Lampiran 1. Lembar Pengumpulan Data Evaluasi Ketepatan Obat dan Dosis pada Pasien Diabetes Mellitus Tipe II dengan Komplikasi Hipertensi di RSUD Dr. Moewardi Surakarta Periode Januari-April 2014.
36
Lampiran 1. Lembar Pengumpulan Data
No.
No.Reg
Umur Jk
( th)
TD
(mmHg)
GDP
GD2JPP
1.
2.
3.
4.
01225329
00539479
01027757
00866801
54
50
74
74
L
L
L
P
140/90
120/80
180/110
120/80
280
-
475
-
5.
6.
00509177
00456756
76
56
L
P
130/60
180/80
131
351
130
462
7.
8.
9.
.
10.
00689898
00611145
00812890
77
58
61
L
L
P
140/70
140/80
150/80
153
136
233
234
00840218
67
L
110/80
109
256
11.
12.
01221859
01125027
52
65
L
L
110/80
160/90
119
118
184
13.
00665024
67
P
130/70
160
221
14
00368763
65
L
170/70
-
140
15.
00919748
55
P
140/90
117
143
16.
01128225
64
P
120/70
127
178
17
18.
01234101
01005860
69
57
P
P
140/80
150/60
-
-
Obat
Antidiabetik
Dosis
(mg)
Frek
(kali/hari)
Standar
Obat
antihipertensi
Dosis (mg)
250-3000
80-320
250-3000
30-120
12-16
12-16
Frek
1-3
1-2
1-3
2-3
-
250-3000
30-120
1-6
-
1-3
2-3
1
-
250-3000
30-120
100-300
80-320
100-300
250-3000
1x1
3x1
2x1
3x1
Inj. Novomix
Metformin
Inj. Novomix
Glucodex
Glucotika
Lodem
Levemir
Novorapid
Inj. Novomix
Metformin
Lodem
Solosa
Inj.Novorapid
Inj.Levemir
Inj.Novorapid
Metformin
Glikuidon
Eclid
Glucodek
Inj. Novomix
Eclid
Metformin
16-0-16
500
14-0-14
40
500
30
0-0-0-16
10-10-8
22-0-22
500
30
2
18-18-16
0-0-0-2
10-10-8
500
30
50
80
38-0-40
50
500
2x1
3x1
2x1
2x1
1x1
3x1
1x1
3x1
2x1
3x1
3x1
1x1
3x1
1x1
3x1
3x1
3x1
3x1
3x1
2x1
2x1
3x1
Solosa
Eclid
Inj. Novomix
Acarbose
2
50
16-0-16
50
Obat lain
Amlodipin
Propanolol
Tanapres
HCT
Amlodipin
Tenapril
-
Aspilet
Intervask
-
Aspilet
Aspilet
Intervask
-
1-3
2-3
3
1-2
3
1-3
Furosemid
Amlodipin
-
Amdixal
-
-
Aspilet
-
Aspilet
1-6
100-300
50-100
1
3
3
Canderin
-
Canderin
Amlodipin
Furosemid
Aspilet
-
Keterangan
(obat antidiabetik)
Tepat obat Tepat dosis
TO
TD
TO
TD
TO
TD
TO
TD
TO
TD
TO
TD
TTO
TD
TTO
TD
TO
TD
TO
TD
TO
TD
TO
TD
TTO
TD
TTO
TD
TO
TD
TO
TD
TO
TD
TO
TD
TO
TTD
TTO
TO
TTD
TO
TD
TO
TO
TO
TO
TD
TD
TD
TD
19.
00911735
57
P
150/80
174
310
Inj. Levemir
Eclid
0-0-10
50
1x1
3x1
10-14
100-300
3
-
Vaclo
TO
TO
TD
TD
20.
00670497
55
P
140/90
140
167
Gludepatic
Glimepirid
850
2
2x1
1x1
250-3000
1-6
1-3
1
-
CPG
TO
TO
TD
TD
36
37
No.
No.Reg
Umur Jk
( th)
TD
(mmHg)
GDP
GD2JPP
Obat
Antidiabetik
Dosis
(mg)
Frek
(kali/hari)
Standar
Obat
antihipertensi
Obat lain
Keterangan
(obat antidiabetik)
Tepat obat Tepat dosis
TO
TD
TO
TD
21.
00766292
65
L
150/70
367
489
Metformin
Glibenclamide
850
5
3x1
2x1
Dosis (mg)
250-3000
2.5-15
Frek
1-3
1-2
Captopril
HCT
-
22.
00298336
65
L
130/70
-
-
Inj. Novomix
Gludepatic
26-0-26
500
2x1
3x1
250-3000
1-3
Intervask
-
TTO
TO
TD
23.
24.
25.
00905223
00834416
00689859
60
54
58
L
L
P
150/80
130/90
150/90
297
-
287
-
Diaversa
Inj. Novomix
Levemir
Glidiab
2
34-0-34
0-0-26
30
1x1
2x1
1x1
3x1
1-6
30-120
1
2-3
Tenapril
Tenapril
Tenapril
-
TO
TO
TTO
TO
TD
TD
TD
26.
00956748
54
L
120/80
96
84
Diaversa
Gludepatic
2
500
1x1
3x1
1-6
250-3000
1
1-3
Canderin
-
TO
TO
TD
TD
27.
