A B C D E F G H

1
2 LAPORAN PENGAWASAN STOK DAN PELABELAN HIGH ALERT DAN LASA
3 GUDANG FARMASI RUMAH SAKIT BUKIT ASAM MEDIKA
4
5 Bulan :
6 Tahun :
7 Label
No. Kelas Terapi Nama Generik Sediaan Dalam RS Bentuk Sediaan Jumlah Stok
8 Ya Tidak
9 Kalium Klorida (KCl) 7,46% KCL 7,46 25 mL Injeksi
10 Magnesium Sulfat (MgSO4) 20%; MgSO4 20% 25 mL
Injeksi
11 1 Elektrolit Konsentrat 40% 25 mL MgSO4 40% 25 mL
12 Natrium Klorida (NaCl) 3% 500 mL Otsu - Salin 3% 500 mL Infus
Natrium Bikarbonat (NaHCO3) 8,4%
13 Meylon 8,4% 25 mL Injeksi
25 mL
14 2 Larutan Hipertonik Dextrose >20% D-40% 25 mL Injeksi
15 bupivacain HCL Marcain 0,5% Ampul
16 Ketamin HCL KTM-100 Vial
17 Propofol Recofol-N Vial
18 Anastesi Lokal dan Sevoflurane Sevodex Botol
3
19 Umum Anesfar Injeksi
20 Midazolam Fortanest Injeksi
21 Miloz Injeksi
22 Lidocain Compositum 2% Injeksi
Lidocain + Epinefrin
23 Pehacain Injeksi
24 Gefitinib Irresa 250 mg Tablet
25 Hidroksiurea Hydroxiurea Medac 500 mg Kapsul
26 Imatinib Glivec FCT 100 mg Tablet
4 Sitotoksik
27 Methotrexat Methotrexate Ebewe 2,5 mg Tablet
28 Rheu-Trex 2,5 mg Tablet
29 Tamoxifen Citrat Tamofen 10 mg Tablet
30 Aspilet Chewable 80 mg Tablet
31 Aspirin Thrombo Aspilets 80 mg Tablet
32 Ascardia 80 mg Tablet
33 Clopidogrel 75 mg Tablet
34 Clopidogrel Plavix 75 mg Tablet
35 Plavos 75 mg Tablet
36 Cilostazol Pletaal 50 mg Tablet
37 Dabigatran Etexilate Pradaxa 75 mg Tablet
38 Pradaxa 110 mg Tablet
39 Pengencer Darah dan Edoxaban Lixiana 60 mg Tablet
5
40 Antikoagulan Enoxaparin Levenox 1000anti-XaIU/0,6 mL Injeksi
41 Fondaparinux Arixtra 2,5 mg/0,5 mL Injeksi
42 Diviti Pfs 2,5 mg/0,5 mL Injeksi
43 Vasola 2,5 mg/0,5 mL Injeksi
44 Venax pfs 2,5 mg/0,5 mL Injeksi
45 Heparin Inviclot 5000 IU/mL, 5 mL Injeksi
46 Rivaroksaban Xarelto 10 mg Tablet
47 Xarelto 15 mg Tablet
48 Xarelto 20 mg Tablet
49 Warfarin Simarc 2 mg Tablet
50 Insulin Aspart Novorapid Flexipen 100 U/mL, 3 mL Injeksi
51 Insulin Determine Levemir Flexpen 100 U/mL, 3 mL Injeksi
52 Lantus Solostar 100 U/mL, 3 mL Injeksi
53 6 Insulin Insulin Glargine Lantus XR 300 U/mL, 1,5 mL Injeksi
54 Ezelin 100 U/mL, 3 mL Injeksi
55 Insulin Glulisine Apidra Solostar 100 U/mL, 3 mL Injeksi
56 Insulin Premix Novomix flexpen 100 U/mL, 3 mL Injeksi
Penghambat Atracurium Besilat 50 mg/5 mL, 5
57 7 Atracurium Besilat Injeksi
Neuromuskular mL
58 Epinephrine Epinephrine 1 mg/mL, 1 mL Injeksi
Vasokonstriktor/
8 Norepinephrine Bitartate 1 mg/mL, 1
59 Agonis Adrenergik Norepinephrine Injeksi
mL
60 Digoxin 0,25 mg Tablet
61 Digoxin Fargoxin 0,25 mg/mL, 2 mL Injeksi
62 Fargoxin 0,25 mg Tablet
63 9 Inotropik Dopamin Udopa 40 mg/mL, 5 mL Injeksi
64 Dobutamin HCl 50 mg/mL, 5 mL Injeksi
65 Dobuject 50 mg/mL, 5 mL Injeksi
Dobutamin
66 Dobutan HCl 50 mg/mL, 5 mL Injeksi
67 Inotrop 25 mg/mL, 10 mL Injeksi
68 codein 10 mg Tablet
codein
69 codein 20 mg Tablet

