SKRIPSI

RIAN NORAHMAN

STUDI PENGGUNAAN OBAT GOLONGAN

STATIN PADA PASIEN SINDROM NEFROTIK

(Penelitian Dilakukan di Rumah Sakit Umum

Daerah Dr. Saiful Anwar Malang)

PROGRAM STUDI FARMASI

FAKULTAS ILMU KESEHATAN

UNIVERITAS MUHAMMADIYAH MALANG

2019

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KATA PENGANTAR

Assalamu’alaikum Wr.Wb.

Puji dan syukur penulis panjatkan ke hadirat Allah subhanahu wa ta’ala

yang telah melimpahkan kasih dan sayang-Nya kepada kita, karena dengan rahmat

dan hidayah-Nya skripsi dengan judul Studi Penggunaan Obat Golongan Statin

pada Pasien Sindrom Nefrotik (Penelitian Dilakukan di Rumah Sakit Umum

Daerah Dr. Saiful Anwar Malang) dapat diselesaikan dengan baik dan tepat

waktu.

Selanjutnya penulis ingin mengucapkan terima kasih yang tidak terhingga kepada :

1. Orang tua tercinta, Mama Hj. Musliani, S.Pd dan Abah H. Iberamsyah S.Pd

sebagai motivasi utama penulis untuk menyelsaikan skripsi ini. Terima kasih

untuk segala do’a, dukungan, baik secara moril dan materi.

2. Direktur dan staf dari Rumah Sakit Umum Daerah Dr. Saiful Anwar Malang

beserta jajarannya, khususnya bagian Diklit, dan seluruh staf pegawai bagian

Rekam Medik yang telah memberikan izin, waktu, dan tempat dalam

kelancaran penelitian skripsi.

3. Bapak Faqih Ruhyanudin M.Kep., Sp. Kep.MB selaku dekan Fakultas Ilmu

Kesehatan Universitas Muhammadiyah Malang.

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

Farmasi Universitas Muhammadiyah Malang.

5. Bapak Drs. Didik Hasmono, M.S., Apt selaku pembimbing I yang telah

meluangkan banyak waktu, tenaga, dan pikiran untuk membimbing,

memotivasi, menginspirasi, serta memberikan semangat dan dorongan kepada

penulis selama menempuh pendidikan hingga terselesaikannaya tugas akhir ini,

semoga Allah selalu memberikan kesehatan.

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

sedikit menyediakan waktu dan tempat untuk membimbing dan mengarahkan

hingga tugas akhir ini dapat diselesaikan dengan baik dan tepat waktu, semoga

Allah selalu memberikan kesehatan.

7. Ibu Ika Ratna Hidayati, S.Farm., M.Sc., Apt. dan Ibu Firasti Agung N.S., M.

Biotech., Apt. selaku penguji I dan II yang telah memberikan kritik dan saran

v

untuk membantu memperbaiki tugas akhir ini dengan sebaik-baiknya, semoga

Allah selalu memberikan kesehatan.

8. Seluruh jajaran prodi, dosen serta staf tata usaha Farmasi yang telah

memberikan dedikasi yang besar kepada penulis.

9. Nenek tercinta, Nini Hj. Masitah yang selalu memberikan motivasi, do’a dan

semangat kepada penulis untuk menyelesaikan skripsi ini. Semoga Allah selalu

melimpahkan rahmat dan hidayah-Nya.

10. Kakak Tersayang, Nisfi Sasmita S. Si dan Raysya Dewi Lestari S.Pd yang telah

memberikan semangat, dan motivasi untuk penulis demi kelancaran penulisan

skripsi. Semoga Allah selalu melimpahkan rahmat dan hidayah-Nya.

11. Teman skripsi Sindrom Nefrotik, yang telah banyak memberikan bantuan dan

berjuang bersama demi terselesaikannya penulisan skripi ini. Khususnya

kepada Jeny Rindiantika, Laura Mayang Lestari, Wika Tanika, dan Richa

Faidhatul Laily.

10. Seluruh teman-teman farmasi angkatan 2015 khususnya Farmasi C yang telah

berjuang bersama penulis untuk menyelesaikan pendidikan di Program Studi

Farmasi Universitas Muhammadiyah Malang.