00378802
65
L
140/90
-
-
Inj. Novorapid
Lantus
Gludepatic
8-8-8
0-0-2
500
3x1
1x1
3x1
250-3000
1-3
Canderin
-
TTO
TTO
TO
TD
28.
00864530
52
L
180/100
-
-
Gludepatic
Glucobay
500
50
3x1
3x1
250-3000
50-100
1-3
3
Candersartan
-
TO
TO
TD
TD
29.
00587499
55
P
150/110
193
284
Selosa
Gludepatic
2
500
1x1
2x1
1-6
250-3000
1
1-3
Intervask
-
TO
TO
TD
TD
30.
00890114
61
L
150/100
-
-
Lantus Flexpen
0-0-0-20
1x1
-
-
Candesartan
Amlodipin
-
TO
TD
31.
32.
00981701
01172719
56
61
P
P
140/90
140/80
91
176
146
178
Metformin
Humulin R
Metformin
500
8-8-6
500
2x1
3x1
3x1
250-3000
10-14
250-3000
1-3
1-3
Amlodipin
Captopril
Diltiazem
-
TO
TO
TD
TTD
TD
33
34.
00980692
00803792
61
52
P
P
160/80
190/100
196
284
Metformin
Humulin N
Merformin
500
10-0-10
500
3x1
3x1
3x1
250-3000
12-16
250-3000
1-3
1-3
Canderin
Captopril
Diltiazem
-
TO
TTO
TO
TD
TTD
TD
35.
36.
37.
00509177
00588221
00662667
76
56
74
L
L
L
110/70
130/80
140/80
131
163
177
130
209
225
Lodem
Solosa
Eclid
Glidiab
30
2
100
30
3x1
1x1
3x1
3x1
30-120
1-6
100-300
30-120
2-3
1
3
2-3
Tenapril
Tenapril
-
Aspilet
Vaclo
TO
TO
TO
TO
TD
TD
TD
TD
37
38
No.
No.Reg
Umur Jk
( th)
TD
(mmHg)
GDP
GD2JPP
Obat
Antidiabetik
Dosis
(mg)
Frek
(kali/hari)
Standar
Obat
antihipertensi
38.
00717805
51
L
110/80
-
-
Eclid
Gludepatic
100
500
3x1
3x1
Dosis (mg)
100-300
250-3000
Frek
3
1-3
39.
00852606
54
L
130/96
-
-
Eclid
Gludepatic
50
500
3x1
3x1
100-300
250-3000
40.
00862046
60
L
140/70
117
128
Eclid
Glidiab
50
30
3x1
3x1
41.
00873414
59
L
150/90
180
371
Novorapid
Levemir
18-18-18
0-0-0-22
42.
00897343
66
P
170/100
156
274
Gludepatic
Eclid
Glidiab
43.
01065678
61
L
140/70
130
100
44.
01110304
66
L
120/80
95
232
45.
46.
47.
01199746
01234428
00264553
50
46
72
P
P
L
140/90
160/100
130/70
112
168
-
120
-
48.
00055922
55
L
140/90
230
49.
00157584
65
P
160/70
.50
00342504
62
L
51.
00267047
58
P
Obat lain
Keterangan
(obat antidiabetik)
Tepat obat Tepat dosis
TO
TD
TO
TD
Noperten
-
3
1-3
Canderin
-
TO
TO
TD
TD
100-300
30-120
3
2-3
Intervask
-
TO
TO
TD
TD
3x1
1x1
10-14
10-14
-
-
vaclo
TTO
TTO
TTD
TTD
500
50
30
3x1
3x1
3x1
250-3000
100-300
30-120
1-3
3
2-3
Canderin
-
TO
TO
TO
TD
TD
TD
Gludepatic
Eclid
Glidiab
500
50
30
3x1
3x1
3x1
250-3000
100-300
30-120
1-3
3
2-3
Alpentin
TO
TO
TO
TD
TD
TD
Metformin
Eclid
Diamicron
Metformin
Metformin
Gludepatic
Glucodex
500
50
40
500
500
500
80
2x1
3x1
2x1
3x1
3x1
3x1
3x1
250-3000
100-300
80
250-3000
250-3000
250-3000
80-320
1-3
3
1-2
1-3
1-3
1-3
1-2
Canderin
-
Captopril
Captopril
Valsartan
-
TO
TO
TO
TO
TO
TO
TO
TD
TD
TD
TD
TD
TTD
TD
337
Novomix flexpen
Metformin
52-0-52
500
2x1
3x1
12-16
250-3000
1-3
Candesartan
-
TTO
TO
TTD
TD
181
335
Lodem
Eclid
30
50
3x1
3x1
30-120
100-300
2-3
3
Canderin
HCT
-
TO
TO
TD
TD
120/90
386
317
Diamicron
Eclid
Gludepatic
20
100
500
2x1
3x1
3x1
80-320
100-300
250-3000
1-2
3
1-3
Adalat
-
TO
TO
TO
TTD
TD
TD
170/90
179
252
Inj. levemir
Gludepatic
0-0-0-44
500
1x1
3x1
10-14
250-3000
1-3
Intervask
-
TTO
TO
TTD
TD
38
39
No.
