LX Stabil:
1. STEMI, NSTEMI, UAP
S 2 dd tab VI a.SVT vagal manuver adenosin
R/ Isosorbid dinitrat tab 5 mg No.I
S 1 dd tab I subling _____________________________# R/ Adenosin inj 12 mg/4mL Vial No. I
_____________________________#
R/ Spuit 10 cc No. I Simm
R/ Asam Asetilsalisilat tab 80 mg No.IV Simm _____________________________#
S 1 dd tab IV
_____________________________# _____________________________# b. Afib/Aflutter CCB non
dihidropiridin
R/ Aquabidest Fl. No. I
R/ Clopidogrel tab 75 mg No. II R/ Bisoprolol tab 10 mg No. X
S 1 dd tab II Simm
_____________________________# S 1 dd tab 1
_____________________________#
_____________________________#
2. Stable Angina Pectoris 4. Hipertensi Primer
R/ Isosorbid dinitrat tab 5 mg No.III VT monomorfik amiodaron
R/ Captopril tab 25 mg No. X
S 1 dd tab I subling prn
R/ Amiodaron inj 50 mg/mL Amp. No. I
_____________________________# S 1 dd tab I
R/ Asam Asetilsalisilat tab 80 mg No.X Simm
_____________________________#
S 1 dd tab I
_____________________________#
_____________________________# 5. CHF Stabil
VT polimorfik/torsade de point Defib
Jika ada kolesterol tinggi tambahkan : R/ Furosemide tab 40 mg No. X
R/ Simvastatin tab 20 mg No. X 7. Bradiaritmia
S 1 dd tab I m
S 1 dd tab R/ Atropin inj 0,25 mg/mL
_____________________________# _____________________________#
3. RHD Simm
R/ Captopril tab 25 mg No. X
R/ Benzatin Benzyl Penisilin 1,2 Juta IU/ml _____________________________#
S 1 dd tab I
vial No. I
_____________________________#
Simm
6. Takiaritmia
_____________________________#
Tidak stabil kardioversi tersinkronasi
B. Respirasi _____________________________#
1. Asma
R/ Salbutamol tab 4 mg No. X Lepasan
Dewasa
S 3 dd tab I Kategori I Fase Intensif (2 minggu)
Akut: _____________________________# R/ Rifampicin tab 450 mg No. XV
R/ Salbutamol inj 1 mg/mL Amp No. I R/ Metil Prednisolon tab 4 mg No. X S 1 dd tab I
S i m m pro nebulisasi S 2 dd tab I _____________________________#
_____________________________# _____________________________# R/ Isoniazid tab 300 mg No. XV
R/ Deksametason inj 5 mg/mL Amp No. I R/ Amoksisilin tab 500 mg No. XV S 1 dd tab I
Simm S 3 dd tab I _____________________________#
_____________________________# _____________________________# R/ Pyrazinamid tab 500 mg No. XXX
Pengontrol: 3. Tuberculosis S 1 dd tab II
R/ Salbutamol tab 4 mg No. X Dewasa berat 50 kg _____________________________#
S 3 dd tab I FDC kategori I fase intensif (per 2 R/ Ethambutol tab 500 mg No. XXX
_____________________________# minggu)
S 1 dd tab II
Anak R/ 4 FDC tab No. XV
_____________________________#
R/ Salbutamol tab 2 mg No. X S 1 dd tab III
Kategori II ada streptomisin:
S 3 dd tab I _____________________________#
R/ Streptomisin Inj 1g Vial No. I
_____________________________# FDC kategori I fase lanjutan (per 2
Simm
minggu)
