Patient’s Name: ___________________________________ Admitting Diagnosis:________________________________________________ Case Number:________________

Age: _______________ Physician: _______________________________________ Ward: ______________

Name of Drug Classification Mechanism of Action Indication Contraindication Adverse Effects Nursing Responsibilities
Generic Name: Before:

Brand Name/s:

Availability: Pharmacokinetics: During:

Absorption:

Distribution:

Minimum Dose: Metabolism:

Excretion:

Maximum Dose: Pharmacodynamics: Patient’s Indication: After:

Route Onset Peak Duration

Patient’s Dose:

Source: