iv

KATA PENGANTAR

Bismillahirohmanirrohim

Assalamu’alaikum warohmatullahi wabarakatuh

Puji syukur di panjatkan kepada Allah SWT yang telah memberikan

rahmat dan karunianya, sehingga skripsi dengan judul “Studi Penggunaan

Calcium Channel Blocker pada Pasien Stroke Hemoragik (Penelitian di

Rumah Sakit Umum Daerah Sidoarjo)” dapat terselesaikan. Penyusunan

skripsi ini dimaksudkan untuk memenuhi persyaratan untuk memperoleh gelar

sarjana Farmasi pada Program Studi Farmasi Fakultas Ilmu Kesehatan Universitas

Muhammadiyah Malang.

Bersamaan dengan ini perkenankanlah penulis mengucapkan terima kasih

yang sebesar-besarnya dengan hati yang tulus kepada pihak yang telah memberi

bantuan, dukungan dan bimbingan dari awal masa perkuliahan hingga pada

penyusunan skripsi ini, antara lain kepada:

1. Allah SWT yang telah memberikan ridho, nikmat kesehatan, kekuatan,

kesabaran dan kelancaran kepada penulis selama proses pengerjaan hingga

skripsi ini dapat terselesaikan.

2. Bapak Faqih Ruhyanudin, M. Kep., Sp. Kep.MB selaku Dekan Fakultas

Ilmu Kesehatan, ibu Sendi Lia Yunita, S.Farm., Apt. selaku wali, terima

kasih telah memberikan masukan dan motivasi selama perkuliahan.

3. Ibu Nailis Syifa, S.Farm, M.Sc., Apt. selaku Ketua Program Studi Farmasi

dan pembimbing I skripsi dan Drs. Didik Hasmono, MS., Apt. selaku

dosen dan juga pembimbing II skripsi, yang dengan penuh perhatian dan

kesabarannya telah menyediakan waktu dan tenaga, mengajar,

memberikan bimbingan dan saran, dalam menyelesaikan skripsi ini.

4. Hidajah Rachmawati, S.Si., Apt., Sp.FRS. dan Dra. Lilik Yusetyani, Apt.,

Sp.FRS., selaku dosen penguji I dan II yang telah meluangkan waktunya

untuk menilai dan memberikan kritik serta saran demi kesempurnaan

skripsi ini.

5. Seluruh dosen, petugas biro skripsi, TU dan laboran Prodi Farmasi yang

telah memberikan bantuan dan bekal ilmu selama perkuliahan.

v

6. Direktur dan seluruh karyawan bagian Diklit serta Ruang Rekam Medik di

RSUD Sidoarjo yang telah memberikan kesempatan untuk melakukan

penelitian dan kerjasama serta bantuan waktu serta tenaga sehingga

pencatatan data dapat terlaksana dan terselesaikan.

7. Keluargaku di Banyuwangi terutama Ibuku tercinta Siti Badriyah dan

Bapakku tersayang Ahmad Sunarto, mbakku Aminatuz Zuhriyah dan juga

keempat adikku yang selalu memberikan cinta, kasih sayang, do’a, dan

restunya setiap saat semoga Allah SWT membalas semua amal baik yang

telah kalian lakukan.

8. Maceku tersayang Siti Maimunah dan Pa’phoku Abdul Rahman

Takerubun, tidak ada kata lain selain ucapan syukur dan terima kasih

sedalam-dalamnya karena selalu memberikan cinta dan kasih sayang,

motivasi, do’a, dan dukungan baik secara moral maupun material hingga

saya bisa memperoleh gelar sarjana ini, semoga berkah. Amiin.

9. Sahabatku Rafina Syfridiana yang udah dapat gelar S.Farm duluan, terima

kasih selama ini sudah banyak membantu dan mendukung selama

diperkuliahan dan penelitian skripsi.

10. Terima kasih untuk teman-teman seperjuangan kelompok skripsi bidang

klinis dan teman-teman kos, Kurnia Hasanah, Dewi sukmalini mbak

Mentari, mbak Erna, Lutvi, Wiwid dan juga Mahmudah, semoga kelak

kita semua bisa menjadi orang yang sukses guys.

11. Semua pihak yang secara langsung maupun tidak langsung membantu

proses penyelesaian skripsi ini.

