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SKRIPSI
BARLANTY FATHANAHIYAH
STUDI PENGGUNAAN CAPTOPRIL PADA
PASIEN STROKE ISKEMIK
(Penelitian di Rumah Sakit Umum Daerah Sidoarjo)
PROGRAM STUDI FARMASI
FAKULTAS ILMU KESEHATAN
UNIVERSITAS MUHAMMADIYAH MALANG
2015
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KATA PENGANTAR
Bismillahirrohmanirrohim
Assalamu’alaikum warohmatullahi wabarokatuh
Puji syukur tercurahkan kepada ALLAh SWT, tuhan semesta alam karena
berkat rahmad dan ridhonya, penulis dapat menyelesaikan skripsi yang berjudul
STUDI PENGGUNAAN CAPTOPRIL PADA PASIEN STROKE ISKEMIK
(Penelitian di Rumah Sakit Umum Daerah Sidoarjo).
Skripsi ini diajukan untuk memenuhi syarat untuk mencapai gelar Sarjana
Farmasi pada Program Studi Farmasi Fakultas Ilmu Kesehatan Universitas
Muhammadiyah Malang. Dalam penyusunan skripsi ini penulis tidak terlepas dari
peranan pembimbing dan bantuan dari seluruh pihak. Oleh karena itu, dengan
segala kerendahan hati, penulis ingin mengucapkan banyak terima kasih kepada:
1. ALLAH SWT, tuhan semesta alam yang memberikan rahmat, nikmat dan
hidayahNYA kepada umatnya, Rosulullah SAW, yang sudah menuntun
kita menuju jalan yang lurus.
2. Bapak Yoyok Bekti Prasetyo, M.Kep., Sp. Kom selaku Dekan Fakultas
Ilmu Kesehatan Universitas Muhammadiyah Malang yang telah
memberikan kesempatan penulis belajar di Fakultas Ilmu Kesehatan
Universitas Muhammadiyah Malang.
3. Ibu Nailis Syifa, S.Farm., MSc., Apt selaku Ketua Program Studi Farmasi
Universitas Muhammadiyah Malang yang telah memberi motivasi dan
kesempatan penulis belajar di Program Studi Farmasi Universitas
Muhammadiyah Malang.
4. dr. Atok Irawan, Sp. P selaku Direktur Rumah Sakit Umum Daerah
Sidoarjo beserta jajarannya yang telah memberikan kesempatan pada
penulis untuk melakukan penelitian di Rumah Sakit Umum Daerah
Sidoarjo.
v
5. Staf pengawai RMK RSUD Sidoarjo yang banyak membantu dalam proses
pengambilan data skripsi.
6. Ibu Nailis Syifa’,S.Farm.,M.Sc.,Apt., dan Bapak Drs. Didik
Hasmono,M.S.,Apt., selaku Dosen Pembimbing I dan II, disela kesibukan
Bapak dan Ibu masih bisa meluangkan waktu untuk membimbing dan
memberi pengarahan dan dorongan moril sampai terselesaikannya skripsi
ini.
7. Ibu Dra. Lilik Yusetyani, Apt., Sp.FRS., dan Ibu Hidajah Rachmawati,
S.Si., Apt., Sp.FRS selaku Dosen Penguji I dan II, yang telah banyak
memberikan saran dan masukan demi kesempurnaan skripsi ini.
8. Ibu Sovia Aprina Basuki, S.Farm., Apt., M. Si. selaku Dosen wali. Terima
kasih banyak atas arahan, nasehat, dan bimbingannya selama ini.
9. Untuk semua Dosen Farmasi Universitas Muhamadiyah Malang yang
sudah memberikan waktunya untuk mengajarkan ilmu-ilmu yang sangat
berguna, khususnya kepada Ibu Sendi Lia Yunita, S.Farm., Apt., selaku
Dosen penanggung jawab skripsi yang telah susah payah membantu
jalanya ujian skripsi sehingga kami dapat melaksanakan ujian skripsi
dengan baik.
