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SKRIPSI
ARIEF RACHMAN
STUDI PENGGUNAAN METILDOPA PADA PASIEN
PREEKLAMPSIA
(Penelitian Dilakukan di RSUD Sidoarjo)
PROGRAM STUDI FARMASI
FAKULTAS ILMU KESEHATAN
UNIVERSITAS MUHAMMADIYAH MALANG
2019
LEMBAR PENGESAHAN
STUDI PENGGUNAAN METILDOPA PADA PASIEN
PREEKLAMPSIA
(Penelitian dilakukan di RSUD Sidoarjo)
SKRIPSI
Dibuat Untuk Memenuhi Syarat Mencapai Gelar Sarjana
Farmasi Pada Program Studi Farmasi Fakultas Ilmu Kesehatan
Universitas Muhammadiyah Malang
2019
Oleh :
ARIEF RACHMAN
NIM : 201510410311127
Disetujui Oleh :
Pembimbing I Pembimbing II
Dr. Lilik Yusetyani, Dra., Apt., Sp.FRS.
NIP. 114.0704.0450
Drs. Didik Hasmono, M.S.,Apt
NIP. 195809111986011001
iii
LEMBAR PENGUJIAN
STUDI PENGGUNAAN METILDOPA PADA PASIEN
PREEKLAMPSIA
(Penelitian dilakukan di RSUD Sidoarjo)
SKRIPSI
Telah diuji dan dipertahankan di depan tim penguji
Pada tanggal : 6 juli 2019
Oleh :
ARIEF RACHMAN
NIM : 201510410311127
Tim penguji
Penguji I Penguji II
Penguji III Penguji IV
Dr. Lilik Yusetyani, Dra., Apt., Sp.FRS.
NIP. 114.0704.0450
Drs. Didik Hasmono, M.S.,Apt
NIP. 195809111986011001
Firasti Agung N. S., M. Biotech., Apt.
NIP. 180924121989
Hidajah Rachmawati, S.Si., Apt., Sp. FRS.
NIP. 114.0609.0449
iv
KATA PENGANTAR
Asslamualaikum wr.wb
Puji syukur ke hadirat Allah SWT yang telah melimpahkan berkah dan nikmat ke
hamba-Nya, karena dengan pertolongan-Nya skripsi yang berjudul Studi
Penggunaan Metildopa Pada Pasien Preeklampsia (Penelitian dilakukan di
Rumah Sakit Umum Daerah Sidoarjo) dapa diselesaikan tepat waktu dan dengan
sebaik-baiknya.Selanjutnya penulis ingin mengucapkan terima kasih yang tidak
terhingga kepada :
1. Orang tua Ibu Supiati dan Bapak Syamsul Bahri yang telah menjadi motivasi
besar saya untuk menyelesaikan skripsi ini.
2. Bapak Faqih Ruhyanudin M.kep., Sp. Kep.MB selaku dekan fakultas Ilmu
Kesehatan Universitas Muhammadiyah Malang.
3. Direktur dan staf Rumah Sakit Umum Sidoarjo yang telah membantu kelancaran
penelitian skripsi.
4. Bapak Drs. Didik Hasmono, Apt., MS selaku pembimbing I yang telah banyak
memberikan solusi, mengarahkan, dan memberi semangat, motivasi, serta
menginspirasi penulis selama pendidikan sampai terselesaikanya tugas akhir ini,
semoga Allah selalu melimpahkan kesehatan.
5. Ibu Dra. Lilik Yusetyani, Apt., Sp. FRS selaku pembimbing II yang selalu
meluangkan waktu untuk membimbing di malam hari, selalu sabar dalam
mengarahkan hingga tugas akhir ini dapat diselesaikan dengan baik dan tepat
waktu, semoga Allah selalu melimpahkan kesehatan.
6. Ibu Hidajah Rachmawati, S.Si., Apt., Sp. FRS selaku dan Firasti Agung N.S.,
M.Biotech., Apt selaku penguji I dan II yang telah banyak memberikan masukan
dan saran demi terselesaikannya tugas akhir ini dengan sebaik-baiknya. Semoga
Allah selalu melimpahkan kesehatan.
