laporan simulasi kasus
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Laporan Simulasi Kasus
Hipertensi Stage 2,Diabetes Mellitus tipe 2
serta Hiperkolesterolemia
Qori Pratiwi I1A004009
Toto HeryantoI1A006078
Ni Luh Wita I1A007071
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Definisii
� The Sixth Report of the Joint National
Commitee on Prevention, Detection, Evaluation,and Treatment of High Blood Pressure (1997)
mendefinisikan hipertensi sebagai tekanan
darah sistolik 140 mmHg atau lebih atau
diastolik 90 mmHg atau lebih.
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Definisi
� Hiperkolesterolemia adalah salah
satu gangguan kadar lemak dalam
darah (dislipidemia) yang mana
kadar kolesterol dalam darah lebih
dari 240 mg/dl. (perkeni 2004).
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DEFINISI
� Diabetes Melitus type 2 (DMT2) adalah
penyakit metabolik yang ditandai olehhiperglikemia kronik akibat dari kekurangan
sekresi insulin atau gangguan kerja insulin
atau kedua-duanya.
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EpidemiologiNational Health and
Nutrition Examination
Survey (NHANES 1999-2000)
hipertensi di Amerika Serikat mengalami peningkatan
sebanyak 3,7% dari tahun
(1988-1991) sampai (1999-2000)
hipertensi di Amerika Serikat mengalami peningkatan
sebanyak 3,7% dari tahun
(1988-1991) sampai (1999-2000)
Diabetes
Mellitus
tipe 2
Diabetes
Mellitus
tipe 2
Hiper
kolesterolemia
Hiper
kolesterolemia
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Etiologi
Hipertensi Primer
Hipertensi Sekunder
Hipertensi
Defek sekresi insulin
Resistensi Insulin
Diabetes Mellitus
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Patofisiologi
Gambar 1. Sistem Renin-Angiotensin-Aldosteron
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Patofisiologi
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Gambar 3. Proses terjadinya aterosklerosis. Dimulai dari cedera pada endotel
pembuluh darah oleh karena faktor hipertensi, merokok, makan makanan
yang mengandung banyak lemak, oksidasi LDL, diabetes mellitus , zat
vasoaktif dan sitokin.
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Diagnosis
Anamnesis
Pemeriksaan
Fisik
Pemeriksaan
Penunjang
DIAGNOSISterapi
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Tabel 1. Klasifikasi Hipertensi HIPERTENSI
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Tabel 2. Berdasarkan NCEP ATP III (National cholesterol Education
Program, Adult Panel Treatment III) Berdasarkan NCEP ATP III
(National cholesterol Education Program, Adult Panel Treatment III)
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Tabel 3. Kriteria Diagnosis Diabetes mellitus
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Tabel 4. Kadar Glukosa Darah Sewaktu dan Puasa
Sebagai Patokan Penyaring dan Diagnosis Diabetes
Mellitus (mg/dl)
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Pengobatan
Non
Farmakologi
Farmakologi
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Gambar4.
Alogaritma
Hipertensi
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No Golongan obat Nama obat
1 Diuretik Tiazid (HCT), diuretik kuat (furosemid), diuretik
hemat kalium (spironolakton, amilorid)
2 Beta-bloker Asebutolol, atenolol, bisoprolol, metoprolol,
alprenolol, karteolol, propanolol.
3 Alfa-bloker Doxazosin, prazosin, terazosin,
4 ACEI Kaptopril, lisinopril, enalapril, delapil,fosinopril
5 Antagonis Kalsium Verapamil, nifedipin, amlodipin, nikardipin
6 Antihipertensi
tambahan
Alfa 2 agonis (metildopa, klonidin, guanfasin),
penghambat saraf adrenergik (reserpin,
guanetidin),Vasodilator langsung
(hidralazin,monoksidil), Antagonis angiotensin II
(losartan, valsartan)
Obat AntihipertensiHIPERTENSI
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Gambar 5. Skema pengobatan
hiperkolesterolemia
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HIPERKOLESTEROLEMIA
No Golongan Obat Nama Obat
1 Penghambat
HMGCoA
reduktase
mevastatin, lovastatin, pravastatin
dan simvastatin.
2 Bile acid
sequestrants
Kolestipol, Kolesteramin
3 Asam nikotinat Niasin
Obat Antihiperkolesterolemia
Menurut NCEP ATP III
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Diabetes Mellitus
� 4 Pilar penatalaksanaan penyakit DM:
1. Edukasi
2. Terapi Gizi Medis3. Latihan Jasmani
4. Intervensi Farmakologis
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Intervensi Farmakologis:
� NICE (2010) :
1. Metformin
2. Metformin and a sulfonylurea 3. Add thiazolidinedione or insulin
4. Insulin and metformin and a sulfonylurea
5. Increase insulin dose and intensify regimen over time
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Perkeni (2006)
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HIPERGLIKEMIA
No
Golongan Obat Nama Obat
1 Meningkatkan jumlah
insulin
1.Sulfonilurea (glipizide GITS,
glibenclamide,dsb.)2.Meglitinide (repaglinide,
nateglinide)
3.Insulin injeksi
2 Meningkatkan sensitivitas insulin
1.Biguanid/metformin2.Thiazolidinedione (pioglitazone,
rosiglitazone)
3 Mempengaruhi
penyerapan makanan
Acarbose
OBAT ANTIHIPERGLIKEMIA
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SIMULASI KASUS
TD : 160/90 mmHg.
