Bukti Pelaksanaan Obat Lasa Dan High Alert [PDF]

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A. FORMULIR MONITORING PELABELAN LASA NO



NAMA OBAT LASA



1



Acyclovir 200mg



Acyclovir 400mg



2



Amlodipin 5mg



Amlodipin 10 mg



3



Cefixim 100 mg



4 5



Cefixim 200 mg Meloxicam 15 Meloxicam 7,5 mg mg



6



Piroxicam 10 mg Paracetamol 500 mg



Piroxicam 20 mg Paracetamol 650 mg



7



Tramadol 50 mg



Tramadol Plus



8



Bisoprolol 2,5 mg Candesartan 8 mg



Bisoprolol 5 mg Candesartan 16 mg



10



Captopril 12,5 mg



Captopril 25 mg



11



Lisinopril 5 mg



Lisinopril 10 mg



12



Nifedipin 10 mg



Nifedipin 30 mg



13



Ramipril 2,5 mg Levotiroxin 50 mcg



Ramipril 5 mg Levotiroxin 100 mcg



Glimepirid 2 mg Allopurinol 100 mg Fenopibrat 100 mg



Glimepirid 4 mg Allopurinol 300 mg Fenopibrat 300 mg



9



14 15 16 17 18



Asam Folat 400 mcg



Asam Folat 1 mg



JML



LABEL HIGH ALERT SDH



BLM



TERPASA



TERPASA



NG



NG



19



Piracetam 800 mg



Vitamin B6 Methylprednisolo n 8 mg Flunarizine 10 mg Piracetam 1.200 mg



23



Salbutamol 2 mg



Salbutamol 4 mg



24



MgSO4 20% Pamol 80 mg supp



MgSO4 40% Pamol 160 mg supp



Stesolid 5 mg AMOXcilin



Stesolid 10 mg AMPIcilin



500mg



500mg



28



TETRAcilin



DOXYcilin



29



AZITROmicin



CLINDAmicin



30



CIPROfloxacin



LEVOfloxacin



31



KETOconazole



FLUconazole



32



MIconazole



KETOconazole



33



COTRIMOXazol



20



Vitamin B1 Methylprednisolon 4 mg



21 Flunarizine 5 mg 22



25 26 27



e



ciLOSTazole



34



metRODINazole



metAMIzole



35



metFORMIN



metRODINazole



36



ANTalgin



MIONalgin



37



ERalgin



ANTalgin



38



IBUprofen



KETOprofen



39



PARACEtamol



SALBUtamol



40



PROPANolol



BISOPRolol



41



AMLOdipin



niFEdipin



42



niCARdipin



AMLOdipin



43



CAPTopril



LISINopril



44



RAMIpril



CAPTopril



45



gliBENCLAMID



gliMEPIRID



46



gliQUIDON



gliBENCLAMID



47



methylPREDNISo methylEGROME lon



48 49



TRIN methylPREDNIS



TRIAMCINolon



olon



asam



asam



MEFENamat



TRANEXamat



50



asam asam FOLAT



MEFENamat



51



levoPAR



levoTIROXINE



52



FLUNARIzine



CETIRIzine



53



CHLORPOMAzi ne



FLUNARIzine



54



ciTICOLIN



ciLOSTazole



55



BETAmetason



DESOXImetason



56



HYDROCORTIs on



DEXAmetason



57



cefOTAXIM



cefTRIAXONE



58



cefADROXIL



cefIXIM



59



FLAmicort



PULmicort



60



CYANOcobalami n



MEcobalamin



61



amiNOPILIN



amiODARON



62



doBUTamin



doPAMINE



63



NORepineprin



epinePRIN



64



kCL



kSR



65



Asam



ciTICOLIN



TRANEXamat injeksi 66



injeksi



cefOTAXIM



cefTRIAXONE



injeksi



injeksi



Diphenhydramine



Metamizole



injeksi



injeksi



68



Ventolin neb



Combiven neb



69



Aminopilin injeksi



Furamin injeksi



70



D40% flash



Kcl flash



71



MgSO4 flash



Mylon flash



72



Ranitidine injeksi



Diazepam injeksi



67



B. FORMULIR MONITORING PELABELAN HIGH ALERT NO



NAMA OBAT HIGH ALERT



1



Atropin Sulfat Injeksi



2



Amiodaron Injeksi



3



Apidra



4



Bupivacaine HCl



5



Calcium Gluconas Injeksi



6



Dobutamin Injeksi



7



Dopamin Injeksi



8



Digoxin Injeksi



9



D40% Infus



10



Enoxaparin Injeksi



11



Epedrin Injeksi



12



Heparin Injeki



13



Hydroxyurea



14



KCL 7,46% Infus



15



Ketamin Injeksi



16



KSR Tablet



17



Isoflurance



18



Lantus



19



Levemir



20



Lidokain Injeksi



21



Mannitol Infus



22



MgSO4 20 % Infus



23



MgSo4 40 % Infus



24



Meylon Infus



JUMLAH



LABEL HIGH ALERT SDH



BLM



TERPASANG



TERPASANG



25



Nacl 3% Infus



26



Neostigmine Methylsulfate Injeksi



27



Nicardipin Injeksi



28



Norephineprin Injeksi



29



Novorapid



30



Oxytocin Injeksi



31



Pehacain Injeksi



32



Propofol



33



Phenitoin Injeksi



34



Regivel



35



Sevoflurance



36



Tracium



37



Codein tab



38



Etanyl injeksi



39



Fentanyl injeksi



40



Morfin injeksi



41



Pethidine injeksi



42



Phenorbabital tablet



43



Miloz injeksi



44



Diazepam injeksi



45



Stesolid Sirup



46



Stesolid Rectal 5 mg



47



Stesolid Rectal 10 mg



48



Alprazolam 0,5 mg



49



Valisanbe tab



50



Clobazam 10 mg tab



51



Phenobarbital injeksi



52



Haloperidol 5 mg



injeksi



C. BUKTI PELAKSANAAN PENYEDIAAN, PENYIMPANAN, PENATAAN, PENYIAPAN DAN PENGGUNAAN OBAT YANG PERLU DIWASPADAI PENYEDIAAN



GAMBAR 1. SURAT PESANAN HIGH ALERT



PENYIMPANAN



GAMBAR 2. PENYIMPANAN OBAT-OBAT LASA



PENYIMPANAN DAN PENATAAN



GAMBAR 3. PENYIMPANAN OBAT-OBAT HIGH ALERT



PENYIAPAN DAN PERESEPAN



GAMBAR 4. PERESEPAN OBAT-OBAT HIGH ALERT



PENYIAPAN DAN PERESEPAN



GAMBAR 5. PERESEPAN OBAT-OBAT HIGH ALERT



Diperiksa,