8.2.1 Ep 6 Formularium-obat-2014

DAFTAR DAFTAR FORMULARIUM FO RMULARIUM OBAT OBAT PELAY PELAYANAN KESEHATAN KESEHATAN DASAR DI PUSKESMAS LANJAS KABUPATEN BARITO UTARA

PEMERINTAH KABUPATEN BARITO UT UTARA ARA DINAS KESEHATAN Jalan Yetro Sinseng No. 67 Telp. 0519 21370 MUARA TEE! " 2016

#A$TAR $%RMU&AR'UM $%RMU& AR'UM %(AT )E&AYA )E&AYANAN *ESE!ATAN *ESE!ATAN #ASAR #' )US*ESMAS &ANJAS *A(U)ATEN (AR'T% UTARA

NAMA OBAT DAN URAIAN

NOMOR

FASILITAS KESEHATAN

FORMULASI KELAS TERAPI

SUB KELAS TERAPI, NAMA GENERIK

[BENTUK SEDIAAN, KEKUATAN, DAN KEMASAN!

PUSKE S MAS

PUST U

Polindes/ P onesdes

"# ANALGESIK, ANTIPIRETIK, ANTIINFLAMASI NON STEROID, ANTIPIRAI 1.1 1.1 ANAL ANALGE GESI SIK K

NARKOTIK

Kodein

$%& "' ()

v

Kaps 500 mg

v v

1.2 ANALGESIK NON

1.

NARKOTIK Asam Mefenamat

v

v

v

v

v

v

v

v

2.

Ibuprofen

$%& *'' () Sir 200 mg/ 5 mL sir 100 mg/5 mL

4.

Ketorola

In! 10 mg/ml"

v

In! #0 mg/ml"

v

$%& +' (), $%& +' (),

v v

&.

Kalium $i%lofena% 'atrium $i%lofena%

(.

)arasetamol

5.

-.

Melo%si%am

.

Metamiole in!

1.3ANTIPIRAI

$%& +'' (), si "-' (),/+ (l, &$l .' (l *ts +$rop, &0 mg/0"& ml supp 240 mg supp 125 mg *ablet 15 mg 250mg/ml" Ampl2ml

v v v v v

#A$TAR $%RMU&AR'UM $%RMU& AR'UM %(AT )E&AYA )E&AYANAN *ESE!ATAN *ESE!ATAN #ASAR #' )US*ESMAS &ANJAS *A(U)ATEN (AR'T% UTARA


NOMOR

FASILITAS KESEHATAN




PUSKE S MAS

PUST U


"# ANALGESIK, ANTIPIRETIK, ANTIINFLAMASI NON STEROID, ANTIPIRAI 1.1 1.1 ANAL ANALGE GESI SIK K

NARKOTIK

Kodein

$%& "' ()

v

Kaps 500 mg

v v

1.2 ANALGESIK NON

1.

NARKOTIK Asam Mefenamat

v

v

v

v

v

v

v

v

2.

Ibuprofen

$%& *'' () Sir 200 mg/ 5 mL sir 100 mg/5 mL

4.

Ketorola

In! 10 mg/ml"

v

In! #0 mg/ml"

v

$%& +' (), $%& +' (),

v v

&.

Kalium $i%lofena% 'atrium $i%lofena%

(.

)arasetamol

5.

-.

Melo%si%am

.

Metamiole in!

1.3ANTIPIRAI

$%& +'' (), si "-' (),/+ (l, &$l .' (l *ts +$rop, &0 mg/0"& ml supp 240 mg supp 125 mg *ablet 15 mg 250mg/ml" Ampl2ml

v v v v v


NOMOR

FASILITAS KESEHATAN


-


1

Alopurinol

2

)robenesid


tab 100 mg" tab 500 mg" btl 100/1000 tab

semprot" btl 100 ml" Kemasan arus %edap udara in! in3ltr 1 +6l," Amp 2 ml

onesdes

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v

v

v

v

in! in3ltr 2 " s.% +6l, 6omp" Amp 2 ml

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v

gel 2" tube 10 g 2.2ANESTETIK UMUM dan OKSIGEN i." gas dalam 7%sigen tabung

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2.3 PROSEDUR PROSEDUR PRE OPERATIF OPERATIF, OBAT OBAT untuk Atropin tab 0"5 mg in!. 0"25 mg/mL +i.v./i.m/s.%., $iaepam in!. i.v./i.m 5 mg/ml"

