ALGORITMA NARANJO .0 ALGORITMA NARANJO .

APOTEK RAODAH APOTEK RAODAH

Nama Pasien : Nama Pasien :

Nomor RM : Nomor RM :
Nama Obat : Nama Obat :
Gejala Yang Diamati : Gejala Yang Diamati :
Tanggal : Tanggal :

Skala/Scale Skala/Scale
No Pertanyaan/Question Tidak No Pertanyaan/Question Tidak
Ya/Yes Tidak/No diketahui/ Ya/Yes Tidak/No diketahui/
Unknown Unknown

( Are there previous conclusive reports on this reaction?) ( Are there previous conclusive reports on this reaction?)

( Did the ADR appear after the suspected drug was administrered) 2 -1 0 ( Did the ADR appear after the suspected drug was administrered) 2 -1 0
khusus diberikan? khusus diberikan?

( Did the ADR improve when the drug was discontinued or a specific antagonist was ( Did the ADR improve when the drug was discontinued or a specific antagonist
administered?) 1 0 0 was administered?) 1 0 0

(Did the ADR recure when the drug was readministrastered?) (Did the ADR recure when the drug was readministrastered?)
2 -1 0 2 -1 0
efek samping obat? efek samping obat?

-1 2 0 -1 2 0
( Are there alternative cause that could on their own have caused the reaction ?) ( Are there alternative cause that could on their own have caused the reaction ?)

-1 1 0 -1 1 0
(Did the ADR reappear when a placebo was given?) (Did the ADR reappear when a placebo was given?)
dengan( konsentrasi yang toksik? dengan( konsentrasi yang toksik?

was )drug detected in the blood (or other fluids ) in concentrations known to was )drug detected in the blood (or other fluids ) in concentrations known to
1 0 0 1 0 0
be toxic? be toxic?
bertambah( ringan ketika obat diturunkan dosisnya? bertambah( ringan ketika obat diturunkan dosisnya?

Was the ADR more )severe when the dose was increased oe less severe when Was the ADR more )severe when the dose was increased oe less severe when
1 0 0 1 0 0
the dose was decreased? the dose was decreased?
yang mirip sebelumnya? yang mirip sebelumnya?

( Did the patient) have a similar ADR to the same or similar drugs in any 1 0 0 ( Did the patient) have a similar ADR to the same or similar drugs in any 1 0 0
previous exposure? previous exposure?
1 0 0 1 0 0
Skala probabilitas(WasNARANJOtheADR confirmed: by objective evidence?) Skala probabilitas(WasNARANJOtheADR confirmed: by objective evidence?)

Total Skor Kategori Total Skor Kategori

Highly probable Highly probable
/ Probable / Probable
Possible Possible
Doubful Doubful

Hasil : Hasil :