You are on page 1of 18

PHARMACEUTICAL CARE

BLOCK HOSPITAL

PRESENTED BY :
INTERNATIONAL CLASS

NAME OF MEMBERS Ahmad Nur Yusran (1508062263) Dian Putri Rahmayati (1508062269) Mala Hikmawan Primana (1508062270) Astri Ayu Bimbika Putri (1508062299) Riskilla Fauziyanda Putri (1508062280) Ayu Purwaningsih (1508062300) Maylina Adani (1508062238) Kurnia Puspa Harleynda (1508062245) Dewinta Annisa Hani Fasa(1508062277) .

FH : Her grandmother died due to Ca Mammae as well .CASE 1 A female patient. 45 years old. visited surgery ward with moderate pain and had swollen in the right breast. The laboratory examination 3 months ago showed that the patient had Ca mammae Dextra Stage II.

Serum Creatinine 0. Leucocyte 5510 mm3.6 g/dl. Trombocyte 257000. Lab data: Hb 12. patient experienced fatigue. and Tramadol 100 mg. nausea and constipation since the 1st day.4 cycles of AC (Doxorubicin and Cyclofosfamid) TREATMENT PLAN 4 cycles of TH (traztuzumab and Docataxel) After the first chemoterapy. Medication were Dexamethason 20 mg.6 SL (%).49 . Hematocrit 39.7 . Erytrocyte 4. Tropisetron 5 mg.

Problem : Moderate pain Erytrocyte 4. constipation Trombocyte Potential since the first 257000.7 chemotherapy mg/dl.49 . Uric acid . fatigue. Serum Problem : day Creatinine 0.6 Ca Mamae in the right SL (%). Dextra Stadium breast. Hb 12. BUN 11 mg/dL.Patient assasement CLINICAL MANIFESTATION AND CLINICAL PROBLEM Subjective : Objective : Clinical Age 45 yo. Actual Problem : and had swollen Hematocrit 39.6 g/dl. Leucocyte 5510 II nausea and mm.

000 woman with a fairly high mortality is 27 / 100.6%.000 women. KPD ranks first with a relative frequency of 18. whereas in the US is about 92 / 100. Registration Agency Cancer Specialist Doctors Association of Pathology Indonesia (IAPI) and the Indonesian Cancer Foundation (ICF)) estimated the number of events in Indonesia is 12 / 100.men . This disease can also be inflicted on men . according to data histopathological. (Data on Cancer in Indonesia in 2010.epidemiology Based Pathological Registration Based in Indonesia.000 or 18% of the deaths were found in women.

Drug related problem (drp) Unappropriate drug selection o Tropisetron for nausea  Adverse drug events o Tramadol can causing constipation o Chemotherapy can causing nausea. leukopeni and fatigue  Indication without therapy o Constipation o Leucopenia  Dosage and protocol chemotherapy .

Pharmaceutical care plan .

Premedication RECOMMENDATION AC DEXAMETAS • 20 MG po/iv ON ONDANSETR • ONDANSETRON 8 MG ON PO/IV TH .

CHEMOTHERAPY RECOMMENDATION DAY DRUG DOSE ROUTE DILUENT AND RATE CYCL E 1 Doxorubicin 60 mg/m2 IV Push N/A 1-4 1 Cyclophospha mide 600 mg/m2 IV infusion 100-250 ml 0.9 % Sodium Chloride Over 20 minutes to 1 hour 1-4 FOLLOWED .

.

BODY SURFACE AREA (BSA) •   BSA = BSA PATIENT = = = 1. 63 m2 .

TRAZTUZUMAB= 8 mg x 60 kg = 480 mg (Loading Dose) = 6 mg x 60 kg = 360 mg (Maintanance Dose) .79 = 1.63 m2 x 600 mg/m2 = 978 mg 3. DOXORUBICIN = 1.63 m2 x 60 mg/m2 = 97. DOCETAXEL = 53.DOSSAGE RECOMMENDATION DOSSAGE RECOMMANDATION 1.63 m2 x 33 mg/m2 4.8 mg 2. CYCLOPHOSPHAMIDE = 1.

satu kali sehari sblm tidur • ANTIEMETIK – PALONOSETRON 0. atau 16 mg po • PAIN – Tramadol 100 mg PO • LEUKOPENIA – Filgastrim 300 mcg/ml.SUPPORTIVE THERAPY • CONSTIPATION : – LAXADIN 1-2 sendok makan. 1x sehari 1 vial selama 5 hari .25 mg iv  tapi karena tidak masuk BPJS digunakan ondansetron 8 mg or 0.15 mg/kg iv.

.

MONITORING CHEMOTHERAPY Monitoring AC Monitoring TH .

NUTRISI .

DOXORUBICIN 500mg/m2) = Myocardial toxicity (>450- 2. DOCETAXEL = 4. TRAZTUZUMAB = Pulmonary Toxicity (SUMBER : DIH ED.TOXICITY 1. CYCLOPHOSPHAMIDE = Cardiotoxicity 3. 17) .