+

Polindes/ P

v

Lido%ain

*

PUST U

ANESTETIK 2.1ANESTETIK LOKAL

til Klorida



PUSKE S MAS

ANTIALERGI d%n OBAT OBAT 0n$0 ANAFILAKSIS in! 5 mg/ml +sebagai 1 $e%sametason natrium fosfat,"Amp  1 ml in! i.v/i.m 10 mg/ml 2 $ife $ifen nid idra rami min n +6l," amp  1 ml in! i.v/ s.%/i.m 0"1 +sebagai # pinef pinefrin rin +Ad +Adre renal nalin, in, 6l/bitartrat," Amp  1 ml 4 Klorfeniramin tab 4 mg +maleat," 5 Loratadin tab. 10 mg & Setiriin tab. 10 mg Sirup 5 mg/ml ANTIDOT ANTIDOT d%n OBAT OBAT LAIN LAIN 0n$0 0n$0 KERA1U KERA1UNAN NAN 4.1KHUSUS 1 At Atropin in!. 0"25 mg/mL # Ka Kalsium 8lu%onat In!. 100 mg/ml +6a 8luonat, 4.2 UMUM Karbon A%tif +%arbo Adsorben, ANTIEPILEPSI 2 ANTIKON3ULSI 1 $iaepam in! i.m/i.v 5 mg/ml"

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NOMOR

FASILITAS KESEHATAN

FORMULASI SUB KELAS TERAPI, NAMA GENERIK

KELAS TERAPI

9enitoin 'a.

2


lar re%tal 5 mg/2"5 mL %aps 100 mg +garam 'a," %aps in! 50 mg/ml +garam 'a," %t% 10 amp  2 ml

.

#

9enobarbital

4

Magnesium Sulfat

5

:alproat

& Karbamaepin ANTIINFEKSI .1ANTELMINTIK .1.1 Ant!"#$nt$k Int!%t$na" 1. Albendaol 2. Mebendaol #. )irantel

tab #0 mg" In!.50 mg/ml in! 20 in! 40 tab sal 250 mg tab sal 500 mg sir 250 mg/5 mL tab 200 mg

tab 400 mg tab 100 mg" 500 mg tab sored 125 mg ;250 mg +sebagai pamoat,"

PUSKE S MAS

PUST U


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v v

v v

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v

v

v

v

v

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v

4. )rai%uatel tab sored #00 mg ; &00 mg

v

tab sored 100 mg +sitrat,"

v

.1.2 Ant$&"a'$a

$ietil%arbamain .2ANTIBAKTERI .2.1 B!ta Lakta# 1

Amo%sisilin *riidrat

2

Ampisilin

#

Amo%si%lav =enatin =enilpenisilin

4

5

&

)ro%ain =enilpenisilin Sefadro%sil

tab sored 500 mg" %t% 10 str  10 tab sored sir <125 mg/5ml Sir. forte 250 mg/5 ml serb in! i.m/i.v 1000 mg/vial +sebagai garam 'a," Kapl. &25 mg in! i.m 1"2 !uta >I/ml" %t% 25 vial  4 ml in! i.m 2"4 !uta >I/ml" %t% 25 vial  10 ml serb in! i.m # !uta >I/vial" %t% 100 vial serb in! i.m 1 !uta >I/vial" %t% 100 vial

Kaptab 500 mg

v

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NOMOR


FASILITAS KESEHATAN


( .2.2 .2.2.1 1


Sefota%sim Ant$(akt!'$ La$n $o%sisi%lin

# *etrasi%lin .2.2.2 K")'a#*!n$k)" Kloramfeni%ol


Serbu% In! 1000 mg/:ial

%aps 100 mg " %aps 500 mg +6l," str  10 %aps

Kaps 250 mg" 500 mg Serbu% In!. 1.000 mg *iamfeniol Kaps. 500 mg susp 125 mg/5 ml " btl &0 ml .2.2.3 Su"*a+T'$#!t)'$# K)#($na%$ 1 Kotrimo%saol $7' I Sulfameto%saol 400 +de?asa, mg *rimetoprim -0 mg K)#($na%$ 2 *iap 5 ml Suspensi @ Sulfameto%saol 200 +=tl  50 ml, mg *rimetoprim 40 mg # Kotrimo%saol forte K)#($na%$ sulfameto%saol -00 mg trimetropim 1&0 mg .2.2.4 Mak')"$d sir 200 mg/5 ml +sebagai etil ritromisin su%sinat," btl &0 ml %aps 500 mg +sebagai stearat," .2.2.4 A(ino)liosid% in!. 10 mg/ml" 40 8entamisin mg/Ml Krim 0"1 " 5 gram KanamBin Serbu% In!. 1.000 mg %lindamisin Kapsul Kaps. 150 mg .2.2. Ku$n)")n SiproCo%sasin tab sored 500 mg .2.2./ )enggunaan Kusus Metronidaol tab 500 mg supp. 500 mg lar infus 5 mg/mL sir 125 mg/ 5 mL

