What drug is potentially associated with the ADR?
Adverse Drug Reaction (ADR)
How do you spell the drug name
Availability of the medication
What is the indication or therapeutic use?
Availability of the medication
Where did you hear about the drug? (e.g. read about it in a journal, saw it on the Internet, etc.)
Availability of the medication
How was the drug given (e.g. dose, route)?
Adverse Drug Reaction (ADR)
How long was the drug given before the reaction occurred?
Adverse Drug Reaction (ADR
What reaction occurred?
Adverse Drug Reaction (ADR
What is the background information? (e.g. informational purposes or patient) o Is this a prescription drug, non-prescription drug, or herbal?
Availability of the medication
What patient information is available? Age, sex, weight, present disease(s), past allergies or reactions (describe), concurrent food/medication, if teratogenicity, what trimester
Adverse Drug Reaction (ADR)
What patient information available?
Dosing & Administration
What is the age of the patient?
Drug Interaction
What are the patient’s health conditions?
Drug Interaction
What other medications or herbals is the patient taking?
Drug Interaction
What is the route of administration?
Dosing & Administration
What is the disease being treated or indication?
Dosing & Administration
What was the most recent drug added?
Drug Interaction
What drugs are involved?
Drug Interaction
Has the interaction actually occurred? If so, what results (what was the reaction, if any)?
Drug Interaction
Are there other drugs being taken?
Dosing & Administration
What trimester is the mother in?
Drugs during pregnancy