A. Cardiovaskular
LX Stabil:
1. STEMI, NSTEMI, UAP
R/ Isosorbid dinitrat tab 5 mg No.I
S 1 dd tab I subling
_____________________________#
R/ Asam Asetilsalisilat tab 80 mg No.IV
S 1 dd tab IV
_____________________________#
R/ Clopidogrel tab 75 mg No. II
S 1 dd tab II
_____________________________#
2. Stable Angina Pectoris
R/ Isosorbid dinitrat tab 5 mg No.III
S 1 dd tab I subling prn
_____________________________#
R/ Asam Asetilsalisilat tab 80 mg No.X
S 1 dd tab I
_____________________________#
Jika ada kolesterol tinggi tambahkan :
R/ Simvastatin tab 20 mg No. X
S 1 dd tab
_____________________________#
3. RHD
R/ Benzatin Benzyl Penisilin 1,2 Juta IU/ml
vial No. I
Simm
_____________________________#
R/ Prednison tab 5 mg No.
S 2 dd tab VI a.SVT  vagal manuver  adenosin
_____________________________# R/ Adenosin inj 12 mg/4mL Vial No. I
R/ Spuit 10 cc No. I Simm
Simm _____________________________#
_____________________________# b. Afib/Aflutter  CCB non
dihidropiridin
R/ Aquabidest Fl. No. I
R/ Bisoprolol tab 10 mg No. X
Simm
S 1 dd tab 1
_____________________________#
_____________________________#
4. Hipertensi Primer
VT monomorfik  amiodaron
R/ Captopril tab 25 mg No. X
R/ Amiodaron inj 50 mg/mL Amp. No. I
S 1 dd tab I
Simm
_____________________________#
_____________________________#
5. CHF Stabil
VT polimorfik/torsade de point  Defib
R/ Furosemide tab 40 mg No. X
7. Bradiaritmia
S 1 dd tab I m
R/ Atropin inj 0,25 mg/mL
_____________________________#
Simm
R/ Captopril tab 25 mg No. X
_____________________________#
S 1 dd tab I
_____________________________#
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
Rawat Jalan:
R/ Ciprofloksasin tab 500 mg No. X
S 2 dd tab I
_____________________________#
R/ Ambroxol tab 30 mg No. XV
S 3 dd tab I
_____________________________#
C. Neurologi
1. Bell’s Palsy
R/ Prednison tab 5 mg No. LX
S 3 dd tab IV pc
_____________________________#
R/ Ranitidin tab 150 mg No. X
S 2 dd tab I
_____________________________#
2. CTS/HNP/LBP
R/ Natrium Diklofenak tab 50 mg No. XV
S 3 dd tab I pc
_____________________________#
R/ Ranitidin tab 150 mg No. X
S 2 dd tab I
_____________________________#
3. TTH
R/ Paracetamol tab 500 mg No. X
S 2 dd tab II
_____________________________#
4. Migraine (di PPK IDI pake PCT
dulu ga bisa baru ergot/triptan)
R/ Ergotamin tab 1 mg No. I
S 1 dd tab I
_____________________________#
5. Cluster Headache
Oksigen 4L/menit
R/ Ergotamin tab 1 mg No. I
S 1 dd tab I
_____________________________#
6. Tetanus
R/ Prokain benzyl penisilin inj 1,2 juta IU
fl. No. IV
SImm
_____________________________#
R/ Anti tetanus serum inj 20.000 IU No.
III
SImm
_____________________________#
R/ Diazepam inj 5 mg/mL No. I
SImm
_____________________________#
7. Trigeminal Neuralgia
R/ Carbamazepine tab 100 mg No. X
S 1 dd tab I
_____________________________#
8. Stroke Iskemik/TIA
R/ Asam asetilsalisilat tab 80 mg No. IV
S 1 dd tab IV
_____________________________#
R/ Sitikolin tab 500 mg No. II
S 2 dd tab I
_____________________________#
R/ Simvastatin tab 20 mg No. X
S 1 dd tab I
_____________________________#
R/ Asam folat tab 0,4 mg No. X
S 1 dd tab I
_____________________________#
9. Stroke Hemoragik
R/ Sitikolin tab 500 mg No. II
S 2 dd tab I
_____________________________#
D. Muskuloskeletal
1. OA
R/ Natrium diklofenak tab 50 mg No. X
S 2 dd tab I pc
_____________________________#
2. GA
Akut:
R/ Kolkisin tab 0,5 mg No. X
S 3 dd tab I pc
_____________________________#
Akut sudah tertangani:
R/ Allopurinol tab 100 mg No. X
S 1 dd tab I
_____________________________#
3. Sprain/Strain/Fraktur
R/ Asam mefenamat tab 500 mg No. XV
S 3 dd tab I pc
_____________________________#
E. Psikiatri
1. Psikotik
Gejala positif:
R/ Haloperidol tab 2 mg No. V
S 2 dd tab I
_____________________________#
R/ Triheksifenidil tab 2 mg No. V
S 1 dd tab I
_____________________________#
gejala negative:
R/ Risperidon tab 2 mg No. V
S 2 dd tab I
_____________________________#
2. Depresi
R/ Fluoxetine cap 10 mg No. V
S 1 dd cap I
_____________________________#
3. Bipolar
R/ Asam valproate tab 500 mg No. X
S 3 dd tab I
_____________________________#
4. Anxietas
R/ Alprazolam tab 0,5 mg No. III
S 1 dd tab I n
_____________________________#
Ada gejala depresinya (ex: PTSD) bisa
ditambah fluoxetine
F. Urologi
1. UTI
Uncomplicated
R/ Kotrimoksazol tab 960 mg No. X
S 2 dd tab I
_____________________________#
Complicated/Pyelonefritis
R/ Ciprofloxacin tab 500 mg No. X
S 2 dd tab I S 3 dd tab I
_____________________________# _____________________________#
2. BPH
R/ Tamsulosin tab 0,4 mg No. X
S 1 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

