Principles Of Drug Information 2008

7,398 views
7,143 views

Published on

Published in: Health & Medicine, Education
0 Comments
28 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
7,398
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
0
Comments
0
Likes
28
Embeds 0
No embeds

No notes for slide

Principles Of Drug Information 2008

  1. 1. Principles of Drug Information Brenda Rosenthal, B.Sc.Pharm Drug Information Centre Health Sciences Center Oct 29, 2008
  2. 2. Learning Objectives <ul><li>Identify main drug information references and understand limitations of each reference </li></ul><ul><li>Be able to select the appropriate drug information reference to answer a patient care related question </li></ul><ul><li>Understand and apply the step of the systematic approach to answering drug information questions to answer a patient care related question </li></ul>
  3. 3. Outline <ul><li>Introduction </li></ul><ul><li>Systematic approach to answering drug information questions </li></ul><ul><li>Reference Books – textbooks & online </li></ul><ul><li>Practice Questions </li></ul>
  4. 4. <ul><li>“ Knowledge is of two kinds. We know a subject ourselves, or we know where we can find information upon it.” </li></ul><ul><ul><ul><li>Samuel Johnson (1709-1784) </li></ul></ul></ul>
  5. 5. Definition <ul><li>Drug Information: </li></ul><ul><ul><li>The integration of locating, analyzing, applying, and communicating information concerning drugs, usually for use by the person in a decision-making role in patient management </li></ul></ul><ul><ul><li>OR simply answering drug related questions </li></ul></ul>
  6. 6. Drug Information Centre <ul><li>What is a drug information pharmacist? </li></ul><ul><li>Education needed </li></ul><ul><li>Two DI centres in Manitoba </li></ul><ul><ul><li>Winnipeg Regional Health Authority (WRHA) DI Centre at HSC </li></ul></ul><ul><ul><li>Medication Information Line for the Elderly (MILE) at U of M </li></ul></ul>
  7. 7. Services Provided <ul><li>Answering DI questions </li></ul><ul><li>Pharmacy & Therapeutics Committee </li></ul><ul><li>Writing and Publications </li></ul><ul><li>Education </li></ul><ul><li>Adverse Event Reporting </li></ul><ul><li>Poison control </li></ul><ul><li>Investigational drugs </li></ul>
  8. 8. Systematic Approach to Answering Drug Information Questions
  9. 9. Systematic Approach <ul><li>10 steps </li></ul><ul><li>Relying on intuition, previous experience or luck not appropriate </li></ul><ul><li>Systematic approach ensures all factors are considered for every request </li></ul>
  10. 10. 1) Collect requestor demographics <ul><li>Identification of caller </li></ul><ul><ul><li>Name </li></ul></ul><ul><ul><li>Type of caller (MD, RN, pharmacist, patient) </li></ul></ul><ul><li>Location </li></ul><ul><li>Contact information </li></ul><ul><ul><li>phone, pager, fax, email </li></ul></ul><ul><li>Date & time </li></ul>
  11. 11. 2) Background Info <ul><li>Let the requestor state the question </li></ul><ul><li>Ask appropriate background questions </li></ul><ul><ul><li>gather extra information </li></ul></ul><ul><ul><li>determine “true” question </li></ul></ul><ul><li>See WRHA Drug Information Resource Table for appropriate background questions </li></ul>
  12. 12. 3) Determine the question(s) <ul><li>What is the requestor asking? </li></ul><ul><li>May be more than one question </li></ul><ul><li>May need to answer other questions before answering the true question </li></ul><ul><ul><li>ex. keratitis sicca </li></ul></ul><ul><li>Anticipate further questions </li></ul>
