PEMERINTAH KABUPATEN SUMENEP

DINAS KESEHATAN, PENGENDALIAN PENDUDUK DAN KELUARGA BERENCANA

PUSKESMAS RUBARU
Jl. Raya Rubaru No.40 Telp. 082335393745
SUMENEP

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT ( LPLPO )

Ruang : Ponkesdes Matanair
Bulan : JUNI -2023

STOK PENERI PENGELU SISA PERMINT PEMBER

No NAMA OBAT SATUAN TOTAL KET
AWAL MAAN ARAN STOCK AAN IAN

1 Albendazol susp 200 mg/5 ml botol - -

2 Albendazol tab 400 mg tablet - -
3 Allopurinol 300 mg tab - -
6 Aminofilin tab tab - -
7 Aminophilin inj 24 mg / ml ampul - -
9 Amlodipin 10 mg tab - -
10 Amlodipin 5 mg tab - -
11 Amoksisilin 250 mg kapsul - -
12 Amoksisilin 500 mg tablet - - 200
13 Amoksisilin sir ker Forte 250 mg/5 ml botol - -
14 Ampisilin injeksi 1000 mg vial - -
15 Antasida DOEN suspensi tab - -
16 Antasida DOEN tablet kunyah tab - - 200
Antibakteri DOEN salep kulit : Basitrasin 500 IU/g
17 + Polimiksin 10000 IU/g tube - -
18 Antihemoroid doen kombinasi supp - -
19 Aqua Pro injeksi steril bebas pirogen (OTSU - WI) vial - -
20 Asam Askorbat (Vitamin C) tab50 mg tablet - -
21 Asam Folat tab 1 mg tab - -
22 Asam Mefenamat 500 mg tablet - - 300
23 Asam Traneksamat 500 mg tab tab - -
24 Asam Traneksamat inj 50 mg/ml vial - -
25 Asetosal 80 mg (Miniaspi) tab - -
26 Asiklovir 200 mg tablet - -
27 Asiklovir 400 mg tablet - -
28 Asiklovir krim 5 % tube 5 gram - -
29 Atropin inj i.m/i.v/s.k/ 0.25 mg/ml (sulfat) amp - -
30 Attapulgit tab - -
31 Betahistine mesilate 6 mg tab - -
32 Betametason krim 0.1 % 5 gram tube - -
33 Bisakodil tab 5 mg tab - -
34 Bisoprolol 2,5 mg (Concor) tab - -
35 Bisoprolol 5 mg tab - -
Cairan inhalasi Budesonid 0,25mg/mL, respoules 2
36 mL (Pulmicort Respules)
can
- -
Cairan Inhalasi Ipratropium 0,5 mg + Salbutamol
37 2,5 mg / Combivent UDV
vial
- -
Cairan inhalasi Terbutalin / Bricasma Respules 2,5
38 mg/ml
nebules
- -
39 Chlorfeniramina Maleat 4 mg (CTM) tab - -
40 Deksametason injeksi i.v 5 mg / ml ampul - - 30
41 Deksametason tab 0.5 mg tab - - 200
42 Diazepam Enema 10 mg/2,5 ml / Stesolid Enema 10 tube - -
43 Diazepam Enema 5 mg/2,5 ml / Stesolid Enema 5 - -
44 Diazepam injeksi 5 mg / ml amp - -
45 Difenhidramin injeksi 10 mg / ml ampul - -
46 Digoksin tab 0,25 mg tab - -
47 Diklofenak Kalium 50 mg tablet - -
48 Diklofenak Natrium 25 mg tab - -
49 Diklofenak Natrium 50 mg tab - - 200
50 Diltiazem 30mg tab - -
51 Dimenhidrinat tab 50 mg tab - -
52 Domperidon 10 mg tab - -
53 Domperidon susp 5 mg / 5 ml botol - -
54 Dopamin inj 40 mg/ml amp - -
55 Dulcolax supp adult 10 mg supp - -
56 Dulcolax supp infant 5 mg supp - -
57 Epinefrin / Adrenalin inj 0.1 ml (sebagai Hcl) amp - -
58 Ergotamin 1mg + kafein 50 mg tab - -
59 Eritromisin 250 mg kapsul - -
60 Eritromisin 500 mg tablet - -
61 Eritromisin syr kering 200 mg/5 ml botol - -
62 Etil Klorida Spray via/can/100ml - -
63 Fenitoin inj 50 mg/ml amp - -
64 Fenobarbital tab 30 mg tab - -
65 Fenofibrat kaps 300 mg kap - -
66 Fenol Gliserol tetes telinga 10 % btl - -
67 Fitomenadion (vitamin K1) inj 2 mg/ml amp - -
68 Fitomenadion tab salut gula10 mg (Vit. K1) tab - -
69 Furamin inj (Vit. B1 + Fursultiamin 2,5 mg/ml) ampul - -
70 Furosemide injeksi 10 mg/ml amp - -
71 Furosemide tab 40 mg tab - -
72 Garam Oralit sachet - -
73 Gemfibrozil 300 mg kapsul - -
74 Gentamicin sulfat tetes mata 0,3 % botol - -
75 Gentamisin sulfat salep mata tube 3,5 gr - -
76 Glibenklamid tab 5 mg tablet - -
77 Glimepiride 1 mg tab - -
78 Glimepiride 2 mg tablet - - 100
79 Glipizid tablet 5 mg(GLUCOTROL XL) tablet - -
 STOK PENERI PENGELU SISA PERMINT PEMBER
No NAMA OBAT SATUAN TOTAL KET
AWAL MAAN ARAN STOCK AAN IAN