Demikian skripsi ini dipersembahkan kepada almamater Fakultas Ilmu

Kesehatan Program Studi Farmasi Universitas Muhammadiyah Malang, kritik dan

saran yang membangun sangat diharapkan dapat membantu menyempurnakan

skripsi ini. Semoga skripsi ini dapat bermanfaat bagi pengembangan ilmu

pengetahuan di dunia kefarmasian dan masyarakat luas pada umumnya.

Wassalamualaikum wr.wb

Malang, 25 Agustus 2017

Miftakhul Jannah

x

DAFTAR SINGKATAN

ACE = Angiotensin-Converting Enzyme

AF = Atrial Fibrilation

AHA = American Heart Association

ARB = Angiotensin Receptor Bloker

ASA = American Stroke Association

AVM = Arteriovenous malformation

BMI = Body mass index

CCB = Calcium Channel Blocker

Cl- = Chlorine

CT = Computerized tumography

CV = Cerebral Vasospasm

d.d = de die (sehari)

FDA = Food and Drug Administration

GABA = Gamma Aminobutyric Acid

GCS = Glasgow Coma Scale

GD = Gula Darah

GDP = Gula Darah Puasa

Hb = Hemoglobin

Hct = Hematocrit

HCO3-

= Bikarbonat

HDL = High Density Lipoprotein

HTS = Hypertonic Saline

ICH = Intracerebral Hemorrhagic

IVH = Intraventricular hemorrhagic

JNC = Joint National Committe

KB = Keluarga Berencana

xi

LDL = Low Density Lipoprotein

LED = Laju Endap Darah

MCV = Mean Corpuscular Volume

MCH = Mean Corpuscular Hemoglobin

MCHC = Mean Corpuscular Hemoglobin Concentration

mg = Miligram

MPV = Mean Platelet Volume

MRI = Magnetic Resonance Imaging

Na+ = Natrium

PDW = Platelet Distribution Width

PERKI = Perhimpunan dokter spesialis kardiovaskular Indonesia

RDW = Red Cell Distribution

RMK = Rekam Medik Kesehatan

RR = Respiration Rate

SAH = Subarachnoid Hemorrhagic

TS = Tekanan darah

TIA = Transient Ischemik Attack

TG = Trigliserida

WBC = White Blood Cell

WHR = Waist- hip ratio

xii

DAFTAR ISI

Halaman

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

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

HALAMAN PENGUJIAN .................................................................................. iii

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

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

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

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

DAFTAR ISI ........................................................................................................ xii

DAFTAR TABEL .............................................................................................. xvi

DAFTAR GAMBAR ........................................................................................ xviii

DAFTAR LAMPIRAN ...................................................................................... xix

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 Anatomi dan Fisiologi Sistem Saraf ............................................................ 5