Akhir kata, penulis memohon maaf apabila terdapat kekurangan dan

ketidaksempurnaan dalam penulisan skripsi ini dan penulis dengan senang hati

untuk menerima kritik dan saran yang membangun. Semoga skripsi ini dapat

memberikan manfaat dalam perkembangan ilmu dalam bidang farmasi klinis bagi

penulis dan pembaca.

Wassalamu’alaikum Wr.Wb.

Malang, 9 Juli 2019

Rian Norahman

ix

DAFTAR ISI

Halaman

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

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

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

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

ABSTRAK ........................................................................................................... vii

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

DAFTAR ISI ......................................................................................................... ix

DAFTAR GAMBAR ........................................................................................... xii

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

DAFTAR LAMPIRAN ...................................................................................... xiv

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 Manfaat Bagi RSUD Dr. Saiful Anwar Malang ........................................ 5

1.4.2 Manfaat Bagi Ilmu Pengetahuan ............................................................... 5

BAB II TINJAUAN PUSTAKA ........................................................................... 6

2.1 Tinjauan Tentang Glomerulus ................................................................... 6

2.2 Tinjauan Tentang Sindrom Nefrotik (SN) ................................................. 8

2.2.1 Definisi SN ................................................................................................ 8

2.2.2 Epidemiologi SN ....................................................................................... 9

2.2.3 Etiologi SN .............................................................................................. 10

2.2.4 Patofisiologi SN ....................................................................................... 15

2.2.5 Manifestasi Klinik SN ............................................................................. 16

2.2.6 Penatalaksanaan SN ................................................................................. 20

2.2.7 Komplikasi............................................................................................... 24

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2.3 Tinjauan Statin ......................................................................................... 26

2.3.1 Definisi Umum Statin .............................................................................. 26

2.3.2 Indikasi Statin .......................................................................................... 27

2.3.3 Farmakokinetika Statin ............................................................................ 28

2.3.4 Mekanisme Kerja Statin .......................................................................... 30

2.3.5 Efek Farmakologis dan Dosis Statin ....................................................... 32

2.3.6 Efek Samping Statin ................................................................................ 33

2.3.7 Interaksi Statin ......................................................................................... 34

2.3.8 Kontraindikasi ......................................................................................... 34

2.4 Terapi Statin pada Hiperlipidemia ........................................................... 34

2.4.1 Mekanisme Kerja Statin pada SN ............................................................ 34

2.4.2 Penggunaan Statin pada SN ..................................................................... 36

2.4.3 Obat Golongan Statin .............................................................................. 37

BAB III KERANGKA KONSEPTUAL ............................................................ 50

3.1 Kerangka Konseptual .............................................................................. 50

3.2 Kerangka Operasional ............................................................................. 51

BAB IV METODE PENELITIAN .................................................................... 52

4.1 Rancangan Penelitian .............................................................................. 52

4.2 Populasi dan Sampel ................................................................................ 52

4.2.1 Populasi ................................................................................................... 52

4.2.2 Sampel ..................................................................................................... 52

4.2.3 Kriteria Inklusi ......................................................................................... 52

4.2.4 Kriteria Eksklusi ...................................................................................... 52

4.3 Metode Pengambilan Sampel .................................................................. 52

4.4 Instrumen Penelitian ................................................................................ 52

4.5 Tempat dan Waktu ................................................................................... 53

4.6 Metode Pengumpulan Data ..................................................................... 53

4.7 Analisa Data ............................................................................................ 53

4.8 Definisi Operasional ................................................................................ 53

BAB V HASIL PENELITIAN ........................................................................... 55

5.1 Data Demografi Pasien Sindrom Nefrotik............................................... 55

5.1.1 Distribusi Pasien Sindrom Nefrotik Menurut Usia .................................. 55

5.1.2 Distribusi Pasien Sindrom Nefrotik Menurut Jenis Kelamin .................. 56

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5.1.3 Distribusi Pasien Sindrom Nefrotik Menurut Status Pasien .................... 56

