Patient’s Name: Age:

Diagnosis: Sex:
Physician: Date of Admission:
Name of Drug Classification Mechanism of Action Indication
Generic Name: Pharmacologic Class: Chemical: General Indication:

Trade/Brand Name:

Patient’s Dose:

Maximum Dose: Therapeutic:

Minimum Dose: Therapeutic: Patient’s Indication:

Contents:
Pharmacokinetics:
Onset:
Availability: Peak:
Duration:
Route(s) of Administration: Pregnancy Risk Category: Drug Half-Life:

Source: Source: Source: Source:

Height:
Weight:
Body Build:
Contraindication Side Effects Nursing Responsibilities
Contraindication: Before:

During:
Precautions:

After:
Drug Interactions:

Source: Source: Source: