JURNAL II

SYRUP

Nama : Risnawati Asri

NIM : 2012004
Gelombang :
Kelompok :1
Asisten :
Sediaan : Syrup

dr. Gabriel

Jl. Basuki Rahmat No.75 Palu

SIP : 265/Kanwil/Nakes/2018

No.1 Tgl.12 Juni 2018

R/ Ekstrak Jahe 100 ml

Ekstrak Bawang Putih tunggal 100 ml

Ekstrak air jeruk nipis 50 ml

Madu 50 ml

S.t.d.d cth I

Pro : Erik (17 thn)

Alamat : Jl Tagkasi No.10 Palu

I. TINJAUAN BAHAN AKTIF
(Kerjakan pada lembar tersendiri)
Meliputi :
FARMAKOLOGI
a. Indikasi
b. Kontraindikasi
c. Efek samping
d. Perhatian
e. Dosis Lazim/Dosis Maksimum
f. Dosis penggunaan
SIFAT FISIKA KIMIA
a. Sinonim
b. Pemerian
c. Kelarutan
d. pH
e. Kompatibilitas
f. Kestabilan
g. Wadah penyimpanan
(Catatan : sertakan beserta literatur)

II. PEMILIHAN BENTUK SEDIAAN

(Tuliskan jenis-jenis sediaan farmasi cair)
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 Bentuk sediaan terpilih adalah :
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 Alasan pemilihan bentuk sediaan :
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 Persyaratan bentuk sediaan terpilih :
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III. PERHITUNGAN DOSIS PAKAI

IV. PEMILIHAN BAHAN TAMBAHAN

a. Pemanis : Syrup simplex
 Macam-macam Pemanis (minimal 3) :
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 Pemanis terpilih :
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 Alasan pemilihan :
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  Konsentrasi :
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b. Pelarut : Propilenglikol
 Macam-macam pengawet (minimal 3) :
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 Pengawet terpilih :
................................................................................................................
 Alasan
pemilihan ........................................................................................................................
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 Konsentrasi :
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c. Flavoring Agent : Gliserin
 Macam-macam flavoring agent (minimal 3) :
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 Pengawet terpilih :
................................................................................................................
 Alasan
pemilihan ........................................................................................................................
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 Konsentrasi :
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V. SPESIFIKASI TERPILIH
 Bentuk sediaan :
 Kadar bahan aktif :
 pH sediaan :
 Ukuran partikel :
 Viskositas :
 Warna :
 Aroma :
 Rasa :

VI. FORMULA ASLI

VII. FORMULA TERPILIH

VIII. PERHITUNGAN BAHAN

IX. PENIMBANGAN BAHAN

Nama Jumlah per R/ Jumlah Total Paraf Asisten
Bahan
 X. CARA PEMBUATAN

XI. RANCANGAN ETIKET

XII. RANCANGAN BROSUR

XIII. RANCANGAN WADAH SEKUNDER

XIV. EVALUASI MUTU SEDIAAN

 Organoleptis
 Warna :
 Aroma :
 Rasa :
 pH :
 Viskositas :
 Volume tuang :

XV. PUSTAKA