It is defined as knowledge of fact through reading, study or practical experience on chemical substance that is used in diagnosis, prevention and treatment of diseases.
It covers all type of information including; objective and subjective information as well as information gathered by scientific observation or practical experience.
It is defined as knowledge of fact through reading, study or practical experience on chemical substance that is used in diagnosis, prevention and treatment of diseases.
It covers all type of information including; objective and subjective information as well as information gathered by scientific observation or practical experience.
Project description future challenges and focus group on pharmaceutical suppl...Dr. Hannes Hofmann
Together with Professor Dr. Constantin Blome (University of Sussex, UK) and Professor Dr. Michael Henke (Fraunhofer IML Dortmund/TU Dortmund, Germany), we conduct an international study on the future of pharmaceutical supply chains.
Based on your personal expertise and experience, we chose to contact you to share your judgments about how certain trends over the next 10 years will affect pharmaceutical supply chains.
With this research project we aim to achieve two goals:
1) Based on expert judgments we will compile a management report illustrating key challenges and prospects for pharmaceutical supply chains in 2025.
2) A Focus Group of practitioners and academia will be established to share expert views on upcoming trends and to develop joint solutions to master upcoming challenges.
Of course, your personal and your company’s identity will not be disclosed and all information will be aggregated.
The Role of Real World Evidence in Clinical Research and Regulatory Decision ...ijtsrd
In recent years, the utilization of real world evidence RWE has gained prominence as a valuable source of information in the realm of clinical research and regulatory decision making. This paper explores the multifaceted role that RWE plays in enhancing the understanding of medical products and their effects beyond traditional randomized controlled trials RCTs . RWE encompasses data derived from various sources, including electronic health records, claims databases, patient registries, and wearable devices. Through the integration of RWE, researchers and regulatory agencies can address questions that may not be feasible or ethical to explore through RCTs alone, providing insights into long term safety, effectiveness, and real world outcomes. Shaik Neelofar | Kinthada Ramesh "The Role of Real-World-Evidence in Clinical Research and Regulatory Decision-Making" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-7 | Issue-4, August 2023, URL: https://www.ijtsrd.com/papers/ijtsrd59813.pdf Paper Url:https://www.ijtsrd.com/other-scientific-research-area/other/59813/the-role-of-realworldevidence-in-clinical-research-and-regulatory-decisionmaking/shaik-neelofar
9/12/2018 Print
https://content.ashford.edu/print/McNeill.2947.17.1?sections=ch18,ch19,ch20,ch21&content=content&clientToken=3e86a398-8c91-136b-ab99-55495… 1/16
18 Partners HealthCare System
Thomas H. Davenport
Partners HealthCare System (Partners) is the single largest provider of healthcare in the Boston area. It consists of 12 hospitals, with more than 7,000
af�iliated physicians. It has 4 million outpatient visits and 160,000 inpatient admissions a year. Partners is a nonpro�it organization with almost $8
billion in revenues, and it spends more than $1 billion per year on biomedical research. It is a major teaching af�iliate of Harvard Medical School.
Partners is known as a “system,” but it maintains substantial autonomy at each of its member hospitals. While some information systems (the
electronic medical record, for example) are standardized across Partners, other systems and data, such as patient scheduling, are speci�ic to particular
hospitals. Analytical activities also take place both at the centralized Partners level and at individual hospitals such as Massachusetts General Hospital
(MGH) and Brigham and Women’s Hospital (usually described as “the Brigham”). In this chapter, both centralized and hospital-speci�ic analytical
resources are described. The focus for hospital-speci�ic analytics is the two major teaching hospitals of Partners—MGH and the Brigham—although
other Partners hospitals also have their own analytical capabilities and systems.
Centralized Data and Systems at Partners
The basis of any hospital’s clinical information systems is the clinical data repository, which contains information on all patients, their conditions, and
the treatments they have received. The inpatient clinical data repository for Partners was initially implemented at the Brigham during the 1980s.
Richard Nesson, the Brigham and Women’s CEO, and John Glaser, the hospital’s chief information of�icer, initiated an outpatient electronic medical
record (EMR) at the Brigham in 1989.1 (http://content.thuzelearning.com/books/McNeill.2947.17.1/sections/ch18#ch18end01) This EMR contributed outpatient data to the
clinical data repository. The hospital was one of the �irst to embark on an EMR, though MGH had begun to develop one of the �irst full-function EMRs as
early as 1976.
A clinical data repository provides the basic data about patients. Glaser and Nesson came to agree that in addition to a repository and an outpatient
EMR, the Brigham—and Partners after 1994, when Glaser became its �irst CIO—needed facilities for doctors to input online orders for drugs, tests, and
other treatments. Online ordering (called CPOE, or Computerized Provider Order Entry) would not only solve the time-honored problem of
interpreting poor physician handwriting, but could also, if endowed with a bit of intelligence, check whether a particular order made sense or not for a
particular patient. Did a prescribed drug comply with best-known medical practice, and did the pa.
Project description future challenges and focus group on pharmaceutical suppl...Dr. Hannes Hofmann
Together with Professor Dr. Constantin Blome (University of Sussex, UK) and Professor Dr. Michael Henke (Fraunhofer IML Dortmund/TU Dortmund, Germany), we conduct an international study on the future of pharmaceutical supply chains.
Based on your personal expertise and experience, we chose to contact you to share your judgments about how certain trends over the next 10 years will affect pharmaceutical supply chains.
With this research project we aim to achieve two goals:
1) Based on expert judgments we will compile a management report illustrating key challenges and prospects for pharmaceutical supply chains in 2025.
2) A Focus Group of practitioners and academia will be established to share expert views on upcoming trends and to develop joint solutions to master upcoming challenges.
Of course, your personal and your company’s identity will not be disclosed and all information will be aggregated.