10 Narkotik
 A B C D E F G H
70 Morfina 10 mg/mL, 1 mL Injeksi
Morfine
71 Mst Continous 10 mg Tablet
10 Narkotik
72 Fentanyl 0,05 mg/mL, 2 mL Injeksi
73 Fentanyl Citrate Durogesic Matrix 12,5 MU Transdermal
74 Durogesic Matrix 25 MU Transdermal
75 Pethidine HCl Phetidina 0,25 mg/mL, 2 mL Injeksi
76 11 Cairan Manitol 20, 500 mL Infus
77 Actos Tablet
Pioglitazone
78 Pioglitazone Tablet
79 Glimepiride Tablet
80 Amadiab Tablet
81 Glimepiride Anpiride Tablet
82 Norizec 2 Tablet
83 Simryl 2 Tablet
84 Glucodex Tablet
Gliclazide
85 Diamicron MR Tablet
86 Glucophage Tablet
87 Metformin Tablet
12 Antihiperglikemik Oral Metformin HCL
88 Eraphage Tablet
89 Glumin XR Tablet
90 Gliquidone Gliquidone Tablet
91 Glibenclamid Glibenclamid Tablet
92 Empagliflozin Jardiance Tablet
93 Sitagliptin Januvia Tablet
94 Linagliptin Trajenta Tablet
95 Trimetazidine Trizedon MR Tablet
96 Glimepiride + Metformin HCL Amaryl M Tablet
97 Linagliptin + Metformin HCL Trajenta Duo Tablet
98 Vidagliptin + Metformin HCL Galvusmet Tablet
99 Cordarone 200 mg Tablet
100 Cordarone 50 mg/mL, 3 mL Injeksi
101 13 Anti Aritmia Amiodaron Tiaryt 200 mg Tablet
102 Tiaryt 50 mg/mL, 3 mL Injeksi
103 Aminofluid 500 mL Infus
104 Aminofusin Hepar 500 mL Infus
105 14 Nutrisi Parenteral Aminoleban 500 mL Infus
106 B-Fluid 500 mL Infus
107 Gelofusine 500 mL Infus
108 Stesolid Rectal Rectal
Diazepam
109 Stesolid injeksi Rectal
110 Alprazolam Tablet
Alprazolam
111 Alganax Tablet
112 Clobazam Tablet
Clobazam
113 Asabium Tablet
114 Clozapine Clozapin Tablet
115 15 Psikotropika Estazolam Tablet
Estazolam
116 Esilgan Tablet
117 Lorazepam Merlopam Tablet
118 Trihexyphenidyl Arkine Tablet
Chlordiazepoxide HCl + Clinidium
119 Braxidin Tablet
Brpomide
120 Analsik Tablet
Methampyrone + Diazepam
121 Metaneuron Tablet
122 Oxytocin 10 IU/mL Injeksi
Oxytocin
123 Induxin 10 IU/mL Injeksi
124 Kalsium Glukonas Calcii Gluconas100 mg/mL, 10 mL Injeksi
125 16 Lain-Lain Human albumin 20%, 100 mL Infus
126 Albuminar 20%, 100 mL Infus
127 Human Albumin Octalbin 20%, 100 mL Infus
128 Plasbumin 20 %, 100 mL Infus
129 Plasbumin 25 %, 100 mL Infus
130 17 LASA Seluruh Obat yang Terkategori LASA (Look Alike, Sound Alike)
131
132 Mengetahui
133 Kepala Instalasi Farmasi
134
135
136
137
138 apt. Sintya Lara Marista, S.Farm
 LAPORAN PENGAWASAN STOK DAN PELABELAN HIGH ALERT DAN LASA
FARMASI RUMAH SAKIT BUKIT ASAM MEDIKA

