Post on 22-Feb-2018
i
SKRIPSI
ROBIANA PRIHANDINI
STUDI PENGGUNAAN ISOSORBID DINITRAT
(ISDN) PADA PASIEN INFARK MIOKARD
AKUT DI RSUD SIDOARJO
PROGRAM STUDI FARMASI
FAKULTAS ILMU KESEHATAN
UNIVERSITAS MUHAMMADIYAH MALANG
2015
ii
Lembar Pengesahan
STUDI PENGGUNAAN ISOSORBID DINITRAT
(ISDN) PADA PASIEN INFARK MIOKARD AKUT DI
RSUD SIDOARJO
SKRIPSI
Dibuat untuk memenuhi syarat mencapai gelar Sarjana Farmasi pada
Program Studi Farmasi Fakultas Ilmu Kesehatan Universitas
Muhammadiyah Malang
2015
Oleh :
ROBIANA PRIHANDINI
201110410311137
Disetujui Oleh :
Pembimbing I Pembimbing II
Drs. Didik Hasmono, M.S., Apt Hidajah Rachmawati, S.Si., Apt., Sp.FRS
NIP. 1195809111986011001 NIP UMM. 11406090449
iii
Lembar Pengujian
STUDI PENGGUNAAN ISOSORBID DINITRAT
(ISDN) PADA PASIEN INFARK MIOKARD AKUT DI
RSUD SIDOARJO
SKRIPSI
Telah diuji dan dipertahankan di depan tim penguji
Pada tanggal 19 Agustus 2015
Oleh :
ROBIANA PRIHANDINI
201110410311137
Tim Penguji
Penguji I Penguji II
Drs. Didik Hasmono, M.S., Apt Hidajah Rachmawati, S.Si., Apt., Sp.FRS
NIP. 1195809111986011001 NIP UMM. 11406090449
Penguji III Penguji IV
Dra. Lilik Yusetyani, Apt., Sp. FRS Ika Ratna Hidayati, S.Farm., Apt., M.Sc
NIP UMM. 11407040450 NIP UMM. 11209070480
iv
KATA PENGANTAR
Puji syukur penulis panjatkan kehadirat Alloh SWT karena berkat rahmat
dan karunia-Nya, alhamdulillah penulis dapat menyelesaikan penyusunan skripsi
yang berjudul STUDI PENGGUNAAN ISOSORBID DINITRAT (ISDN)
PADA PASIEN INFARK MIOKARD AKUT DI RSUD SIDOARJO untuk
memenuhi satu persyaratan akademik dalam menyelesaikan Program Sarjana
Farmasi Fakultas Ilmu Kesehatan Universitas Muhammadiyah Malang.
Terselesaikannya skripsi ini tidak terlepas dari bantuan banyak pihak,
sehingga pada kesempatan ini dengan segala kerendahan hati dan penuh rasa
hormat bagi semua pihak yang telah memberikan bantuan moril maupun materiil
baik langsung maupun tidak langsung dalam penyusunan skripsi ini hingga
selesai, penulis meyampaikan terimakasih sebesar-besarnya kepada:
1. Yoyok Bekti Prasetyo, M.Kep., Sp. Kom selaku Dekan Fakultas Ilmu
Kesehatan Universitas Muhammadiyah Malang.
2. Dr. Atok Irawan, Sp.P, selaku Direktur RSUD Sidoarjo yang telah
memberikan izin untuk melaksanakan penelitian di RSUD Sidoarjo.
3. Nailis Syifa’, S.Farm,. Apt,. M.Sc. selaku Ketua Program Studi Farmasi
Universitas Muhammadiyah Malang.
4. Drs. Didik Hasmono, M.S., Apt sebagai Pembimbing I dan Hidajah
Rachmawati, S.Si., Apt., Sp.FRS sebagai Pembimbing II yang bersedia
meluangkan waktu dengan tulus ikhlas dan penuh kesabaran memberikan
bimbingan, nasihat, dan arahan kepada saya.
