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)

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. FH : Her
grandmother died due to Ca
Mammae as well

4 cycles of AC (Doxorubicin and

Cyclofosfamid)
TREATMENT PLAN
4 cycles of TH (traztuzumab and
Docataxel)
After the first chemoterapy,
patient experienced fatigue,
nausea and constipation since the
1st day, Medication were
Dexamethason 20 mg, Tropisetron
5 mg, and Tramadol 100 mg. Lab
data: Hb 12,6 g/dl, Erytrocyte 4,49
, Hematocrit 39,6 SL (%),
Leucocyte 5510 mm3, Trombocyte
257000, Serum Creatinine 0,7

Patient assasement
CLINICAL MANIFESTATION AND CLINICAL
PROBLEM
Subjective :
Objective :
Clinical
Age 45 yo,
Hb 12,6 g/dl,
Problem :
Moderate pain
Erytrocyte 4,49 , Actual Problem :
and had swollen Hematocrit 39,6 Ca Mamae
in the right
SL (%),
Dextra Stadium
breast, fatigue, Leucocyte 5510 II
nausea and
mm,
constipation
Trombocyte
Potential
since the first
257000, Serum Problem :
day
Creatinine 0,7
chemotherapy
mg/dl, BUN 11
mg/dL, Uric acid

epidemiology
Based Pathological
Registration Based in
Indonesia, KPD ranks first with a relative
frequency of 18.6%. (Data on Cancer in
Indonesia in 2010, according to data
histopathological; 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 / 100,000 women,
whereas in the US is about 92 / 100,000
woman with a fairly high mortality is 27 /
100,000 or 18%
of the deaths were found in women. This
disease can also be inflicted on men - men

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

Doxorubicin

60 mg/m2

IV Push

N/A

1-4

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

DOSSAGE
RECOMMENDATION
DOSSAGE RECOMMANDATION
1. DOXORUBICIN
= 1,63 m2 x 60 mg/m2
= 97,8 mg
2. CYCLOPHOSPHAMIDE = 1,63 m2 x 600 mg/m2
= 978 mg
3. DOCETAXEL
= 53,79

= 1,63 m2 x 33 mg/m2

4. TRAZTUZUMAB= 8 mg x 60 kg
= 480 mg (Loading Dose)
= 6 mg x 60 kg
= 360 mg (Maintanance Dose)

SUPPORTIVE THERAPY
CONSTIPATION :
LAXADIN 1-2 sendok makan, satu kali
sehari sblm tidur

ANTIEMETIK
PALONOSETRON 0,25 mg iv tapi karena
tidak masuk BPJS digunakan ondansetron
8 mg or 0,15 mg/kg iv, atau 16 mg po

PAIN
Tramadol 100 mg PO

LEUKOPENIA
Filgastrim 300 mcg/ml, 1x sehari 1 vial
selama 5 hari

MONITORING CHEMOTHERAPY
Monitoring AC

Monitoring TH

NUTRISI

TOXICITY
1. DOXORUBICIN
500mg/m2)

= Myocardial toxicity (>450-

2. CYCLOPHOSPHAMIDE

= Cardiotoxicity

3. DOCETAXEL

4. TRAZTUZUMAB

= Pulmonary Toxicity
(SUMBER : DIH ED. 17)