Form:DrugProjectForm: Difference between revisions
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Instructions for how to use this from will go here. | Instructions for how to use this from will go here. | ||
{{{for template|DrugProjectFormSinglePage}}} | {{{for template|DrugProjectFormSinglePage}}} | ||
Please enter your author tag here: {{{field|authorTag|input type=text| size=40}}} | 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 enter the generic drug name here: {{{field|genericName|input type=text| size=40}}} | ||
{| | {| | ||
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|- | |- | ||
!Please enter any established Off-Label Use and Dosage for Adults | !Please enter any established Off-Label Use and Dosage for Adults | ||
|{{{field| | |- | ||
!Guideline-Supported Use | |||
|{{{field|offLabelAdultGuideSupport|input type=textarea|size=35}}} | |||
|- | |||
!Non-Guideline-Supported Use | |||
|{{{field|offLabelAdultNoGuideSupport|input type=textarea|size=35}}} | |||
|} | |} | ||
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|- | |- | ||
!Please enter any established Off-Label Use and Dosage for Children | !Please enter any established Off-Label Use and Dosage for Children | ||
|{{{field| | |- | ||
!Guideline-Supported Use | |||
|{{{field|offLabelPedGuideSupport|input type=textarea|size=35}}} | |||
|- | |||
!Non-Guideline-Supported Use | |||
|{{{field|offLabelPedNoGuideSupport|input type=textarea|size=35}}} | |||
|} | |} | ||
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{| | {| | ||
!Please enter the FDA reported contraindications: | !Please enter the FDA reported contraindications: | ||
| {{{field|contraindications|input type=textarea| | | {{{field|contraindications|input type=textarea|size=35}}} | ||
}}} | |||
|} | |} | ||
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=Adverse Reactions= | =Adverse Reactions= | ||
{| | {| | ||
!Please enter the adverse reactions reported from Clinical Trial Experience | !Please enter the adverse reactions reported from Clinical Trial Experience | ||
| {{{field|clinicalTrials|input type=textarea|size=35}}} | | {{{field|clinicalTrials|input type=textarea|size=35}}} | ||
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=Use in Specific Populations= | =Use in Specific Populations= | ||
{| | {| | ||
!Please enter any information related to the FDA reported pregnancy category | !Please enter any information related to the FDA reported pregnancy category | ||
| {{{field|useInPregnancyFDA|input type=textarea|size=35}}} | | {{{field|useInPregnancyFDA|input type=textarea|size=35}}} | ||
|- | |- | ||
!Please enter any information related to the Australian reported pregnancy category | !Please enter any information related to the Australian reported pregnancy category | ||
| {{{field|useInPregnancyAUS|input type=textarea|size=35}}} | | {{{field|useInPregnancyAUS|input type=textarea|size=35}}} | ||
|- | |- | ||
!Please enter any information related to the use of the drug during Labor and Delivery | !Please enter any information related to the use of the drug during Labor and Delivery | ||
|{{{field|useInLaborDelivery|input type=textarea|size=35}}} | |{{{field|useInLaborDelivery|input type=textarea|size=35}}} | ||
|- | |- | ||
!Please enter any information related to the use of the drug during Nursing | !Please enter any information related to the use of the drug during Nursing | ||
|{{{field|useInNursing|input type=textarea|size=35}}} | |{{{field|useInNursing|input type=textarea|size=35}}} | ||
|- | |- | ||
!Please enter any information related to the use of the drug in Pediatrics | !Please enter any information related to the use of the drug in Pediatrics | ||
|{{{field|useInPed|input type=textarea|size=35}}} | |{{{field|useInPed|input type=textarea|size=35}}} | ||
|- | |- | ||
!Please enter any information related to the use of the drug in Geriatrics | !Please enter any information related to the use of the drug in Geriatrics | ||
|{{{field|useInGeri|input type=textarea|size=35}}} | |{{{field|useInGeri|input type=textarea|size=35}}} | ||
|- | |- | ||
!Please enter any information related to the use of the drug and Gender | !Please enter any information related to the use of the drug and Gender | ||
|{{{field|useInGender|input type=textarea|size=35}}} | |{{{field|useInGender|input type=textarea|size=35}}} | ||
|- | |- | ||
!Please enter any information related to the use of the drug and Race | !Please enter any information related to the use of the drug and Race | ||
|{{{field|useInRace|input type=textarea|size=35}}} | |{{{field|useInRace|input type=textarea|size=35}}} | ||
|- | |- | ||
!Please enter any information related to the use of the drug in patients with Renal Impairment | !Please enter any information related to the use of the drug in patients with Renal Impairment | ||
|{{{field|useInRenalImpair|input type=textarea|size=35}}} | |{{{field|useInRenalImpair|input type=textarea|size=35}}} | ||
|- | |- | ||
!Please enter any information related to the use of the drug in patients with Hepatic Impairment | !Please enter any information related to the use of the drug in patients with Hepatic Impairment | ||
|{{{field|useInHepaticImpair|input type=textarea|size=35}}} | |{{{field|useInHepaticImpair|input type=textarea|size=35}}} | ||
|- | |- | ||
!Please enter any information related to the use of the drug in Females of Reproductive Potential and Males | !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}}} | |{{{field|useInReproPotential|input type=textarea|size=35}}} | ||
|- | |- | ||
!Please enter any information related to the use of the drug in Immunocompromised Patients | !Please enter any information related to the use of the drug in Immunocompromised Patients | ||
|{{{field|useInImmunocomp|input type=textarea|size=35}}} | |{{{field|useInImmunocomp|input type=textarea|size=35}}} | ||
|} | |} | ||
= | ==Administration and Monitoring== | ||
{| | {| | ||
!Please enter information pertaining to | !Please enter information pertaining to drug administration here | ||
| {{{field| | | {{{field|administration|input type=textarea|size=35}}} | ||
|- | |- | ||
!Please enter information pertaining to the drug | !Please enter information pertaining to the drug monitoring here | ||
|{{{field| | |{{{field|monitoring|input type=textarea|size=35}}} | ||
|} | |} | ||
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=Pharmacology= | =Pharmacology= | ||
{| | {| | ||
!Please enter the DrugBox template in it's entirety here: | |||
|{{{field|drugBox|input type=textarea|size=35}}} | |||
|- | |||
!Please enter any information related to the Mechanism of Action | !Please enter any information related to the Mechanism of Action | ||
| {{{field|mechAction|input type=textarea|size=35}}} | | {{{field|mechAction|input type=textarea|size=35}}} | ||
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!Please enter information pertaining to the How the Drug is Supplied | !Please enter information pertaining to the How the Drug is Supplied | ||
|{{{field|howSupplied|input type=textarea|size=35}}} | |{{{field|howSupplied|input type=textarea|size=35}}} | ||
|- | |||
!National Drug Code (NDC): | |||
|{{{field|NDC|input type=text|size=40}}} | |||
|- | |||
!Storage: | |||
|{{{field|storage|input type=text|size=40}}} | |||
|- | |||
!Manufactured by: | |||
|{{{field|manBy|input type=text|size=40}}} | |||
|- | |||
!Distributed by: | |||
|{{{field|distBy|input type=text|size=40}}} | |||
|} | |} | ||
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|{{{field|packLabel|input type=textarea|size=35}}} | |{{{field|packLabel|input type=textarea|size=35}}} | ||
|} | |} | ||
=Pill Characteristics= | =Pill Characteristics= | ||
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|} | |} | ||
=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}}} | |||
=Look-Alike Drug Names= | |||
Please enter any drug names that could be confused for the drug whose page is currently being created. | |||
{{{lookAlike}}} | |||
=Price= | =Price= |
Revision as of 20:56, 21 March 2014