St.

Michael’s College
College of Nursing
Iligan City

DRUG STUDY FORM

Name of Patient: X Date/Shift: FEBRUARY 17, 2024 / 7:00AM – 3:00PM

DRUG ID:
 Generic/Brand name
 Classification/
Subclassification
 Dosage range
 Client dosage
 Frequency/Route
Area: STATION 1
NURSING RESPONSIBILITIES
(what need to assess to
MECHANISM INDICATIONS CLIENT’S RESPONSE/ administer safely & pertinent
OF ACTION ADVERSE/SIDE EFFECTS CONTRAINDICATIONS DESIRED ACTION teaching specific to client’s meds)
(Own interpretation/words) Use AIM H format

Generic Name:  Suppresses Adverse effects: Indications: Client’s response:  Assess for
Omeprazole gastric acid Headache, - Short-term treatment After administration of hypersensitivity
secretion by dizziness, apathy, of active duodenal ulcer omeprazole patient to omeprazole
Brand name: specific inhibition rash, alopecia, - Treatment of was able to report or any of its
Losec (CAN), Prilosec, of the hydrogen- diarrhea, vomiting, heartburn or symptoms signs of relief from components,
Prilosec OTC, Zegerid potassium back pain, or of GERD pain with a pain scale pregnancy,
(with sodium ATPase enzyme epistaxis - Short-term treatment from 6/10 to 2/10 lactation
bicarbonate) system at the of active benign gastric  Asses for any
secretory surface Side effects: ulcer Desired action: skin lesions, T;
Classification:
of the gastric Headache, nausea, - GERD, severe erosive To reduce the reflexes, affect;
Proton Pump Inhibitor parietal cells; vomiting, or diarrhea esophagitis, poorly production of acid and urinary output,
Dosage range:
blocks the final responsive symptomatic alleviate symptoms abdominal
20 – 40 mg step of acid GERD associated with examination,
production conditions like respiratory
Client dosage: Contraindications: heartburn, acid reflux, auscultation
40 mg Hypersensitivity to and gastritis.  Assess for the
omeprazole or its pain scale
components before and after
Frequency/ Route: administration
OD / IVTT  Assess vital
signs before
and after
administration
 Explain the side
effects that may
occur and also
danger signs
for adverse
reaction
 Instruct patient
or s/o to report
severe
headache,
worsening of
symptoms,
fever, chills

St. Michael’s College

 College of Nursing
Iligan City

DRUG STUDY FORM

Name of Patient: X Date/Shift: FEBRUARY 17, 2024 / 7:00 AM – 3:00 PM

DRUG ID:
 Generic/Brand name
 Classification/
Subclassification
 Dosage range
 Client dosage
 Frequency/Route
Area: STATION 1
NURSING RESPONSIBILITIES
(what need to assess to
MECHANISM INDICATIONS CLIENT’S RESPONSE/ administer safely & pertinent
OF ACTION ADVERSE/SIDE EFFECTS CONTRAINDICATIONS DESIRED ACTION teaching specific to client’s meds)
(Own interpretation/words) Use AIM H format

Generic Name:  Anti-inflammatory Adverse effects: Indications: Client’s response:  Monitor vital
Ketorolac and analgesic Drowsiness, Short-term (butangan pa nako) signs
Tromethamine activity; inhibits Headache, asthma, management of pain  Assess for
prostaglandins dyspnea, edema, (up to 5 days) history of renal
Brand name: and leukotriene pallor, GI bleeding, impairment;
Acular LS, Acular PF synthesis diarrhea, GI pain, Desired action: impaired
oliguria Contraindications: To provide relief from hearing;
Classification:
Patient with significant moderate to severe allergies;
Antipyretic, Nonopioid
renal impairment, pain and inflammation hepatic, CV,
analgesic, NSAID
Side effects: aspirin allergy, recent and GI
Dosage range: Nausea, vomiting, GI bleed or conditions;
30 mg abdominal pain, perforation. lactation and
itching, fluid retention, pregnancy
Client dosage: heartburn, fatigue,  Monitor for
30 mg excessive sweating, pain; PQRST,
Frequency/ Route: dry mouth or mouth ROM before
Q6 / IV ulcers administration

 Explain the side

 effects that may
occur and also
danger signs
for adverse
reaction
 Encourage
client to report
severe pain and
difficulty
breathing for
prompt
intervention
 Terminate or
discontinue
infusion if
uterine
hypersensitivity
occurs.
 St. Michael’s College
College of Nursing
Iligan City

DRUG STUDY FORM

Name of Patient: X Date/Shift: FEBRUARY 17, 2024 / 7:00AM – 3:00PM

Area: STATION 1
DRUG ID:
 Generic/Brand name NURSING RESPONSIBILITIES
 Classification/Subclassification (what need to assess to
 Dosage range MECHANISM INDICATIONS CLIENT’S RESPONSE/ administer safely & pertinent
 Client dosage OF ACTION ADVERSE/SIDE EFFECTS CONTRAINDICATIONS DESIRED ACTION teaching specific to client’s meds)
 Frequency/Route (Own interpretation/words) Use AIM H format

Generic Name:  Bactericidal: Adverse effects: Indications: Client’s response:  Question for
Ceftriaxone Sodium Inhibits synthesis Severe diarrhea, Treatment of lower (-----------) history of
of bacterial cell difficulty breathing, respiratory infections, allergies,
Brand name: wall, causing unusual tiredness or acute bacterial otitis, Desired action: particularly
Rocephin death fatigue, pain at UTI, Gonorrhea, skin To kill the bacteria cephalosporin,
injection site and skin structure responsible for the penicillin
Classification:
infections, meningitis, infection that allows  Assess history
Cephalosporin (third Side effects: resolution of fever, of hepatic and
generation) Stomach ache, Contraindications: reduction in pain, renal
Dosage range:
diarrhea Hypersensitivity to alleviation of impairment.
1-2 g cephalosporins or inflammation.  Assess skin
penicillin. status
Client dosage: Use cautiously with  Monitor vital
10 ml renal failure, lactation, signs including
pregnancy. I&O
Frequency/ Route:  Do not mix
Q8 / IV ceftriaxone with
 another
antimicrobial
drug
 Educate patient
to avoid alcohol
 Inform about
the side effects
 Encourage
patient to report
any signs of
adverse effects
 St. Michael’s College
College of Nursing
Iligan City

DRUG STUDY FORM

Name of Patient: X Date/Shift: FEBRUARY 17, 2024 / 7:00AM – 3:00PM
Area: STATION 1
DRUG ID:
 Generic/Brand name NURSING RESPONSIBILITIES
 Classification/ (what need to assess to
Subclassification MECHANISM INDICATIONS CLIENT’S RESPONSE/ administer safely & pertinent
 Dosage range OF ACTION ADVERSE/SIDE EFFECTS CONTRAINDICATIONS DESIRED ACTION teaching specific to client’s meds)
 Client dosage (Own interpretation/words) Use AIM H format
 Frequency/Route

Generic Name:  Stimulates CNS Adverse effects: Indications: Client’s response:  Assess history;
Clonidine alpha2- adrenergic Transient Hypertension, used Patient verbalizes hypersensitivity
Hydrochloride receptors, inhibits hypertension or alone or as part of feeling of relaxation to clonidine,
sympathetic profound combination therapy and no headaches or cerebrovascular
Brand name: cardioaccelerator hypotension, Treatment of severe dizziness, which are disease,
Catapres, Duraclon and respiratory pain in cancer patients symptoms associated chronic renal
vasoconstrictor depression, with high blood failure
Classification:
centers, and convulsion, Contraindication: pressure  Assess body
Antihypertensive decreases bradycardia, or coma Hypersensitivity to weight, skin
Dosage range:
sympathetic clonidine or any Desired action: color, lesions
0.2 mg – 0.6 mg outflow from the Side effects: adhesive layer Reduces blood  Do not
CNS Drowsiness, dry components of the pressure levels to discontinue
Client dosage: mouth, headache, transdermal system within the normal abruptly
75 mcg dizziness, Pregnancy and range  Monitor vital
constipation, nausea, lactation signs especially
Frequency/ Route: BP
Q7 / SL  Teach patient to
take drug
exactly as
 prescribed
 Inform patient
of the side
effects
 Instruct patient
to report urinary
retention,
changes in
vision,
blanching of
fingers, rash
 St. Michael’s College
College of Nursing
Iligan City

DRUG STUDY FORM

Name of Patient: X Date/Shift: FEBRUARY 17, 2024 / 7:00AM – 3:00PM

DRUG ID:
 Generic/Brand name
 Classification/
Subclassification
 Dosage range
 Client dosage
 Frequency/Route
Area: STATION 1
NURSING RESPONSIBILITIES
(what need to assess to
MECHANISM INDICATIONS CLIENT’S RESPONSE/ administer safely & pertinent
OF ACTION ADVERSE/SIDE EFFECTS CONTRAINDICATIONS DESIRED ACTION teaching specific to client’s meds)
(Own interpretation/words) Use AIM H format

Generic Name: Reduces fever by Adverse effects: Indications: Client’s response:  Ask for allergy
Paracetamol/ Panadol acting directly of Hemolytic anemia, Temporary reduction (-----------------) to medication
hypothalamic heat- acute renal failure, of fever, minor pain, before
Brand name: regulating center to renal tubular necrosis pain that caused of a Desired action: administering
Calpol,Alvedon cause vasodilation and thrombocytopenia common colds and To relieve the pain of  Discontinue the
and sweating, which influenza, muscle the patient from mild drug if
Classification: helps dissipate heat aches and arthritis to moderate pain. hypersensitivity
Analgesic (nonopioid) Side effects: pain. reaction occurs
Antipyretic Chest pain, dyspnea,  Monitor Vital
headache, jaundice Contraindications: signs before
Dosage range:
and rash Contraindicated with and after
1000mg
allergy to administration
Client dosage: acetaminophen.  Monitor serum
100 ml Acute liver failure levels
 Inform patient
of the side
Frequency/ Route: effects and
Q6 / IV slow possible
adverse effects