FORMULARIUM OBAT PUSKESMAS

KOTA TANGERANG SELATAN

KELAS TERAPI
FORMULASI
NAMA GENERIK
Bentuk Sediaan Dan Kekuatan
1. ANALGESIK, ANTIPIRETIK, ANTIINFLAMASI NONSTEROID, ANTIPIRAL
1.1 ANALGESIK NARKOTIK
Kodein
tab 10mg
Petidin
................................
................................
1.2 ANALGESIK NON- NARKOTIK
Ibuprofen

Natrium diklofenak
Parasetamol

asam mefenamat
kalium diklofenak
meloksikam
metampiron
.....................................................
1.3 ANTIPIRAL
Alopurinol
kolkisin
.....................................................
.....................................................
2. ANESTETIK
2.1 ANESTETIK LOKAL
Etil Klorida
Lidokain

.................................
.................................
2.2 ANESTETIK UMUM dan OKSIGEN
Ketamin
Oksigen

inj. i.m/s.k/i.v
lambat 50mg/ml (HCl)
........................................................
.......................................................
tab 200mg
tab 400mg
sirup 100mg/5ml
tab 25mg
tab 50mg
tab 100mg
tab 500mg
sirup 120mg/5ml
supositoria 125mg
supositoria 240mg
tetes 60mg/0,6 ml
tab 500mg
tab 25 mg
tab 50mg
tab 7,5mg
tab 15mg
tab 500mg
........................................................
tab 100mg
tab 300mg
tab 500mcg
........................................................
........................................................

semprot
inj infiltr 2%
jeli 2%
semprot 10%
.........................................................
.........................................................
inj i.v 50mg/ml
inj i.v 100mg/ml
inhalasi, gas dalam tabung

.................................
.........................................................
.................................
.........................................................
2.3 PRESEDUR PRE OPERATIF, OBAT untuk
Atropin
inj i.v/i.m/s.k. 0,25mg/ml
Diazepam
tab 5mg
inj i.v/i.m 5mg/ml
.................................
.........................................................
.................................
.........................................................
3. ANTIALERGI dan OBAT untuk ANAFILAKSIS
Deksametasom
inj i.v/i.m 5mg/ml
Difenhidramin
inj i.v/i.m 10mg/ml (HCl)
Epinefrin (adrenalin)
inj i.v/s.k/i.m 0,1%
klorfeniramin
tab 4mg
loratadin
tab 10mg
cetirizin
tab 10mg
betahistin mesilt
tab 6mg
.....................................................
........................................................
4. ANTIDOT dan OBAT LAIN untuk KERACUNAN
4.1 KHUSUS
Atropin
inj 0,25mg/ml
Natrium bikarbonat
tab 500mg
Natrium tiosulfat
inj i.v 25%
.................................
.........................................................
.................................
.........................................................
4.2 UMUM
Karbon aktif
tab
Magnesium sulfat
serbuk
.................................
.........................................................
.................................
.........................................................
5. ANTIEPILEPSI - ANTIKONVULSAN
Diazepam
inj i.m/i.v 5mg/ml
tab 2mg

Fenitoin

fenobarbital
karbamazepin

Magnesium sulfat
Valporat

.................................

larutan rektal 5mg/2,5ml tube

larutan rektal 10mg/2,5ml tube
Kapsul 30mg
kapsul 100mg
inj 50mg/5ml
tab 30mg
tab 100mg
tab 200mg
tab kunyah 100mg
sirup 100mg/5ml
inj i.v 20%
inj i.v 40%
tab 250mg
tab 500mg
sirup 250mg/5ml
.........................................................