10. Untuk semua angggota tata usaha Program Studi Farmasi Fakultas Ilmu
kesehatan Universitas Muhammadiyah Malang, yang telah banyak
membantu untuk kebutuhan administrasi kelengkapan skripsi.
11. Orang Tuaku tercinta, Bapak Tri Akbari Hadi dan Ibu Sarulin, yang tiada
hentinya memotivasi dalam segala hal, dengan sabar mendoakan untuk
kebaikan dan kesuksesan anak-anaknya. Terima kasih banyak atas didikan
dan kerja keras untuk membuat anak-anaknya bahagia serta mendapatkan
ilmu yang bemanfaat.
12. Saudariku Hazra Farahiyah Ramadhani dan Albirr Rifqi Raziz, terima
kasih buat motivasi dan doanya sehingga skripsi ini dapat selesai tepat
waktu.
13. Sahabat seperjuanganku Dwi Qurrothul Aini, Zeni Putri A.D.T, Nifda
Novi A, Siti Maslahah S, dan Bernika Ika I terima kasih atas kebersamaan,
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bantuan, motivasi, semangat kalian selama ini sebagai sahabat yang
membantu dan mendukung saat senang maupun susah.
14. Teman-teman seperjuangan kelompok skripsi Dwi, Zeni, Ayu, Fina dan
Alif dengan keceriaan dan semangat kalian selama ini sebagai sahabat
yang membantu dan mendukung sehingga skripsi ini dapat terwujud.
15. Teman-teman Farmasi UMM 2011, khususnya Farmasi D terima kasih
atas kebersamaan dan kenangan indah selama ini, terima kasih atas
pelajaran hidup yang diberikan.
16. Keluarga besar kontrakan MSC AS SYFA terima kasih banyak atas
kebersamaannya, dukungan, semangat, doa, dan motivasinya serta ilmu
agama yang telah diajarkan kepada saya hingga Insyaallah bermanfaat
nantinya.
17. Untuk semua pihak yang belum disebutkan namanya, penulis mohon maaf
dan terima kasih yang sebesar-besarnya. Semua keberhasilan ini tak luput
dari bantuan, doa yang telah kalian semua berikan.
Jasa dari semua pihak yang telah membantu dalam penelitian ini, penulis
tidak mampu membalas dengan apapun. Semoga amal baik semua pihak
mendapat imbalan dari Allah SWT. Penulis menyadari bahwa skripsi ini jauh dari
kesempurnaan, oleh karena itu penulis mengharapkan saran dan kritik yang
membangun dari pembaca demi kebaikan skripsi ini. Semoga penulisan ini dapat
berguna bagi penelitian berikutnya, amiin.
Wassalamu’alaikum warohmatullohi wabarokatuh
Malang, 26 Juni 2015
Penyusun
(Barlanty Fathanahiyah)
vii
DAFTAR ISI
Halaman
HALAMAN JUDUL ........................................................................................ i
DAFTAR ISI .................................................................................................... ii
DAFTAR TABEL ............................................................................................ iv
DAFTAR GAMBAR ....................................................................................... v
BAB I PENDAHULUAN ............................................................................. 1
1.1 Latar Belakang ............................................................................ 1
1.2 Rumusan Masalah ........................................................................ 4
1.3 Tujuan .......................................................................................... 4
1.4 Manfaat ........................................................................................ 4
BAB II TINJAUAN PUSTAKA .................................................................... 5
2.1 Tinjauan Tentang Stroke .............................................................. 5
2.1.1 Definisi ............................................................................ 5
2.1.2 Epidemiologi ................................................................... 5
2.1.3 Etiologi ............................................................................ 6
2.1.3.1 Aterosklerosis ............................................................. 6
2.1.3.2 Emboli ........................................................................ 7
2.1.3.3 Trombosis ................................................................... 7
2.1.3.4 AIDS .......................................................................... 8
2.1.3.5 Infeksi ......................................................................... 8
2.1.3.6 Angiitis granulomatosa .............................................. 8
2.1.3.7 Obat-obatan ................................................................ 9
2.1.3.8 Vena atau sinus trombosis .......................................... 9
2.1.3.9 Infark lakunar ............................................................. 10
2.1.4 Klasifikasi ....................................................................... 10
2.1.5 Faktor Resiko .................................................................. 13
2.1.5.1 Usia ............................................................................ 13
2.1.5.2 Jenis kelamin .............................................................. 13
2.1.5.3 Faktor Genetik ............................................................ 14
2.1.5.4 Ras .............................................................................. 14
2.1.5.5 Hipertensi ................................................................... 15
2.1.5.6 Diabetes ...................................................................... 15
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2.1.5.7 Merokok ..................................................................... 16
2.1.5.8 Dislipidemia ............................................................... 16
2.1.5.9 Konsumsi Alkohol ..................................................... 17
2.1.6 Patofisiologi .................................................................... 18
2.1.7 Komplikasi ...................................................................... 20
2.1.7.1 Pneumonia, Septicemia .............................................. 21
2.1.7.2 Infark miokard, aritmia, dan gagal jantung ................ 21
2.1.7.3 DVT ........................................................................... 21
2.1.7.4 Ketidakseimbangan Cairan ........................................ 21
2.1.8 Tanda dan Gejala............................................................. 21
2.1.9 Penatalaksanaan Terapi ................................................... 22
2.1.10 Terapi Stroke Iskemik ..................................................... 24
2.1.10.1 rTPA ......................................................................... 25
2.1.10.2 Antiplatelet ............................................................... 26
2.1.10.3 Antikoagulan ............................................................ 28
2.1.10.4 Neuroprotektan ......................................................... 28
2.1.10.5 Antihipertensi ........................................................... 29
2.1.11 Rehabilitasi Setelah Stroke ............................................. 34
2.2 Tinjauan Captopril ....................................................................... 35
2.2.1 Struktur Kimia ................................................................... 35
2.2.2 Mekanisme Kerja ............................................................... 36
2.2.3 Dosis .................................................................................. 37
2.2.4 Farmakokinetik .................................................................. 37
2.2.5 Efek Samping ..................................................................... 37
2.2.6 Penggunaan Captopril pada Ischemic CVA ...................... 37
2.2.7 Sediaan ............................................................................... 38
BAB III KERANGKA KONSEP .................................................................... 39
BAB IV METODE PENELITIAN .................................................................. 42
4.1 Rancangan Penelitian ................................................................... 42
4.2 Populasi dan Sampel .................................................................... 42
4.2.1 Populasi .............................................................................. 42
4.2.2 Sampel ............................................................................... 42
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4.2.3 Kriteria Data Inklusi ......................................................... 42
4.2.4 Kriteria Data Eksklusi ........................................................ 42
4.3 Bahan penelitian .......................................................................... 43
4.4 Intrumen Penelitian ...................................................................... 43
4.5 Tempat dan Waktu penelitian ...................................................... 43
4.6 Definisi Operasional ................................................................... 43
4.7 Metode Pengumpulan Data .......................................................... 44
4.8 Analisis Data ................................................................................ 44
BAB V HASIL PENELITIAN ...................................................................... 45
5.1 Data Demografi Pasien ................................................................ 46
5.1.1 Jenis Kelamin .......................................................................... 46
5.1.2 Usia Pasien .............................................................................. 46
5.1.3 Status Pasien ........................................................................... 46
5.2 Faktor Resiko ................................................................................ 47
5.3 Profil Tekanan Darah .................................................................... 47
5.4 Diagnosis Penyerta Pasien Stroke Iskemik ................................... 48
5.5 Pola terapi pada pasien stroke iskemik ......................................... 49
5.6 Pola terapi pendukung pada pasien stroke iskemik ..................... 50
5.7 Pola terapi captopril pada pasien stroke iskemik ......................... 51
5.8 Pola Terapi Captopril Tunggal Tanpa Switch ............................... 51
5.9 Pola Switch Captopril .................................................................... 52
5.10 Kombinasi Obat Captopril dengan Antihipertensi lain ............... 52
5.11 Dosis & Frekuensi Penggunaan Captopril pada Stroke Iskemik 53
5.12 Lama Masuk Rumah Sakit (MRS) .............................................. 54
5.13 Kondisi Keluar Rumah Sakit (KRS) ........................................... 55
BAB VI PEMBAHASAN ................................................................................ 56
BAB VII KESIMPULAN DAN SARAN ....................................................... 69
7.1 Kesimpulan ................................................................................... 69
7.2 Saran ............................................................................................. 69
DAFTAR PUSTAKA ...................................................................................... 70
LAMPIRAN…. ................................................................................................ 77
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DAFTAR TABEL
Halaman
2.1 Gejala dan tanda-tanda iskemia pada sirkulasi anterior dan posterior ...... 22
2.2 Rekomendasi farmakoterapi stroke iskemik ............................................. 24
2.3 Kriteria inklusi dan eksklusi rtPA pada stroke iskemik ............................ 26
2.4 Sediaan di Indonesia ................................................................................. 37
V.1 Jenis Kelamin Pasien Stroke Iskemik ...................................................... 46
V.2 Usia Pasien Stroke Iskemik ...................................................................... 46
V.3 Status Pasien Stroke Iskemik ................................................................... 47
V.4 Faktor Resiko Stroke Iskemik .................................................................. 47
V.5 Distribusi Tekanan Darah......................................................................... 48
V.6 Diagnosis Penyerta Stroke Iskemik.......................................................... 49
V.7 Terapi Stroke Iskemik .............................................................................. 49
V.8 Terapi Pendukung pada pasien stroke iskemik ........................................ 50
V.9 Pola Penggunaan Captopril pada pasien stroke iskemik .......................... 51
V.10 Pola Captopril Tanpa Switch .................................................................. 52
V.11 Pola Switch Captopril ............................................................................. 52
V.12 Distribusi jumlah, Dosis dan Frekuensi terapi kombinasi captopril ...... 53
V.13 Distribusi Penggunaan Dosis dan Frekuensi Captopril .......................... 54
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DAFTAR GAMBAR
Halaman
2.1 Penyebab stroke...................................................................................... 8
2.2 Stroke iskemik ........................................................................................ 10
2.3 Stroke hemoragik ................................................................................... 11
2.4 Klasifikasi stroke .................................................................................... 12
2.5 Patofisiologi stroke................................................................................. 19
2.6 Managemen stroke dan TIA ................................................................... 23
2.7 Struktur kimia captopril ......................................................................... 36
2.8 Mekanisme kerja captopril ..................................................................... 36