  13. 13. 4) Determine the urgency <ul><li>Stat, few hours, few days? </li></ul><ul><li>To be useful question must be answered in the appropriate time frame </li></ul><ul><li>Important in prioritizing workload </li></ul><ul><ul><li>requestor may look elsewhere for answer </li></ul></ul><ul><ul><li>may make decision without answer </li></ul></ul>
  14. 14. 5) Type of response needed? <ul><li>Verbal, written, fax, email, photocopies </li></ul><ul><li>Type of response depends on several factors </li></ul><ul><ul><li>caller </li></ul></ul><ul><ul><li>question </li></ul></ul><ul><ul><li>depth of response </li></ul></ul>
  15. 15. 6) Classify question(s) <ul><li>What type of question(s)? </li></ul><ul><ul><li>ex. availability, dosage, side effects, etc </li></ul></ul><ul><li>Important for a systematic approach </li></ul><ul><li>Determines types of resources that are appropriate </li></ul><ul><li>See WRHA Drug Information Resource Table for examples of types of questions </li></ul>
  16. 16. 6) Classify question(s), cont’d <ul><li>Classification Categories </li></ul><ul><ul><li>Availability / Identification </li></ul></ul><ul><ul><li>Drug Interactions </li></ul></ul><ul><ul><li>Dosage </li></ul></ul><ul><ul><li>Adverse Drug Reactions / Side effects </li></ul></ul><ul><ul><li>IV administration / compatibility </li></ul></ul><ul><ul><li>Poisoning / Toxicology </li></ul></ul><ul><ul><li>Pregnancy & Lactation </li></ul></ul><ul><ul><li>Natural Products </li></ul></ul><ul><ul><li>Patient Information </li></ul></ul><ul><ul><li>Therapeutics </li></ul></ul>
  17. 17. 7) Select appropriate references <ul><li>Always check at least two references </li></ul><ul><li>Start with books, reviews, e-books </li></ul><ul><ul><ul><li>tertiary references </li></ul></ul></ul><ul><li>Proceed to literature search using a search database like PubMed </li></ul><ul><ul><ul><li>secondary references </li></ul></ul></ul><ul><li>May need to find original studies </li></ul><ul><ul><ul><li>primary references </li></ul></ul></ul>
  18. 18. 8) Formulate a response <ul><li>Facts are better than guesses or opinions </li></ul><ul><li>Gather appropriate info from references to support answer </li></ul><ul><li>Important to document what references are used </li></ul><ul><li>If no facts are available, expert opinion may be needed </li></ul>
  19. 19. 9) Summarize & deliver answer <ul><li>Verbal (phone or in person) </li></ul><ul><ul><li>30 seconds to get main point across </li></ul></ul><ul><ul><li>Restate question </li></ul></ul><ul><ul><li>State answer, then “extra” info </li></ul></ul><ul><li>Written / email / fax </li></ul><ul><ul><li>Summarize question and answer, include references </li></ul></ul><ul><ul><li>Document on chart or prescription </li></ul></ul>
  20. 20. 10) Follow up <ul><li>Done in order to determine if: </li></ul><ul><ul><li>the correct question was asked and answer was sufficient </li></ul></ul><ul><ul><li>the answer was accepted and if an impact was made on patient care </li></ul></ul><ul><ul><li>further assistance is needed </li></ul></ul>
  21. 21. Drug Information References General References Specialized References
  22. 22. General Drug Information References <ul><li>Contain information on </li></ul><ul><ul><li>dosing </li></ul></ul><ul><ul><li>side effects </li></ul></ul><ul><ul><li>drug interactions </li></ul></ul><ul><ul><li>contraindications & precautions </li></ul></ul><ul><ul><li>pharmacokinetics & pharmacology </li></ul></ul><ul><ul><li>how the medication is supplied (tablet, injection, etc) </li></ul></ul><ul><ul><li>how the medication should be stored </li></ul></ul>
  23. 23. Compendium of Pharmaceuticals and Specialties
  24. 24. CPS <ul><li>Referred to as the CPS </li></ul><ul><li>Published yearly by the Canadian Pharmacists Association </li></ul><ul><li>e-CPS available via U of M library </li></ul><ul><ul><li>updated monthly </li></ul></ul>
