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Dobutamine 250 mg Dobutamine 250 mg

Nama Pasien : …................................................. Nama Pasien : …...................................................


No. MR : …................................................. No. MR : …...................................................
BB Pasien : …................................................. BB Pasien : …...................................................

Rumus = Dosis Permintaan (dlm mcg ) X KgBB X 60 menit Rumus = Dosis Permintaan (dlm mcg ) X KgBB X 60 menit
Dosis yang tersedia (mcg/cc) Dosis yang tersedia (mcg/cc)

= …........ X …........ X 60 =…....... cc/jam = …........ X …........ X 60 =…....... cc/jam


5000 5000

Tabel Dosis Yang Diberikan Tabel Dosis Yang Diberikan


1 mcg = ........... cc/jam 11 mcg = ........... cc/jam 1 mcg = ........... cc/jam 11 mcg = ........... cc/jam
2 mcg = ........... cc/jam 12 mcg = ........... cc/jam 2 mcg = ........... cc/jam 12 mcg = ........... cc/jam
3 mcg = ........... cc/jam 13 mcg = ........... cc/jam 3 mcg = ........... cc/jam 13 mcg = ........... cc/jam
4 mcg = ........... cc/jam 14 mcg = ........... cc/jam 4 mcg = ........... cc/jam 14 mcg = ........... cc/jam
5 mcg = ........... cc/jam 15 mcg = ........... cc/jam 5 mcg = ........... cc/jam 15 mcg = ........... cc/jam
6 mcg = ........... cc/jam 16 mcg = ........... cc/jam 6 mcg = ........... cc/jam 16 mcg = ........... cc/jam
7 mcg = ........... cc/jam 17 mcg = ........... cc/jam 7 mcg = ........... cc/jam 17 mcg = ........... cc/jam
8 mcg = ........... cc/jam 18 mcg = ........... cc/jam 8 mcg = ........... cc/jam 18 mcg = ........... cc/jam
9 mcg = ........... cc/jam 19 mcg = ........... cc/jam 9 mcg = ........... cc/jam 19 mcg = ........... cc/jam
10 mcg = ........... cc/jam 20 mcg = ........... cc/jam 10 mcg = ........... cc/jam 20 mcg = ........... cc/jam

Dobutamine 250 mg Dobutamine 250 mg


Nama Pasien : …................................................. Nama Pasien : …...................................................
No. MR : …................................................. No. MR : …...................................................
BB Pasien : …................................................. BB Pasien : …...................................................

Rumus = Dosis Permintaan (dlm mcg ) X KgBB X 60 menit Rumus = Dosis Permintaan (dlm mcg ) X KgBB X 60 menit
Dosis yang tersedia (mcg/cc) Dosis yang tersedia (mcg/cc)

= …........ X …........ X 60 =…....... cc/jam = …........ X …........ X 60 =…....... cc/jam


5000 5000

Tabel Dosis Yang Diberikan Tabel Dosis Yang Diberikan


1 mcg = ........... cc/jam 11 mcg = ........... cc/jam 1 mcg = ........... cc/jam 11 mcg = ........... cc/jam
2 mcg = ........... cc/jam 12 mcg = ........... cc/jam 2 mcg = ........... cc/jam 12 mcg = ........... cc/jam
3 mcg = ........... cc/jam 13 mcg = ........... cc/jam 3 mcg = ........... cc/jam 13 mcg = ........... cc/jam
4 mcg = ........... cc/jam 14 mcg = ........... cc/jam 4 mcg = ........... cc/jam 14 mcg = ........... cc/jam
5 mcg = ........... cc/jam 15 mcg = ........... cc/jam 5 mcg = ........... cc/jam 15 mcg = ........... cc/jam
6 mcg = ........... cc/jam 16 mcg = ........... cc/jam 6 mcg = ........... cc/jam 16 mcg = ........... cc/jam
7 mcg = ........... cc/jam 17 mcg = ........... cc/jam 7 mcg = ........... cc/jam 17 mcg = ........... cc/jam
8 mcg = ........... cc/jam 18 mcg = ........... cc/jam 8 mcg = ........... cc/jam 18 mcg = ........... cc/jam
9 mcg = ........... cc/jam 19 mcg = ........... cc/jam 9 mcg = ........... cc/jam 19 mcg = ........... cc/jam
10 mcg = ........... cc/jam 20 mcg = ........... cc/jam 10 mcg = ........... cc/jam 20 mcg = ........... cc/jam

Dobutamine 250 mg Dobutamine 250 mg


Nama Pasien : …................................................. Nama Pasien : …...................................................
No. MR : …................................................. No. MR : …...................................................
BB Pasien : …................................................. BB Pasien : …...................................................