No.Reg
Umur Jk
( th)
TD
(mmHg)
GDP
GD2JPP
Obat
Antidiabetik
Dosis
(mg)
Frek
(kali/hari)
Standar
Obat
antihipertensi
Obat lain
Keterangan
(obat antidiabetik)
Tepat obat Tepat dosis
TTO
TTD
TO
TD
52.
00414025
70
L
140/80
140
224
Inj. levemir
Metformin
0-0-0-22
500
1x1
3x1
Dosis (mg)
8-12
250-3000
Frek
1-3
Intervask
Irbesartan
-
53.
00425749
60
L
180/110
-
-
Lodem
Gludepatic
30
500
3x1
3x1
30-120
250-3000
2-3
1-3
Intervask
Noperten
-
TO
TO
TD
TD
54.
00307997
61
P
150/100
343
434
Lodem
Eclid
30
100
3x1
3x1
30-120
100-300
2-3
3
Canderin
-
TO
TO
TD
TD
55.
00160973
67
L
140/90
-
-
Inj. novomix
Eclid
4-0-4
100
2x1
2x1
100-300
3
Noperten
-
TTO
TO
TTD
56.
57.
01239857
01234143
67
64
L
P
140/90
150/90
214
303
Metformin
Novopid
Metformin
500
6-6-6
500
3x1
3x1
3x1
250-3000
12-16
250-3000
1-3
1-3
Captopril
Captopril
HCT
-
TO
TTO
TO
TD
TTD
TD
58.
01175132
48
P
160/90
-
-
Gludepatic
Eclid
500
100
3x1
3x1
250-3000
100-300
1-3
3
Tenapril
Propanolol
-
TO
TO
TD
TD
59.
01124776
61
L
120/80
109
275
Eclid
Glucodex
50
80
3x1
3x1
100-300
80-320
3
1-2
Tenapril
-
TO
TO
TD
TTD
60.
01063262
53
P
110/80
152
238
Glidiab
Eclid
30
50
3x1
3x1
30-120
100-300
2-3
3
Canderin
-
TO
TO
TD
TD
61.
01049357
61
P
150/90
-
-
Gludepatic
Eclid
500
50
3x1
3x1
250-3000
100-300
1-3
3
Tenapril
-
TO
TO
TD
TD
62.
01057874
52
L
130/80
194
261
Solosa
Eclid
2
50
3x1
3x1
1-6
100-300
1
3
Canderin
-
TO
TO
TTD
TD
63.
64.
65
00804644
00749660
00644911
50
69
65
P
P
L
150/90
120/80
160/80
126
131
164
126
197
172
Gludepatic
Metformin
Gludepatic
Eclid
500
500
500
50
2x1
3x1
3x1
3x1
250-3000
250-3000
250-3000
100-300
1-3
1-3
1-3
3
Intervask
Captopril
Intervask
Canderin
-
TO
TO
TO
TO
TD
TD
TD
TD
66.
00319555
59
L
130/80
-
-
Deculin
Diaversa
Eclid
15
3
100
1x1
1x1
2x1
15-30
1-6
100-300
1
1
3
-
Aspilet
TO
TO
TO
TD
TD
TD
67.
00957011
55
L
130/80
-
-
Novomix flexpen
20-0-20
2x1
-
-
Furosemid
Aspilet
TTO
-
39
40
No.
No.Reg
Umur Jk
( th)
TD
(mmHg)
GDP
GD2JPP
Obat
Antidiabetik
Dosis
(mg)
Frek
(kali/hari)
Standar
Obat
antihipertensi
68.
00455997
48
P
150/100
118
182
Glidiab
Eclid
30
100
3x1
2x1
Dosis (mg)
30-120
100-300
Frek
2-3
3
69.
00912564
57
L
130/80
153
176
Novorapid
Levemir
6-6-4
0-0-0-4
3x1
1x1
10-14
10-14
70.
01240269
56
L
130/100
-
-
Inj. novomix
Metformin
10-0-10
500
2x1
3x1
71.
72.
01239624
00711551
57
55
L
L
140/90
140/100
196
194
315
Glibenklamid
Humalog mix
Eclid
5
24-0-24
50
73.
00141185
77
L
150/90
161
261
Lodem
Eclid
74.
00304948
64
P
120/70
118
150
75.
00514779
58
P
120/80
112
76.
00714531
64
P
130/80
77.
01167386
62
L
78.
00489611
71
79.
00860360
80.
81.