Leptospirosis Cacing2an Malaria

R/Doksisiklin caps 100 mg No. XV Malaria falciparum
S 2 dd caps I # R/Albendazole tab 400 mg No. I R/ACT (DHP) tab No.IX
R/ Paracetamol tab 500 mg No. X S1 dd tab 1 # S 3 dd tab I #
S 3 dd tab I prn # R/Primakuin tab 25mg No.I
S 1 dd tab I #
Skistosomiasis dan Taeneasis
R/Praziquantel tab 600 mg No.V MalariaVivax/ovale
S 2dd tab 2 1/2 # R/ACT (DHP) tab No. IX
Tifoid Filariasis S 3 dd tab I #
R/Ciprofloxacin tab 500mg No. XX Contoh resep untuk BB 50kg R/Primakuin tab 25mg No.XIV
S 2 dd tab I # R/ Dietilcarbamazin 50mg tab No. LXXII S 1dd tab I #
R/ Paracetamol tab 500 mg No. X
S 3 dd tab I prn #
S 3dd tab 2 #
Malaria malariae
R/ Paracetamol tab 500 mg No. X
R/ACT (DHP) tab No.IX
S 3 dd tab I prn #
S 3 dd tab I #
DENGUE
R/ Paracetamol tab 500 mg No. X
S 3 dd tab I prn #

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 #

PTIRIASIS VERSIKOLOR Varicella/ HZ

R/ Acyclovir tab 400 mgNo. LXX
R/ Selenium sulfida 1% shampoo flNo.I
S5 dd tab II #
S ue (Seminggu3x, 15 menitsebelummandi) #
Akne
PEDIKULOSIS KAPITIS
R/ Asamtretinoin 0.025% cr tube No. I
R/ R/ Malathion 0,5 % lotion fl No. I S 1 ddue #
Suc (tutup handuk diamkan 8-12 jam) # R/ Doksisiklintab 100 mgNo. XXVIII
PEDIKULOSIS KORPORIS/PUBIS S 2 dd tab I pc #
R/ Permethrin 1% cr tube No. I PIODERMA
S ue # R/ Amoxicillin tab 500 mg No. XV
S3 dd tab I #
R/ Mupirosin 2% cr tube No.I
S2 dd ue #
Kusta INFEKSI MENULAR SEKSUAL
R/ Rifampicin tab 300mg No. II Sifilis Primer
S1 dd tab II #
R/ Benzatin- benzilpenisilin 2,4 jt IU No. I
R/ Klofazimin caps100mg No. III
S imm #
S1 ddcaps III #
Chancroid
R/ Dapsontab100mg No. XXX
S1 dd tab I # R/ Siprofloksasin tab 500 mg No.VI

R/ Klofazimincaps50mg No. XXX S 2 dd tab I pc #

S1 ddcaps I (mulaihari ke-2) # Herpes Genital
R/ Acyclovirtab 200 mg No.XXXV
DKA/DKI S 5 dd tab I #
Topikal :
Duh tubuhec BV atautrikomoniasis
R/ Hidrokortison 1% cr tube No.I
R/ Metronidazol tab 500 mgNo.IV
S 4 ddue #
S 2 dd tab I #
Untuk DKA, ditambah :
Duh tubuhecKandidiasis
R/ Cetirizine tab 10mg No.X
R/ Flukonazol tab 150 mgNo.I
S 1 dd tab I #
S 1 dd tab I #
Gonore
NEURODERMATITIS
R/ Sefiksim tab 200 mg No. II
R/ Klobetasol propionate 0,05% cr tube No.I
S 1 dd tab II #
S 2 ddue #
R/ Azitromisin tab 500 mg No. II
R/ Cetirizine tab 10mg No.X
S 1 dd tab II #
S 1 dd tab I #
ANAK

1. Apapun sakitnya jika demam 5. Diare

(+)
R/Paracetamol syr 125mg/5ml Fl.I Dehidrasi diare
S 3 dd Cth I prn # R/Oralit sachet No.X
S prn #
R/Amoxicilin syr 250mg/5ml Fl.1
S 3 dd Cth I (habiskan) # Tambah:
Usia >6bln :
2. Semua Infeksi Cacing (kecuali
R/ Zinc tab 20mg No. XIV
enterobiasis)
S 1dd tab 1 pc #
R/Albendazol tab 200 mg No.I
Usia<6bln:
S 1dd tab I #
R/ Zinc tab 20mg No. VII
3. Enterobiasis S 1dd tab 1/2 pc #
R/Pirantel pamoat tab 125 mg No.I
S 1 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
____________________#