.................................
6. ANTIINFEKSI
6.1 ANTELMINTIK
6.1.1 Antelmintik Intestinal
Albendazol
Mebendazol

Pirantel
Prazikuantel
.................................
.................................
6.1.2 Antifilaria
Dietilkarbamazin
.................................
.................................
6.1.3 antisistosoma
Prazikuantel

.................................
.................................
6.2 ANTIBAKTERI
6.2.1 Beta Laktam
Amoksisilin
Ampisilin
Benzatin penisilin
Fenoksimetil penisilin
(Penisilin V)
Prokain benzilpenisilin
sefadroksil
seftriakson
amoksisilin+as. Klavulanat
6.2.2 Antibakteri Lain
6.2.2.1 Tetrasiklin
Doksisiklin
Tetrasiklin
.................................
.................................
6.2.2.2 Kloramfenikol
Kloramfenikol

.........................................................

tab 400mg
tab 100mg
sirup 100mg/5ml
tab 500mg
Tab scored 250mg
suspensi 125mg/5ml
tab 300mg
tab 600mg
.........................................................
.........................................................
tab scored 100mg
.........................................................
.........................................................
tab 600mg

.........................................................
.........................................................

tab scored 500mg

sirup kering 125mg/5ml
serbuk inj i.m/i.v 250mg/vial
serbuk inj i.v 1000mg/vial
inj i.m 1,2juta UI/ml
inj i.m 2,4 juta UI/ml
tab 500mg
tab 250mg
sirup kering 250mg/5ml
serbuk inj i.m 1juta UI/vial
serbuk inj i.m 3juta UI/vial
tab 500mg
sirup kering
serbuk inj 1g/vial
tab 625mg

kapsul 100mg
kapsul 250mg (HCl)
kapsul 500mg (HCl)
.........................................................
.........................................................
kapsul 250mg

tiamfenikol
.................................
6.2.2.3 Sulfa- Trimetropim
Kotrimoksazol DOEN I
(dewasa), kombinasi:
Sufametoksazol 400mg
trimetropim 80mg
Kotrimoksazol DOEN II
(pediatrik), kombinasi:
Sufametoksazol 100mg
trimetropim 20mg
kotrimoksazol kombinasi:
sulfametoksazol 200mg
trimetropin 40mg
.................................
6.2.2.4 Makrolid
Eritromisin
linkomisin
klindamisin

6.2.2.5 Aminoglikosida
.................................
.................................
6.2.2.6 Kuinolon
Siprofloksasin

levofloksasin
.................................
6.2.2.7 Penggunaan Khusus
Metronidazol

.................................
.................................
6.3 ANTIINFEKSI KHUSUS
6.3.1 Antilepra
Dapson
Klofazimin, micronized
Rifampisin
.................................
.................................
6.3.2 Antituberkulosis
Isoniazid
Streptomisin

suspensi 125mg/5ml
tab 500mg
.........................................................
tab

tab

.........................................................
kapsul 250mg
sirup kering 200mg/5ml
tab 500mg
tab 150mg
tab 300mg

.........................................................
.........................................................
tab scored 500mg

tab 500mg
.........................................................
tab 250mg
tab 500mg
supositoria 500mg
lar infus 5mg/ml
.........................................................
.........................................................

tab scored 100mg

kapsul dalam minyak 100mg
Kapsul 300mg
.........................................................
.........................................................
tab 100mg
tab 300mg
serbuk inj 1000mg/vial

Kombinasi untuk dewasa :

Paduan dalam bentuk dosis
tetap (KDT/FDC)
Rifampisin
isoniazid
pirazinamid
etambutol
Kombinasi untuk dewasa :
Paduan dalam bentuk dosis
tetap (KDT/FDC)
Rifampisin
Isoniazid
kombinasi untuk anak :
Paduan dalam bentuk dosis
tetap (KDT/FDC)
Rifampisin
Isoniazid
pirazinamid
kombinasi untuk anak :
Paduan dalam bentuk dosis
tetap (KDT/FDC)
Rifampisin
Isoniazid
Kombinasi untuk dewasa :
(paduan dalam bentuk kombipak)
Rifampisin
Isoniazid
pirazinamid
etambutol
kombinasi untuk anak :
(paduan dalam bentuk kombipak)
Rifampisin
Isoniazid
pirazinamid
kombinasi untuk anak :
(paduan dalam bentuk kombipak)
Rifampisin
Isoniazid
.................................
.................................
6.3.3 Antiseptik Saluran Kemih
Metanamin mandelat
(heksamin mandelat)
.................................
.................................
6.4 ANTIFUNGI
6.4.1 Antifungi, sistemik
Griseofulvin, micronized

kapsul 150mg
tab 75mg
tab 400mg
tab 275mg

kapsul 150mg
tab 150mg

kapsul 75mg
tab 50mg
tab 150mg

kapsul 75mg
tab 50mg

kapsul 450mg
tab 300mg
tab 500mg
tab 250mg; 500mg

kapsul 75mg
tab 100mg
tab 200mg

kapsul 75mg
tab 100mg
.........................................................
.........................................................
tablet salut enterik
.........................................................
.........................................................

