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"Penggunaan angiotensin converting enzyme inhibitor (ACEi) sebagai antihipertensi dapat menyebabkan efek samping berupa batuk kering. Penelitian ini bertujuan untuk menilai risiko penggunaan ACEi, yaitu kaptopril sebagai standar dibandingkan ACEi lain terhadap kejadian batuk kering pada pasien hipertensi di RSUD Cengkareng Jakarta Barat dan RSUD Tarakan Jakarta Pusat. Desain penelitian ini adalah kohort prospektif. Kriteria inklusi adalah pasien hipertensi rawat jalan yang mendapatkan terapi obat golongan ACEi selama ≤ 3 bulan dan bersedia untuk diikutsertakan sebagai sampel dalam penelitian di RSUD Cengkareng Jakarta Barat dan RSUD Tarakan tahun 2014. Sampel terdiri dari 54 pasien yang mendapat kaptopril dan 54 pasien yang mendapat obat ACEi bukan kaptopril yang diambil secara consecutive sampling pada bulan Januari-Juli 2014. Alat pengumpul data menggunakan wawancara terstruktur dan rekam medis pasien. Kejadian batuk kering akibat ACEi dievaluasi dengan menggunakan Algoritma Naranjo dan analisis data menggunakan uji Chi Square. Kejadian batuk kering terjadi pada 19,44% sampel. Faktor usia, jenis kelamin, suku bangsa, komorbiditas, body mass index (BMI), dosis obat, dan lama penggunaan tidak berhubungan bermakna dengan kejadian batuk kering akibat penggunaan ACEi. Tidak ada perbedaan risiko penggunaan ACEi kelompok kaptopril dibanding bukan kaptopril terhadap kejadian batuk kering.

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Use of angiotensin converting enzyme inhibitors (ACEi) as an antihypertensive agent can cause side effects such as dry cough. This study aimed to evaluate the risk of ACEi administration with captopril as the standard against another ACEi on dry cough incidence in hypertensive patients from various tribes at RSUD Cengkareng West Jakarta and RSUD Tarakan Central Jakarta. The design of this study is prospective cohort. The inclusion criteria were patients who received ACEi as hypertension therapy for ≤ 3 months gathered from outpatient polyclinics and those willing to participate as sample in this study at RSUD Cengkareng West Jakarta and RSUD Tarakan Central Jakarta.

Sample consist of 54 patients who received captopril and 54 patients received non captopril ACEi, taken by consecutive sampling from January-July 2014. The data was collected using structured interviews and from medical record. Dry cough incidence due to ACEi was evaluated using Naranjo Algorithm and the data was analyzed using Chi Square test. Dry cough incidence was found in 19,44% of sample. No significant relationship of age, gender, tribe, comorbidity, body mass index (BMI), dosage, and duration of use with dry cough incidence due to the use of ACEi. Furthermore there is no difference in risk between the use of captopril group and non captopril ACEi group on dry cough incidence."

"[ABSTRAKLatar belakang:Hipertensimerupakan salah satu faktor risiko gagal jantung kongestif. Di rawat inap RSUD Pasar Rebo pada tahun 2014, gagal jantung kongestif masuk dalam 10 penyakit terbanyak, dengan biaya total yang cukup besar dan terdapat selisih tarif antara tarif RS dengan tarif JKN, sehingga perlu dilakukan analisis minimalisasi biaya salah satunya pada obat antihipertensi.Tujuan: Penelitian ini bertujuan untuk memilih alternatif yang lebih cost- minimize antara ramipril-spironolakton dengan valsartan pada pengobatan gagal jantung kongestif di RSUD Pasar Rebo tahun 2014.Metode Penelitian: Penelitian ini merupakan penelitian kuantitatifberupa analisis cross-sectional retrospektif. Penelitian dilakukan dengan membandingkan nilai rata-rata biaya total dua alternatif pengobatan gagal jantung kongestif, yaitu ramipril-spironolakton dengan valsartan dengan menggunakan perspektif Rumah Sakit. Komponen biaya langsung medis yang dihitung adalah biaya obat, biaya jasa dokter dan biaya rawat inap. Sedangkan efektivitas dipastikan memiliki efek yang setara.Hasil: Berdasarkan hasil penelitian yang telah dilakukan pada pasien gagal jantung kongestif di RSUD Pasar Rebo tahun 2014 didapatkan bahwa: (1) Nilairata-rata biaya total penggunaan kombinasi obat ramipril-spironolakton sebesar Rp.2.527.743; (2) Rata-rata biaya total penggunaan obat valsartan sebesar Rp.2.430.923; (3) Obat ramipril-spironolakton efektivitasnya tidak berbeda signifikan atau setara dengan obat valsartan; (4) Adanya penghematan pada rata- rata biaya total obat valsartan sebesar Rp.96.820 per pasien; (5) Adanya penghematan pada biaya rawat inap obat valsartan sebesar Rp.299.031 per pasien.Kesimpulan: Obat valsartan memberikan nilai rupiah yang terendah dan menjadi pilihan yang lebih cost-minimize dibandingkan obat ramipril-spironolakton pada pasien gagal jantung kongestif di RSUD Pasar Rebo Tahun 2014.

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ABSTRACTBackground: Hypertension once of risk factor for congestive heart failure. The Pasar Rebo Hospital inpatient care in 2014, congestive heart failure is the top 10 most prevalent diseases, with a large of number total cost and there is a difference between tariff rates RS and JKN rate, so we need a cost-effectiveness analysis one with antihypertensive drug.Objective: This study aimed to choose an alternative that is more cost-minimize between the ramipril-spironolactone with valsartan in the treatment of congestive heart failure at Pasar Rebo Hospital in 2014.Methods: This is a quantitative research in the form of a retrospective cross- sectional analysis. The study was conducted by comparing the average value of total cost of two alternative treatment of congestive heart failure, ramipril- spironolactone with valsartan by using Hospital’s perspective. The direct medical cost component are cost of drugs, cost of physician services and cost of hospitalizations. Whereas effectiveness measuredand firmly to be equivalent.Results: Based on the research that has been conducted in patients with congestive heart failure at Pasar Rebo Hospital in 2014 found that: (1) The average total cost of ramipril-spironolactone’s drugare Rp.2.527.743; (2) The average total cost of valsartan’s drug are Rp.2.430.923; (3) Ramipril- spironolactone’s drug effectiveness does not significantly difference to valsartan’s drug; (4) There is cost saving on the average of total cost using valsartan’s drug Rp.96.820 per patient; (5) There is cost saving on hospitalization cost using valsartan’s drug Rp.299.031 per patient.Conclusions:V alsartan’ s drug give lowest rupiah value and be more cost minimizes option than ramipril-spironolactone’s drug for patient with congestive heart failure at Pasar Rebo Hospital in 2014., Background: Hypertension once of risk factor for congestive heart failure. The Pasar Rebo Hospital inpatient care in 2014, congestive heart failure is the top 10 most prevalent diseases, with a large of number total cost and there is a difference between tariff rates RS and JKN rate, so we need a cost-effectiveness analysis one with antihypertensive drug.Objective: This study aimed to choose an alternative that is more cost-minimize between the ramipril-spironolactone with valsartan in the treatment of congestive heart failure at Pasar Rebo Hospital in 2014.Methods: This is a quantitative research in the form of a retrospective cross- sectional analysis. The study was conducted by comparing the average value of total cost of two alternative treatment of congestive heart failure, ramipril- spironolactone with valsartan by using Hospital’s perspective. The direct medical cost component are cost of drugs, cost of physician services and cost of hospitalizations. Whereas effectiveness measuredand firmly to be equivalent.Results: Based on the research that has been conducted in patients with congestive heart failure at Pasar Rebo Hospital in 2014 found that: (1) The average total cost of ramipril-spironolactone’s drugare Rp.2.527.743; (2) The average total cost of valsartan’s drug are Rp.2.430.923; (3) Ramipril- spironolactone’s drug effectiveness does not significantly difference to valsartan’s drug; (4) There is cost saving on the average of total cost using valsartan’s drug Rp.96.820 per patient; (5) There is cost saving on hospitalization cost using valsartan’s drug Rp.299.031 per patient.Conclusions:V alsartan’ s drug give lowest rupiah value and be more cost minimizes option than ramipril-spironolactone’s drug for patient with congestive heart failure at Pasar Rebo Hospital in 2014.]"