5. Nailis Syifa’, S.Farm,. Apt,. M.Sc, Ika Ratna Hidayati, S.Farm., Apt., M.Sc
dan Dra.Lilik Yusetyani, Apt.,Sp.FRS sebagai Tim Penguji yang memberikan
kritik dan saran yang membangun terhadap skripsi yang saya kerjakan.
6. Program Studi Farmasi beserta seluruh staf pengajar Program Studi Farmasi
Universitas Muhammadiyah Malang
7. Heru prabowo, S.Farm., Apt sebagai Dosen Wali yang telah memberikan
bimbingan, arahan dan nasehat.
8. Sendi Lia Yunita, S.Farm., Apt., selaku Sekretaris Program Studi yang telah
melancarkan proses jalannya skripsi.
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9. Teristimewa kepada orang tua saya tercinta ayah Adiwinarko dan bunda
Rochmiasih yang dengan penuh kasih sayang selalu mendoakan, memberikan
motivasi, semangat dan pengorbanannya baik segi moril maupun materiil.
Serta adik-adik kesayangan Aqmarina Shabrina, Annisa Yumna Nabiilah, dan
M. Roziq Hanan, terimakasih atas doa dan dukungan kalian untuk saya.
10. Teman-teman klinis geng darjo tersayang: Dila, Mahiru, Lili, Roura, mbak
Sulis. Terimaksih atas bantuan yang selalu kalian berikan kepada saya dalam
menyelesaikan skripsi ini, menemani dalam segala kesusahan, kebingungan,
maupun kebahagiaan yang kita lalui.
11. Teman seperjuangan Khilmi Abdul Rahman. Terimakasih selalu ada untuk
saya, mengantar, mengajak, mengingatkan, memberi dorongan, dukungan,
canda dan tawa. Semoga kita tetap dapat saling menjaga dalam doa.
12. Teman-teman Farmasi C 2011: Anggi, Adel, Luluk, Sri, Irvan, Ilham, Izu,
Hasby, Inna, Shinta, Yuli, Rizqi, Arin, Resti, Wanda, Della, Fina, Adis, Putri,
Reza, Afnan dan teman-teman lainnya.
13. Sahabat terbaik yang saya miliki: Galih Nur Rendra Wijaya, Ridwana
Syafaati Rohmah, Rizki Sulis Sanjaya, Shinta Rosdiana Anggraini, Fitri Eko
Setyafani, Septi Aning Tyas Dwi Arti. Terimakasih telah memberikan doa,
dukungan dan motivasi terus menerus.
14. Serta semua pihak yang tidak bisa saya sebutkan satu persatu, terimakasih
telah membantu, memberikan dukungan, semangat, dan doa kepada saya.
Akhir kata, semoga Alloh SWT membalas kebaikan dan ketulusan semua
pihak yang telah membantu. Semoga skripsi ini dapat memberikan manfaat dan
kebaikan bagi banyak pihak serta bernilai ibadah dihadapan Alloh SWT. Aamiin.