tab scored 250mg

tab 125mg

nistatin
.................................
.................................
6.4.2 Antifungi, topikal
antifungi DOEN,
Kombinasi :
asam benzoat 6%
asam salisilat 3%
nistatin
mikonazol
.................................
.................................
6.5 ANTIPROTOZOA
6.5.1 Antiamuba dan Antigiardiasis
Metronidazol
.................................
.................................
6.5.2 Antimalaria
6.5.2.1 Untuk Pencegahan
doksisiklin
.................................
.................................
6.5.2.2 Untuk Pengobatan
Antimalaria DOEN Kombinasi:
sulfadoksin 500mg
pirimetamin 25mg
artemether
artesunat
kombinasi (kombipak)
artesunat tab 50mg
amodiakuin tab 200mg
kuinin

primakuin
.................................
.................................
6.6 ANTIVIRUS
6.6.1 Antiherpes
asiklovir
.................................
.................................
7. ANTIPARKINSON
Antiparkinson DOEN, kombinasi :
benserazid 25mg

tab salut 500.000 UI/tab

suspensi 100.000 UI/ml
.........................................................
.........................................................
salep

tab vagina 100.000 UI/tab

serbuk 2%
krim 2%
.........................................................
.........................................................

tab 250mg
tab 500mg
.........................................................
.........................................................

kapsul 100mg
.........................................................
.........................................................
tablet

inj 80mg/ml
inj i.v/i.m 60mg/ml
tablet

tab 200mg
tab 222mg
tab 250mg
inj i.v 25%
tab 15mg
.........................................................
.........................................................

tab scored 200mg

tab scored 400mg
.........................................................
.........................................................
tablet

levodopa 100mg
Triheksifenidil
tab 2mg
.................................
.........................................................
.................................
.........................................................
8. DARAH, OBAT yang MEMPENGARUHI
8.1 ANTIENEMI
Asam folat
tab 1mg
tab 0,5mg
besi (II) sulfat 7H2O
tab salut 300mg
sirup 150mg/5ml
Kombinasi :
tablet
besi (II) sulfat 200mg
asam folat 0,25mg
Sianokobalamin (Vitamin B12)
tab 50mcg
.................................
.........................................................
.................................
.........................................................
8.2 KOAGULASI, OBAT yang MEMPENGARUHI
Fitomenadion (Vitamin K1)
tab salut 10mg
inj 10mg/ml
inj i.m 2mg/ml
.................................
.................................
9. ANTISEPTIK dan DESINFEKTAN
9.1 ANTISEPTIK
hidrogen peroksida

.........................................................
.........................................................

cairan konsentrat

klorheksidin
lar 5,0%
polikresulen
cairan
povidon iodin
larutan
.................................
.........................................................
.................................
.........................................................
9.2 DESINFEKTAN
etanol 70%
cairan
kalsium hipoklorit
serbuk
paraformaldehid
larutan 5%
etakridin (rivanol)
larutan 0,1%
.................................
.........................................................
10. GIGI dan MULUT, OBAT dan BAHAN untuk
10.1 PERAWATAN SALURAN AKAR, ANTISEPTIK dan BAHAN untuk
Eugenol
cairan
formokresol
cairan
gutta percha points
15mm- 40mm
45mm- 80mm
kalsium hidroksida
bubuk, pasta
klorfenol kamfer mentol (CHKM)
cairan
klorheksidin
larutan 0,2%
natrium hipoklorit
cairan konsentrat 5%
pasta pengisi saluran akar
pasta