The Role of Real World Evidence in Clinical Research and Regulatory Decision ...ijtsrd
In recent years, the utilization of real world evidence RWE has gained prominence as a valuable source of information in the realm of clinical research and regulatory decision making. This paper explores the multifaceted role that RWE plays in enhancing the understanding of medical products and their effects beyond traditional randomized controlled trials RCTs . RWE encompasses data derived from various sources, including electronic health records, claims databases, patient registries, and wearable devices. Through the integration of RWE, researchers and regulatory agencies can address questions that may not be feasible or ethical to explore through RCTs alone, providing insights into long term safety, effectiveness, and real world outcomes. Shaik Neelofar | Kinthada Ramesh "The Role of Real-World-Evidence in Clinical Research and Regulatory Decision-Making" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-7 | Issue-4, August 2023, URL: https://www.ijtsrd.com/papers/ijtsrd59813.pdf Paper Url:https://www.ijtsrd.com/other-scientific-research-area/other/59813/the-role-of-realworldevidence-in-clinical-research-and-regulatory-decisionmaking/shaik-neelofar
9/12/2018 Print
https://content.ashford.edu/print/McNeill.2947.17.1?sections=ch18,ch19,ch20,ch21&content=content&clientToken=3e86a398-8c91-136b-ab99-55495… 1/16
18 Partners HealthCare System
Thomas H. Davenport
Partners HealthCare System (Partners) is the single largest provider of healthcare in the Boston area. It consists of 12 hospitals, with more than 7,000
af�iliated physicians. It has 4 million outpatient visits and 160,000 inpatient admissions a year. Partners is a nonpro�it organization with almost $8
billion in revenues, and it spends more than $1 billion per year on biomedical research. It is a major teaching af�iliate of Harvard Medical School.
Partners is known as a “system,” but it maintains substantial autonomy at each of its member hospitals. While some information systems (the
electronic medical record, for example) are standardized across Partners, other systems and data, such as patient scheduling, are speci�ic to particular
hospitals. Analytical activities also take place both at the centralized Partners level and at individual hospitals such as Massachusetts General Hospital
(MGH) and Brigham and Women’s Hospital (usually described as “the Brigham”). In this chapter, both centralized and hospital-speci�ic analytical
resources are described. The focus for hospital-speci�ic analytics is the two major teaching hospitals of Partners—MGH and the Brigham—although
other Partners hospitals also have their own analytical capabilities and systems.
Centralized Data and Systems at Partners
The basis of any hospital’s clinical information systems is the clinical data repository, which contains information on all patients, their conditions, and
the treatments they have received. The inpatient clinical data repository for Partners was initially implemented at the Brigham during the 1980s.
Richard Nesson, the Brigham and Women’s CEO, and John Glaser, the hospital’s chief information of�icer, initiated an outpatient electronic medical
record (EMR) at the Brigham in 1989.1 (http://content.thuzelearning.com/books/McNeill.2947.17.1/sections/ch18#ch18end01) This EMR contributed outpatient data to the
clinical data repository. The hospital was one of the �irst to embark on an EMR, though MGH had begun to develop one of the �irst full-function EMRs as
early as 1976.
A clinical data repository provides the basic data about patients. Glaser and Nesson came to agree that in addition to a repository and an outpatient
EMR, the Brigham—and Partners after 1994, when Glaser became its �irst CIO—needed facilities for doctors to input online orders for drugs, tests, and
other treatments. Online ordering (called CPOE, or Computerized Provider Order Entry) would not only solve the time-honored problem of
interpreting poor physician handwriting, but could also, if endowed with a bit of intelligence, check whether a particular order made sense or not for a
particular patient. Did a prescribed drug comply with best-known medical practice, and did the pa.
Water billing management system project report.pdfKamal Acharya
Our project entitled “Water Billing Management System” aims is to generate Water bill with all the charges and penalty. Manual system that is employed is extremely laborious and quite inadequate. It only makes the process more difficult and hard.
The aim of our project is to develop a system that is meant to partially computerize the work performed in the Water Board like generating monthly Water bill, record of consuming unit of water, store record of the customer and previous unpaid record.
We used HTML/PHP as front end and MYSQL as back end for developing our project. HTML is primarily a visual design environment. We can create a android application by designing the form and that make up the user interface. Adding android application code to the form and the objects such as buttons and text boxes on them and adding any required support code in additional modular.
MySQL is free open source database that facilitates the effective management of the databases by connecting them to the software. It is a stable ,reliable and the powerful solution with the advanced features and advantages which are as follows: Data Security.MySQL is free open source database that facilitates the effective management of the databases by connecting them to the software.
A review on techniques and modelling methodologies used for checking electrom...nooriasukmaningtyas
The proper function of the integrated circuit (IC) in an inhibiting electromagnetic environment has always been a serious concern throughout the decades of revolution in the world of electronics, from disjunct devices to today’s integrated circuit technology, where billions of transistors are combined on a single chip. The automotive industry and smart vehicles in particular, are confronting design issues such as being prone to electromagnetic interference (EMI). Electronic control devices calculate incorrect outputs because of EMI and sensors give misleading values which can prove fatal in case of automotives. In this paper, the authors have non exhaustively tried to review research work concerned with the investigation of EMI in ICs and prediction of this EMI using various modelling methodologies and measurement setups.
6th International Conference on Machine Learning & Applications (CMLA 2024)ClaraZara1
6th International Conference on Machine Learning & Applications (CMLA 2024) will provide an excellent international forum for sharing knowledge and results in theory, methodology and applications of on Machine Learning & Applications.
Understanding Inductive Bias in Machine LearningSUTEJAS
This presentation explores the concept of inductive bias in machine learning. It explains how algorithms come with built-in assumptions and preferences that guide the learning process. You'll learn about the different types of inductive bias and how they can impact the performance and generalizability of machine learning models.
The presentation also covers the positive and negative aspects of inductive bias, along with strategies for mitigating potential drawbacks. We'll explore examples of how bias manifests in algorithms like neural networks and decision trees.
By understanding inductive bias, you can gain valuable insights into how machine learning models work and make informed decisions when building and deploying them.
