1.

JUMLAH KEBUTUHAN ADALAH JUMLAH KEBUTUHAN SELAMA SATU TAHUN PADA TAHUN 2014 DALAM SATUAN TERKECIL SEPERTI : TABLET / KAPSUL / KAPLET /
AMPUL / VIAL / TUBE / SACCHET
2. SATUAN KERJA ADALAH DINAS KESEHATAN PROPINSI / KABUPATEN/KOTA / RSUD / RSUP / RSTNI / RSPOLRI
3. SURAT PENGANTAR DAN LAMPIRAN HARUS DI TANDATANGANI OLEH KEPALA SATUAN KERJA
4. FORMAT RKO JANGAN DITAMBAH/DIKURANG ITEM OBATNYA (JANGAN DILAKUKAN PENAMBAHAN BARIS MAUPUN KOLOM)
5. UNTUK OBAT TAMBAHAN DIMASUKKAN DALAM DAFTAR KEBUTUHAN OBAT LAINNYA

RENCANA KEBUTUHAN OBAT TAHUN 2014

SATUAN KERJA : RSUD TELUK KUANTAN

NO NAMA OBAT SATUAN

1 ACT (Artesunate tablet 50 mg + Amodiaquine anhydrida tablet 200 mg) tablet

2 Air untuk injeksi 20 ml botol
3 Albendazol suspensi 200 mg/5 ml botol
4 Albendazol tablet 400 mg tablet
5 Alopurinol tablet 100 mg tablet
6 Alopurinol tablet 300 mg tablet
7 Alprazolam tablet 0,25 mg tablet
8 Alprazolam tablet 0,5 mg tablet
9 Alprazolam tablet 1 mg tablet
10 Ambroxol sirup 15 mg/ml botol
11 Ambroxol tablet 30 mg tablet
12 Amfoterisin B injeksi i.v. 50 mg/10 ml ampul
13 Amfoterisin salep mata 3% tube
14 Amilorida tablet 5 mg (HCl) tablet
15 Amilorid tablet 5 mg tablet
16 Aminodaron tablet 200 mg tablet
17 Aminodaron injeksi 150 mg/ 3 ml vial
18 Aminofilin injeksi 24 mg/ml ampul
19 Aminofilin tablet 150 mg tablet
20 Aminofilin tablet scored 200 mg tablet
21 Amitriptilin tablet salut 25 mg (HCl) tablet salut
22 Amlodipin tablet 10 mg tablet
23 Amlodipin tablet 5 mg tablet
24 Amoksisilin + As. Klavulanat 625 mg tablet tablet
25 Amoksisilin kapsul/kaplet/tablet scored 500 mg kaplet
26 Amoksisilin kapsul/kaplet 250 mg kapsul
27 Amoksisilin serbuk injeksi 1000 mg vial
28 Amoksisilin sirup kering 125 mg/ 5 ml botol
29 Ampisilin serbuk injeksi i.v. 1000 mg/vial vial
30 Ampisilin serbuk injeksi i.m./i.v. 250 mg/vial vial
31 Ampisilin serbuk injeksi i.m./i.v. 500 mg/vial vial
Anestetik lokal gigi DOEN Injeksi, komposisi :
lidokain HCL 2% vial
32 epinefrin 1 : 80.000

Antasida DOEN I tablet kunyah, kombinasi :

Aluminium Hidroksida 200 mg tablet kunyah
33 Magnesium Hidroksida 200 mg

Antasida DOEN II suspensi, kombinasi :

Aluminium Hidroksida 200 mg/5 ml botol
34 Magnesium Hidroksida 200 mg/5 ml

Anti Bakteri DOEN salep kombinasi:

Basitrasin 500 IU/g tube
35 Polimiksin 10.000 IU/g

36 Articulating paper kertas warna penanda oklusi kotak

Antifungi DOEN Salep, Kombinasi:
Asam Benzoat 6% pot
37 Asam Salisilat 3%

Antihemoroid DOEN kombinasi : Bismut subgalat 150 mg Heksaklorofen 2,5 mg suppositoria

38
Antibakteri Salep DOEN, kombinasi :
basitrasin 500 UI/g pot
39 polimiksin B 10.000 UI/g

Antihemoroid suppositoria DOEN , kombinasi :

bismut subgalat 150 mg
heksaklorofen 2,5 mg
suppositoria
lidokain 10 mg
seng oksida 120 mg
sup ad 2 g
40
Antimalaria kombinasi (kombipak) :
Artesunat tablet 50 mg tablet
41 Amodiakuin tablet 200 mg

Antimalaria DOEN kombinasi :