_____________________________#
R/ 2 FDC tab No. XV
2. PPOK
S 1 dd tab III
Akut samain asma
4. Pneumonia S 2 dd tab I _____________________________#
G. Gastroenterologi
1. Disentri bakteri
R/ Ciprofloksasin tab 500 mg No. X
S 2 dd tab I
_____________________________#
2. Disentri amoeba
R/ Metronidazol tab 500 mg No. XX
S 3 dd tab I
_____________________________#
3. Dispepsia
R/ Ranitidin tab 150 mg No X
S 2 dd tab I
_____________________________#
4. Antiemetik
R/ Domperidon tab 10 mg No. X
INFEKSI
Anemia def.Besi
ANAK
R/Sulfas ferrous tab 325 mg No.X
MATA
S 1 dd tab I ac #
THT
MATA
THT
a. Konjungtivitis bakteri a. OMA Stadium oklusi a. OMA Stadium perforasi
R/ Kloramfenikol eye drop 0,5% fl No. I R/ Oxymethazoline 0,05% NS No. I
R/ Amoxycillin 500mg tab No. X
S 4ddgtt I OD/S # S2 dd puff I NDS #
S3 dd tab I #
b. Konjungtivitis alergi R/ Paracetamol500 mg tab No. X
S3 dd tab I #
R/ H2O2 3% sol flNo.I
R/ Sodium Chromolyn 4% eye dropflNo. I
b. OMA Stadium presupurasi (hiperemis) S2 ddgtt 10 ADS #
S4 ddgtt I ODS #
R/ Cetirizine tab 10 mgNo. X R/ Oxymethazoline 0,05% NS No. I R/ Ofloxacin 0,3% ND flNo.I
S1 dd tab I # S2 dd spray I NDS # S2 ddgtt I #
R/ Paracetamol 500 mg tab No. X
c. Konjungtivitis viral b. Rhinitis alergi
S3 dd tab I #
R/ Artificial tears eye drop flNo.I R/ Cetirizine 10 mg tab No X
c. OMA Stadium supurasi
S 4 ddgtt I #
R/ Oxymethazoline 0,05% NS No. I
S1dd tab I #
d. Keratitis jamur
S2 ddpuff I NDS # R/ Oxymethazoline 0,05% NS No. I
R/ Amfoterisin B eye drop flNo.I
R/ Amoxycillin tabn 500mg No. X S2 ddpuff I NDS #
S4 ddgtt I #
S3 dd tab I # c. Laringitis/ Faringitis
e. Glaukoma akut
R/ Paracetamol 500 mg tab No. X
R/ Asetazolamide tab 500 mg No. X R/ Amoxicilin tab 500 mgNo. XXI
S2 dd tab I #
S 3 dd tab I # S 3 dd tab I #
- Miringotomi ->rujuk
R/ Timolol 0,5%eye drop fl No. I R/ Paracetamol tab 500 mg No. XV
S2 ddgtt I OD/S #
S3 dd tab I prn #
f. Hordeolum
d. BPPV&Menniere’s Disease
R/ Kloramfenikol ointment 3% tube No.I
R/ Betahistine mesylate tab8 mg No. X
Sue ODS #
S3 dd tab I pc #
KULIT
SKABIES
TINEA KRURIS/KORPORIS R/ Permethrin 5% cr tube No. I
R/ Ketokonazol 2% 5gram cream tube No.I S ue #
S2 ddue # Jika terjad iinfeksi sekunder, ditambahkan :
TINEA KAPITIS Herpes Simpleks
R/ Griseofulvin tab 500mg No.XV R/ Acyclovir tab 200mg No. XXXV
S 1 dd tab I # S5 dd tab I #
4. Anemia
R/Sulfas ferrous syr 30mg/5ml Fl.1
S 1 dd Cth I
#
OBSGYN 2. HEG
1. ANC R/ Ondansentron tab 8 mg No. X
- TS 1
S 1 dd tab I
R/ Asam folat tab 0,4 mg No. XXX
____________________#
S 1 dd tab I
____________________#
IMS
- TS II dan III
Ikutin kulit
Di atas tambah
R/ Sulfas Ferosus tab 325 mg No.
Implan : Ikutin bedah
XXX
S 1 dd tab I pc
____________________#
- Cegah Spina Bifida
R/ Asam folat tab 4 mg No. XXX
S 1 dd tab I
____________________#
- Cegah Preeklampsia
R/ Kalsium karbonat tab 500 mg No.
LX
S 1 dd tab II
____________________#