Form:DrugProjectForm2: Difference between revisions

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CMEAdmin, Bureaucrats, bureaucrats, editnews, exportpages, interwiki, nocaptcha, nukepages, smwadministrator, Administrators, Widget editors
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<noinclude>
<noinclude>
{{#forminput:form=DrugProjectForm|size=60|button text=Create or edit a Drug Page.}}
{{#forminput:form=DrugProjectForm2|size=60|button text=Create or edit a Drug Page.}}
</noinclude><includeonly>
</noinclude><includeonly>


=Instructions=
=Instructions=


{{{for template|DrugProjectForm2}}}


----
=Administration and Monitoring=
 
<BIG><BIG>'''''1.  BEFORE YOU START'''''</BIG></BIG>
 
----
 
{{{for template|DrugProjectFormSinglePage}}}
Please enter your author tag here: {{{field|authorTag|input type=text| size=40}}}


=Overview Statement=
Please enter the generic drug name here: {{{field|genericName|input type=text| size=40}}}
{|
{|
!Please indicate the Class to which the drug belongs {{{field|aOrAn|input type=dropdown|values=a,an}}}:
| style="width: 50%;" valign=top | Please enter information pertaining to '''drug administration''' here:
|  {{{field|drugClass|input type=two listboxes|values=5-Alpha reductase inhibitor,5-Lipoxygenase inhibitor,Acetylcholine release inhibitor,Acetylcholine releasing agent,Actinomycin,Adenosine receptor agonist,Adrenal steroid synthesis inhibitor,Adrenergic receptor agonist,Adrenocorticotropic hormone,Aldehyde dehydrogenase inhibitor,Aldosterone antagonist,Alkylating drug,Allogeneic cord blood hematopoietic progenitor cell therapy,Allogeneic cultured cell scaffold,Allylamine antifungal,Alpha-adrenergic agonist,Alpha-adrenergic blocker,Alpha-glucosidase inhibitor,Aluminum complex,Amide local anesthetic,Amino acid,Amino acid hypertonic solution,Aminoglycoside antibacterial,Aminoketone,Aminosalicylate,Amphenicol-class antibacterial,Amphetamine anorectic,Amylin analog,Androgen,Androgen receptor inhibitor,Angiontensin converting enzyme inhibitor,Angiotensin 2 receptor blocker,Angiotensin converting enzyme inhibitor,Anthracycline topoisomerase inhibitor,Anti-anginal,Anti-coagulant,Anti-epileptic agent,Anti-IgE,Anti-inhibitor coagulant complex,Antiarrhythmic,Anticholinergic,Antidiarrheal,Antidote,Antidote for acetaminophen overdose,Antiemetic,Antifibrinolytic agent,Antihelminthic,Antihistamine,Antimalarial,Antimetabolite,Antimetabolite immunosuppressant,Antimycobacterial,Antiparasitic,Antiprotozoal,Antirheumatic agent,Antiseptic,Antivenin,Aromatase inhibitor,Aromatic amino acid decarboxylation inhibitor,Arteriolar vasodilator,Asparagine-specific enzyme,Atypical antipsychotic,Autologous cellular immunotherapy,Autologous cultured cell,Autonomic ganglionic blocker,Azole antifungal,B lymphocyte stimulator-specific inhibitor,Barbiturate,Benzodiazepine,Benzodiazepine antagonist,Benzothiazole,Benzylamine antifungal,Beta lactamase inhibitor,Beta-adrenergic agonist,Beta-adrenergic blocker,Beta2-adrenergic agonist,Beta3-adrenergic agonist,Biguanide,Bile acid,Bile acid sequestrant,Bismuth,Bisphosphonate,Blood coagulation factor,Blood viscosity reducer,Bovine intestinal adenosine deaminase,Bradykinin B2 receptor antagonist,Calcineurin inhibitor immunosuppressant,Calcitonin,Calcium,Calcium channel blocker,Calcium-sensing receptor agonist,Calculi dissolution agent,Cannabinoid,Carbamoyl phosphate synthetase 1 activator,Carbonic anhydrase inhibitor,Cardiac glycoside,Carnitine analog,Catechol-O-methyltransferase inhibitor,Catecholamine,Catecholamine synthesis inhibitor,Catecholamine-depleting sympatholytic,CCR5 co-receptor antagonist,CD20-directed cytolytic antibody,CD20-directed radiotherapeutic antibody,CD25-directed cytotoxin,CD3 blocker immunosuppressant,CD30-directed immunoconjugate,CD52-directed cytolytic antibody,Cell death inducer,Central alpha-2 adrenergic agonist,Central nervous system depressant,Central nervous system stimulant,Cephalosporin antibacterial,Chloride channel activator,Cholecystokinin analog,Cholinergic muscarinic agonist,Cholinergic muscarinic antagonist,Cholinergic nicotinic agonist,Cholinergic receptor agonist,Cholinesterase inhibitor,Cholinesterase reactivator,Collagen-specific enzyme,Complement inhibitor,Contrast agent for ultrasound imaging,Copper absorption inhibitor,Copper-containing intrauterine device,Corticosteroid,Cysteine depleting agent,Cystic fibrosis transmembrane conductance regulator potentiator,Cytochrome p450 2D6 inhibitor,Cytomegalovirus nucleoside analog DNA polymerase inhibitor,Cytoprotective agent,Decarboxylase inhibitor,Demulcent,Depigmenting agent,Depolarizing neuromuscular blocker,Diagnostic dye,Dietary cholesterol absorption inhibitor,Dihydrofolate reductase inhibitor antibacterial,Dihydrofolate reductase inhibitor antimalarial,Dihydropyridine calcium channel blocker,Dipeptidyl peptidase 4 inhibitor,Direct thrombin inhibitor,Dopamine-2 receptor antagonist,Dopaminergic agonist,Echinocandin antifungal,Endoglycosidase,Endothelin receptor antagonist,Epidermal growth factor receptor antagonist,Ergot derivative,Ergot-derived dopamine receptor agonist,Ergotamine derivative,Erythropoiesis-stimulating agent,Ester local anesthetic,Estrogen,Estrogen agonist/antagonist,Estrogen receptor antagonist,Factor VIII activator,Factor Xa inhibitor,Folate analog,Folate analog metabolic inhibitor,Gadolinium-based contrast agent,Gamma-aminobutyric acid a receptor agonist,Gamma-aminobutyric acid-ergic agonist,General anesthetic,Glinide,GLP-1 receptor agonist,Glucosylceramide synthase inhibitor,Glycopeptide antibacterial,Glycosaminoglycan,Gonadotropin,Gonadotropin releasing hormone antagonist,Gonadotropin releasing hormone receptor agonist,Growth hormone releasing factor analog,Guanylate cyclase-C agonist,Hedgehog pathway inhibitor,Helicobacter pylori diagnostic,Hematopoietic stem cell mobilizer,Heparin reversal agent,Hepatitis B virus nucleoside analog reverse transcriptase inhibitor,Hepatitis C virus NS3/4a protease inhibitor,Her2 receptor antagonist,Herpes simplex virus nucleoside analog dna polymerase inhibitor,Herpes zoster virus nucleoside analog dna polymerase inhibitor,Herpesvirus nucleoside analog dna polymerase inhibitor,Histamine-1 receptor antagonist,Histamine-1 receptor inhibitor,Histamine-2 receptor antagonist,Histone deacetylase inhibitor,HMG-CoA reductase inhibitor,Human alpha-1 proteinase inhibitor,Human antihemophilic factor,Human blood coagulation factor,Human C1 esterase inhibitor,Human immunodeficiency virus 1 fusion inhibitor,Human immunodeficiency virus 1 non-nucleoside analog reverse transcriptase inhibitor,Human immunodeficiency virus integrase strand transfer inhibitor,Human immunodeficiency virus nucleoside analog reverse transcriptase inhibitor,Human immunoglobulin,Human immunoglobulin G,Human platelet-derived growth factor,Human serum albumin,Hydrolytic lysosomal glucocerebroside-specific enzyme,Hydrolytic lysosomal glycogen-specific enzyme,Hydrolytic lysosomal glycosaminoglycan-specific enzyme,Hydrolytic lysosomal