Bulan :
Tahun :
Label
No. Kelas Terapi Nama Generik Sediaan Dalam RS Bentuk Sediaan Jumlah Stok
Ya Tidak
Kalium Klorida (KCl) 7,46% KCL 7,46 25 mL Injeksi

Magnesium Sulfat (MgSO4) 20%; MgSO4 20% 25 mL

Injeksi
1 Elektrolit Konsentrat 40% 25 mL MgSO4 40% 25 mL
Natrium Klorida (NaCl) 3% 500 mL Otsu - Salin 3% 500 mL Infus
Natrium Bikarbonat (NaHCO3) 8,4%
Meylon 8,4% 25 mL Injeksi
25 mL
2 Larutan Hipertonik Dextrose >20% D-40% 25 mL Injeksi
Ketamin HCL KTM-100 Vial
Propofol Propofol Vial
Sevoflurane Sevoflurane Botol
3 Anastesi Lokal dan Umum
Midazolam Anesfar Injeksi
Lidocain Compositum 2% Injeksi
Lidocain + Epinefrin
Pehacain Injeksi
Hidroksiurea Hydroxiurea Medac 500 mg Kapsul
Imatinib Imatero 100 mg Tablet
4 Sitotoksik
Methotrexat Rheu-Trex 2,5 mg Tablet
Tamoxifen Citrat Tamofen 10 mg Tablet
Aspilet Chewable 80 mg Tablet
Thrombo Aspilets 80 mg Tablet
Aspirin
Aptor 100 mg Tablet
Ascardia 80 mg Tablet
Clopidogrel 75 mg Tablet
Clopidogrel
Plavix 75 mg Tablet
Pletaal 50 mg Tablet
Cilostazol
Cilostazol 100 mg Tablet
Dabigatran Etexilate Pradaxa 110 mg Tablet
Pengencer Darah dan
5 Edoxaban Lixiana 60 mg Tablet
Antikoagulan
Enoxaparin Levenox 1000anti-XaIU/0,6 mL Injeksi
Arixtra 2,5 mg/0,5 mL Injeksi
Fondaparinux Vasola 2,5 mg/0,5 mL Injeksi
Venax pfs 2,5 mg/0,5 mL Injeksi
Heparin Inviclot 5000 IU/mL, 5 mL Injeksi
Xarelto 10 mg Tablet
Rivaroksaban Xarelto 15 mg Tablet
Xarelto 20 mg Tablet
Warfarin Simarc 2 mg Tablet
6 Insulin Insulin Aspart Novorapid Flexipen 100 U/mL, 3 mL Injeksi
Insulin Determine Levemir Flexpen 100 U/mL, 3 mL Injeksi
Lantus Solostar 100 U/mL, 3 mL Injeksi
Insulin Glargine Lantus XR 300 U/mL, 1,5 mL Injeksi
Ezelin 100 U/mL, 3 mL Injeksi
Insulin Glulisine Apidra Solostar 100 U/mL, 3 mL Injeksi
Novomix flexpen 100 U/mL, 3 mL Injeksi
Insulin Premix
Ryzodeg 100 U/mL, 3 mL Injeksi
Penghambat Atracurium Besilat 50 mg/5 mL, 5
7 Atracurium Besilat Injeksi
Neuromuskular mL

Epinephrine Epinephrine 1 mg/mL, 1 mL Injeksi

Vasokonstriktor/Agonis
8
Adrenergik Norepinephrine Bitartate 1 mg/mL, 1
Norepinephrine Injeksi
mL
Digoxin 0,25 mg Tablet
Digoxin
Fargoxin 0,25 mg/mL, 2 mL Injeksi
9 Inotropik Dopamin Proinfarik 20 mg/mL Injeksi
Dobutamin HCl 50 mg/mL, 5 mL Injeksi
Dobutamin
Inotrop 25 mg/mL, 10 mL Injeksi
codein codein 10 mg Tablet
Morfine Mst Continous 10 mg Tablet
10 Narkotik Fentanyl 0,05 mg/mL, 2 mL Injeksi
Fentanyl Citrate
Durogesic Matrix 12,5 MU Transdermal
Pethidine HCl Phetidina 0,25 mg/mL, 2 mL Injeksi
11 Cairan Manitol 20, 500 mL Infus
Pioglitazone Actos 15 mg Tablet
Actos 30 mg Tablet
Pioglitazone 15 mg Tablet
Pioglitazone 30 mg Tablet
Glimepiride Glimepiride 1 mg Tablet
Glimepiride 2 mg Tablet
 Glimepiride 3 mg Tablet
Glimepiride 4 mg Tablet
Gliclazide Glucodex Tablet
Gliklazide 80 mg Tablet
Diamicron MR Tablet
Fonylin MR 60 mg Tablet
12 Antihiperglikemik Oral
Metformin HCL Glucophage 500 mg Tablet
Metformin 500 mg Tablet
Eraphage 500 mg Tablet
Glumin XR Tablet
Gliquidone Gliquidone Tablet
Empagliflozin Jardiance Tablet
Linagliptin Trajenta 5 mg Tablet
Trimetazidine Trizedon MR Tablet
Glimepiride + Metformin HCL Amaryl M Tablet
Velacom Plus Tablet
Linagliptin + Metformin HCL Trajenta Duo Tablet
Vidagliptin + Metformin HCL Galvusmet Tablet
Tiaryt 200 mg Tablet
Amiodarone 50 mg/mL Injeksi
13 Anti Aritmia Amiodaron
Tiaryt 50 mg/mL, 3 mL Injeksi
Aminofusin Hepar 500 mL Infus
Aminoleban 500 mL Infus
14 Nutrisi Parenteral B-Fluid 500 mL Infus
Gelofusine 500 mL Infus
Gelofusal 500 mL Infus
Valisanbe 2 mg Tablet
Valisanbe 5 mg Tablet
Diazepam Diazepam Rectal Rectal
Stesolid Rectal Rectal
Valisanbe injeksi Rectal
Alprazolam 0,5 mg Tablet
Alprazolam 1 mg Tablet
Alprazolam
Alganax 0,5 mg Tablet
Alganax 1 mg Tablet
Clobazam Clobazam 10 mg Tablet
15 Psikotropika
Clozapin 25 mg Tablet
Clozapine
Clozapin 100 mg Tablet
Estazolam Esilgan 2 mg Tablet
Lorazepam Merlopam Tablet
Arkine Tablet
Trihexyphenidyl Hexymer 2 mg Tablet
Trihexyphenidyl 2 mg Tablet
Chlordiazepoxide HCl + Clinidium
Braxidin Tablet
Brpomide
Methampyrone + Diazepam Analsik Tablet
Oxytocin 10 IU/mL Injeksi
Oxytocin
Induxin 10 IU/mL Injeksi
16 Lain-Lain Kalsium Glukonas Calcii Gluconas100 mg/mL, 10 mL Injeksi
Human albumin 20%, 100 mL Infus
Human Albumin Octalbin 25%, 100 mL Infus
Plasbumin 25 %, 100 mL Infus
17 LASA Seluruh Obat yang Terkategori LASA (Look Alike, Sound Alike)

