SKRIPSI

MONIX SHOLIKHATIN ANISA’

STUDI PENGGUNAAN KETOROLAK PADA

PASIEN BENIGN PROSTATIC HYPERPLASIA (BPH)

(Penelitian Dilakukan di Rumah Sakit Umum Daerah

Kertosono)

PROGRAM STUDI FARMASI

FAKULTAS ILMU KESEHATAN

UNIVERSITAS MUHAMMADIYAH MALANG

2019

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KATA PENGANTAR

Bismillahirohmanirrohin

Assalamu’alaikum warohmatullahi wabarokatuh

Alhamdullillah puji syukur peneliti panjatkan kepada Allah SWT atas berkat

rahmat dan ridho-Nya sehingga peneliti dapat menyelesaikan skripsi yang

berjudul “Studi Penggunaan Ketorolak Pada Pasien Benign Prostatic Hyperplasia

(BPH)” (Penelitian di Rumah Sakit Umum Daerah Kertosono).

Tujuan dari penyusunan skripsi ini adalah untuk memenuhi syarat mencapai gelar

Sarjana Farmasi pada Program Studi Farmasi Fakultas Ilmu Kesehatan

Universitas Muhammadiyah Malang tahun 2019. Keberhasilan penyelesaian

skripsi ini tidak terlepas dari doa, bantuan dan bimbingan dari berbagai pihak,

untuk itu peneliti memberikan ucapan terimakasih kepada:

1. Bapak Faqih Ruhyanudin, M. Kep., Sp.Kep.MB. selaku Dekan Fakultas Ilmu

Kesehatan Universitas Muhammadiyah Malang.

2. Ibu Dian Ermawati, S.Farm., M.Farm., Apt. selaku Ketua Program Studi

Farmasi Fakultas Ilmu Kesehatan Universitas Muhammadiyah Malang.

3. Ibu dr. Tien Farida Yani, MMRS selaku Direktur Rumah Sakit Umum

Daerah Kertosono yang telah memberikan izin kepada peneliti untuk

melakukan penelitian skripsi ini di Rumah Sakit Umum Daerah Kertosono.

4. Ibu Sovia Aprina Basuki, S.Farm., Apt., M.Si selaku Dosen Wali yang selalu

memberikan saran dan masukan kepada Farmasi D 2013.

5. Bapak Drs. Didik Hasmono, MS., Apt. selaku Dosen Pembimbing I yang

bersedia meluangkan waktu disela kesibukan beliau dan memberikan

bimbingan, ide, saran, serta motivasi sehingga dapat terselesaikannya skripsi

ini.

6. Ibu Hidajah Rachmawati, S.Si., Apt., Sp.FRS. selaku Dosen Pembimbing II

yang telah bersedia meluangkan waktu disela kesibukan dan memberikan

saran, bimbingan, ide, serta motivasi sehingga dapat terselesaikannya skripsi

ini.

7. Ibu Dr. Lilik Yusetyani, Dra., Apt., Sp.FRS. selaku Dosen Penguji I yang

telah memberikan saran demi kesempurnaan skripsi ini.

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DAFTAR ISI

Halaman

Halaman Judul ......................................................................................................... i

Lembar Pengesahan ................................................................................................ ii

Lembar Pengujian .................................................................................................. iii

KATA PENGANTAR ........................................................................................... iv

RINGKASAN ........................................................................................................ vi

ABSTRACT ......................................................................................................... viii

ABSTRAK ............................................................................................................. ix

DAFTAR ISI ........................................................................................................... x

DAFTAR TABEL ................................................................................................ xiii

DAFTAR GAMBAR ........................................................................................... xiv

