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PENGANTAR TERAPI

PARENTERAL

Hansen, S.Si., Apt., Sp.FRS

INTRAVENA ( IV)
TERAPI
• PENGANTAR TERAPI PARENTERAL
• KESETIMBANGAN ELEKTROLIT DAN AIR
• PEMBERIAN IV TERAPI YANG RASIONAL
• PENYIAPAN & PENCAMPURAN SEDIAAN
INFUS IV
• PELAYANAN FARMASI DALAM PENYIAPAN
SEDIAAN SITOSTATIKA IV

Amen..this is my pride ….. Motto Farmasis ( source unknown): “ I am a pharmacist. this is the way I walk through ……… to dedicate my profession to life and humanity” Mari kita wujudkan bersama Pelayanan Kefarmasian Nasional membangun bangsa Indonesia Sehat dan Berkualitas. This is my calling ……. I am a specialist in medication ………….. . May God be with Us.

Oath of a Pharmacist • I vow to devote my professional life to the service of all humankind through the profession of Pharmacy above other considerations. • School of Pharmaceutical Sciences. •   •   . • I will keep abreast of developments and the latest pharmaceutical care to assure the best care to the community and other healthcare providers. • Universiti Sains Malaysia • August 2004. •    • Pharmacy Students’ Oath Committee. •  I will consider the welfare of humanity and relief of human suffering through optimal drug therapy and the best pharmaceutical care.

Kurikulum S1 farmasi inggris .

it is common for the physician to make the diagnosis and the pharmacist to prescribe the medicine . The Great Myth: • In the United States.

Perkembangan farmasi • Tradisional (sebelum thn 60 an) • Transisional ( mulai 60 an) • Farmasi klinik ( 40 th lalu) • Pharmaceutical care (awal abad 21) .

Farmasis • Sekarang Patient oriented dimana pasien? .

Prof. Historical Milestones in the Clinical Pharmacy Movement • 1944.the term “Clinical Pharmacy” comes to be used to denote patient- oriented pharmacy practice . L.Clinical Pharmacy as an educational tool first used – University of Washington. Wait Rising – Disapproved by AACP and ACPE in 1946 • 1969.

Clinical pharmacy cannot be defined. term should not be used • 1981. What is a Clinical Pharmacist? • 1972.“All pharmacists are clinical pharmacists” (ASHP) • 1981-American College of Clinical Pharmacy counters with “a pharmacist’s duties define whether he is a clinical pharmacist” .

Am J Hosp Pharm 1976. DC.Clinical Pharmacist’s Functions in the Drug Use Process • Medication history taking • Drug therapy advisor • Drug therapy monitoring • Patient drug counseling • Drug usage review • Drug therapy management McLeod.33:904-911 .

“Clinical” Pharmacy • Traditional • Clinical Pharmacy Services – Individualized Pharmacy Services medication monitoring – Synthesis and and evaluation chemistry of – Patient-centered care medication – Integrated health care – Preparation of drugs team in which pharmacist is directly – Dispensing involved in patient care medication services – PATIENT focus – PRODUCT focus .“Traditional” vs.

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© 2003 Pharmacy Manpower Project. Inc . Common vision of pharmacy practice: helping patients make the best use of their medicines.

. counseling and monitoring drug therapy • Dealing with medication misadventures: $177 billion drug morbidity/mortality Ernst F.Pharmacists Roles in Patient Care • Pharmacists as drug therapy managers • Assessing. • Overseeing medication management systems • Delivering pharmaceutical care: could save over $105 billion annually if universally available Johnson JA. 192-200. Bootman JL AJHP 1997 54: 554-558. Grizzle A JAPhA 2001.

What if This Was Your Mom? • Elderly consume 34% of all Rx’s • Many have issues related to medication access and coverage • Adverse drug reactions (ADRs) are among the top 5 threats to senior’s health What Will You Do When You Leave? © 2003 Pharmacy Manpower Project. Inc .

What Will You Do When You Le © 2003 Pharmacy Manpower Project. Inc . • 65-75% of FDA-approved meds not approved for use in children Yaffe et. Pharmacology 1992: 3-9.al Ped. What If This Was Your Child? • Little known about ADR’s in children • Pediatric ADR Reporting System--Pediatric Pharmacy Advocacy Group • 2 to 17% of children admitted to hospitals were admitted due to ADRs Mitchell et al AmJEpid: 1979: 196-204.

Y and Z? • What can I do? © 2003 Pharmacy Manpower Project. Inc Or… .How Are You Spending Your Time? • I’ll get to that project tomorrow? • My colleagues are tackling that issue • That issue is the responsibility of X.

• TERAPI PARENTERAL – TIDAK MELIBATKAN USUS – MISALNYA…………………………..? .

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TERAPI PARENTERAL • KENAPA DIPERLUKAN? .

sejarah .

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Indikasi Pemberian .

KOMPONEN UTAMA • AIR • ELEKTROLIT .

