NAMA ANGGOTA KELOMPOK :

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KASUS PAIN MANAGEMENT

Mrs NP is a 55-year-old care home assistant who has type 2 diabetes. Her current prescription is
for metformin 500 mg three times a day and amitriptyline 50 mg at night. When collecting her
repeat prescription, she mentions that she ‘Can’t get on with the new tablets’ because they make
her very drowsy in the mornings. You invite Mrs NP for a review of her medication. During the
consultation, Mrs NP explains that for some time she has suffered from constant tingling and
occasional shooting pain in her legs and feet, and 3 months ago amitriptyline 10 mg daily was
prescribed. About one month ago, the dose of amitriptyline was increased to 50 mg daily. She
takes the dose at night, as advised by her primary care doctor. When she works an early shift (about
three times a week), she usually omits the dose of amitriptyline to be sure that she wakes up in
time to get to work. Mrs NP says that she takes the metformin regularly and has no associated
problems. She is keen to be fit enough to work because she is supporting her youngest son, who is
studying to be a doctor.

1. SUBJECTIVE
Identitas Pasien
Nama : Ny.NP
Umur : 55 tahun
Jenis kelamin : Perempuan
Pekerjaan : Asisten perawat rumah

Keluhan : Selama beberapa waktu ia menderita kesemutan dan nyeri penembakan

yang kadang-kadang terjadi di kakinya
 2. OBJECTIVE
Menderita diabetes tipe 2

3. ASSASMENT
Diagnosa pasien : Neuropati perifer diabetic
Terapi yang diberikan : Metformin 500 mg tiga kali sehari dan amitriptyline 50 mg pada
malam hari.3 bulan lalu amitriptyline 10 mg setiap hari diresepkan.
Sekitar satu bulan yang lalu, dosis amitriptyline ditingkatkan
menjadi 50 mg setiap hari.

4. PLAN
- Peningkatan dosis amitriptyline sedikit demi sedikit untuk mengurangi terjadinya efek
samping
- Mengonsumsi amitriptyline 60-90 menit sebelum tidur di malam hari untuk
mengurangi efek mabuk
- Jika masih mengalami efek samping yang merugikan disarankan untuk menggantinya
dengan obat alternative lain yaitu seperti gabapentin, pregabalin atau duloxetine
sebagai alternatif dari antidepresan trisiklik sebagai terapi lini pertama untuk nyeri
neuropatik (NICE, 2013).

5. MONITORING

Referensi
Whittlesea cate and Karen Hodson. 2018. Clinical Pharmacy and Therapeutics E-book. Elsevier
Health Sciences. Diakses pada tanggal 29 Oktober 2019.