.................................
.........................................................
.................................
.........................................................
10.2 ANTUFUNGI OROFARINGEAL
nistatin
suspensi 100.000 UI/ml
.................................
.........................................................
.................................
.........................................................
10.3 PENCEGAHAN KARIES, OBAT untuk
Flour
kaplet 1mg
sediaan topikal
.................................
.........................................................
.................................
.........................................................
10.4 BAHAN TUMPAT
bahan tumpatan sementara
larutan, serbuk
glass ionomer ART (Atraumatic
serbuk
Restorative Treatment)
larutan
cocoa butter 5kg
komposit resin
set
.................................
.........................................................
.................................
.........................................................
10.5 PREPARAT LAINNYA
anestetik lokal gigi
injeksi
DOEN kombinasi :
lidokain HCl 2%
epinefrin 1:80.0000
articulating paper
kertas warna penanda oklusi
etil klorida
semprot 0,05-0,2ml
lidokain
inj 2% (HCl)
pasta 5% (HCl)
semprot 15% (HCl)
pasta devitalisasi (non arsen)
pasta
spons gelatin
cubicles 1x1x1 cm
surgical ginggival pack
pasta
.................................
.........................................................
.................................
.........................................................
11. DUIRETIK
amilorid
tab 5mg
furosemid
tab 40mg
inj i.v/i.m 10mg/ml
hidroklortiazid
tab 12,5mg
tab 25mg
spironolakton
tab 25mg
.................................
.........................................................
.................................
.........................................................
12. HORMON, OBAT ENDOKRIN LAIN dan KONTRASEPTIK
12.1 HORMON ANTIDIURETIK
.................................
.........................................................
.................................
.........................................................
12.2 ANTIDIABETES
12.2.1 Antidiabetes, Oral
glibenklamid
tab 2,5mg

tab 5mg
glipizid
tab 5mg
metformin
tab 500mg
.................................
.........................................................
.................................
.........................................................
12.2.2 Antidiabetes, parenteral
.................................
.........................................................
.................................
.........................................................
12.3 HORMON KELAMIN dan OBAT yang MEMPENGARUHI FERTILITAS
12.3.1 Kontraseptik
12.3.1.1 Kontraseptik, Oral
kombinasi :
pil
levonorgestrel 150mcg
etinilestradiol 30mcg
.................................
.........................................................
.................................
.........................................................
12.3.1.2 Kontraseptik, Parenteral
medroksi progesteron asetat
inj depo 150mg
.................................
.........................................................
.................................
.........................................................
12.3.1.3 Kontraseptik ,AKDR (IUD)
copper T
set/buah
.................................
.........................................................
.................................
.........................................................
12.3.1.4 Kontraseptik, Implan
levonorgestrel
implan 2 rods (3-4 tahun)
.................................
.........................................................
.................................
.........................................................
12.3.1.5 Lain-lain
.................................
.........................................................
.................................
.........................................................
12.3.2 HORMON TIROID dan ANTITIROID
lugol
larutan
propiltiourasil
tab scored 100mg
.................................
.........................................................
.................................
.........................................................
12.3.3 KORTIKOSTEROID
deksametason
tab 0,5mg
inj 5mg/ml
hidrokortison
serbuk inj 100mg/vial
prednison
tab 5mg
.................................
.........................................................
.................................
.........................................................
13. KARDIOVASKULER, OBAT
13.1 ANTIANGINA
amlodipin
tab 5mg
atenolol
diltiazem HCl
isosorbid dinitrat

tab 50mg
tab 30mg
tab sublungual 5mg

nitrogliserin
.................................
.................................
13.2 ANTIARITMA
digoksin

propanolol
.................................
.................................
13.3 ANTIHIPERTENSI
atenolol
diltiazem
hidroklortiazid
kaptopril

nifedipin
.................................
.................................
13.4 ANTIAGREGASI PLATELET
asam asetilsalisita (asetosal)
.................................
.................................
13.5 TROMBOLITIK
.................................
.................................
13.6 GAGAL JANTUNG,OBAT
digoksin

inj i.v 10mg

tab sublingual 0,5mg
.........................................................
.........................................................
tab 0,0625mg
tab 0,1mg
tab 0,25mg
tab 10mg
.........................................................
.........................................................
tab 50mg
tab 100mg
tab 30mg
tab 25mg
tab scored 12,5mg
tab scored 25mg
tab 50mg
kapsul 10mg
.........................................................
.........................................................
tab 80mg
.........................................................
.........................................................
.........................................................
.........................................................