neutral glycosphingolipid-specific enzyme,Hydroxyphenyl-pyruvate dioxygenase inhibitor,Immunoglobulin G,Inactivated Salmonella typhi vaccine,Influenza A M2 protein inhibitor,Inhalation diagnostic agent,Insulin,Insulin analog,Integrin receptor antagonist,Interferon alpha,Interferon gamma,Interleukin-1 receptor antagonist,Interleukin-2 receptor blocking antibody,Intestinal lipase inhibitor,Iron chelator,Ketolide antibacterial,Kinase inhibitor,L-Thyroxine,L-Triiodothyronine,Lead chelator,Leukocyte growth factor,Leukotriene receptor antagonist,Lincosamide antibacterial,Lipid-based polyene antifungal,Lipopeptide antibacterial,Live attenuated Bacillus Calmette-Guerin immunotherapy,Live attenuated Bacillus Calmette-Guerin vaccine,Live attenuated mumps virus vaccine,Live human adenovirus type 4 vaccine,Live human adenovirus type 7 vaccine,Live rotavirus vaccine,Local anesthetic,Loop diuretic,Low molecular weight heparin,Lymphocyte growth factor,Macrolide,Macrolide antibacterial,Macrolide antimicrobial,Mast cell stabilizer,Megakaryocyte growth factor,Melanin synthesis inhibitor,Melatonin receptor agonist,Metal chelator,Methylated sulfonamide antibacterial,Methylating agent,Methylxanthine,Microtubule inhibitor,Monoamine oxidase inhibitor,Monoamine oxidase type B inhibitor,Monobactam antibacterial,Mood stabilizer,Mtor inhibitor immunosuppressant,Mucocutaneous epithelial cell growth factor,Mucolytic,Muscle relaxant,N-Methyl-D-aspartate receptor antagonist,N-Type calcium channel antagonist,Natriuretic peptide,Neuraminidase inhibitor,Nicotinic acid,Nitrate vasodilator,Nitrofuran antibacterial,Nitrogen binding agent,Nitroimidazole antimicrobial,Non-narcotic antitussive,Non-standardized animal dander allergenic extract,Non-standardized animal hair allergenic extract,Non-standardized animal skin allergenic extract,Non-standardized bacterial allergenic extract,Non-standardized chemical allergen,Non-standardized feather allergenic extract,Non-standardized food allergenic extract,Non-standardized fungal allergenic extract,Non-standardized house dust allergenic extract,Non-standardized insect allergenic extract,Non-standardized insect venom allergenic extract,Non-standardized plant allergenic extract,Non-standardized plant fiber allergenic extract,Non-standardized pollen allergenic extract,Noncompetitive ampa glutamate receptor antagonist,Nondepolarizing neuromuscular blocker,Nonergot dopamine agonist,Nonsteroidal anti-inflammatory drug,Norepinephrine reuptake inhibitor,"Norepinephrine, serotonin, and dopamine reuptake inhibitor anorectic",Nucleoside analog antifungal,Nucleoside analog antiviral,Nucleoside metabolic inhibitor,Omega-3 fatty acid,Opioid agonist,Opioid agonist/antagonist,Opioid antagonist,Osmotic diuretic,Osmotic laxative,Oxazolidinone antibacterial,Oxytocic,P2Y12 platelet inhibitor,Paramagnetic contrast agent,Parathyroid hormone analog,Parental iron replacement,Partial cholinergic nicotinic agonist,Partial opioid agonist,Partial opioid agonist/antagonist,Pediculicide,Penem antibacterial,Penicillin-class antibacterial,Peroxisome proliferator receptor alpha agonist,Peroxisome proliferator receptor gamma agonist,Phenothiazine,Phosphate binder,Phosphodiesterase 3 inhibitor,Phosphodiesterase 5 inhibitor,Photoactivated radical generator,Photoenhancer,Plasma volume expander,Platelet aggregation inhibitor,Platelet-reducing agent,Platinum-based drug,Pleuromutilin antibacterial,Polyene antifungal,Polyene antimicrobial,Polymyxin-class antibacterial,Porphyrin precursor,Potassium channel opener,Potassium salt,Potassium-sparing diuretic,Progesterone,Progestin,Progestin antagonist,Progestin-containing intrauterine device,Prostacycline,Prostacycline vasodilator,Prostaglandin analog,Prostaglandin E1 agonist,Prostaglandin E1 analog,Protease inhibitor,Proteasome inhibitor,Proton pump inhibitor,Provitamin D2 compound,Psoralen,Purine antimetabolite,Pyrethroid,Pyrimidine synthesis inhibitor,Pyrophosphate analog dna polymerase inhibitor,Quinolone antimicrobial,Radioactive diagnostic agent,Radioactive diagnostic agent for positron emission tomography,Radioactive therapeutic agent,Radiographic contrast agent,RANK ligand inhibitor,Recombinant antithrombin,Recombinant human deoxyribonuclease 1,Recombinant human growth hormone,Recombinant human interferon beta,Reducing and complexing thiol,Renal dehydropeptidase inhibitor,Renin inhibitor,Respiratory stimulant,Respiratory syncytial virus anti-f protein monoclonal antibody,Retinoid,Rifamycin antibacterial,Rifamycin antimycobacterial,Rna synthetase inhibitor antibacterial,Sclerosing agent,Selective T cell costimulation blocker,Selective T cell costimulation modulator,Serotonin and norepinephrine reuptake inhibitor,Serotonin reuptake inhibitor,Serotonin-1B and serotonin-1D receptor agonist,Serotonin-2C receptor agonist,Serotonin-3 receptor antagonist,Serotonin-4 receptor antagonist,Sigma-1 agonist,Skeletal muscle relaxant,Skin test antigen,Somatostatin analog,Sphingosine 1-phosphate receptor modulator,Standardized animal hair allergenic extract,Standardized animal skin allergenic extract,Standardized chemical allergen,Standardized insect allergenic extract,Standardized insect venom allergenic extract,Standardized pollen allergenic extract,Stimulant laxative,Streptogramin antibacterial,Substance P/neurokinin-1 receptor antagonist,Sucrose-specific enzyme,Sulfonamide antibacterial,Sulfonamide antimicrobial,Sulfone,Sulfonylurea,Surfactant,Sympathomimetic amine anorectic,Sympathomimetic-like agent,Tetracycline-class antibacterial,Tetracycline-class antimicrobial,Tetracycline-class drug,Thiazide diuretic,Thiazide-like diuretic,Thiazolidinedione,Thrombolytic agent,Thrombopoiesis stimulating agent,Thyroid hormone synthesis inhibitor,Thyroid stimulating hormone,Topoisomerase inhibitor,Tricyclic antidepressant,Tuberculosis skin test,Tumor necrosis factor blocker,Typical antipsychotic,Uncompetitive N-methyl-D-aspartate receptor antagonist,Unfractionated heparin,Urease inhibitor,Uric acid-specific enzyme,Vascular endothelial growth factor-directed antibody,Vasodilator,Vasopressin analog,Vasopressin antagonist,Vinca alkaloid,Vitamin A,Vitamin B complex member,Vitamin B12,Vitamin D,Vitamin D analog,Vitamin D2 analog,Vitamin D3 analog,Vitamin K,Vitamin K antagonist,Warfarin reversal agent,Xanthine oxidase inhibitor}}}
| {{{field|administration|input type=textarea|size=35|editor}}}
|-
! Please describe which indications the FDA has approved the use of the drug:
| {{{field|indication|input type=textarea|size=35|editor|editor}}}
|-
! Is there a Black Box warning associated with the drug?:
|{{{field|hasBlackBoxWarning|input type=dropdown|values=,Yes}}}
|-
|-
! Please list the most common adverse reactions associate with the drug:
| style="width: 50%;" valign=top | Please enter information pertaining to the '''drug monitoring''' here:
| {{{field|adverseReactions|input type=textarea|size=35|editor}}}
| style="width: 50%;" valign=top | {{{field|monitoring|input type=textarea|size=35|editor}}}
|}
|}