2.2 Definisi Stroke ............................................................................................. 7

2.3 Epidemiologi Stroke .................................................................................... 7

2.4 Manifestasi Klinik Stroke ............................................................................ 9

2.5 Etiologi dan Klasifikasi Stroke ................................................................. 10

2.5.1 Stroke Iskemik ...................................................................................... 11

2.5.2 Stroke Hemoragik ................................................................................. 11

2.5.2.1 Perdarahan Subarachnoid .............................................................. 12

2.5.2.2 Perdarahan Intracerebral............................................................... 13

2.6 Faktor Resiko ............................................................................................ 15

2.6.1 Non-modifiable (Faktor resiko tidak dapat diubah) .............................. 15

2.6.2 Modifiable (Faktor resiko dapat diubah) .............................................. 16

xiii

2.7 Patofisiologi Stroke Hemoragik ................................................................ 19

2.8 Penatalaksanaan Terapi Stroke .................................................................... 20

2.8.1 Golden Period ...................................................................................... 21

2.8.2 Terapi Non Farmakologi Stroke Hemoragik ........................................ 22

2.8.2.1 Operasi ........................................................................................... 22

2.8.2.2 Rehabilitasi .................................................................................... 22

2.8.3 Terapi Farmakologi Stroke Hemoragik ................................................ 22

2.8.3.1 Neuroprotektan .............................................................................. 22

2.8.3.1.1 Piracetam ................................................................................ 23

2.8.3.1.2 Citicolin .................................................................................. 23

2.8.3.2 Antifibrinolitik ............................................................................... 23

2.8.3.2.1 Asam Aminokaproat ............................................................... 23

2.8.3.2.2 Asam Traneksamat ................................................................. 23

2.8.3.3 Osmoterapi .................................................................................... 24

2.8.3.3.1 Manitol ................................................................................... 25

2.8.3.3.2 Salin Hipertonik ..................................................................... 27

2.8.3.4 Antihipertensi ................................................................................ 28

2.8.3.4.1 Penghambat Angiotensin-Converting Enzyme

(ACE Inhibitor) ......................................................................... 32

2.8.3.4.2 Angiotensin Receptor Bloker (ARB) ...................................... 32

2.8.3.4.3 Diuretika ................................................................................. 33

2.8.3.4.4 Beta-Bloker (β-Blocker) ......................................................... 34

2.8.3.4.5 Calcium Channel Blocker (CCB) ........................................... 35

BAB III KERANGKA KONSEPTUAL ............................................................ 55

3.1 Kerangka Konseptual ................................................................................ 55

3.2 Skema Kerangka Konseptual .................................................................... 57

3.3 Kerangka Operasional ............................................................................... 58

BAB IV METODE PENELITIAN .................................................................... 59

4.1 Rancangan Penelitian ................................................................................ 59

4.2 Populasi dan Sampel ................................................................................. 59

4.2.1 Populasi ................................................................................................ 59

4.2.2 Sampel .................................................................................................. 59

4.3 Kriteria Inklusi .......................................................................................... 59

xiv

4.4 Kriteria Eksklusi ........................................................................................ 59

4.5 Bahan Penelitian ........................................................................................ 60

4.6 Instrumen Penelitian .................................................................................. 60

4.7 Tempat dan Waktu Penelitian ................................................................... 60

4.8 Definisi Operasional .................................................................................. 60

4.9 Metode Pengumpulan Data ....................................................................... 61

4.10 Analisis Data ............................................................................................. 61

BAB V HASIL PENELITIAN ........................................................................... 62

5.1 Jumlah Sampel Penelitian ......................................................................... 62

5.2 Data Demografi Pasien .............................................................................. 63

5.2.1 Distribusi Berdasarkan Usia ................................................................. 63

5.2.2 Distribusi Berdasarkan Jenis Kelamin .................................................. 63

5.2.3 Diagnosa ............................................................................................... 63

5.2.4 Status Penjaminan Pasien ..................................................................... 63

5.3 Penggunaan Calcium Channel Blocker (CCB) pada Pasien Stroke

Hemoragik ................................................................................................. 64

5.3.1 Pola Penggunaan Calcium Channel Blocker (CCB) pada Pasien

Stroke Hemoragik ................................................................................. 64

5.3.2 Pola Penggunaan Tunggal Calcium Channel Blocker (CCB) pada

Pasien Stroke Hemoragik ..................................................................... 64

5.3.3 Pola Penggunaan Kombinasi Calcium Channel Blocker (CCB) pada

Pasien Stroke Hemoragik ..................................................................... 65

5.3.4Pola Penggunaan Terapi Dua Antihipertensi yang Diterima Pasien


5.3.5Pola Penggunaan Terapi Tiga Antihipertensi yang Diterima Pasien


5.3.6Pola Penggunaan Terapi Empat Antihipertensi yang Diterima Pasien


5.3.7Pola Penggunaan Terapi Lima Antihipertensi yang Diterima Pasien


5.3.8 Pola Penggunaan Switch Calcium Channel Blocker (CCB) pada

Pasien Stroke Hemoragik......................................................................71

5.4 Lama Penggunaan Calcium Channel Blocker (CCB) ............................... 73

5.5 Pola Terapi Utama pada Pasien Stroke Hemoragik .................................. 73

5.6 Diagnosa Penyerta pada Pasien Stroke Hemoragik .................................. 74

5.7 Lama MRS pada Pasien Stroke Hemoragik .............................................. 74

xv

5.8 Kondisi Keluar Rumah Sakit (KRS) ......................................................... 75

BAB VI PEMBAHASAN .................................................................................... 76

BAB VII KESIMPULAN DAN SARAN ........................................................... 89

7.1 Kesimpulan ................................................................................................ 89

7.2 Saran .......................................................................................................... 89

DAFTAR PUSTAKA .......................................................................................... 90

xvi

DAFTAR TABEL

Tabel Halaman

Tabel II.1 Prevalensi penyakit stroke menurut provinsi di Indonesia......................8