Obat lain
Keterangan
(obat antidiabetik)
Tepat obat Tepat dosis
TO
TD
TO
TTD
Actapin
Canderin
-
-
-
Aspilet
TTO
TTO
TTD
TTD
250-3000
1-3
-
Vaclo
TTO
TO
TD
1x1
2x1
3x1
2.5-15
100-300
1-2
3
Canderin
Aspilet
Aspilet
TO
TTO
TO
TD
TTD
TD
30
50
3x1
3x1
30-120
100-300
2-3
3
Tenapril
-
TO
TO
TD
TD
Eclid
Glukotica
50
500
3x1
3x1
100-300
250-3000
3
1-3
Intervask
Canderin
-
TO
TO
TD
TD
126
Lodem
Eclid
Gludepatic
30
50
500
3x1
3x1
3x1
30-120
100-300
250-3000
2-3
3
1-3
Intervask
-
TO
TO
TO
TD
TD
TD
200
126
Novomix
Eclid
16-0-16
50
2x1
3x1
12-16
100-300
3
Tenapril
Intervask
-
TTO
TO
TD
TD
160/80
218
337
Diaversa
Glukotica
Eclid
2
850
50
1
2x1
3x1
1-6
250-3000
100-300
1
1-3
3
CPG
-
TO
TO
TO
TD
TD
TD
L
90/60
164
185
Eclid
Diamicron MR
100
30
3x1
1x1
100-300
30-60
3
1
Intervask
-
TO
TO
TD
TD
52
L
120/70
155
213
L
130/80
176
197
3x1
3x1
3x1
1x1
3x1
30-120
250-3000
100-300
1-6
250-3000
2-3
1-3
3
1
1-3
Ganin
73
30
500
50
2
500
-
00246671
Lodem
Gludepatic
Eclid
Solosa
Gludepatic
Intervask
-
TO
TO
TO
TO
TO
TD
TD
TD
TD
TD
01190678
46
P
150/100
-
-
Inj. Levemir
Inj. Novorapid
0-0-0-10
16-16-16
1x1
3x1
Furosemid
-
TTO
-
-
40
41
No.
No.Reg
Umur Jk
( th)
TD
(mmHg)
GDP
GD2JPP
Obat
Antidiabetik
Dosis
(mg)
Frek
(kali/hari)
Standar
Obat
antihipertensi
82.
00197003
73
L
170/100
122
235
Gludepatic
Lodem
Eclid
500
30
50
3x1
3x1
3x1
Dosis (mg)
250-3000
30-120
100-300
Frek
1-3
2-3
3
83.
00457502
55
P
140/90
145
183
Novomix pen
Gludepatic
58-0-0-58
500
2x1
3x1
10-14
250-3000
84.
85.
86.
01030879
01125027
01228119
52
65
65
P
L
P
130/90
120/70
150/80
98
224
136
356
Metformin
Metformin
Inj. Levemir
Metformin
500
500
0-0-0-14
500
1x1
3x1
1x1
3x1
87.
00482835
50
P
130/70
-
-
Metformin
Solosa
500
2
88.
89.
01241561
01030050
61
54
L
P
140/100
150/80
243
313
Inj. novomix
Gludepatic
Eclid
Lodem
90.
91.
00684977
00644525
57
66
P
L
130/80
140/90
121
265
92.
93.
00749660
00751661
69
59
P
P
140/70
120/80
152
-
94.
00792162
60
P
120/90
95.
96.
97.
01231614
00803421
00931219
50
66
56
P
L
P
98
01246902
55
P
Obat lain
Keterangan
(obat antidiabetik)
Tepat obat Tepat dosis
TO
TD
TO
TD
TO
TD
Amlodipin
-
1-3
Adalat oros
Clonidin
-
TTO
TO
TTD
TD
250-3000
250-3000
250-3000
1-3
1-3
1-3
Captopril
Candesartan
Amlodipin
-
TO
TO
TTO
TO
TD
TD
TD
TD
3x1
1x1
250-3000
1-6
1-3
1
Amlodipin
-
TO
TO
TD
TD
14-0-12
500
50
30
2x1
3x1
3x1
3x1
250-3000
100-300
30-120
1-3
3
2-3
Amlodipin
-
Ganin
TTO
TO
TO
TO
TD
TD
TD
Metformin
Glidiab
Gludepatic
Eclid
500
30
500
50
2x1
3x1
3x1
3x1
250-3000
30-120
250-3000
100-300
1-3
2-3
1-3
3
Amlodipin
Noperten
-
TO
TO
TO
TO
TD
TD
TD
TD
258
390
Metformin
Novomix
Eclid
850
18-0-18
50
3x1
2x1
3x1
250-3000
100-300
1-3
3
Captopril
Intervask
-
TO
TTO
TO
TD
TD
485
412
Novorapid
18-18-16
3x1
12-16
-
Furosemid
Captopril
-
TTO
TTD
140/90
120/80
120/80
118
-
135
-
Inj. Humulin R
Glmepiride
Novomix
Eclid
12-12-10
2
46-0-46
50
3x1
1x1
2x1
3x1
1-6
100-300
1
3
Captopril
Tenapril
Candesartan
-
TO
TTO
TO
TD
TD
150/90
-
-
Novorapid
Metformin
12-12-12
500
3x1
2x1
250-3000
1-3
Captopril
-
TTO
TO
TD
41
42
No.
No.Reg
Umur Jk
( th)
TD
(mmHg)
GDP
GD2JPP
Obat
Antidiabetik
Dosis
(mg)
Frek
(kali/hari)
Standar
Obat
antihipertensi
Obat lain
99.
01248427
51
P
150/90
288
362
Glikuidon
Metformin
30
500
2x1
3x1
Dosis (mg)
30-120
250-3000
Frek
2-3
1-3
Amlodipin
Furosemid
-
100.
