SKRIPSI

NORFADILLAH

STUDI PENGGUNAAN ASAM TRANEKSAMAT

PADA PASIEN BENIGN PROSTATIC

HYPERPLASIA (BPH)

(Penelitian di Rumah Sakit Umum Daerah Sidoarjo)

PROGRAM STUDI FARMASI

FAKULTAS ILMU KESEHATAN

UNIVERSITAS MUHAMMADIYAH MALANG

2017

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KATA PENGANTAR

Bismillahirrohmanirrohim

Assalamu’alaikum warohmatullahi wabarokatuh

Puji syukur tercurahkan kepada Allah SWT, Sang Semesta Alam berkat

rahmat dan ridho-Nya sehingga penulis dapat menyelesaikan skripsi yang

berjudul “STUDI PENGGUNAAN ASAM TRANEKSAMAT PADA PASIEN

BENIGN PROSTATIC HYPERPLASIA (BPH) (Penelitian di Rumah Sakit

Umum Daerah Sidoarjo)” untuk memenuhi salah satu persyaratan akademik

dalam menyelesaikan Program Sarjana Farmasi Fakultas Ilmu Kesehatan

Universitas Muhammadiyah Malang.

Dalam proses penyusunan skripsi ini, penulis tidak terlepas dari berbagai

pihak yang memberikan bantuan, bimbingan serta doa sehingga penulis dapat

menyelesaikan skripsi ini dengan baik. Untuk itu penulis menyampaikan rasa

terimakasih yang sebesar-besarnya kepada :

1. Kedua orang tua saya Saukani dan Dahliana yang telah memberikan

semangat, nasehat, dukungan serta doanya sehingga saya dapat

menjalani studi farmasi dengan baik.

2. Bapak Yoyok Bekti Prasetyo, M.Kep., Sp. Kom selaku Dekan Fakultas

Ilmu Kesehatan Universitas Muhammadiyah Malang.

3. Bapak Ahmad Shobrun Jamil, S.Si., MP selaku Dosen Wali. Terima

kasih banyak atas arahan, nasehat dan bimbingannya selama ini.

4. Ibu Hidajah Rachmawati, S.Si. Apt., Sp.FRS selaku Dosen

Pembimbing I yang dengan sabar dan tiada hentinya memberikan

arahan, nasehat serta motivasi penulis saat bimbingan hingga skripsi ini

dapat terselesaikan.

5. Bapak Drs. Didik Hasmono, M.S., Apt selaku Dosen Pembimbing II,

yang telah banyak meluangkan waktu untuk membimbing dan memberi

pengarahan serta dorongan moril hingga skripsi ini dapat terselesaikan.

6. Ibu Dra. Lilik Yusetyani, Apt., Sp.FRS dan ibu Nailis Syifa’, S.Farm.,

M.Sc., Apt selaku Dosen Penguji I dan II yang telah banyak

memberikan saran dan masukan demi kesempurnaan skripsi ini.

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DAFTAR ISI

Halaman

JUDUL .................................................................................................................... i

LEMBAR PENGESAHAN .................................................................................. ii

LEMBAR PENGUJIAN ...................................................................................... iii

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

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

ABSTRAK .......................................................................................................... viii

ABSTRACT .......................................................................................................... ix

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

DAFTAR TABEL .............................................................................................. xiv

DAFTAR GAMBAR ............................................................................................xv

DAFTAR LAMPIRAN ...................................................................................... xvi

DAFTAR SINGKATAN ................................................................................... xvii

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

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

2.1 Prostat ............................................................................................................ 5

2.1.1 Struktur Anatomi Prostat ........................................................................ 5

2.1.2 Fisiologi Normal Kelenjar Prostat .......................................................... 6

2.2 Definisi Benign Prostatic Hyperplasia ......................................................... 6

2.3 Epidemiologi Benign Prostatic Hyperplasia ................................................ 7

2.4 Etiologi Benign Prostatic Hyperplasia ......................................................... 7

2.4.1 Teori Dihidrotestosteron (DHT) ............................................................. 8

2.4.2 Teori Ketidakseimbangan Estrogen dan Testosteron ............................. 8

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2.4.3 Teori Interaksi Stroma dan Epitel ........................................................... 9

2.4.4 Berkurangnya Kematian Sel Prostat ....................................................... 9

2.4.5 Teori Sel Stem ...................................................................................... 10

2.5 Patofisiologi Benign Prostatic Hyperplasia ................................................ 10

2.6 Faktor Penyebab Benign Prostatic Hyperplasia ......................................... 11

2.6.1 Kadar Hormon DHT ............................................................................. 12

2.6.2 Usia ....................................................................................................... 12

2.6.3 Genetik .................................................................................................. 12

2.7 Manifestasi Klinis BPH ............................................................................... 12

2.8 Pemeriksaan dan Diagnosis BPH ................................................................ 13

2.8.1 Anamnesis ............................................................................................. 12

2.8.2 Pemeriksaan Fisik ................................................................................. 14

2.8.3 Urinalisis ............................................................................................... 15

2.8.4 Pemeriksaan Laboratorium ................................................................... 15

2.8.5 Pemeriksaan Fungsi Ginjal ................................................................... 16

2.9 Penatalaksanaan BPH .................................................................................. 16

2.8.1 Watchful Waiting (Follow Up) ............................................................. 17

2.8.2 Medikamentosa (Terapi Farmakologi) ................................................. 18

2.9.2.1 Antagonis reseptor adrenergik-α ................................................... 18

2.9.2.2 Inhibitor 5 α-reduktase .................................................................. 18

2.9.3 Terapi Intervensi ................................................................................... 19

2.9.3.1 Minimally Invansive Therapies..................................................... 19

2.9.3.2 Terapi Bedah (Surgical Therapies) ............................................... 20

2.10 Resiko Pembedahan Pasca Operasi BPH .................................................. 23

2.10.1 Resiko Infeksi ..................................................................................... 23

2.10.1.1 Infeksi Luka Operasi ................................................................... 23

2.10.1.2 Infeksi Nosokomial ..................................................................... 24

2.10.1.3 Infeksi Saluran Kemih................................................................. 24

2.10.2 Gangguan Perdarahan ......................................................................... 24

2.11 Terapi Perdarahan ...................................................................................... 25

2.11.1 Asam Traneksamat ............................................................................. 25

2.11.2 Vit K ................................................................................................... 25

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2.12 Tinjauan Pustaka Obat ............................................................................... 26

2.12.1 Asam Traneksamat ............................................................................. 26

2.12.2 Indikasi................................................................................................ 26

2.12.3 Mekanisme Kerja ................................................................................ 27

2.12.4 Farmakodinamik ................................................................................. 28

2.12.5 Farmakokinetik ................................................................................... 28

2.12.6 Dosis dan Rute Pemberian .................................................................. 28

2.12.7 Efek Samping ...................................................................................... 29

2.12.8 Nama Dagang Indonesia ..................................................................... 30

BAB III KERANGKA KONSEPTIONAL .......................................................32

3.1 Bagan Kerangka Konseptional .................................................................... 32

3.2 Bagan Kerangka Operasional ...................................................................... 33

BAB IV METODE PENELITIAN .....................................................................34

4.1 Rancangan Penelitian .................................................................................. 34

4.2 Populasi dan Sampel ................................................................................... 34

4.2.1 Populasi ................................................................................................. 34

4.2.2 Sampel .................................................................................................. 34

4.2.3 Kriteria Data Eksklusi ........................................................................... 34

4.2.3 Kriteria Data Inklusi ............................................................................. 35

4.3 Bahan Penelitian .......................................................................................... 35

4.4 Instrumen Penelitian .................................................................................... 35

4.5 Tempat dan Waktu Penelitian ..................................................................... 35

4.6 Definisi Operasional .................................................................................... 35

4.7 Metode Pengumpulan Data ......................................................................... 36

4.8 Analisis Data ............................................................................................... 37

BAB V HASIL PENELITIAN ............................................................................38

5.1 Jumlah Sampel Penelitian ........................................................................... 38

5.2 Data Demografi Pasien ................................................................................ 38

5.2.1 Distribusi Berdasarkan Usia ................................................................. 39

5.2.2 Status Pasien ......................................................................................... 39

5.3 Jenis Tindakan Operasi ............................................................................... 39

5.4 Profil Terapi Hemostatik pada Pasien BPH ................................................ 40

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5.4.1 Pola Penggunaan Terapi Tunggal dan Kombinasi Asam Traneksamat

pada Pasien BPH .................................................................................. 40