Pirimetamin 25 mg tablet
42 Sulfadoksin 500 mg

43 Antimigren: Ergotamin Tartrat 1 mg + Kofein 50 mg tablet

44 Antiparkinson DOEN tablet kombinasi : Benserazid 25 mg Levodopa 100 mg tablet
45 Antiparkinson DOEN tablet kombinasi : Karbidopa 25 mg Levodopa 250 mg tablet
46 Artemether injeksi 80 mg/ml ampul
47 Artesunate injeksi i.v./i.m. 60 mg/ml vial
48 Asam Asetilsalisilat tablet 100 mg (Asetosal) tablet
49 Asam Asetilsalisilat (asetosal) tablet 80 mg tablet
50 Asam Asetilsalisilat tablet 500 mg (Asetosal) tablet
51 Asam Askorbat (Vitamin C) tablet 250 mg tablet
52 Asam Askorbat (Vitamin C) tablet 100 mg tablet
53 Asam Askorbat (Vitamin C) tablet 50 mg tablet
54 Asam Folat tablet 0,5 mg tablet
55 Asam Folat tablet 1 mg tablet
56 Asam Folat tablet 5 mg tablet
57 Asam Mefenamat kapsul/kaplet 500 mg kaplet
58 Asam Mefenamat kapsul/kaplet 250 mg kapsul
59 Asam retinoat krim 0,05% pot
60 Asam salisilat salep 5% tube
61 Asetazolamid tablet 250 mg tablet
62 Asetazolamid serbuk injeksi i.m/i.v. 500 mg/vial vial
63 Asiklovir krim 5% tube
64 Asiklovir tablet 200 mg tablet
65 Asiklovir tablet 400 mg tablet
66 Asparaginase serbuk injeksi 10.000 UI/vial vial
67 Atapulgit tablet tablet
68 Atenolol tablet 100 mg tablet
69 Atenolol tablet 50 mg tablet
70 Atropin injeksi i.v./i.m./s.k. 0,25 mg/ml ampul
71 Atrakurium injeksi 25 mg/2,5 ml vial
72 Atropin tetes mata 1% botol
73 Atropin Sulfat tetes mata 0,5% botol
74 Atropin Sulfat tablet 0,5 mg tablet
75 Azatioprin tablet 50 mg tablet
76 Barium Sulfat serbuk botol
77 Barium Sulfat suspensi 2,2% botol
78 Barium Sulfat suspensi 55% botol
79 Barium Sulfat suspensi 65% botol
80 Bedak salisil serbuk 2% sachet
81 Benzatin Benzil Penisilin 1,2 juta IU/ vial vial
82 Benzatin Benzil Penisilin 2,4 juta IU/vial vial
83 Besi (II) Sulfat 200 mg + Asam Folat 0,25 mg tablet (tablet tambah darah kombinasi ) tablet
84 Besi (II) sulfat 7 H2O tablet salut 300 mg tablet salut
85 Besi (II) sulfat 7 H2O sirup 150 mg/5 ml botol
86 Betahistin Mesilat tablet 6 mg tablet
87 Betametason krim 0,1% (sebagai Valerat) tube
88 Betametason salep 0,1% tube
89 Betametason tetes mata 1 mg/ml botol
90 Betametason tablet 0,5 mg tablet
91 Bisoprolol tablet 5 mg tablet
92 Bisakodil suppositoria 5 mg suppositoria
93 Bleomisin serbuk injeksi 15 mg/ampul ampul
94 Bromheksin tablet 8 mg tablet
95 Budesonid inhalasi/nebulizer 100 mcg/dosis inhaler
96 Budesonid inhalasi/nebulizer 200 mcg/dosis inhaler
97 Budesonid inhalasi/nebulizer 200 mcg/dosis ampul
98 Bupivakain injeksi 0,50% (HCl) + glukosa 8% ampul
99 Busulfan tablet salut 2 mg tablet
100 Cetirizin sirup 5 mg/5 ml botol
101 Cetirizine tablet 10 mg tablet
102 Cisapride tablet 10 mg tablet
103 Cisapride tablet 5 mg tablet
104 Clobazam tablet 10 mg tablet
105 Clobetasol krim 0,05% tube
106 Copper T set/buah set
107 Coal tar larutan 5% botol
108 Dakarbazin serbuk injeksi 100 mg/vial vial
109 Daktinomisin injeksi i.v. 0,5 mg/vial vial
110 Darrow glukosa ana (DG ana) larutan infus botol
111 Darrow glukosa half strength larutan infus botol
112 Dapson tablet 100 mg botol
113 Daunorubisin serbuk injeksi 20 mg/vial vial
114 Deferoksamin Mesilat serbuk injeksi 500 mg vial
115 Deksametason injeksi i.v./i.m. 5 mg/ml ampul
116 Deksametason tablet 0,75 mg tablet
117 Deksametason tablet 0,5 mg tablet
118 Dekstran 70 - larutan infus 6% steril botol
119 Dekstrometorfan sirup 10 mg/5 ml (HBr) botol
120 Dekstrometorfan tablet 15 mg (HBr) tablet
121 Dekstrosa larutan infus 5% botol
122 Desmopresin tablet 0,1 mg tablet
123 Desmopresin tablet 0,2 mg tablet
124 Diazepam injeksi i.v./i.m 5 mg/ml ampul
125 Dialisa peritoneal larutan infus botol
126 Diazepam larutan rektal 5 mg/2,5 ml botol
127 Diazepam larutan rektal 10 mg/2,5 ml botol
