CLINICAL PHARMACIST’S FORM

CLINICAL PHARMACY PATIENT PROFILE

Admission Date and Time: January 2, 2023 Station: Room Number:

Patient’s Name: Caleb Jornadal Admitting Diagnosis: Acute Gout in flare

Attending Physician: Dr. Kardo Dalisay Final Diagnosis:

Acute Gout in flare, Newly Diagnosed CKD Stage 3A
Nationality:

Age: 68 Gender: M Weight: 76.8 kg Diet: Low purine Allergies:

CLINICAL PHARMACY MEDICATION PROFILE

STANDING MEDICATIONS
Date/Time
First dose Last dose Drug description Dose Frequency Route Remarks
ordered
01/02/23 0400 Ketorolac 30mg IV 30mg Intravenous Not relieved
0400 Every 8 hrs
01/02/23
0600 0600 Colchicine 500mcg tab 500mcg Every 8 hrs Oral
01/02/23 Twice a day
0600 0600 Probenecid 250mg tab 250mg Oral
01/02/23 Hydrocortisone 100mg IV 100mg Every 6 hrs Intravenous
0600 0600
01/02/23 Cefuroxime 750mg IV 750mg Every 8 hrs Intravenous
0600 0600
01/02/23 2200 Potassium Chloride tab
0700 0700 3 doses only Three times a day Oral
01/02/2023 Once a day
1900 Febuxostat (Atenurix) 80mg tab 80mg PO Increased
1900 (bed time)

PRN MEDICATIONS
Date/Time Number of
Drug description Dose Frequency Route Remarks
ordered doses given
01/02/23 01/02/23 For breakthrough
2 Tramadol 50mg SIVP 50mg Every 8 hrs Intravenous
0515 1905 pain

 STAT MEDICATIONS
Date/Time ordered Drug description Dose Frequency Route Remarks
01/02/23 Colchicine 500mcg tab 2 tabs (500mcg) Now Oral
0600
01/02/23 250mg Intravenous
Hydrocortisone 250mg IV Now
0600

INSULIN PREPARATIONS
Date/Time ordered Drug description Dose Frequency Route Remarks

TOTAL PARENTERAL NUTRITIONS

Date/Time ordered Drug description Dose Frequency Route Remarks

VACCINES AND BIOLOGICALS

Date/Time ordered Drug description Dose Frequency Route Remarks

DIET PREPARATIONS
Date/Time ordered Drug description Dose Frequency Route Remarks

BOWEL PREPARATIONS
Date/Time ordered Drug description Dose Frequency Route Remarks

 TREATMENT MEDICATIONS
Date/Time ordered Drug description Dose Frequency Route Remarks

NEBULIZATIONS
Date/Time
First dose Last dose Drug description Dose Frequency Route Remarks
ordered

IV FLUIDS
Date/Time ordered Drug description Dose Flowrate Remarks

IV INCORPORATIONS
Date/Time ordered Drug description Dose Flowrate Remarks
CLINICAL PHARMACIST’S NOTES