80 Gliseril Guaiakolat 100 mg tablet - -

81 Griseofulvin tab 125 mg tablet - -
82 Haloperidol 1,5 mg tab - -
83 Hidroklortiazida tab 25 mg tab - -
84 Hidrokortison krim 2.5 % tube - -
85 Hiosin Butilbromid tab tablet - -
86 Human Tetanus Imunoglobulin i.m 250 IU prefilled
(Tetagam) syringe - -
87 Ibuprofen 400 mg tab tab - - 200
88 Ibuprofen suspensi 100 mg / ml btl 60 ml - -
89 Insulin analog fast acting inj 100 IU/mL, penfill ca pen - -
90 Insulin analog intermediate acting combine with shor pen - -
91 Insulin human fast acting inj 100 IU/mL, vial 10 mL vial - -
92 Isosorbid Dinitrat sublingual 5 mg (ISDN) tab - -
93 Kalsium Glukonas inj 10% amp - -
94 Kalsium Laktat tab 500 mg tab - -
95 Kaptopril 25 mg tab - - 300
96 Karbamazepin tab 200 mg tab - -
97 Ketoconazole krim 2 % tube 15 gr - -
98 Ketokonazole tab 200 mg tab - -
99 Klindamisin 150 mg kap - -
100 Klindamisin 300 mg kapsul tab - -
101 Kloramfenicol 250 mg kapsul kap - -
102 Kloramfenicol Salep Mata 1 % tube - -
103 Kloramfenicol suspensi 125 mg/5 ml btl 60 ml - -
104 Kloramfenicol Tetes Mata 0.5 % btl 5 ml - -
105 Kloramfenicol tetes telinga 3 % 5 ml botol - -
106 Kloramfenikol Salep Kulit 2% tube - -
107 Klorfeniramin Maleat (CTM) tablet - -
108 Klozapin 25 mg tab - -
109 Kodein 10 mg tablet - -
110 Kodein 15 mg tab - -
111 Kodein 20 mg tab - -
112 Kolkisin tab - -
113 Kotrimoksasol suspensi kombinasi suffametoksasol botol - -
114 Kotrimoksasol tab 480 mg tab - -
115 Kotrimoksazol Forte 960 mg tab - -
116 Laktulosa sir. 3,3335 gr/5 ml botol - -
117 Larutan infus Asering / WIDA BES softbag - -
118 Larutan Infus Asering 5 botol 500 ml - -
119 Larutan infus D10 / Glukosa 10% btl 500 ml - -
120 Larutan infus D40 /Glukosa 40 % ampul - -
121 Larutan Infus D5 - ¼ NS botol - -
122 Larutan Infus D5 - ½ NS botol - -
123 Larutan Infus D5 - NS botol - -
124 Larutan infus D5 / Glukosa 5% btl 500 ml - -
125 Larutan infus Ka En 1B botol - -
126 Larutan infus Ka En 3A btl / 500 ml - -
127 Larutan infus Ka En 3B botol - -
128 Larutan infus Ka En Mg3 softbag - -
129 Larutan Infus Natrium Klorida 0.9 % btl 500 ml - -
130 Larutan Infus Ringer D5 / WIDA RD botol - -
131 Larutan infus Ringer Laktat btl 500 ml - -
132 Lidokain inj 2% amp - - 30

