viii

DAFTAR ISI

HALAMAN JUDUL ....................................................................................... i

HALAMAN PENGESAHAN ........................................................................ ii

SURAT PERNYATAAN.............................................................................. iii

PERNYATAAN PERSETUJUAN PUBLIKASI KARYA ILMIAH........... iv

PRAKATA ..................................................................................................... v

DAFTAR ISI ............................................................................................... viii

DAFTAR SINGKATAN ............................................................................... x

DAFTAR TABEL ........................................................................................ xii

DAFTAR GAMBAR .................................................................................. xiii

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

INTISARI ..................................................................................................... xv

BAB I PENDAHULUAN ......................................................................... 1

1.1 Latar Belakang ..................................................................... 1

1.2 Rumusan masalah................................................................. 3

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 Teoritis ....................................................... 4

1.4.2 Manfaat Praktis ........................................................ 5

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

2.1 Stroke ................................................................................... 6

2.1.1 Pengertian Stroke ..................................................... 6

2.1.2 Klasifikasi Stroke ..................................................... 6

2.1.3 Epidemologi Stroke .................................................. 7

2.2 Stroke Iskemik ..................................................................... 8

2.2.1 Patofisiologi Stroke Iskemik .................................... 8

2.2.2 Faktor Risiko Stroke Iskemik ................................. 10

ix

2.2.3 Manifestasi Klinis Stroke Iskemik ......................... 15

2.2.4 Pemeriksaan penunjang Stroke .............................. 15

2.2.5 Penatalaksanaan Terapi .......................................... 18

2.3 Antihipertensi ..................................................................... 26

2.3.1 Definisi hipertensi .................................................. 26

2.3.2 Hubungan Hipertensi dan Stroke ........................... 26

2.3.3. Penatalaksanaan Hipertensi pada Stroke Iskemik .. 29

2.3.4 Obat – Obat yang Digunakan ................................. 30

2.3.5. Guideline terapi anti hipertensi .............................. 34

2.3.6 Algoritma Terapi Hipertensi Pada Stroke menurut

JNC 7 ...................................................................... 40

2.4 Kerasionalan Penggunaan Obat ......................................... 41

2.4.1 Penggunaan Obat Yang Rasional ........................... 41

2.5 Rumah Sakit ....................................................................... 42

2.6 Kerangka Teori................................................................... 45

2.7 Kerangka Konsep ............................................................... 45

2.8 Keterangan Empiris ............................................................ 46

BAB III METODE PENELITIAN.............................................................. 47

3.1 Jenis Penelitian Dan Rancangan Penelitian ....................... 47

3.2 Variabel Dan Definisi Operasional .................................... 47

3.2.1 Variabel .................................................................. 47

3.2.2 Definisi operasional ................................................ 47

3.3 Populasi Dan Sampel ......................................................... 48

3.3.1 Populasi penelitian ................................................. 48

3.3.2 Sampel penelitian ................................................... 48

3.4 Instrument penelitian .......................................................... 49

3.5 Cara Penelitian ................................................................... 49

3.6 Tempat Dan Waktu Penelitian ........................................... 50

3.6.1 Tempat Penelitian ................................................... 50

3.6.2 Waktu Penelitian .................................................... 50

3.7 Alur Penelitian ................................................................... 50

x

3.8 Pengolahan Dan Analisa Data ............................................ 51

3.8.1 Pengolahan data ...................................................... 51

3.8.2 Analisis Data .......................................................... 51

BAB IV HASIL PENELITIAN DAN PEMBAHASAN ........................... 53

4.1. Hasil Penelitian ..................................................................... 53

4.1.1. Data Karakteristik .................................................... 53

4.1.2 Analisis Kerasionalan ............................................. 55

4.1.3 Analisis Data .......................................................... 57

4.2 Pembahasan .......................................................................... 57

4.2.1 Data Karakteristik................................................... 57

4.2.2 Analisis Kerasionalan ............................................. 64

BAB V KESIMPULAN DAN SARAN ................................................... 71

5.1 Kesimpulan ........................................................................... 71

5.2 Saran ..................................................................................... 71

DAFTAR PUSTAKA .................................................................................. 73

LAMPIRAN ................................................................................................. 78

xi

DAFTAR SINGKATAN

ACEI : Angiotensin Converting Enzyme Inhibitor

AF : Atrial Fibrilasi

ARB : Angotensin Receptor Blocker

ATP : Adenosine Triphosphate

BB : Berat Badan

BMI : Body Mass Index

CCB : Calcium Channel Blocker

CKD : Chronic Channel Disease

CPOB : Cara Pembuatan Obat yang Baik

CT-Scan : Computerized Tomoraphic Scanner

DM : Diabetes Mellitus

EAFT : Eropa Atrial Fibrilasi Trial

GABA : Gamma Amino Butyric Acid

HDL : High Density Lipoprotein

IFRS : Instalasi Farmasi Rumah Sakit

JNC : Joint National Commitee

LDL : Low Density Lipoprotein

LMWH : Low Molecular Weight Heparin

mmHg : Millimeter Hydrargyrum

MRI : Magnetic Resonance Imaging

PERDOSSI : Persatuan Dokter Saraf Seluruh Indonesia

Riskesdas : Riset Kesehatan Dasar

TB : Tinggi Badan

TIA : Transsient Ischemic Attack

TD : Tekanan Darah

t-PA : Tissue Plasminogen Activator

WHO : World Health Organization

xii

DAFTAR TABEL

Tabel 2.1. Karakteristik pasien stroke yang mungkin sesuai untuk terapi

tissue plasminogen aktivator intravena ............................................... 22

Tabel 2.2. Obat antihipertensi pada stroke akut menurut PERDOSSI, 2011 ....... 38

Table 4. 1 Karakteristik berdasarkan usia ............................................................ 53

Table 4. 2 Karakteristik Berdasarkan Jenis Kelamin ........................................... 54

Table 4. 3 Karakteristik Berdasarkan Lama Rawat Inap Pasien .......................... 54

Table 4. 4 Terapi Obat Antihipertensi pada Pasien Stroke Iskemik (Terapi

Tunggal) .............................................................................................. 54

Table 4. 5 Terapi Obat Antihipertensi Pada Pasien Stroke Iskemik (Terapi

Kombinasi) .......................................................................................... 54

Table 4. 6 Dosis Penggunaan Obat Antihipertensi Pada Pasien Stroke

Iskemik Terapi Tunggal dan Kombinasi ............................................. 55

Table 4. 7 Analisis ketepatan indikasi .................................................................. 56

Table 4. 8 Analisis ketepatan obat........................................................................ 56

Table 4. 9 Analisa ketepatan pasien ..................................................................... 56

Table 4. 10 Analisis ketepatan dosis ...................................................................... 56

xiii

DAFTAR GAMBAR

Gambar 2. 1. Algoritma Terapi Hipertensi Pada Stroke menurut JNC 7 ....... 40

Gambar 2. 2. Kerangka Teori ......................................................................... 45

Gambar 2.3. Kerangka Konsep ..................................................................... 45

Gambar 3.1. Bagan Alur Penelitian .................................................................... 50

xiv

DAFTAR LAMPIRAN

Lampiran 1. Ethical Clearance ....................................................................... 79

Lampiran 2. Surat Ijin Penelitian .................................................................... 80

Lampiran 3. Surat Keterangan Telah Melaksanakan Penelitian ..................... 81

Lampiran 4. Data Sampel ................................................................................ 82

Lampiran 5. Hasil SPSS uji Spearman ............................................................ 92