=Black Box Warning=
{|
!Please enter the title of the Black Box Warning
| {{{field|blackBoxWarningTitle|input type=<span style="color:#FF0000;">text</span>|size=40}}}
|-
!Please enter the body of the Black Box Warning
|{{{field|blackBoxWarningBody|input type=textarea|editor|size=35|editor|default=''{{fontcolor|#FF0000|Condition Name:}}'' (Content)}}}
|}
=Adult Indications and Dosage=
{|
!Please enter the FDA-Labeled Indications and Dosage Information for Adults
| {{{field|fdaLIADAdult|input type=textarea|size=35|editor|default= <h4>Condition 1</h4>
* Dosing Information
:: (Dosage)}}}
|-
!Please enter any established Off-Label Use and Dosage for Adults
|-
!Guideline-Supported Off-Label Use
|{{{field|offLabelAdultGuideSupport|input type=textarea|size=35|editor}}}
|-
!Non-Guideline-Supported Off-Label Use
|{{{field|offLabelAdultNoGuideSupport|input type=textarea|size=35|editor}}}
|}


=IV Compatibility=


=Pediatric Indications and Dosage=
{|
{|
!Please enter the FDA-Labeled Indications and Dosage Information for Children
| style="width: 50%;" valign=top | Please enter information pertaining to the '''IV compatibility''' here:
| {{{field|fdaLIADPed|input type=textarea|size=35|editor}}}
| style="width: 50%;" valign=top | {{{field|IVCompat|input type=textarea|size=35|editor}}}
|-
!Please enter any established Off-Label Use and Dosage for Children
|-
!Guideline-Supported Off-Label Use
|{{{field|offLabelPedGuideSupport|input type=textarea|size=35|editor}}}
|-
!Non-Guideline-Supported Off-Label Use
|{{{field|offLabelPedNoGuideSupport|input type=textarea|size=35|editor}}}
|}
|}


=Contraindications=
{|
!Please enter the FDA reported contraindications:
| {{{field|contraindications|input type=textarea|size=35|editor}}}
|}


=Warnings=
{|
!Please enter the FDA reported warnings associated with the drug:
| {{{field|warnings|input type=textarea|size=35|editor}}}
|}


=Adverse Reactions=
=Overdose=
{|
!Please enter the adverse reactions reported from Clinical Trial Experience
| {{{field|clinicalTrials|input type=textarea|size=35|editor}}}
|-
!Please enter the adverse reactions reported from Postmarketing Experience
|{{{field|postmarketing|input type=textarea|size=35|editor}}}
|}


=Drug Interactions=
{|
{|
!Please enter the known drug interactions:
| style="width: 50%;" valign=top | Please enter information pertaining to the '''drug overdose''' here:
| {{{field|drugInteractions|input type=textarea|size=35|editor}}}
| style="width: 50%;" valign=top | {{{field|overdose|input type=textarea|size=35|editor}}}
|}
|}