01093088
62
L
150/90
470
-
Novorapid
Metformin
10-10-10
500
3x1
3x1
12-16
250-3000
1-3
HCT
Captopril
-
Keterangan
(obat antidiabetik)
Tepat obat Tepat dosis
TO
TD
TO
TD
TTO
TO
TTD
TD
42
43
44
45
46
Lampiran 1. Lembar Pengumpulan Data
No.
No.Reg
Umur Jk
( th)
TD
(mmHg)
GDP
GD2JPP
1.
2.
3.
4.
01225329
00539479
01027757
00866801
54
50
74
74
L
L
L
P
140/90
120/80
180/110
120/80
280
-
475
-
5.
6.
00509177
00456756
76
56
L
P
130/60
180/80
131
351
130
462
7.
8.
9.
.
10.
00689898
00611145
00812890
77
58
61
L
L
P
140/70
140/80
150/80
153
136
233
234
00840218
67
L
110/80
109
256
11.
12.
01221859
01125027
52
65
L
L
110/80
160/90
119
118
184
13.
00665024
67
P
130/70
160
221
14
00368763
65
L
170/70
-
140
15.
00919748
55
P
140/90
117
143
16.
01128225
64
P
120/70
127
178
17
18.
01234101
01005860
69
57
P
P
140/80
150/60
-
-
Obat
Antidiabetik
Dosis
(mg)
Frek
(kali/hari)
Standar
Obat
antihipertensi
Dosis (mg)
250-3000
80-320
250-3000
30-120
12-16
12-16
Frek
1-3
1-2
1-3
2-3
-
250-3000
30-120
1-6
-
1-3
2-3
1
-
250-3000
30-120
100-300
80-320
100-300
250-3000
1x1
3x1
2x1
3x1
Inj. Novomix
Metformin
Inj. Novomix
Glucodex
Glucotika
Lodem
Levemir
Novorapid
Inj. Novomix
Metformin
Lodem
Solosa
Inj.Novorapid
Inj.Levemir
Inj.Novorapid
Metformin
Glikuidon
Eclid
Glucodek
Inj. Novomix
Eclid
Metformin
16-0-16
500
14-0-14
40
500
30
0-0-0-16
10-10-8
22-0-22
500
30
2
18-18-16
0-0-0-2
10-10-8
500
30
50
80
38-0-40
50
500
2x1
3x1
2x1
2x1
1x1
3x1
1x1
3x1
2x1
3x1
3x1
1x1
3x1
1x1
3x1
3x1
3x1
3x1
3x1
2x1
2x1
3x1
Solosa
Eclid
Inj. Novomix
Acarbose
2
50
16-0-16
50
Obat lain
Amlodipin
Propanolol
Tanapres
HCT
Amlodipin
Tenapril
-
Aspilet
Intervask
-
Aspilet
Aspilet
Intervask
-
1-3
2-3
3
1-2
3
1-3
Furosemid
Amlodipin
-
Amdixal
-
-
Aspilet
-
Aspilet
1-6
100-300
50-100
1
3
3
Canderin
-
Canderin
Amlodipin
Furosemid
Aspilet
-
Keterangan
(obat antidiabetik)
Tepat obat Tepat dosis
TO
TD
TO
TD
TO
TD
TO
TD
TO
TD
TO
TD
TTO
TD
TTO
TD
TO
TD
TO
TD
TO
TD
TO
TD
TTO
TD
TTO
TD
TO
TD
TO
TD
TO
TD
TO
TD
TO
TTD
TTO
TO
TTD
TO
TD
TO
TO
TO
TO
TD
TD
TD
TD
19.
00911735
57
P
150/80
174
310
Inj. Levemir
Eclid
0-0-10
50
1x1
3x1
10-14
100-300
3
-
Vaclo
TO
TO
TD
TD
20.
00670497
55
P
140/90
140
167
Gludepatic
Glimepirid
850
2
2x1
1x1
250-3000
1-6
1-3
1
-
CPG
TO
TO
TD
TD
36
37
No.
No.Reg
Umur Jk
( th)
TD
(mmHg)
GDP
GD2JPP
Obat
Antidiabetik
Dosis
(mg)
Frek
(kali/hari)
Standar
Obat
antihipertensi
Obat lain
Keterangan
(obat antidiabetik)
Tepat obat Tepat dosis
TO
TD
TO
TD
21.
00766292
65
L
150/70
367
489
Metformin
Glibenclamide
850
5
3x1
2x1
Dosis (mg)
250-3000
2.5-15
Frek
1-3
1-2
Captopril
HCT
-
22.
00298336
65
L
130/70
-
-
Inj. Novomix
Gludepatic
26-0-26
500
2x1
3x1
250-3000
1-3
Intervask
-
TTO
TO
TD
23.
24.
25.
00905223
00834416
00689859
60
54
58
L
L
P
150/80
130/90
150/90
297
-
287
-
Diaversa
Inj. Novomix
Levemir
Glidiab
2
34-0-34
0-0-26
30
1x1
2x1
1x1
3x1
1-6
30-120
1
2-3
Tenapril
Tenapril
Tenapril
-
TO
TO
TTO
TO
TD
TD
TD
26.
00956748
54
L
120/80
96
84
Diaversa
Gludepatic
2
500
1x1
3x1
1-6
250-3000
1
1-3
Canderin
-
TO
TO
TD
TD
27.
