LAMPIRAN KEPALA POLIKLINIK POLRESTA MATARAM

KEPOLISIAN REPUBLIK INDONESIA NOMOR : KEP / /MPLK/VII/ 2022

FKTP POLIKLINIK POLRESTA MATARAM TANGGAL : 2022

DAFTAR NAMA OBAT SESUAI FORMULARIUM

DI FKTP POLIKLINIK POLRESTA MATARAM

NO NAMA OBAT SATUAN

1 2 3
I ANTI INFEKSI SISTEMIK
ANTIBIOTIK, KEMOTERAPIKA
A ANTIBIOTIKA
a. Aminoglikosida & derivat
1 Bioplacenton Gel Tube
2 Gentamycin salep Tube

b. Cepalosporin
3 Cefadroxyl 500mg Kapsul
4 Cefadroxyl Syr (125mg/5ml) Botol
5 Cefixime 100mg Kapsul
6 Cefixim Syr (100mg/5ml) Botol

c. Kloramfenikol
7 Chloramphenicol Botol
8 Thiamphenikol Kapsul

e. Penisillin
12 Amoxicillin 500mg Kaplet
13 Amoxicillin Syr (125mg/5ml) Botol
14 Amoxicillin Drop Botol

f. Tetrasiklin
15 Doksisiklin Kapsul
16 Tetracyclin Kapsul

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 g. Lincomycin
17 Clindamycin 150mg Kapsul
Clindamycin 300mg Kapsul

h. Sulfonamida (Campuran)
18 Cotrimoxazole Tablet
19 Cotrimoxazole Syr Botol

i. Quinolone
20 Ciprofloxacin 500mg Tablet

j. Antibiotika lain-lain
23 Pirantel Pamoat Tablet

k. Fungisida
24 Ketoconazole Tablet
25 Ketoconazole Cream Tube
26 Metronidazole Tablet
27 Metronidazole Syr Botol
29 Kandistatin Syr Botol
31 Miconazole Cream Tube

l. Antiviral
32 Acyclovir 400 MG Tablet
33 Acyclovir Cream Tube

B IMUNOLOGIKUM
35 Curcuma Tablet
37 Multivitamin Tab Tablet
38 Multivitamin Syr Botol

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 40 Vitamin B 1, Vitamin B 6, Vitamin B 12 Tablet
43 Vitamin E Tablet
II KARDIOVASKULER
a. Diuretikum
44 Furosemide Tablet

b. Antimigrain
46 Betahistin Tablet

c.Antivarikosis
47 Sodium Heparin Gel (Hico) Tube

d. Vasodiolator koroner
50 ISDN Tablet

e. Anti Haemorroid
51 Ambeven Kapsul

f. Anti Hipertensi
54 Amlodipin 5mg Tablet
55 Amlodipin 10mg Tablet
56 Captopril Tablet

g. Anti Aritmia
58 Asam Asetil Salisilat (Mini Aspi) Tablet

h. Hemostatikum
59 Asam Traneksamat (Trasamin/Nexa) Tablet
60 Vit K Tablet

i. Anti Anemia

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 63 Sangobion Tablet

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 III DEPRESAN SISTEM SARAF PUSAT
a. Analgetik Antipiretik
65 Asam Mefenamat 500mg Tablet
67 Ibuprofen 400mg Tablet
67 Ibuprofen 200mg Tablet
68 Ibuprofen Syr (100mg/5ml) Botol
69 Meloxicam Tablet
70 Natrium Diklofenak Tablet
71 Parasetamol 500mg Tablet
71 Parasetamol 650mg Tablet
72 Parasetamol Drops Botol
73 Parasetamol Sirup Botol
74 Piroxicam Tablet

b. Antiepilepsi, Antikonvulsi

c. Neuromialgikum
77 Mecobalamin Tablet
78 Glucosamin Tablet
80 Neurobion Tablet
81 Nerobion Injeksi Ampul

d. Antiemetik, vertigo
82 Domperidone Tablet
83 Domperidone Syr Tablet
84 Ondasetron Injeksi Ampul
85 Ondansetron 4 MG Tablet
86 Metoklopramide Tablet

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 e. Antiradang, Antireumatik
87 Allopurinol 100mg Tablet
88 Allopurinol 300mg Tablet
89 Dexametason Injeksi Ampul