tab 0,0625mg
tab 0,1mg
tab 0,25mg
inj 0,25mg/ml
furosemid
tab 40mg
inj i.v/i.m 10mg/ml
kaptopril
tab scored 12,5mg
tab scored 50mg
bisoprolol
tab 5mg
.................................
.........................................................
13.7 SYOK KARDIOGENIK dan SEPSIS, OBAT untuk
.................................
.........................................................
.................................
.........................................................
13.8 ANTIHIPERLIPIDEMIA
simvastatin
tab scored 10mg
tab 20mg
.................................
.........................................................
.................................
.........................................................
14. KULIT, OBAT TOPIKAL untuk
14.1 ANTIAKNE

asam retinoat
.................................
.................................
14.2 ANTIBAKTERI
antibakteri DOEN kombinasi :
basitrasin 500 UI/g
polimiksin B 10.000 UI/g
perak sulfadiazin
.................................
.................................
14.3 ANTUFUNGI
antifungi DOEN kombinasi :
asam benzoat 6%
asam salisilat 3%
mikonazol

krim 0,05%
.........................................................
.........................................................
salep

krim 1%
.........................................................
.........................................................
salep

serbuk 2%
krim 2%
.........................................................
.........................................................

.................................
.................................
14.4 ANTIINFLAMASI dan ANTIPURITIK
betametason
salep 0,1%
krim 0,1%
hidrokortison
krim 2,5%
kelamin
lotio
.................................
.........................................................
.................................
.........................................................
14.5 ANTISKABISES dan ANTIPEDIKULOSIS
permetrin
krim 5%
salep 2-4, kombinasi :
salep
asam salisilat 2%
belerang endap 4%
.................................
.........................................................
.................................
.........................................................
14.6 KAUSTIK
perak nitrat
larutan 20%
.................................
.........................................................
.................................
.........................................................
14.7 KERATOLITIK dan KERATOPLASTIK
asam salisilat
salep 5%
coal tar
larutan 5%
.................................
.........................................................
.................................
.........................................................
14.8 LAIN-LAIN
bedak salisil
serbuk 2%
liquor carbonis
suspensi 2%
detergens
suspensi 5%
liquor faberi
cairan
.................................
.........................................................
.................................
.........................................................
15. LARUTAN ELEKTROLIT, NUTRISI dan LAIN-LAIN
15.1 ORAL

garam oralit, kombinasi :

natriium klorida 0,52g
kalium klorida 0,30g
trinatrium sitrat dihidrat 0,58g
glukosa anhidrat 2,70g
natrium bikarbonat
.................................
.................................
15.2 PARENTERAL
dekstrosa
glukosa

ringer laktat
natrium klorida
.................................
15.3 LAIN-LAIN
air untuk injeksi
.................................
.................................
16. MATA, OBAT untuk
16.1 ANTIMIKROBA
kloramfenikol

oksitetrasiklin
sulfasetamid natrium
.................................
16.2 ANTIINFLAMASI
betametason
.................................
.................................
16.3 LAIN-LAIN
natrium kromoglikat
.................................
.................................
17. OKSITOSIK
metilergometrin

serbuk untuk 200ml air

tab 500mg
.........................................................
.........................................................
larutan infus 5%
larutan infus 5%
larutan infus 10%
larutan infus 40%
larutan infus
larutan infus 0,9%
.........................................................
cairan
.........................................................
.........................................................

tetes mata 0,5%

tetes mata 1%
salep mata 1%
salep mata 1%
tetes mata
.........................................................
tetes mata 1mg/ml
.........................................................
.........................................................
tetes mata 2%
.........................................................
.........................................................
tab salut 0,125mg
inj 0,200mg/ml
inj 10 UI/ml
.........................................................
.........................................................

