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ANALISIS KEFARMASIAN PADA KASUSCHORIOCARSINOMA VAGINA
METASTASE PARU ON KEMOTERAPI SERI
VI + HIPERTIROID
OLEH : KELOMPOK 4
1. OKTAVIA INDAH 0515131430602. EMAZ ZULFIAH 051513143062
3. MAHARDHILA N Z 051513143124
4. AU MA!ARI 051513143125
1
TUGAS PRESENTASI KASUS
PRAKTEK KERJA PROFESI APOTEKER PERIODE 102
RSUD Dr. SAIFUL ANWAR MALANG
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DEFINISIGESTASIONAL TROPHO"LASTIK DISEASE
#GTD$
Gestational Trophoblastic Disease (GTD) yaitusekelompok sel yang tumbuh abnormal pada rahim
wanita bagian dalam.Biasanya sel ini adalah tumor lunak dan tidak dapat menyebar ke
jaringan lain, tetapi ada sel yang bersifat cancerous yangdisebut malignant
(merican !ancer "ociety, #$%&)
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DEFINISICHORIOCARSINOMA
VAGINA
!horiocarsinoma merupakan salah satuGestational Trophoblastic Disease (GTD) yaitu sekelompok sel tumor
ganas (malignant) yang berkembangsecara cepat pada bagian dalam rahimdan mampu menyebar ke organ lain yang terletak jauh dari rahim seperti
paru'paru (*).
3
(merican !ancer "ociety, #$%&)
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EPIDEMIOLOGI !+-!-"/01G/
Terjadi pada #' setiap %$$.$$$ kehamilan di 2" danlebih sering terjadi di sia dan frika.
(merican !ancer "ociety, #$%&)
Terjadi pada % 3 %$.$$$'%&$.$$$ pada kehamilannormal
(+iramatsu et al .,#$$)Di ndonesia3 angka kejadian mola hidatidosa di -"+"
antara tahun %4%'%45 %&,67 %48'%4895 #%,%87 %488'%44%5%$,&6 per %$$$ kehamilan.
(:i:, #$%$)
4
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PATOFISIOLOGI!+-!-"/0 1G/
Hami a!""#r$ %ami&i#ar ra%im$
'("#"#ra!
M(!"aami )r*+(+'#r(,-a*r+i
T(r&a)a, +i+a /ari!"a! &i (a'a!"
ra%im a!" ,i&a'
,((r+i%'a!
T#m#% m(!/a&i +("a!a+
M(!(ar '( /ari!"a! ai! +()(r,i a"i!a$ )ar#)ar#$
i(r &a! *,a'
(merican !ancer "ociety, #$%&)
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%. 2mur ( ;9 th, dan <#$ th)#. =anita yang pernah
mengalami hamil anggur
9. >ehamilan di saluran telur6. >eguguran?aborsi. Golongan darah ( atau B)&. @il >B. Genetik
FAKTOR RESIKO!+-!-"/0 1G/
(merican !ancer "ociety, #$%&)
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MANISFESTASI KLINIS!+-!-"/0 1G/
P(r&ara%a! &i a"i!a
A!(mia
P(m(+ara! &i &a(ra% )(r#,
Oaria! 'i+,a
M#a &a! m#!,a%
Pr( (am)+ia
Hi)(r,ir*i&
(merican !ancer "ociety, #$%&)
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KOMPLIKASI!+-!-"/0 1G/
nemia
Gangguan Ginjal
sites
Afusi @leura
"yok
(:i:, #$%$)
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%. @emeriksaan darah lengkap dan urin#. @emeriksaan β+!G (+uman !horionic Gonadotropin )
9. 2"G6. !T'scan. 0- scan
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PEMERIKSAAN LA"
(merican !ancer "ociety, #$%&)
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MANA%EMEN TERAPI !+-!-"/0 1G/
10
1. S#r"(r 8P(m(&a%a!9
a. S#,i*! &ia,i*! a!&currettage 8D:;9
. H+,(r(,*m
2. K(m*,(ra)i