128 Diazepam tablet 2 mg tablet
129 Diazepam tablet 5 mg tablet
130 Dietilkarbamazin tablet scored 100 mg tablet
131 Difenhidramin injeksi i.v./i.m. 10 mg/ml (HCl) ampul
132 Digoksin tablet 0,25 mg tablet
133 Digoksin tablet 0,0625 mg tablet
134 Digoksin tablet 0,1 mg tablet
135 Digoksin injeksi 0,25 mg/ml vial
136 Dikloksasilin kapsul/kaplet 125 mg kapsul
137 Dikloksasilin kapsul/kaplet 250 mg kapsul
138 Dikloksasilin kapsul/kaplet 500 mg kapsul
139 Diloksanid tablet 500 mg tablet
140 Diltiazem HCl tablet 30 mg tablet
141 Dimenhidrinat tablet 50 mg tablet
142 Disopiramid kapsul/kaplet 100 mg kapsul
143 Doksisiklin kapsul/kaplet 100 mg kapsul
144 Dobutamin injeksi 25 mg/ml vial
145 Doksorubisin serbuk injeksi i.v. 10 mg/vial vial
146 Doksorubisin serbuk injeksi i.v. 50 mg/vial vial
147 Dopamin injeksi 40 mg/ml ampul
148 Domperidon suspensi/sirup 5 mg/5 ml botol
149 Domperidon tablet 10 mg tablet
150 Dosetaksel injeksi 20 mg/0,5 ml ampul
151 Dosetaksel injeksi 80 mg/2 ml ampul
152 Efavirens tablet 200 mg tablet
153 Efavirens tablet 600 mg tablet
154 Efedrin tablet 25 mg (HCl) tablet
155 Efedrin injeksi 50 mg/ml ampul
156 Ekstraks Belladona tablet 10 mg tablet
157 Epinefrin (Adrenalin) injeksi i.v/s.k./i.m 0,1% ampul
158 Eritromisin kapsul/kaplet 500 mg tablet
159 Eritromisin kapsul/kaplet 250 mg kapsul
160 Ergokalsiferol (vitamin D3) kapsul 50.000 UI kapsul
161 Ergokalsiferol (vitamin D3) suspensi 10.000 UI/ml botol
162 Eritromisin sirup kering 200 mg/ 5 ml botol
163 Estrogen terkonjugasi tablet 0,625 mg tablet
164 Etanol 70% cairan botol
165 Etakridin larutan 0,1% botol
166 Etambutol tablet 250 mg (HCl) tablet
167 Etambutol tablet salut 500 mg (HCl) tablet salut
168 Etinilestradiol tablet 0,05 mg tablet
169 Etinilestradiol tablet 0,5 mg tablet
170 Etil Klorida semprot botol
171 Etil Klorida semprot 0,05-0,2 ml botol
172 Etoposid injeksi 20 mg/ml ampul
173 Eugenol cairan botol
174 Etoposid kapsul/kaplet 100 mg kapsul
175 Faktor VIII (konsentrat) serbuk injeksi 250UI/vial + pelarut 10 ml vial
176 Faktor IX kompleks serbuk injeksi 1000 UI/vial + pelarut 25 ml vial
177 Faktor IX kompleks serbuk injeksi 500 UI/vial + pelarut 10 ml vial
178 Famotidine tablet 40 mg tablet
179 Famotidine tablet 20 mg tablet
180 Fenilbutason tablet 200 mg tablet
181 Fenitoin kapsul/kaplet 100 mg kapsul
182 Fenitoin injeksi 50 mg/ml ampul
183 Fenitoin kapsul/kaplet 30 mg kapsul
184 Fenobarbital injeksi i.m./i.v. 50 mg/ml ampul
185 Fenobarbital injeksi i.v. 100 mg/ml ampul
186 Fenobarbital tablet 30 mg tablet
187 Fenobarbital tablet 100 mg tablet
188 Fenoksimetil Penisilin tablet 250 mg tablet
189 Fenoksimetil Penisilin tablet 500 mg tablet
190 Fenoksimetil Penisilin sirup kering 250 mg/5 ml botol
191 Fenol Gliserol tetes telinga 10% botol
192 Fentanil injeksi i.m/i.v 0,05 mg/ml ampul
193 Fitomenadion (Vit.K1) tablet salut gula 10 mg tablet
194 Fitomenadion (Vitamin K1) injeksi 10 mg/ml ampul
195 Fitomenadion (Vitamin K1) injeksi i.m. 2 mg/ml ampul
196 Flufenazin tablet 2,5 mg tablet
197 Flufenazin injeksi i.m. 25 mg/ml vial
198 Flukonazol injeksi 2 mg/ml ampul
199 Fluoksetin tablet 10 mg tablet
200 Fluoksetin tablet 20 mg tablet
201 Fluoresein tetes mata 2,5 mg/ml botol
202 Fluoresein injeksi 10 % ampul
203 Flukonazol kapsul 50 mg kapsul
204 Formokresol cairan botol
205 Flukonazol tablet/kapsul 150 mg tablet
206 Fluoride tablet 0,5 mg tablet
207 Fluoride tablet 1 mg tablet
208 Fluor kaplet 1 mg kaplet
209 Fluor sedian topikal tube
210 Fluorourasil injeksi i.v. 50 mg/ml ampul
211 Fluorourasil serbuk injeksi 250 mg vial
212 Furosemid injeksi i.v./i.m. 10 mg/ml ampul
213 Furosemid tablet 40 mg tablet
214 Gadodiamid injeksi 287 mg/10 ml vial
215 Gameksan lotion 1 % botol