oksitosin
.................................
.................................
18. PSIKOFARMAKA
18.1 ANTIANSIETAS dan ANTIINSOMNIA
diazepam
tab 2mg
tab 5mg
inj i.m 5mg/ml
.................................
.........................................................
.................................
.........................................................
18.2 ANTIDEPRESI dan ANTIMANIA

amitriptilin
.................................
.................................
18.3 ANTIPSIKOSIS
haloperidol

tab salut 25mg

.........................................................
.........................................................

tab 0,5mg
tab 1,5mg
tab 2mg
tab 5mg
tts 2mg/ml
inj i.m 2mg/ml
inj i.m 5mg/ml
inj 50mg/ml
klorpromazin
tab salut 25mg
tab salut 100mg
inj i.m 25mg/ml
.................................
.........................................................
.................................
.........................................................
18.4 PROGRAM UNTUK KETERGANTUNGAN, OBAT untuk
metadon
sirup 50mg/5ml
.................................
.........................................................
.................................
.........................................................
19. SALURAN CERNA, OBAT untuk
19.1 ANTASIDA dan ANTIULKUS
antasida DOEN kombinasi:
tablet kunyah
alumunium hidroksida 200mg
magnesium hidroksida 200mg
omeprazol
kapsul 20mg
ranitidin
tablet 150mg, inj 25mg/2ml
.................................
.........................................................
.................................
.........................................................
19.2 ANTIEMETIK
dimendihrinat
tab 50mg
domperidon
sirup 5mg/5ml, tab 10mg
klorpromazin
tab salut 25mg
inj i.m 25mg/ml
inj i.m 5mg/ml
metoklopramid
tab 10mg, inj 5mg/ml
.................................
.........................................................
.................................
.........................................................
19.3 ANTIHEMOROID
antihemoroid DOEN, kombinasi :
supositoria
bismut subgalat 150mg
heksaklorofen 2,5mg
lidokain 10mg
seng oksida 120mg
sup ad 2g
.................................
.........................................................
.................................
.........................................................
19.4 ANTISPASMODIK
atropin
tab 0,5mg

hiosin butilbromid
.................................
.................................
19.5 DIARE, OBAT untuk
atapugit
garam oralit, kombinasi :
natrium klorida 0,52g
kalium klorida 0,30g
trinatrium sitrat dihidrat 0,58g
glukosa anhidrat 2,70g
zinc
loperamid
.................................
19.6 KATARTIK
bisakodil
gliserin
laktulosa
.................................
.................................
20. SALURAN NAPAS, OBAT untuk
20.1 ANTIASMA
aminofilin

deksametason
efedrin
epinefrin (adrenalin)
salbutamol

.................................
.................................
20.2 ANTITUSIF
dekstrometorfan
kodein
.................................
.................................
20.3 EKSPEKTORAN
obat batuk hitam (OBH)
gliseril guaikolat

inj i.m/i.v/s.k 0,25mg/ml

inj i.m/i.v/s.k 1mg/ml
tab 10mg
.........................................................
.........................................................
tab
serbuk untuk 200ml air

tab dispersible 20mg

sirup
tablet 2mg
.........................................................
supositiria 5mg
supositiria 10mg
tts 10mg/ml
tts 100mg/ml
sirup 10g/15ml
.........................................................
.........................................................

tab scored 200mg

tab 150mg
inj 24mg/ml
tab 0,5mg
inj i.v 5mg/ml
tab 25mg
inj 0,1%
tab 2mg
tab 4mg
larutan inhalasi 0,5%
inhalasi/aerosol 100mcg/dosis
larutan respirator untuk nebulizer
2,5mg/2,5ml NaCl
.........................................................
.........................................................
tablet 15mg
sirup 10mg/5ml
tab 10mg
.........................................................
.........................................................
cairan
tab 100mg

