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RENCANA KEBUTUHAN OBAT DAN BAHAN MEDIS PAKAI HABI

PUSKESMAS TAMPO
TAHUN 2018

Sisa
Pemakaian Kebutuhan
Stok /31
No Nama Obat Satuan Kemasan Rata-rata / (kolom 5 x
Desember
bulan 18 bulan)
2017
1 2 3 4 5 6
I Obat - Obatan
1 Albendazol suspensi 200 mg/5 ml ktk 10 botol@10 ml
2 Albendazol tablet 400 mg Ktk 5 x 6 tablet
3 Alopurinol tablet 100 mg Ktk 10 x 10 tab
4 Ambroxol sirup 15 mg/ml btl 60 ml
5 Ambroxol tablet 30 mg Ktk 10 x 10 tab
6 Aminofilin injeksi 24 mg/ml ktk 30 ampul@10 ml
7 Aminofilin tablet 200 mg btl 100 tablet
8 Amlodipin tablet 10 mg ktk 5 x 10 tab
9 Amlodipin tablet 5 mg ktk 5 x 10 tab
10 Amoksisilin kapsul/kaplet 250 mg Ktk 10 x 10 tab
11 Amoksisilin kapsul/kaplet 500 mg Ktk 10 x 10 tab
12 Amoksisilin sirup kering 125 mg/ 5 ml btl 60 ml
13 Ampisillin injeksi ampul
14 Ampisillin tablet 500 mg Kotak 10 x 10 Tab
15 Ampisillin Syrup kering 125 mg/ml Botol 60 ml
16 Anti Fungi DOEN Kombinasi Kotak 24 pot @ 30 g
Antasida DOEN I tablet kunyah, kombinasi : Aluminium
17 Ktk 10 x 10 tab
Hidroksida 200 mg Magnesium Hidroksida 200 mg
Antasida DOEN II suspensi, kombi : Aluminium
18 Hidroksida 200 mg/5 ml Magnesium Hidroksida 200 mg/5 btl 60 ml
ml
Anti Bakteri DOEN salep kombinasi: Basitrasin 500 IU/g
19 ktk 25 tube @ 5 g
+ Polimiksin 10.000 IU/g
Antimalaria DOEN kombinasi : Pirimetamin tablet 25 mg
20 Ktk 10 x 10 tab
Sulfadoksin tablet 500 mg
21 Anti Migren : Ergotamin tartrat 1 mg+kofein 50 mg Botol 100 tab
22 Aqua pro Injeksi steril, bebas pirogen ktk 10 vial @ 20 ml
23 Aquadest steril botol 500 ml
24 Asam Mefenamat kapsul/kaplet 500 mg Ktk 10 x 10 tab
25 Asam Askorbat (Vit. C) tab 50 mg Ktk 10 x 10 tab
26 Asiklovir krim 5% tube 5 gram
27 Asiklovir tablet 200 mg ktk 5 x 10 tab
28 Asiklovir tablet 400 mg ktk 5 x 10 tab
29 Atropin injeksi i.m./i.v./s.k. 0,25 mg/ml (Sulfat) ktk 30 ampul@1 ml
30 Atropin Sulfat tablet 0,5 mg btl 100 tablet
31 Benzatin Benzil Penisilin 1,4 juta IU/vial ktk 10 vial@20 ml
32 Benzatin Benzil Penisilin 2,4 juta IU/vial ktk 10 vial@20 ml
33 Betametason krim 0,1 % (sebagai Valerat) tube 5 gram
34 Bisoprolol tablet 5 mg ktk 3x 10 tab
35 Bromheksin tablet 8 mg Kotak 10 x 10 Tab
36 Cetirizine tablet 10 mg ktk 5 x 10 tab
37 Deksametason injeksi i.v. 5 mg/ml ktk 100 amp@1 ml
38 Deksametason tablet 0,5 mg Ktk 10 x 10 tab
39 Diazepam tablet 2 mg Botol 1000 tab
40 Diazepam injeksi 5 mg/ml ktk 30 amp
41 Difenhidramin injeksi i.m. 10 mg/ml (HCl) ktk 30 amp
42 Digoksin tablet 0,25 mg Ktk 10 x 10 tab
43 Doksisiklin kapsul/kaplet 100 mg Ktk 10 x 10 tab
44 Domperidon suspensi 5 mg/5 ml btl 60 ml
45 Domperidon tablet 10 mg Ktk 10 x 10 tab
46 Efedrin tablet 25 mg Botol 250 tablet
47 Ekstrak Belladona tablet 10 mg btl 1000 tablet
48 Epinefrin (Adrenalin) injeksi 0,1 % (sebagai HCl) ktk 30 amp @ 1ml
49 Eritromisin kapsul/kaplet 250 mg Ktk 10 x 10 tab
50 Eritromisin kapsul/kaplet 500 mg Ktk 10 x 10 tab
51 Etakridin larutan 0,1 % btl 300 ml
52 Etanol 70% Botol 1000 ml
53 Etambutol tablet 250 mg (HCl) Ktk 10 x 10 tab
54 Etambutol tablet salut 500 mg (HCl) ktk 10x10 tab salut
55 Fenilbutason tablet 200 mg btl 1000 tablet
56 Fenitoin Natrium injeksi 50 mg/ml amp @ 2 ml
57 Fenobarbital injeksi i.m./i.v. 50 mg/ml ktk 30 amp
58 Fenobarbital tablet 30 mg btl 1000 tablet
59 Fenol Gliserol tetes telinga 10% ktk 24 btl @ 5 ml
60 Fitomenadion (Vit.K1) tablet salut gula 10 mg btl 100 tablet
61 Fitomenadion (Vitamin K1) injeksi 10 mg/ml ktk 30 amp @ 1ml
62 Furosemid injeksi i.v./i.m. 10 mg/ml ktk 25 amp @ 2 ml
63 Furosemid tablet 40 mg ktk 20 x 10 tab
Garam Oralit I serbuk, kombinasi : Natrium 0,52 g Kalium
klorida 0,30 g
64
Trinatrium sitrat dihidrat 0,58 g ktk 25 bungkus
Glukosa Anhidrat 2,7 g
65 Gemfibrozil kapsul/kaplet 300 mg ktk 10 x 10 tab
66 Gentamisin injeksi 40 mg/ ml ktk 5 amp
67 Gentamisin salep kulit 0.1% Kotak 25 tube@5g
68 Gentamisin Sulfat tetes mata 0,3 % btl 5 ml
69 Gentian Violet larutan 1 % btl 10 ml
70 Glibenklamida tablet 5 mg ktk 10 x 10 tab
71 Glimepiride tablet 1 mg ktk 5 x 10 tab
72 Glimepiride tablet 2 mg ktk 5 x 10 tab
