skripsi amelia indri hapsari studi penggunaan bisoprolol

SKRIPSI
AMELIA INDRI HAPSARI
STUDI PENGGUNAAN BISOPROLOL PADA
PASIEN GAGAL JANTUNG
(Penelitian di Instalasi Rawat Inap RSUD Sidoarjo)
PROGRAM STUDI FARMASI
FAKULTAS ILMU KESEHATAN
UNIVERSITAS MUHAMMADIYAH MALANG
2016
DAFTAR SINGKATAN
ACC
ACEI
AF
AHA
ARB
AT1
AT2
ATP
: American College of Cardiology
: Angiotensin Converting Enzyme Inhibitor
: Atrial Fibrilation
: America Heart Association
: Angiotensin Receptor Bloker
: Angiotensin Tipe 1
: Angiotensin Tipe 2
: Adenosin triphospat
: Beta Blocker
BNP : B-type natriuretic peptide
BUN : Blood Urea Nitrogen
CAD : Coronary Arthery Disease
CIBIS : Ardiac Insufficiency Bisoprolol Study
Cl
: Klorida
CO
: Cardiac Output
CVD : Cardiovascular
CVDs : Cardiovascular Diseases
Depkes: Departemen Kesehatan
DM : Diabetes Melitus
ECG : Electrocardiography
ECHO: Echocardiography
EDV : End Diastole Volume
et al : Et Alii
GD2P : Gula darah 2 jam Postprandial
GDP : Gula Darah Puasa
GDS : Gula Darah Sesaat
GFR : Glomerular Filtration Rate
Hb
: Hemoglobin
HERS : Heart dan Estrogen / Progestin Replacement Study
HDL : High Density Lipoprotein
HF
: Heart Failure
HHF : Hypertension Heart Disease
HR
: Hate Rate
HT
: Hipertensi
ISDN : Isosorbid Dinitrat
Iv
: Intravena
Ipm : Liter per menit
LV
: Left Atrium
LVED : Left Ventricle End-Diastolic
LVEF : Left Ventricle Ejection Fraction
K+
: Kalium
KRS : Keluar Rumah Sakit
LPD : Lembar Pengumpulan Data
mcg : microgram
MmHg : Millimeter Hydragyrum
MRS : Masuk Rumah Sakit
Na+ : Natrium
NYHA : New York Heart Association
O2
: Oksigen
Po
: Per Oral
PJK : Penyakit Jantung Koroner
RAA : Renin-Angiotensin-Aldosteron
RAAS : Renin- Angiotensin-Aldosteron System
RR
: Respiratory Rate
RV
: Right Ventricle
RMK : Rekam Medis Kesehatan
RSUD : Rumah Sakit Umum Daerah
SGPT : Serum Glutamic Pyruvic Transminase
SGOT : Serum Glutamic Oxaloacetic Transminase
WHO : Word health Organization
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 ................................................................................ xvi
BAB I PENDAHULUAN .............................................................................. 1
1.1. Latar Belakang Masalah .................................................................. 1
1.2. Rumusan Masalah ........................................................................... 4
1.3. Tujuan Penelitian............................................................................. 4
1.4. Manfaat Penelitian ........................................................................... 4
BAB II TINJAUAN PUSTAKA ................................................................... 5
2.1. Tinjauan Tentang Definisi Gagal Jantung ....................................... 5
2.2. Tinjauan Epidemiologi Gagal Jantung ........................................... 5
2.3. Etiologi Gagal Jantung .................................................................. 6
2.3.1 Gangguan Primer Gagal Jantung ......................................... 7
2.3.1.1 Disfungsi Miokard ................................................... 7
2.3.1.2 Overload Volume .................................................... 7
2.3.1.3 Aterosklerosis.......................................................... 7
2.3.1.4 Aritmia ..................................................................... 7
2.3.1.5 Overload Tekanan ................................................... 8
2.3.1.6 Faktor Sistemik ........................................................ 8
2.4. Klasifikasi Gagal Jantung .............................................................. 8
2.5. Macam-Macam Gagal Jantung....................................................... 9
2.5.1 Gagal Jantung Akut- Kronik ............................................... 9
2.5.2 Gagal Jantung Kanan Kiri ................................................... 9
2.5.3 Gagal Jantung Sistolik Diastolik ......................................... 9
2.6
Faktor Resiko Gagal Jantung ........................................................ 9
2.6.1 Faktor yang tidak dapat dirubah .......................................... 10
2.6.2 Faktor yang dapat dirubah ................................................... 11
2.7.
Patofisiologi Gagal Jantung .......................................................... 12
2.7.1 Mekanisme Fisiologi Gagal Jantung.................................... 13
2.7.1.1 Preload (Beban awal) .............................................. 13
2.7.1.2 Kontraktilitas........................................................... 14
2.7.1.3 Afterload (beban akhir) ........................................... 14
2.8.
Mekanisme Kompensasi Pada Gagal Jantung ................................ 14
2.8.1 Peningkatan Aktivitas Adregenik Simpatik ......................... 15
2.8.2 Aktivasi System Renin-Angiontensin Aldosteron................ 16
2.9.
