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"Obat anti-inflamasi nonsteroid (OAINS) berhubungan dengan meningkatnya insidens komplikasi tukak gastrointestinal yang mendadak dan menetap. Penelitian ini bertujuan untuk menemukan kelainan-kelainan endoskopik yang ditemukan pada duodenum dan jejunum proksimal karena obat OAINS. Tiga puluh delapan pasien yang mengkonsumsi OAINS untuk penyakit arthritis atau rematiknya dimasukkan dalam penelitian ini. Pemeriksaan gastro-duodeno-jejunoskopi dilakukan dengan alat Olympus PCF-10. Gambaran endoskopik entero-gastropati-OAINS dievaluasi dengan sistim skor. Gambaran enterogastropati-OAINS secara endoskopik terlihat berupa hiperemis, erosi dan tukak. Keluhan diare terjadi pada 7,9% pasien dan dispepsia terjadi pada 71,1% pasien. Dari pemeriksaan endoskopi di bulbus duodenum, ditemukan 79% kasus dengan hiperemis, 39,5% kasus dengan erosi dan 7,9% kasus tukak. Di duodenum bagian kedua (pars desendens) ditemukan 28,9% kasus dengan hiperemis, 15,8% kasus dengan erosi dan 2,6% kasus tukak. Di jejunum, ditemukan 7,9% kasus dengan hiperemis, 2,6% kasus dengan erosi dan tidak ditemukan tukak. Disimpulkan bahwa kelainan endoskopik terbanyak yang ditemukan pada enteropati-OAINS yaitu hiperemis. Lokasi kelainan enteropati-OAINS tersering yaitu di bulbus duodenum. (Med J Indones 2005; 14: 225-9)

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Non Steroidal Anti Inflammatory Drugs (NSAID) have been associated with a sudden and sustained rise in the incidence of gastrointestinal ulcer complications. The aim of the study was to reveal the endoscopical abnormalities found in the duodenum & proximal jejunum due to NSAID. Thirty eight patients taking NSAID for their arthritis or rheumatism were included in this study. Gastro-duodeno-jejunoscopy was done with Olympus PCF-10. The endoscopical appearances of NSAID entero-gastropathy were evaluated with a scoring system. The NSAID-entero-gastropathy appearances were endoscopically seen as hyperemia, erosion and ulcer. From all patient recruited, 7.9% complaint of diarrhea and 71.1% complaint of dyspepsia. Endoscopically, in the duodenal bulb we found 79% cases of hyperemia, 39.5% cases of erosion and 7.9% cases of ulcer. In the second part (descending part) of the duodenum we found 28.9% cases of hyperemia, 15.8% cases of erosion and 2.6% case of ulcer. In the jejunum, we found 7.9% cases of hyperemia, 2.6% case of erosion and no ulcer. It is concluded that the most frequent abnormal endoscopical appearances in NSAID- enteropathy was hyperemia. The most frequent site of NSAID-enteropathy abnormal findings was in the duodenal bulb. (Med J Indones 2005; 14: 225-9)"

"Hiperlipidemia merupakan kelainan metabolisme lipid dan salah satu penyakit kronis yang sering dialami oleh masyarakat Indonesia dengan prevalensi 72,8%. Selain hiperlipidemia, gout adalah penyakit kronis yang sering dijumpai di Indonesia. Pasien dengan penyakit kronis terutama penyakit yang menimbulkan nyeri, umumnya harus mengkonsumsi obat dalam jangka panjang dan termasuk dalam kategori obat keras yang dapat diperoleh melalui resep dokter. Oleh karena itu, salah satu peran apoteker adalah melakukan pengkajian resep untuk memastikan pasien mendapatkan pengobatan yang tepat dan rasional serta menghindari terjadinya kesalahan dalam pelayanan kefarmasian dan medication error. Berdasarkan hasil pengkajian resep yang masuk di Apotek Roxy Ciledug mengenai terapi OAINS dan pengaruh OAINS terhadap penyakit hiperlipidemia dan gout, pada kajian administratif, resep memenuhi hampir semua aspek administratif, kecuali SIP dokter, alamat praktik dokter, dan nomor telepon dokter. Pada kajian farmasetik, resep memenuhi seluruh aspek dan persyaratan farmasetik. Pada kajian pertimbangan klinis, resep hampir memenuhi kriteria, namun terdapat masalah terkait obat, yaitu pemilihan dosis dan pemilihan obat yang dapat menyebabkan peningkatan risiko efek samping, yaitu terdapat interaksi mayor antara meloxicam dengan methylprednisolone dan pemilihan dosis meloxicam yang melebihi dosis maksimal per hari.

