Name of patient:

DRUG STUDY
NURSING
DRUG ORDER MECHANISM INDICATIONS CONTRAINDICATIONS ADVERSE EFFECTS RESPONSIBILITY/
OF ACTION PRECAUTION
Generic Name: Serious Reaction:
TELMISARTAN
 Hypersensitivity
Brand Name:
rxn
MICARDIS  Anaphylaxis
Classification  Angioedema
Route:  Hypotension,
ORAL severe
Dosage:  Hyperkalemia
 Renal impairment/
TAB: 20 mg, 40
failure
mg, 80 mg  Anemia
Frequency:  Thrombocytopenia
 Rhabdomyolysis

Common Reactions:

 URI sx
 Back pain
 Diarrhea

Generic
Name:
Brand Name:
Classification
Route
Dosage:
Frequency:

PHENYTOIN

Generic
Name:
Brand Name:
Classification
Route
Dosage:
Frequency:

INSULIN
GLARGINE