PUSKE S MAS

PUST U


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NOMOR

FASILITAS KESEHATAN



ANTIINFEKSI .3 KHUSUS .3.1 Ant$"!'a $apson

.3.2

1 2

#

4

5

&


tab sored 100 mg" %aps dalam minBa% Klofaimin" micronized 100 mg" Difampisin %aps #00 mg Ant$tu(!'ku")%$% tab #00 mg" btl 1000 Isoniaid tab 1 tab/15 %g ==" o(&in%si 0n$0 ma%s de4%s%5 P%d0%n selama 2 bulan d%l%( &en$0 dosis pertama. $e$%6 7KDT/FD18 Difampisin %apl 150 mg Isoniaid tab (5 mg )irainamid tab 400 mg tambutol tab 2(5 mg o(&in%si 0n$0 1 tab/15 %g ==" ma%s de4%s%5 P%d0%n selama 2 bulan d%l%( &en$0 dosis pertama. $e$%6 7KDT/F1D8 Difampisin %apl 150 mg Isoniaid tab 150 mg Ko(&in%si 0n$0 %n% 5 P%d0%n 1 tab/5E- %g==" d%l%( ma%s &en$0 dosis $e$%6 2 bulan pertama" 7KDT/F1D8 pemberian setiap Difampisin %apl (5 mg Isoniaid tab 50 mg )irainamid tab 150 mg 1 tab/5E- %g==" Ko(&in%si 0n$0 ma%s %n% 5 P%d0%n d%l%( 4 bulan lan!utan &en$0 dosis $e$%6 pemberian #F 7KDT/F1D8 seminggu Difampisin %apl (5 mg Isoniaid tab 50 mg o(&in%si 0n$0 ma%simal 44- tab de4%s%5 7P%d0%n selama 2 bulan d%l%( &en$0 pertama" pemberian Ko(&i6%8 setiap ari. %apl 150 mgG 450 Difampisin mg Isoniaid tab (5 mgG #00 mg )irainamid tab 400 mgG 500 mg tab 2(5 mgG 250 mgG tambutol 500 mg

PUSKE S MAS

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PUST U



NOMOR

FASILITAS KESEHATAN


(


Ko(&in%si 0n$0 de4%s% 5 P%d0%n d%l%( &en$0 o(&i6% Difampisin Isoniaid

o(&in%si 0n$0 %n% 5 7P%d0%n d%l%( &en$0 Ko(&i6%8 Difampisin Isoniaid )irainamid

 o(&in%si 0n$0 %n% 5 7P%d0%n d%l%( &en$0 o(&i6%8 Difampisin Isoniaid

Streptomisin


ma%simal 144 tab selama 4 bulan" lan!utan pemberian #F seminggu 450 mg #00 mg ma%simal 2-0 tab selama 2 bulan pertama pemberian setiap ari. %apl (5 mg tab 100 mg tab 200 mg ma%simal ##& tab selama 4 bulan

PUSKE S

MAS

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lan!utan pemberian setiap ari. %apl (5 mg tab 100 mg $enga n serb in! 1000 mg/vial %emas +sebagai sulfat," %ota% an %usu 100 vial s

Ant$%!t$k Sa"u'an .3.3 K!#$0 Asam Pipemidat

Kaps 400 mg (Katalogue 2014)Urotractin 400 ( Rp.181!-) tab salut enteri% 500 mg

Metenamin mandelat +e%samin mandelat, .4 ANTIFUNGI .4.1 Ant$*un$, S$%t!#$k

1 #lu"onazol

Kaps 0 mg! 10 mg

v

v

untu" Kandidis ais sisemi"

v tab sored 125 mg" 8riseofulvin" 2 micronized

500 mg"

# Ketoonaol

tab.200 mg

4 'istatin

tab salut 500.000 >I/tab" susp 100.000 >I/ml" btl 12 ml

v

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PUST U



NOMOR

FASILITAS KESEHATAN


.4.2 1

2 # 4 .4.3


Ant$*un$, T)$ka" Antifungi $7' K)#($na%$ Asam =enoat & Asam Salisilat #

'istatin Mi%onaol Keto%onaol La$n+"a$n, )(at T)$ka"

)oli%resulen *oolgras . ANTIPROTOOA Ant$a#u(a dan ..1 Ant$$a'd$a%$% Metronidaol


Salep" pot #0 g

tab vagina 100.000 >I/tab" %rim 2  %rim 2 

Artesunat K)#($na%$ Artesunat tab 50 mg Amodia%uin tab 200 mg Kombinasi@ artemeter Lumefantrin Kuinin

)rima%uin .#.ANTI3IRUS .#.#" Antierpes Asi%lovir

PUST U

Polindes/ P

v

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v

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onesdes

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Konsentrat #"& mg/ml

tab 500 mg" btl 100 tab sir 125 mg/5 mL lar infus 5 mg/ mL

..2 Ant$#a"a'$a ..2.1 Untuk P!n!a0an do%sisi%lin %aps 100 mg ..2.2 Untuk P!n)(atan Antimalaria $7' K)#($na%$ )irimetamin 25 mg Sulfado%sin 500 mg Artemeter

PUSKE S MAS

tab" btl 500 tab

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in! -0 mg/ml"  1 ml in! i.v/i.m &0 mg/ml" 1 ml

v v v

tab

v

20 mg 120 mg tab 200 mg tab 222 mg tab 250 mg in! 25  +i.v, tab 15 mg +sebagai fosfat,"

tab 400 mg %rim 5 

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NAMA OBAT DAN NOMOR

URAIAN

KELAS TERAPI

9


ANTIMIGREN .1PROFILAKSIS )ropanolol .2SERANGAN AKUT

KESEHATAN FORMULASI [BENTUK SEDIAAN, KEKUATAN, DAN KEMASAN!

*ab 10 mg tab 1 mg +tartrat," btl 100 tab tab"

1 rgotamin 2 K)#($na%$ rgotamin 1 mg Kafein 50 mg # :D*I87 =etaistin mesilat tab - mg : ANTIPARKINSON *rie%sifenidil tab 2 mg +6l," "' DARAH, OBAT ;%n) MEMPENGARUHI 15.1 ANTIANEMI 1 Asam 9olat tab 1 mg" tab 0.4 mg 2 %ombinasi @ ferro sulfat 200 mg tab asam folat 0.25 mg 9erro 8lu%onat # HHHH.250 mg :it 6 HHHHHHHHHH 50 mg Asam 9olat HHHHHHH 1 mg :it =12 HHHHHHHH ("5 mg 6upri Sulfat+6uS74, H.. 0"2 mg Mangan Sulfat +MnS74, 0"2 mg Sorbitol HHHHHHHH. 25 mg

NOMO R

FASILITAS

Kapsul

PUSKE S MAS

PUST U


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in! 500 mg/ml" amp Siano%obalamin 4 +:itamin  1 ml =12, tab 50 mg KOAGULASI, OBAT ;%n) "'#- MEMPENGARUHI " Asam *rane%samat *ablet 500 mg In!. 100 mg/ml tab salut 10 mg" 9itomenadion +:itamin in! 10 mg/ml" amp 

2 K1,

1 ml in! i.m 2 mg/ml" amp 1 ml

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NOMOR

FASILITAS KESEHATAN


KELAS TERAPI


PUSKE S MAS

PUST U


"- DIAGNOSTIK "-#TES FUNGSI "-#-# L%in 2 l%in

9luoresein 12.3 TES KULIT *uber%ulin )rotein Puri$ed %eri&ati&e " DISINFEKTAN d%n ANTISEPTIK 13.1 ANTISEPTIK idrogen )ero%sida Klore%sidin 8lu%onat

)oli%resulen

)ovidon Iodida 13.2 DISINFEKTAN

tts mata 2.5 mg/ml

in! i.% 1@10" %t% 1 vial 2 ml

airan #  " btl 1000 ml lar 15 lar 4  airan %onsentrat #.& mg/mL lar 100 mg/ml" =tl #0 mL" #00mL

airan (0. 1000 tanol mL Kresol *ersaponi3%asi airan" btl -00 mL" 1000 50 +lisol, mL6#45$44 "* GIGI d%n MULUT, OBAT d%n BAHAN 0n$0 14.1

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PERA6ATAN SALURAN AKAR, ANTISEPTIK DAN

BAHAN UNTUK AKAR GIGI

1 ugenol 2 9ormo%resol gutta pera dan paper # points 4 Kalsium idro%sida Klor fenol metol%amfer 5 +6KM, & %lore%sidin ( 'atrium ipo%lorid )asta )engisi Saluran - A%ar  6resofen

airan" btl 10 ml airan"

v

15E40 mm 45E-0 mm pasta

v

airan" lar 0.2 airan %onsentrat 5

v

v

v

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airan" btl

v v

A'*I9>'8I 14.2 7D79ADI'8AL

'istatin

v

susp 100.000 I>/mL

14.# 7=A* untu% )'68AA' KADIS 9luor Kapl 1 mg

v

Sediaan *opi%al

NOMOR


FASILITAS KESEHATAN


KELAS TERAPI

14

1

2 #

4 5 14.5 1

2 #

"+

Sementara 8lass Ionomer AD*+ig Str, Komposit ligt ure + baan tumpatan tetap , =onding aing )D)ADA* LAI''JA anestei% lo%al gigi $7' %ombinasi @ lido%ain 6l 2 epinefrin 1 @ -0.000

5 &

Spons 8elatin

(  10

KEKUATAN, DAN KEMASAN!

PUSKE S MAS

PUST U


BAHAN TUMPAT =aan *umpatan

arti%ulating paper etil %lorida $evitalisasi )asta +'on Arsen, surgial ginggival pa%

4

[BENTUK SEDIAAN,

Semen in fosfat 6eluloid Strip MatriF =and Mata =oor

11 $islosing agent DIURETIK

lar dan serb" btl 100 g serb" btl 10 g lar" btl & g +4"- ml, A2 A#

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in! 2 ml pasta 5 semprot 15 %ertas ?arna penanda o%lusi semprot " btl 100 ml

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pasta

v

pasta cu'icles 1F1F1 m" %lg 50 butir lite 6ement

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round" 3ssure pan!ang" 3ssure pende%" tapper boor poles" rubber poles +untu% sreening/ si%at gigi bersama,

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v

tab 40 mg" btl 250 tab v in! i.v/i.m 10 mg/ml"  2 ml v idro%lortiaid tab 25 mg v spironola%ton tab 25 mg v ". HORMON, OBAT ENDOKRIN LAIN d%n KONTRASEPTIK 1.2 ANTIDIABETES 1.2.1 Ant$d$a(!t!%, O'a" 1 8liben%lamida v tab 5 mg" tab 500 mg" 2 Metformin v # glemipirid v tab 2 mg 9urosemida

1.3

HORMON KELAMIN dan OBAT 7an

MEMPENGARUHI FERTILITAS

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S!%ua$ d!nan P')'a# KB Na%$)na" 7an d$k))'d$n$' BKKBN


NOMOR

FASILITAS KESEHATAN




1.3.4 K)nt'a%!t$k 1.3.4.1 K)nt'a%!t$k, O'a" pil" 1 blister  21 K)#($na%$ tablet ormon Levonorgestrel 150 mg dan ( tablet plaebo tinil stradiol #0 mg K)nt'a%!t$k, 1.3.4.2 Pa'!nt!'a" edro"si Progesteron in! depo 150 mg Asetat K)nt'a%!t$k, AKDR 1.3.4.3 8IUD9 set / bua copper  1&.#.4.4 "ontrasepti"! implan implan 2 rods" (5 mg +#E4 tn, le&onorgestrel implan &- mg etonogestrel 1.4 HORMON TIROID dan ANTITIROID )ropilitiourasil + )*>, tab sored 100 mg" 1. KORTIKOSTEROID tab 0"5 mg" 1 $e%sametason in! 5 mg/ml +sbg 'atrium 9osfat,"amp 1 ml # Metilprednisolon *ablet - mg" tab 5 mg" 4 )rednison "9 KARDIO3ASKULER, OBAT 1.1 ANTIANGINA tab sublingual 5 mg" 1 Isosorbid $initrat 2 Lido%ain in!. i.v 100 mg # Amlodipin tab 10 mg 1.2 ANTIARITMIA 1 )ropanolol tab 10 mg +6l," 2 digo%sin tab 0.25 mg 1.3 ANTIHIPERTENSI 1 Amlodipin tab 10 mg 2 idro%lorotiaida +6*, tab 25 mg" # Kaptopril tab sored 25 mg"

4 nifedipin

5 propanolol & diltiaem

%aps 10 mg *ab SD 20 mg +A$ALA* 7ros , *ab SD #0 mg tab 10 mg tab #0 mg

PUSKE S MAS

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PUST U


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NOMOR

FASILITAS KESEHATAN FORMULASI

KELAS TERAPI

1.4

1. 1

2

#

5

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ANTIAGREGASI PLATELET tab -0 mg" bls  Asam Asetilsalisilat 10 +Asetosal, tab tab 100 mg" bls  10 tab GAGAL :ANTUNG, OBAT =isoprolol tab 2"5 mg tab 0"25 mg" +anBa u/ gagal !antung dg $igo%sin atrial 3brilasi atau sinus ta%i%ardi, tab 40 mg" str  10 9urosemida tab in! i.v/i.m 10 mg/ml" amp  2 ml tab sored 12"5 Kaptopril mg"str10 tab tab sored 25 mg" str  10 tab sored spironola%ton tab 25 mg

PUSKE S MAS

v

v

v

v

v

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1. S;OK, OBAT untuk S7)k Ka'd$)!n$k dan 1..1 SEPSIS

# pinefrin +Adrenalin, norepinefrin

in! 1 mg/ml in! 1 mg/ml

1./ ANTIHIPERLIPIDEMIA 5 Simvastatin tab sored 10 mg" tab 20 mg "9#: ANTIHEMORHOID 1(..1 Antieoroid 7ral aemorogard Kap 1(..1 Antieoroid *opi%al Antieoroid $oen Supp. Antieoroid Steroid Supp. Antieoroid  'eomiin Supp.

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KULIT,OBAT TOPIKAL 0n$0 "<#" ANTIAKNE asam retinoat 1/.2 ANTIBAKTERI 1 Antiba%teri $7'

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v v v

%rim 0"1 

v

salep" tube 5 g

v

PUST U


K)#($na%$ =asitrasin 500 >I/g )olimi%sin = 10.000 >I/g


NOMOR



KELAS TERAPI


Salep" Krim 20 'atrium 9usidat mg/g salep 1 " tube 5 gentamiin g eli 15 gram" 20 'eomisin 0"5%stra% gram

2 #

4 plaenta 10 1/.3 ANTIFUNGI 1 Antifungi $7' K)#($na%$ Asam =enoat & Asam Salisilat #

salep" pot #0 g

1/. ANTISKABIES dan ANTIPEDIKULOSIS Salep" pot #0 g 1 Salep 2 E 4 K)#($na%$ Asam Salisilat 2 =elerang ndap 4 %rim 5  2 )ermetrin # 8ameFan  >sni Aid %rim 15 mg 1/./ LAIN + LAIN =eda% Salisil serb 2" %t% 100 g

'atrium =i%arbonat # in 25.2 PARENTERAL 8lu%osa

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v

v v v

v v

v

v

v v

v

v

v

v

v

tab 500 mg" tab 20 mg"

v v

v

lar infus 5" btl 500 ml

v

LARUTAN ELEKTROLIT, NUTRISI d%n LAIN2LAIN 25.1 ORAL serb" 100 %tg" tiap 8aram 7ralit %tg 1 untu% 200 ml air K)#($na%$ 'atrium Klorida 0"52 g $iminum sedi%it demi sedi%it 2E# tegu% untu% Kalium Klorida 0"#0 g mengindari munta *rinatrium Sitrat $iidrat 0"5- g 8lu%osa Anidrat 2"(0 g 2

PUST U

v

tab vaginal 100.000 'istatin >I/tab 2 %rim 2  # Mi%onaol Krim 4 Keto%onaol 1/.4 ANTIINFLAMASI dan ANTIPRURITIK %rim 0"1 +valerat," tube 5 g 1 =etametason Krim " Salep 0"025  4 9lusinolon Asetonit %rim 2"5 +asetat," 5 idro%ortison tube 5 g

-'

PUSKE S MAS

v


lar infus 10" btl 500 ml lar infus 40" btl 25 ml

v v

NOMOR



KELAS TERAPI

25.3


Dinger La%tat Dinger Asetat KAE' #A" #= 'a6l 0" $5 1/2 'S" $5 1/4 'S LAIN + LAIN


PUSKE S MAS

lar infus" btl 500 ml lar infus" btl 500 ml lar infus" btl 500 ml lar infus" btl 500 ml lar infus" btl 500 ml

v v v v v

%t%" amp/vial  10 ml/20 ml

v

Air untu% In!e%si -" MATA, OBAT 0n$0 21.1 ANESTETIK LOKAL tts mata 0"5 +6l," *etra%ain btl 5 ml 21.2 ANTIMIKROBA 4 Kloramfeni%ol tts mata 0"5  tts mata 1  salep mata 1  Salep mata " *etes # 8entamisin Mata 0"#  -- OKSITOSIK d%n RELAKSAN UTERUS 22.1 OKSITOSIK tab salut 0"125 mg Metilergometrin +maleat," in! 0"200 mg/ml amp  1 ml in! 10 >I/ml" amp  1 7%sitosin ml - PSIKOFARMAKA 23.1 ANTIANSIETAS dan ANTIINSOMNIA $iaepam tab 2 mg" tab 5 mg" in! i.m 5 mg/ml"amp  2 ml 23.2 ANTIDEPRESI dan ANTIMANIA tab salut 25 mg Amitriptilin +6l,"bls  10 tab 23.3 ANTIOBSESI KOMPULSI 23.4 ANTIPSIKOSIS aloperidol tab 0"5 mg" tab 1"5 mg" tab 2 mg" tab 5 mg" in! i.m 2 mg/ml +6l," p  1 ml in! i.m 5 mg/ml +6l," amp  1 ml

PUST U

v

v

v v v v

v

v

v

v

v v v

v

v v v v v v



NOMOR


KELAS TERAPI



in! 50 mg/ml +sebagai de%anoat," amp  1 ml (long acting) tab salut 100 mg +6l," in! i.m 25 mg/ml +6l," %t% 100 amp  1 ml in! 5 mg/mL +i.m., SALURAN 1ERNA, OBAT 0n$0

PUSKE S MAS

PUST U

v

Klorpromain

+

2.1 1

2 # 4 5

2.2 1 2

#

ANTASIDA dan ANTIULKUS Antasida $7' I tab %unBa" K)#($na%$ Aluminium idro%sida 200 mg Magnesium idro%sida 200 mg Antasida  Simeti%on Susp Suspensi &0 ml Antasida  Simeti%on tab tab %unBa" 7mepraol Kaps 20 mg" I am a Danitidin tab 150 mg in!e%si" 25 mg/ml" Ampl  2 ml ANTIEMETIK $imenidrinat tab 50 mg" $omperidon tab 10 mg sir 5 mg/ 5 mL tab salut 25 mg Klorpromain +6l," in! i.m 25 mg/ml +6l," amp  1 ml in! i.m 5 mg/ml +6l,"amp  2 ml