73 Glimepiride tablet 3 mg ktk 5 x 10 tab
74 Glimepiride tablet 4 mg ktk 5 x 10 tab
75 Gliserin lar 50 % Botol 100 ml
76 Gliseril Guaiakolat tablet 100 mg Kotak 100 tablet
77 Glukosa larutan infus 10 % steril btl 500 ml
78 Glukosa larutan infus 5 % steril btl 500 ml
79 Griseofulvin tablet 125 mg ktk 10 x 10 tab
80 Haloperidol tablet 0,5 mg ktk 10 x 10 tab
81 Haloperidol tablet 1,5 mg ktk 10 x 10 tab
82 Haloperidol 2 mg ktk 10 x 10 tab
83 Hidrokortison krim 2,5 % tube 5 gram
84 Hidroklortiazida (HCT) tablet 25 mg btl 1000 tablet
85 Ibuprofen suspensi 200 mg/5 ml btl 60 ml
86 Ibuprofen tablet 200 mg ktk 10 x 10 tab
87 Ibuprofen tablet 400 mg ktk 10 x 10 tab
88 Isosorbid Dinitrat tablet sublingual 5 mg ktk 10 x 10 tab
89 Kalsium Laktat (Kalk) tablet 500 mg btl 1000 tablet
90 Kaptopril tablet 12,5 mg ktk 10 x 10 tab
91 Kaptopril tablet 25 mg ktk 10 x 10 tab
92 Karbamazepin tablet 200 mg ktk 10 x 10 tab
93 Ketokonazol krim 2% tube 5 gram
94 Ketokonazol tablet 200 mg ktk 5 x 10 tab
95 Ketorolac injeksi 30 mg ktk 6 amp @ 1 ml
96 Klindamisin kapsul/kaplet 150 mg ktk 10 x 10 tab
97 Klindamisin kapsul/kaplet 300 mg ktk 5 x 10 tab
98 Kloramfenikol kapsul/kaplet 250 mg ktk 10 x 10 tab
99 Kloramfenikol salep mata 1 % Ktk 24 tube@5 g
100 Kloramfenikol salep mata 2 % Ktk 24 tube@15 g
101 Kloramfenikol tetes telinga 3 % btl 5 ml
102 Kloramfenikol tetes mata 0,5 % ktk 10 btl @ 10 ml
103 Kloramfenikol suspensi 125 mg btl 60 ml
104 Klorfeniramina Maleat (CTM) tablet 4 mg btl 1000 tablet
105 Klorokuin tablet 150 mg btl 1000 tablet
106 Klorokuin tablet 250 mg btl 1000 tablet
107 Klorpromazin Injeksi salut 25 mg (HCl) ktk 30 amp
108 Klorpromazin tablet salut 25 mg (HCl)
109 Kodein tablet 10 mg btl250 tab
Kotrimoksazol DOEN I (dewasa) kombinasi :
110
Sulfametoksazol 400 mg , Trimetoprim 80 mg ktk 10 x 10 tab
Kotrimoksazol DOEN II (pediatrik) kombinasi :
111 Sulfametoksazol 100 mg
Trimetoprim 20 mg
ktk 10 x 10 tab
Kotrimoksazol Suspensi komb:
112 Sulfametoksazol 200 mg + Trimetoprim 40 mg
/ 5 ml btl 60 ml