a. MTX . A,i!*mi!D. ;*)%*+)%ami&(&. ;%*ram#i(. <i!ri+,i!(
f. Etoposide". ;i+)a,i!%. I=*+=ami&(i. >(*mi! /. F#*r*#rai'. Pai,a?(
(merican !ancer "ociet , #$%&)
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MANA%EMEN TERAPI !+-!-"/0 1G/(lanj)
11
Single drug treatment #!,#' )a+i(! &(!"a! low risk&a! (#m ,(r/a&i m(,a+,a+(
M&'(')&*'&
IM ,&- 5 /)& (,, 50
ctinomycin'D 1 selama haridengan dosis $,mg?hari
E'((,& 2502 /) 1 3
(>elechi et al ., #$%9)
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MANA%EMEN TERAPI !+-!-"/0 1G/(lanj) Cow -isk
>i+ar*$ 2014
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(>elechi et al ., #$%9)
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MANA%EMEN TERAPI !+-!-"/0 1G/(lanj)
14
(>elechi et al ., #$%9)
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>i+ar*$ 2014
MANA%EMENTERAPI
!+-!-"/0
1G/ (lanj) +igh -isk
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STUD KASUS
1
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/ama 3 /y Cilik 02mur?BB?TB 3 9#th ? 6 kg ? %9 cmBB ? T0 3 9 kg ? #9 kg?m#
"tatus 3 >/ >elas lamat 3 @asuruan0-"?>-" 3 $#'$9'%&?$&'$9'%&-/?-uang3 9 ? 4Dokter 3 dr. !ecep
IDENTITAS PASIEN
1
6
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!horiocarcinoma Eagina metastase paruperasi 3 '-adiasi 3 '-iwayat keluarga 3 '>ebiasaan 3 Dulu pasien sering masak dengan tambahan 0"G
penyedap masakan instan>epatuhan 3 @asien patuh dan memiliki semangat tinggi untuk
sembuh
RI!AAT KESEHATAN
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DAFTAR MASALAH MEDIS
1. ;%*ri* ;a <a"i!a2. Hi)(r,ir*i&3. M(,a+,a+( Par#4. O! '(m*,(ra)i +(ri
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%&?$?#$% @asien mengalami keguguran hamilanak ke 9
!uretisasi di -" Buberta @asuruan
GAM"ARAN PER%ALAN PENAKITPASIEN
20
"etelah itu pasien mengalamipendarahan hingga 9 bulan, lalupasien juga sering merasa mual
muntah
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@asien periksa ke dokter dikatakanFhamil anggur atau istilahmedisnya choriocarcinoma Eagina.
Diduga karena curret tidak bersih
17-07-2015
Ma'r*@ /ari!"a! '(i'(*'a,a!Mi'r*@ /ari!"a! i'a, m(ra&a!",a%#!a! &a! '(*m)*' +(+( ,%r*)*a+, +a!"a,)r*i=(ra,i= &a! a,i)i' K(+im)#a! &ia"!*+a@;%*ri*ari!*ma
Pa,**"i A!a,*mi RS S*(&ar+*!*
GAM"ARAN PER%ALAN PENAKITPASIEN #LAN%$
21
>emoterapi di -"" %$ hari. @ulangpaksa ok tidak kerasan di ruangan !2ntensiEe. @asien mengalami pendarahanberat menghabiskan % pack pad dewasa.BB pasien turun #kg saat menjalani
kemoterapi pertama.
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2-11-2015
30-07-2015
2-10-2015
Ti&a' &i,(m#'a! +( "a!a+T(r&a)a, ()i,( &(!"a!)(r#a%a! ra&a!"
Pr*+(+ m(,a+,a+(&i )ar#
E=#+i )(#ra 'iri
Ra&i**"i
T%*ra? PA
Pa,**"i A!a,*mi
M#,i)( !*&#
)ar#$ +(+#ai)r*+(+ m(,a+,a+(
>emoterapi di -"".BB pasien perlahan naik H 9kg ? minggu.BB pasien saat ini &kg. >ondisi pasien
membaik.
22
$%?%$?#$%
@asien sering mengalami keputihan denganlendir dan bercak darah, serta bau H %bulan.da benjolan di rahim H % bulan.