=Use in Specific Populations=
{|
!FDA Pregnancy Category: {{{field|FDAPregCat|input type=dropdown|values=A,B,C,D,X,N}}}
|-
!Please enter any information related to the FDA reported pregnancy category
| {{{field|useInPregnancyFDA|input type=textarea|size=35|editor}}}
|-
!Australian Pregnancy Category: {{{field|AUSPregCat|input type=dropdown|values=A,B1,B2,B3,C,D,X}}}
|-
!Please enter any information related to the Australian reported pregnancy category
| {{{field|useInPregnancyAUS|input type=textarea|size=35|editor}}}
|-
!Please enter any information related to the use of the drug during Labor and Delivery
|{{{field|useInLaborDelivery|input type=textarea|size=35|editor}}}
|-
!Please enter any information related to the use of the drug during Nursing
|{{{field|useInNursing|input type=textarea|size=35|editor}}}
|-
!Please enter any information related to the use of the drug in Pediatrics
|{{{field|useInPed|input type=textarea|size=35|editor}}}
|-
!Please enter any information related to the use of the drug in Geriatrics
|{{{field|useInGeri|input type=textarea|size=35|editor}}}
|-
!Please enter any information related to the use of the drug and Gender
|{{{field|useInGender|input type=textarea|size=35|editor}}}
|-
!Please enter any information related to the use of the drug and Race
|{{{field|useInRace|input type=textarea|size=35|editor}}}
|-
!Please enter any information related to the use of the drug in patients with Renal Impairment
|{{{field|useInRenalImpair|input type=textarea|size=35|editor}}}
|-
!Please enter any information related to the use of the drug in patients with Hepatic Impairment
|{{{field|useInHepaticImpair|input type=textarea|size=35|editor}}}
|-
!Please enter any information related to the use of the drug in Females of Reproductive Potential and Males
|{{{field|useInReproPotential|input type=textarea|size=35|editor}}}
|-
!Please enter any information related to the use of the drug in Immunocompromised Patients
|{{{field|useInImmunocomp|input type=textarea|size=35|editor}}}
|-
!Others
|Title of Section: {{{field|othersTitle|input type=text|size=40}}}
Body: {{{field|useInOthers|input type=textarea|size=35|editor}}}
|}


=Administration and Monitoring=
{|
!Please enter information pertaining to drug administration here
| {{{field|administration|input type=textarea|size=35|editor}}}
|-
!Please enter information pertaining to the drug monitoring here
|{{{field|monitoring|input type=textarea|size=35|editor}}}
|}
=IV Compatibility=
{|
!Please enter information pertaining to the IV Compatibility here
|{{{field|IVCompat|input type=textarea|size=35|editor}}}
|}
=Overdose=
{|
!Please enter information pertaining to the drug Overdose here
|{{{field|overdose|input type=textarea|size=35|editor}}}
|}