133 Lidokain injeksi 2 % (Hcl+epinefrin) 1 : 80.000 - 2 vial

ml - -
134 Lidokain jel 2% (Xylocain JELLY 2%) syringe - -
135 Lidokain spray oral 10% (Xylocain SPRAY) botol - -
136 Loratadin 10 mg tab - -
137 Lorazepam 0,5 mg tab - -
138 Magnesium Sulfat inj 20 % - 25 ml vial - -
139 Magnesium Sulfat inj 40 % - 25 ml vial - -
140 Metamizol inj amp - - 100
141 Metampiron tablet 500 mg tab - -
142 Metformin 850 mg tablet - -
143 Metildopa tab 250 mg / Dopamet tab - -
144 Metilergometrin Maleat inj 0.200 mg-1 ml amp - -
145 Metilergometrin Maleat tab salut 0,125 mg tablet - -
146 Metilprednisolon 4 mg tab - -
147 Metoklopramid 10 mg tab - -
148 Metoklopramide inj 5 mg/ml ampul - -
149 Metronidasol infus 500 mg / 100ml botol - -
150 Metronidasole tab 250 mg tab - -
151 Metronidasole tab 500 mg tab - -
152 Metronidazol susp 125 mg/5 ml botol - -
153 N-asetil sistein tab - -
154 Nistatin tablet salut 500.000 IU/g tab - -
155 Nistatin suspensi 100.000 IU/mL - -
156 Nistatin vaginal tablet 100.000 IU/g tab - -
157 Oksigen 1 m ³ tabung - -
158 Oksigen 6 m ³ tabung - -
159 Oksitosin injeksi 10 IU/ml - 1 ml amp - -
160 Omeprazol serb inj 40 mg vial - -
161 Omeprazole 20 mg kap - - 100
162 Ondansetron injeksi 4 mg/2 ml ampul - -
163 Oxymetazolin tts hidung 0,025% (Iliadin) botol - -
164 Oxymetazolin tts hidung 0,05% (Iliadin) botol - -
165 Parasetamol 1000 mg/100 ml infus btl 100 ml - -
166 Parasetamol srp 125 mg/ 5 ml botol - -
167 Parasetamol tab 500 mg tab - - 400
168 Permetrin krim 5% (Scabimite) tube - -
169 Piridoksin (Vitamin B6) tab 10 mg (Hcl) tab - -
170 Prednison 5 mg tablet - - 200
 STOK PENERI PENGELU SISA PERMINT PEMBER
No NAMA OBAT SATUAN TOTAL KET
AWAL MAAN ARAN STOCK AAN IAN

171 Propanolol 10 mg tab - -

172 Propiltiourasil 100 mg tab tab - -
173 Ranitidin inj 25 mg/ml amp - -
174 Risperidon 2 mg tab - -
175 Risperidone 1 mg tab - -
176 Salbutamol 4 mg tab - -
177 Salep 2-4 kombinasi asam salisilat 2 % belerang en pot - -
178 Salisil Bedak 2% box 50 gr - -
179 Sefadroksil 500 mg kap - -
180 Sefadroksil syrup kering 125 mg / 5 ml botol - -
181 Sefadroksil syrup kering 250 mg / 5 ml botol - -
182 Sefotaksim injeksi 1 gram vial - -
183 Seftriakson injeksi ampul - -
184 Serum Anti Bisa Ular / SABU vial 5 ml - -
185 Serum Anti Tetanus /ATS 1500 IU ampul 1 ml - -
186 Sianokobalamin inj 500 mcg/ml amp - - 60
187 Sianokobalamin tablet 50 mcg tab - -
188 Simvastatin 10 mg tablet - -
189 Simvastatin 20 mg tab - - 100
190 Siprofloksasin 500 mg tab tab - -
191 Spironolakton 25 mg tab tablet - -
192 Sulfadiazin Silver Krim 1% tube 35 gr - -
193 Terbutalin inj 0,5 mg/ml (Bricasma inj sk/iv 0,5 mg/ml amp - -
194 Thiamin Hcl tab 50 mg tab - -
195 Tiamazol 5 mg (THYROZOL 5) tablet - -
196 Topiramat 25 mg (Topamax) tab - -
197 Triheksifenidil tablet 2 mg tab - -
198 Vitamin B Kompleks tablet - - 400
199 Zinc elemental 10 mg/ml (Zincpro drops) botol - -
200 Zinc tab dispersible 20 mg tab - -