DAFTAR LAMPIRAN ......................................................................................... xv

DAFTAR SINGKATAN ...................................................................................... xv

BAB I PENDAHULUAN ....................................................................................... 1

1.1 Latar Belakang .......................................................................................... 1

1.2 Rumusan Masalah ..................................................................................... 4

1.3 Tujuan Penelitian ...................................................................................... 4

1.3.1 Tujuan Umum ................................................................................... 4

1.3.2 Tujuan Khusus .................................................................................. 4

1.4 Manfaat Penelitian .................................................................................... 4

1.4.1 Bagi Peneliti ...................................................................................... 4

1.4.2 Bagi Rumah Sakit ............................................................................. 4

BAB II TINJAUAN PUSTAKA ............................................................................. 5

2.1 Anatomi dan Fisiologi Urologi ................................................................. 5

2.2 BPH (Benign Prostatic Hyperplasia) ....................................................... 6

2.2.1 Definisi BPH (Benign Prostatic Hyperplasia) .................................. 6

2.2.2 Epidemiologi BPH (Benign Prostatic Hyperplasia) .........................

2.2.3 Etiologi BPH (Benign Prostatic Hyperplasia) ..................................

2.2.4 Patofisiologi BPH (Benign Prostatic Hyperplasia) ........................ 10

2.2.5 Manifestasi Klinik ........................................................................... 11

2.2.6 Faktor Resiko BPH (Benign Prostatic Hyperplasia) ...................... 13

2.2.7 Diagnosa dan Pemeriksaan BPH (Benign Prostatic Hyperplasia) . 16

2.2.7 Penatalaksanaan Terapi BPH (Benign Prostatic Hyperplasia) ....... 19

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2.3 Tinjauan Tentang Nyeri .......................................................................... 30

2.3.1 Definisi Nyeri .................................................................................. 30

2.3.2 Mekanisme Terjadinya Nyeri .......................................................... 30

2.3.3 Klasifikasi Nyeri ............................................................................. 32

2.3.4 Penilaian Nyeri ................................................................................ 33

2.4 Tinjauan Tentang Analgesik ................................................................... 36

2.4.1 Pengertian Analgesik ...................................................................... 36

2.4.2 Penggolongan Analgesik ................................................................. 36

2.5 Analgesik pada BPH (Benign Prostatic Hyperplasia)............................ 49

2.6 Tinjauan tentang Ketorolak pada BPH ................................................... 52

2.4.1 Ketorolak pada BPH (Benign Prostatic Hyperplasia) .................... 52

2.4.2 Mekanisme Aksi Ketorolak............................................................. 53

2.4.3 Farmakodinamik dan Farmakokinetik Ketorolak ........................... 53

2.4.4 Dosis dan Rute Pemberian Ketorolak pada BPH ............................ 53

2.4.5 Interaksi Ketorolak .......................................................................... 54

2.4.6 Kontraindikasi Ketorolak ................................................................ 55

2.4.7 Efek Samping Ketorolak ................................................................. 55

2.4.8 Sediaan Ketorolak di Indonesia ...................................................... 56

BAB III KERANGKA KONSEPTUAL DAN OPERASIONAL ........................ 58

3.1 Kerangka Konseptual .............................................................................. 58

3.2 Kerangka Operasional ............................................................................. 59

BAB IV METODE PENELITIAN ....................................................................... 60

4.1 Rancangan Penelitian .............................................................................. 60

4.2 Bahan Penelitian ..................................................................................... 60

4.2.1 Kriteria Inklusi dan Eksklusi ........................................................... 60

4.3 Populasi dan Sampel Penelitian .............................................................. 60

4.3.1 Populasi Penelitian .......................................................................... 60

4.3.2 Sampel Penelitian ............................................................................ 61

4.4 Instrumen Penelitian ............................................................................... 61

4.5 Tempat dan Waktu Penelitian ................................................................. 61

4.6 Definisi Operasional ............................................................................... 61

4.7 Prosedur Pengumpulan Data ................................................................... 62

4.8 Analisis Data ........................................................................................... 63

BAB V HASIL PENELITIAN ............................................................................. 64

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5.1 Data Demografi Pasien ........................................................................... 65

5.1.1 Data Usia Pasien BPH (Benign Prostatic Hyperplasia) ................. 65

5.1.2 Data Status Pasien BPH (Benign Prostatic Hyperplasia) ............... 65

5.2 Jenis Operasi Pasien BPH (Benign Prostatic Hyperplasia) ................... 65

5.3 Data Diagnosis Penyerta Pasien BPH (Benign Prostatic Hyperplasia) . 65

5.4 Data Riwayat Penyakit BPH (Benign Prostatic Hyperplasia) ............... 65

5.5 Data Pola Penggunaan Terapi Ketorolak Tunggal Dan Kombinasi Pada

Pasien Data Riwayat Penyakit BPH (Benign Prostatic Hyperplasia) .... 66

5.6 Data Pola Penggunaan Terapi Ketorolak Tunggal Pada Pasien BPH ..... 66

5.7 Data Pola Penggunaan Terapi Ketorolak dengan Switch pada Pasien BPH

(Benign Prostatic Hyperplasia) .............................................................. 66