=Pharmacology=


=Pharmacology=
{|
{|
!Please enter the DrugBox template in its entirety here:
| style="width: 50%;" valign=top | Please enter the '''<u>DrugBox2</u> template''' here:<BR><SMALL>
|{{{field|drugBox|input type=textarea|size=35|editor}}}
* '''Step 1: Construct the <u>Drugbox2</u> template based on the original drugbox template'''<BR>
* '''Step 2: Cultivate the structure image from [https://pubchem.ncbi.nlm.nih.gov/search/index.html#collection=compounds PubChem]'''<BR>
* '''Step 3: Rename and upload the image to accommodate the Drugbox2 template'''</SMALL>
| {{{field|drugBox|input type=textarea|size=35|editor}}}
|-
|-
!Please enter any information related to the Mechanism of Action
| style="width: 50%;" valign=top | Please enter information related to the '''mechanism of action''':
| {{{field|mechAction|input type=textarea|size=35|editor}}}
| {{{field|mechAction|input type=textarea|size=35|editor}}}
|-
|-
!Please enter any information related to the Structure
| style="width: 50%;" valign=top | Please enter information related to the '''structure''':
| {{{field|structure|input type=textarea|size=35|editor}}}
| {{{field|structure|input type=textarea|size=35|editor}}}
|-
|-
!Please enter any information related to the Pharmacodynamics
| style="width: 50%;" valign=top | Please enter information related to the '''pharmacodynamics''':
|{{{field|PD|input type=textarea|size=35|editor}}}
| style="width: 50%;" valign=top | {{{field|PD|input type=textarea|size=35|editor}}}
|-
|-
!Please enter any information related to the Pharmacokinetics
| style="width: 50%;" valign=top | Please enter information related to the '''pharmacokinetics''':
|{{{field|PK|input type=textarea|size=35|editor}}}
| style="width: 50%;" valign=top | {{{field|PK|input type=textarea|size=35|editor}}}
|-
|-
!Please enter any information related to the Nonclinical Toxicology
| style="width: 50%;" valign=top | Please enter information related to the '''nonclinical toxicology''':
|{{{field|nonClinToxic|input type=textarea|size=35|editor}}}
| style="width: 50%;" valign=top | {{{field|nonClinToxic|input type=textarea|size=35|editor}}}
|}
|}


=Clinical Studies=
=Clinical Studies=
{|
{|
!Please enter information pertaining to the Clinical Studies of the drug
| style="width: 50%;" valign=top | Please enter information pertaining to the '''clinical studies''' of the drug:
|{{{field|clinicalStudies|input type=textarea|size=35|editor}}}
| style="width: 50%;" valign=top | {{{field|clinicalStudies|input type=textarea|size=35|editor}}}
|}
|}


=How Supplied=
=How Supplied=
{|
{|
!Please enter information pertaining to the How the Drug is Supplied
| style="width: 50%;" valign=top | Please enter information pertaining to '''how the drug is supplied''':
|{{{field|howSupplied|input type=textarea|size=35|editor}}}
| style="width: 50%;" valign=top | {{{field|howSupplied|input type=textarea|size=35|editor}}}
|-
|-
!Storage:
| style="width: 50%;" valign=top | Please enter information pertaining to '''how the drug should be stored''':
|{{{field|storage|input type=textarea|size=35|editor}}}
| style="width: 50%;" valign=top | {{{field|storage|input type=textarea|size=35|editor}}}
|}
|}


=Free Text for Image Section=
=Free Text for Image Section=
{|
{|
!Please enter information pertaining to the Drug Images here
| style="width: 50%;" valign=top | Please enter information pertaining to the '''drug images''' here:
|{{{field|drugImages|input type=textarea|size=35|editor}}}
| style="width: 50%;" valign=top | {{{field|drugImages|input type=textarea|size=35|editor}}}
|-
|-
!Please enter information pertaining to the FDA Package Label here
| style="width: 50%;" valign=top | Please enter information pertaining to the '''FDA package label''' here:
|{{{field|packLabel|input type=textarea|size=35|editor}}}
| style="width: 50%;" valign=top | {{{field|packLabel|input type=textarea|size=35|editor}}}
|}
|}


=Patient Information=
=Patient Information=
{|
{|
!Please enter the FDA Provided Patient Information here
| style="width: 50%;" valign=top | Please enter the '''FDA provided patient information''' here:
|{{{field|fdaPatientInfo|input type=textarea|size=35|editor}}}
| style="width: 50%;" valign=top | {{{field|fdaPatientInfo|input type=textarea|size=35|editor}}}
|-
|-
!Please enter the NLM Provided Patient Information Here
| style="width: 50%;" valign=top | Please enter the '''NLM provided patient information''' here:
|{{{field|nlmPatientInfo|input type=textarea|size=35|editor}}}
| style="width: 50%;" valign=top | {{{field|nlmPatientInfo|input type=textarea|size=35|editor}}}
|}
|}