00378802
65
L
140/90
-
-
Inj. Novorapid
Lantus
Gludepatic
8-8-8
0-0-2
500
3x1
1x1
3x1
250-3000
1-3
Canderin
-
TTO
TTO
TO
TD
28.
00864530
52
L
180/100
-
-
Gludepatic
Glucobay
500
50
3x1
3x1
250-3000
50-100
1-3
3
Candersartan
-
TO
TO
TD
TD
29.
00587499
55
P
150/110
193
284
Selosa
Gludepatic
2
500
1x1
2x1
1-6
250-3000
1
1-3
Intervask
-
TO
TO
TD
TD
30.
00890114
61
L
150/100
-
-
Lantus Flexpen
0-0-0-20
1x1
-
-
Candesartan
Amlodipin
-
TO
TD
31.
32.
00981701
01172719
56
61
P
P
140/90
140/80
91
176
146
178
Metformin
Humulin R
Metformin
500
8-8-6
500
2x1
3x1
3x1
250-3000
10-14
250-3000
1-3
1-3
Amlodipin
Captopril
Diltiazem
-
TO
TO
TD
TTD
TD
33
34.
00980692
00803792
61
52
P
P
160/80
190/100
196
284
Metformin
Humulin N
Merformin
500
10-0-10
500
3x1
3x1
3x1
250-3000
12-16
250-3000
1-3
1-3
Canderin
Captopril
Diltiazem
-
TO
TTO
TO
TD
TTD
TD
35.
36.
37.
00509177
00588221
00662667
76
56
74
L
L
L
110/70
130/80
140/80
131
163
177
130
209
225
Lodem
Solosa
Eclid
Glidiab
30
2
100
30
3x1
1x1
3x1
3x1
30-120
1-6
100-300
30-120
2-3
1
3
2-3
Tenapril
Tenapril
-
Aspilet
Vaclo
TO
TO
TO
TO
TD
TD
TD
TD
37
38
No.
No.Reg
Umur Jk
( th)
TD
(mmHg)
GDP
GD2JPP
Obat
Antidiabetik
Dosis
(mg)
Frek
(kali/hari)
Standar
Obat
antihipertensi
38.
00717805
51
L
110/80
-
-
Eclid
Gludepatic
100
500
3x1
3x1
Dosis (mg)
100-300
250-3000
Frek
3
1-3
39.
00852606
54
L
130/96
-
-
Eclid
Gludepatic
50
500
3x1
3x1
100-300
250-3000
40.
00862046
60
L
140/70
117
128
Eclid
Glidiab
50
30
3x1
3x1
41.
00873414
59
L
150/90
180
371
Novorapid
Levemir
18-18-18
0-0-0-22
42.
00897343
66
P
170/100
156
274
Gludepatic
Eclid
Glidiab
43.
01065678
61
L
140/70
130
100
44.
01110304
66
L
120/80
95
232
45.
46.
47.
01199746
01234428
00264553
50
46
72
P
P
L
140/90
160/100
130/70
112
168
-
120
-
48.
00055922
55
L
140/90
230
49.
00157584
65
P
160/70
.50
00342504
62
L
51.
00267047
58
P
Obat lain
Keterangan
(obat antidiabetik)
Tepat obat Tepat dosis
TO
TD
TO
TD
Noperten
-
3
1-3
Canderin
-
TO
TO
TD
TD
100-300
30-120
3
2-3
Intervask
-
TO
TO
TD
TD
3x1
1x1
10-14
10-14
-
-
vaclo
TTO
TTO
TTD
TTD
500
50
30
3x1
3x1
3x1
250-3000
100-300
30-120
1-3
3
2-3
Canderin
-
TO
TO
TO
TD
TD
TD
Gludepatic
Eclid
Glidiab
500
50
30
3x1
3x1
3x1
250-3000
100-300
30-120
1-3
3
2-3
Alpentin
TO
TO
TO
TD
TD
TD
Metformin
Eclid
Diamicron
Metformin
Metformin
Gludepatic
Glucodex
500
50
40
500
500
500
80
2x1
3x1
2x1
3x1
3x1
3x1
3x1
250-3000
100-300
80
250-3000
250-3000
250-3000
80-320
1-3
3
1-2
1-3
1-3
1-3
1-2
Canderin
-
Captopril
Captopril
Valsartan
-
TO
TO
TO
TO
TO
TO
TO
TD
TD
TD
TD
TD
TTD
TD
337
Novomix flexpen
Metformin
52-0-52
500
2x1
3x1
12-16
250-3000
1-3
Candesartan
-
TTO
TO
TTD
TD
181
335
Lodem
Eclid
30
50
3x1
3x1
30-120
100-300
2-3
3
Canderin
HCT
-
TO
TO
TD
TD
120/90
386
317
Diamicron
Eclid
Gludepatic
20
100
500
2x1
3x1
3x1
80-320
100-300
250-3000
1-2
3
1-3
Adalat
-
TO
TO
TO
TTD
TD
TD
170/90
179
252
Inj. levemir
Gludepatic
0-0-0-44
500
1x1
3x1
10-14
250-3000
1-3
Intervask
-
TTO
TO
TTD
TD
38
39
No.
