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Student Name Client Room #

Dates Client Initials

Med. Dx

INDIVIDUALIZED MEDICATION FORM

DRUG ORDERED *MECHANISM OF UNIQUE NURSING INDIVIDUALIZED MEDICATION


(INCLUDE): GENERIC ACTION: CONSIDERATIONS RATIONALE FOR USE CALCULATION:
AND TRADE NAME; How does the drug work - Assess OF THIS DRUG
The student is to
DOSE; ROUTE AND in the body to achieve the Note: The student is to
calculate the dosage of
FREQUENCY; DOSAGE therapeutic effect? place emphasis on the
- Do the medication to be
RANGE; AND DRUG individualized rationale
*Side Effects/Adverse administered to this
CLASSIFICATION for the drug. Why is
Effects particular client.
- Teach this client taking this
*Significant Interactions drug? How would you Work is to be shown on
with Drugs/Food evaluate the the form
effectiveness of this Indicate how drug
drug? supplied and then do
calculation
MOA: ↓BP & HR, Assess: Monitor BP, ↓BP
Generic: metoprolol ↓frequency of attacks of ECG, pulse frequency Reduction in
angina pectoris, during dose frequency of angina
Trade: Lopressor ↓cardiovascular mortality & adjustment. attacks.
hospitalization in pt’s w/ Monitor VS, ECG ever Increase in activity
Route: Oral, IV heart failure. 5-15 min. Monitor I/O tolerance.
ratios and daily weight Prevention of MI.
Dose: Adverse Effects: fatigue,
Oral- 25- 100mg/day weakness, anxiety, Do:
as single dose depression, dizziness, Oral- Take apical pulse
initially or 2 divided drowsiness, insomnia, before admin. If
doses memory loss, mental status <50bpm withhold
IV- 5mg q 2 min. for 3 changes, nervousness, med.
doses, followed by nightmares, blurred vision, Admin. w/ meals or
oral dosing stuffy nose, bronchospasm, after eating
wheezing, bradycardia, CHF, IV- Admin undiluted
Classification: pulmonary edema, 1mg/mL
Therapeutic- hypotension, peripheral
antianginals, vasoconstriction, Teach: Pt. how to
antihypertensives constipation, diarrhea, dry check pulse daily and
Pharmacologic- beta mouth, flatulence, gastric BP bi-weekly and
blockers pain, heartburn, erectile report sig. changes to
dysfunction, ↓libido, urinary MD.
frequency, rashes, Report difficulty
hyper/hypo glycemia. breathing, night
cough, swelling, slow
pulse, confusion,
depression, rash,
fever, sore throat.

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