Rumus = Dosis Permintaan (dlm mcg ) X KgBB X 60 menit Rumus = Dosis Permintaan (dlm mcg ) X KgBB X 60 menit
Dosis yang tersedia (mcg/cc) Dosis yang tersedia (mcg/cc)

= …........ X …........ X 60 =…....... cc/jam = …........ X …........ X 60 =…....... cc/jam


5000 5000

Tabel Dosis Yang Diberikan Tabel Dosis Yang Diberikan


1 mcg = ........... cc/jam 11 mcg = ........... cc/jam 1 mcg = ........... cc/jam 11 mcg = ........... cc/jam
2 mcg = ........... cc/jam 12 mcg = ........... cc/jam 2 mcg = ........... cc/jam 12 mcg = ........... cc/jam
3 mcg = ........... cc/jam 13 mcg = ........... cc/jam 3 mcg = ........... cc/jam 13 mcg = ........... cc/jam
4 mcg = ........... cc/jam 14 mcg = ........... cc/jam 4 mcg = ........... cc/jam 14 mcg = ........... cc/jam
5 mcg = ........... cc/jam 15 mcg = ........... cc/jam 5 mcg = ........... cc/jam 15 mcg = ........... cc/jam
6 mcg = ........... cc/jam 16 mcg = ........... cc/jam 6 mcg = ........... cc/jam 16 mcg = ........... cc/jam
7 mcg = ........... cc/jam 17 mcg = ........... cc/jam 7 mcg = ........... cc/jam 17 mcg = ........... cc/jam
8 mcg = ........... cc/jam 18 mcg = ........... cc/jam 8 mcg = ........... cc/jam 18 mcg = ........... cc/jam
9 mcg = ........... cc/jam 19 mcg = ........... cc/jam 9 mcg = ........... cc/jam 19 mcg = ........... cc/jam
10 mcg = ........... cc/jam 20 mcg = ........... cc/jam 10 mcg = ........... cc/jam 20 mcg = ........... cc/jam
Dopamine 200 mg Dopamine 200 mg
Nama Pasien : …............................................... Nama Pasien : …..............................................
No. MR : …............................................... No. MR : …..............................................
BB Pasien : …............................................... BB Pasien : …..............................................
Rumus = Dosis Permintaan (dlm mcg ) X KgBB X 60 menit Rumus = Dosis Permintaan (dlm mcg ) X KgBB X 60 menit
Dosis yang tersedia (mcg/cc) Dosis yang tersedia (mcg/cc)
= …........ X …........ X 60 =…....... cc/jam = …........ X …........ X 60 =…....... cc/jam
4000 4000

Tabel Dosis Yang Diberikan Tabel Dosis Yang Diberikan


1 mcg = ........... cc/jam 11 mcg = ........... cc/jam 1 mcg = ........... cc/jam 11 mcg = ........... cc/jam
2 mcg = ........... cc/jam 12 mcg = ........... cc/jam 2 mcg = ........... cc/jam 12 mcg = ........... cc/jam
3 mcg = ........... cc/jam 13 mcg = ........... cc/jam 3 mcg = ........... cc/jam 13 mcg = ........... cc/jam
4 mcg = ........... cc/jam 14 mcg = ........... cc/jam 4 mcg = ........... cc/jam 14 mcg = ........... cc/jam
5 mcg = ........... cc/jam 15 mcg = ........... cc/jam 5 mcg = ........... cc/jam 15 mcg = ........... cc/jam
6 mcg = ........... cc/jam 16 mcg = ........... cc/jam 6 mcg = ........... cc/jam 16 mcg = ........... cc/jam
7 mcg = ........... cc/jam 17 mcg = ........... cc/jam 7 mcg = ........... cc/jam 17 mcg = ........... cc/jam
8 mcg = ........... cc/jam 18 mcg = ........... cc/jam 8 mcg = ........... cc/jam 18 mcg = ........... cc/jam
9 mcg = ........... cc/jam 19 mcg = ........... cc/jam 9 mcg = ........... cc/jam 19 mcg = ........... cc/jam
10 mcg = ........... cc/jam 20 mcg = ........... cc/jam 10 mcg = ........... cc/jam 20 mcg = ........... cc/jam