BMHP
1 Alkohol 70 % 1 liter BOTOL - -
2 Alkohol 70 persen 100 ml BOTOL - -
3 Alkohol Swab box isi 100 - -
Antiseptik Sabun tangan/Onescrub 2% 500 ml +
4 Dispenser
botol
- -
Antiseptik tangan tanpa bilas /Alkohol Perokside
5 500 ml
BOTOL
- -
6 Apron 75 x 130/025 lembar - -
7 Benang Catgut Plain 2/0 + jarum pcs - -
8 Benang Catgut Plain 3/0 tanpa jarum pcs - -
9 Benang Catgut Plain 3/0+jarum pcs - -
10 Benang Catgut Chromic 2/0+jarum pcs - -
11 Benang Catgut Chromic 3/0+jarum pcs - -
12 Benang Silk 3/0+jarum pcs - -
13 Blood transfusion set pcs - -
14 Dental Needle 30 G x 13 mm box isi 30 box isi 30 - -
15 Dental Needle 30 G x 21 mm box isi 30 box isi 30 - -
16 Foley Catheter (16 fr) pcs - -
17 Foley Catheter (18 fr) pcs - -
18 Gantungan Handwash / Bracket Hand Wash Plastik pcs
- -
19 Hidrogen Peroxide 3% botol 100ml BOTOL - -
20 Infusion set anak pcs - -
21 Infusion set dewasa pcs - -
22 Infusion Set type Y Dewasa pcs - -
23 Infusion Type Y Anak pcs - -
24 IV catheter 18 G port side pcs - -
25 IV Catheter 18G pcs - -
26 IV catheter 20 G port side pcs - -
27 IV Catheter 20G pcs - -
28 IV catheter 22 G port side pcs - -
29 IV Catheter 22G pcs - -
30 IV catheter 24 G port side pcs - -
31 IV Catheter 24G pcs - -
32 IV catheter 26 G pcs - -
33 IV catheter 26 G port side pcs - -
34 Kapas Pembalut 250 gram bungkus - -
35 Kasa Kompres Steril 16 x 16cm box isi - -
36 Kasa Kompres Steril 40cm x 40cm box isi - -
37 Kasa Pembalut Hidrofil 40y x 80cm rol - -
38 Kasa Pembalut Hidrofil 4y x 10cm rol - -
39 Kasa Pembalut Hidrofil 4y x 3cm rol - -
40 Kasa Pembalut Hidrofil 4y x 5cm rol - -
41 Lancet, Ukuran 28 G box isi 100 - -
42 Masker box isi 50 - -
43 Masker Nebulizer Adult pcs - -
44 Masker Nebulizer Pediatric pcs - -
45 Masker Oxygen Adult pcs - -
46 Masker Oxygen Pediatric pcs - -
47 Mucus Extractor pcs - -
48 Nasal Oxygen Canula Adult pcs - -
49 Nasal Oxygen Canula Child pcs - -
50 Plester Dermafix (10 x 20cm) pcs - -
51 Plester Dermafix (10 x 25cm) pcs - -
52 Plester Non Woven 5 x 10 cm pcs - -
53 Plester Paper tape 2,5 x 9,14 pcs - -
54 Plester Surgical tape pcs - -
55 Pot Sputum pcs - -
56 POVIDONE IODINE LARUTAN 10% 300 ml BOTOL - -
57 Sarung Tangan Examination size L pcs - -
58 Sarung Tangan Examination Size M pcs - -
59 Sarung Tangan Obgyn pasang - -
 STOK PENERI PENGELU SISA PERMINT PEMBER
No NAMA OBAT SATUAN TOTAL KET
AWAL MAAN ARAN STOCK AAN IAN

60 Sarung tangan steril no. 7 pasang - -

61 Sarung tangan steril no. 7,5 pasang - -
62 Sarung tangan steril no.8 pasang - -
63 Spuit /Alat Suntik 1ml pcs - -
64 Spuit 20 ml tanpa jarum pcs - -
65 Spuit/Alat Suntik 3 ml pcs - -
66 Spuit/Alat Suntik 5 ml pcs - -
67 Steril Pouch With Indicator 9 x26cm pcs - -
68 Stomach Tube 16FR 125 cm pcs - -
69 Stomach Tube 18FR 125 cm pcs - -
70 Underpad pcs - -
71 Urine bag 2L pcs - -
72 Wing needle 21 G pcs - -
73 Wing needle 23 G pcs - -

Sumenep, 2023
an. Penanggung Jawab UKP Petugas Gudang Farmasi Penanggung Jawab

dr. Riza Wulandari H. Apt. Moh. Syarif Hidayatullah K., S. Farm Yasid Anovali Amd. Kep
NIP. 19870423 201407 2 001 NITK. 3529 219811 2010 056

Mengetahui
Kepala Puskesmas Rubaru

Desy Febryana, S.ST., M. Mkes

NIP. 19840214 200801 2 008