Mengetahui
Kepala Instalasi Farmasi

apt. Sintya Lara Marista, S.Farm

 LAPORAN PENGAWASAN STOK DAN PELABELAN HIGH ALERT DAN LASA
RUANG PELAYANAN FARMASI RUMAH SAKIT BUKIT ASAM MEDIKA

Bulan :
Tahun :
Label
No. Kelas Terapi Nama Generik Sediaan Dalam RS Bentuk Sediaan Jumlah Stok
Ya Tidak
Kalium Klorida (KCl) 7,46% KCL 7,46 25 mL Injeksi

Magnesium Sulfat (MgSO4) 20%; MgSO4 20% 25 mL

Injeksi
1 Elektrolit Konsentrat 40% 25 mL MgSO4 40% 25 mL
Natrium Klorida (NaCl) 3% 500 mL Otsu - Salin 3% 500 mL Infus
Natrium Bikarbonat (NaHCO3) 8,4%
Meylon 8,4% 25 mL Injeksi
25 mL
2 Larutan Hipertonik Dextrose >20% D-40% 25 mL Injeksi
bupivacain HCL Marcain 0,5% Ampul
Ketamin HCL KTM-100 Vial
Propofol Recofol-N Vial
Anastesi Lokal dan Sevoflurane Sevodex Botol
3
Umum Anesfar Injeksi
Midazolam Fortanest Injeksi
Miloz Injeksi
Lidocain Compositum 2% Injeksi
Lidocain + Epinefrin
Pehacain Injeksi
Gefitinib Irresa 250 mg Tablet
Hidroksiurea Hydroxiurea Medac 500 mg Kapsul
Imatinib Glivec FCT 100 mg Tablet
4 Sitotoksik
Methotrexat Methotrexate Ebewe 2,5 mg Tablet
Rheu-Trex 2,5 mg Tablet
Tamoxifen Citrat Tamofen 10 mg Tablet
Aspilet Chewable 80 mg Tablet
Aspirin Thrombo Aspilets 80 mg Tablet
Ascardia 80 mg Tablet
Clopidogrel 75 mg Tablet
Clopidogrel Plavix 75 mg Tablet
Plavos 75 mg Tablet
Cilostazol Pletaal 50 mg Tablet
Dabigatran Etexilate Pradaxa 75 mg Tablet
Pradaxa 110 mg Tablet
Pengencer Darah dan Edoxaban Lixiana 60 mg Tablet
5
Antikoagulan Enoxaparin Levenox 1000anti-XaIU/0,6 mL Injeksi
Fondaparinux Arixtra 2,5 mg/0,5 mL Injeksi
Diviti Pfs 2,5 mg/0,5 mL Injeksi
Vasola 2,5 mg/0,5 mL Injeksi
Venax pfs 2,5 mg/0,5 mL Injeksi
Heparin Inviclot 5000 IU/mL, 5 mL Injeksi
Rivaroksaban Xarelto 10 mg Tablet
Xarelto 15 mg Tablet
Xarelto 20 mg Tablet
Warfarin Simarc 2 mg Tablet
Insulin Aspart Novorapid Flexipen 100 U/mL, 3 mL Injeksi
Insulin Determine Levemir Flexpen 100 U/mL, 3 mL Injeksi
Lantus Solostar 100 U/mL, 3 mL Injeksi
6 Insulin Insulin Glargine Lantus XR 300 U/mL, 1,5 mL Injeksi
Ezelin 100 U/mL, 3 mL Injeksi
Insulin Glulisine Apidra Solostar 100 U/mL, 3 mL Injeksi
Insulin Premix Novomix flexpen 100 U/mL, 3 mL Injeksi
Penghambat Atracurium Besilat 50 mg/5 mL, 5
7 Atracurium Besilat Injeksi
Neuromuskular mL
Epinephrine Epinephrine 1 mg/mL, 1 mL Injeksi
Vasokonstriktor/
8 Norepinephrine Bitartate 1 mg/mL, 1
Agonis Adrenergik Norepinephrine Injeksi