Harnessing WebAssembly for Real-time Stateless Streaming PipelinesChristina Lin
Traditionally, dealing with real-time data pipelines has involved significant overhead, even for straightforward tasks like data transformation or masking. However, in this talk, we’ll venture into the dynamic realm of WebAssembly (WASM) and discover how it can revolutionize the creation of stateless streaming pipelines within a Kafka (Redpanda) broker. These pipelines are adept at managing low-latency, high-data-volume scenarios.
KuberTENes Birthday Bash Guadalajara - K8sGPT first impressionsVictor Morales
K8sGPT is a tool that analyzes and diagnoses Kubernetes clusters. This presentation was used to share the requirements and dependencies to deploy K8sGPT in a local environment.
We have compiled the most important slides from each speaker's presentation. This year’s compilation, available for free, captures the key insights and contributions shared during the DfMAy 2024 conference.
3. Introduction
The provision of medication information is
among the most fundamental responsibilities of
pharmacists.
The information may be
patient specific, as an integral part of
pharmaceutical care
relative to a group of patients, such as:
development of a therapeutic guideline
publishing an electronic newsletter
updating a website
5/9/2024
3
4. Intro…
The term drug information may have different
meanings to different people depending on the
context in which it is used.
If asked to define this term,
one could describe it as printed information in a
reference or verbalized by an individual that pertains to
medications.
In many cases, individuals use this term in different
contexts by associating it with other words:
1. Specialist/practitioner/pharmacist/provider
2. Center/service/practice
3. Functions/skills 5/9/2024
4
5. Intro…
The first group of words implies a specific
individual
The second group implies a place
The third implies activities and abilities of
individuals.
5/9/2024
5
6. Intro…
The term drug information will be used in these
different contexts to describe the beginnings and
evolution of this area of practice.
Relative to current practice, the term medication
information is used in place of drug information to
convey the management and use of information on
medication therapy
These terms may refer to
provision of information for a specific patient
Provision of information in the context of addressing
medication use issues for a group of patients
(e.g., development of policies and procedures on medication
5/9/2024
6
7. Intro…
Drug informatics is another term used to
describe the evolving roles of the medication
information specialist.
Drug informatics
emphasizes the use of technology as an
integral tool in effectively organizing,
analyzing, and managing information on
medication use in patients.
5/9/2024
7
8. Intro…
The term drug information developed in the early
1960s
when used in conjunction with the words center
and specialist.
In 1962, the first drug information center was
opened at the University of Kentucky Medical
Center in USA.
An area separated from the pharmacy was
dedicated to provide drug information.
5/9/2024
8
10. Intro…
The center was to be "a source of selected,
comprehensive drug information for
Physicians
Dentists
Nurses
The center was expected to take an active role in the
education of health professional students including
Pharmacy
Medicine
Dentistry
Nursing
5/9/2024
10
11. Intro…
Several other drug information centers were
established shortly thereafter.
Different approaches to providing drug information
services included
decentralizing pharmacists in the hospital
offering a clinical consultation service, and providing
services for a geographic area through a regional
center.
The first formal survey, conducted in 1973,
identified 54 pharmacist operated centers in the
5/9/2024
11
12. Intro….
The individual responsible for operation of the
center was called the drug information
specialist.
The expectation was that drug information would
be stored in the center and retrieved, selected,
evaluated, and disseminated by the specialist.
Information would be disseminated to respond to
specific questions, to assist in the evaluation of
drugs for use in the hospital, or to inform others
through newsletters of current developments
related to drugs.
These and other functions, as listed in , have
evolved over a period of years and reflect the
services provided in most drug information centers.
5/9/2024
12
13. Medication Information Services
1. Support for clinical services
2. Answering questions
3. Developing criteria/guidelines for medication use
4. Pharmacy and therapeutics committee activity
5. Development of medication use policies
6. Formulary management
7. Publications—newsletter, journal columns, websites
8. Education—in-services for health professionals, students,
consumers
9. Medication usage evaluation/medication use evaluation
10. Investigational medication control
11. Institutional Review Board activities
12. Information for practitioners
13. Coordination of reporting programs, e.g., adverse medication
reactions
14. Poison information
5/9/2024
13
14. Medication Information Skills
1. Assess available information and gather situational
data needed to characterize question or issue
2. Formulate appropriate question(s)
3. Use a systematic approach to find needed
information
4. Evaluate information critically for validity and
applicability
5. Develop, organize, and summarize response for
question or issue
6. Communicate clearly when speaking or writing,
considering the audience level
7. Anticipate other information needs
5/9/2024
14
15. Factors Influencing the Evolution of the
Pharmacist's Role as a Medication Information
Provider
In addition to the changing philosophy of practice,
several other factors are influential in the evolution of
the pharmacist's role as a medication information
provider.
These include:
the prevention of adverse drug events (ADEs)
growth of information technology
changes in the health care environment with a focus on
evidence-based medicine and the evaluation of outcomes
the sophistication of medication therapy
a more knowledgeable patient 5/9/2024
15
16. Drug Information Resources
5/9/2024
16
Objectives
After completing this chapter, the students will be able to
Differentiate between primary, secondary, and tertiary
sources of information.
Select resources relevant to different pharmacy practice
areas.
Identify the most appropriate resource for a specific drug
information request.
Describe the role of Internet and personal digital
assistant (PDA) resources in the provision of drug
information.
Critique tertiary resources to determine appropriateness of
information.
17. Drug information resource
The quantity of medical information and medical
literature available is growing at an astounding
rate.
The technology by which this information can be
accessed is also improving exponentially.
The introduction of PDAs(personal digital assistance)
and Internet resources has to some extent changed
the methods by which information is accessed, but
not the process of providing drug information.
5/9/2024
17
18. Resource…..
Pharmacists are being asked daily to provide
responses to numerous drug information
requests for a variety of people.
It is tempting just to select the easiest, most
familiar resources to find information.
Generally, the best method to find information
includes a stepwise approach moving first
through:
tertiary (e.g., textbooks, full-text databases, and
review articles),
then secondary (e.g., indexing or abstracting service),
finally primary (e.g., clinical studies) literature.