Malang, 19 Agustus 2015
Robiana Prihandini
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DAFTAR ISI Halaman
HALAMAN JUDUL ................................................................................................ i
LEMBAR PENGESAHAN .................................................................................... ii
LEMBAR PENGUJIAN ........................................................................................ iii
KATA PENGANTAR ........................................................................................... iv
RINGKASAN ........................................................................................................ vi
ABSTRAK ........................................................................................................... viii
DAFTAR ISI ............................................................................................................ x
DAFTAR GAMBAR ........................................................................................... xiv
DAFTAR TABEL .................................................................................................. xv
DAFTAR LAMPIRAN ........................................................................................ xvi
DAFTAR SINGKATAN .................................................................................... xvii
BAB 1 PENDAHULUAN ....................................................................................... 1
1.1 Latar Belakang ................................................................................................. 1
1.2 Rumusan Masalah ............................................................................................ 3
1.3 Tujuan Penelitian ............................................................................................. 3
1.3.1 Tujuan Umum .......................................................................................... 3
1.3.2 Tujuan Khusus ......................................................................................... 4
1.4 Manfaat Penelitian ........................................................................................... 4
BAB 2 TINJAUAN PUSTAKA .............................................................................. 5
2.1 Definisi Infark Miokard Akut .......................................................................... 5
2.2 Epidemiologi Infark Miokard Akut ................................................................. 5
2.3 Etiologi Infark Miokard Akut .......................................................................... 6
2.3.1 Klasifikasi IMA Berdasarkan Jenis Penyebabnya ................................... 6
2.3.1.1 Infark Miokard Tipe 1 ...................................................................... 6
2.3.1.2 Infark Miokard Tipe 2 ...................................................................... 7
2.3.1.3 Infark Miokard Tipe 3 ...................................................................... 7
2.3.1.4 Infark Miokard Tipe 4 ...................................................................... 7
2.3.1.5 Infark Miokard Tipe 5 ...................................................................... 7
2.3.2 Faktor Risiko ............................................................................................ 7
2.4 Patogenesis Infark Miokard Akut .................................................................... 9
2.5 Patofisiologi Infark Miokard Akut ................................................................ 12
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2.6 Manifestasi Klinis .......................................................................................... 13
2.6.1 Nyeri Dada ............................................................................................. 14
2.6.2 Bradikardi dan Takikardi ....................................................................... 14
2.6.3 Perubahan Elektrokardiografi (EKG) .................................................... 15
2.6.4 Peningkatan Serum Biomarker Jantung ................................................. 15
2.7 Diagnosis Infark Miokard Akut ..................................................................... 16
2.7.1 Elektrokardiogram (EKG)...................................................................... 17
2.7.2 Tes Laboratorium ................................................................................... 17
2.7.3 Cardiac Imaging ..................................................................................... 17
2.7.4 Serum Biomarker ................................................................................... 18
2.7.4.1 Creatinin Kinase (CK) .................................................................... 19
2.7.4.2 Serum Troponin .............................................................................. 20
2.7.4.3 Myoglobin ...................................................................................... 21
2.7.4.4 Serum Glutamic Oxalo-acetic Transaminase (SGOT) ................... 21
2.7.4.5 Serum Lactate Dehydrogenase (SLDH) ......................................... 21
2.8 Komplikasi Infark Miokard Akut .................................................................. 21
2.9 Penatalaksanaan Infark Miokard Akut .......................................................... 23
2.9.1 Oksigen .................................................................................................. 24