Nadi : 90 kali/menit
Respirasi : 24 kali/menit
Suhu : 37°C Kepala : dalam batas normal
Leher : otot leher teraba tegang
Thorax, Abdomen dan extremitas : dalam batas
normal Pemeriksaan darah : hiperkolesterolemia (280 mg/dl),
hiperglikemia ( GDP 220 mg/dl)
Diagnosis : Hipertensi dan hiperkolesterolemia
PEMERIKSAAN FISIK
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SIMULASI KASUS
Mencegah terjadinya morbiditas dan
mortalitas akibat tekanan darah tinggi
Sasaran tekanan darah 130/80 mmHg
Pengobatan hiperkolesterolemia terutama
ditujukan bagi pasien dengan riwayat
ateroskelosis prematur dalam keluarga dan dengan adanya faktor risiko lain seperti
dibates melitus, hipertensi dan merokok.
TUJUAN PENGOBATAN
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Kelompok Obat Antihipertensi Jenis Obat
Diuretic Tiazid Hidroklorotiazid, klorotiazid, indapamide
Beta blocker Propanolol, metoprolol, labetalol
ACE inhibitor Kaptopril, lisinopril, imidapril, perindopril
Calcium chanel blocker Nifedipin, diltiazem, verapamil
Angiotensinreseptor blocker (ARB) Valsartan, losartan, candersartan
Kelompok Obat Hiperkolesterolemia Jenis Obat
Penghambat HMGCoA Reduktase Simvastatin, Lovastatin, Pravastatin ,Fluvastatin
Bile acid sequestrants Kolestiramin
Asam Nikotimat Niasin Vitamin B
Probukol Probukol
Kelompok Obat Diabetes Meliitus Jenis Obat
Biguanid Metformin
Sulfonilurea Klorpropamid, Glibenklamid, Glipizid, Gliklazid, Glikuidon, Glimepirid
Glinid Rapeglinid, Nateglinid
Thoazolidinediones Pioglitazon, Rosiglitason
Inhibitor Glukosidase Acarbose
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ANJURAN
RESEP YANG
BENAR DAN
RASIONAL
(pilihan)
dr. Towiti, Sp.PD
SIP. 0467/12/2009
PRAKTEK UMUM
Rumah:
Jl. Huru-hara no.56
Banjarmasin Telp.6545688
Praktek:Jl. Sinar Mas Utama no.56
Banjarbaru
No telp. (0511) 65456
Banjarbaru, 25 juni 2010
R/Hidroklortiazid tab 25 mg No. VIIIS s.d.d tab ½ a.c h.m
R/Captopril tab 12,5 mg No.XXX
S b.d.d tab I a.c. m et v
R/Simvastatin tab10 mg No.XV
S s.d.d. tab II d.c o.n
R/Metformin tab 500 mg No.XXX
S b.d.d. tab I d.c
Pro : Tn. Victor Umur : 50 tahunBB : 87 kg Alamat: Jl. Cendana I No. 12 Banjarmasin
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ANJURAN
RESEP YANG
BENAR DAN
RASIONAL
(alternatif)
dr. Towiti, Sp.PD
SIP. 0467/12/2009
PRAKTEK UMUM
Rumah:
Jl. Huru-hara no.56
Banjarmasin Telp.6545688
Praktek:Jl. Sinar Mas Utama no.56
Banjarbaru
No telp. (0511) 65456
Banjarbaru, 25 juni 2010
R/Hidroklortiazid tab 25 mg No.VIIIS s.d.d tab ½ a.c h.m
R/Angioten tab 50 mg No.VIII
S.s.d.d tab ½ a.c h.m
R/Pravastatin tab 20 mg No.XV
S.s.d.d. tab I d.c o.n
R/Glipizid tab 5 mg No.XV
S.s.d.d tab I a.c h.m
Pro : Tn. Victor Umur : 50 tahunBB : 87 kg Alamat: Jl. Cendana I No. 12 Banjarmasin
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Pengendalian obat
� Pengendalian obat terutama dilakukan dengan
memperhatikan dosis, frekuensi pemberian
dan lama pemberian serta efek samping obat
� Penanggulangan penyakit seperti pada kasus,
dibagi menjadi 2 yakni terapi non farmakologis
dan terapi farmakologis.
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