5/9/2024
18
20. Definition
Tertiary literature is core knowledge
established via primary literature or
accepted as standard of practice within the
medical community.
Introduction
tertiary resources include:-
textbooks, monographs, compendia, handbooks,
and published symposia.
They represent the condensation of basic facts
originally published in the primary literature.
5/9/2024
20
21. Evaluation of tertiary resources
Several points should be considered in evaluating
tertiary resources as follows:
1-Does the author has sufficient experience and
expertise to write on the topic?
2-What credentials do the authors/contributors have?
3-Assess the text for timeliness (i.e. when was the last
edition published?)
4-Is this the most recent edition of the tertiary reference?
5-Are statements of fact appropriately supported by
references?
6-How many references does each section have and
how up-to-date are they?
5/9/2024
21
22. Cont.
7-To assess consistency, compare information
presented in one text to the same information
presented in another text.
8-Is the reference likely to contain information
relevant to the subject being researched?
9-Is the reference clear, concise and easy to
use?
5/9/2024
22
23. Availability of Tertiary Resources
Tertiary resources are available in many
formats, including hard copy, microfiche, and
computerized versions.
Computerized resources may be available on
floppy disks, or CD-ROMs for use in a single
personal computer or computer network, a
main frame system or via internet.
5/9/2024
23
25. A. General References
General features
1-They are referral books.
2-Their formats are either monographs or
monographs plus chapters.
3-Used through their indexes NOT through
their contents lists.
5/9/2024
25
26. Cont.
Textbooks
Different from the general references in:
1-Their formats are chapters.
2-One can read them from cover to cover.
3-One can use their contents list Not necessary to
go to index.
5/9/2024
26
27. The most helpful of them to answer a drug
related questions are:
5/9/2024
27
29. Cont.
Martindale’s The complete drug reference
European and investigational drugs
-Published by the Royal Pharmaceutical Society of
Great Britain every 4 years
-Has a manufacturer directory and index by clinical
use (typical European style of indexing)
-Lists other pharmacopeias the drug is found in.
5/9/2024
29
31. Cont.
Drug Facts and Comparisons (F&C)
* Updated monthly (loose-leaf version)
* Lag time 3 months
* Arranged by therapeutic class
* Prescription and OTC listings
* Helpful summary/comparison tables
* Contains information about investigational,
orphan, and discontinued products and off label
uses
* Not referenced, cumbersome
5/9/2024
31
33. Cont.
American Hospital Formulary Service (AHFS)
Drug Information
* Arranged by AHFS classification number
* Monographs listed alphabetically
* Information in monograph:
-Chemistry, pharmacology, mechanism
-Dose, administration, pharmacokinetics
-Drug interactions, preparations, toxicity
5/9/2024
33
34. Cont.
(AHFS) Drug Information
* FDA-approved and off-label uses
* Published annually with quarterly updates
* More clinically oriented
* References are not available in the hard copy but
may be available online or with software CD-
ROMS
* Not comprehensive, significant lag time
5/9/2024
34
36. Cont.
* Three volumes
i-DRUG Information for the Healthcare
Professional
ii-Drug Information for the Patient (in lay
language)
iii-Legal Requirements
* Monographs in alphabetical order in Volume
I
* Published annually
* Also contains some Canadian drug names
* Most thorough information on:5/9/2024
36
37. Cont.
* Useful Appendices: (typical American style
of indexing)
-Selected List of Drug-Induced Effects
-Therapeutic Guidelines
-Poison Control Center Listing
-Veterinary Medication Classification
-Excluded Monograph Listing
5/9/2024
37
38. Cont.
* Off-label uses indexed by drug and by
indication
* Not referenced, lag time, only FDA-approved
uses, inconvenient to compare agents in the
same therapeutic class
5/9/2024
38
40. Cont.
Drug Information Handbook (Lexi-Comp)
* Pocket-sized; PDA & online versions are also
available
* Published annually
* Drugs listed alphabetically by generic name
* Useful charts and tables.
* Specialty versions are available:
-Pediatric, psychiatric, geriatric
* Not referenced
* Lists all reported adverse events but does not always
provide the incidence
5/9/2024
40
41. MICROMEDEX®
* CD-ROM
* Access information by brand or generic name of
drugs
* Referenced, quick and easy to use
* Expensive, uses other tertiary references
* Databases available:
-DRUGDEX®-main drug information database
-DISEASEDEX®-disease states
-IDENTIDEX®-drug identification by imprint code
-POISINDEX®-poisoning and toxicology
-Martindale’s –foreign drugs 5/9/2024
41
43. Cont.
Physicians’ Desk Reference (PDR)
* Updated annually
* Color pictures and markings for drug identification
* Has FDA-approved product information only
* Manufacturers pay to have product information
Included
* Contains section on diagnostics
* May not contain the complete package insert
* Not referenced
5/9/2024
43
46. Cont.
* Well-written and referenced with helpful tables.
* Pocket version is available.
* Focuses on drug therapy, good background
information.
* Also covers non-drug treatment options.
* Updated edition about every 4 years.
5/9/2024
46
48. cont
* Well-written with focus on drug therapy.
* Updated every 4 years.
* Useful summary tables.
* Case presentation format, may be more difficult
to use as a quick reference.
5/9/2024
48
49. cont
The Washington Manual of Medical
Therapeutics
Quick reference with many charts and tables.
Updated about every 2 to 3 years.
5/9/2024
49
51. Internal Medicine
Harrison’s Principles of Internal Medicine
* Gold standard for internal medicine
* Published every 5 years, referenced
* Pathophysiology, clinical presentation, diagnosis and
treatment guidelines
* Little drug information & dosing
recommendations
5/9/2024
51
53. cont
The Merck Manual
Used by many healthcare professionals
Also includes pediatrics, gynecology, psychiatry,
ophthalmology, otolaryngology, dental disorders
5/9/2024
53
56. Cont.
Clinical Medicine (Kumar &Clark )
* comprehensive and authoritative single-volume
textbook of internal medicine.