Garam Oralit I serbuk, kombinasi :

Natrium klorida 0,52 g
kalium klorida 0,30 g
Trinatrium sitrat dihidrat 0,58 g
216 Glukosa Anhidrat 2,70 g sachet
217 Gemfibrozil kapsul/kaplet 300 mg kapsul
218 Gemfibrozil tablet 600 mg tablet
219 Gentamisin injeksi 10 mg/ ml ampul
220 Gentamisin injeksi 40 mg/ ml ampul
221 Gentamisin injeksi 40 mg/ml vial
222 Gentamisin salep mata 0,3% tube
223 Gentamisin tetes mata 0,3% botol
224 Gentamisin salep kulit 0.1% tube
225 Gentian Violet larutan 1 % botol
226 Glass ionomer ART (Atraumatic Restorative Treatment) serbuk sachet
227 Glass ionomer ART (Atraumatic Restorative Treatment) larutan botol
228 Glass ionomer ART (Atraumatic Restorative Treatment) cocoa butter 5 g sachet
229 Glibenklamida 2,5 mg tablet
230 Glibenklamida tablet 5 mg tablet
231 Glimepiride tablet 1 mg tablet
232 Glimepiride tablet 2 mg tablet
233 Glimepiride tablet 3 mg tablet
234 Glimepiride tablet 4 mg tablet
235 Glipizid tablet 5 mg tablet
236 Gliquidon tablet 30 mg tablet
237 Gliseril guaiakolat tablet 100 mg tablet
238 Gliserin tetes 10 mg/ml botol
239 Gliserin tetes 100 mg/ml botol
240 Glukosa larutan infus 10 % steril botol
241 Glukosa larutan infus 40 % steril ampul
242 Glukosa larutan infus 5 % steril botol
243 Griseofulvin tablet 125 mg tablet
244 Griseofulvin tablet 250 mg tablet
245 Gutta percha points 15 mm- 40 mm kotak
246 Gutta percha points 45 mm- 80 mm kotak
247 Haloperidol tablet 0,5 mg tablet
248 Haloperidol tablet 5 mg tablet
249 Haloperidol tablet 1,5 mg tablet
250 Haloperidol tablet 2 mg tablet
251 Haloperidol tetes 2 mg/ml botol
252 Haloperidol injeksi i.m 2 mg/ml botol
253 Haloperidol injeksi i.m 5 mg/ml botol
254 Haloperidol 50 mg/ml botol
255 Halotan inhalasi botol
256 Heparin injeksi i.v./s.k. 5000 UI/ml vial
257 Hemodialisa larutan botol
258 Hidroklorotiazida tablet 25 mg tablet
259 Hidrokortison krim 1% tube
260 Hidrokortison krim 2,5 % tube
261 Homatropin tetes mata 2% botol
262 Hidrokortison serbuk injeksi 100 mg vial
263 Hidroklortiazid tablet 12,5 mg tablet
264 Hidroklortiazid tablet 25 mg tablet
265 Hidrogen peroksida cairan konsentrat botol
266 Hidroksi progesteron injeksi 125 mg/ml vial
267 Hidroksi Urea kapsul 500 mg kapsul
268 Hiosin butilbromid tablet 10 mg tablet
269 Hiosin butilbromid injeksi 20 mg/ml ampul
270 Human tetanus imunus imunoglobulin injeksi i.m. 250 UI ampul
271 Hydroxy Ethyl Starch larutan infus 6% botol
272 Hydroxy Ethyl Starch larutan infus 10% botol
273 Hyoscine -N-Butilbromide tablet 10 mg tablet
274 Ibuprofen sirup 100 mg/5 ml botol
275 Ibuprofen suspensi 200 mg/5 ml botol
276 Ibuprofen tablet 200 mg tablet
277 Ibuprofen tablet 400 mg tablet
278 Idoksuridin tetes mata 0,1% botol
279 Idoksuridin salep mata 0,5% tube
280 Ifosfamid serbuk injeksi 500 mg vial
281 Ifosfamid serbuk injeksi 1000 mg/vial vial
282 Indometasin kapsul/kaplet 25 mg kapsul
283 Insulin intermediate injeksi 100 UI/ml vial
284 Insulin regulator injeksi 100 UI/ml vial
285 Iodiol kapsul lunak kapsul
286 Iodium kapsul lunak 200 mg kapsul
287 Ioheksol injeksi 140 - 350 mg/ml vial
288 Iopamidol injeksi 0,408 g/ml vial
289 Iopamidol injeksi 0,612 g/ml vial
290 Ipratropium bromida inhalasi 20 mcg/semprot botol
kombinasi :
Ipratropium bromida inhalasi 0,5 mg botol
291 sabutamol 2,5 mg

292 Ipratropium bromida nebulizer 0,025% botol

293 Isofluran inhalasi botol
294 Isoniazid tablet 100 mg tablet
295 Isoniazid tablet 300 mg tablet
296 Isosorbid Dinitrat tablet sublingual 5 mg tablet
297 Isosorbid Dinitrat injeksi i.v 10 mg/10 ml vial
298 Itrakonazol kapsul/kaplet 100 mg kapsul
299 Kalium Diklofenak tablet 25 mg tablet
300 Kalium Diklofenak tablet 50 mg tablet
301 Kalium Klorida tablet siap larut 300 mg tablet
302 Kalium Klorida tablet 600 mg tablet
303 Kalium klorida injeksi 25 ml botol
304 Kalsium Folinat (Leukovorin Ca) injeksi 3 mg/ml ampul
305 Kalsium Folinat (Leukovorin Ca) tablet 15 mg tablet
306 Kalsium hipoklorit serbuk sachet
307 Kalsium hidroksida bubuk, pasta sachet
308 Kalamin lotion botol
309 Karbogliserin tetes telinga 10% botol
310 Kalsium Glukonat injeksi i.v 10% (100 mg/ml) ampul
311 Kalsium Karbonat tablet 500 mg tablet
312 Kalsium Laktat (Kalk) tablet 500 mg tablet
313 Kaptopril tablet scored12,5 mg tablet
314 Kaptopril tablet scored 25 mg tablet
315 Kaptopril tablet 50 mg tablet
316 Karbamazepin tablet 200 mg tablet
317 Karbamazepin tablet kunyah 100 mg tablet
318 Karbamazepin sirup 100 mg/5 ml botol
319 Karbon Aktif tablet tablet
320 Ketamin injeksi i.v. 50 mg/ml ampul
321 Ketamin injeksi i.v. 100 mg/ml ampul
322 Ketokonazol krim 2% tube
323 Ketokonazol tablet 200 mg tablet
324 Ketoprofen injeksi 100 mg ampul
325 Ketoprofen supositoria 100 mg supositoria
326 Ketoprofen tablet 100 mg tablet
327 Ketorolac injeksi 10 mg ampul
328 Ketorolac injeksi 30 mg ampul
329 Klindamisin kapsul/kaplet 150 mg kapsul
330 Klindamisin kapsul/kaplet 300 mg kapsul
331 Klofazimin kapsul dalam minyak 100 mg, micronize kapsul
332 Klomifen tablet 50 mg tablet
333 Klomipramin tablet 25 mg tablet
334 Klomifen sitrat tablet 50 mg tablet
335 Klonidin injeksi i.v 0,15 mg/ml (HCL) VIAL
336 Klonidin tablet 0,15 mg tablet
337 Klorambusil tablet 2 mg tablet
338 Kloramfenikol kapsul/kaplet 250 mg kapsul
339 Kloramfenikol salep mata 1 % tube
340 Kloramfenikol serbuk injeksi i.v. 100 mg vial
341 Kloramfenikol suspensi 125 mg/ 5 ml botol
342 Kloramfenikol tetes mata 0,5 % botol
343 Kloramfenikol tetes mata 1% botol
344 Kloramfenikol tetes telinga 3 % botol
345 Klorfeniramina Maleat (CTM) tablet 4 mg tablet
346 Klorfenol kamfer mentol (CHKM) cairan botol
347 Klorheksidin larutan 5,0% botol
348 Klorheksidin larutan 0,2% botol
349 Klorokuin tablet 150 mg tablet
350 Klorokuin tablet 250 mg tablet
351 Klorpromazin tablet salut 100 mg (HCl) tablet
352 Klorpromazin injeksi i.m. 25 mg/ml (HCl) ampul
353 Klorpromazin injeksi i.m 5 mg/ml - 2 ml (HCl) ampul
354 Klorpromazin tablet salut 25 mg (HCl) tablet salut
355 Klozapin tablet 50 mg tablet
356 Klozapin tablet 100 mg tablet
357 Kodein tablet 10 mg tablet
358 Kodein tablet 15 mg tablet
359 Kodein tablet 20 mg tablet
360 Kodein tablet 30 mg tablet
Kombinasi tablet salut :
besi (II) sulfat 7H2O 200 mg tablet salut
361 asam folat 0,25 mg

362 Komposit resin sachet

kontrasepsi pil oral, kombinasi :
levonorgestrel 150 mcg pil
363 etinilestradiol 30 mcg
364 Kolkisin tablet 500 mcg tablet
Kotrimoksazol DOEN I (dewasa) kombinasi :
Sulfametoksazol 400 mg tablet
365 Trimetoprim 80 mg

Kotrimoksazol DOEN II (pediatrik) kombinasi :