TERAPI PARENTERAL • MANA YG SEBAIKNYA DIBERIKAN JIKA DIBANDINGKAN DENGAN ORAL? .

KARENA TERAPI PER ORAL – LEBIH AMAN – LEBIH MURAH – LEBIH MUDAH DIGUNAKAN .• PASIEN SEBAIKNYA TIDAK DIBERIKAN TERAPI PARENTERAL JIKA TERAPI PERORAL DAPAT DILAKUKAN.

• JIKA TERAPI PER ORAL TIDAK MEMUASKAN. DIPERTIMBANGKAN DIBERIKAN RUTE LAIN YANG BUKAN INJEKSI .

KASUS • BAGAIMANA KALAU PASIEN SALAH INJEKSI? • BAGAIMANA KALAU SALAH MINUM OBAT? .

ANTIBIOTIKA • DIANJURKAN UNTUK MERUBAH PEMBERIAN ANTIBIOTIKA IV MENJADI ANTIBIOTIKA ORAL SESEGERA MUNGKIN UNTUK MENCEGAH RISIKO YANG TIDAK PERLU DAN BESARNYA BIAYA YANG DIKELUARKAN • SWITCH ANTIBIOTIKA ? .

ANTIBIOTIKA • SEGERA SETELAH MEMENUHI KRITERIA BERIKUT. PERTIMBANGKAN UNTUK MENGGANTI RUTE SEDIAAN OBAT JADI PER ORAL – SUHU BADAN < 38 DERJAT SELAMA 48 JAM – DAPAT MENERIMA MAKANAN/ CAIRAN MELALUI MULUT – TDK ADA MASALAH ABSORBSI – TIDAK MENGALAMI TAKIKARDI TANPA ALASAN YG JELAS – KONDISI PASIEN TIDAK MEMERLUKAN KOSENTRASI ANTIBIOTIKA DALAM JARINGAN YANG TINGGI. SEPERTI PD MENINGTIS – FORMULASI ORAL / ALTERNATIF PEMBERIAN PER ORAL YG SESUAI TERSEDIA .

KERUGIAN RUTE IV • RISIKO TOXISITAS TINGGI & TIDAK DAPAT DITARIK LAGI • PERLU LATIHAN & TEKNIK KHUSUSUNTUK MINIMALISIR KONTAMINASI MIKROBA & RESIKO • MASALAH PENYIMPANAN & PEMBUANGAN PERALATAN BEKAS PAKAI UNTUK HINDARI HIV/ HEPATITIS • TEKNIK PEMBERIAN LEBIH KOMPLEK ( CENDERUNG KELIRU ) MISAL PEMILIHAN PELARUT YANG SALAH AKAN MENGURANGI EFEKTIFITAS. . MENINGKATKAN TOXISITAS/ BIAYA.

METODE PEMBERIAN INJEKSI IV • INJEKSI BOLUS – VOLUMENYA KECIL DAN BERUPA INJEKSI SESAAT – INJEKSI BISA LANGSUNG. KEHILANGAN SEJUMLAH OBAT KERENA EKSTRA VASASI ATAU SHOK KECEPATAN . – BEBERAPA AHLI MENYARANKAN PENGENCERAN UNTUK MENGHINDARI KEINGINAN MENINJEKSI DALAM BEBERAPA DETIK. VIA IV CATHETER. TUJUANNYA MENGURANGI RISIKO IRITASI VENA.

RASA TERBAKAR/ BENGKAK PADA TEMPAT INJEKSI • SPEED SHOCK : OBAT YG DIBERIKAN TERLALU CEPAT. SULIT BERNAFAS . BRADIKARDI.TANDA” NYA NYERI. ISTILAH • EKTRAVASASI : BOCORNYA OBAT DARI VENA KE JARINGAN SEKITARNYA. TDK NYAMAN. KOLAPS. MENYEBABKAN KOMPLIKASI YG MELIPUTI HIPOTENSI.

TINGGI U. FUROSEMID ( OTOTOXIC RESPON CEPAT. ANTIBIOTIKA MENGIRITASI VENA ( EX. ERITROMISIN). PASIEN DPT BERAKTIVITAS DIANTARA PEMBERIAN DOSIS . INJEKSI BOLUS KEUNTUNGAN KERUGIAN CEPAT& TEKNIK SEDERHANA(PERLU BAHAYA. OBAT KOSENT.

INFUS SINGKAT ( INTERMITEN) • DIBERIKAN 10 MENIT – 6 JAM • VOL. 50 ML.500 ML .

INFUS CONTINIUS • DIBERIKAN SELAMA 24 JAM • VOL INFUS BERAGAM. MISAL PADA NUTRISI PARENTERAL . MULAI 1 ML PER JAM ( DENGAN POMPA SUNTIK< SYRINGE PUMP) HINGGA 3 LTR ATAU LEBIH SELAMA 24 JAM.