7. Seluruh jajaran prodi, dosen dan staf tata usaha Farmasi yang telah memberikan
dedikasi yang besar kepada penulis.
8. Teman skripsi sesama departemen klinis, yang telah banyak memberikan
bantuan pada penulisan skripsi ini. Khususnya Faiz dan Tria.
v
9. Seluruh teman-teman farmasi angkatan 2015 yang telah berjuang bersama
penulis untuk menyelesaikan pendidikan di Program Studi Farmasi Universitas
Muhammadiyah Malang.
10. Teman main yang selalu memberikan semangat dari awal skripsi sampai
selesainya skripsi ini yaitu azza mayrose.
11. Terakhir, teman-teman yang membantu saya selama proses pembuatan skripsi
ini, teman saya rizki, taufik, dzul, sultan yang selalu memberikan support untuk
menyelesaikan skripsi ini. serta teman-teman farmasi C yang telah membantu
saya selama bimbingan skripsi dan seminar proposal (Fauz dan wika) dan teman-
teman team futsal farmasi sianida yang selalu memberikan semangat sehingga
dapat terselesaikanya skripsi ini (dicky, sigit, abid, bagas, shalhan, dika, adam,
rahmat, hendri, adit, harzelin, dimas, raihan, andri dan banyak lagi yang tidak
bisa saya sebutkan semuanya).
Akhir kata, penulis mohon maaf atas kekurangan dan ketidaksempurnaan penulisan
skripsi dan dengan senang hati menerima kritik dan saran yang membangun. Semoga
skrpsi ini bermanfaat dalam mengembangkan ilmu pengetahuan bidang farmasi
klinis bagi penulis maupun pembaca.
Wasslamualaikum Wr.Wb
Malang, 2 juni 2018
Arief Rahman
DAFTAR ISI
Halaman
LEMBAR PENGESAHAN .................................................................................. ii
LEMBAR PENGUJIAN ...................................................................................... iii
KATA PENGANTAR .......................................................................................... iv
RINGKASAN ........................................................... Error! Bookmark not defined.
ABSTRAK ................................................................ Error! Bookmark not defined.
DAFTAR ISI .......................................................................................................... x
DAFTAR TABEL .............................................................................................. xiv
DAFTAR BAGAN ............................................................................................... xv
DAFTAR GAMBAR .......................................................................................... xvi
DAFTAR LAMPIRAN ..................................................................................... xvii
DAFTAR SINGKATAN .................................................................................. xviii
BAB I PENDAHULUAN ......................................... Error! Bookmark not defined.
1.1 Latar Belakang ................................................. Error! Bookmark not defined.
1.2 Rumusan Maslah .............................................. Error! Bookmark not defined.
1.3 Tujuan penelitian .............................................. Error! Bookmark not defined.
1.3.1 Tujuan Umum ............................................... Error! Bookmark not defined.
1.4 Manfaat Penlitian ............................................. Error! Bookmark not defined.
1.4.1Bagi peneliti ................................................... Error! Bookmark not defined.
1.4.2 Bagi rumah sakit ........................................... Error! Bookmark not defined.
BAB II TINJAUAN PUSTAKA .............................. Error! Bookmark not defined.
2.1 Preeklampsia .................................................... Error! Bookmark not defined.
2.1.1 Definisi Preeklampsia ................................... Error! Bookmark not defined.
2.1.2 Epidemiologi Preeklampsia .......................... Error! Bookmark not defined.
2.1.3 Klasifikasi Preeklampsia ............................... Error! Bookmark not defined.
2.1.3.1 Klasifikasi Preeklampsia ............................ Error! Bookmark not defined.
xi
2.1.4 Faktor resiko ................................................. Error! Bookmark not defined.
2.1.5 Etiologi dan patogenesis hipertensi pada kehamilan .. Error! Bookmark not
defined.