Sulfametoksazol 100 mg tablet
366 Trimetoprim 20 mg

Kotrimoksazol Suspensi komb:

botol
367 Sulfametoksazol 200 mg + Trimetoprim 40 mg / 5 ml
368 Kuinidin tablet 100 mg tablet
369 Kuinidin tablet 200 mg tablet
370 Kuinin (Kina) tablet 200 mg tablet
371 Kuinin tablet 222 mg tablet
372 Kuinin tablet 250 mg tablet
373 Kuinin injeksi i.v. 25% (sebagai 2 HCl) tablet
374 Kuinin tablet 222 mg (H2SO4.7H2O) tablet
375 Laktulosa sirup 10 g/ 15 ml botol
376 Lamivudine tablet 150 mg tablet
377 Lanzoprazol kapsul/kaplet 30 mg kapsul

Larutan nutrisi larutan infus, kombinasi :

glukosa 5% botol
378 natrium klorida 0,225%

Larutan nutrisi larutan infus, kombinasi :

glukosa 10% botol
379 natrium klorida 0,225%

Larutan nutrisi larutan infus, kombinasi :

glukosa 4% botol
380 natrium klorida 0,18%
381 Levonorgestrel implan 2 rods (3-4 tahun) implan
382 Levotiroksin tablet 100 mcg tablet
383 Levotiroksin tablet 25 mcg tablet
384 Levamisol tablet 50 mg tablet
385 Levofloksasin tablet 500 mg tablet
386 Lidokain injeksi infiltrasi 2% ampul
387 Lidokain injeksi i.v 100 mg vial
388 Lidokain injeksi 2% (HCl) + Epinefrin 1 : 80.000 - 2ml ampul
389 Lidokain injeksi 5% + glukosa 5% ampul
390 Lidokain jeli 2% tube
391 Lidokain semprot 10% botol
392 Lidokain injeksi 2% (HCL) vial
393 Lidokain pasta 5% tube
394 Lidokain semprot 15% botol
395 Liquor carbonis detergens suspensi 2% botol
396 Liquor carbonis detergens suspensi 5% botol
397 Litium karbonat tablet 200 mg botol
398 Liquor faberi cairan botol
399 Linkomisin kapsul/kaplet 250 mg kapsul
400 Linkomisin kapsul/kaplet 500 mg kapsul
401 Lisinopril tablet 10 mg tablet
402 Lisinopril tablet 20 mg tablet
403 Lisinopril tablet 5 mg tablet
404 Loperamid tablet 2 mg tablet
405 Lugol larutan (dilarutkan dulu) botol
406 Loratadin tablet 10 mg tablet
407 Lorazepam tablet 0,5 mg tablet
408 Lorazepam tablet 1 mg tablet
409 Lorazepam tablet 2 mg tablet
410 Manitol larutan infus 20% botol
411 Magnesium Sulfat inj (IV) 20% - 25 ml vial
412 Magnesium Sulfat inj (IV) 40% - 25 ml vial
413 Magnesium Sulfat serbuk 30 gram sachet
414 Mebendazol sirup 100 mg / 5 ml botol
415 Mebendazol tablet 100 mg tablet
416 Mebendazol tablet 500 mg tablet
417 Medroksi Progesteron Asetat tablet 250 mg tablet
418 Medroksi Progesteron Asetat injeksi 200 mg/ml vial
419 Medroksi progesteron asetat injeksi depo 150 mg vial
420 Meglumin Natrium Amidotrizoat injeksi 76% vial
421 Melfalan tablet 2 mg tablet
422 Meloksikam suppositoria suppositoria
423 Meloksikam tablet 15 mg tablet
424 Meloksikam tablet 7,5 mg tablet
425 Menadion (Vit.K3) tablet salut gula 10 mg tablet
426 Menadion (Vitamin K3) injeksi 10 mg/ml ampul
427 Merkaptopurin tablet 50 mg tablet
428 Mesna injeksi 400 mg/2 ml ampul
429 Metampiron injeksi 250 mg ampul
430 Metampiron tablet 500 mg tablet
431 Metadon sirup 50 mg/ml botol
432 Metenamin Mandelat (Heksamin Mandelat) tablet salut enterik 500 mg tablet
433 Metformin HCl tablet 500 mg tablet
434 Metformin HCl tablet 850 mg tablet
435 Metildopa tablet salut 250 mg tablet
436 Metilergometrin Maleat (Metilergometrin) tablet salut 0,125 mg tablet
437 Metilergometrin Maleat injeksi 0,200 mg-1 ml ampul
438 Metilfenidat tablet RR 10 mg tablet
439 Metilfenidat tablet ER 10 mg tablet
440 Metilprednisolon injeksi 500 mg vial
441 Metilprednisolon injeksi 125 mg vial
442 Metilprednisolon tablet 16 mg tablet
443 Metilprednisolon tablet 4 mg tablet
444 Metilprednisolon tablet 8 mg tablet
445 Metoklopramide injeksi 5 mg/ml ampul
446 Metoklopramide sirup 5 mg/ 5 ml botol
447 Metoklopramide tablet 10 mg tablet
448 Metoklopramide tablet 5 mg tablet
449 Metotreksat tablet 2,5 mg tablet
450 Metotreksat serbuk injeksi 50 mg/vial vial
451 Metotreksat serbuk injeksi i.v/i.m./i.t. 5 mg/vial vial
452 Metronidazol infus 500 mg/100 ml botol
453 Metronidazol supositoria 500 mg supositoria
454 Metronidazol tablet 250 mg tablet
455 Metronidazol tablet 500 mg tablet
456 Midazolam injeksi i.v. 1 mg/ml ampul
457 Midazolam injeksi i.v. 5 mg/ml ampul
458 Mikonazol serbuk 2% sachet
459 Mikonazol krim/salep 2 % (Nitrat) tube

