Amelia Lorensia, et al.
Proceeding I nternational Conference on Pharmacy and Advanced Pharmaceutical Sciences Yogyakarta, I ndonesia, 2009
205
D r u g in t e r a ct ion st u dy in h osp it a liz e d h e pa t ic cir r h osis pa t ie n t in
D r . Ra m e la n n a v y h ospit a l
Amelia Lorensia1*), Aziz Hubeis2, Widyati3, Hary Bagijo4
1
Lecturer, Faculty of Pharmacy Surabaya University, Surabaya, I ndonesia, 2Senior Lecturer, Faculty of Pharmacy Surabaya University, Surabaya, I ndonesia,
3
Clinical Pharmacist of Dr. Ramelan Navy Hospital, Surabaya, I ndonesia, 4
I nternist of Dr. Ramelan Navy Hospital, Surabaya, I ndonesia
Abst r a ct
Cirrhot ic liver lead t o som e changes in pat hophysiology such as r educt ion in liver blood flow , decr ease som e m et abolic and synt het ic funct ion of t he liver . Also t here is a change in endot helial lining from hepat ic sinusoid. These changes result in som e consequences t hat are incr ease in drugs sensit ivit y and adverse ev ent s due t o pharm acokinet ic and phar m acodynam ic influences. Tr eat m ent s for com plicat ions cir r hosis induce polyphar m acy . Therefore, hepat ic cirrhosis pat ient are at risk for ser ious drug int eract ions. The out com e can be harm ful if t he int eact ions causes an increase in t he t oxicit y of t he drug. To st udy drug int er act ion event s fr om drug t herapy in hospit alized hepat ic cirrhosis pat ient . Sam ples w er e collect ed using pur posive sam pling m et hods. Bot h drug t her apy and disease progr ess w er e follow ed pr ospect ively unt il pat ient dischar ged fr om t he hospit al. Dr ug int er act ions event s w er e r ecor ded and evaluat ed accor ding t o som e lit er at ur e. Pat ient s involv ed in t his st udy w ere 85. The t ot al num ber of drug int eract ions occur ed in t his st udy were 5 cases ( 5,88% ) . All event s is pot ent ial drug int eract ions. Pot ent ial drug int eract ion involved spir onolact one, fur osem ide, kalium supplem ent , am inophylline, ranit idine, and digoxin. This st udy dem onst rat es t hat pot ent ial dr ug int eract ions were com m on am ong hepat ic cirrhosis pat ient , and pharm aceut ical car e capable in reducing drug int eract ions event s.
Ke y w or ds : drug int eract ion; hepat ic cirrhosis
I n t r odu ct ion
Cirrhosis is defined as a diffuse pr ocess char act er ized by fibr osis and a conver sion of t he norm al hepat ic archit ect ure int o st ruct urally abnorm al nodules.1
I n cir rhosis, scar t issue replaced t he norm al t issue, disrupt ed t he blood cir culat ion t hat t hrough t he liver .2
Cir r hosis w as t he cause of t he biggest deat h of t he nine in Unit ed St at es and 1,2% fr om all t he deat hs in Unit ed St at es.3 Cirrhosis affect s 3.6 per 1000 adult s in t he Unit ed
St at es and is responsible for 26,000 deat hs per year .1
The pat hophysiologic changes t hat occur in pat ient s wit h cir rhosis, including r educed liv er blood flow , alt er ed m icr ocir culat or y dist r ibut ion of blood flow w it hin t he liv er , dim inished m et abolic and synt het ic funct ion, and changes in t he endot helial lining of t he sinusoids, can have a significant im pact on each of t hese fact ors.1 Finally , pat ient s w it h cir r hosis fr equent ly
accum ulat e lar ge am ount s of int erst it ial fluid result ing in subst ant ial changes in t he volum e of dist r ibut ion, w hich also pr olongs dr ug half- life.1,4 Mor eover , t he pr oduct ion fr om prot ein
t hat w as produced in t he liver experienced t he decline so as t he free drug fract ion in blood incr eased because a lit t le t hat binding wit h pr ot ein. The incr ease in t he fr ee dr ug fr act ion in blood will influence clir ens of renal and hepat ic like t he volum e of t he dist ribut ion of m edicine t hat t he associat ion of his prot ein w as high.4 This caused t he pat ient cir rhosis m or e w as sensit ive t o t he m edicine and t he side- effect .
The m aj or com plicat ions of cir rhosis include ascit es,1 ,5,6,7,8,9,10 por t al hyper t ension and var iceal bleeding 1,7,11 hepat ic encephalopat hy ( HE) ,1,11 spont aneous bact er ial perit onit is
( SBP) ,1 ,8 ,7,11 hepat or enal syndr om e,1 and coagulat ion disor der s.1 Ot her less com m only seen problem s in pat ient s w it h cirrhosis include pept ic ulcer disease,12,13 hepat opulm onar y
syndr om e,14 and insulin r esist ance in diabet es m ellit us t ype 2.15 So t he t reat m ent s for com plicat ions cir rhosis induce polypharm acy.