* Explains the management of disease, based on an
understanding of scientific principles and including the
latest developments in treatment.
* Colour-coded chapters are attractive and make the
book easy to navigate.
* Comprehensive index, clearly displayed, pinpoints
information rapidly.
5/9/2024
56
57. cont
Clinical Medicine (Kumar &Clark )
* Boxes and tables pull out and display important
information.
* Drawings and photographs.
* Carefully structured headings provide a useful
outline for study and quick reference.
* Gastrointestinal, Rheumatology, Renal,
Cardiovascular, Respiratory ,Intensive care
medicine, Drug Therapy and poisoning……
5/9/2024
57
58. Cardiology
Textbook of Cardiovascular Medicine
* Published every 5 years.
* Good illustrations.
* Addresses modern-day issues such as medical
economics and assessing quality of care.
* Well-referenced.
5/9/2024
58
60. Cont
Hurst’s The Heart
* Organized by condition
* Comprehensive information on drug therapies and
regimens
* Rapid Interpretation of ECG’s
* Best guide to learning ECG’s
* User-friendly format.
5/9/2024
60
62. cont
Harriet Lane Handbook
* Useful pocket guide published every 3 years
* Has dosing information
* Electronic version updated annually
* Four sections: emergency management,
diagnostic, formulary, and therapeutic data
* Some information on pregnancy and lactation
* Not referenced, not frequently updated,
confusing organization, not complete
5/9/2024
62
63. Cont.
Pediatric InjectableDrugs (“TeddybearBook”)
* Alphabetical order by generic name
* Formerly known as Guidelines for Administration
of Intravenous Medications to Pediatric Patients
* Dose, concentration, rate, cautions
5/9/2024
63
64. Cont.
Pediatric Dosage Handbook (Lexi-Comp)
* Pediatric version of the Drug Information
Handbook
* Dose, administration, how supplied,
contraindications, adverse effects, drug
interactions, antidotes
* Also contains adult doses
* May sometimes have information on
extemporaneous formulations
5/9/2024
64
65. Pregnancy
Drugs in Pregnancy and Lactation (Briggs)
* Excellent reference, gold standard
* Updated every 4 years
* Alphabetical by generic name
* Generic name, class, & pregnancy risk factor
* Summaries of risk to fetus and risk during
breastfeeding
* Editors assign categories for drugs not classified
by the manufacturer
* Referenced
5/9/2024
65
66. Infectious Diseases
Mandell’s Principles and Practice of
* Gold standard reference
* Infection, diagnosis, treatment and useful
background information Infectious Disease
5/9/2024
66
67. cont
Sanford Guide to Antimicrobial Therapy
* Published annually
* Pocket-sized and easy to use
* Includes: dosing in renal impairment, brand &
generic names, empiric therapy guidelines,
antimicrobial spectra of the agents
* Not well-referenced
5/9/2024
67
68. Oncology
Cancer: Principles and Practice of Oncology
(devita)
* Gold standard, published every 3 to 4 years
* Pathology, treatment options, & adverse effects
* Referenced
5/9/2024
68
69. cont
Cancer Chemotherapy Handbook
* Useful index, introduction on malignancies
* Pharmacology and use of chemotherapeutic
agents
* Lists investigational drugs and combinations
* Well-referenced
5/9/2024
69
70. Pharmacology
Goodman & Gilman’s Pharmacological Basis of
Therapeutics
* Gold standard pharmacology text
* Grouped by therapeutic class
* Mechanism, absorption, distribution, and
metabolism
* Contains review of pharmacokinetics,
therapeutics, and toxicology
* Well-referenced
* Updated every 5 years (infrequent)
5/9/2024
70
71. Drug interaction
Drug Interaction Facts
* Published by F&C
* Alphabetical by drug name
* Referenced
* Provides information regarding:
-Significance and severity
-Onset of interaction
-Documentation
* Not complete, subjective rating scale
5/9/2024
71
72. cont
Stockley'sDrug Interactions
* A typical monograph contains a summary,
clinical evidence for the interactions under
discussion, the probable mechanism, clinical
importance and management
* Covers interactions between therapeutic drugs,
proprietary medicines, herbal medicines,
foods, drinks, pesticides and some drugs of
abuse
5/9/2024
72
74. cont
Stockley'sDrug Interactions
* Based on published sources and fully
referenced
* Covers over 14,000 drug interactions
* Contains over 2,800 monographs
* Includes 17,600 references
* Book & CD-ROM
5/9/2024
74
76. cont
Meyler’sSide Effects of Drugs
* Indexed by drug and by adverse event
* Most comprehensive
* Published every 4 years with annual updates
* Contains tables and lists
* References for some side effects not included
* Information provided:
-Effects on organs and systems, lab/diagnostic
interference, withdrawal and overdose
* May not be complete, references for widely known
effects are not included
5/9/2024
76
78. cont
Handbook on InjectableDrugs (Trissel’s)
* Gold standard reference
* Updated every 2 years with annual supplements
* Drugs organized alphabetically by generic name
* Information on compatibility and stability with
diluents and drugs
* Solution, Y-site, syringe, and additive compatibility
* Table format, very useful
* Not complete, lag time
5/9/2024
78
79. cont
King Guide to Parenteral Admixtures
* Chart format, loose-leaf
* Alphabetical listing by generic name
* Pages are not numbered
5/9/2024
79
80. Compounding and
Pharmaceutics
Remington’s The Science and Practice of
Pharmacy
* Helpful for extemporaneous compounding
* Pharmaceutical calculations, chemistry,
radioisotopes
* New edition every 5 years
5/9/2024
80
82. cont
Merck Index
* Chemical name, formula, & structure
* Physical data, therapeutic category
* Published every 6 to 10 years
5/9/2024
82
83. cont
United States Pharmacopeia –National Formulary
(USP-NF)
* Official monographs for preparation and assay of
pharmaceutical products
* Published every 5 years with periodic supplements
* Information on storage, packaging, labeling, reference
standards, & assays
* USP: drug substances & dosage forms
* NF: pharmaceutical ingredients
* Not a very useful reference since most
pharmaceuticals are mass-produced
5/9/2024
83
84. Pharmacokinetics
Basic Clinical Pharmacokinetics (Winters)
* Case-study format
* Includes principles of monitoring therapy, basic
pharmacokinetics, & clinical applications
* Appendix of commonly used equations
* Mostly theory, little patient integration
5/9/2024
84
86. Toxicology
Toxicologic Emergencies (Goldfrank’s)
Poison management guidelines
Useful tables and case studies
Practice multiple-choice questions
5/9/2024
86
87. cont
Casarett & Doull's Toxicology: The Basic
Science of Poisons
* gold standard in toxicology field
* basic concepts and fundamental principles
needed to grasp current issues in modern
toxicology
* The text is organized and presented in a logical
progression of general principles to specific
topics such as organ system toxicology,
specific agent toxicology, and environmental
toxicology
5/9/2024
87
88. cont
POISINDEX®
Toxicology component of MICROMEDEX®
Search by brand or generic name
Describes what substance looks like, any imprint
codes, management of toxicity
5/9/2024
88
89. Drug Identification
1.American Drug Index
* Cross-referenced by brand, generic, and chemical
names
2.The Pill Book
3.IDENTIDEX®
* Component of MICROMEDEX®
* Identify drug by imprint code
5/9/2024
89
90. cont
4.British National Formulary
* BMJ Publishing, London, United Kingdom.