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Hyperlipidemia is a disorder of lipid metabolism and one of the chronic diseases often experienced by Indonesians with a prevalence of 72.8%. In addition to hyperlipidemia, gout is a chronic disease that is often found in Indonesia. Patients with chronic diseases, especially diseases that cause pain, generally have to take drugs in the long term and are included in the category of hard drugs that can be obtained through a doctor's prescription. Therefore, one of the roles of pharmacists is to review prescriptions to ensure that patients receive appropriate and rational treatment and avoid errors in pharmaceutical services and medication errors. Based on the results of the review of incoming prescriptions at Roxy Ciledug Pharmacy regarding NSAID therapy and the effect of NSAIDs on hyperlipidemia and gout, in the administrative review, the prescription fulfilled almost all administrative aspects, except for the doctor's SIP, doctor's practice address, and doctor's telephone number. In the pharmaceutical review, the prescription fulfilled all pharmaceutical aspects and requirements. In the clinical consideration review, the prescription almost met the criteria, but there were drug-related problems, namely dose selection and drug selection that could lead to an increased risk of side effects, namely there was a major interaction between meloxicam and methylprednisolone and meloxicam dose selection that exceeded the maximum dose per day.

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"ABSTRAKNyeri pinggang pada pasien batu ginjal dan batu ureter membutuhkan pengobatan yang cepat dan tepat. Banyak obat-obatan yang sudah diteliti sebagai pengobatan nyeri pada pasien batu ginjal dan batu ureter. Kebanyakan pasien dengan nyeri pinggang diberikan obat golongan NSAID. Efek samping NSAID terhadap gastrointestinal, ginjal dan sistem kardiovaskular cukup berbahaya untuk pasien sehingga harus dibatasi penggunaannya. Agropyron repens selain sebagai pengobatan MET juga dapat mengurangi rasa nyeri pada pasien batu ginjal dan batu ureter.

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ABSTRACTFlank pain in kidney stone and ureter stone s patient needs a fast and appropriate medication. Most of flank pain patients were prescribed NSAID medicine. The side effect of NSAID in terms of gastrointestinal, kidney, and cardiovascular system is adequately dangerous, thus it needs to be in control. Agropyron repens is not only for medication, but also for decreasing pain in kidney stone and ureter stone."

"Gastropathy refers to the damage of the epithelial cells of the gastric mucosa and disturbance of epithelial cell regeneration unaccompanied by inflammation. Gastropathy occurs due to irritation by chemical agents (such as non-steroidal anti inflammatory drugs - NSAIDs and alcohol), bile reflux, hypovolemic conditions, and chronic obstruction.NSAIDs in general are chemical agents that cause irritation of the upper gastrointestinal tract through direct and indirect topical effects and by inhibiting prostaglandin synthesis through inhibition of COX-1 and COX-2. There are many data that demonstrates that the anti-inflammatory function of NSAIDs is mainly through inhibition of COX-2, while many of their side effects are due to inhibition of COX-1.In general, there is a correlation between the influence of NSAID and the administered dose. The higher the dose, the higher the risk for upper gastrointestinal tract disorder. NSAID users who frequently switch drugs have a risk twice higher than those only receiving one kind of NSAID. Those who use NSAID with corticosteroids have 15 times the risk. Use ofNSAID simultaneously with anticoagulants increases the risk of bleeding from ulcer 13 times compared to control subjects. NSAID use in a patient with history of bleeding from the gastrointestinal tract is 17.2 times non-users. Smoking also increases the percentage of gastroduodenal ulcer due to NSAID.Clinical symptoms ofNSAID gastropathy are often only dyspepsia syndrome. There is no correlation between symptoms and endoscopic findings.The first step in the therapy ofNSAID gastropathy is termination ofNSAID administration. To treat and prevent risks of gastropathy due to NSAID, mucosal protection agents may be used. Out of the various kinds of medicine available, proton-pump inhibitors turn out to be more effective compared to H2 receptor antagonists or cytoprotectiveagents."