Kombinasi : Ferro Fumarat 60 mg + As. Folat 0,4 mg tab


113
salut gula (tablet tambah darah)
ktk 3 strip @ 10 tsg
Kombinasi : Dekstromethorfan, GG, CTM,
114
Phenilprophanolamina HCl Botol 60 ml
Kombinasi : Dekstromethorfan, GG, CTM,
115
Phenilprophanolamina HCl ktk 150 tablet
Kombinasi : Vitamin B1 100 mg, Vitamin B6 200 mg,
116
Vitamin B12 200 mg ktk 10 x 10 tab
Kombinasi : Vitamin A, Vit. D, Vit. B1, Vit. B6, Vit. B12,
117 Vit. C, Nikotinamida, Ca. Pantotenat, Ca. Gluconate, Ca.
Hyphophosphite, Ca. Glycerophosphate
btl 60 ml
Kombinasi : Vitamin A, Vit. D, Vit. B1, Vit. B6, Vit. B12,
Vit. C, Nikotinamida, Ca. Pantotenat, Asam Folat, Calac,
118
tembaga, CuSO4, Yodium (sebagai KI),
Dimetilpolisiloksan, Na. Fluorida
ktk 10 x 10 tab
119 Kuinin Dihidroklorida injeksi 25% - 2 ml ktk 30 amp
120 Lanzoprazol kapsul/kaplet 30 mg ktk 2 x 10 tab
121 Levofloksasin tablet 500 mg ktk 5 x 10 tab
122 Lidokain injeksi 2% ktk 100 amp@2 ml
123 Lidokain injeksi 2% (HCl) + Epinefrin 1 : 80.000 - 2ml ktk 30 amp
124 Loperamide tablet 2 mg ktk 10 x 10 tab
125 Loratadin tablet 10 mg ktk 5 x 10 tab
126 Metampiron injeksi 250 mg ktk 30 amp@2 ml
127 Metampiron tablet 500 mg ktk 10 x 10 tab
128 Metformin tablet 500 mg ktk 10 x 10 tab
129 Metilergometrin Maleat tablet salut 0,125 mg Ktk 10 x 10 tab
130 Metilergometrin Maleat Inj. 0,200 mg-1 ml ktk 30 amp
131 Metilprednisolon tablet 16 mg ktk 10 x 10 tab
132 Metilprednisolon tablet 4 mg ktk 10 x 10 tab
133 Metilprednisolon tablet 8 mg ktk 10 x 10 tab
134 Metoklorpramide injeksi 5 mg/ml ktk 10 amp@2 ml
135 Metoklorpramide syrup 5 mg/5 ml btl 60 ml
136 Metoklorpramide tablet 10 mg ktk 10 x 10 tab
137 Metronidazol infus 500 mg/100 ml btl 100 ml
138 Metronidazol tablet 250 mg ktk 10 x 10 tab
139 Metronidazol tablet 500 mg ktk 10 x 10 tab
140 Mikonazol krim/salep 2 % (Nitrat) tube 10 gr
Mineral Mix, kombinasi : Kalium klorida 1792 mg
Trikalium sitrat (1H2O) 648 mg
141 Magnesium klorida (6H2O) 608 mg ktk 40 bungkus
Seng asetat (2H2O) 66 mg
Tembaga sulfat (5H2O) 11 mg
142 Natrium Diklofenak tablet 50 mg ktk 5 x 10 tab
143 Natrium Diklofenak tablet 25 mg ktk 5 x 10 tab
144 Natrium Klorida larutan infus 0,9 % btl 500 ml
145 Nifedipin tablet 10 mg ktk 10 x 10 tab
146 Nistatin tablet salut 500.000 IU/ g ktk 10x10 tab salut
147 Nistatin vaginal tablet 100.000 IU/ g ktk 10 x 10 tab
148 Obat Antituberkulosis FDC Kategori 1 pkt
149 Obat Antituberkulosis FDC Kategori 2 pkt
150 Obat Antituberkulosis FDC Kategori Anak pkt
151 Obat Antituberkulosis FDC Kategori Sisipan pkt
152 Obat Batuk Hitam ( O.B.H. ) cairan btl 100 ml
153 Oksitetrasiklin HCl salep mata 1 % Ktk 25 tube @ 3,5 g
154 Oksitetrasiklin salep kulit 3% Ktk 25 tube @ 5 g
155 Oksitosin injeksi 10 IU/ml - 1 ml ktk 30 amp