Tabel II.2 Farmakokinetika obat-obatan golongan calcium channel blocker

(CCB).....................................................................................................39

Tabel II.3 Nama obat, kandungan dan bentuk sediaan nifedipin menurut

FDA U.S Food & Drug Administration...............................................41

Tabel II.4 Nama obat, kandungan dan bentuk sediaan nifedipin yang tersedia

di pasaran (ISO Indonesia, 2016) .........................................................41

Tabel II.5 Nama obat, kandungan dan bentuk sediaan nicardipin menurut

FDA U.S Food & Drug Administration................................................43

Tabel II.6 Nama obat, kandungan dan bentuk sediaan nikardipin yang tersedia

di pasaran (ISO Indonesia, 2016)..........................................................44

Tabel II.7 Nama obat, kandungan dan bentuk sediaan amlodipin menurut

FDA U.S Food & Drug Administration................................................46

Tabel II.8 Nama obat, kandungan dan bentuk sediaan amlodipin yang tersedia

di pasaran (ISO Indonesia, 2016).........................................................46

Tabel II.9 Nama obat, kandungan dan bentuk sediaan nimodipin menurut


Tabel II.10 Nama obat, kandungan dan bentuk sediaan nimodipin yang tersedia


Tabel II.11 Nama obat, kandungan dan bentuk sediaan isradipin menurut


Tabel II.12 Nama obat, kandungan dan bentuk sediaan isradipin yang tersedia

di pasaran (ISO Indonesia, 2016) ........................................................50

Tabel II.13 Nama obat, kandungan dan bentuk sediaan felodipin menurut


Tabel II.14 Nama obat, kandungan dan bentuk sediaan felodipin yang tersedia

di pasaran (ISO Indonesia, 2016) ........................................................51

Tabel II.15 Nama obat, kandungan dan bentuk sediaan verapamil menurut


Tabel II.16 Nama obat, kandungan dan bentuk sediaan verapamil yang tersedia di

pasaran (ISO Indonesia, 2016).............................................................52

Tabel II.17 Nama obat, kandungan dan bentuk sediaan diltiazem menurut


Tabel II.18 Nama obat, kandungan dan bentuk sediaan diltiazem yang tersedia


Tabel V.1 Usia pasien stroke hemoragik di Instalasi Rawat Inap RSUD Sidoarjo

periode 01 Juli 2016 – 31 Desember 2016 ........................................... 63

Tabel V.2 Jenis kelamin pasien stroke hemoragik di Instalasi Rawat Inap RSUD

Sidoarjo periode 01 Juli 2016 – 31 Desember 2016 ............................. 63

Tabel V.3 Diagnosa pasien stroke hemoragik yang dirawat di Instalasi Rawat

Inap RSUD Sidoarjo periode 01 Juli 2016 – 31 Desember 2016 ......... 63

Tabel V.4 Status penjaminan pasien stroke hemoragik di Instalasi Rawat Inap

RSUD Sidoarjo periode 01 Juli 2016 – 31 Desember 2016 ................. 63

xvii

Tabel V.5 Pola Penggunaan Calcium Channel Blocker (CCB) yang diterima

pasien stroke hemoragik di Instalasi Rawat Inap RSUD Sidoarjo

periode 01 Juli 2016 – 31 Desember 2016 ........................................... 64

Tabel V.6 Pola penggunaan tunggal Calcium Channel Blocker (CCB) yang

diterima pasien stroke hemoragik di Instalasi Rawat Inap RSUD


Tabel V.7 Pola penggunaan kombinasi Calcium Channel Blocker (CCB) yang

diterima pasien stroke hemoragik di Instalasi Rawat Inap RSUD


Tabel V.8 Pola Penggunaan terapi kombinasi dua antihipertensi yang diterima


Periode 01 Juli 2016 – 31 Desember 2016 ........................................... 68