"Non-steroid anti-inflammatory drugs (NSAID) can cause gastropathy and gastric mucosa, especially the mucous may play an important prevention role. This cross-sectional, single group study was conducted to evaluated the difference of mucous thickness in antrum or corpus mucosa and the correlation of gastric mucous thickness to gastropathy. Patients who received NSAID from the rheumatology clinic were studied. Healthy subjects of 14 - 65 years old who never received NSAID were included as normal controls. Piroxicam 20 mg daily was given to the patients for 7 days, then gastroscopy and gastric mucosa biopsy with frozen section were performed. Specimens were stained with haematoxyline eosin and thickness of the mucous layer was measured using ocular micrometer. Thirty-two out of 70 patients participated in the study. All cases had hyperemia on gastroscopy with erosions and ulcer in 32 and 9 cases, respectively. The mean thickness of mucosa in distal antrum, proximal antrum and corpus was 28.5 ± 9, 37.4 ± 13.1 and 43.3 ± 13.1 microns, respectively. There was significant relationship between gastric mucosa mucous thickness with gastroscopic findings. In conclusion, this study confirmed that thickness of gastric mucosa mucous has an important role in preventing NSAID gastropathy and dyspeptic complaints in this kind of patients does not suggest abnormalities of gastric mucosa."

"Alarm symptoms for dyspepsia, such as anemia, evidence of gastrointestinal bleeding, weight loss, dysphagia, odynophagia and new onset at age > 50 years are associated with an increase risk of cancer. Most guidelines for the management of dyspepsia emphasize that patients with alarm symptoms should undergo aggressive evaluation including endoscopy.We reported a case of 65 years old female with several alarm symptoms that suggesting of malignancy, but endoscopy finding revealed gastroduodenitis erosive NSAID due to the pain killer herbal medicine use."

"ABSTRACTAcquired hemophilia A (AHA) is a blood clotting disorder caused by the presence of autoantibodies (inhibitors) against factor VIII. The typical symptom of this disorder is bleeding under the skin and soft tissue (rarely in the joints), with no family or personal previous history of bleeding. This case reports is tended to build up awareness for better diagnosis and therapy. Woman, 39 years old, bruises on both forearms are intermittent for 2 months with a history of long term drug consumption for headache treatment. Hemostatic test showed the elongation of activated partial thromboplastin test (APTT) to 87,1 (normal 24,4-44,4 seconds) and the decreament of factor VIII (FVIII) activity to 5% (normal 60-150%). Provision of recombinant factor VIII lowered factor VIII activity to 2%. Factor VIII inhibitor titer was 21,12 BU and diagnosis AHA was made. Inhibitor eradication by methylprednisolone tablet 3x16mg which was given for 2 months, improved the APPT to 46,7 seconds and factor VIII activity to 36%. Acquired Hemophilia A should be suspected in an adult bleeding patient with history of taking a long time non-steroidal anti-inflammatory drugs (NSAIDs). This case is a rare case in Indonesia and therefore the procedure for diagnosis needs to be improved in order to avoid errors in delivering a therapy which can cause the decreament of factor VIII activity."

"Non steroidal anti-inflammatory drugs (NSAIDS) are now commonly used in clinical practice. On the other hands, this drug could result severe complication such as bleeding and perforation. In such condition, proton pump inhibitor can be used to stop bleeding than H, antagonists. We reported one cases of upper gastrointestinal bleeding due to NSAID gastropathy that was unresponsive to Ranitidine. The treatment was suitable to proton pump inhibitor that could overcome upper gastrointestinal bleeding."