2.1.5.1 Genetik ....................................................... Error! Bookmark not defined.
2.1.5.2 Iskemi plasenta ........................................... Error! Bookmark not defined.
2.1.5.3 Disfungsi Endotel ....................................... Error! Bookmark not defined.
2.1.5.4 Imunologis .................................................. Error! Bookmark not defined.
2.1.6 Patofisologis Preeklampsia ........................... Error! Bookmark not defined.
2.1.7 Diagnosis dan tes laboratorium Preeklampsia ............ Error! Bookmark not
defined.
2.1.7.1 Diagnosis preeklampsia ............................. Error! Bookmark not defined.
2.1.7.2 Tes laboratorium ........................................ Error! Bookmark not defined.
2.1.8 Manifestasi klinik Preeklampsia ................... Error! Bookmark not defined.
2.1.8.1 Hipertensi ................................................... Error! Bookmark not defined.
2.1.8.2 Edema ......................................................... Error! Bookmark not defined.
2.1.8.3 Proteinuria .................................................. Error! Bookmark not defined.
2.2 Penatalaksanaan pada preeklampsia berat dan eklampsia .... Error! Bookmark
not defined.
2.2.1 Terapi pada Preeklampsia ............................. Error! Bookmark not defined.
2.2.1.1 Antikonvulsan ............................................ Error! Bookmark not defined.
2.2.1.2 Antihipertensi ............................................. Error! Bookmark not defined.
2.2.1.3 Kortikosteroid ............................................ Error! Bookmark not defined.
2.2.1.4 Diuretik ...................................................... Error! Bookmark not defined.
2.3 Tinjauan Metildopa .......................................... Error! Bookmark not defined.
2.3.1 Definisi umum metildopa .............................. Error! Bookmark not defined.
2.3.2 Sifat Fisika Kimia metildopa ........................ Error! Bookmark not defined.
2.3.3 Nama kimia metildopa .................................. Error! Bookmark not defined.
xii
2.3.4 Bobot molekul ............................................... Error! Bookmark not defined.
2.3.5 Struktur Kimia ............................................... Error! Bookmark not defined.
2.3.6 Mekanisme kerja metildopa .......................... Error! Bookmark not defined.
2.3.7 Indikasi metildopa ......................................... Error! Bookmark not defined.
2.3.8 Kontraindikasi metildopa .............................. Error! Bookmark not defined.
2.3.9 Dosis penggunaan metildopa ........................ Error! Bookmark not defined.
2.3.10 Farmakokinetik dan Farmakodinamik metildopa ..... Error! Bookmark not
defined.
2.3.11 Efek samping metildopa .............................. Error! Bookmark not defined.
2.3.12 Pengobatan efek samping dari Metildopa ... Error! Bookmark not defined.
2.3.13 Interaksi obat metildopa .............................. Error! Bookmark not defined.
2.3.14 Penyerapan metabolisme dan eksresi Metildopa ...... Error! Bookmark not
defined.
2.4 Sediaan Metildopa di Indonesia ....................... Error! Bookmark not defined.
2.5 Metildopa untuk Preeklampsia ......................... Error! Bookmark not defined.
BAB III KERANGKA KONSEPTUAL ................. Error! Bookmark not defined.
BAB IV METODE PENELITIAN ......................... Error! Bookmark not defined.
4.1 Rancangan Penlitian ......................................... Error! Bookmark not defined.
4.2 Populasi dan Sampel ........................................ Error! Bookmark not defined.
4.2.1 Populasi ......................................................... Error! Bookmark not defined.
4.2.2 Sampel ........................................................... Error! Bookmark not defined.
4.2.3 Kriteria Inklusi .............................................. Error! Bookmark not defined.
4.2.4 Kriteria Ekslusi.............................................. Error! Bookmark not defined.
4.3 Bahan Penelitian............................................... Error! Bookmark not defined.
4.4 Instrumen Penelitian......................................... Error! Bookmark not defined.
4.5 Tempat dan Waktu ........................................... Error! Bookmark not defined.
4.6 Metode pengumpulan data ............................... Error! Bookmark not defined.
xiii
4.7 Analisis Data .................................................... Error! Bookmark not defined.
4.8 Definisi operasional ......................................... Error! Bookmark not defined.
BAB V HASIL PENELITIAN ................................ Error! Bookmark not defined.