Dopamine 200 mg Dopamine 200 mg


Nama Pasien : …............................................... Nama Pasien : …..............................................
No. MR : …............................................... No. MR : …..............................................
BB Pasien : …............................................... BB Pasien : …..............................................
Rumus = Dosis Permintaan (dlm mcg ) X KgBB X 60 menit Rumus = Dosis Permintaan (dlm mcg ) X KgBB X 60 menit
Dosis yang tersedia (mcg/cc) Dosis yang tersedia (mcg/cc)
= …........ X …........ X 60 =…....... cc/jam = …........ X …........ X 60 =…....... cc/jam
5000 5000

Tabel Dosis Yang Diberikan Tabel Dosis Yang Diberikan


1 mcg = ........... cc/jam 11 mcg = ........... cc/jam 1 mcg = ........... cc/jam 11 mcg = ........... cc/jam
2 mcg = ........... cc/jam 12 mcg = ........... cc/jam 2 mcg = ........... cc/jam 12 mcg = ........... cc/jam
3 mcg = ........... cc/jam 13 mcg = ........... cc/jam 3 mcg = ........... cc/jam 13 mcg = ........... cc/jam
4 mcg = ........... cc/jam 14 mcg = ........... cc/jam 4 mcg = ........... cc/jam 14 mcg = ........... cc/jam
5 mcg = ........... cc/jam 15 mcg = ........... cc/jam 5 mcg = ........... cc/jam 15 mcg = ........... cc/jam
6 mcg = ........... cc/jam 16 mcg = ........... cc/jam 6 mcg = ........... cc/jam 16 mcg = ........... cc/jam
7 mcg = ........... cc/jam 17 mcg = ........... cc/jam 7 mcg = ........... cc/jam 17 mcg = ........... cc/jam
8 mcg = ........... cc/jam 18 mcg = ........... cc/jam 8 mcg = ........... cc/jam 18 mcg = ........... cc/jam
9 mcg = ........... cc/jam 19 mcg = ........... cc/jam 9 mcg = ........... cc/jam 19 mcg = ........... cc/jam
10 mcg = ........... cc/jam 20 mcg = ........... cc/jam 10 mcg = ........... cc/jam 20 mcg = ........... cc/jam

Dopamine 200 mg Dopamine 200 mg


Nama Pasien : …............................................... Nama Pasien : …..............................................
No. MR : …............................................... No. MR : …..............................................
BB Pasien : …............................................... BB Pasien : …..............................................
Rumus = Dosis Permintaan (dlm mcg ) X KgBB X 60 menit Rumus = Dosis Permintaan (dlm mcg ) X KgBB X 60 menit
Dosis yang tersedia (mcg/cc) Dosis yang tersedia (mcg/cc)
= …........ X …........ X 60 =…....... cc/jam = …........ X …........ X 60 =…....... cc/jam
5000 5000

Tabel Dosis Yang Diberikan Tabel Dosis Yang Diberikan


1 mcg = ........... cc/jam 11 mcg = ........... cc/jam 1 mcg = ........... cc/jam 11 mcg = ........... cc/jam
2 mcg = ........... cc/jam 12 mcg = ........... cc/jam 2 mcg = ........... cc/jam 12 mcg = ........... cc/jam
3 mcg = ........... cc/jam 13 mcg = ........... cc/jam 3 mcg = ........... cc/jam 13 mcg = ........... cc/jam
4 mcg = ........... cc/jam 14 mcg = ........... cc/jam 4 mcg = ........... cc/jam 14 mcg = ........... cc/jam
5 mcg = ........... cc/jam 15 mcg = ........... cc/jam 5 mcg = ........... cc/jam 15 mcg = ........... cc/jam
6 mcg = ........... cc/jam 16 mcg = ........... cc/jam 6 mcg = ........... cc/jam 16 mcg = ........... cc/jam
7 mcg = ........... cc/jam 17 mcg = ........... cc/jam 7 mcg = ........... cc/jam 17 mcg = ........... cc/jam
8 mcg = ........... cc/jam 18 mcg = ........... cc/jam 8 mcg = ........... cc/jam 18 mcg = ........... cc/jam
9 mcg = ........... cc/jam 19 mcg = ........... cc/jam 9 mcg = ........... cc/jam 19 mcg = ........... cc/jam
10 mcg = ........... cc/jam 20 mcg = ........... cc/jam 10 mcg = ........... cc/jam 20 mcg = ........... cc/jam
Norepinefrine (NE) 8 mg Norepinefrine (NE) 8 mg

Nama Pasien : …................................................. Nama Pasien : …...............................................


No. MR : …................................................. No. MR : …...............................................
BB Pasien : …................................................. BB Pasien : …...............................................