  25. 25. CPS: contents of paper version <ul><li>White pages </li></ul><ul><ul><li>contain monographs voluntarily submitted by pharmaceutical manufacturers arranged alphabetically by brand name </li></ul></ul><ul><li>Green pages </li></ul><ul><ul><li>the index, listing both brand and generic names </li></ul></ul><ul><li>Glossy white pages </li></ul><ul><ul><li>Product Identification Section with pictures of brand names products </li></ul></ul>
  26. 26. CPS: contents of paper version <ul><li>Yellow Pages </li></ul><ul><ul><li>manufacturers, health organizations & poison control centres addresses & phone numbers </li></ul></ul><ul><li>Purple pages </li></ul><ul><ul><li>clinical information </li></ul></ul><ul><li>Appendices at the back of the book </li></ul><ul><ul><li>Canadian Adverse Drug Reaction program information and their reporting form </li></ul></ul>
  27. 27. AHFS Drug Information                                                       
  28. 28. AHFS <ul><li>AHFS = American Hospital Formulary Service </li></ul><ul><li>Published yearly by the American Society of Health-System Pharmacists </li></ul><ul><li>Not written by pharmaceutical manufacturers </li></ul><ul><li>Available online via the U of M library in the Stat!Ref and Lexi-Comp Online databases </li></ul><ul><li>Organized by therapeutic classification, index at the back of the book </li></ul>
  29. 29. AHFS <ul><li>U.S. based reference </li></ul><ul><ul><li>NOTE: brand names in the US may be different from Canadian brand names, and some products only available in Canada may not be listed </li></ul></ul><ul><li>Not all drugs listed have complete monograph, and monograph do not have references </li></ul><ul><ul><li>online version contains references </li></ul></ul>
  30. 30. Martindale’s <ul><li>Published every 3 years by the Pharmaceutical Press, London, England. </li></ul><ul><li>Not written by pharmaceutical manufacturers </li></ul><ul><li>Index contains brand and generic names from 37 countries </li></ul>
  31. 31. Martindale’s <ul><li>List references to support information in text </li></ul><ul><li>Good for </li></ul><ul><ul><li>identification of foreign drugs </li></ul></ul><ul><ul><li>off label uses </li></ul></ul><ul><ul><li>molecular weight </li></ul></ul><ul><ul><li>“ odd-ball” questions </li></ul></ul><ul><li>Available online via UM e-books </li></ul>
  32. 32. Drug Information Handbook <ul><li>Drug Interaction Program </li></ul><ul><li>King’s Guide to Parenteral Admixture online </li></ul><ul><li>Lexi-Drugs Online </li></ul><ul><li>Pediatric Lexi-Drugs Online </li></ul><ul><li>AHFS Essentials (Adult and Pediatric) </li></ul><ul><li>AHFS DI (Adult and Pediatric) </li></ul><ul><li>Lexi-Drugs International Online </li></ul><ul><li>Geriatric Lexi-Drugs Online </li></ul><ul><li>Natural Products Database </li></ul><ul><li>Pharmacogenomics Online </li></ul><ul><li>Infectious Diseases </li></ul><ul><li>Poisoning and Toxicology </li></ul><ul><li>Nuclear, Biological, and Chemical Agent Exposures </li></ul><ul><li>Lab Tests and Diagnostic Procedures </li></ul>
  33. 33. Micromedex <ul><li>Available at WRHA sites only (hospitals and some community based clinics) </li></ul><ul><li>Online database that is useful for general drug information, IV compatibility, drug interactions </li></ul>
  34. 34. Specialized references
  35. 35. Drug Interaction References
  36. 36. Stockley’s Drug Interactions <ul><li>Published by the Pharmaceutical Press (same as Martindale’s) </li></ul><ul><li>European based, watch some drug names. ex acetaminophen/paracetamol </li></ul><ul><li>The best drug interactions reference, BUT not well known in Canada </li></ul><ul><li>Online version available for purchase (not available via UM library) </li></ul>
