Lorensia Drug Interaction Study Abstract 2009
Amelia Lorensia, et al.
D r u g in t e r a ct ion st u dy in hospit a liz e d h e pa t ic cir rh osis pa t ie n t in
D r . Ra m e la n n a vy h ospit a l
Amelia Lorensia1 * ) , Aziz Hubeis2 , Widyati3 , Hary Bagijo4
1
2
Lecturer, Faculty of Pharmacy Surabaya University, Surabaya, I ndonesia,
Senior 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 ra ct
Cirrhot ic liver lead t o som e changes in pat hophysiology such as reduct ion in liver blood
flow, decrease 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
increase in drugs sensit ivit y and adverse event s due t o pharm acokinet ic and
pharm acodynam ic influences. Treat m ent s for com plicat ions cirrhosis induce polypharm acy.
Therefore, hepat ic cirrhosis pat ient are at risk for serious 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 eract ion event s from drug t herapy in hospit alized hepat ic cirrhosis pat ient . Sam ples were
collect ed using purposive sam pling m et hods. Bot h drug t herapy and disease progress were
followed prospect ively unt il pat ient discharged from t he hospit al. Drug int eract ions event s
were recorded and evaluat ed according t o som e lit erat ure. Pat ient s involved in t his st udy
were 85. The t ot al num ber of drug int eract ions occured 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 spironolact one,
furosem ide, kalium supplem ent , am inophylline, ranit idine, and digoxin. This st udy
dem onst rat es t hat pot ent ial drug int eract ions were com m on am ong hepat ic cirrhosis pat ient ,
and pharm aceut ical care capable in reducing drug int eract ions event s.
Ke y w ords : drug int eract ion; hepat ic cirrhosis
I n t r odu ct ion
Cirrhosis is defined as a diffuse process charact erized by fibrosis and a conversion of
t he norm al hepat ic archit ect ure int o st ruct urally abnorm al nodules. 1
I n cirrhosis, scar t issue replaced t he norm al t issue, disrupt ed t he blood circulat ion t hat
t hrough t he liver . 2
Cirrhosis was t he cause of t he biggest deat h of t he nine in Unit ed St at es and 1,2%
from 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 cirrhosis, including reduced
liver blood flow, alt ered m icrocirculat ory dist ribut ion of blood flow wit hin t he liver, 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 wit h cirrhosis frequent ly
accum ulat e large am ount s of int erst it ial fluid result ing in subst ant ial changes in t he volum e
of dist ribut ion, which also prolongs drug half- life. 1,4 Moreover, t he product ion from prot ein
t hat was produced in t he liver experienced t he decline so as t he free drug fract ion in blood
increased because a lit t le t hat binding wit h prot ein. The increase in t he free drug fract ion in
blood will influence clirens 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 was high. 4 This caused t he pat ient cirrhosis m ore was
sensit ive t o t he m edicine and t he side- effect .
The m aj or com plicat ions of cirrhosis include ascit es, 1,5,6,7,8,9,10 port al hypert ension and
variceal bleeding 1,7,11 hepat ic encephalopat hy ( HE) , 1,11 spont aneous bact erial perit onit is
( SBP) , 1,8,7,11 hepat orenal syndrom e, 1 and coagulat ion disorders. 1 Ot her less com m only seen
problem s in pat ient s wit h cirrhosis include pept ic ulcer disease, 12,13 hepat opulm onary
syndrom e, 14 and insulin resist ance in diabet es m ellit us t ype 2. 15 So t he t reat m ent s for
com plicat ions cirrhosis induce polypharm acy.
The pat ient wit h t he dist urbance of t he funct ion of t he liver such as cirrhosis was risky
received t he problem because of t he effect of m edicat ion t hat was used experienced drug-
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 hospit a liz e d h e pa t ic cir rh osis pa t ie n t in
D r . Ra m e la n n a vy h ospit a l
Amelia Lorensia1 * ) , Aziz Hubeis2 , Widyati3 , Hary Bagijo4
1
2
Lecturer, Faculty of Pharmacy Surabaya University, Surabaya, I ndonesia,
Senior 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 ra ct
Cirrhot ic liver lead t o som e changes in pat hophysiology such as reduct ion in liver blood
flow, decrease 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
increase in drugs sensit ivit y and adverse event s due t o pharm acokinet ic and
pharm acodynam ic influences. Treat m ent s for com plicat ions cirrhosis induce polypharm acy.
Therefore, hepat ic cirrhosis pat ient are at risk for serious 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 eract ion event s from drug t herapy in hospit alized hepat ic cirrhosis pat ient . Sam ples were
collect ed using purposive sam pling m et hods. Bot h drug t herapy and disease progress were
followed prospect ively unt il pat ient discharged from t he hospit al. Drug int eract ions event s
were recorded and evaluat ed according t o som e lit erat ure. Pat ient s involved in t his st udy
were 85. The t ot al num ber of drug int eract ions occured 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 spironolact one,
furosem ide, kalium supplem ent , am inophylline, ranit idine, and digoxin. This st udy
dem onst rat es t hat pot ent ial drug int eract ions were com m on am ong hepat ic cirrhosis pat ient ,
and pharm aceut ical care capable in reducing drug int eract ions event s.
Ke y w ords : drug int eract ion; hepat ic cirrhosis
I n t r odu ct ion
Cirrhosis is defined as a diffuse process charact erized by fibrosis and a conversion of
t he norm al hepat ic archit ect ure int o st ruct urally abnorm al nodules. 1
I n cirrhosis, scar t issue replaced t he norm al t issue, disrupt ed t he blood circulat ion t hat
t hrough t he liver . 2
Cirrhosis was t he cause of t he biggest deat h of t he nine in Unit ed St at es and 1,2%
from 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 cirrhosis, including reduced
liver blood flow, alt ered m icrocirculat ory dist ribut ion of blood flow wit hin t he liver, 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 wit h cirrhosis frequent ly
accum ulat e large am ount s of int erst it ial fluid result ing in subst ant ial changes in t he volum e
of dist ribut ion, which also prolongs drug half- life. 1,4 Moreover, t he product ion from prot ein
t hat was produced in t he liver experienced t he decline so as t he free drug fract ion in blood
increased because a lit t le t hat binding wit h prot ein. The increase in t he free drug fract ion in
blood will influence clirens 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 was high. 4 This caused t he pat ient cirrhosis m ore was
sensit ive t o t he m edicine and t he side- effect .
The m aj or com plicat ions of cirrhosis include ascit es, 1,5,6,7,8,9,10 port al hypert ension and
variceal bleeding 1,7,11 hepat ic encephalopat hy ( HE) , 1,11 spont aneous bact erial perit onit is
( SBP) , 1,8,7,11 hepat orenal syndrom e, 1 and coagulat ion disorders. 1 Ot her less com m only seen
problem s in pat ient s wit h cirrhosis include pept ic ulcer disease, 12,13 hepat opulm onary
syndrom e, 14 and insulin resist ance in diabet es m ellit us t ype 2. 15 So t he t reat m ent s for
com plicat ions cirrhosis induce polypharm acy.
The pat ient wit h t he dist urbance of t he funct ion of t he liver such as cirrhosis was risky
received t he problem because of t he effect of m edicat ion t hat was used experienced drug-
Proceeding I nternational Conference on Pharmacy and Advanced Pharmaceutical Sciences
Yogyakarta, I ndonesia, 2009
205