2.9.2 Antiplatelet ............................................................................................. 24
2.9.2.1 Aspirin ............................................................................................ 25
2.9.2.2 Klopidogrel ..................................................................................... 25
2.9.3 Beta Bloker ............................................................................................ 26
2.9.4 ACE Inhibitor ......................................................................................... 27
2.9.5 Calcium Chanel Blocker (CCB) ............................................................ 27
2.9.6 Analgesik. .............................................................................................. 28
2.9.7 Nitrat. ..................................................................................................... 28
2.10 Penggunaan Isosorbid Dinitrat (ISDN) sebagai Terapi
Farmakologis IMA........................................................................................ 30
BAB 3 KERANGKA KONSEPTUAL .................................................................. 33
3.1 Uraian Kerangka Konseptual ......................................................................... 33
3.2 Bagan Alir Kerangka Konseptual .................................................................. 35
3.3 Kerangka Operasional Terapi pada Pasien IMA ........................................... 36
viii
BAB 4 METODE PENELITIAN........................................................................... 37
4.1 Rancangan Penelitian ..................................................................................... 37
4.2 Populasi dan Sampel ...................................................................................... 37
4.2.1 Populasi .................................................................................................. 37
4.2.2 Sampel. ................................................................................................... 37
4.2.3 Kriteria Data Inklusi............................................................................... 37
4.2.4 Kriteria Data Eksklusi. ........................................................................... 37
4.3 Bahan Penelitian ............................................................................................ 38
4.4 Instrumen Penelitian ...................................................................................... 38
4.5 Tempat dan Waktu Penelitian ........................................................................ 38
4.6 Definisi Operasional ...................................................................................... 38
4.7. Metode Pengumpulan Data ........................................................................... 39
4.8. Analisis Data ................................................................................................. 39
BAB 5 HASIL PENELITIAN ............................................................................... 41
5.1 Data Demografi ............................................................................................. 42
5.1.1 Jenis Kelamin ......................................................................................... 42
5.1.2 Usia Pasien ............................................................................................. 42
5.1.3 Status Pasien .......................................................................................... 43
5.2 Faktor Risiko ................................................................................................. 43
5.3 Penggunaan Obat pada Pasien Infark Miokard Akut .................................... 44
5.4 Penggunaan Vasodilator Nitrat pada Pasien Infark Miokard Akut ............... 46
5.5 Pola Penggunaan ISDN pada Pasien IMA ..................................................... 46
5.5.1 Pola Penggunaan ISDN .......................................................................... 46
5.5.2 Penggunaan ISDN Tunggal ................................................................... 47
5.5.3 Terapi ISDN Tunggal dengan Pergantian .............................................. 47
5.5.4 Terapi Kombinasi ISDN dengan Satu Antihipertensi ............................ 47
5.5.5 Terapi Kombinasi ISDN dengan Dua Antihipertensi ............................ 47
5.5.6 Terapi Kombinasi ISDN dengan Tiga Antihipertensi............................ 49
5.5.7 Terapi Kombinasi ISDN dengan Empat Antihipertensi ........................ 50
5.6 Lama Penggunaan Isosorbid Dinitrat ............................................................ 50
5.7 Lama Perawatan ............................................................................................. 50
5.8 Kondisi Keluar Rumah Sakit ......................................................................... 51
ix
BAB 6 PEMBAHASAN ........................................................................................ 52
BAB 7 KESIMPULAN DAN SARAN ................................................................. 64
7.1 Kesimpulan .................................................................................................... 64
7.2 Saran .............................................................................................................. 64
DAFTAR PUSTAKA ............................................................................................ 65