23
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KEMOTERAPI PASIEN
>emoterapi3 metotreIate'etoposideDiagnosa3 !horio !a 1agina
@rimer treatment3 metotreIate'etoposideDosis3 BB?TB?C@B3 64kg?%$cm?%,6#m#
-egimen 3 0etotreIate #$ mgAtoposide %6$mg
"eri 3 $6?%#?%, 9 minggu yang akan datang diulang"eri 3 9 minggu yang akan datang diulang
"eri 3 9 minggu yang akan datang diulang"eri 1 3 9 minggu yang akan datang diulang"eri 1 3 9 minggu yang akan datang diulang"eri 1 3 $#?$9?%&
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KEMOTERAPI PASIEN#L78'$
Hari Jam Obat
I 0
I!/. MTB 20 m" IMI!=. D5C %ai+ &aam 2 /am
2
I!=. NS %ai+ &aam 2 /amI!/. <a!(ra! 1 am)# I< ,ia) 30 +((#m E,*)*+i&(
4
E,*)*+i&( 140m" &aam 500 NS %ai+ &aam a',# 2 /am &im#ai
,(,(+ )(a! 15,)m
II< I!/. MTB 20m" IM
24
25
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DATA KLINIK
ParameterNilai
Normal
Tanggal
02-3 03-3 04-3 05-3 0-3
S#%# 8*;9 33 3$5 3$3 3$5 3$2 3$5
Na&i8?-m(!i,9
6065 66 64 64 60 62
RR 8?-m(!i,9 20 20 16 20 20 20
TD 8mmH"9 120-60 150-0 100-0 120-60 110-0 110-0
25
2
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ParameterTanggal
02-3 03-3 04-3 05-3 0-3
M#!,a%
M#a
Sariaa!
>iir )(a%)(a%
S(m(i,
S(+a'
Sa'i, "i"i
DATA KLINIK #LAN%$
2
2
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DATA LA"
P)&'&) N()- 0110
2015
2511
2015
2912
2015
101
2016
002
2016
0103
2016
0203
2016
0403
2016
+BG %%'%&, * %#,&$ %% %%,8 %%,8 %%,%
=B! 9,'%$
%$9?ul
6,84 6,#8 6,9 6,&
-B! %%,$%& 6,68 6,%% 9,8
@!1 9'$ * 9,$ 9&,%$ 94,%$ 98,&$ 9&,#
@CT %$$$$'
94$$$$?ul
994.$$$ %.$#%.$$$ &.$$$ $$.$$$ 64.$$$
J +!GDarah Tidakhamil < ,6
@ost
menopouse
< 8,9
8&.$6 %%6.6
2
26
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@arameter /ormal $%?%$
#$%
#?%%
#$%
#8?%#
#$%
%4?$%
#$%&
$4?$#
#$%&
$%??$9
#$%&
$#?$9
#$%&
$6?$9
#$%&
/a %9'%6
mmol?l
%98 %9% %9 %9 %9
> 9,'
mmol?l
9,&6 9,8 9,4 9,9 9,64
!l 48'%$&mmol?l
%$4 %$ %$ %$
T9 Total 6, 6,94 %,%
Kree T6 9,9 %,8 $,8#
T"+ $,$% $,$# %,#
T?@T %%'6% 2?l
%$'6% 2?l
#9?%4 %#?%% %6?4 %?% %#?%9
B2/?!r %$'$
mg?dl
,'%,
mg?dl
%%,$?
$,68
4?$,69 4,6?$,69 %$,4$?$,66 &,?$,64
!l!r ml?menit? %&,&% %4,&9 %48,4
DATA LA" #LAN%$
26
27
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CATATAN PERKEM"ANGAN PASIEN
Tgl Kondisi Pasien
02-3 Pa+i(! !am)a' +a'i, ri!"a!$ '(#%a! m#a ma+i% a&a$ +a'i, "i"i$ iir)(a%)(a%
03-3 Pa+i(! !am)a' +a'i, ri!"a!$ '(#%a! m#a ma+i% a&a$ +a'i, "i"i 'a&a!"'a&a!"$ +ariaa! &i iir$ iir )(a%)(a%
04-3 Pa+i(! !am)a' +a'i, ri!"a!$ '(#%a! m#a ma+i% a&a$ +a'i, "i"i 'a&a!"'a&a!"$ +ariaa! &i iir$ iir )(a%)(a%
05-3 Pa+i(! !am)a' +a'i, ri!"a!$ '(#%a! m#a ma+i% a&a$ +a'i, "i"i 'a&a!"'a&a!"$ +ariaa! &i iir$ iir )(a%)(a%$ '*!+,i)a+i
0-3 Pa+i(! KRS$ '(#%a! ma+i% +ama
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PROFIL TERAPI
Obat Rute DosisTanggal Pemberian
02-3 03-3 04-3 05-3 0-3
E,*)*+i&( I<FD 140m"
MTB IM 20m"
A+am F*a, PO 2?1
<i,ami! >'*m)('+
PO 2?50m"
O!&a!+(,r*! I< 1?6 m"
PO 3? 6m"
A+amM(=(!ama,
PO 3?500m"
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TIN%AUAN TERAPI
31
32
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METHOTRE;ATE
32
33
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Mekanisme Kerja
33
M(,*,r('+a, a&aa% a!,a"*!i+ =*a,. T(,ra%&r*=*a,( (!,#' a',i=a+am =*a, a!" &i)(r#'a! #!,#' +i!,(+i+ )#ri! &a! ,imi!. A+am =*a,&ir(&#'+i m(!/a&i ,(,ra%i&r*=*a, *(% &i%i&r*=*a, r(&#',a+( 8DHFR9.M('a!i+m( +i,*,*'+i+i,a+ m(,%*,r(?a,(@ )(!"%ama,a! DHFR$)(!"%ama,a! ,imi&ia,$ &a! )(r#a%a! ,ra!+)*r,a+i a+am =*a,.M(,%*,r(?a,( a&aa% *a, )ai!" (=(',i= 'ar(!a (=(' +i,*,*'+i' ,(r/a&i,(r#,ama +(ama =a+( S &ari +i'#+ +(. M(,%*,r(?a,( /#"a m(mii'ia',ii,a+ im#!*+#)r(+i= .