90 Methylprednisolone 4mg Tablet

91 Methylprednisolone 8mg Tablet

92 Dexamethason 0,5 MG Tablet

93 Dexamethason 0,75 MG Tablet

g. Anestetika Lokal & General

94 Pehacain 2% Injeksi Ampul
95 Lidokain 2 % Injeksi Ampul
96 Chloretyl spray Botol

IV SALURAN PERNAFASAN
a. Antitusiv, Ekspektoran, Mukolitik
97 Ambroxol Tablet
98 Ambroxol Syr Botol
99 Bromheksin Tablet
100 Bromheksin Syr Botol
101 Gliceryl Guaicolat Tablet
102 OBHC Syr Botol

b. Antiasma
103 Aminophylin Tablet
104 Salbutamol Botol
105 Salbutamol Syr Botol
106 Ventolint Nebulizer Fless

c. Dekongestan
107 Pseudoefedrin+Tripolidin (Alegi) Tablet

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 108 Pseudoefedrin+Tripolidin Syr (Eflin) Botol

d. Anti Influenza
109 Parasetamol+PPA+CTM (Flu-Tab) Tablet
110 Parasetamol+PPA+CTM Syr (tropidril) Botol

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 V SALURAN PENCERNAAN
a. Adsorben, Antasid, Protektan
111 Antasida Tablet
112 Antasida Syr Botol
113 Ranitidin Tablet
114 Ranitidin Injeksi Ampul
115 Omeprazole Kapsul
116 Lansoprazole Kapsul

b. Antidiare
117 Attapulgit (Molagit) Tablet
118 Kaolin, Pectin Syr Botol
119 Oralit Sachet
120 Loperamide HCI 2mg Tablet
121 Zinc Tablet
122 Zinc syr Botol

c. Antispasmodikum
123 Hyoscine Tablet
124 Hyoscine + Paracetamol Kaplet

d. Digestan

e. Laksatif
125 Bisakodil Tablet

VI SALURAN UROGENITAL
a. Oksitosikum

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 VII OBAT METABOLISME
a. Antilipidemikum
126 Simvastatin Tablet
127 Atorvastatin Tablet

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 VIII OBAT SISTEM ENDOKRIN
a. Anti diabetik oral
128 Glibenklamid Tablet
129 Glimepiride 2 MG Tablet
130 Metformin Tablet

b. Kortikoidum
138 Dexametason Tablet
139 Metil Prednisolone Tablet
140 Prednisone Tablet

IX OBAT PENYAKIT KULIT

a. Antiradang, Anti inflamasi
142 Betametason Tube
143 Betametason + Hidrokortison (Armacort) Tube
145 Gentamycin Cream Tube
147 Hidrocortison Cream Tube
149 Kloramfenikol Cream Tube
152 Salep 24 Cream Tube

X OBAT PENYAKIT MATA

a. Anti infeksi, Antiseptik
155 Dexa+Neomycin ED (Alletrol) Botol
156 Dexa+Kloramfenicol ED (Erlamycetin) Botol
160 Kloramfenikol Eye Oint Tube

XI OBAT TELINGA
173 Chloramfenicol Ear Drop Botol
Dexamethasone + Chloramfenicol ED (Erlamycetin
Botol
Tetes Telinga)

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 XII OBAT LAIN-LAIN
a. Anti Alergi dan Obat Anafilaksis
175 Adrenalin Injeksi Ampul
176 Cetirizine Tablet
177 Cetirizine Syr Botol
178 Cetirizine Drop Botol
179 CTM Tablet
180 Dexchlorpeniramin + Dexa (Grafachlor) Tablet
181 Loratadine Tablet
184 Salicyl Talk Botol

b. Relaksan Otot
185 Eperisone Tablet

c. Obat Hormon
d. Larutan Elektrolit, Nutrisi, DLL
188 Aqua bides 500mL Botol
189 Aqua bides 50mL Botol
190 Aquadest 5L Botol
191 Dextrose 5 % Infus Labu
192 H²O² Botol
194 Nacl 0,9 % Infus Labu
195 Ringer Laktat Infus Labu

e. Antiseptik dan Desinfektan

196 Alloclair Gargle Botol
197 Alloclair Cream Tube
198 Alkohol 70% Botol
200 Povidon Iodine 15mL Botol
201 Povidon Iodine 1L Botol
202 Povidon Iodine Cream Tube
203 Rivanol Botol

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