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v v

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4

Meto%lopramid

tab 10 mg in!e%si

v v v

5

7ndansetron

*ab" 4 mg" - mg In!. 2 mg/ml

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sup" %t% 100 sup

v

2.3 1

ANTIHEMOROID Antiemoroid $7' K)#($na%$ =ismut Subgalat 150 mg e%sa%lorofen 2"5 mg Lido%ain 10 mg Seng 7%sida 120 mg sup ad 2 g

v



NOMOR



KELAS TERAPI

# 4


aemorogard Kap Antieoroid Steroid Supp. Antieoroid  'eomiin Supp. ANTISPASMODIK tab 0"5 mg +Sulfat," Atropin %lg 100 tab

PUSKE S MAS

PUST U


v v v

2.4

v

in! i.m/i.v/s.% 0"25 mg/ml +Sulfat,"  1 ml

iosin butilbromid

tab 10 mg In! 20 mg/ml 2. DIARE, OBAT untuk 1 Attapulgit tab" &00 mg *ab. Komb. +(00 Attapulgit  )e%tin mg50 mg, tiap %tg untu% 200 ml air 2 8aram 7ralit K)#($na%$ $iminum sedi%it 'atrium Klorida 0"52 g demi Kalium Klorida 0"#0 g sedi%it 2E# tegu% *rinatrium Sitrat $iidrat untu% mengindari 0"5- g munta 8lu%osa Anidrat 2"(0 g # in tab disp 20 mg sir 20 mg/5mL Saet  1 gram 4 Latobaillus Komb

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L. Aidopillus" =. Longum" S. *ermopillus 1.000.000 fu/g" %alsium susu" :it 6" :it =#" in% glu%onat" :it =&" :it =2" :it =1

4 %ombinasi

%aolin pe%tin 5 Loperamid 2. KATARTIK 1 8liserin

2 bisa%odil

# La%tulosa -. SALURAN NAPAS, OBAT 0n$0 2.1 ANTIASMA 1 Metilprednisolon

SBrup 550 mg 20 mg *ablet td% diguna%an u/ ana% tts 10 mg/mL tts 100 mg/mL tab sal 5 mg sup 5 mg sup 10 mg sir 10 g/ 15 mL

a'let 8 mg

v

v

v v

v

v

v

2 Amini$lin

a'let 200 mg *n+ 24 mg,ml

v v

v

v


NOMOR


KELAS TERAPI


PUSKE S MAS

PUST U

tab 0"5 mg"

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v

in! i.v 5 mg/ml +'atrium 9osfat, amp  1 ml

v

v

v

v

v

v v

v

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[BENTUK SEDIAAN, KEKUATAN, DAN


KEMASAN!

#

$e%sametason

4 5

Efedrin Epinefrin (Adrenalin)

"

#alb$taml



*mbinasi ('eb$les)

v

tab 25 mg (HCl), inj 0,1% (sebagai HCl/itartrat), amp ! 1 ml

tab 4 mg (sebagai #$lfat), lar i& 0,5 % lar i& 0,1 % 'eb$les 2,5 mg/2,5 ml Dotaap 200 mg/ap pratrpi$m rmida 0,52 mg #alb$taml 2,5 mg (Cmbivent)

ANTI IFLUENA Parasetamol Kom'. a'let 1 *ablet #lu )arasetamol H.. 500 mg *ripolidina 6l ...2"5 mg )seudoefedrina ...#0 mg 2.3 ANTITUSIF 1 $e%strometorfan *ab. Kombinasi @

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26.2

$e%strometorfan 15 mg" )arasetamol 500 mg. ))A 12"5 mg" 6*M 2 mg

2

$e%strometorfan SBr. Komb.@

=tl &0 ml

)er 5 ml mgd.$e%strometorfan ("5 mg )seudoefedrin 15 mg"

# 6odein tab 10 mg" 2.4 EKSPEKTORAN 7bat =atu% itam 1 +7=, airan 100 ml 2 7= Komb =atu% )ile% Sirup &0 ml

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%omposisi" Setip 5 ml mengandung @ 125 Suus mg Liuiritiae Ammonium 6lorida 100 mg pedrine 6l

# mg

6*M

1 mg

# 8liseril 8uaia%olat # AmbroFol

*ab. 100 mg *ab.#0 mg

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4 =rome%sin *ab.- mg 5 =rome%sin Kombinasi *A=L* *ab @ =rome%sin - mg" $ifenBdramin 6l 25 mg" )arasetamol 400 mg

v v


NOMOR


KELAS TERAPI



OBAT 0n$0 PENYAKIT -.#+ PARU OBSTRUKSI KRONIS o(&in%si nebulier 0"025  Ipratropium =romida 0"52 mg i. 20 mg/puN salbutamol #"01 mg -9 SISTEM IMUN, OBAT ;%n) MEMPENGARUHI 2.1 SERUM dan IMUNOGLOBULIN in! i.m/i.v" %t% 10 vial  Serum Anti =isa >lar 5 ml A.=.>. I in! i.m 10.000 >I/vial" Serum Antidifteri +A.$.S, %t% 10 vial  5 ml