  37. 37. Drug Interaction Facts <ul><li>Two separate publication </li></ul><ul><ul><li>drug-drug interactions </li></ul></ul><ul><ul><li>drug-herb or food interactions </li></ul></ul><ul><li>Available online but subscription required </li></ul><ul><ul><li>not available via UM library </li></ul></ul>
  38. 38. Drug Interaction Facts <ul><li>Index in front, lists drugs alphabetically then all interacting drugs below </li></ul><ul><li>Significant rating system based on severity and documentation of the interaction </li></ul><ul><ul><ul><li>1 = most severe and well-documented interaction </li></ul></ul></ul><ul><ul><ul><li>5 = least severe or no interaction or poor documentation </li></ul></ul></ul>
  39. 39. Drug Interaction Facts <ul><li>Each interaction has a one page monograph including: </li></ul><ul><ul><li>onset, severity, documentation, mechanism and management of the interaction, and references to support the information </li></ul></ul>
  40. 40. Hansten & Horn: Drug Interactions <ul><li>Includes prescription, non-prescription and herbal products </li></ul><ul><li>Index at the front of the book, similar to Drug Interaction Facts </li></ul>
  41. 41. Hansten & Horn <ul><li>Significance rating system assesses the degree of risk to the patient based on clinical significance and the degree of documentation </li></ul><ul><ul><ul><li>1 = avoid combination </li></ul></ul></ul><ul><ul><ul><li>5 = no interaction </li></ul></ul></ul><ul><li>Each interaction has a monograph with similar information as Drug Facts and Comparisons </li></ul>
  42. 42. Adverse Reaction References
  43. 43. Meyler’s Side Effects of Drugs <ul><li>AKA Meyler’s </li></ul><ul><li>Published every 4-6 years with annual updates </li></ul><ul><li>Two indices: Drug Index and Side Effect Index </li></ul><ul><li>Not all side effect of a drug listed </li></ul><ul><li>Includes references to support information </li></ul><ul><li>Only in libraries or DI centres </li></ul>
  44. 44. Intravenous Compatibility References
  45. 45. Trissel’s: Handbook on Injectable Drugs <ul><li>Administration of intravenous (IV) medications </li></ul><ul><li>Compatibility between two IV medications or solutions </li></ul><ul><li>Online in Micromedex (WRHA only) </li></ul>
  46. 46. Other IV compatibility references <ul><li>Trissel’s Tables </li></ul><ul><ul><li>Y-site compatibility only </li></ul></ul><ul><li>Guide to Parenteral Admixtures </li></ul><ul><ul><li>AKA King’s </li></ul></ul><ul><ul><li>Info is similar to Trissel’s, but may contain additional compatibility info </li></ul></ul><ul><ul><li>Available online via Lexi-Comp Online (UM) </li></ul></ul>
  47. 47. Pregnancy & Breastfeeding References
  48. 48. Brigg’s: Drugs in Pregnancy and Lactation <ul><li>Summarizes literature and rates the safety of drugs in pregnancy and lactation </li></ul><ul><li>Includes monographs on drugs of abuse and cigarette smoking </li></ul><ul><li>Available online via e-books at the U of M </li></ul>
  49. 49. Drugs During Pregnancy and Lactation (Schaefer) <ul><li>Discusses classes of drugs in pregnancy and lactation </li></ul><ul><li>Better for clinical cases </li></ul><ul><li>Not as comprehensive as Briggs </li></ul><ul><li>Textbook available at NJM library </li></ul>
  50. 50. Medications and Mother’s Milk <ul><li>Information on drugs in breastfeeding only </li></ul><ul><li>Used in conjunction with Brigg’s </li></ul><ul><li>Has a lactation risk category system: </li></ul><ul><ul><li>L1 (safest) to L5 (contraindicated) </li></ul></ul><ul><ul><li>NB. The absolute safest drug in breastfeeding is no drug </li></ul></ul>