Mineral Mix, kombinasi : Kalium klorida 1792 mg

Trikalium sitrat (1H2O) 648 mg sachet
Magnesium klorida (6H2O) 608 mg
Seng asetat (2H2O) 66 mg
460 Tembaga sulfat (5H2O) 11 mg
461 Momethason krim 0,1 % 5 gr tube
462 Momethason krim 0,1 % 10 gr tube
463 Morfin injeksi i.m./s.k./i.v. 10 mg/ml ampul
464 Morfin tablet 10 mg tablet
465 Morfin tablet SR 10 mg tablet
466 Morfin tablet SR 30 mg tablet
467 Nalokson injeksi 0,4 mg/ml ampul
468 Natrium Bikarbonat injeksi i.v 8,4% vial
469 Natrium Bikarbonat injeksi 1,4% isotonik vial
470 Natrium Bikarbonat tablet 500 mg tablet
471 Natrium Diklofenak tablet 50 mg tablet
472 Natrium Diklofenak tablet 25 mg tablet
473 Natrium aminohipurat injeksi i.v 200 mg/ml ampul
474 Natrium Fluoresein tetes mata 2% botol
475 Natrium hipoklorit cairan konsentrat 5% botol
476 Natrium Iopodat kapsul 500 mg kapsul
477 Natrium Klorida larutan infus 3% botol
478 Natrium Klorida injeksi 15% vial
479 Natrium Klorida larutan 0,9% botol
480 Natrium kromoglikat tetes mata 2% botol
481 Natrium Tiosulfat injeksi i.v. 25% ampul
482 Neomisin kapsul/kaplet 500 mg kapsul
483 Neostigmin injeksi 0,5 mg/ml vial
484 Nevirapin tablet 200 mg tablet
485 Nifedipin tablet/kapsul 10 mg tablet
486 Nistatin suspensi 100.000 UI/ml botol
487 Nistatin tablet salut 500.000 IU/ g tablet salut
488 Nistatin vaginal tablet 100.000 IU/ g tablet vagina
489 Nitrofurantoin tablet 100 mg tablet
490 Nikotinamid tablet 5 mg tablet
491 Nikotinamid tablet 20 mg tablet
492 Nitrogen Oksida inhalasi, gas dalam tabung tabung
493 Noretisteron tablet 5 mg tablet
494 Norepinefrin injeksi 1 mg/ml ampul
495 Nitrogliserin tablet sublingual 0,5 mg tablet
496 Obat Antituberkulosis FDC Kategori 1 paket
497 Obat Antituberkulosis FDC Kategori 2 paket
498 Obat Antituberkulosis FDC Kategori Anak paket
499 Obat Antituberkulosis FDC Sisipan paket
500 Obat Antituberkulosis Kategori 1 dewasa Paket / dos
501 Obat Antituberkulosis Kategori anak Paket / dos
502 Obat Batuk Hitam ( O.B.H. ) cairan 100 ml botol
503 Obat Batuk Hitam ( O.B.H. ) cairan 200 ml botol
504 Ofloxacin tablet 200 mg tablet
505 Ofloxacin tablet 400 mg tablet
506 Ondansetron tablet 8 mg tablet
507 Ondansetron injeksi 8 mg/ 2 ml vial
508 Oksimetazolin tetes hidung 0,025% botol
509 Oksimetazolin tetes hidung 0,050% botol
510 Oksigen inhalasi, gas dalam tabung tabung
511 Oksitetrasiklin HCl salep mata 1 % tube
512 Oksitetrasiklin HCl injeksi i.m. 50 mg/ml-10 ml vial
513 Oksitetrasiklin injeksi i.m. 250 mg/3 ml (HCl) vial
514 Oksitetrasiklin tetes mata 1 % botol
515 Oksitetrasiklin salep kulit 3% tube
516 Oksitosin injeksi 10 IU/ml - 1 ml ampul
517 Omeprazol kapsul/kaplet 20 mg kapsul
518 Omeprazo injeksi 40 mg/ 10 ml vial
519 Oseltamivir kapsul/kaplet 75 mg kapsul
520 Pakliktaksel injeksi 30 mg/5 ml vial
521 Papaverin injeksi 40 mg/ml ampul
522 Papaverin tablet 40 mg tablet
523 Parasetamol tetes 60 mg/0,6 mL botol
524 Parasetamol sirup 120 mg / 5 ml botol
525 Parasetamol supositoria 125 mg supositoria
526 Parasetamol supositoria 240 mg supositoria
527 Parasetamol tablet 100 mg tablet
528 Parasetamol tablet 500 mg tablet
529 Pasta pengisi saluran akar tube
530 Pasta devitalisasi (non arsen) tube
 Pengganti Plasma DOEN kombinasi (larutan infus) :
Poligelin (ekivalen dengan 0,63 g nitrrogen) 17,5 g
Natrium Klorida 4,25 g botol
Kalium Klorida 0,19 g
Kalsium (terikat pada polipeptida) 0,125 g
531
532 Permetrin krim 5% pot
533 Pentoksifilin injeksi 300 mg/15 ml vial
534 Pentoksifilin tablet 400 mg tablet
535 Paraformaldehid larutan 5% botol
536 Perak sulfadiazin krim 1% tube
537 Perak nitrat larutan 20 % botol
538 Perfenazin tablet 4 mg (HCl) tablet
539 Perfenazin tablet 2 mg (HCl) tablet
540 Perfenazin tablet 8 mg (HCl) tablet
541 Petidin injeksi i.m/s.k/i.v lambat 50 mg/ml (HCl) ampul
542 Pilokarpin tetes mata 2 % (HCl/ Nitrat) botol
543 Piracetam injeksi 1 g/5 ml ampul
544 Piracetam injeksi 3 g/15 ml tablet
545 Piracetam tablet 1200 mg tablet
546 Piracetam tablet 400 mg tablet
547 Piracetam tablet 800 mg tablet
548 Pirantel suspensi 125 mg/5 ml botol
549 Pirantel tablet score (base) 125 mg tablet
550 Pirantel tablet scored 250 mg tablet
551 Pirazinamid tablet 500 mg tablet
552 Piridostigmin tablet 60 mg tablet
553 Piridoksin (Vitamin B6) tablet 10 mg (HCl) tablet
554 Piridoksin (Vitamin B6) tablet 25 mg (HCl) tablet
555 Piridoksin injeksi 100g/ml ampul
556 Piroksikam kapsul/kaplet/tablet 10 mg kapsul
557 Podofilin tingtur 25% tingtur
558 Povidon Iodida larutan 10% 30 ml botol
559 Povidon Iodida larutan 10% 60 ml botol
560 Povidon Iodida larutan 10% 300 ml botol
561 Povidon Iodida larutan 10% 1000 ml botol
562 Pravastatin tablet 10 mg tablet
563 Pravastatin tablet 20 mg tablet
564 Prazikuantel tablet 300 mg tablet
565 Prazikuantel tablet 600 mg tablet
566 Prednison tablet 5 mg tablet
567 Primakuin tablet 15 mg tablet
568 Prokain Benzilpenisilin serbuk injeksi 1 juta IU/vial vial
569 Prokain Benzilpenisilin serbuk injeksi 3 juta IU/vial vial
570 Prokarbazin kapsul 50 mg kapsul
571 Prometazin tablet 25 mg tablet
572 Propanolol tablet 40 mg (HCl) tablet
573 Propanolol tablet 10 mg ( HCl ) tablet
574 Propiltiourasil tablet 100 mg tablet
575 Propiltiourasil tablet 50 mg tablet
576 Propofol injeksi i.v., bolus 1% ampul
577 Protamin Sulfat injeksi i.m. 10 mg/ml ampul
578 Polikresulen cairan botol
579 Ramipril tablet 2,5 mg tablet
580 Ramipril tablet 5 mg tablet
581 Ranitidin injeksi 25 mg/2 ml ampul
582 Ranitidin tablet 150 mg tablet
583 Reserpin tablet 0,10 mg tablet
584 Reserpin tablet 0,25 mg tablet
585 Retinol (Vitamin A) 100.000 IU kapsul lunak kapsul lunak
586 Retinol (Vitamin A) 200.000 IU kapsul lunak kapsul lunak
587 Rifampisin kapsul/kaplet 600 mg kaplet
588 Rifampisin kapsul/kaplet 300 mg kapsul
589 Rifampisin tablet salut 450 mg tablet salut
590 Ringer Laktat larutan infus botol
591 Risperidon tablet 1 mg tablet
592 Risperidon tablet 2 mg tablet
593 Risperidon tablet 3 mg tablet
594 Rokuronium injeksi i.v. 10 mg/ml vial
595 Salbutamol larutan inhalasi 0,5% botol
596 Salbutamol inhalasi/aerosol 100 mcg/dosis botol
597 Salbutamol larutan respirator untuk nebulizer 2,5 mg/2,5 ml NaCl botol
598 Salbutamol tablet 2 mg (sebagai Sulfat) tablet
599 Salbutamol tablet 4 mg (sebagai Sulfat) tablet
600 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang endap 4% pot
601 Sefadroksil sirup kering 125 mg/5ml botol
602 Sefadroksil kapsul/kaplet 250 mg kapsul
603 Sefadroksil kapsul/kaplet 500 mg kapsul
604 Sefaklor kapsul/kaplet 250 mg kapsul
605 Sefaklor kapsul/kaplet 500 mg kapsul
606 Sefaleksin kapsul/kaplet 250 mg kapsul
607 Sefaleksin kapsul/kaplet 500 mg kapsul
608 Sefazolin injeksi 1 g vial
609 Sefazolin serbuk injeksi 1 g/vial vial
610 Sefiksim 400 mg + Azitromisin 1000 mg paket
611 Sefiksim kapsul/kaplet 100 mg kapsul
612 Sefiksim kapsul/kaplet 50 mg kapsul
613 Sefiksim sirup kering 100 mg/ 5 ml botol
614 Sefotaksim injeksi 0,5 g vial
615 Sefotaksim injeksi 1 g vial
616 Seftazidim injeksi 1 g vial
617 Seftriakson serbuk injeksi 1 g/vial vial
618 Sefuroksim serbuk injeksi 750 mg/vial vial