5.8 Data Terapi Lain yang Diterima Pasien BPH ......................................... 6

5.9 Lama Penggunaan Ketorolak pada Pasien BPH ..................................... 68

5.10 Lama Masuk Rumah Sakit Pasien BPH.................................................. 68

5.11 Kondisi Keluar Rumah Sakit Pasien BPH .............................................. 68

BAB VI PEMBAHASAN ..................................................................................... 69

BAB VII KESIMPULAN DAN SARAN ............................................................. 6

7.1 Kesimpulan ............................................................................................. 6

7.2 Saran ....................................................................................................... 6

DAFTAR PUSTAKA ........................................................................................... 77

LAMPIRAN .......................................................................................................... 80

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DAFTAR TABEL

Tabel Halaman

Tabel II. 1 Gejala BPH (Benign Prostatic Hyperplasia) ...................................... 11

Tabel II. 2 Kategori BPH berdasarkan tanda dan gejala ....................................... 12

Tabel II. 3 Penatalaksanaan BPH .......................................................................... 20

Tabel II. 4 Berbagai penyulit TURP, selama maupun setelah pembedahan ......... 27

Tabel II. 5 Sediaan Ketorolak di Indonesia ........................................................... 56

Tabel V. 1 Usia Pasien BPH (Benign Prostatic Hyperplasia) .............................. 65

Tabel V. 2 Status Pasien BPH (Benign Prostatic Hyperplasia) ........................... 65

Tabel V. 3 Jenis Operasi Pasien BPH (Benign Prostatic Hyperplasia) ................ 65

Tabel V. 4 Diagnosis Penyerta Pasien BPH (Benign Prostatic Hyperplasia) ...... 65

Tabel V. 5 Data Riwayat Penyakit BPH (Benign Prostatic Hyperplasia) ............ 65

Tabel V. 6 Pola Penggunaan Ketorolak pada pasien BPH ................................... 66

Tabel V. 7 Pola Penggunaan Terapi Ketorolak Tunggal Pada Pasien BPH ......... 66

Tabel V. 8 Pola Penggunaan Terapi Ketorolak dengan Switch pada Pasien ........ 66

Tabel V. 9 Terapi Lain yang Diterima Pasien BPH .............................................. 67

Tabel V. 10 Lama Penggunaan Ketorolak pada Pasien BPH ............................... 68

Tabel V. 11 Lama Masuk Rumah Sakit Pasien BPH ............................................ 68

Tabel V. 12 Kondisi KRS Pasien BPH (Benign Prostatic Hyperplasia) .............. 68

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DAFTAR GAMBAR

Gambar Halaman

Gambar 2. 1 Organ Genitalia Pria ........................................................................... 5

Gambar 2. 2 Anatomi Prostat .................................................................................. 5

Gambar 2. 3 Perbandingan Prostat Normal dan BPH ............................................. 6

Gambar 2. 4 Perubahan Testosteron Menjadi Dihidrotestosteron .......................... 8

Gambar 2. 5 Skema Terjadinya Benign Prostatic Hyperplasia ............................ 10

Gambar 2. 6 Pemeriksaan Colok Dubur ............................................................... 18

Gambar 2. 7 Open Prostatectomy ......................................................................... 25

Gambar 2. 8 TURP (Transurethral resection of the prostate) .............................. 27

Gambar 2. 9 Visual Analog Scale (VAS) ............................................................. 33

Gambar 2. 10 Verbal Rating Scale (VRS) ............................................................ 34

Gambar 2. 11 Numeric Rating Scale (NRS) ......................................................... 34

Gambar 2. 12 Wong Baker Pain Rating Scale ...................................................... 35

Gambar 2. 13 McGill Pain Questionnaire (MPQ) ................................................ 35

Gambar 2. 14 Memorial Pain Assessment Card ................................................... 36

Gambar 2. 15 Mekanisme Kerja NSAID .............................................................. 44