  51. 51. LactMed database <ul><li>http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT </li></ul>
  52. 52. Natural Products References
  53. 53. Natural Medicines Comprehensive Database <ul><li>Available in a hard copy and online version but subscription to online version required </li></ul><ul><ul><li>not available via UM library </li></ul></ul><ul><li>Reliable scientific source of information on herbal products </li></ul><ul><li>Contains both brand and generic names of herbals </li></ul>
  54. 54. Natural Standard
  55. 55. Natural Standard <ul><li>UM library subscribes to online version, textbook also available </li></ul><ul><li>An international research collaboration </li></ul><ul><li>Evidence-based, consensus-based, and peer-reviewed </li></ul>
  56. 56. Therapeutic & Clinical References
  57. 57. Pharmacotherapy <ul><li>AKA Dipiro’s </li></ul><ul><li>Disease based pharmacotherapy textbook </li></ul><ul><li>Used by the Faculty </li></ul><ul><li>Use with caution in practice as information may be out of date </li></ul>
  58. 58. Therapeutic Choices <ul><li>Published by the Canadian Pharmacists Association (CPhA) </li></ul><ul><li>Disease based but less detailed than Dipiro’s </li></ul><ul><li>Has good tables on therapeutic options </li></ul>
  59. 59. The Merck Manual <ul><li>Disease based text </li></ul><ul><li>Much more comprehensive disease state coverage but not a lot of detail on drug therapy </li></ul><ul><li>Useful as a quick reference </li></ul><ul><li>Available free online </li></ul><ul><ul><li>http://www.merck.com/pubs/ </li></ul></ul><ul><li>Geriatric & veterinary version also available </li></ul>
  60. 60. Patient Self Care <ul><li>Published by the CPhA </li></ul><ul><li>Disease based text </li></ul><ul><li>Information on diseases & conditions that can be treated with non-prescription products (medications, vitamins, devices, diet) </li></ul>
  61. 61. Goodman & Gilman’s: The Pharmacological Basis of Therapeutics <ul><li>Pharmacology based text </li></ul><ul><li>Pharmacology = science of drugs </li></ul><ul><li>Chapters organized on drug classes </li></ul>
  62. 62. Basic Skills in Interpreting Lab Data <ul><li>Written by pharmacists for pharmacists </li></ul><ul><li>Useful for hospital practice or any location where pharmacists have access to lab values </li></ul>
  63. 63. UpToDate <ul><li>Evidence-based, written by 3,800 expert physicians in their respective fields </li></ul><ul><ul><li>Not a systematic review or meta-analysis </li></ul></ul><ul><li>Covers more than 7,400 topics in 13 medical specialties </li></ul><ul><ul><li>specific, practical recommendations for diagnosis and treatment </li></ul></ul><ul><li>Updated every four months </li></ul><ul><li>Unbiased: no $ from pharmaceutical companies or other advertisers </li></ul>
  64. 64. University of Manitoba Health Sciences Library <ul><li>Useful for pharmacy </li></ul><ul><ul><li>e-CPS </li></ul></ul><ul><ul><li>Lexi-Comp with AHFS </li></ul></ul><ul><ul><li>Martindale’s </li></ul></ul><ul><ul><li>Briggs </li></ul></ul><ul><ul><li>StatRef! </li></ul></ul><ul><ul><li>UpToDate </li></ul></ul><ul><ul><li>Natural Standard </li></ul></ul><ul><ul><li>PubMed </li></ul></ul><ul><ul><li>e-journals </li></ul></ul>www.umanitoba.ca/libraries/units/health
  65. 65. Practice Questions <ul><li>Use the WRHA Drug Information Resource Table as a guide </li></ul><ul><ul><li>Identify the type of question </li></ul></ul><ul><ul><li>Background information needed </li></ul></ul><ul><ul><li>Then list the most appropriate resources to find the answer </li></ul></ul>

×