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| {{#forminput:form=Drug_Project_Form|size=60|button text=Create or edit a Drug Page.}} | | {{#forminput:form=Drug_Project_Form|size=60|button text=Create or edit a Drug Page.}} |
| </noinclude><includeonly> | | </noinclude><includeonly> |
| {{{for template|Label template}}}
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| =Overview Statement=
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| {{FormHelpGeneral}}
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| {|
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| ! Please indicate the Class to which the drug belongs:
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| | {{{field|drugClass|input type=textarea|size=35}}}
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| |-
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| ! Please describe which indications the FDA has approved the use of the drug:
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| | {{{field|indication|input type=textarea|size=35}}}
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| |-
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| ! Is there a Black Box warning associated with the drug?:
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| | {{{field|blackBoxWarning|input type=dropdown|values=,Yes}}}
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| |-
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| ! Please list the most common adverse reactions associate with the drug:
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| | {{{field|adverseReactions|input type=textarea|size=35}}}
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| |}
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| {{{end template}}}
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|
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| =Black Box Warning=
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| {{{for template|DrugProjectForm}}}
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| {|
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| !Please enter the title of the Black Box Warning
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| | {{{field|blackBoxWarningTitle|input type=text|size=40}}}
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| |-
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| !Please enter the body of the Black Box Warning
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| |{{{field|blackBoxWarningTitle|input type=textarea|size=35}}}
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| |}
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|
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| =Adult Indications and Dosage=
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| {|
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| !Please enter the FDA-Labeled Indications and Dosage information for Adults
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| | {{{field|fdaLIADAdult|input type=text|size=40}}}
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| |-
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| !Please enter any established Off-Label Use and Dosage for Adults
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| |{{{field|offLabelAdult|input type=textarea|size=35}}}
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| |}
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|
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|
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| =Pediatric Indications and Dosage=
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| {|
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| !Please enter the FDA-Labeled Indications and Dosage information for Adults
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| | {{{field|fdaLIADPed|input type=text|size=40}}}
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| |-
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| !Please enter any established Off-Label Use and Dosage for Adults
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| |{{{field|offLabePed|input type=textarea|size=35}}}
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| |}
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|
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| =Contraindications=
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| {|
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| !Please enter the FDA reported contraindications:
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| | {{{field|contraindications|input type=textarea|size=35}}}
| |
| |}
| |
|
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| =Warnings=
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| {|
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| !Please enter the FDA reported warnings associated with the drug:
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| | {{{field|warnings|input type=textarea|size=35}}}
| |
| |}
| |
|
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| =Adverse Reactions=
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| {|
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| !Please enter the adverse reactions reported from Clinical Trial Experience
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| | {{{field|clinicalTrials|input type=textarea|size=35}}}
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| |-
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| !Please enter the adverse reactions reported from Postmarketing Experience
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| |{{{field|postmarketing|input type=textarea|size=35}}}
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| |}
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|
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| =Drug Interactions=
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| {|
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| !Please enter the known drug interactions:
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| | {{{field|drugInteractions|input type=textarea|size=35}}}
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| |}
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|
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| =Use in Specific Populations=
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| {|
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| !Please enter any information related to the FDA reported pregnancy category
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| | {{{field|useInPregnancyFDA|input type=textarea|size=35}}}
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| |-
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| !Please enter any information related to the Australian reported pregnancy category
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| | {{{field|useInPregnancyAUS|input type=textarea|size=35}}}
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| |-
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| !Please enter any information related to the use of the drug during Labor and Delivery
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| |{{{field|useInLaborDelivery|input type=textarea|size=35}}}
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| |-
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| !Please enter any information related to the use of the drug during Nursing
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| |{{{field|useInNursing|input type=textarea|size=35}}}
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| |-
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| !Please enter any information related to the use of the drug in Pediatrics