Tabel V.9 Pola Penggunaan terapi kombinasi tiga antihipertensi yang diterima


Periode 01 Juli 2016 – 31 Desember 2016 ........................................... 69

Tabel V.10 Pola Penggunaan terapi kombinasi empat antihipertensi yang diterima


Periode 01 Juli 2016 – 31 Desember 2016 ......................................... 70

Tabel V.11 Pola Penggunaan terapi kombinasi lima antihipertensi yang diterima


Periode 01 Juli 2016 – 31 Desember 2016 ......................................... 71

Tabel V.12 Pola Penggunaan Calcium Channel Blocker (CCB) dengan Pergantian

(switch) pada Pasien Stroke Hemoragik............................................ 71

Tabel V.13 Presentase lama penggunaan Calcium Channel Blocker (CCB) pada


periode 01 Juli 2016 – 31 Desember 2016 ......................................... 73

Tabel V.14 Terapi utama selain Calcium Channel Blocker (CCB) yang diterima


periode 01 Juli 2016 – 31 Desember 2016 ......................................... 73

Tabel V.15 Diagnosa penyerta pasien stroke hemoragik di Instalasi Rawat Inap

RSUD Sidoarjo periode 01 Juli 2016 – 31 Desember 2016 ............... 74

Tabel V.16 Presentase lama MRS pada pasien stroke hemoragik di Instalasi

Rawat Inap RSUD Sidoarjo periode 01 Juli 2016 – 31 Desember

2016 .................................................................................................... 74

Tabel V.17 Kondisi KRS pada pasien stroke hemoragik di Instalasi Rawat Inap

RSUD Sidoarjo periode 01 Juli 2016 – 31 Desember 2016 .............. 75

xviii

DAFTAR GAMBAR

Gambar Halaman

Gambar 2.1 Anatomi Otak Manusia ....................................................................... 5

Gambar 2.2 Klasifikasi Stroke...............................................................................10

Gambar 2.3 Stroke Iskemik....................................................................................11

Gambar 2.4 Stroke Hemoragik..............................................................................12

Gambar 2.5 Perdarahan Subarachnoid..................................................................13

Gambar 2.6 Perdarahan Intracerebral...................................................................14

Gambar 2.7 Pathway Stroke Hemoragik...............................................................20

Gambar 2.8 Efek manitol pada tubulus proksimal renal........................................27

Gambar 2.9 Algoritma penanganan hipertensi (JNC 8)........................................31

Gambar 2.10 Farmakologi obat golongan diuretik................................................34

Gambar 2.11 Mekanisme calcium channel blocker (CCB)...................................36

Gambar 2.12 Mekanisme calcium channel blocker sebagai arterial vasodilator...37

Gambar 2.13 Struktur kimia Nifedipin..................................................................40

Gambar 2.14 Struktur kimia Nikardipin................................................................41

Gambar 2.15 Struktur kimia Amlodipin................................................................45

Gambar 2.16 Struktur kimia Nimodipin................................................................47

Gambar 2.17 Struktur kimia Isradipin...................................................................49

Gambar 2.18 Struktur kimia Felodipin..................................................................50

Gambar 2.19 Struktur kimia Verapamil.................................................................51

Gambar 2.20 Struktur kimia Diltiazem..................................................................53

Gambar 3.1 Skema Kerangka Konseptual.............................................................57

Gambar 3.2 Kerangka Operasional .......................................................................58

Gambar 5.1 Skema Inklusi dan Eksklusi pada pasien stroke hemoragik .............. 62

xix

DAFTAR LAMPIRAN

Lampiran Halaman

Lampiran 1 Daftar Riwayat Hidup ........................................................................ 95

Lampiran 2 Surat Pernyataan ................................................................................ 96

Lampiran 3 Nota Dinas ......................................................................................... 97

Lampiran 4 Surat Jawaban Permohonan Ijin Penelitian ....................................... 98

Lampiran 5 Ethical Clearence .............................................................................. 99

Lampiran 6 Lembar Pengumpulan Data Pasien Stroke Hemoragik ................... 100

Lampiran 7 Tabel Induk ...................................................................................... 147

Lampiran 8 Perhitungan Konversi Dosis Nimodipin..........................................156

90

DAFTAR PUSTAKA

Abdihalim M.M , Hassan A.E, Qureshi A.I et al. 2013. Off-Label Use of Drugs

and Deviced in the Neuroendovascular Suite. Minneapolis:

dx.doi.org/10.3174/anjr.A3447.

Alviar, C.L., et al. 2012. Efficacy and safety of dual calcium channel blockade

for the treatment of hypertension: a meta- analysis. St. Luke’s-

Roosevelt Hospital Center Columbia University College of Physicians

and Surgeons, New York, NY, USA.

Amran. 2012. Analisis Faktor Resiko Kematian Penderita Stroke. Staf Bidang

Bina Pengendalian Masalah Kesehatan: Dinas Kesehatan Provinsi

Sulawesi Utara.

Arboix, Adria. 2015. Cardiovascular Risk Factors for Acute Stroke: Risk

Profiles in the Different Subtypes of Ischemic Stroke. Baishideng

Publishing Group Inc. Barcelona, http://www.wjgnet.com.sci-

hub.cc/2307-8960/full/v3/i5/418.htm, Diakses pada tanggal 04 Februari

2017.

Badan Penelitian dan Pengembangan Kesehatan. 2011. Laporan Nasional Riset

Kesehatan Dasar. Jakarta : Departemen Kesehatan Republik Indonesia.

Barrett, K.M., Meschia, J.F.,2013. Treatment of Hemorrhagic Stroke in Stroke.

UK. Wiley-Blackwell.

Bashir, Asma et al. 2016. Intra-arterial Nimodipine for Cerebral Vasospasm after

Subarachnoid Haemorrhage: Influence on clinical coure and predictors

of clinical outcome. The Neuroradiology Journal. Denmark.

Bernstein, R. A., 2012. Cerebrovascular Disease: Hemorrhagic Stroke in Brust,

John C.M., (Ed), Lange Medical Book: Current Diagnosis and

Treatment in Neurology. 128 – 148. McGraw-Hill companies, Inc.

New York.

BNF Staff. 2015. British National Formulary 69. Pharmaceutical Press.

London.UK. p.133-138

Brainin, M., Heiss, W., 2010. Textbook of Stroke Medicine. New York:

Cambridge University Press. Page 5.

Cannon CM, Levy P,Baumann BM, et al. 2013. Intravenous nicardipine and

labetalol use in hypertensive patients with signs or symptoms

suggestive of endorgan damage in the emergency department: a

subgroup analysis of the CLUE trial. BMJ Open

2013;3:e002338.doi:10.1136/bmjopen-2012-002338.

Caplan, L.R. 2009. Caplan’s Stroke: A Clinical Approach, Fourth Edition.

Saunders Elsevier. Philadelphia.p. 446 - 486.

http://www.wjgnet.com.sci-hub.cc/2307-8960/full/v3/i5/418.htm

http://www.wjgnet.com.sci-hub.cc/2307-8960/full/v3/i5/418.htm

91

Curran M.,P et al. 2006. Intravenous Nicardipine Its Use in the Short-Term

Treatment of Hypertension and Various Other Indications. New Zealand.

Adis International Limited.

Departemen Kesehatan Republik Indonesia. 2006. Pharmaceutical Care untuk

Penyakit Hipertensi. Jakarta : Departemen Kesehatan Republik

Indonesia

De Portu, S,. Mantovani LG., 2009. Amlodipin: a Pharmacoeconomic Review.

Informa UK Ltd. Italy.

Dexa Medica (2017). Nikardipin HCl Injeksi. Tersedia di http://www.dexa-

medica.com/en/ourproduct/prescriptions/ogb/Nicardipine%20HCl%20I

njeksi [Diakses pada tanggal 14 September 2017].

Dipiro,J.T., et al. 2015. Pharmaceutical Handbook. Ninth Edition. USA :The

Mc. Graw Hill Company. Page : 120-124.

Fauci AS, Braunwald, Kasper DL, et al.2008. Cerebrovascular Disease, Diseases

of the Central Nervous System In Harrison’s Principle of Internal

Medicine 17 th edition. USA : The Mc. Graw Hill Company. Chapter

364.

Fioravanti, M., Ann E. B. 2006. Citicoline (Cognizin) in the Treatment of

Cognitive Impairment. Clinical Interventions in Aging.