5.1 Klasifikasi Preeklampsia .................................. Error! Bookmark not defined.
5.2 Data Demografi Pasien .................................... Error! Bookmark not defined.
5.2.1 Distribusi Berdasarkan Usia .......................... Error! Bookmark not defined.
5.2.2 Distribusi Berdasarkan Usia Kehamilan ....... Error! Bookmark not defined.
5.2.3 Distribusi Berdasarkan Status pasien ............ Error! Bookmark not defined.
5.2.4 Distribusi Berdasarkan Faktor Resiko pada Pasien Preeklampsia ........ Error!
Bookmark not defined.
5.3 Penggunaan Metildopa Pasien Preeklmapsia ... Error! Bookmark not defined.
5.3.1 Pola Penggunaan Metildopa Pada Pasien Preeklampsia .... Error! Bookmark
not defined.
5.3.2 Pola Penggunaan Metildopa Tunggal Pasien Preeklampsia ................. Error!
Bookmark not defined.
5.3.3 Pola Penggunaan Kombinasi Metildopa Pada Pasien Preeklmpasia ... Error!
Bookmark not defined.
5.4 Pola Penggunaan Swicth Metildopa Pada Pasien Preeklampsia .............. Error!
Bookmark not defined.
5.5 Lama Pemakaian Metildopa ............................. Error! Bookmark not defined.
5.6 Lama pasien Masuk Rumah Sakit (MRS) ........ Error! Bookmark not defined.
5.7 Keadaan keluar pasien...................................... Error! Bookmark not defined.
5.8 Pola Penggunaan terapi selain metildopa pada pasien preeklampsia....... Error!
Bookmark not defined.
BAB VI PEMBAHASAN ......................................... Error! Bookmark not defined.
BAB VII KESIMPULAN ........................................ Error! Bookmark not defined.
DAFTAR PUSTAKA .......................................................................................... 70
LAMPIRAN .............................................................. Error! Bookmark not defined.
xiv
DAFTAR TABEL
Halaman
2.1 Nama dagang metildopa yang dipasaran.......... Error! Bookmark not defined.
5.1 Klasifikasi Preeklampsia .................................. Error! Bookmark not defined.
5.2 Distribusi Berdasarkan Usia ............................. Error! Bookmark not defined.
5.3 Usia Kehamilan Pasien Preeklampsia .............. Error! Bookmark not defined.
5.4 Distribusi Berdasarkan Pasien.......................... Error! Bookmark not defined.
5.5 Distribusi Berdasarkan Faktor Resiko pada Pasien Preeklampsia ........... Error!
Bookmark not defined.
5.6 Pola Penggunaan Metildopa ............................. Error! Bookmark not defined.
5.7 Pola Penggunaan Metildopa Tunggal pasien preeklampsia .. Error! Bookmark
not defined.
5.8 Pola Kombinasi Dua Antihipertensi Pasien Preeklampsia.... Error! Bookmark
not defined.
5.9 Pola Penggunaan Switch Metildopa Pada Pasien Preeklampspia ............ Error!
Bookmark not defined.
5.10 Lama Pemakaian Metildopa ........................... Error! Bookmark not defined.
5.11 Lama perawatan pasien preeklampsia ............ Error! Bookmark not defined.
Tabel
xv
5.12 Keadaan keluar pasien.................................... Error! Bookmark not defined.
5.13 Terapi Pada Pasien Preeklampsia Selain Metildopa .... Error! Bookmark not
defined.