Rumus = Dosis Permintaan (dlm mcg ) X KgBB X 60 menit Rumus = Dosis Permintaan (dlm mcg ) X KgBB X 60 menit
Dosis yang tersedia (mcg/cc) Dosis yang tersedia (mcg/cc)

= …........ X …........ X 60 =…....... cc/jam = …........ X …........ X 60 =…....... cc/jam


160 160

Tabel Dosis Yang Diberikan Tabel Dosis Yang Diberikan


0,05 mcg = ........... cc/jam 0,05 mcg = ........... cc/jam
0,04 mcg = ........... cc/jam 0,04 mcg = ........... cc/jam
0,03 mcg = ........... cc/jam 0,03 mcg = ........... cc/jam
0,02 mcg = ........... cc/jam 0,02 mcg = ........... cc/jam
0,01 mcg = ........... cc/jam 0,01 mcg = ........... cc/jam
0,1 mcg = ........... cc/jam 0,1 mcg = ........... cc/jam
0,2 mcg = ........... cc/jam 0,2 mcg = ........... cc/jam
0,3 mcg = ........... cc/jam 0,3 mcg = ........... cc/jam
0,4 mcg = ........... cc/jam 0,4 mcg = ........... cc/jam
0,5 mcg = ........... cc/jam 0,5 mcg = ........... cc/jam

Norepinefrine (NE) 8 mg Norepinefrine (NE) 8 mg


Nama Pasien : …................................................. Nama Pasien : …...............................................
No. MR : …................................................. No. MR : …...............................................
BB Pasien : …................................................. BB Pasien : …...............................................

Rumus = Dosis Permintaan (dlm mcg ) X KgBB X 60 menit Rumus = Dosis Permintaan (dlm mcg ) X KgBB X 60 menit
Dosis yang tersedia (mcg/cc) Dosis yang tersedia (mcg/cc)

= …........ X …........ X 60 =…....... cc/jam = …........ X …........ X 60 =…....... cc/jam


160 160

Tabel Dosis Yang Diberikan Tabel Dosis Yang Diberikan


0,05 mcg = ........... cc/jam 0,05 mcg = ........... cc/jam
0,04 mcg = ........... cc/jam 0,04 mcg = ........... cc/jam
0,03 mcg = ........... cc/jam 0,03 mcg = ........... cc/jam
0,02 mcg = ........... cc/jam 0,02 mcg = ........... cc/jam
0,01 mcg = ........... cc/jam 0,01 mcg = ........... cc/jam
0,1 mcg = ........... cc/jam 0,1 mcg = ........... cc/jam
0,2 mcg = ........... cc/jam 0,2 mcg = ........... cc/jam
0,3 mcg = ........... cc/jam 0,3 mcg = ........... cc/jam
0,4 mcg = ........... cc/jam 0,4 mcg = ........... cc/jam
0,5 mcg = ........... cc/jam 0,5 mcg = ........... cc/jam

Norepinefrine (NE) 8 mg Norepinefrine (NE) 8 mg


Nama Pasien : …................................................. Nama Pasien : …...............................................
No. MR : …................................................. No. MR : …...............................................
BB Pasien : …................................................. BB Pasien : …...............................................

Rumus = Dosis Permintaan (dlm mcg ) X KgBB X 60 menit Rumus = Dosis Permintaan (dlm mcg ) X KgBB X 60 menit
Dosis yang tersedia (mcg/cc) Dosis yang tersedia (mcg/cc)

= …........ X …........ X 60 =…....... cc/jam = …........ X …........ X 60 =…....... cc/jam


160 160

Tabel Dosis Yang Diberikan Tabel Dosis Yang Diberikan


0,05 mcg = ........... cc/jam 0,05 mcg = ........... cc/jam
0,04 mcg = ........... cc/jam 0,04 mcg = ........... cc/jam
0,03 mcg = ........... cc/jam 0,03 mcg = ........... cc/jam
0,02 mcg = ........... cc/jam 0,02 mcg = ........... cc/jam
0,01 mcg = ........... cc/jam 0,01 mcg = ........... cc/jam
0,1 mcg = ........... cc/jam 0,1 mcg = ........... cc/jam
0,2 mcg = ........... cc/jam 0,2 mcg = ........... cc/jam
0,3 mcg = ........... cc/jam 0,3 mcg = ........... cc/jam
0,4 mcg = ........... cc/jam 0,4 mcg = ........... cc/jam
0,5 mcg = ........... cc/jam 0,5 mcg = ........... cc/jam
Nicardipine 10 mg Nicardipine 10 mg

Nama Pasien : …................................................. Nama Pasien : …...................................................


No. MR : …................................................. No. MR : …...................................................
BB Pasien : …................................................. BB Pasien : …...................................................

Rumus = Dosis Permintaan (dlm mcg ) X KgBB X 60 menit Rumus = Dosis Permintaan (dlm mcg ) X KgBB X 60 menit
Dosis yang tersedia (mcg/cc) Dosis yang tersedia (mcg/cc)

= …........ X …........ X 60 =…....... cc/jam = …........ X …........ X 60 =…....... cc/jam


200 200

Tabel Dosis Yang Diberikan Tabel Dosis Yang Diberikan


0,05 mcg = ........... cc/jam 0,05 mcg = ........... cc/jam
0,04 mcg = ........... cc/jam 0,04 mcg = ........... cc/jam
0,03 mcg = ........... cc/jam 0,03 mcg = ........... cc/jam
0,02 mcg = ........... cc/jam 0,02 mcg = ........... cc/jam
0,01 mcg = ........... cc/jam 0,01 mcg = ........... cc/jam
0,1 mcg = ........... cc/jam 0,1 mcg = ........... cc/jam
0,2 mcg = ........... cc/jam 0,2 mcg = ........... cc/jam
0,3 mcg = ........... cc/jam 0,3 mcg = ........... cc/jam
0,4 mcg = ........... cc/jam 0,4 mcg = ........... cc/jam
0,5 mcg = ........... cc/jam 0,5 mcg = ........... cc/jam

Nicardipine 10 mg Nicardipine 10 mg
Nama Pasien : …................................................. Nama Pasien : …...................................................
No. MR : …................................................. No. MR : …...................................................
BB Pasien : …................................................. BB Pasien : …...................................................

Rumus = Dosis Permintaan (dlm mcg ) X KgBB X 60 menit Rumus = Dosis Permintaan (dlm mcg ) X KgBB X 60 menit
Dosis yang tersedia (mcg/cc) Dosis yang tersedia (mcg/cc)

= …........ X …........ X 60 =…....... cc/jam = …........ X …........ X 60 =…....... cc/jam


200 200

Tabel Dosis Yang Diberikan Tabel Dosis Yang Diberikan


0,05 mcg = ........... cc/jam 0,05 mcg = ........... cc/jam
0,04 mcg = ........... cc/jam 0,04 mcg = ........... cc/jam
0,03 mcg = ........... cc/jam 0,03 mcg = ........... cc/jam
0,02 mcg = ........... cc/jam 0,02 mcg = ........... cc/jam
0,01 mcg = ........... cc/jam 0,01 mcg = ........... cc/jam
0,1 mcg = ........... cc/jam 0,1 mcg = ........... cc/jam
0,2 mcg = ........... cc/jam 0,2 mcg = ........... cc/jam
0,3 mcg = ........... cc/jam 0,3 mcg = ........... cc/jam
0,4 mcg = ........... cc/jam 0,4 mcg = ........... cc/jam
0,5 mcg = ........... cc/jam 0,5 mcg = ........... cc/jam

Nicardipine 10 mg Nicardipine 10 mg
Nama Pasien : …................................................. Nama Pasien : …...................................................
No. MR : …................................................. No. MR : …...................................................
BB Pasien : …................................................. BB Pasien : …...................................................

Rumus = Dosis Permintaan (dlm mcg ) X KgBB X 60 menit Rumus = Dosis Permintaan (dlm mcg ) X KgBB X 60 menit
Dosis yang tersedia (mcg/cc) Dosis yang tersedia (mcg/cc)

= …........ X …........ X 60 =…....... cc/jam = …........ X …........ X 60 =…....... cc/jam


200 200

Tabel Dosis Yang Diberikan Tabel Dosis Yang Diberikan


0,05 mcg = ........... cc/jam 0,05 mcg = ........... cc/jam
0,04 mcg = ........... cc/jam 0,04 mcg = ........... cc/jam
0,03 mcg = ........... cc/jam 0,03 mcg = ........... cc/jam
0,02 mcg = ........... cc/jam 0,02 mcg = ........... cc/jam
0,01 mcg = ........... cc/jam 0,01 mcg = ........... cc/jam
0,1 mcg = ........... cc/jam 0,1 mcg = ........... cc/jam
0,2 mcg = ........... cc/jam 0,2 mcg = ........... cc/jam
0,3 mcg = ........... cc/jam 0,3 mcg = ........... cc/jam
0,4 mcg = ........... cc/jam 0,4 mcg = ........... cc/jam
0,5 mcg = ........... cc/jam 0,5 mcg = ........... cc/jam

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