=Precautions with Alcohol=
Please describe any guidelines on the concurrent use of the drug with the consumption of alcohol:
{{{field|alcohol|input type=textarea|size=35|editor}}}


=Look-Alike Drug Names=
Please enter any drug names that could be confused for the drug whose page is currently being created.
{{{field|lookAlike|input type=textarea|size=35|editor}}}


=Price=
=Precautions with Alcohol=
{|
!Please enter the drugs a patient may want to compare for Price
|{{{field|price|input type=textarea|size=35|editor}}}
|}


=Drug Shortages=
{|
{|
!Please enter information relevant to Drug Shortages
| Please describe any guideline on the '''concurrent use of the drug with alcohol''':
|{{{field|drugShortage|input type=textarea|size=35|editor}}}
| style="width: 50%;" valign=top | {{{field|alcohol|input type=textarea|size=35|editor|default=Alcohol-{{PAGENAME}} interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.}}}
|}
|}


{{{end template}}}


=Add Images=
{{{for template|PillImage||multiple|add button text=Add Another Image}}}


Please Enter the Name of the pill here: {{{field|fileName|input type=text|size=40|uploadable}}}
=Look-Alike Drug Names=


Please Enter the Name of the Drug here: {{{field|drugName|input type=text|size=40}}}
{|
| style="width: 50%;" valign=top | Please enter '''look-alike names''' that could be confused with the drug:
| style="width: 50%;" valign=top | {{{field|lookAlike|input type=textarea|size=35|editor}}}
|}


Please Enter the NDC: {{{field|NDC|input type=text|size=40}}}


Please Enter the Author of the Drug Label: {{{field|drugAuthor|input type=text|size=40}}}
=Price=


Please Enter all Listed Ingredients separated by a comma: {{{field|ingredients|input type=textbox|size=35|editor}}}


Pill Imprint:
{|
{{{field|pillImprint|input type=text|size=40}}}
| style="width: 50%;" valign=top | Please enter the drugs a patient may want to compare for '''price''':
 
| style="width: 50%;" valign=top | {{{field|price|input type=textarea|size=35|editor}}}
Dosage: {{{field|dosageValue|input type=text|size=40}}} {{{field|dosageUnit| input type=dropdown|values=ug,mg,g,kg,,uL,mL (cc),dL,L,,gtt(s),AU,IU,umol,mmol,U}}}
|}
 
If the dosage does not fit the above format, you may enter it here: {{{field|dosageFreeText|input type=text|size=40}}}


Pill Color:
{{{field|pillColor|input type=two listboxes|values=Brown,Red,Orange,Yellow,Green,Turquoise,Blue,Purple,Pink,Black,Grey,White}}}
Pill Shape:
{{{field|pillShape|input type=dropdown| values=Round,Oval,Square,Rectangular,Triangular,Capsule,Pentagon,Hexagon,Diamond,Gear,DoubleCircle,Clover,TearDrop,Octagon,SemiCircle,Bullet,Trapezoid,FreeForm}}}
Pill Size (in mm):
{{{field|pillSize|input type=text|size=40}}}
Pill Scoring:
{{{field|pillScore|input type=dropdown|values=1,2,3,4,5,6,7,8,9,10}}}
{{{end template}}}
{{{end template}}}


=Add Images of the Package=
{{{for template|LabelImage||multiple|add button text=Add Another Image}}}
Please Enter the Name of the file here: {{{field|fileName|input type=text|size=40|uploadable}}}
{{{end template}}}


<headertabs />{{{standard input|save}}} {{{standard input|preview}}} {{{standard input|changes}}} {{{standard input|cancel}}}
<headertabs />{{{standard input|save}}} {{{standard input|preview}}} {{{standard input|changes}}} {{{standard input|cancel}}}
</includeonly>
</includeonly>

Latest revision as of 19:01, 2 May 2014


Retrieved from "https://www.wikidoc.org/index.php?title=Form:DrugProjectForm2&oldid=968077"