* The standard reference for prescribing and
dispensing drugs in Britain.
* Included are notes on the different drug groups to
help in the choice of appropriate treatment.
* The BNF is updated in March and September of
each year
* Available on disk and CD-ROM as the Electronic
British National Formulary and An electronic web-
based format is also available.
5/9/2024
90
91. Non-Prescription Products
PDR for Nonprescription Drugs and Dietary
Supplements
* Format similar to PDR, updated every year
* Indexed by product name, category, manufacturer,
& active ingredient
* Includes color pictures of products
* Information: indications, cautions, dose,
administration, patient instructions, precautions,
how supplied
5/9/2024
91
92. cont
Handbook of Nonprescription Drugs
* Useful tables and comparisons
* Includes:
-Patient assessment and counseling guidelines
-Pathophysiology and treatment options
-Dosing, adverse events, & interactions
5/9/2024
92
93. Electronic tertiary resource
Multipurpose resource
Access Medicine
(http://www.accessmedicine.com/)
* Collection of textbooks, clinical practice guidelines,
news
* Includes: Goodman & Gilman, Harrison’s, Current
Medical Diagnosis & Treatment, and the Lange
series.
* Drug monographs (include images, chemical
structures, patient education materials) provided by
Gold Standard™ 5/9/2024
93
95. cont
MD Consult
http://home.mdconsult.com/groups/uwash8783.ht
ml)
*Collection of textbooks, journals, drug information,
guidelines, patient education handouts, news and
updates
*Drug information and updates from Mosby’s drug
Consult, package insert information, FDA
information
*Customizable patient handouts –diseases and
drugs
5/9/2024
95
96. cont
MedlinePlus
(http://medlineplus.gov)
* NLM’s database aimed at consumers for health
and wellness information
* English and Spanish versions as well as “large
print” and audio
* Includes health topics, drug information,
dictionaries, interactive tutorials, directories
and links to other resources
5/9/2024
96
97. cont
MedlinePlus
* Especially good for quick overview, including
statistics, of topics and illustrations
*Drug information includes MedMaster from ASHP,
USP DI Advice for Patients, Natural Standard
Online (for natural products) and links to FDA and
ClinicalTrials.gov
5/9/2024
97
98. cont
Micromedex Healthcare series
(http://www.thomsonhc.com/hcs/librarian/)
* Collection of databases that can be searched
individually or all together contents of
collection depends on your subscription
* Includes DrugDex and Drug Consults, IV
Compatibility, PoisIndex, AltMedDex,
Martindale, Reproprisk, TOMES and
CareNotes
5/9/2024
98
99. cont
Micromedex Healthcare series
* Use for detailed information about medications
(US and foreign) and natural products as well
as exposures to chemicals, toxins and
poisonous animals and plants
* Lengthy bibliographie
* Instructions for citing under Warranties &
Disclaimers link
5/9/2024
99
100. Drug and Natural Products
Information Resources
Facts & Comparisons
(http://online.factsandcomparisons.com/)
* Collection of resources that can be searched
individually or all together –drugs and natural
products
* Includes Drug Facts & Comparisons,
Nonprescription Drug therapy, Drug Interaction
Facts, Review of Natural Products, MedFacts
Patient information
5/9/2024
100
101. cont
Facts & Comparisons
* Print version has been gold standard for drug
information for years
* Includes comparison tables for drugs by class or
pharmacological action
* In general, references are included in the Drug
Interactions section and in drug class monographs
but not in individual drug monographs
5/9/2024
101
102. cont
Natural Medicines Comprehensive Database
(http://www.therapeuticresearch.net/nd/Search.a
spx?s=ND)
* Comprehensive, evidence-based information
about herbal and dietary supplements used in
the US and Canada
* Produced by publishers of Prescribers' Letter
and Physicians' Letter
* Many products have patient handouts
5/9/2024
102
103. cont
Natural Medicines Comprehensive Database
* Updated daily
* Several entry points, e.g. product or common
name, scientific name, people use
* this for, interactions with foods, herbs, dietary
supplements, lab tests, diseases or conditions
5/9/2024
103
104. Resource cont.
Secondary literature
provides a summary, index, or abstract of a piece
of primary literature, usually written by the authors
of a primary literature paper.
The vast majority of secondary resources are
utilized primarily in an electronic format, although
some may still have a print form.
5/9/2024
104
105. Resource cont.
Secondary literature refers to:-
references that either index or abstract the primary
literature
The goal is:
to direct the user to the primary literature.
5/9/2024
105
106. Resource cont.
The two terms, indexing and abstracting, differ
slightly.