2.8.3
Hipertrofi Ventrikel ........................................................... 18
2.8.4
Hukum Frank Starling ......................................................... 20
Manifestasi Klinis .......................................................................... 22
2.10 Diagnosa dan Pemeriksaan Fisik Gagal Jantung ........................... 22
2.10.1 Pemeriksaan Elektrodiagram(EKG) ........................... 23
2.10.2 Pemeriksaan Rontgen ................................................. 23
2.10.3 Pemeriksaan Echocardiography (ECHO) ................... 26
2.10.4 Pemeriksaan Laboratorium ........................................ 23
2.10.4.1 BNP atau NT-pro BNT............................................ 24
2.11. Penata Laksanaan Terapi ............................................................. 24
2.12 Terapi Gagal Jantung ..................................................................... 24
2.12.1 Dieuretik .......................................................................... 24
2.12.2 ACEI ............................................................................... 25
2.12.3 Angiotensin Reseptor Blocker (ARB) ............................. 26
2.12.4 Antagonis Aldosteron....................................................... 26
2.12.5 Calcium Chanel Blocker ................................................... 27
2.12.6 Beta Blocker ..................................................................... 27
2.12.6.1 Tinjauan Bisoprolol ............................................. 34
2.12.7 Glikosida Digitalis ............................................................ 30
2.12.8 Nitrat dan Hydralazine ..................................................... 34
BAB III
KERANGKA KONSEPTUAL ....................................................... 35
3.1. Kerangka Konseptual .................................................................... 35
3.2
Kerangka Operasional .................................................................. 36
BAB IV
METODE PENELITIAN ............................................................ 37
4.1. Rancangan Penelitian .................................................................... 37
4.2. Populasi Sampel ............................................................................ 37
4.3. Kriteria Data Inklusi .................................................................... 37
4.4. Kriteria Data Eksklusi.................................................................... 38
4.5. Bahan Penelitian ........................................................................... 38
4.6. Instrumen Penelitian ..................................................................... 38
4.7. Tempat dan Waktu ....................................................................... 38
4.8. Definisi Operasional ...................................................................... 38
4.9. Metode Pengumpulan Data ............................................................ 40
4.10. Analisis Data ................................................................................. 40
BAB V HASIL PENELITIAN .....................................................................
5.1 Data Demografi Pasien .................................................................... 42
5.1.1 Jenis kelamin ................................................................................ 42
5.1.2 Usia Pasien ................................................................................... 42
5.2 Faktor Resiko Terdiagnosis Gagal Jantung ......................................... 43
5.3 Penggunaan Terapi pada pasien Gagal Jantung ................................... 43
5.3.1 Pola penggunaan Bisoprolol dan Kombinasi pada Gagal Jantung 44
5.4 Lama Perawatan Pasien ...................................................................... 48
5.6 Kondisi Keluar Rumah Sakit ............................................................. 48
BAB VI PEMBAHASAN ............................................................................. 49
BAB VII KESIMPULAN DAN SARAN ..................................................... 58
DAFTAR PUSTAKA ................................................................................... 59
LAMPIRAN ................................................................................................. 63
DAFTAR TABEL
II.1 Penyebab gagal jantung ................................................................................... 6
II.2 Klasifikasi gagal jantung menurut fungsi NYH ............................................... 8
II.3 Penatalaksana terapi menurut kelas NYH ....................................................... 24
II.4 Dosis β-bloker yang digunakan pada terapi gagal jantung ................................ 32
II.5 Beta Bloker yang digunakan untuk Gagal Jantung ........................................... 32
II.6 Sediaan Bisoprolol di Indonesia....................................................................... 32
V.1 Faktor resiko terdiagnosis gagal jantung .......................................................... 36
V.2 Penggunaan terapi Bisoprolol pada pasien gagal jantung ................................. 36
V.3 Pola penggunaan Bisoprolol ............................................................................ 36
DAFTAR GAMBAR
2.1 Gagal jantung .................................................................................................. 5
2.2 Prevalensi Gagal Jantung di USA berdasarkan usia dan jenis kelamin ............. 10
2.3 Cardiak output ................................................................................................ 13
2.4 Mekanisme kompensasi ................................................................................. 15
2.5 Sistem Renin Angiotensin .............................................................................. 17
2.6 Hipertropi concentric dan eccentric ................................................................. 19
2.7 Konsep remodeling kardiak terkait disfungi jantung pada kasus gaga .............. 20
2.8 Patofisiologi Gagal Jantung ............................................................................. 21
2.9 Manifestasi Gagal Jantung ............................................................................... 22
3.1 Kerangka Konseptual Studi Penggunaan Obat pada Pasien Gagal Jantung ...... 35
3.2 Kerangka Operasional Pada Pasien Gagal Jantung…………………………….
36
5.1 Skema Kriteria Inklusi dan Eklusi penelitian gagal jantung .............................. 34
5.2 Jenis kelamin pasien gagal jantung dengan terapi Bisoprolol ............................ 35
5.3 Usia pasien gagal jantung dengan Terapi Bisoprolol......................................... 35
5.5 Lama perawatan pasien dengan terapi Bisoprolol ............................................. 41
5.6 Kondisi Keluar Rumah Sakit ............................................................................ 41
DAFTAR LAMPIRAN
LAMPIRAN
Halaman
LAMPIRAN 1 Daftar Riwayat Hidup
LAMPIRAN 2 Surat Pernyataan
LAMPIRAN 3 Surat Ijin Penelitian
LAMPIRAN 4 Lembar Pengumpulan Data
LAMPIRAN5 Lembar Data induk
63
64
65
66
73
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