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Drug Card Template

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NURS 1566 Clinical Form 3: Clinical Medications Worksheets

(You will need to make additional copies of these forms)

Generic Name Trade Name Classification Dose Route Time/frequency

Peak Onset Duration Normal dosage range

Why is your patient getting this medication For IV meds, compatibility with IV drips and/or
solutions

Mechanism of action and indications Nursing Implications (what to focus on)


(Why med ordered) Contraindications/warnings/interactions

Common side effects

Interactions with other patient drugs, OTC or Lab value alterations caused by medicine
herbal medicines (ask patient specifically)
Be sure to teach the patient the following about this
medication

Nursing Process- Assessment Assessment Evaluation


(Pre-administration assessment) Why would you hold or not give this Check after giving
med?

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