PUSKE S MAS

PUST U


v

v

v

v

in! i.m 20.000 >I/vial" %t% 10 vial  10 ml

Serum Antirabies

Serum Antitetanus +A.*.S,

in! i.m 100 >I/ml" vial  20 ml +$iguna%an untu% pengobatan postE eFposure di daera rabies, in! i.m 200 >I/ml" vial  20 ml Untuk P!n!a0an in! i.m 1500 >I/amp"  1 ml Untuk P!n)(atan in! i.m/i.v 10.000 >I/amp" amp  2 ml in! i.m/i.v 20.000 >I /vial"vial  4 ml

epatitis = imunoglubulin +uman, H0(%n $e$%n0s i(0no)lo&0lin +*etagam ), tetanus toFoid 2.2
:a%sin 6ampa%

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in! 0.5 ml v in! i.m 250 >I in! i.m 500 >I in! in! i.% in! s.%" %t% 10 vial +10 dosis,  5 ml

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v

v

v

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:a%sin epatitis = De%ombinan

in! 20 mg/ml" %t% 1 vial 0"5G 1 ml in! i.m" %t% 10 vial  :a%sin erap $ifteri 5 *etanus +$*, ml in! i.m" %t% 10 vial  :a%sin erap $ifteri 5 *etanus )ertusis +$*), ml

v

v

NOMOR


FASILITAS KESEHATAN



:a%sin erap *etanus+*etanus Adsorbed *oFoid, :a%sin )olio :a%sin Dabies" untu% manusia

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-:


tts" %t% vial 10/20 dosis drops 10 dosis serb in! s.%/i.%"  1 dosis  ( amp pelarut  2 ml =ooster @ %t% 5 amp  1 dosis  5 amp pelarut  4 ml

5

9erro 8lu%onat H250 mg Kapsul :it 6 HHHHH..H 50 mg Asam 9olatHHHH 1 mg :it =12 HHHHH ("5 mg 6upri Sulfat+6uS74, 0"2 mg Mangan Sulfat +MnS74, 0"2 mg Sorbitol HHHHH. 25 mg 9erro sulfat 200 mg tab salut

&

Asam folat 0.25 mg 9itometadion +vitamin K1,



PUST U

Polindes/ P

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v

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v

v

v

v

v

onesdes

in! i.m" %t% 1 vial 5 ml

va%sin !erap difteri in! i.m tetanus +d*, va%sin penta valent TELINGA, HIDUNG d%n TENGGOROKAN, OBAT 0n$0 1 idrogen pero%sida lar #  2 lido%ain airan semprot 10 3ITAMIN d%n MINERAL Asam Asorbat +:itamin 1 6, tab 50 mg" tab 250 mg 2 Asam 9olat *ablet 1 mg *ablet 400 mg 2 rgo%alsiferol +vit $2, %aps 50.000 >I susp 10.000 >I/ml # 9erro fumarat %aps luna% #00 mg 4 Kombinasi @

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PUSKE S MAS

in! 10 mg/ml in! 2 mg/ml Kalsium La%tat +Kal%, tab 500 mg" Kalsium glu%onat in! 100 mg/ml in! 10 )irido%sin +:itamin =&, tab 10 mg +6l," tab 25 mg +6l," in! 100 mg/ml

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NOMOR

FASILITAS KESEHATAN


10

11

12 1# 14 15 a.

b.

1& 1( 1-


Detinol +:itamin A,

Siano%obalamin +vit =12,

*iamin +:itamin =1, :itamin = Komple%s :itamin = Komple%s %satra% ati :itamin 'eurotropi Kombinasi :it =1 100 mg" :it =& 200 mg :it =12 200 mg 'e$rtpi+ nj (-i 1 100 mg, " 100 mg, 12 5000 m+g)


%aps luna% 100.000 >I" %aps luna% 200.000 >I +sebagai )almitat," tab 50 mg In!. 500 mg/ml E Amp.1ml tab 50 mg +6l," tab" tablet salut gula

PUST U

Polindes/ P

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onesdes

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*ab

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In!

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.$ltivit  +$r+$ma #r$p =tl m$ltivit tamba& dara&  *ablet Salut selaput asflat Ampul $rsitiamin HCl (alinamin inj)

:itamin  400" :it  1 200 :egiapm / liap dEalpa *ooperol 200 dEalpa *ooperol 400 '#Koen=;( d%n Me$%&oli$i0( l%in )iraetam tablet -00mg in!e%si #gr/ampul itiolin in!e%si dema%olin tablet obat batu% pile% ustab sBr SBrup LibroBm plus tablet :it  400 I> sofaps bisoprolol 5 mg gentian violet latobailus tab #1 Ales H%&is 6%%i lester Leuoplast Bpa3F mas%er andsoen

PUSKE S MAS

tali/ %aret/loop steril non steril

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8.2.1 Ep 6 Formularium-obat-2014

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