5.2 Diagnosa Pasien Sindrom Nefrotik ......................................................... 56

5.2.1 Diagnosa Utama Pasien Sindrom Nefrotik .............................................. 56

5.2.2 Diagnosa Penyerta Sindrom Nefrotik ...................................................... 57

5.3 Pola Pemberian Terapi Golongan Statin pada Pasien Sindrom Nefrotik 58

5.3.1 Pola Terapi Golongan Statin pada Pasien Sindrom Nefrotik .................. 58

5.3.2 Lama Pemberian Golongan Statin pada Pasien Sindrom Nefrotik .......... 58

5.4 Terapi Selain Golongan Statin pada Pasien Sindrom Nefrotik ............... 59

5.5 Lama Perawatan Pasien di Rumah Sakit ................................................. 64

5.6 Keadaan Pasien Saat Keluar Rumah Sakit .............................................. 64

BAB VI PEMBAHASAN .................................................................................... 65

BAB VII KESIMPULAN ................................................................................... 74

7.1 Kesimpulan .............................................................................................. 74

7.2 Saran ........................................................................................................ 74

DAFTAR PUSTAKA .......................................................................................... 75

xii

DAFTAR GAMBAR

Gambar Halaman

2. 1 Struktur Glomerulus ......................................................................................... 6

2. 2 Lapisan Membran Glomerulus ......................................................................... 7

2. 3 Podosit Kapsul Bowman .................................................................................. 8

2. 4 Kelainan Lesi Minimal ................................................................................... 11

2. 5 Glomerulosklerosis Fokal dan Segmental ...................................................... 11

2. 6 Nefropati Membranosa................................................................................... 12

2. 7 Diabetik Nefropati .......................................................................................... 13

2. 8 Amiloidosis .................................................................................................... 14

2. 9 Lupus Eritematosus Sistemik ......................................................................... 14

2. 10 Patofisiologi Sindrom Nefrotik. ................................................................... 16

2. 11 Lipid Abnormal pada Sindrom Nefrotik ...................................................... 19

2. 12 Obat Golongan Statin ................................................................................... 27

2. 13 Site of Action Statin pada Biosintesis Kolesterol ......................................... 30

2. 14 Mekanisme Kerja Statin ............................................................................... 31

2. 15 Struktur Atorvastatin .................................................................................... 37

2. 16 Struktur Simvastatin ..................................................................................... 39

2. 17 Struktur Fluvastatin ...................................................................................... 42

2. 18 Struktur Pravastatin ...................................................................................... 44

2. 19 Struktur Lovastatin ....................................................................................... 46

2. 20 Struktur Rusovastatin .................................................................................. 48

3. 1 Kerangka Konseptual ..................................................................................... 50

3. 2 Kerangka Operasional .................................................................................... 51

5. 1 Skema Inklusi Penelitian pada Pasien Sindrom Nefrotik .............................. 55

xiii

DAFTAR TABEL

Tabel Halaman

II. 1 Interpretasi Hasil Tes Dipstik Urin untuk Proteinuria ................................... 17

II. 1 Farmakokinetik Statin ................................................................................... 29

II. 2 Dosis Obat Golongan Statin untuk Hiperkolestrolemia pada SN ................. 32

II. 3 Dosis Statin untuk Mencapai Penurunan Kolesterol LDL ............................ 33

II. 4 Rangkuman berbagai obat golongan statin.................................................... 33

V. 1 Distribusi Pasien Sindrom Nefrotik Menurut Usia ....................................... 55

V. 2 Distribusi Pasien Sindrom Nefrotik Menurut Jenis Kelamin ........................ 56

V. 3 Distribusi Pasien Sindrom Nefrotik Menurut Status Pasien ......................... 56

V. 4 Diagnosa Utama Pasien Sindrom Nefrotik ................................................... 56

V. 5 Diagnosa Penyerta Pasien Sindrom Nefrotik ................................................ 57

V. 6 Pola Pemberian Terapi Golongan Statin pada Pasien Sindrom Nefrotik ...... 58

V. 7 Pola Terapi Golongan Statin pada Pasien Sindrom Nefrotik ........................ 58

V. 8 Lama Pemberian Golongan Statin pada Pasien Sindrom Nefrotik ............... 58

V. 9 Terapi Selain Golongan Statin pada Pasien Sindrom Nefrotik ..................... 60

V. 10 Lama Perawatan Pasien di Rumah Sakit ..................................................... 64

V. 11 Keadaan Pasien Saat Keluar Rumah Sakit .................................................. 64

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DAFTAR LAMPIRAN

Lampiran halaman

1 Daftar Riwayat Hidup ........................................................................................ 83

2 Surat Pernyataan................................................................................................. 84

3 Surat Izin Penelitian ........................................................................................... 85

4 Surat Laik Etik ................................................................................................... 86

5 Lembar Pengumpulan Data Pasien .................................................................... 87

6 Tabel Data Induk .............................................................................................. 186

75

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