3.1 Skema Kerangka Konseptual ................................................................. 40
3.2 Skema Kerangka Operasional ................................................................ 41
5.1 Skema Inklusi Pasien Stroke Iskemik .................................................... 45
5.2 Distribusi Lama MRS Pasien stroke iskemik ............................................ 54
5.3 Distribusi Status KRS Pasien stroke iskemik ........................................ 55
xii
DAFTAR LAMPIRAN
Lampiran Halaman
1. Daftar Riwayat Hidup .............................................................................. 77
2. Surat Pernyataan....................................................................................... 78
3. Surat Ijin Rumah Sakit ............................................................................. 79
4. Surat Ijin Bakesbangpol Provinsi ............................................................. 81
5. Surat Ijin Bakesbangpol Kabupaten ......................................................... 82
6. Harga Normal Data Labolatorik dan Klinik............................................. 84
xiii
DAFTAR SINGKATAN
ACCESS : Acute Candesartan Cilexetil Therapy in Stroke Survivors
ACEI : Angiotensin-Converting Enzyme Inhibitors
ACTIVE I : The Atrial Fibrillation Clopidogrel Trial with Irbesartan for
Prevention of Vascular Events
ADP : Adenosine Diphosphate
ADVANCE : Action in Diabetes and Vascular Disease: Preterax and Diamicron
MR Controlled Evaluation
AHA :American Heart Association
AIDS : Acquired Immune Deficiency Syndrom
AIS : Acute Ischemic Stroke
ALLHAT : The Antihypertensive and Lipid-Lowering Treatment
APTT : Activated Partial Thromboplastin Time
ARB : Angiotensin Receptor Blocker
ARIC : Atherosclerosis Risk In Communities
ASA : American Stroke Association
ASI : Air Susu Ibu
AT1 : Angiotensin I
BP : Blood Pressure
BPJS PBI : Badan Penyelenggara Jaminan Sosial Penerima Bantuan Iuran
BPJS Non PBI : Badan Penyelenggara Jaminan Sosial Non Penerima Bantuan Iuran
CAPP : Captopril Prevention Project
CAST : Chinese Acute Stroke Trial
CBF : Cerebral Blood Flow
CCB : Calcium Channel Blockers
CDC : Centers for Disease Control and Prevention
CSF : Cairan Serebrospinal
CT-Scan : Computerized Tomography Scan
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CVA : Cerebrovascular Accident
DVT : Deep Vein Thrombosis
ECASS : European Cooperative Acute Stroke Study
GCS : Glasgow Coma Scale
GIT : Gastro Intestinal Tract
HDL : High Density Lipid
HMGCoA : 3-hydroxy-3-methylglutaryl-CoA
IGD : Instalasi Gawat Darurat
ICH : Intracranial Hemmorrage
INR : International Normalized Ratio
IST : International Stroke Trial
JNC-7 : The Seventh Report of the Joint National Committee
KRS : Keluar Rumah Sakit
LDL : Low Density Lipid
LMWH : Low-Molecular-Weight Heparin
MCA : Middle Cerebral Artery
mmHg : millimeter merkuri Hydragyrum
MOSES : Morbidity and Mortality After Stroke-Eprosartan vs. Nitrendipine
for Secondary Prevention
MRI : Magnetic Resonance Imaging
MRS : Masuk Rumah Sakit
NCEP : National Cholesterol Education Program
NIH : National Institute of Health
NIHSS : National Institute of Stroke Scale
NINDS : National Institute of Neurological Disorders and Stroke
ONTARGET : Ongoing Telmisartan Alone and in Combination with Ramipril
Global Endpoint Trial
PCD : Programmed Cell Death
PJK : Penyakit Jantung Koroner
PNS : Pegawai Negeri Sipil
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PROGRESS : Perindopril Protection against Recurrent Stroke Study
RAAS : Renin Angiotensin Aldosteron System
REGARDS : Reasons for Geographic And Racial Differences in Stroke
RE-LY : Randomized Evaluation of Long-Term Anticoagulant therapy
RISKESDAS : Riset Kesehatan Dasar
RMK : Rekam Medik Kesehatan
RSUD : Rumah Sakit Umum Daerah
r-TPA : Recombinant Tissue Plasminogen Activator
SAH : Subarachnoid Hemorrage
SALSA : Sacramento Area Latino Study on Aging
SHRsp : Stroke-Prone Hypertensive Rats
SHS : Study Strong Heart
SPARCL : Stroke Prevention by Aggressive Reduction in Cholesterol
SSP : Sistem Saraf Pusat
Syst-Eur : The Systolic Hypertension in Europe
TD : Tekanan Darah
TIA : Transcient ischemic attack
TNI : Tentara Nasional Indonesia
TOAST : Trial of Organon 10172 in Acute Stroke Treatment
UK : United Kingdom
UFG : Universidade Federal de Goiás
UU SJSN : Undang-UNdang Sistem Jaminan Sosial Nasional
VALUE : Valsartan Antihypertensive Long-term Use Evaluation
WHO : World Health Organization
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