sirup 25mg/5ml
bromhexin
tab 8mg
ambroxol
tab 30mg, sirup 15mg/ml
.................................
.........................................................
20.4 PENYAKIT PARU OBSTRUKSI KRONIS, OBAT untuk
ipratropium bromida
inhalasi 20mcg/semprot
nebulizer 0,025%
kombinasi :
larutan inhalasi
ipratropium bromida 0,5mg
salbutamol 2,5mg
.................................
.........................................................
.................................
.........................................................
21. TELINGA, HIDUNG dan TENGGOROKAN, OBAT untuk
hidrogen peroksida
cairan konsentrat

karbogliserin
lidokain
oksimetazolin
.................................
.................................
22. VITAMIN dan MINERAL
asam askorbat (vitamin C)
ergokalsiferol (vitamin D3)
fitomenadion (vitamin K1)
iodium
kalsium glukonat
kalsium karbonat
kalsium laktat (kalk)
kombinasi :
besi (II) sulfat 7H2O 200mg
asam folat 0,25mg
nikotinamid
piridoksin (vitamin B6)

retinol
tiamin (Vitamin B1)
vitamin B kompleks
.................................
.................................

tts telinga 10%

cairan semprot 10%
tts hidung 0,025%
tts hidung 0,050%
.........................................................
.........................................................
tab 50mg
tab 250mg
kapsul 50.000 UI
suspensi 10.000 UI/ml
inj 10mg/ml
kapsul lunak 200mg
inj 10%
tab 500mg
tab 500mg
tablet salut

tab 5mg
tab 20mg
tab 10mg
tab 25mg
inj 100g/ml
kapsul lunak 100.000UI
kasul lunak 200.000UI
tab 50mg
tablet
.........................................................
.........................................................

petunjuk pengisian :
1. bila ada tambahan obat diisi di baris yang telah disediakan di masing-masing kelas terapi. Baris dapat ditambahkan sesuai kebutu
2. tabel keterangan diisi bila ada obat yang dikurangi

3. bila ada tambahan obat yang tidak termasuk kelas terapi diatas ditambahkan dikolom terakhir

RMULARIUM OBAT PUSKESMAS

KOTA TANGERANG SELATAN
CATATAN

KETERANGAN

Hanya untuk di Puskesmas

Perawatan
Hanya untuk di Puskesmas
Perawatan
.........................................
.........................................

................................
................................

................................................................

................................

Tidak diberikan saat

serangan akut
................................................................
.................................................................

.................................
.................................

....................................................
.....................................................

.................................
.................................

Hanya untuk di puskesmas

perawatan

.........................................
.........................................

.................................
.................................

.........................................
.........................................

.................................
.................................

................................................................

.................................

.........................................
.........................................

.................................
.................................

.........................................
.........................................

.................................
.................................

untuk anak hanya diberikan

pada kasus kejang demam
dengan kombinasi antipiretik

hanya untuk eklampsia

.........................................

.................................

.........................................

.................................

.........................................
.........................................

.................................
.................................

.........................................
.........................................

.................................
.................................

#Hanya untuk daerah Sulawesi Tengah

#Khusus di Kalimantan Selatan untuk
pengobatan Fasciolopsis buski
.........................................
.........................................

.................................
.................................

Hanya untuk di Puskesmas Perawatan

.........................................
.........................................

.................................
.................................

.........................................

.................................

.........................................

.................................

.........................................
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.................................
.................................

#Tidak untuk pilihan utama pada infeksi

kuman gram positif
#Tidak untuk pasien <18 tahun
.........................................

.................................

Hanya untuk di Puskesmas Perawatan

.........................................
.........................................

.................................
.................................

Hanya untuk lepra

.........................................
.........................................

.................................
.................................

untuk profilaksis TB pada anak dan

HIV/AIDS
Penggunaan sesuai dengan program TB

Nasional
bentuk sediaan dan penggunaan sesuai
dengan program TB Nasional

bentuk sediaan dan penggunaan sesuai

dengan program TB Nasional

dengan program TB Nasional

bentuk sediaan dan penggunaan sesuai

dengan program TB Nasional

bentuk sediaan dan penggunaan sesuai

dengan program TB Nasional

bentuk sediaan dan penggunaan sesuai

dengan program TB Nasional

bentuk sediaan dan penggunaan sesuai

dengan program TB Nasional

.........................................
.........................................