DAFTAR BAGAN
3.1 Skema Kerangka Konseptual .......................... Error! Bookmark not defined.
3.2 Skema Kerangka Operasional ......................... Error! Bookmark not defined.
5.1 Skema Sampel yang Memenuhi Kriteria Inklusi dan Eksklusi Penelitian pada
Pasien Preeklampsia ....................................................................................... 49
Bagan
Halaman
xvi
xvii
DAFTAR GAMBAR
Halaman
2.1 Distribusi penyebab kematian ibu melahirkan berdasarkan laporan KIA
provinsi tahun 2011 ......................................... Error! Bookmark not defined.
2.2 Laporan kematian ibu (LKI) kabupaten/kota seksi KGM, dinas kesehatan
provinsi Jawa Timur ....................................... Error! Bookmark not defined.
2.3 Invasi sitotrofoblas normal dan invasi sitotrofoblas preeklampsia ......... Error!
Bookmark not defined.
2.4 Plasenta pada kehamilan normotensi dan preeklampsia Error! Bookmark not
defined.
2.5 Sistem imun normal dan sistem imun preeklmapsia ..... Error! Bookmark not
defined.
2.6 Skema patofisiologis terjadinya preeklampsia. ............. Error! Bookmark not
defined.
2.8 Struktur metildopa ........................................... Error! Bookmark not defined.
2.9 Mekanisme aksi metildopa ............................... Error! Bookmark not defined.
Gambar
xviii
DAFTAR LAMPIRAN
1. Daftar Riwayat Hidup ........................................ Error! Bookmark not defined.
2.Surat Pernyataan.................................................. Error! Bookmark not defined.
3. Surat ijin peneltian ............................................. Error! Bookmark not defined.
4. Surat laik Etik ..................................................... Error! Bookmark not defined.
5. Lembar Pengumpulan data ................................. Error! Bookmark not defined.
6. Tabel Data Induk ................................................ Error! Bookmark not defined.
Lampiran Halaman
xix
DAFTAR SINGKATAN
AKI : Angka Kematian Ibu
ANC : Antenatal Care
APC : Antigen Precenting Cells
APS :Antiphospholipid Antibodi Syndrom
ASI : Air Susu Ibu
AT1-AA : Angiotensin II Type I Receptor Agonistic Autoantibodies
BP : Blood Pressure
cAMP : Adenosina Monofosfat Siklik
CCBs : Calcium Channel Blockers
CNS : Central Nervous System
CYP : Cytochrome
DBP : Diastolic Blood Pressure
DMTI : Diabetes Mellitus Tergantung Insulin
eNOS : Endothelial Nitric Oxide Synthase
FLT : Fms-Like Tyrosine Kinase
GFR : Glomerular Filtration Rate
HDK : Hipertensi Dalam Kehamilan
HELLP : Hemolysis Elevated Liver Enzymes and Low Platelet Count
HLA : Human Leukocyte Antigene
HLD : High Density Lipoprotein
IFN : Interferon
IL : Interleukin
xx
IM : Intramuskular
IMT : Indeks Massa Tubuh
ISK : Infeksi Saluran Kemih
IUGR : Intra Uterin Growth Restricted
IV : Intravena
KIA : Kesehatan Ibu dan Anak
LDL : Low Density Lipoprotein
MAP : Mean Areterial Pressure
MgSO4 : Magnesium Sulfat
MHC : Major Histocompatibility Complex
NK : Natural Killer
NO : Nitric Oxide
PEB : Preeklampsia Berat
PER : Preeklampsia Ringan
PGI2 : Prostaglandin I2
PI3K : Phosphoinositide 3-Kinases
PIGF : Placental Growth Factors
PNPK : Pedoman Nasional Pelayanan Kedokteran
PO : Per Oral
RMK : Rekam Medik Kesehatan
SA : Sinoatrial
SDKI : Survei Demografi dan Kesehatan Indonesia
S-ENG : Soluble Endoglin
xxi
SFLT-1 : Soluble Fms-Like Tyrosine Kinase 1
TC : T Cytolitic
TD : Tekanan Darah
TNF : Tumor Necrosis Factor
TXA : Tromboksan
VE : Vascular Endothelial
VEGF : Vascular Endothelial Growth Factor
VLDL : Very Low Density Lipoprotein
WHO : World Health Organization
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