Gambar 2. 16 Nyeri Pada Benign Prostatic Hyperplasia ..................................... 49

Gambar 2. 17 Terbentuknya PGE2 pada Luka dan Peradangan ........................... 50

Gambar 2. 18 Struktur Kimia Ketorolak ............................................................... 52

Gambar 3. 1 Kerangka Konseptual ....................................................................... 58

Gambar 3. 2 Kerangka Operasional ...................................................................... 59

Gambar 5. 1 Skema Inklusi dan Eksklusi Penelitian pasien BPH ........................ 64

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DAFTAR LAMPIRAN

Lampiran Halaman

Lampiran 1 Daftar Riwayat Hidup ........................................................................ 80

Lampiran 2 Surat Pernyataan ................................................................................ 81

Lampiran 3 Daftar Nilai Normal Data Klinik dan Data Laboratorium ................. 82

Lampiran 4 Rekomendasi Penelitian Bakesbangpol Provinsi Jawa Timur .......... 83

Lampiran 5 Jawaban Permohonan Izin Penelitian RSUD Kertosono ................... 84

Lampiran 6 Keterangan Kelaikan Etik .................................................................. 85

Lampiran 7 Surat Tugas ........................................................................................ 86

Lampiran 8 Hasil Deteksi Plagiasi ........................................................................ 87

Lampiran 9 Kartu Kendali Deteksi Plagiasi.......................................................... 88

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DAFTAR SINGKATAN

ACEI : Angiotensin Converting Enzyme Inhibitor

ADH : Antidiuretic Hormone

bFGF : Basic Fibroblast Growth Factor

BMI : Body Mass Index

BNI : Bladder Neck Incision

BOO : Bladder Outlet Obstruction

BPE : Benign Prostatic Enlargement

BPH : Benign Prostatic Hyperplasia

BPO : Benign Prostatic Obstruction

cAMP : Adenosina Monofosfat siklik

CCB : Calsium Channel Blocker

CKD : Chronic Kidney Disease

CNS : Central Nervous System

COX : Cyclooxygenase

cPGES : Cytosolic Prostaglandin E Synthase

CYP : Cytochrome

DHT : Dihidrotestosteron

DRE : Digital Rectal Examination

EGF : Epidermal Growth Factor

FDA : Food and Drug Administration

GI : Gastrointestinal

GMP : Guanosin Monofosfat siklik

HIFU : High Intensity Focused Ultrasound

HoLAP : Holmium Laser Ablation of the Prostate

HoLEP : Holmium Laser Enucleation of the Prostate

HoLRP : Holmium Laser Resection of the Prostate

IM : Intramuscular

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IPP : Intra Prostatic Protrusion

IPSS : International Prostatic Symptom Score

ISK : Infeksi Saluran Kemih

IV : Intravena

IVU : Intravenous Urogram

LUTS : Lower Urinary Track Symptoms

mPGES : Microsomal Prostaglandin E Synthase

MPQ : McGill Pain Questionnaire

NADPH : Nikotinamida adenin dinukleotida fosfat

NRS : Numeric Rating Scale

NSAID : Non Steroid Anti Inflamation Drugs

PAE : Prostatic Artery Embolization

PGE2 : Prostaglandin E2

PGH2 : Prostaglandin H2

PI : Inhibitor Phosphodiesterase

PKA : Protein Kinase A

PKC : Protein Kinase C

PSA : Prostate Specific Antigen

PVR : Post Voiding Residual

RA : Reseptor androgen

RMK : Rekam Medis Kesehatan

RR : Respiratory Rate

SHBG : Sex Hormone Binding Globulin

SSP : Sistem Saraf Pusat

TAUS : Trans Abdominal Ultrasonography

TGF : Transforming Growth Factor

TRPV : Transient Receptor Potencial Vanilloid

TRUS : Trans Uretral Ultrasonography

TUBD : Transurethral Balloon Dilation of the Prostate

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TUIP : Transurethral Incision of the Prostate

TULP : Transurethral Laser of the Prostate

TUMT : Transurethral Microwave Thermotherapy

TUNA : Transurethral Needle Ablasion

TURP : Trans Ureterhral Resection of the Prostate

VAS : Visual Analogue Scale

VRS : Verbal Rating Scale

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