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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
xv
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
xvi
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
xvii
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
xviii
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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