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
 Motto Farmasis ( source unknown):
I am a pharmacist,
I am a specialist in medication ..
This is my calling .this is my pride ..,
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.
May God be with Us. Amen.
 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.
I will consider the welfare of humanity and relief of human
suffering through optimal drug therapy and the best
pharmaceutical care.
I will keep abreast of developments and the latest
pharmaceutical care to assure the best care to the community
and other healthcare providers.

Pharmacy Students Oath Committee,
School of Pharmaceutical Sciences,
Universiti Sains Malaysia
August 2004.


Kurikulum S1 farmasi
inggris
 The Great Myth:
In the United States, it is common
for the physician to make the
diagnosis and the pharmacist to
prescribe the medicine
 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?
 Historical Milestones in
the Clinical Pharmacy
Movement
1944- Clinical Pharmacy as an
educational tool first used
University of Washington, Prof. L. Wait
Rising
Disapproved by AACP and ACPE in 1946
1969- the term Clinical Pharmacy
comes to be used to denote patient-
oriented pharmacy practice
 What is a Clinical
Pharmacist?
1972- Clinical pharmacy cannot be defined;
term should not be used
1981- All pharmacists are clinical
pharmacists (ASHP)
1981-American College of Clinical Pharmacy
counters with a pharmacists duties define
whether he is a clinical pharmacist
Clinical Pharmacists 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, DC, Am J Hosp Pharm 1976;33:904-911
Traditional vs. 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
 Common vision of
pharmacy practice:
helping patients
make the best use of
their medicines.

2003 Pharmacy Manpower

Project, Inc
Pharmacists Roles in Patient Care
Pharmacists as drug therapy managers
Assessing, counseling and monitoring drug therapy
Dealing with medication misadventures: $177 billion
drug morbidity/mortality Ernst F, Grizzle A JAPhA 2001; 192-200.
Overseeing medication management systems
Delivering pharmaceutical care: could save over
$105 billion annually if universally available Johnson JA,
Bootman JL AJHP 1997 54: 554-558.
What if This Was Your Mom?
Elderly consume 34% of
all Rxs
Many have issues
related to medication
access and coverage
Adverse drug reactions
(ADRs) are among the
top 5 threats to
seniors health

What Will You Do When You

Leave?
2003 Pharmacy Manpower Project, Inc
 What If This Was Your
Child?
Little known about ADRs 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.
65-75% of FDA-approved meds
not approved for use in children
Yaffe et.al Ped. Pharmacology 1992: 3-9.

What Will You Do When You Le

2003 Pharmacy Manpower Project, Inc
How Are You Spending Your
Time?
Ill get to that
project tomorrow?
My colleagues are
tackling that issue
That issue is the
responsibility of X, Y
and Z?
What can I do?

2003 Pharmacy Manpower Project, Inc

Or
 TERAPI PARENTERAL
TIDAK MELIBATKAN USUS
MISALNYA..?
 TERAPI PARENTERAL

KENAPA DIPERLUKAN?
sejarah
Indikasi Pemberian
 KOMPONEN UTAMA
AIR
ELEKTROLIT
 TERAPI PARENTERAL
MANA YG SEBAIKNYA DIBERIKAN
JIKA DIBANDINGKAN DENGAN
ORAL?
 PASIEN SEBAIKNYA TIDAK DIBERIKAN
TERAPI PARENTERAL JIKA TERAPI
PERORAL DAPAT DILAKUKAN, KARENA
TERAPI PER ORAL
LEBIH AMAN
LEBIH MURAH
LEBIH MUDAH DIGUNAKAN
 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, VIA IV
CATHETER,
BEBERAPA AHLI MENYARANKAN
PENGENCERAN UNTUK MENGHINDARI
KEINGINAN MENINJEKSI DALAM
BEBERAPA DETIK, TUJUANNYA
MENGURANGI RISIKO IRITASI VENA,
KEHILANGAN SEJUMLAH OBAT KERENA
EKSTRA VASASI ATAU SHOK KECEPATAN
 ISTILAH
EKTRAVASASI : BOCORNYA OBAT DARI
VENA KE JARINGAN
SEKITARNYA.TANDA NYA NYERI, TDK
NYAMAN, RASA TERBAKAR/ BENGKAK
PADA TEMPAT INJEKSI
SPEED SHOCK : OBAT YG DIBERIKAN
TERLALU CEPAT, MENYEBABKAN
KOMPLIKASI YG MELIPUTI HIPOTENSI,
KOLAPS, BRADIKARDI, SULIT
BERNAFAS
 INJEKSI BOLUS

KEUNTUNGAN KERUGIAN
CEPAT& TEKNIK SEDERHANA(PERLU BAHAYA, OBAT KOSENT. TINGGI
U. ANTIBIOTIKA MENGIRITASI VENA ( EX.
ERITROMISIN), FUROSEMID
( OTOTOXIC
RESPON CEPAT, PASIEN DPT
BERAKTIVITAS DIANTARA
PEMBERIAN DOSIS
 INFUS SINGKAT
( INTERMITEN)
DIBERIKAN 10 MENIT 6 JAM
VOL. 50 ML- 500 ML
 INFUS CONTINIUS
DIBERIKAN SELAMA 24 JAM
VOL INFUS BERAGAM, MULAI 1 ML
PER JAM ( DENGAN POMPA
SUNTIK< SYRINGE PUMP) HINGGA
3 LTR ATAU LEBIH SELAMA 24
JAM, MISAL PADA NUTRISI
PARENTERAL