LAMPIRAN ........................................................................................................... 70
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DAFTAR GAMBAR
Gambar Halaman
2.1 Jantung dan Gambaran Pembuluh Darah dengan Plak Aterosklorosis ......... 10
2.2 Perbedaan aliran darah normal dan yg mengalami aterosklerosis............... .. 11
2.3 Perubahan EKG pada IMA ............................................................................ 15
2.4 Kenaikan Biomarker Jantung setelah IMA .................................................... 16
2.5 Biomarker Jantung pada IMA ....................................................................... 20
2.6 Rumus Struktur Isosorbid Dinitrat ................................................................. 30
3.1 Kerangka Konseptual ..................................................................................... 35
3.2 Kerangka Operasional ................................................................................... 36
5.1 Skema Kriteria Inklusi dan Eksklusi Penelitian pada Pasien Infark
Miokard Akut................................................................................................ 41
5.2 Jenis Kelamin Pasien Infark Miokard Akut dengan Terapi ISDN ................ 42
5.3 Usia Pasien Infark Miokard Akut dengan Terapi ISDN ................................ 42
5.4 Status Pasien Infark Miokard Akut dengan Terapi ISDN ............................. 43
5.5 Diagram Distribusi Kondisi 38 Pasien Infark Miokard Akut saat KRS
di RSUD Sidoarjo ......................................................................................... 51
xi
DAFTAR TABEL
Tabel Halaman
II.1 Sediaan Isosorbid Dinitrat ............................................................................. 32
V.1 Faktor Risiko Infark Miokard Akut .............................................................. 43
V.2 Pola Penggunaan Terapi Infark Miokard Akut tanpa ISDN ......................... 44
V.3 Pola Penggunaan Terapi Penyerta pada 38 Pasien Infark Miokard Akut
di RSUD Sidoarjo ......................................................................................... 45
V.4 Tabel Penggunaan Vasodilator Nitrat ........................................................... 46
V.5 Pola Penggunaan ISDN pada Pasien IMA .................................................... 46
V.6 Pola Penggunaan ISDN Tunggal tanpa Pergantian ...................................... 47
V.7 Pola Penggunaan ISDN dengan Pergantian .................................................. 47
V.8 Pola Penggunaan Kombinasi ISDN dengan Satu Antihipertensi ................. 47
V.9 Pola Penggunaan Kombinasi ISDN dengan Dua Antihipertensi .................. 47
V.10 Pola Penggunaan Kombinasi ISDN dengan Tiga Antihipertensi ............... 49
V.11 Pola Penggunaan Kombinasi ISDN dengan Empat Antihipertensi ............ 50
V.10 Lama Perawatan Pasien Infark Miokard Akut dengan Terapi ISDN ......... 50
xii
DAFTAR LAMPIRAN
Lampiran Halaman
1 Daftar Riwayat Hidup ....................................................................................... 67
2 Surat Pernyataan Bebas Plagiasi ...................................................................... 68
3 Keteranga Kelayakan Etik ................................................................................ 69
4 Daftar Nilai Normal Data Laboratorium .......................................................... 71
5 Lembar Pengumpul Data .................................................................................. 72
xiii
DAFTAR SINGKATAN
ACC : American College of Cardiology
ACEI : Angiotensin Converting Enzyme Inhibitor
ACS : Acute Coronary Syndrome
ACTH : Adrenocorticotropic Hormone
ADH : Anti Diuretic Hormone
ADP : Adenosine Di Phosphate
AHA : American Heart Association
ALDH2 : Aldehide Dehydrogenase-2
ALDH3 : Aldehide Dehydrogenase-3
aPTT : Activated Partial Thromboplastine Time
ARB : Angiotensin Receptor Blocker
ATP : Adenosine Tri Phosphate
CABG : Coronary Artery Bypass Grafting
CCB : Calcium Channel Blocker
cGMP : Cyclase Guanylyl Mono Phosphate
CK : Creatine Kinase
CKMB : Creatine Kinase Myocard Band
COX 2 : Cyclo-Oxygenase 2
cTnC : Serum Troponin C
cTnI : Serum Troponin I
cTnT : Serum Troponin T
CVD : Cardiovascular Disease
EKG : Elektrokardiogram
ESC : European Society of Cardiology
GC : Guanylyl cyclase
HIT : Heparin Induced Thrombocytopenia
IL-1 : Interleukin 1
IMA : Infark Miokard Akut
LBBB : Left Bundle Branch Block
LD : Laktat Dehidrogenase
LMWH : Low Molecule Weight Heparin
LV : Left Ventricular
MLC : Myosin Light Chain
MLCK : Myosin Light Chain Kinase
NO : Nitrat Oksida
Non Q MI : Non Q Wave Myocardial Infarction
NSAID : Non Steroid Anti Inflammation Drug
NSTEMI : Non ST Elevation Myocardial Infarction
PCI : Percutaneous Coronary Intervention
PJK : Penyakit Jantung Koroner
Q MI : Q Wave Myocardial Infarction
RISKESDAS : Riset Kesehatan Dasar
rPa : Reteplase
RV : Right Ventricular
SA : Sino Atrial
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SGOT : Serum Glutamic Oxalo-Acetic Transaminase
SLDH : Serum Laktat Dehidrogenase
STEMI : ST Elevation Myocardial Infarction
TNF : Tumour Necrosis Factor
TNK-tPa : Tenekplase
tPa : Alteplase
TPR : Total Peripheral Resistency
UA : Unstable Angina
UFH : UnFractionated Heparin
WHO : World Health Organization
xv
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