156 Omeprazol kapsul/kaplet 20 mg ktk 3 x 10 tab
157 Papaverin tablet 40 mg btl 1000 tablet
158 Papaverin Injeksi 40 mg/ml ktk 100 amp @ 1 ml
159 Parasetamol drops btl 15 ml
160 Parasetamol sirup 120 mg / 5 ml btl 60 ml
161 Parasetamol tablet 100 mg btl 100 tab
162 Parasetamol tablet 500 mg ktk 10 x 10 tab
163 Pirantel tablet score (base) 125 mg ktk 30 x 2 tab
164 Pirazinamid tablet 500 mg ktk 10 x 10 tab
165 Piroksikam kapsul/kaplet/tablet 10 mg Ktk 10 x 10 tab
166 Piroksikam kapsul/kaplet/tablet 20 mg ktk 10 x 10 tab
167 Piridoksin HCl (Vit. B6) tablet 10 mg Botol 1000 tab
168 Povidon Iodida larutan 10% btl 30 ml
169 Povidon Iodida larutan 10% btl 300 ml
170 Povidon Iodida larutan 10% btl 1000 ml
171 Prednison tablet 5 mg btl 1000 tablet
172 Primakuin tablet 15 mg btl 1000 tablet
173 Prokain Benzil Penisilin G. injeksi 3 jt IU/vial ktk 30 vial
174 Propanolol tablet 40 mg (HCl) btl 100 tablet
175 Propiltiourasil tablet 100 mg btl 100 tablet
176 Ranitidin injeksi 25 mg/2 ml ktk 25 amp
177 Ranitidin tablet 150 mg ktk 10 x 10 tab
178 Reserpin tablet 0,25 mg btl 1000 tablet
179 Retinol (Vitamin A) 100.000 IU kapsul lunak btl 50 kapsul lunak
180 Retinol (Vitamin A) 200.000 IU kapsul lunak btl 50 kapsul lunak
181 Rifampisin tablet salut 300 mg ktk 10 x 10 tab
182 Rifampisin tablet salut 450 mg ktk 10 x 10 tab
183 Rifampisin tablet salut 600 mg ktk 10 x 10 tab
184 Ringer Laktat larutan infus btl 500 ml
185 Risperidon tablet 1 mg ktk 5 x 10 tab
186 Risperidon tablet 2 mg ktk 5 x 10 tab
Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang
187 Pot @ 30 gram
endap 4%
188 Salbutamol tablet 2 mg (sebagai Sulfat) ktk 10 x 10 tab
189 Salbutamol tablet 4 mg (sebagai Sulfat) ktk 10 x 10 tab
190 Salbutamol aerosol / inhalasi 100 cg dus @200 dosis canister
191 Salisil Bedak 2 % ktk 50 gram
192 Sefadroksil sirup kering 125 mg/5ml btl 60 ml
193 Sefadroksil kapsul/kaplet 500 mg ktk 5 x 10 tab
194 Sefiksim kapsul/kaplet 100 mg ktk 5 x 10 kapsul
195 Sefiksim sirup kering 100 mg/ 5 ml btl 30 ml
196 Sefotaksim injeksi 1 g ktk 2 vial
197 Seftazidim injeksi 1 g ktk 2 vial
198 Seftriakson injeksi 1 g ktk 1 vial
199 Setrizine tablet 10 mg ktk 10 x 10 Kapsul
200 Sianokobalamin (vitamin B12) injeksi 500 mcg ktk 100 amp
201 Sianokobalamin (vitamin B12) tablet 50 mg Kotak 10 x 10 tab
202 Simetidin tablet 200 mg ktk 10 x 10 tab
203 Simvastatin tablet 10 mg ktk 5 x 10 tab
204 Simvastatin tablet 20 mg ktk 5 x 10 tab
205 Siprofloksasin infus 2% btl 100 ml
206 Siprofloksasin tablet 500 mg (sebagai HCl) ktk 10 x 10 tab
207 Siprofloksasin tablet 250 mg (sebagai HCl) ktk 10 x 10 tab
208 Spiramisin tablet 500 mg ktk 5 x 10 tab
209 Streptomisin serbuk injeksi I,v, 1000 ml/ml Ktk 56 Vial
210 Sulfasalazin tablet 500 mg btl 500 tab
211 Sulfasetamida Natrium tetes mata 15 % ktk 24 tab @ 5 ml
212 Tablet tambah darah Kotak 100 Sachet
213 Tetrasiklin kapsul/kaplet 250 mg btl 1000 tablet
214 Tetrasiklin kapsul/kaplet 500 mg ktk 10 x 10 tab
215 Tiamfenikol kapsul/kaplet 500 mg ktk 10 x 10 tab
216 Tiamin (Vitamin B1) 100 mg tablet btl 1000 tablet
217 Tiamin (Vitamin B1) injeksi 100 mg/ml ktk 30 amp @ 1 ml
218 Tramadol injeksi 50 mg/ml ktk 5 amp
219 Tramadol kapsul/kaplet/tablet 50 mg ktk 5 x 10 tab
220 Vitamin B Kompleks tablet Kotak 10 x 10 tab
221 Zidovudin tablet 300 mg + Lamivudine tablet 150 mg btl 60 tab
222 Zinc tablet 20 mg ktk 10 x 10 tab
II OBAT GIGI
1 Devitalisasi Pasta (non arsen) botol
2 Etil Klorida Spray vial
3 Eugenol cairan kotak
4 Glass Ionomer Cement ART Set
5 Kalsium Hidroksida Pasta kotak
6 Klorfenol Kamfer Menthol (CHKM) botol
7 Mummifying Pasta botol
8 Semen Seng Fosfat serbuk dan cairan Set
9 Spons Gelatin Cubiles 1 x 1 x 1 cm kotak
10 Temporary stopping (Fletcher) serbuk dan cairan botol
III VAKSIN
1 Rabies kuur
IV SERUM
1 ATS 1.500 amp 1 ml
V Alat Kesehatan
1 Alat Suntik 1 ml pcs
2 Alat Suntik 2,5 ml at 3ml pcs
3 Alat Suntik 5 ml pcs/100
4 Catgut 2/0 With needle Pcs
5 Catgut 3/0 With needle Pcs
6 Foley Catheter No 18 pcs
7 Foley catheter No. 20 pcs
8 Foley Catheter No. 22 pcs
9 Foley Catheter No. 24 pcs
10 Handscoen No. 7 pasang
11 Handscoen No. 7,5 pasang
12 Handscoen No. 8 pasang
13 Handscoen sampai siku pcs
14 Infusion Set Anak Set/Kantong
15 Infusion Set Dewasa Set/Kantong
16 I.V. Catheter No. 16 G Pcs
17 I.V. Catheter No. 18 G Pcs
18 I.V. Catheter No. 20 G Pcs
19 I.V. Catheter No. 22 G Pcs
20 I.V. Catheter No. 24 G Pcs
21 Jarum Jahit n 9 s/d 14 Pcs
22 Kapas Berlemak 500 gram Roll
23 Kapas Pembalut/absorben 250 gram Roll
24 Kasa Kompres 40 / 40 steril Roll
25 Kasa Pembalut Hidrofil 4 m x 15 cm Roll
26 Kasa pembalut Hidrofil 4 m x 3 cm Roll
27 Kasa Pembalut Hidrofil 2 m x 80 cm Pad
28 Kasa Pembalut hidrofil 40 m x 80 cm Roll
29 Masker pcs
30 Pembalut Gips 3 inchi Roll
31 Pembalut Gips 4 inchi Roll
32 Pembalut Gips 6 inchi Roll
33 Plester 5 yard x 2 inchi Roll
34 Pisau Bedah Pcs
35 Sak Obat 14 x 20 cm Pcs
36 Sak Obat 7 x 10 cm Pcs
37 Sak Obat 5 x 4 cm Pcs
38 Silk No. 3/0 Pcs
39 Test kit Asam urat Strip
40 Test kit Glukosa Strip
41 Test kit Kolesterol Strip
42 Underpad Pcs
43 Urine bag pcs
Jumlah
Mengetahui,
Kepala Puskesmas Tampo

(La Ode Poto, SE)


NIP. 19621231 198412 1 048
EDIS PAKAI HABIS (BMHP)
O

Pengadaan
(Kolom 6 - Harga Satuan Jumlah Ket.
kolom 4)

7 8 9 10

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Tampo, Januari 2018
Pengelola Obat Puskesmas Tampo

(Siti Sri Juniati, S.Farm, Apt)


NIP. 19820604 200604 2 018