang progresif dengan manifestasi penumpukan sisa metabolit (toksik uremik) di dalam darah. Pasien dengan penyakit ini memerlukan terapi pengganti ginjal berupa transplantasi ginjal atau dialisis yang terdiri dari dialisis peritonial dan hemodialisis. Terapi pengganti ginjal yang paling banyak digunakan saat ini adalah hemodialisis dengan jumlahnya yang terus meningkat dari tahun ke tahun (Smeltzer, 2010). Jumlah pasien GGK di Indonesia yang menjalani hemodialisis mengalami peningkatan dari tahun ke tahun. Peningkatan yang cukup tajam terlihat pada rentang tahun 2007 sampai 2015. Jumlah pasien GGK yang aktif menjalani hemodialisis pada tahun 2007 sebanyak 1.885 pasien, sedangkan di tahun 2015 pasien GGK yang aktif menjalani hemodialisis mencapai jumlah yang cukup banyak yaitu 30.554 pasien (Pernefri, 2015). Kondisi ini menunjukkan adanya peningkatan jumlah pasien gagal ginjal yang menjalani hemodialisis. Pasien GGK yang menjalani hemodialisis umumnya mendapatkan obat lebih dari satu yang dikenal dengan polifarmasi. Penggunaan polifarmasi berpotensi menimbulkan permasalahan obat-obat terutama interaksi obat. Obat antihipertensi pada pasien GGK yang diketahui sering mengalami interaksi adalah furosemid dan kaptopril (Rahmiati, 2012; Fiqrianty, 2014; Suwantika, 2016). Interaksi dari kedua obat ini termasuk dalam mekanisme farmakodinamik, karena keduanya bekerja pada sistem yang sama yaitu kardiovaskular. Efek samping yang ditimbulkan akibat penggunaan kedua obat ini adalah hipotensi dan hipovolemia. Jika ditinjau dari tingkat keparahan, kedua obat tersebut menimbulkan keparahan yang moderat/ sedang. Namun demikian jika digunakan dalam jangka waktu yang lama penggunaan kedua obat tersebut dapat mengakibatkan kematian jaringan (Baxter, 2008). Informasi tentang interaksi obat diperlukan untuk mendukung keberhasilan terapi agar sesuai dengan tujuan utama pasien. Keberadaan farmasis sangat penting agar bisa mengawasi dan mengkaji interaksi obat yang diresepkan pada pasien GGK yang menjalani hemodialisis. Oleh karena itu, peneliti tertarik untuk melakukan penelitian mengenai kajian interaksi obat antihipertensi pada pasien GGK yang menjalani hemodialisis di Rumah Sakit Umum Yarsi Pontianak Tahun 2017. METODOLOGI PENELITIAN Alat dan Bahan Alat–alat yang digunakan dalam penelitian ini adalah lembar pengumpul data, laptop yang dilengkapi dengan software Microsoft Excel serta aplikasi Drug Interaction yang dapat di akses di drugs.com, dan buku Stockley’s Drug Interaction. Bahan yang digunakan dalam penelitian ini berupa rekam medik, resep dan data elektronik pasien GGK yang menjalani hemodialisis di Rumah Sakit Umum Yarsi Pontianak pada tahun 2017. Rancangan Penelitian Penelitian ini merupakan penelitian observasional yang dirancang menggunakan rancangan studi potong lintang (cross sectional) yang bersifat deskriptif. Data dikumpulkan secara retrospektif berdasarkan data rekam medik dan resep yang didapatkan oleh subyek penelitian. Subyek yang dilihat dalam penelitian ini adalah pasien GGK yang menjalani hemodialisis dan mendapatkan resep di Rumah Sakit Umum Yarsi Pontianak pada tahun 2017. Adapun aspek penelitian yang ditinjau adalah mengkaji interaksi obat dengan obat pada resep yang didapatkan oleh pasien GGK yang menjalani hemodialisis di Rumah Sakit Umum Yarsi tahun 2017. Kriteria Inklusi Kriteria inklusi sampel pada penelitian ini adalah pasien GGK yang menjalani hemodialisis, berusia ≥ 18 tahun, memiliki komorbid penyakit kardiovaskular dan Pasien yang menggunakan kombinasi obat sedikitnya 2 obat, yang terdiri dari kombinasi OAH dengan OAH atau OAH dengan golongan obat lain. Kriteria Eksklusi Kriteria Eksklusi sampel pada penelitian ini adalah pasien dengan data rekam medik yang tidak lengkap. Definisi Operasional 1. Data rekam medik adalah data rekam medik yang mencantumkan nama pasien, jenis kelamin dan lain-lain. 2. Pasien hemodialisis adalah pasien gagal ginjal kronik yang menjalani hemodialisis di Rumah Sakit Umum Yarsi Pontianak pada tahun 2017. 3. Interaksi obat dengan obat adalah efek samping yang terjadi setelah dilakukan analisis menggunakan aplikasi drugs.com 4. Tingkat Keparahan adalah tingkat interaksi obat yang terdiri dari minor, moderate dan mayor. Metode Pengumpulan Data Pengumpulan data dilakukan di Rumah Sakit Umum Yarsi Pontianak. Data berasal dari rekam medik dan resep obat yang didapatkan oleh pasien GGK yang menjalani hemodialisis. Data yang diperoleh disalin pada lembar pengumpulan data . Data yang dikumpulkan berupa data karakteristik pasien berupa usia, jenis kelamin serta data peresepan berupa resep yang didapatkan pasien GGK sebelum menjalani hemodialisis. Resep yang didapatkan berupa obat antihipertensi dan obat lainnya. Analisis Data Analisis data dilakukan dengan cara mengolah data penggunaan obat yang diperoleh dari rekam medik dan resep pasien GGK kemudian dilakukan analisis interaksi obat dari obat-obat yang diresepkan menggunakan perangkat lunak Drug Interaction Checker yang dapat diakses di drugs.com. Analisis data dilakukan secara kuantitatif, berdasarkan hasil analisis tersebut ditentukan persentase obat yang paling sering berinteraksi, kejadian interaksi obat berdasarkan mekanisme kerja obat (farmakokinetik dan farmakodinamik) serta tingkat keparahan. Data yang diperoleh kemudian diolah menggunakan software Microsoft Excel. Hasil analisis data akan disajikan dalam bentuk uraian dan tabel. HASIL DAN PEMBAHASAN Berdasarkan hasil
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