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| |{{{field|useInPed|input type=textarea|size=35}}}
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| |-
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| !Please enter any information related to the use of the drug in Geriatrics
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| |{{{field|useInGeri|input type=textarea|size=35}}}
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| |-
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| !Please enter any information related to the use of the drug and Gender
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| |{{{field|useInGender|input type=textarea|size=35}}}
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| |-
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| !Please enter any information related to the use of the drug and Race
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| |{{{field|useInRace|input type=textarea|size=35}}}
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| |-
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| !Please enter any information related to the use of the drug in patients with Renal Impairment
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| |{{{field|useInRenalImpair|input type=textarea|size=35}}}
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| |-
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| !Please enter any information related to the use of the drug in patients with Hepatic Impairment
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| |{{{field|useInHepaticImpair|input type=textarea|size=35}}}
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| |-
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| !Please enter any information related to the use of the drug in Females of Reproductive Potential and Males
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| |{{{field|useInReproPotential|input type=textarea|size=35}}}
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| |-
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| !Please enter any information related to the use of the drug in Immunocompromised Patients
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| |{{{field|useInImmunocomp|input type=textarea|size=35}}}
| |
| |}
| |
|
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| =Routes and Preparations=
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| {|
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| !Please enter information pertaining to the administration Routes here
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| | {{{field|routes|input type=textarea|size=35}}}
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| |-
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| !Please enter information pertaining to the drug Preparations here
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| |{{{field|preparations|input type=textarea|size=35}}}
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| |}
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|
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| =IV Compatibility=
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| {|
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| !Please enter information pertaining to the IV Compatibility here
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| |{{{field|IVCompat|input type=textarea|size=35}}}
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| |}
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|
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| =Overdose=
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| {|
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| !Please enter information pertaining to the drug Overdose here
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| |{{{field|overdose|input type=textarea|size=35}}}
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| |}
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|
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|
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| =Pharmacology=
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| {|
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| !Please enter any information related to the Mechanism of Action
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| | {{{field|mechAction|input type=textarea|size=35}}}
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| |-
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| !Please enter any information related to the Structure
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| | {{{field|structure|input type=textarea|size=35}}}
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| |-
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| !Please enter any information related to the Pharmacodynamics
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| |{{{field|PD|input type=textarea|size=35}}}
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| |-
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| !Please enter any information related to the Pharmacokinetics
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| |{{{field|PK|input type=textarea|size=35}}}
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| |-
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| !Please enter any information related to the Nonclinical Toxicology
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| |{{{field|nonClinToxic|input type=textarea|size=35}}}
| |
| |}
| |
|
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| =Clinical Studies=
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| {|
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| !Please enter information pertaining to the Clinical Studies of the drug
| |
| |{{{field|clinicalStudies|input type=textarea|size=35}}}
| |
| |}
| |
|
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| =How Supplied=
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| {|
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| !Please enter information pertaining to the How the Drug is Supplied
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| |{{{field|howSupplied|input type=textarea|size=35}}}
| |
| |}
| |
|
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|
| | =Instructions= |
| | Instructions for how to use this from will go here. |
| | {{{for template|DrugProjectFormSinglePage}}} |
| =Images= | | =Images= |
| {| | | {| |
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| |} | | |} |
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| =Patient Information=
| | {{{end template}}} |
| {| | |
| !Please enter the FDA Provided Patient Information here
| |
| |{{{field|fdaPatientInfo|input type=textarea|size=35}}}
| |
| |-
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| !Please enter the NLM Provided Patient Information Here
| |
| |{{{field|nlmPatientInfo|input type=textarea|size=35}}}
| |
| |}
| |
| | |
| | |
| =Price=
| |
| {|
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| !Please enter the drugs a patient may want to compare for Price
| |
| |{{{field|price|input type=textarea|size=35}}}
| |
| |}
| |
| | |
| =Price=
| |
| {|
| |
| !Please enter information relevant to Drug Shortages
| |
| |{{{field|drugShortage|input type=textarea|size=35}}}
| |
| |}
| |
| | |
| =Help=
| |
| {{FormHelpTab}}
| |
| <headertabs/> | | <headertabs/> |
| {{{standard input|save}}} {{{standard input|preview}}} {{{standard input|changes}}} {{{standard input|cancel}}} | | {{{standard input|save}}} {{{standard input|preview}}} {{{standard input|changes}}} {{{standard input|cancel}}} |
| </includeonly> | | </includeonly> |