CASE REPORT :DRUG RELATED PROBLEM (DRP) ASSOCIATED WITH THE

TREATMENT OF PATIENTS WITH DISEASE SPONDYLODISCITIS K WARDS

PGI CIKINI HOSPITAL

Dorence Th Marcus1, Aprilita Rinayanti Efi2, Diana Laila Rahmatillah2

1
MahasiswaProfesiApoteker, FakultasFarmasi UTA'45 Jakarta
2
Dosen Fakultas Farmasi UTA'45 Jakarta
Email:Noviamarcus36@gmail.com

ABSTRACT
Spondylodiscitis is an infection of the diskus and vertebrae adjacent to discus the
caused by piogen, piogen infection is a condition in which the pathogenic organisms
multiply and spread between the body tissues. This situation usually results in reactions
both acute and chronic inflammation. Patients Ny Ys, age of 40 years entered in ward K
PGI Cikini Hospital on September 30 2014 with a diagnosis Spondylodyscitis. Therapy
treatment for 9 days is Farpain (ketorolak), Lyrica (Pregabalin), Pirofel (Piroxicam),
Myonep (Eperisone HCL), Medrol (Methylprednisolone), Lanfix (Cefixime), Pantazol
(Pantoprazol), Dulcolax (Bisacodyl). Based on the results of clinical work practice at
the ward K internal disease PGI Cikini Hospital it can be concluded there is DRP (Drug
Related Problem) there is drug interaction.

KEYWORDS : Spondylodiscitis, PGI Cikini Hospital

INTRODUCTION

Spondylodiscitis is an infection of the diskus and vertebrae adjacent to discus the

caused by piogen, piogen infection is a condition in which the pathogenic organisms
multiply and spread between the body tissues. Spondylodiscitis happen because there
are viral or bacterial infection. Swelling and inflammation on the spondylodiscitis can
cause back pain 1.

Symptoms of this infection is not specific, including fever, local pain and
neurological signs when abnormalities structure form which exposed getting worse.
looks normal in the early stages show vertebral endplate are looks blurred and reduced
discus height which lasted rapid. MRA is the supporting investigation the
recommended because it can detect edema in trabecular bone very early before happen
the destruction 2.

PERCENTAGE CASE

Patients Ny Ys, age of 40 years entered in ward K PGI Cikini Hospital on

September 30 2014 with a diagnosis Spondylodyscitis. Patients present with a
complaint has been experiencing back pain for 7 years, with a chief complaint of
lower back pain Patients with a history of peptic ulcer disease.

EVALUATION CLINIC

In the case of patients treated with Farpain (ketorolak) indicated for short-term
treatment for moderate to severe acute pain. Lyrica (Pregabalin) indicated for the
treatment of peripheral neuropathic pain. Pirofel (Piroxicam) for the symptomatic
treatment (pain) in rheumatoid arthritis. Myonep (Eperisone HCL) for the treatment
of low back pain by treating musculoskeletal stiffness or muscle stiffness. Medrol
(Methylprednisolone) for the treatment of inflammatory and allergic disorders
 Suppression. Lanfix (Cefixime) for the treatment of infections caused by
microorganisms. Pantazol (pantoprazole) diidndikasikan to treat peptic ulcer patients.
Dulcolax (Bisacodyl) for constipation and reduce pain in patients 3.

DOSAGE AND HOW TO USE

Ketorolac 10 mg given 2 x 1 day orally, pregabalin 50 mg given 2 x 1 day orally,

piroxicam 10 mg given 2 x 1 dy orally, Eperisone hcl 50 mg 2 x 1 day given orally,
methylprednisolone 4 mg 2 x 1 day given orally, cefixime 200 mg 2 x 1 day given
orally, pantoprazole 20 mg 2 x 1 day given orally, 10 mg bisacodyl 1 x 1 day in
suppository 4.

LABORATORY EXAMINATION RESULTS

Hematological examination results on the 1st of October 2014 showed increased

erythrocyte sedimentation rate (12 of the normal values of 0-10 mm / h) indicate high
infection or inflammation, eosinophils increased (5 of normal values 1-3%) indicate a
parasitic infection, lymphocytes decreased (15% of normal values 20-4-) indicate a
bacterial infection, leukocytes increased (7 of normal values 0-3) indicate the
presence of infection and spinal marrow disorders, increased erythrocyte (5 of normal
values 0-4) indicate severe inflammation, bacteria increased (134 from its normal
value <24 ) showed the presence of bacterial infection.

DISCUSSION

Patients Ny Ys, age of 40 years entered in ward K with The main complaint of
back pain, fatigue and anxiety The patient has a history of back pain for 7 years, On
the first day the patient is given Lanfix for bacterial infections, Farpain
(inflammation) to address moderate acute pain - heavy on the patient's back, Myonep
treat symptoms associated with musculoskeletal spasm (spasm of the skeletal
 muscle), Pantazol for the reduction of gastric acid secretion based on the patient's
history of peptic ulcer disease and Pirofel to treat pain patients based on physician
diagnosis Spodylodiscitis. On the second day of the examination conducted lab tests
include hematology, clinical chemistry, urine and parasitological and a CT scan of the
lumbar (bone reconstruction), on day 3 patients still feel pain in the waist and a weak
3-6 scale, blood pressure 110/90 mm Hg, the results scan lumbar L5-S1 looks HNP
and obligation to perform MRI for accurate results,

MRI test results stating that the infection of the lower lumbar spine and
partnership in the lumbar spine that causes pain, so additional Lyrica drug to cope
with peripheral neuropathic pain, Medrol suppression of inflammatory and allergic
disorders and Dulcolax supp for constipation. Furthermore, the thorax / lung and
lumbosacral photo, seen from the results obtained radiological joint inflammation in
the patient's spine.

DRUG RELATED PROBLEM

1. DRP : Drug Interactions

piroxicam, ketorolac. Either increases toxicity of the other by pharmacodynamic

synergism. High likelihood serious or life-threatening interaction. Contraindicated unless
benefits outweigh risks and no alternatives available. Never use combination. ketorolac,
methylprednisolone. Either increases toxicity of the other by pharmacodynamic
synergism. Significant interaction possible, monitor closely. Increased risk of GI
ulceration. piroxicam, methylprednisolone. Either increases toxicity of the other by
pharmacodynamic synergism. Significant interaction possible, monitor closely. Increased
risk of GI ulceration 5.

CONCLUSION

Based on the results of clinical work practice in ward K internal disease in the PGI
Cikini Hospital, then be concluded that the results of laboratory shows the value of DRP
(Drug Related Problems) form of drug interaction.
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