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Principles Of Drug Information 2008


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Published in: Health & Medicine, Education

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> </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> </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>
  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>