5.4.2 Pola Penggunaan Terapi Tunggal Asam Traneksamat pada Pasien BPH

.............................................................................................................. 40

5.4.3 Pola Penggunaan Terapi Kombinasi Asam Traneksamat pada Pasien

BPH ...................................................................................................... 40

5.4.4 Pola Penggunaan Terapi Asam Traneksamat dengan Switching Rute,

Dosis, Jenis Hemostatik pada Pasien BPH ........................................... 41

5.4.5 Lama Penggunaan Terapi Asam Traneksamat pada Pasien BPH......... 41

5.5 Pola Terapi Selain Asam Traneksamat pada Pasien BPH ........................... 41

5.6 Diagnosa Penyakit Penyerta pada Pasien BPH ........................................... 42

5.7 Lama Rawat Inap pada Pasien BPH ............................................................ 43

5.8 Kondisi Klinik Keluar Rumah Sakit (KRS) pada Pasien BPH ................... 43

BAB VI PEMBAHASAN.....................................................................................44

BAB VII KESIMPULAN DAN SARAN ............................................................50

7.1 Kesimpulan .................................................................................................. 50

7.2 Saran ............................................................................................................ 50

DAFTAR PUSTAKA ...........................................................................................51

LAMPIRAN ..........................................................................................................56

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DAFTAR TABEL

Tabel Halaman

II.1 LUTS pada BPH ............................................................................................. 12

II.2 Nilai IPSS yang menunjukkan derajat BPH ................................................... 13

II.3 Pengobatan untuk pasien dengan gejala rngan sampai berat pada BPH ........ 16

II.4 Sediaan asam traneksamat di Indonesia ......................................................... 29

V.1 Distribusi Usia pada Pasien BPH di Instalasi Rawat Inap RSUD Sidoarjo

periode 1 Juli - 31 Desember 2016 ................................................................39

V.2 Status Pasien pada Pasien BPH di Instalasi Rawat Inap RSUD Sidoarjo

periode 1 Juli - 31 Desember 2016 ................................................................39

V.3 Jenis Tindakan Operasi pada Pasien BPH di Instalasi Rawat Inap RSUD

Sidoarjo periode 1 Juli - 31 Desember 2016 ................................................39

V.4 Pola Penggunaan Terapi Tunggal dan Kombinasi Asam Traneksamat pada

Pasien BPH di Instalasi Rawat Inap RSUD Sidoarjo periode 1 Juli - 31

Desember 2016...............................................................................................39

V.5 Pola Penggunaan Terapi Tunggal Asam Traneksamat pada Pasien BPH di

Instalasi Rawat Inap RSUD Sidoarjo periode 1 Juli – 31 Desember

2016.................................................................................................................40

V.6 Pola Penggunaan Terapi Kombinasi Asam Traneksamat pada Pasien BPH di

Instalasi Rawat Inap RSUD Sidoarjo periode 1 Juli – 31 Desember

2016.................................................................................................................40

V.7 Pola Penggunaan Terapi Asam Traneksamat dengan Switching Rute, Dosis

dan Jenis Hemostatik pada Pasien BPH di Instalasi Rawat Inap RSUD

Sidoarjo periode 1 Juli - 31 Desember 2016...................................................40

V.8 Lama Penggunaan Terapi Asam Traneksamat pada Pasien BPH di Instalasi

Rawat Inap RSUD Sidoarjo periode 1 Juli – 31 Desember

2016.................................................................................................................41