Indexing
consists of providing bibliographic citation
information (e.g., title, author, and citation of the
article),
abstracting
includes a brief description (or abstract) of the
information provided by the article or resource
cited.
Various systems will index or abstract literature from
different journals, meetings, or publications, therefore,
in order to perform a comprehensive search different
databases must be used.
5/9/2024
106
108. Resource cont.
main benefit
location of primary literature
main problem
not enough information to determine quality of
research work
5/9/2024
108
109. Resource cont.
challenges in searching secondary database systems.
Systems do not index all terms in the same manner
therefore it is necessary to determine what terms a
database is using to conduct a successful search.
For example, databases through the National Library of
Medicine index terms by their Medical Subject Heading
(MeSH term)
while the Iowa Drug Information Service (IDIS) uses the
United States Adopted Name and the International
Classification of Diseases
5/9/2024
109
110. Resource cont.
Most computerized databases also include a free-
text search option, which is very useful when the
defined index terms are not identifying relevant
data.
This option may also be helpful when only limited data
have been published or are available, perhaps before
an official index term is defined.
5/9/2024
110
111. Resource cont.
Searches generally use Boolean operators, often
AND, OR, and NOT (see ).
The operator AND will combine two terms, returning
only citations containing both of those concepts or
terms.
The operator OR will have an equal or greater number
of returns since it will include any citation where either
term is used.
Use of the term NOT will always decrease the number
of responses, since it eliminates any references having
the term that follows that operator
therefore it should be used with caution, since it may
eliminate articles that may be appropriate, simply
because the term being eliminated happens to appear
5/9/2024
111
112. Resource cont.
Primary literature
contains new/original
material.
Examples:
• study published in health
sciences journal (including
symposium and conference
proceedings and abstracts)
• package insert and other
manufacturer technical
pamphlets
• patents and trademarks
• government bulletins
main benefit
you can determine the
quality of the research
and usability of
information
main problem
not enough time to read
it all
5/9/2024
112
113. Internet Resources
5/9/2024
113
Another method to identify relevant resources
might be a general Internet search for
information.
This can be especially helpful to serve as a
starting point for questions about unusual
diseases or about marketed over-the-counter
products and combination dietary supplements
115. Consumer Health Information
5/9/2024
115
As consumers become more active and educated
in their health care and disease management, the
need for health information sources geared at
consumers has increased.
Currently there are a variety of sources where
consumers obtain their health information
118. Receiving and Classifying Drug
Information Requests
An essential component within pharmacy
practice is the ability to effectively answer
questions posed by health care professionals
and the lay public.
In 1975, Watanabe et al. presented a systematic
approach for responding to drug information
requests.
The systematic approach comprised of five steps
5/9/2024
118
119. Cont…
Systematic Approach (1975)
Step I. Classification of the request
Step II. Obtaining background information
Step III. Systematic search
Step IV. Response
Step V. Reclassification
5/9/2024
119
120. Receiving and Classifying Drug
Information Requests
• Answering Drug Information Questions
– These are the steps you should go through when you
are asked a question:
• Step 1: Identify the requester.
– This will help you get an idea of the depth and
detail of information the requester is probably
expecting.
• Step 2: Determine and categorize the “real”
question.
– It is remarkably common for the question you are
asked to not be the requester’s “real” question.
5/9/2024
120
121. Drug Information Requests
cont.
Ask for background information.
Examples:
“I want to make sure I answer (or understand)
your question adequately, so tell me a little more
about what led you to ask me this question.”
“There are several different answers to that
question.
To make sure I give you the right answer, I’d like you
to describe in more detail what it is you wish to better
understand.”
“Tell me how you want to use this information.”
5/9/2024
121
122. Drug Information Requests
cont.
• In some cases, it is appropriate to use an
algorithm similar to the one you will learn for
patient interviewing, considering each area but
including only questions about those variables that
might affect your answer.
– history of current question (is this a general question
or specific to a person or situation?)
– other disease states that might affect the answer to the
question, including potential disease states, i.e., signs
or symptoms that have not been diagnosed
(pharmacokinetic, pharmacodynamic, adverse
reaction masquerade)
5/9/2024
122
123. Drug Information Requests
cont.
other medications (Rx, OTC, herbal, illicit) that
might affect the answer to the question (drug
interactions
pertinent social or family history (financial,
medical, or belief issues)
desired detail of response
5/9/2024
123
124. Drug Information Requests
cont.
• Questions you receive will usually be in one of the
following categories:
– proper use of drugs: efficacy for specified disease
state, dosing, compatibility, use in pregnancy or
lactation, monitoring parameters, drug identification,
pharmacokinetics, pharmacodynamics, storage
conditions, stability
– adverse reactions: side effects, drug interactions,
allergic reactions, toxicity, poisoning, contraindications,
warnings
5/9/2024
124
126. Drug Information Requests
cont.
Once you think you know the real question,
repeat it to the requester to confirm you have
identified the appropriate question.
Step 3: Choose an appropriate resource (or
resources) to consult.
5/9/2024
126
127. Drug Information Requests
cont.
• Tertiary literature
– provides an interpretation and summary of the
primary literature by someone other than the
original authors of the primary literature
publication.
Examples:
• review in health sciences journal
• textbooks and other reference material
• computer databases (e.g., Micromedex)
• web sites
• advertisements 5/9/2024
127
128. Drug Information Requests
cont.
main benefit
can get a lot of information in a short amount of
time relative to reading all the studies of a subject
yourself
main problem
subject to interpretation bias: “spin”
5/9/2024
128
129. Drug Information Requests
cont.
Secondary literature
provides a summary, index, or abstract of a piece
of primary literature
Examples:
• Medline (PubMed is the web portal)
• IPA
• EMBASE
• current contents
5/9/2024
129
130. Drug Information Requests cont.
• Primary literature
– contains new/original material.