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Dosis
34
&r#"+.*m$ 201
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35
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Profil farmakokinetik MTX dalam darah
3
3
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3
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3
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37
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ETOPOSIDE
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Dosis Etoposide
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ONDANSETRON
ndi!asi Me!anisme!er"a
E#O O
M(!("a% ,(r/a&i!a
m#a m#!,a% )a&a)a+i(! '(m*,(ra)i$)*+,*)(ra+i.O== a(@ %*(+,a,i)r#ri,i+$ J#r(mi)r#ri,i+$ +)i!a *)i*i&
i!&#(& )r#ri,i+$r*+a(a
S((',i= )a&a
a!,a"*!i+ r(+(),*r 5HT3 ai' &i)(ri=(rma#)#! ;NS$&(!"a! (=('
#,ama &i GI,ra'
10C@ +a'i,
'()aa 872C9$maai+($ )#+i!"8713C9$'*!+,i)a+i 811C9
Ami,ri),ii!$
ami*&ar*!$%*r)r*mai!($(ri,r*mi+i!$#i!i!($#i!i&i!($ri+)(ri&*!($
+#ma,ri),a!$,ar*im#+
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ASAM MEFENAMAT
ndi!asi Me!anisme !er"a E#O O
A#,( )ai!$
)rimar&i+m(!*rr%(a.O== a(@ a+#ar%(a&a%(
M(!"%ama,
+i!,(+i+)r*+,a"a!&i!&(!"a!m(!"%ama,i+*(!im ;OB1&a! ;OB2
N(ri )(r#,$ &iar($
'*!+,i)a+i$ )#+i!"8110C9.
S(ri#+@ a)i?aa!$
(i"air-*ii+,a,-(m,ri,ai!(-,(!*=*ir DF$'(,*r*a$met$otre%ate$)(m(,r(?(&$
,ar*im#+.
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ANALISA TERAPI
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ANALISA TERAPI
Pr*(m M(&i' @ *! '(m*,(ra)i +(ri
S-O T(ra)i T#/#a! M*!i,*ri!"
Pa+i(!m(!/aa!i'(m*,(ra)ir#,i! +(+#ai /a&a
Hari [email protected]@ I!/. MTB 20 m" IMI!=. D5C %ai+ &aam 2 /am16.00@ I!=. NS %ai+ &aam 2 /amI!/. <a!(ra! 1 am)# I< ,ia) 30+((#m E,*)*+i&(22.00@ E,*)*+i&( 140m" &aam500 NS %ai+ &aam a',# 2 /am
&im#ai ,(,(+ )(a! 15,)mHari II<@ I!/. MTB 20m" IM
M(!"%ama,)(r,#m#%a! +('a!'(r$m(!"i!,(r(!+i+i!,(+i+ DNA$m(m)(rai'i DNA&a! r()i'a+i +(.
ESO '(m*,(ra)i +()(r,im#a m#!,a%$ +ariaa!.
Oa, R#,( D*+i+Ta!""a P(m(ria!