V.9 Pola Terapi Selain Asam Traneksamat pada Pasien BPH di Instalasi Rawat

Inap RSUD Sidoarjo periode 1 Juli - 31 Desember 2016...............................41

V.10 Diagnosa Penyakit Penyerta pada Pasien BPH di Instalasi Rawat Inap RSUD

Sidoarjo periode 1 Juli – 31 Desember 2016..................................................42

V.11 Lama Rawat Inap pada Pasien BPH di Instalasi Rawat Inap RSUD Sidoarjo

periode 1 Juli – 31 Desember 2016.................................................................43

V.12 Kondisi Klinik Keluar Rumah Sakit (KRS) pada Pasien BPH di Instalasi

Rawat Inap RSUD Sidoarjo periode 1 Juli – 31 Desember

2016.................................................................................................................43

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DAFTAR GAMBAR

Gambar Halaman

2.1 Zona pada prostat (Eipstein et al., 2011) .......................................................... 5

2.2 Perbedaan Prostat Normal dengan BPH (Lernard, 2013) ................................. 6

2.3 Perubahan testosteron menjadi dihidrotestosteron oleh enzim 5α-reduktase

(Purnomo, 2011) .............................................................................................. 8

2.4 Keseimbangan Proliferasi Sel dan Apoptosis pada Prostat .............................. 9

2.5 Patofisiologi Benign Prostatic Hyperplasia (Dhingra and Bhagwat.,2011).....10

2.6 Struktur asam traneksamat (Cormack, 2012)..................................................26

2.7 Mekanisme agen antifibrinolitik asam traneksamat (Cormack, 2012)............27

5.1 Skema Kriteria Inklusi dan Eksklusi Penelitian pada Pasien BPH..................38

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DAFTAR LAMPIRAN

Lampiran Halaman

1 Daftar Riwayat Hidup ........................................................................................ 56

2 Surat Pernyataan................................................................................................. 57

3 Ethical Clearence ............................................................................................... 58

4 Surat Jawaban Permohonan Ijin Penelitian ....................................................... 59

5 Nota Dinas .......................................................................................................... 60

6 Lembar Pengumpulan Data Pasien BPH........................................................... 61

7 Tabel Induk ..................................................................................................... 105

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DAFTAR SINGKATAN

5-ARIs : 5-Alpha Reductase Inhibitors

AUA : American Urological Association

BUN : Blood Urea Nitrogen

BPE : Benign Prostatic Enlargement

BPO : Benign Prostate Obstruction

BPOM : Badan Pengawasan Obat dan Makanan

BPH : Benign Prostatic Hyperplasia

BUN : Blood Urea Nitrogen

DHT : Dihidrotestosteron

EACA : epsilon aminocaproic acid

GCS : Glasgow Coma Scale

Hb : Hemoglobin

HoLAP : Transurethral holmium laser ablation of the prostate

HoLEP : Transurethral holmium laser enucleation of the prostate

HoLRP : Holmium laser resection of the prostate

IPSS : International Prostatic Symptom Score

ISK : Infeksi Saluran Kemih

LED : Laju Endap Darah

m-RNA : messenger Ribonucleic Acid

NADPH : Nicotinamide Adenine Dinucleotide Phosphate-oxidase

PPJ : Pembesaran Prostat Jinak

PSA : Prostate-Specific Antigen

PVP : Photoselective Vaporization of the Prostate

PVR : Post-Void Residual

QoL : Quality of Life

RBC : Red Blood Cell

RR : Respiratory Rate

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RSUD : Rumah Sakit Umum Daerah

SGOT : Serum Glutamic Oxaloacetic Transaminase

SGPT : Serum Glutamic Pyruvic Transaminase

TD : Tekanan Darah

TRUS : Transrectal Ultrasonography

TUIP : Transurethral Incision of the Prostate

TUMT : Transurethral Microwave heat Treatment

TUNA : Transurethral Needle Ablation

TURP : Transurethral Resection of the Prostate

TUVP : Transurethral Vaporization of the Prostate

WBC : White Blood Cell

WHO : Who Health Organization

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