Serum anti bisa ular : vial

619 A.B.U.I (khusus ular dari luar papua)
Serum anti bisa ular : vial
620 A.B.U.II (khusus ular dari papua)
621 Serum antidifteri (A.D.S) injeksi i.m. 10.000 UI/vial vial
622 Serum antidifteri (A.D.S) injeksi i.m. 20.000 UI/vial vial
623 Serum antirabies injeksi 200 UI/ml ampul
624 Serum antitetanus (A.T.S) untuk pencegahan injeksi i.m. 1500 UI ampul

Serum antitetanus (A.T.S) untuk pengobatan ampul

625 injeksi i.m./i.v. 10.000 UI

Serum antitetanus (A.T.S) untuk pengobatan

ampul
626 injeksi i.m./i.v. 20.000 UI
627 Sianokobalamin (vitamin B12) injeksi 500 mcg ampul
628 Sianokobalamin (vitamin B12) tablet 50 mcg tablet
629 Siklofosfamid serbuk injeksi i.v. 200 mg vial
630 Siklofosfamid serbuk injeksi i.v. 500 mg vial
631 Siklofosfamid serbuk injeksi i.v. 1000 mg vial
632 Siklofosfamid tablet 50 mg tablet
633 Siklosporin injeksi 50 mg/ml ampul
634 Siklosporin kapsul lunak 25 mg kapsul
635 Simetidin tablet 200 mg tablet
636 Simvastatin scored tablet 10 mg tablet
637 Simvastatin tablet 20 mg tablet
638 Simvastatin tablet 5 mg tablet
639 Siprofloksasin tetes mata 0,3 % botol
640 Siprofloksasin infus 2% botol
641 Siprofloksasin tablet 250 mg (sebagai HCl) tablet
642 Siprofloksasin tablet 500 mg (sebagai HCl) tablet
643 Sisplatin serbuk injeksi 10 mg vial
644 Sisplatin serbuk injeksi 50 mg vial
645 Sitarabin serbuk injeksi i.m./i.v./s.k. 100 mg vial
646 Spiramisin tablet 250 mg tablet
647 Spiramisin tablet 500 mg tablet
648 Spironolakton tablet 100 mg tablet
649 Spironolakton tablet 25 mg tablet
650 Spons gelatin cubicles 1x1x1 cm kotak
651 Stavudin tablet 30 mg tablet
652 Streptomisin serbuk injeksi i.v 1000 mg/ml vial
653 Streptokinase injeksi 750.000 UI/vial vial
654 Streptokinase injeksi 1,5 juta UI/vial vial
655 Streptomisin serbuk injeksi i.v 1500 mg/ml vial
656 Sufentanil injeksi iv, epidural 5 mcg/ml ampul
657 Sulfadiazin tablet 500 mg tablet
658 Sulfametoksazol tablet 400 mg tablet
659 Sulfasalazin tablet/kapsul salut enterik 500 mg tablet
660 Sulfasetamida Natrium tetes mata 15 % botol
661 Suksinikolin injeksi i.v./i.m. 50 mg/ml vial
662 Surgical ginggival pack pasta tube
663 Tamoksifen tablet 20 mg tablet
664 Teofilin tablet 150 mg tablet
665 Terbutalin tablet 2,5 mg tablet
666 Terbutalin injeksi s.k./i.v. 0,5 mg/ml vial
667 Testoterone kapsul lunak 40 mg kapsul
668 Testoterone injeksi 250 mg/ml vial
669 Tetrakain HCl tetes mata 0,5% botol
670 Tetrasiklin kapsul/kaplet 250 mg kapsul
671 Tetrasiklin kapsul/kaplet 500 mg kapsul
672 Tiamfenikol kapsul/kaplet 250 mg kapsul
673 Tiamfenikol kapsul/kaplet 500 mg kapsul
674 Tiamin (Vitamin B1) 100 mg tablet tablet
675 Tiamin (Vitamin B1) injeksi 100 mg/ml ampul
676 Tiamin (Vitamin B1) tablet 50 mg (HCl/ Nitrat) tablet
677 Timolol tetes mata 0,25% botol
678 Timolol tetes mata 0,5% botol
679 Tiopental serbuk injeksi i.v., bolus 500 mg/ampul (garam Na) ampul
680 Tiopental Natrium serbuk injeksi 1000 mg/amp ampul
681 Tramadol injeksi 50 mg/ml ampul
682 Tramadol kapsul/kaplet/tablet 50 mg kapsul
683 Trifluoperazin tablet 1 mg tablet
684 Trifluoperazin tablet 5 mg tablet
685 Triheksifenidil tablet 2 mg tablet
686 Trimetoprim tablet 200 mg tablet
687 Tuberkulin protein purified derivative injeksi i.k. 1:10 ampul
688 Urea krim 10% pot
689 Vaksin BCG injeksi i.k. ampul
690 Vaksin campak injeksi s.k vial
691 Vaksin hepatitis B rekombinan vial
692 Vaksin jerap diferi tetanus (DT) injeksi i.m ampul
693 Vaksin jerap diferi tetanus pertisis (DTP) injeksi i.m ampul
694 Vaksin jerap diferi tetanus (tetanus adsorbed toxoid) injeksi i.m ampul
695 Vaksin polio tetes ampul
696 Vaksin rabies, untuk manusia serbuk injeksi s.k./i.k. + booster ampul
697 Vaksin jerap diferi tetanus (dT) injeksi i.m ampul
698 Valproat tablet 150 mg tablet
699 Valproat tablet 200 mg tablet
700 Valproat tablet ER 200 mg tablet
701 Valproat tablet 250 mg tablet
 702 Valproat tablet 500 mg tablet
703 Valproat sirup 250 mg/5 ml botol
704 Vasopresin injeksi i.m/s.k. 20 UI/ml vial
705 Vankomisin serbuk injeksi 500 mg/vial vial
706 Verapamil tablet 80 mg (HCl) tablet
707 Verapamil tablet 40 mg tablet
708 Verapamil injeksi 2,5 mg/ml vial
709 Vinblastin serbuk injeksi 10 mg vial
710 Vinkristin serbuk injeksi i.v. 1 mg vial
711 Vitamin B Kompleks tablet tablet
712 Warfarin tablet 2 mg tablet
713 Zidovudin 300 mg + Lamivudine 150 mg tablet
714 Zidovudin tablet 100 mg tablet
715 Zinc tablet dispersible20 mg tablet

DAFTAR KEBUTUHAN OBAT LAINNYA

NO NAMA OBAT SATUAN

1 Zinc Syrup botol

2 Ondansetron 4 mg/2 ml ampul
3 Tiamfenicol syrup botol
4 Azitromisin tablet tablet
5 Atorvastatin tablet tablet
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
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

KEPALA SATUAN KERJ

NIP. 19650801 200003 1

IL SEPERTI : TABLET / KAPSUL / KAPLET / BOTOL /

OM)

JUMLAH KEBUTUHAN KETERANGAN

15,000

21,000
20,000

11,000
5,000
5,000
9,000

400

20,000
5,000
25,000
11,000
3,000
90,000

1,500
1,500
 1,500

60,000

3,000

500

1,000
1,000

25,000

10,000
20,000

2,000
60,000
3,000

200

300

5,000

3,000

500
300
1,000

7,000
300

5,000
300

1,500

500
6,000
11,000

20,000

500
4,000
8,000

4,000

500
500
800
3,000

300
3,000

500

8,000
2,000

1,000
 1,000
500
15,000

3,000
1,500

600
3,000

500

400

20,000
20,000

2,000
30

40

200
200
200

3,500

1,000
2,000

200
 200
2,000

1,000

6,000

5,000
7,000

1,500
5,000

700
500
500
400
200

2,000
2,000
9,000
3,000
 2,000

2,000
200

2,000
500
8,000
1,000
1,000

5,000

100
1,000

5,000

300

20
100

5,000
500
500
1,500
12,000
 400
400

30
2,000

2,000
12,000
1,000
5,000
12,000
8,000

5,000
10,000

3,000

500
500

5,000
15,000
50,000
8,000
5,000

500
 1,000
5,000
1,000
2,000
3,000
2,000
15,000

8,000

5,000
1,000

1,000

1,000
30,000

1,000

5,000
5,000

5,000

15,000

10,000

10,000
 7,000

6,000

1,000

500

8,000

35,000

1,000

18,000

5,000

5,000
 5,000
3,000

6,000

5,000

500

8,000
8,000
5,000
4,000

15,000

9,000

8,000
10,000
1,000

500
250

53,000
20,000
 8,000

8,000

10,000

60,000

1,800

200

5,000
5,000

200

5,000
10,000
8,000

15,000

100

5,000
8,000
 5,000
10,000

8,000

1,000

2,000
4,000
5,000

5,000
15,000
8,000

2,500
5,000
1,000
1,000

70,000
 1,000

1,800

1,000
4,000
3,000
2,000
7,000
1,000
1,000
1,000
8,000

15,000

2,000

500
500
300
400

30,000
12,000
 8,000
25,000

1,000

10,000
30,000

5,000
8,000
7,000
60,000

4,000
6,000
10,000

2,000
5,000
15,000

6,000

3,000

7,000

45,000
 200

100

2,000

1,000

8,000
5,000

5,000

60,000

6,000
7,000
5,000

400

2,000
2,000
8,000
2,000

500
400

3,000
7,000

6,000

100
 25,000

4,000

JUMLAH KEBUTUHAN KETERANGAN

1000
6000
1000
7000
6000
 KEPALA SATUAN KERJA

dr. David Oloan, MARS

NIP. 19650801 200003 1 001