No.Reg
Umur Jk
( th)
TD
(mmHg)
GDP
GD2JPP
Obat
Antidiabetik
Dosis
(mg)
Frek
(kali/hari)
Standar
Obat
antihipertensi
Obat lain
Keterangan
(obat antidiabetik)
Tepat obat Tepat dosis
TTO
TTD
TO
TD
52.
00414025
70
L
140/80
140
224
Inj. levemir
Metformin
0-0-0-22
500
1x1
3x1
Dosis (mg)
8-12
250-3000
Frek
1-3
Intervask
Irbesartan
-
53.
00425749
60
L
180/110
-
-
Lodem
Gludepatic
30
500
3x1
3x1
30-120
250-3000
2-3
1-3
Intervask
Noperten
-
TO
TO
TD
TD
54.
00307997
61
P
150/100
343
434
Lodem
Eclid
30
100
3x1
3x1
30-120
100-300
2-3
3
Canderin
-
TO
TO
TD
TD
55.
00160973
67
L
140/90
-
-
Inj. novomix
Eclid
4-0-4
100
2x1
2x1
100-300
3
Noperten
-
TTO
TO
TTD
56.
57.
01239857
01234143
67
64
L
P
140/90
150/90
214
303
Metformin
Novopid
Metformin
500
6-6-6
500
3x1
3x1
3x1
250-3000
12-16
250-3000
1-3
1-3
Captopril
Captopril
HCT
-
TO
TTO
TO
TD
TTD
TD
58.
01175132
48
P
160/90
-
-
Gludepatic
Eclid
500
100
3x1
3x1
250-3000
100-300
1-3
3
Tenapril
Propanolol
-
TO
TO
TD
TD
59.
01124776
61
L
120/80
109
275
Eclid
Glucodex
50
80
3x1
3x1
100-300
80-320
3
1-2
Tenapril
-
TO
TO
TD
TTD
60.
01063262
53
P
110/80
152
238
Glidiab
Eclid
30
50
3x1
3x1
30-120
100-300
2-3
3
Canderin
-
TO
TO
TD
TD
61.
01049357
61
P
150/90
-
-
Gludepatic
Eclid
500
50
3x1
3x1
250-3000
100-300
1-3
3
Tenapril
-
TO
TO
TD
TD
62.
01057874
52
L
130/80
194
261
Solosa
Eclid
2
50
3x1
3x1
1-6
100-300
1
3
Canderin
-
TO
TO
TTD
TD
63.
64.
65
00804644
00749660
00644911
50
69
65
P
P
L
150/90
120/80
160/80
126
131
164
126
197
172
Gludepatic
Metformin
Gludepatic
Eclid
500
500
500
50
2x1
3x1
3x1
3x1
250-3000
250-3000
250-3000
100-300
1-3
1-3
1-3
3
Intervask
Captopril
Intervask
Canderin
-
TO
TO
TO
TO
TD
TD
TD
TD
66.
00319555
59
L
130/80
-
-
Deculin
Diaversa
Eclid
15
3
100
1x1
1x1
2x1
15-30
1-6
100-300
1
1
3
-
Aspilet
TO
TO
TO
TD
TD
TD
67.
00957011
55
L
130/80
-
-
Novomix flexpen
20-0-20
2x1
-
-
Furosemid
Aspilet
TTO
-
39
40
No.
No.Reg
Umur Jk
( th)
TD
(mmHg)
GDP
GD2JPP
Obat
Antidiabetik
Dosis
(mg)
Frek
(kali/hari)
Standar
Obat
antihipertensi
68.
00455997
48
P
150/100
118
182
Glidiab
Eclid
30
100
3x1
2x1
Dosis (mg)
30-120
100-300
Frek
2-3
3
69.
00912564
57
L
130/80
153
176
Novorapid
Levemir
6-6-4
0-0-0-4
3x1
1x1
10-14
10-14
70.
01240269
56
L
130/100
-
-
Inj. novomix
Metformin
10-0-10
500
2x1
3x1
71.
72.
01239624
00711551
57
55
L
L
140/90
140/100
196
194
315
Glibenklamid
Humalog mix
Eclid
5
24-0-24
50
73.
00141185
77
L
150/90
161
261
Lodem
Eclid
74.
00304948
64
P
120/70
118
150
75.
00514779
58
P
120/80
112
76.
00714531
64
P
130/80
77.
01167386
62
L
78.
00489611
71
79.
00860360
80.
81.