"Gagal jantung merupakan masalah kesehatan yang progresif dengan angka mortalitas dan morbiditas yang tinggi di negara maju maupun negara berkembang termasuk Indonesia. Banyak pilihan yang dapat diberikan kepada pasien gagal jantung, salah satu contohnya adalah kombinasi ramipril-bisoprolol dan kandesartan-bisoprolol. Tujuan penelitian ini adalah menganalisis minimalisasi biaya antara kelompok terapi kombinasi ramipril-bisoprolol dan kandesartan-bisoprolol pada pasien BPJS rawat inap gagal jantung di RSJPD Harapan Kita tahun 2017. Penelitian ini merupakan penelitian cross-sectional dengan pengambilan data secara retrospektif terhadap rekam medis, resep dan sistem informasi rumah sakit. Pengambilan sampel dilakukan secara total sampling di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita. Efektivitas pengobatan diukur berdasarkan penurunan tekanan darah sistol dan diastol yang diasumsikan sama. Biaya didapatkan dari median total biaya pengobatan, meliputi biaya obat gagal jantung, obat non-gagal jantung, rawat inap, pemeriksaan penunjang dan jasa dokter. Sampel pada penelitian ini berjumlah 65 pasien, yaitu 37 pasien terapi kombinasi ramipril-bisoprolol dan 28 pasien terapi kombinasi kandesartan-bisoprolol. Median total biaya pengobatan kelompok terapi kombinasi ramipril-bisoprolol Rp 7.391.584,00 lebih mahal dibandingkan dengan kelompok terapi kombinasi kandesartan-bisoprolol Rp 7.061.533,00, terdapat selisih sebesar Rp 330.051,00. Analisis sensitivitas satu arah/-25 dilakukan untuk mengetahui kekuatan dari evaluasi ekonomi melalui perubahan terhadap hasil penelitian. Oleh karena itu, dapat disimpulkan bahwa kelompok terapi kombinasi kandesartan-bisoprolol lebih cost-minimal dibandingkan kelompok terapi kombinasi ramipril-bisoprolol dengan efektivitas yang setara.

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Heart failure is a progressive health problem with high mortality and morbidity in both developed and developing countries including Indonesia. Many options can be given to patients with heart failure, one example is a combination of ramipril bisoprolol and candesartan bisoprolol. The aim of this study was to analyze cost minimization between the combination therapy group of ramipril bisoprolol and candesartan bisoprolol in BPJS hospitalized patients with heart failure. This research was a cross sectional study with retrospective data retrieval on medical record, prescriptions, and hospital rsquo s information system. Sampling was done by total sampling. The effectiveness of treatment was measured by the decrease in systolic and diastolic blood pressure that was assumed to be the same. Cost was obtained from the median total cost of treatment, including the cost of heart failure drugs, non heart failure drugs, hospitalization, laboratorium and physician services. The sample in this study amounted to 65 patients, 37 patients from combination therapy ramipril bisoprolol and 28 patients from combination therapy candesartan bisoprolol. Based on the results of the study, the median total cost of treatment of Ramipril group Rp 7,391,584.00 was more expensive compared with the candesartan group Rp 7.061.533,00 , there was a difference of Rp 330,051.00. One way sensitivity analysis 25 was performed to determine the strength of the economic evaluation through changes to the research results. Therefore, it can be concluded that the candesartan therapy group is more cost minimal than the ramipril therapy group with equal effectiveness."