.................................
.................................

.........................................
.........................................

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.........................................
.........................................

.................................
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.........................................

.................................
.................................

.........................................
.........................................

.................................
.................................

.........................................
.........................................

.................................
.................................

hanya untuk puskesmas perawatan

hanya untuk puskesmas perawatan

hanya untu malaria yang berat

.........................................
.........................................

.................................
.................................

.........................................
.........................................

.................................
.................................

.........................................
.........................................

.................................
.................................

.........................................
.........................................

.................................
.................................

# dosis untuk bayi baru lahir 1mg

# dosis untuk bayi prematur 0,5mg
.........................................
.........................................

.................................
.................................

# disimpan dalam botol kedap udara,

terlindung dari cahaya
# untuk diencerkan sampai 3%
untuk diencerkan bila akan digunakan

.........................................
.........................................

.................................
.................................

.........................................

.................................

untuk diencerkan

.........................................
.........................................

.................................
.................................

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.........................................

.................................
.................................

.........................................
.........................................

.................................
.................................

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.........................................

.................................
.................................

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.................................

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.........................................

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.................................

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.................................
.................................

.........................................
.........................................

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.................................
.................................

.........................................
.........................................

.................................
.................................

.........................................
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.................................
.................................

dilarutkan dulu
.........................................
.........................................

.................................
.................................

.........................................
.........................................

.................................
.................................

hanya untuk pasien anginan dengan

bradiaritma

.........................................
.........................................

.................................
.................................

tablet 0,0625mg untuk pediatrik

.........................................
.........................................

.................................
.................................

hanya untuk preeklampsia dan tokolitik

.........................................
.........................................

.................................
.................................

.........................................
.........................................

.................................
.................................

.........................................
.........................................

.................................
.................................

tab 0,0625mg untuk pediatrik

hanya untuk di Puskesmas perawatan

.........................................

.................................

.........................................
.........................................

.................................
.................................

.........................................
.........................................

.................................
.................................

.........................................
.........................................

.................................
.................................

hanya untuk luka bakar yang luas

.........................................
.........................................

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.................................

.........................................
.........................................

.................................
.................................

.........................................
.........................................

.................................
.................................

.........................................
.........................................

.................................
.................................

untuk lesi hipergranulasi

.........................................
.........................................

.................................
.................................

.........................................
.........................................

.................................
.................................

.........................................
.........................................

.................................
.................................

diminum sedikit demi sedikit 2-3 teguk

untuk menghindari muntah

.........................................
.........................................

.................................
.................................

hanya untuk di puskesmas perawatan

.........................................

.................................

.........................................
.........................................

.................................
.................................

.........................................

.................................

.........................................
.........................................

.................................
.................................

.........................................
.........................................

.................................
.................................

.........................................
.........................................

.................................
.................................

hanya untuk di Puskesmas perawatan

.........................................
.........................................

.................................
.................................

.........................................
.........................................

.................................
.................................

.........................................
.........................................

.................................
.................................

.........................................
.........................................

.................................
.................................

.........................................
.........................................

.................................
.................................

hanya untuk di Puskesmas perawatan

.........................................
.........................................

.................................
.................................

.........................................
.........................................

.................................
.................................

.........................................
.........................................

.................................
.................................

tidak untuk anak

hanya sebagai tambahan pada pemberian

oralit untuk balita diare
.........................................

.................................

.........................................
.........................................

.................................
.................................

hanya untuk di Puskesmas perawatan

inhalasi untuk serangan intermitten dan

untuk serangan akut pertama

.........................................
.........................................

.................................
.................................

.........................................
.........................................

.................................
.................................

.........................................

.................................

.........................................
.........................................

.................................
.................................

# disimpan dalam botol kedap udara,

terlindung dari cahaya
# untuk diencerkan sampai 3%

.........................................
.........................................

.................................
.................................

pemakaian terapeutik pada hipokalsemia

.........................................
.........................................

.................................
.................................

i masing-masing kelas terapi. Baris dapat ditambahkan sesuai kebutuhan

atas ditambahkan dikolom terakhir