Obat lain
Keterangan
(obat antidiabetik)
Tepat obat Tepat dosis
TO
TD
TO
TTD
Actapin
Canderin
-
-
-
Aspilet
TTO
TTO
TTD
TTD
250-3000
1-3
-
Vaclo
TTO
TO
TD
1x1
2x1
3x1
2.5-15
100-300
1-2
3
Canderin
Aspilet
Aspilet
TO
TTO
TO
TD
TTD
TD
30
50
3x1
3x1
30-120
100-300
2-3
3
Tenapril
-
TO
TO
TD
TD
Eclid
Glukotica
50
500
3x1
3x1
100-300
250-3000
3
1-3
Intervask
Canderin
-
TO
TO
TD
TD
126
Lodem
Eclid
Gludepatic
30
50
500
3x1
3x1
3x1
30-120
100-300
250-3000
2-3
3
1-3
Intervask
-
TO
TO
TO
TD
TD
TD
200
126
Novomix
Eclid
16-0-16
50
2x1
3x1
12-16
100-300
3
Tenapril
Intervask
-
TTO
TO
TD
TD
160/80
218
337
Diaversa
Glukotica
Eclid
2
850
50
1
2x1
3x1
1-6
250-3000
100-300
1
1-3
3
CPG
-
TO
TO
TO
TD
TD
TD
L
90/60
164
185
Eclid
Diamicron MR
100
30
3x1
1x1
100-300
30-60
3
1
Intervask
-
TO
TO
TD
TD
52
L
120/70
155
213
L
130/80
176
197
3x1
3x1
3x1
1x1
3x1
30-120
250-3000
100-300
1-6
250-3000
2-3
1-3
3
1
1-3
Ganin
73
30
500
50
2
500
-
00246671
Lodem
Gludepatic
Eclid
Solosa
Gludepatic
Intervask
-
TO
TO
TO
TO
TO
TD
TD
TD
TD
TD
01190678
46
P
150/100
-
-
Inj. Levemir
Inj. Novorapid
0-0-0-10
16-16-16
1x1
3x1
Furosemid
-
TTO
-
-
40
41
No.
No.Reg
Umur Jk
( th)
TD
(mmHg)
GDP
GD2JPP
Obat
Antidiabetik
Dosis
(mg)
Frek
(kali/hari)
Standar
Obat
antihipertensi
82.
00197003
73
L
170/100
122
235
Gludepatic
Lodem
Eclid
500
30
50
3x1
3x1
3x1
Dosis (mg)
250-3000
30-120
100-300
Frek
1-3
2-3
3
83.
00457502
55
P
140/90
145
183
Novomix pen
Gludepatic
58-0-0-58
500
2x1
3x1
10-14
250-3000
84.
85.
86.
01030879
01125027
01228119
52
65
65
P
L
P
130/90
120/70
150/80
98
224
136
356
Metformin
Metformin
Inj. Levemir
Metformin
500
500
0-0-0-14
500
1x1
3x1
1x1
3x1
87.
00482835
50
P
130/70
-
-
Metformin
Solosa
500
2
88.
89.
01241561
01030050
61
54
L
P
140/100
150/80
243
313
Inj. novomix
Gludepatic
Eclid
Lodem
90.
91.
00684977
00644525
57
66
P
L
130/80
140/90
121
265
92.
93.
00749660
00751661
69
59
P
P
140/70
120/80
152
-
94.
00792162
60
P
120/90
95.
96.
97.
01231614
00803421
00931219
50
66
56
P
L
P
98
01246902
55
P
Obat lain
Keterangan
(obat antidiabetik)
Tepat obat Tepat dosis
TO
TD
TO
TD
TO
TD
Amlodipin
-
1-3
Adalat oros
Clonidin
-
TTO
TO
TTD
TD
250-3000
250-3000
250-3000
1-3
1-3
1-3
Captopril
Candesartan
Amlodipin
-
TO
TO
TTO
TO
TD
TD
TD
TD
3x1
1x1
250-3000
1-6
1-3
1
Amlodipin
-
TO
TO
TD
TD
14-0-12
500
50
30
2x1
3x1
3x1
3x1
250-3000
100-300
30-120
1-3
3
2-3
Amlodipin
-
Ganin
TTO
TO
TO
TO
TD
TD
TD
Metformin
Glidiab
Gludepatic
Eclid
500
30
500
50
2x1
3x1
3x1
3x1
250-3000
30-120
250-3000
100-300
1-3
2-3
1-3
3
Amlodipin
Noperten
-
TO
TO
TO
TO
TD
TD
TD
TD
258
390
Metformin
Novomix
Eclid
850
18-0-18
50
3x1
2x1
3x1
250-3000
100-300
1-3
3
Captopril
Intervask
-
TO
TTO
TO
TD
TD
485
412
Novorapid
18-18-16
3x1
12-16
-
Furosemid
Captopril
-
TTO
TTD
140/90
120/80
120/80
118
-
135
-
Inj. Humulin R
Glmepiride
Novomix
Eclid
12-12-10
2
46-0-46
50
3x1
1x1
2x1
3x1
1-6
100-300
1
3
Captopril
Tenapril
Candesartan
-
TO
TTO
TO
TD
TD
150/90
-
-
Novorapid
Metformin
12-12-12
500
3x1
2x1
250-3000
1-3
Captopril
-
TTO
TO
TD
41
42
No.
No.Reg
Umur Jk
( th)
TD
(mmHg)
GDP
GD2JPP
Obat
Antidiabetik
Dosis
(mg)
Frek
(kali/hari)
Standar
Obat
antihipertensi
Obat lain
99.
01248427
51
P
150/90
288
362
Glikuidon
Metformin
30
500
2x1
3x1
Dosis (mg)
30-120
250-3000
Frek
2-3
1-3
Amlodipin
Furosemid
-
100.
01093088
62
L
150/90
470
-
Novorapid
Metformin
10-10-10
500
3x1
3x1
12-16
250-3000
1-3
HCT
Captopril
-
Keterangan
(obat antidiabetik)
Tepat obat Tepat dosis
TO
TD
TO
TD
TTO
TO
TTD
TD
42
43
44
45
46