FORM OBSERVASI DI PUSAT PELAYANAN OBAT BAGIAN FARMASI PUSKESMAS IMOGIRI 2

NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32

NAMA OBAT Acyclovir Allupurinol Ambroxol Aminofilina Amitriptilina Amoksilina Amoksilina Amoksilina Antasida Levodopa+Carbidopa Asam askorbat Asam mefenamat Asetosal Asetosal Attapulgit Bisakodil Bromhexin Captopril Cemitidine Ciprofloxacin Clobazam Clonidine Deksametason Dekstromethorban Dekstromethorban Diazepam Digoksina Diltiazem Dimenhidrinat Efedrina HCL Ekstrak Belladona Ergotamine+kofeina

BENTUK SEDIAAN Tablet 400 mg Tablet 100 mg Tablet 30 mg Tablet 200 mg Tablet salut 25 mg Kaplet 500 mg Kapsul 250 mg Syrup 125 mg/5 ml Tablet Tablet Tablet 50 mg Kaplet 500 mg Tablet 100 mg Tablet 500 mg Tablet 600 mg Tablet 5 mg Tablet Tablet 25 mg Tablet 200 mg Tablet 500 mg Tablet 10 mg Tablet 0,15 mg Tablet 0,15 mg Syrup 10 mg/ml Tablet 15 mg Tablet 2 mg Tablet 0,25 mg Tablet Tablet 50 mg Tablet 25 mg Tablet 10 mg Tablet kombinasi

DOSIS FUNGSI (GOLONGAN OBAT) Antivirus Antigout, menurunkan asam urat Mukokinetik & Sekretolitik Bronkodilator, anti asma Antidepresi Antibiotik Antibiotik Antibiotik Antiulkus, menetralkan asam lambung Antiparkinson Vitamin C Analgesik Anti agregasi platelet Anti agregasi, analgesik Anti diare Pencahar Mukolitik Anti hipertensi 2 Blocker Antibiotik Anti anxietas Anti hipertensi Anti inflamasi, Kortiko Antitusif Antitusif Anti anxietas Inutropik, memacu kontraksi jantung Anti hipertensi Anti emetik Nasal dekongestan Anti spasme, kejang perut Migrain
(ANAK DAN DEWASA)

5 x 800 S.prn S 3 dd tab I S.prn

S.prn S 1 dd tab I

S 3 dd tab I S 3 dd tab I S 2 dd tab I S 1 dd tab I S.prn

33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75

Erytromycin Fenobarbital Fitomenadion Furosemida Garam oralit Gemfibrozil Glibenklamid Gliseril guayacolat Griseofulvin Haloperidol Haloperidol Haloperidol Hidroklortiazida Ibuprofen Ibuprofen Isoniazid Isosorbid dinitrat Kalsium laktat Karbamazepin KCL Ketokonazol Kloramfenikol Klorfeniramine maleat (CTM) Klorpromazina HCL Klorpromazina HCL Kotrimoksazol Kotrimoksazol Kotrimoksazol Loperamide Mebendazol Mebendazol Metformin HCL Metilergometrina maleat Metoklopramida Metronidazol Metronidazol Natrium Bikarbonat Natrium diklofenak Natrium diklofenak Natrium fenitoin Natrium fenitoin Nifedipin Nistatin

Kapsul 500 mg Tablet 100 mg Tablet salut 10 mg Tablet 40 mg Sachet Kapsul 300 mg Tablet 5 mg Tablet 100 mg Tablet 125 mg Tablet 0,5 mg Tablet 1,5 mg Tablet 5 mg Tablet 25 mg Tablet 200 mg Tabet 400 mg Tablet 300 mg Tab sublingual 5 mg Tablet 500 mg Tablet 200 mg Tablet 600 mg Tablet 200 mg Kapsul 250 mg Tablet 4 mg Tablet salut 100 mg Tablet salut 25 mg Suspensi Tablet 480 mg Tablet ped Tablet 2 mg Syr 100 mg/5 ml Tablet 100 mg Tablet 500 mg Tablet salut 0,125 mg Tablet 10 mg Tablet 250 mg Tablet 500 mg Tablet 500 mg Tablet 25 mg Tablet 50 mg Kapsul 30 mg Kapsul 100 mg Tablet 10 mg Tablet vagina

Antibiotik Antikonvulsi Vitamin K, koagulan Diuretik Rehidrasi Dislipidemia Hipoglikemik, antidiabet Ekspektoran Antifungi Anti psikotik Anti psikotik Anti psikotik Diuretik Analgesik,Antipiretik Analgesik Anti TBC Vasodilator Suplemen Anti epilepsi Suplemen kalium Anti fungal Antibiotik Anti histamin Anti psikotik Anti psikotik Antibiotik Antibiotik Antibiotik Anti diare Antelmetika Antelmetika Anti diabetes Uterotonik Anti emetik Anti parasit Anti parasit Keracunan makanan Analgesik, Anti inflamasi Analgesik, Anti inflamasi Anti epilepsi Anti epilepsi Anti hipertensi Anti fungal

So8h S.prn S.prn S 1 dd tab I

kombinasi

So6h

S o 12 h S o 12 h S o 12 h

76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98

Nistatin OBH Parasetamol Parasetamol Parasetamol Pirantel pamoat Piroksikam Prednison Propanolol Propiltiourasil Pirazinamida Ranitidine Retinol Retinol Salbutamol Salbutamol Sianocobalamin Simvastatin Sonchii/Nephrolit /calcusol Thiamina monohidrat Trihexylphenidil Vitamin B komplek Zinc OBAT LUAR Acyclovir 5 % Antihemmoroid Asam salisilat Bacitracinpolymyxin B Hydrocortison 2,5 % Kloramfenikol 0,5 % Kloramfenikol 1 % Miconazole 2 % Phenol glycerol 10 % Sulfacetamide 15 %

100.000 iu/g Tablet salut gula 500.000 IU Syrup Tablet 100 mg Syrup 120 mg/5 ml Tablet 500 mg Tablet 125 mg Tablet 20 mg Tablet 5 mg Tablet 40 mg Tablet 100 mg Tablet Tablet 150 mg Kapsul Kapsul Tablet 2 mg Tablet 4 mg Tablet Tablet 10 mg Kapsul Tablet 50 mg Tablet 2 mg Tablet Tablet

Anti fungal

Antipiretik Antipiretik Antipiretik Anti helmintes Analgesik Anti inflamasi, kortiko Anti hipertensi Anti tiroid Anti ulkus Vitamin A Vitamin A Bronkodilator Bronkodilator Vitamin B 12 Menurunkan kolesterol Menghancurkan batu saluran kencing Vitamin B 1 Anti parkinson Suplemen Suplemen

1 2 3 4 5 6 7 8 9 10

Cream 50 mg Suppositoria Cream 20 mg Salep kulit Cream 28 mg Tetes mata 5 ML Salep mata 10 mg Cream Tetes telinga 5 ml Tetes mata 5 ml

Anti virus Anti hemoroid Antiseptik, Anti fungal Antiinflamasi Antihistamin, Anti inflamasi Antibiotik Antibiotik Anti fungal Bakteriostatik

S o 4 h ue S 1 dd supp I S 4 dd ue S o 4 h ue S 3 dd ue

S 2 dd ue S 4 dd gtt II