"Hipertensi dan diabetes melitus menjadi salah satu faktor risiko kejadian kardiovaskuler. Tidak terkontrolnya hipertensi dapat menyebabkan perburukan kesehatan dan ekonomi pada penderitanya. Kombinasi terapi antihipertensi dinilai adekuat untuk mencapai target tekanan darah <140/90 mmHg. Obat antihipertensi golongan ACEI, ARB, dan CCB merupakan terapi yang sesuai untuk pasien dengan diabetes melitus tipe 2 dan harganya bervariasi. Penelitian sebelumnya menunjukkan bahwa golongan ARB lebih cost-effective dibandingkan yang lainnya. Tujuan penelitian ini adalah untuk menganalisis efektivitas biaya dari kombinasi terapi amlodipin-kandesartan dibandingkan dengan amlodipin-ramipril pada pasien hipertensi dengan diabetes melitus tipe 2. Penelitian cross-sectional ini dilakukan di RSUPN dr. Cipto mangunkusumo dengan menggunakan rekam medis pasien tahun 2017-2019. Subjek penelitian yang memenuhi kriteria inklusi sebanyak 87 pasien. Pasien dibagi menjadi dua kelompok: kelompok yang mendapat terapi amlodipin-kandesartan dan kelompok yang mendapat terapi amlodipin-ramipril. Analisis efektivitas biaya diperoleh dari perhitungan biaya medik langsung, menghitung efektivitas terapi berdasarkan jumlah pasien yang mencapai target tekanan darah <140/90 mmhg, serta menghitung nilai ACER. Kombinasi amlodipin-kandesartan memiliki efektivitas terapi 48.9%, sedangkan efektivitas terapi amlodipin-ramipril 45,2%. Nilai ACER kelompok amlodipin-kandesartan dan kelompok amlodipin-ramipril adalah Rp. 1.604.736,2 per efektivitas and Rp 1.811.278,8 per efektivitas. Dapat disimpulkan bahwa amlodipin-kandesartan lebih cost-effective dibandingkan amlodipin-ramipril.

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Hypertension and diabetes mellitus are risk factors for cardiovascular events. Uncontrolled hypertension can cause health and economic burdens in patients. The combination of antihypertensive therapy is considered adequate to achieve the targeted blood pressure <140/90 mmHg. Antihypertensive drugs class such as ACEIs, ARBs, and CCBs are appropriated therapies for patients with type 2 diabetes mellitus and the price differences. Previous studies have shown that the ARBs are more cost-effective than others. The aim of this study was to analyze the cost-effectiveness of combination of amlodipine-candesartan compared to amlodipine-ramipril in hypertensive patients with type 2 diabetes mellitus. This cross-sectional study was conducted at Dr. Cipto Mangunkusumo Hospital by using patient medical records in 2017-2019. Research subjects who met the inclusion criteria were 87 patients. Patients were divided into two groups: group receiving amlodipine-candesartan and group receiving amlodipine-ramipril. Cost effectiveness analysis obtained from the calculation of direct medical costs, calculated the effectiveness of therapy based on the number of patients who reached the target blood pressure <140/90 mmHg, and calculated the value of ACER. Amlodipine-candesartan has a therapeutic effectiveness of 48.9%, while the effectiveness of amlodipine-ramipril is 45.2%. The ACER value of the amlodipine-candesartan group and the amlodipine-ramipril group were Rp 1,604,736.2 per effectiveness and Rp 1,811,278.8per effectiveness. To conclude, amlodipine-candesartan is more cost-effective than amlodipine-ramipril."