Food and Drug Administration. 2011. FDA Approved Drug Product : Terdapat di:

https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overv

iew.process&applno=078226 [Diakses pada 20 Juli 2016].

Gilman, Alfred Goodman. 2012. Goodman & Gilman Dasar Farmakologi

Terapi, Ed. 10, Vol.2 . Jakarta. EGC.

Guyton A.C. and J.E. Hall 2008. Buku Ajar Fisiologi Kedokteran. Edisi 11.

Jakarta: EGC.

Herminawati, Anisa. 2013. Perbedaan Lama Rawat Inap Antara Stroke

Hemoragik dan Stroke Non Hemoragik di RSUD Tugurejo Semarang.

IA, Iliescu. 2015. Current Diagnosis and Treatment of Chronic Subdural

Hematomas. Carol Davila University Press. Romania

IAI. 2013. ISO Indonesia, Informasi Spesialite Obat Volume 48. ISFI Penerbitan.

Jakarta.

Ipema, Heather J., Tanzi, Maria G. 2012. Use of Topical Tranexamic Acid or

Aminocaproic Acid to Prevent Bleeding After Major Surgical

Procedures. The Annals of Pharmacotherapy ,

https://www.ncbi.nlm.nih.gov/pubmed/22202494 Diakses pada tanggal

6 Februari 2017

http://www.dexa-medica.com/en/ourproduct/prescriptions/ogb/Nicardipine%20HCl%20Injeksi



https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&applno=078226

https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&applno=078226

https://www.ncbi.nlm.nih.gov/pubmed/22202494

92

Irianto, Koes. 2014. Epidemiologi Penyakit Menular & Tidak Menular.

Bandung: Alfabeta. Hal: 576-579.

Irianto, Koes. 2015. Memahami Berbagai Penyakit Penyebab, Gejala,

Penularan, Pengobatan, Pemulihan, dan Pencegahan. Bandung:

Alfabeta. Hal: 541-542.

JNC-7. 2003. The Seventh Report of the Joint National Committee on Prevention,

Detection, Evaluation, and Treatment of High Blood Pressure. JAMA

289:2560 - 2571

JNC-8. 2014. The Eight Report of the Joint National Committee. Hypertension

Guidelines: An In-Depth Guide. Am J Manag Care

Kasper, D.L., Fauci, A.S., Longo, D.L., Braund, E., Hauser, S.L., Jameson, J.L.,

Harrison’s Principle of Internal Medicine.17th Edition. USA:

McGraw-Hill. Page.364.

Katzan, I.L.,et al. 2013. Stroke Risk Factor in Handbook of Clinical Nutrition

and Stroke. New York. Business Media.

Khoirunisa, R. 2017. Mengenal Perbedaan BPJS PBI dan Non PBI. Tersedia di:

http://www.pasienbpjs.com/2017/01/mengenal-perbedaan-bpjs-pbi-dan-

non-pbi.html [Diakses pada tanggal 5 september 2017].

Klabunde, Richard E. PhD,. 2015. Cardiovascular Physiology Concepts.

Lippincott William & Wilkins, http://cvpharmacology.com/ vasodilator

/CCB, Diakses tanggal 24 Desember 2016.

Kochhar, G.S., et al. 2013. Stroke Risk Factor in Handbook of Clinical Nutrition

and Stroke. New York. Business Media.

Lacy,C.F, Amstrong, L.L, Goldman, M.P, and Lance, L.L., 2009. Drug

Information Handbook, 17th edition. Lexi-Comp for the American.

Pharmacists Association.

Macdonald, R. L.2013. Delayed Neurological Deterioration after Subarachnoid

Haemorrhage. Nature Reviews Neurology.