02-3 03-3 04-3 05-3 0-3
E,*)*+i&( I<FD 140m"
MTB IM 20m"
A+am F*a, PO 2?1
<i,ami! >'*m)('+
PO 2?1
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Pr*(m M(&i' @ Pa+i(! m(!"aami &+)()+ia +!&r*m(
#&O Terapi Tu"uan MonitoringPa+i(!m(!"aami m#a
O!&a!+(,r*! 3?18)*9
M(!"a,a+i'(#%a! m#a)a&a )a+i(!
ESO*!&a!+(,r*!@'*!+,i)a+i
ANALISA TERAPI#-7..$
Param(,(rTanggal
02-3 03-3 04-3 05-3 0-3
M#a
Oa, R#,( D*+i+Ta!""a P(m(ria!
02-3 03-3 04-3 05-3 0-3
O!&a!+(,r*! I<
PO 3?6m"
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Pr*(m M(&i' @ Pa+i(! +a'i, "i"i
#&O Terapi Tu"uan Monitoring
Sa'i, "i"i$ +'aa!(ri@ 2
A+am M(=(!ama,500 m" 8)*9
M(!"#ra!"i ra+a!(ri 'ar(!a +a'i,"i"i
S'aa !(ri$'(#%a! +a'i, "i"i)a+i(!R('*m(!&a+i@a!,a"i!
3?500m"
ANALISA TERAPI#-7$
Oa, R#,( D*+i+Ta!""a P(m(ria!
02-3 03-3 04-3 05-3 0-3
A+amM(=(!ama,
PO 3?500m"
Param(,(rTa!""a
02-3 03-3 04-3 05-3 0-3
Sa'i, "i"i
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ANALISA DRP
5
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Jenis DRP 'nalisis Re!omendasi
I!,(ra'+i Oa, A+am m(=(!ama, m(!i!"'a,'a! 'a&arMTB &aam &ara% &(!"a!m(!#r#!'a! ;Lr &a! m(!"a'ia,'a!,*'+i+i,a+ GI &a! %(ma,**"i (ra,
M(!""a!,i ,(ra)i a+amm(=(!ama, &(!"a! m(=i!aa,a# )ara+(,am*
Jenis DRP 'nalisis Re!omendasi A&a i!&i'a+i ,i&a'a&a ,(ra)i
Pa+i(! m(!"aami +ariaa!$ &a! iir)(a% )(a% +(ama )r*+(+ '(m*,(ra)i
M(m(ri'a! i,ami! &*+i+,i!""i
Jenis DRP 'nalisis Re!omendasi
A&a i!&i'a+i ,i&a'a&a ,(ra)i
Pa+i(! m(!"aami '*!+,i)a+i +(amaMRS %a!a >A> 2?
M(!ara!'a! #!,#'m(!"'*!+#m+i ma'a!a! (r+(ra,
ANALISA DRP
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Jenis DRP 'nalisis Re!omendasi
A&a i!&i'a+i ,i&a'a&a ,(ra)i Pa+i(! ,i&a' m(!&a)a, ,(ra)i #!,#'m(!"a,a+i %i)(r,ir*i& P(r# m(!"(,a%#i &a,aa*ra,*ri#m ,(rar# #!,#'m(ma+,i'a! )a+i(!m(!"aami %i)(r,ir*i&M(!ara!'a! #!,#'m(!"'*!+#m+i ma'a!a! a!" m(!"a!&#!" "aram
(r*&i#m
ANALISA DRP
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@"A/ D>TA- @A-=T GL
- 0enjelaskan
tentang Asoobat
kemoterapi- 0enyarankan
terkait life
style
' 0elakukan
pemantauanterhadap
penyakit dan
perkembangan
kondisi pasien
- 0elakukan
pemantauanterhadap
perkembangan
kondisi pasien- 0emberi
penjelasanterkait
pemberian
obat
' 0elakukan
pemantauanasupan
makanan
KIE
0
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Kemoterapi untuk pasien choriocarcinoma vaginayang diberikan sudah sesuai dengan guideline.
Sebaiknya dilakukan pemantauan ESOkemoterapi yang dialami pasien.
Sebaiknya dilakukan monitoring terkait hipertiroidyang dialami pasien.
KESIMPULAN DAN SARAN
1
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DAFTAR PUSTAKA
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PERHITUNGAN STADIUM
(/gan et al ., #$%#)
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(merican !ancer "ociet , #$%&)
#tage
#tage
#tage
#tage (
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(merican !ancer "ociety, #$%&)
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0
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