"Acute Kidney Injury (AKI) merupakan komplikasi serius yang umum terjadi pada pasien rawat inap. Berdasarkan penelitian tahun 2005, terjadi peningkatan insiden dan keparahan AKI hingga 50% akibat penggunaan obat selama rawat inap. Salah satu tugas apoteker di RS adalah melakukan pemantauan terapi obat, terdapat beberapa obat di RSUI yang dinilai mampu menginduksi terjadinya AKI. Oleh karena itu, dilakukan pembuatan daftar obat yang dapat menginduksi terjadinya AKI serta studi kasus terjadinya AKI pada pasien rawat inap akibat penggunaan obat di RSUI pada bulan Maret 2023. Daftar obat penginduksi AKI dibuat berdasarkan studi literatur dari pustaka tahun 2005 – 2023 kemudian obat dikategorikan berdasarkan kelas terapi obat. Sedangkan, studi kasus dilaksanakan secara retrospektif menggunakan data sekunder pasien rawat inap RSUI pada bulan Maret 2023 yaitu rekam medis salah satu pasien yang memenuhi kriteria inklusi dan eksklusi. Terdapat 26 obat yang mampu menginduksi AKI di RSUI. Berdasarkan studi kasus, terapi ramipril diduga mampu meningkatkan risiko terjadinya AKI pada salah satu pasien RSUI yang dinilai berdasarkan peningkatan nilai serum kreatinin dan penurunan nilai GFR. Ramipril diduga menjadi penyebab peningkatan risiko terjadinya AKI berdasarkan angka prevalensinya sebesar 28%, adanya riwayat perbaikan fungsi ginjal saat penghentian obat, serta fungsi ginjal yang kembali memburuk ketika terapi ramipril kembali dilanjutkan. Penilaian kondisi pasien menggunakan instrumen naranjo dibutuhkan untuk mengonfirmasi insiden terjadinya AKI akibat ramipril.

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Acute Kidney Injury (AKI) was a serious complication that commonly occurs in inpatients. Based on a study in 2005, there was an increase in the incidence and severity of AKI up to 50% due to drug induce during hospitalization. One of the responsibilities of the pharmacist in the hospital was to perform drug therapy monitor and several drugs in RSUI were considered likely to induce AKI. Therefore, a list of drugs induced AKI was created, and a case study of drug-induced AKI in hospitalized patients at RSUI in March 2023 was performed. The list of drugs induced AKI was made based on a literature study from 2005 – 2023, then the drugs were categorized based on the drug therapy class. Meanwhile, the case study was carried out retrospectively using secondary data from hospitalized patients at RSUI in March 2023, which was the medical records from one of the patients who met the inclusion and exclusion criteria. There are 26 drugs-induced AKI in RSUI. Based on the case study, ramipril therapy was thought to be likely to increase the risk of developing AKI in one of the RSUI patients as assessed by the increase of creatinine serum and the decrease GFR values. Ramipril is thought to be the cause of the increased risk of AKI based on its prevalence rate which was 28%, history of improvement in kidney function when stopping the drug, and worsened kidney function when ramipril therapy is resumed. Assessment of the patient's condition using the Naranjo instrument is needed to confirm the incidence of AKI due to ramipril."

"From pharmacologic investigations and clinical studies it is known that angiotensin-converting enzyme (ACE) inhibitors exhibit additional local actions, which are not related to hemodynamic changes and which cannot be explained simply by interference with the renin-angiotensin system with subsequent inhibition of angiotensin II formation. Because ACE is identical to kininase II, which inactivates the nonapeptide bradykinin (BK), potentiation of BK might be responsible for these additional effects of ACE inhibitors. To prove the specificity of BK-mediated effects by ACE inhibition, we used the specific B2 kinin receptor antagonist HOE 140 in different models: endothelial cell cultures; atherosclerosis in high-cholesterol-fed rabbits; neointima formation with smooth cell proliferation and migration after endothelial denudation in rats; myocardial ischemia in rats, rabbits, and dogs; and left ventricular hypertrophy in rats. The beneficial effects of ramipril or BK given in non-blood pressure-lowering doses in these models were abolished by HOE 140 (icatibant). Ramipril exerts cardioprotective effects in different experimental models. The formation of the endothelial autacoids nitric oxide and prostacyclin, enhanced when BK degradation is inhibited by ACE inhibition, may contribute to the observed beneficial effects."