Malykh, Andrei G et al. 2010 Piracetam and Piracetam- Like Drugs From Basic

Science to Novel Clinical Applications to CNS Disorder. Adis Data

Information.USA. Terdapat pada https:// www.ncbi.nlm.nih.gov/

pubmed/ 20166767. [Diakses pada tanggal 06 Februari 2017]

Mangat, H.S., Hartl, Roger. 2015. Hypertonic Saline for the Management of

Raised Intracranial Pressure after Severe Traumatic Brain Injury. New

York. Academy of Sciences

McEvoy, G.K., 2008. AHFS Drug Information. Maryland : American Society of

Health-System Pharmacist, Inc.

http://www.pasienbpjs.com/2017/01/mengenal-perbedaan-bpjs-pbi-dan-non-pbi.html

http://www.pasienbpjs.com/2017/01/mengenal-perbedaan-bpjs-pbi-dan-non-pbi.html

http://cvpharmacology.com/%20vasodilator%20/CCB

http://cvpharmacology.com/%20vasodilator%20/CCB

93

Mc. Phee JS, Ganong FW, Nervous System Disorders in Pathophysiology of

Disease, Lange Medical Books McGraw Hill, second edition 1997;

166-170.

Mukete, B.N., et al. 2015. Long-Term Anti-Hipertensive Therapy and Stroke

Prevention: A Meta Analysis. Switzerland. Springer International

Publishing.

Nastiti, Dian. 2012. Gambaran Faktor Resiko Kejadian Stroke Pada Pasien Rawat

Inap Di Rumah sakit Krakatau Medika Tahun 2011. Depok: Skripsi.

National Stroke Association. 2013. Explaining Stroke: National Stroke

Association.

Pedelty, Laura. 2011. A Practical Guide to Recurrent Stroke Prevention From

Clinical Hypertension and Vascular Diseases: Hypertension and Stroke

Pathophysiology and Management. New York. Humana press.

Perhimpunan Dokter Spesialis Syaraf Indonesia (PERDOSSI). 2011. Guideline

Stroke. Jakarta.

Perhimpunan Dokter Spesialis Kardiovaskular Indonesia (PERKI). 2015.

Pedoman Tatalaksana Hipertensi Pada Penyakit Kardiovaskular.

Jakarta. Indonesian Heart Association.

Ravenni, R. et al. 2011. Primary Stroke Prevention And Hypertension Treatment:

Which Is The First-Line Strategy?. Italy. Neurology International

Licensee PAGEpress.

Romero, J.R et al. 2008. Review: Stroke Prevention. Modifying Risk Factors.

Sage Publications. London.

Shawkat, Hany et al. 2012. Mannitol: A Review Of Its Clinical Uses. UK.Oxford

University Press.

Shinohara Y. 2009. Hemorrhagic Stroke Syndromes: Clinical Manifestations of

Intracerebral and Subarachnoid Hemorrhage. Dalam: Fisher M (Ed),.

Handbook of clinical neurology. New York: Elsevier BV; 577.

Simon, Harvey et al. 2009. Hemorrhagic Stroke. USA. ADAM Inc.

http://www.nytimes.com/health/guides/disease/hemorrhagic-

stroke/risk-factors.html, [Diakses pada tanggal 3 Februari 2017].

Snell R. S. 2010. Clinical Neuroanatomy, 7th ed. Philadelphia, PA: Lippincott

Williams & Wilkins.

Siswandono & Soekardjo, B. 2008. Kimia Medisinal. Surabaya. Pusat Penerbitan

dan Percetakan Unair (AUP).

Sorganvi, V., Kulkarni, MS., Kadeli, D., Athargas, S. 2014. Risk Factors For

Stroke : A Case Control Study. International Journal Of Current

Research And Review. Volume 06 issue 03. 49

http://www.nytimes.com/health/guides/disease/hemorrhagic-stroke/risk-factors.html

http://www.nytimes.com/health/guides/disease/hemorrhagic-stroke/risk-factors.html

94

Suwanwela NC, Poungvarin N, the Asian Stroke Advisory Panel. 2016. Stroke

Burden and Stroke Care System in Asia. Thailand. Neurology India,

http://www.neurologyindia.com, Diakses pada tanggal 29 Januari 2017.

Varelas P.N et al. 2010. Nicardipine Infusion for Blood Pressure Controll in

Patients with Subarachnoid Hemorrhage. LLC:Springer

Science+Business Media.

Winblad, Bengt. 2005. Piracetam: A Review of Pharmacological Properties and

Clinical Uses. Neva Press. Sweden.

Yayasan Stroke Indonesia (YASTROKI). 2010. Sekilas Tentang Stroke. Jakarta.

http://www.neurologyindia.com/

miftakhul jannah studi penggunaan calcium channel...

Documents