Form:DrugProjectForm: Difference between revisions
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{| | {| | ||
| style="width: 50%;" valign=top | Please enter the '''generic name''' here: {{{field|genericName|input type=text| size=40}}} | | style="width: 50%;" valign=top | Please enter the '''generic name''' here: | ||
| style="width: 50%;" valign=top | {{{field|genericName|input type=text| size=40}}} | |||
|- | |- | ||
| style="width: 50%;" valign=top | Please indicate the '''class''' to which the drug belongs {{{field|aOrAn|input type=dropdown|values=a,an}}}:<BR><SMALL> | | style="width: 50%;" valign=top | Please indicate the '''class''' to which the drug belongs {{{field|aOrAn|input type=dropdown|values=a,an}}}:<BR><SMALL> | ||
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{| | {| | ||
| style="width: 50%;" valign=top | Please enter the '''title''' of the Black Box | | style="width: 50%;" valign=top | Please enter the '''title''' of the Black Box warning: | ||
| style="width: 50%;" valign=top | {{{field|blackBoxWarningTitle|input type=textarea|editor|size=40|default='''{{fontcolor|#FF0000|TITLE}}'''}}} | | style="width: 50%;" valign=top | {{{field|blackBoxWarningTitle|input type=textarea|editor|size=40|default='''{{fontcolor|#FF0000|TITLE}}'''}}} | ||
|- | |- | ||
| style="width: 50%;" valign=top | Please enter the '''body''' of the Black Box | | style="width: 50%;" valign=top | Please enter the '''body''' of the Black Box warning: | ||
| style="width: 50%;" valign=top | {{{field|blackBoxWarningBody|input type=textarea|editor|size=35|default=''{{fontcolor|#FF0000|Condition Name:}}'' (Content)}}} | | style="width: 50%;" valign=top | {{{field|blackBoxWarningBody|input type=textarea|editor|size=35|default=''{{fontcolor|#FF0000|Condition Name:}}'' (Content)}}} | ||
|} | |} | ||
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{| | {| | ||
| style="width: 50%;" valign=top | Please enter '''FDA-labeled indications and dosing information''' for '''adults'''<BR><SMALL> | | style="width: 50%;" valign=top | Please enter '''FDA-labeled indications and dosing information''' for '''adults''':<BR><SMALL> | ||
* '''Step 1: Check the "Dosage And Administration" section from the FDA label'''<BR> | * '''Step 1: Check the "Dosage And Administration" section from the FDA label'''<BR> | ||
* '''Step 2: Insert the dosing information for each indication'''</SMALL> | * '''Step 2: Insert the dosing information for each indication'''</SMALL> | ||
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:: (Dosage)}}} | :: (Dosage)}}} | ||
|- | |- | ||
| style="width: 50%;" valign=top | Please enter established '''off-label use and dosage''' for '''adults''' | | style="width: 50%;" valign=top | Please enter established '''off-label use and dosage''' for '''adults''': | ||
|- | |- | ||
| style="width: 50%;" valign=top | | | style="width: 50%;" valign=top | Please enter '''guideline-supported off-label use''' in this field: | ||
| style="width: 50%;" valign=top | {{{field|offLabelAdultGuideSupport|input type=textarea|size=35|editor|default= | | style="width: 50%;" valign=top | {{{field|offLabelAdultGuideSupport|input type=textarea|size=35|editor|default= | ||
'''Condition 1''' | '''Condition 1''' | ||
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:* (Dosage)}}} | :* (Dosage)}}} | ||
|- | |- | ||
| style="width: 50%;" valign=top | | | style="width: 50%;" valign=top | Please enter '''non–guideline-supported off-label use''' in this field: | ||
| style="width: 50%;" valign=top | {{{field|offLabelAdultNoGuideSupport|input type=textarea|size=35|editor|default= | | style="width: 50%;" valign=top | {{{field|offLabelAdultNoGuideSupport|input type=textarea|size=35|editor|default= | ||
'''Condition 1''' | '''Condition 1''' | ||
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{| | {| | ||
| style="width: 50%;" valign=top | Please enter '''FDA- | | style="width: 50%;" valign=top | Please enter '''FDA-labeled indications and dosage information''' for '''children''':<BR><SMALL> | ||
* '''Step 1: Check the "Dosage And Administration" section from the FDA label'''<BR> | * '''Step 1: Check the "Dosage And Administration" section from the FDA label'''<BR> | ||
* '''Step 2: Insert the dosing information for each indication'''</SMALL> | * '''Step 2: Insert the dosing information for each indication'''</SMALL> | ||
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:: (Dosage)}}} | :: (Dosage)}}} | ||
|- | |- | ||
| style="width: 50%;" valign=top | Please enter established '''off-label use and dosage''' for '''children''' | | style="width: 50%;" valign=top | Please enter established '''off-label use and dosage''' for '''children''': | ||
|- | |- | ||
| style="width: 50%;" valign=top | | | style="width: 50%;" valign=top | Please enter '''guideline-supported off-label use''' in this field: | ||
| style="width: 50%;" valign=top | {{{field|offLabelPedGuideSupport|input type=textarea|size=35|editor|default= | | style="width: 50%;" valign=top | {{{field|offLabelPedGuideSupport|input type=textarea|size=35|editor|default= | ||
'''Condition 1''' | '''Condition 1''' | ||
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:* (Dosage)}}} | :* (Dosage)}}} | ||
|- | |- | ||
| style="width: 50%;" valign=top | | | style="width: 50%;" valign=top | Please enter '''non–guideline-supported off-label use''' in this field: | ||
| style="width: 50%;" valign=top | {{{field|offLabelPedNoGuideSupport|input type=textarea|size=35|editor|default= | | style="width: 50%;" valign=top | {{{field|offLabelPedNoGuideSupport|input type=textarea|size=35|editor|default= | ||
'''Condition 1''' | '''Condition 1''' | ||
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}}} | }}} | ||
|- | |- | ||
| style="width: 50%;" valign=top | Please enter the '''adverse reactions''' reported from '''postmarketing experience'''<BR><SMALL> | | style="width: 50%;" valign=top | Please enter the '''adverse reactions''' reported from '''postmarketing experience''':<BR><SMALL> | ||
* '''Step 1: Check the "Adverse Reactions" section from the FDA label'''<BR> | * '''Step 1: Check the "Adverse Reactions" section from the FDA label'''<BR> | ||
* '''Step 2: Arrange the contents based on organ systems'''</SMALL> | * '''Step 2: Arrange the contents based on organ systems'''</SMALL> | ||
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| style="width: 50%;" valign=top | FDA Pregnancy Category: {{{field|FDAPregCat|input type=dropdown|values=A,B,C,D,X,N}}} | | style="width: 50%;" valign=top | FDA Pregnancy Category: {{{field|FDAPregCat|input type=dropdown|values=A,B,C,D,X,N}}} | ||
|- | |- | ||
| style="width: 50%;" valign=top | Please enter information related to the FDA reported pregnancy category | | style="width: 50%;" valign=top | Please enter information related to the FDA reported pregnancy category: | ||
| {{{field|useInPregnancyFDA|input type=textarea|size=35|editor}}} | | {{{field|useInPregnancyFDA|input type=textarea|size=35|editor}}} | ||
|- | |- | ||
| style="width: 50%;" valign=top | Australian Pregnancy Category: {{{field|AUSPregCat|input type=dropdown|values=A,B1,B2,B3,C,D,X}}} | | style="width: 50%;" valign=top | Australian Pregnancy Category: {{{field|AUSPregCat|input type=dropdown|values=A,B1,B2,B3,C,D,X}}} | ||
|- | |- | ||
| style="width: 50%;" valign=top | Please enter information related to the Australian reported pregnancy category | | style="width: 50%;" valign=top | Please enter information related to the Australian reported pregnancy category: | ||
| {{{field|useInPregnancyAUS|input type=textarea|size=35|editor}}} | | {{{field|useInPregnancyAUS|input type=textarea|size=35|editor}}} | ||
|- | |- | ||
| style="width: 50%;" valign=top | Please enter information related to the use of the drug during labor and delivery | | style="width: 50%;" valign=top | Please enter information related to the use of the drug during labor and delivery: | ||
| style="width: 50%;" valign=top | {{{field|useInLaborDelivery|input type=textarea|size=35|editor}}} | | style="width: 50%;" valign=top | {{{field|useInLaborDelivery|input type=textarea|size=35|editor}}} | ||
|- | |- | ||
| style="width: 50%;" valign=top | Please enter information related to the use of the drug during nursing | | style="width: 50%;" valign=top | Please enter information related to the use of the drug during nursing: | ||
| style="width: 50%;" valign=top | {{{field|useInNursing|input type=textarea|size=35|editor}}} | | style="width: 50%;" valign=top | {{{field|useInNursing|input type=textarea|size=35|editor}}} | ||
|- | |- | ||
| style="width: 50%;" valign=top | Please enter information related to the use of the drug in pediatrics | | style="width: 50%;" valign=top | Please enter information related to the use of the drug in pediatrics: | ||
| style="width: 50%;" valign=top | {{{field|useInPed|input type=textarea|size=35|editor}}} | | style="width: 50%;" valign=top | {{{field|useInPed|input type=textarea|size=35|editor}}} | ||
|- | |- | ||
| style="width: 50%;" valign=top | Please enter information related to the use of the drug in geriatrics | | style="width: 50%;" valign=top | Please enter information related to the use of the drug in geriatrics: | ||
| style="width: 50%;" valign=top | {{{field|useInGeri|input type=textarea|size=35|editor}}} | | style="width: 50%;" valign=top | {{{field|useInGeri|input type=textarea|size=35|editor}}} | ||
|- | |- | ||
| style="width: 50%;" valign=top | Please enter information related to the use of the drug and gender | | style="width: 50%;" valign=top | Please enter information related to the use of the drug and gender: | ||
| style="width: 50%;" valign=top | {{{field|useInGender|input type=textarea|size=35|editor}}} | | style="width: 50%;" valign=top | {{{field|useInGender|input type=textarea|size=35|editor}}} | ||
|- | |- | ||
| style="width: 50%;" valign=top | Please enter information related to the use of the drug and race | | style="width: 50%;" valign=top | Please enter information related to the use of the drug and race: | ||
| style="width: 50%;" valign=top | {{{field|useInRace|input type=textarea|size=35|editor}}} | | style="width: 50%;" valign=top | {{{field|useInRace|input type=textarea|size=35|editor}}} | ||
|- | |- | ||
| style="width: 50%;" valign=top | Please enter information related to the use of the drug in patients with renal impairment | | style="width: 50%;" valign=top | Please enter information related to the use of the drug in patients with renal impairment: | ||
| style="width: 50%;" valign=top | {{{field|useInRenalImpair|input type=textarea|size=35|editor}}} | | style="width: 50%;" valign=top | {{{field|useInRenalImpair|input type=textarea|size=35|editor}}} | ||
|- | |- | ||
| style="width: 50%;" valign=top | Please enter information related to the use of the drug in patients with hepatic impairment | | style="width: 50%;" valign=top | Please enter information related to the use of the drug in patients with hepatic impairment: | ||
| style="width: 50%;" valign=top | {{{field|useInHepaticImpair|input type=textarea|size=35|editor}}} | | style="width: 50%;" valign=top | {{{field|useInHepaticImpair|input type=textarea|size=35|editor}}} | ||
|- | |- | ||
| style="width: 50%;" valign=top | Please enter information related to the use of the drug in females of reproductive potential and males | | style="width: 50%;" valign=top | Please enter information related to the use of the drug in females of reproductive potential and males: | ||
| style="width: 50%;" valign=top | {{{field|useInReproPotential|input type=textarea|size=35|editor}}} | | style="width: 50%;" valign=top | {{{field|useInReproPotential|input type=textarea|size=35|editor}}} | ||
|- | |- | ||
| style="width: 50%;" valign=top | Please enter information related to the use of the drug in immunocompromised patients | | style="width: 50%;" valign=top | Please enter information related to the use of the drug in immunocompromised patients: | ||
| style="width: 50%;" valign=top | {{{field|useInImmunocomp|input type=textarea|size=35|editor}}} | | style="width: 50%;" valign=top | {{{field|useInImmunocomp|input type=textarea|size=35|editor}}} | ||
|- | |- | ||
| style="width: 50%;" valign=top | Others | | style="width: 50%;" valign=top | Others: | ||
|Title of Section: {{{field|othersTitle|input type=text|size=40}}} | |Title of Section: {{{field|othersTitle|input type=text|size=40}}} | ||
Body: {{{field|useInOthers|input type=textarea|size=35|editor}}} | Body: {{{field|useInOthers|input type=textarea|size=35|editor}}} | ||
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{| | {| | ||
| style="width: 50%;" valign=top | Please enter information pertaining to drug administration here | | style="width: 50%;" valign=top | Please enter information pertaining to drug administration here: | ||
| {{{field|administration|input type=textarea|size=35|editor}}} | | {{{field|administration|input type=textarea|size=35|editor}}} | ||
|- | |- | ||
| style="width: 50%;" valign=top | Please enter information pertaining to the drug monitoring here | | style="width: 50%;" valign=top | Please enter information pertaining to the drug monitoring here: | ||
| style="width: 50%;" valign=top | {{{field|monitoring|input type=textarea|size=35|editor}}} | | style="width: 50%;" valign=top | {{{field|monitoring|input type=textarea|size=35|editor}}} | ||
|} | |} | ||
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{| | {| | ||
| style="width: 50%;" valign=top | Please enter information pertaining to the IV compatibility here | | style="width: 50%;" valign=top | Please enter information pertaining to the IV compatibility here: | ||
| style="width: 50%;" valign=top | {{{field|IVCompat|input type=textarea|size=35|editor}}} | | style="width: 50%;" valign=top | {{{field|IVCompat|input type=textarea|size=35|editor}}} | ||
|} | |} | ||
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{| | {| | ||
| style="width: 50%;" valign=top | Please enter information pertaining to the drug overdose here | | style="width: 50%;" valign=top | Please enter information pertaining to the drug overdose here: | ||
| style="width: 50%;" valign=top | {{{field|overdose|input type=textarea|size=35|editor}}} | | style="width: 50%;" valign=top | {{{field|overdose|input type=textarea|size=35|editor}}} | ||
|} | |} | ||
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| {{{field|drugBox|input type=textarea|size=35|editor}}} | | {{{field|drugBox|input type=textarea|size=35|editor}}} | ||
|- | |- | ||
| style="width: 50%;" valign=top | Please enter 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}}} | ||
|- | |- | ||
| style="width: 50%;" valign=top | Please enter 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}}} | ||
|- | |- | ||
| style="width: 50%;" valign=top | Please enter information related to the pharmacodynamics | | style="width: 50%;" valign=top | Please enter information related to the pharmacodynamics: | ||
| style="width: 50%;" valign=top | {{{field|PD|input type=textarea|size=35|editor}}} | | style="width: 50%;" valign=top | {{{field|PD|input type=textarea|size=35|editor}}} | ||
|- | |- | ||
| style="width: 50%;" valign=top | Please enter information related to the pharmacokinetics | | style="width: 50%;" valign=top | Please enter information related to the pharmacokinetics: | ||
| style="width: 50%;" valign=top | {{{field|PK|input type=textarea|size=35|editor}}} | | style="width: 50%;" valign=top | {{{field|PK|input type=textarea|size=35|editor}}} | ||
|- | |- | ||
| style="width: 50%;" valign=top | Please enter information related to the nonclinical toxicology | | style="width: 50%;" valign=top | Please enter information related to the nonclinical toxicology: | ||
| style="width: 50%;" valign=top | {{{field|nonClinToxic|input type=textarea|size=35|editor}}} | | style="width: 50%;" valign=top | {{{field|nonClinToxic|input type=textarea|size=35|editor}}} | ||
|} | |} | ||
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{| | {| | ||
| style="width: 50%;" valign=top | 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: | ||
| style="width: 50%;" valign=top | {{{field|clinicalStudies|input type=textarea|size=35|editor}}} | | style="width: 50%;" valign=top | {{{field|clinicalStudies|input type=textarea|size=35|editor}}} | ||
|} | |} | ||
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{| | {| | ||
| style="width: 50%;" valign=top | Please enter information pertaining to how the drug is supplied | | style="width: 50%;" valign=top | Please enter information pertaining to how the drug is supplied: | ||
| style="width: 50%;" valign=top | {{{field|howSupplied|input type=textarea|size=35|editor}}} | | style="width: 50%;" valign=top | {{{field|howSupplied|input type=textarea|size=35|editor}}} | ||
|- | |- | ||
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{| | {| | ||
| style="width: 50%;" valign=top | Please enter information pertaining to the drug images here | | style="width: 50%;" valign=top | Please enter information pertaining to the drug images here: | ||
| style="width: 50%;" valign=top | {{{field|drugImages|input type=textarea|size=35|editor}}} | | style="width: 50%;" valign=top | {{{field|drugImages|input type=textarea|size=35|editor}}} | ||
|- | |- | ||
| style="width: 50%;" valign=top | 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: | ||
| style="width: 50%;" valign=top | {{{field|packLabel|input type=textarea|size=35|editor}}} | | style="width: 50%;" valign=top | {{{field|packLabel|input type=textarea|size=35|editor}}} | ||
|} | |} | ||
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{| | {| | ||
| style="width: 50%;" valign=top | Please enter the FDA provided patient information here | | style="width: 50%;" valign=top | Please enter the FDA provided patient information here: | ||
| style="width: 50%;" valign=top | {{{field|fdaPatientInfo|input type=textarea|size=35|editor}}} | | style="width: 50%;" valign=top | {{{field|fdaPatientInfo|input type=textarea|size=35|editor}}} | ||
|- | |- | ||
| style="width: 50%;" valign=top | Please enter the NLM provided patient information | | style="width: 50%;" valign=top | Please enter the NLM provided patient information here: | ||
| style="width: 50%;" valign=top | {{{field|nlmPatientInfo|input type=textarea|size=35|editor}}} | | style="width: 50%;" valign=top | {{{field|nlmPatientInfo|input type=textarea|size=35|editor}}} | ||
|} | |} | ||
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=Precautions with Alcohol= | =Precautions with Alcohol= | ||
{| | |||
c Please describe any guideline on the concurrent use of the drug with alcohol: | |||
| style="width: 50%;" valign=top | {{{field|alcohol|input type=textarea|size=35|editor}}} | | style="width: 50%;" valign=top | {{{field|alcohol|input type=textarea|size=35|editor}}} | ||
|} | |||
=Look-Alike Drug Names= | =Look-Alike Drug Names= | ||
Please enter | |||
{{{field|lookAlike|input type=textarea|size=35|editor}}} | {| | ||
| 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}}} | |||
|} | |||
=Price= | =Price= | ||
{| | {| | ||
| style="width: 50%;" valign=top | Please enter the drugs a patient may want to compare for | | 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}}} | | style="width: 50%;" valign=top | {{{field|price|input type=textarea|size=35|editor}}} | ||
|} | |} | ||
=Drug Shortages= | =Drug Shortages= | ||
{| | {| | ||
| style="width: 50%;" valign=top | Please enter information relevant to | | style="width: 50%;" valign=top | Please enter information relevant to drug shortages: | ||
| style="width: 50%;" valign=top | {{{field|drugShortage|input type=textarea|size=35|editor}}} | | style="width: 50%;" valign=top | {{{field|drugShortage|input type=textarea|size=35|editor}}} | ||
|} | |} | ||
{{{end template}}} | {{{end template}}} |
Revision as of 23:18, 1 May 2014