mL
Digoxin 0,25 mg Tablet
Digoxin Fargoxin 0,25 mg/mL, 2 mL Injeksi
Fargoxin 0,25 mg Tablet
9 Inotropik Dopamin Udopa 40 mg/mL, 5 mL Injeksi
Dobutamin HCl 50 mg/mL, 5 mL Injeksi
Dobuject 50 mg/mL, 5 mL Injeksi
Dobutamin
Dobutan HCl 50 mg/mL, 5 mL Injeksi
Inotrop 25 mg/mL, 10 mL Injeksi
codein 10 mg Tablet
codein
codein 20 mg Tablet
Morfina 10 mg/mL, 1 mL Injeksi
Morfine
10 Narkotik
 Morfine
Mst Continous 10 mg Tablet
10 Narkotik
Fentanyl 0,05 mg/mL, 2 mL Injeksi
Fentanyl Citrate Durogesic Matrix 12,5 MU Transdermal
Durogesic Matrix 25 MU Transdermal
Pethidine HCl Phetidina 0,25 mg/mL, 2 mL Injeksi
11 Cairan Manitol 20, 500 mL Infus
Actos Tablet
Pioglitazone
Pioglitazone Tablet
Glimepiride Tablet
Amadiab Tablet
Glimepiride Anpiride Tablet
Norizec 2 Tablet
Simryl 2 Tablet
Glucodex Tablet
Gliclazide
Diamicron MR Tablet
Glucophage Tablet
Metformin Tablet
12 Antihiperglikemik Oral Metformin HCL
Eraphage Tablet
Glumin XR Tablet
Gliquidone Gliquidone Tablet
Glibenclamid Glibenclamid Tablet
Empagliflozin Jardiance Tablet
Sitagliptin Januvia Tablet
Linagliptin Trajenta Tablet
Trimetazidine Trizedon MR Tablet
Glimepiride + Metformin HCL Amaryl M Tablet
Linagliptin + Metformin HCL Trajenta Duo Tablet
Vidagliptin + Metformin HCL Galvusmet Tablet
Cordarone 200 mg Tablet
Cordarone 50 mg/mL, 3 mL Injeksi
13 Anti Aritmia Amiodaron Tiaryt 200 mg Tablet
Tiaryt 50 mg/mL, 3 mL Injeksi
Aminofluid 500 mL Infus
Aminofusin Hepar 500 mL Infus
14 Nutrisi Parenteral Aminoleban 500 mL Infus
B-Fluid 500 mL Infus
Gelofusine 500 mL Infus
Stesolid Rectal Rectal
Diazepam
Stesolid injeksi Rectal
Alprazolam Tablet
Alprazolam
Alganax Tablet
Clobazam Tablet
Clobazam
Asabium Tablet
Clozapine Clozapin Tablet
15 Psikotropika Estazolam Tablet
Estazolam
Esilgan Tablet
Lorazepam Merlopam Tablet
Trihexyphenidyl Arkine Tablet
Chlordiazepoxide HCl + Clinidium
Braxidin Tablet
Brpomide
Analsik Tablet
Methampyrone + Diazepam
Metaneuron Tablet
Oxytocin 10 IU/mL Injeksi
Oxytocin
Induxin 10 IU/mL Injeksi
Kalsium Glukonas Calcii Gluconas100 mg/mL, 10 mL Injeksi
16 Lain-Lain Human albumin 20%, 100 mL Infus
Albuminar 20%, 100 mL Infus
Human Albumin Octalbin 20%, 100 mL Infus
Plasbumin 20 %, 100 mL Infus
Plasbumin 25 %, 100 mL Infus
17 LASA Seluruh Obat yang Terkategori LASA (Look Alike, Sound Alike)

Mengetahui
Kepala Instalasi Farmasi

apt. Sintya Lara Marista, S.Farm