Examples:
• study published in health sciences journal
(including symposium and conference
proceedings and abstracts)
• package insert and other manufacturer
technical pamphlets
• patents and trademarks
• government bulletins
• case studies
5/9/2024
130
131. Drug Information Requests cont.
In general, it is most efficient to start with
tertiary literature (especially for questions from
nonhealth care professionals).
Sometimes you will use secondary literature to
locate primary literature and then will need
primary literature to answer the question (not
uncommon with questions from health care
professionals: they will expect you to be able to
interpret and explain a study).
5/9/2024
131
132. Drug Information Requests
cont.
• Step 4: Analyze quality and appropriateness of
material in resource(s).
– Summarize the best evidence in your own words.
• Step 5: Synthesize (formulate) a response.
• Step 6: document and follow up on
recommendations, so that others will know what
you advised and why, and so that you can see if your
advice was sound. 5/9/2024
132
133. Using Tertiary Resources
Introduction
Tertiary resources are summaries of available
information in an understandable format.
Examples include textbooks, reference texts,
databases, review articles, lecture notes, and web
sites.
Tertiary resources are the best starting point
for finding the answer to drug information
queries. 5/9/2024
133
134. Using Tertiary Resources
• Strengths of tertiary resources:
– Most answers to questions you are asked will be
found in a tertiary resource.
– Because the information is organized, they are
time-efficient to use compared to examining
primary literature yourself.
– Because they summarize information from many
sources, they may contain information important
to the question which you might miss if you
consulted only one piece of the primary literature.
5/9/2024
134
135. Tertiary Resources cont.
• Tertiary resources often provide background
information.
– For example, you may be asked about the treatment
of choice for a sinus infection.
– Many reviews of sinus infections will also include a
short summary of the epidemiology and microbiology
of sinus infections, which can help you better
understand and remember the treatment alternatives.
• Tertiary resources are generally more accessible
to the average pharmacist than secondary or
primary resources.
5/9/2024
135
136. Tertiary Resources cont.
Limitations of Tertiary resources:
– A literature summary is only as good as its
author(s).
• All authors will have interpretation bias.
• Author(s) may not have the expertise to correctly
interpret the literature or may not have consulted the
literature (opinion versus fact).
• Author may not write well.
• You may have no information about the author.
5/9/2024
136
137. Tertiary Resources cont.
– Information may not be complete.
• Literature search may not be extensive.
• Space limitations of publisher may limit amount of
information that can be included.
– Information may be out of date.
– Tertiary resources which draw on information from
other tertiary resources can perpetuate incorrect
information.
– Some sources can be difficult to use.
5/9/2024
137
138. Tertiary Resources cont.
Tertiary resources you will use (print and online)
• General medication information.
– You will use these resources for questions involving
indications, pharmacology, pharmacokinetics,
precautions and adverse effects, administration and
dosing, drug interactions, and available commercial
products.
– Example questions for which you should use these
resources: “What is propranolol used for?” “Is there a
liquid form of morphine available?” “Could citalopram
cause an increase in sweating?”
5/9/2024
138
139. Tertiary Resources cont.
• Drugdex (Micromedex) on-line, via Healthlinks
• Facts and Comparisons (eFacts) on-line, via
Healthlinks
• Drug Information Handbook (Lexi-Comp) book, PDA
version
• AHFS (Stat!Ref) on-line, via Healthlinks
• USPDI-I (Stat!Ref) on-line, via Healthlinks
• [Physician’s Desk Reference (PDR)] available on-line,
but not via Healthlinks; medical, bu not pharmacy
5/9/2024
139
140. Tertiary Resources cont.
• Natural Product Resources
– Natural Medicines Comprehensive Database on-line, via
Healthlinks
– Review of Natural Products (eFacts) on-line, via Healthlinks
– AltMedDex (Micromedex) on-line, via Healthlinks
– HerbMed and American Herbal Products Association on-
line at www.ahpa.org.
• These are quasi-tertiary resources, because links to other
tertiary resources are available.
• They are also secondary resources (indexing) as they connect
you to PubMed for info about specific studies.
• HerbMed is assembled by the Alternative Medicine Foundation
and AHPA by a consortium of herbal product manufacturers.
You will find the information on each to be similar.
5/9/2024
140
141. Tertiary Resources cont.
• Disease state information.
– You will use these resources to better understand
medical conditions.
– Examples of questions you would use these
resources to answer: “What is the most common
cause of diarrhea in children?” “What are the most
common complications of uncontrolled diabetes?”
• UpToDate on-line, via Healthlinks
• The Merck Manual (www.merck.com) on-line, via
Healthlinks
• Harrison’s Online on-line, via Healthlinks
• medical specialty textbooks (MD Consult) on-line, via
Healthlinks
5/9/2024
141
142. Tertiary Resources cont.
• Pharmacotherapy references.
– Use these for general information about treatment
alternatives for specific disease states.
– Examples of questions you would use these
resources to answer: “What is the recommended
agent and dose for a 45-year old male with newly
diagnosed hypertension?” “What are reasonable
monitoring parameters for patients taking
medication for chronic obstructive lung disease?”
• Pharmacotherapy: a Pathophysiologic Approach book
only
• Applied Therapeutics: The Clinical Use of Drugs book
only
5/9/2024
142
143. Tertiary Resources cont.
Over-the-counter Drugs
Example of questions you would use this
resource to answer: “What is available over-the-
counter that I could use for my cough?” “What
can I use for this rash?”
• Handbook of Non-Prescription Drugs book only
5/9/2024
143
144. Tertiary Resources cont.
Drug Interaction references
• Example of question you would use these
resources to answer:
– “Can I drink grapefruit juice if I’m taking
atorvastatin?”
• Hansten and Horn’s Drug Interactions book only; in
PCLC
• Drug Interaction Facts (eFacts) on-line, via Healthlinks
• Micromedex also has a decent drug interaction section
on-line, via Healthlinks
5/9/2024
144
145. Tertiary Resources cont.
Terminology
Examples of questions you would use these
resources to answer: “Where is the ‘lateral’ chest
located?” “What does DNR mean?”
• medical dictionary; Stedman’s is on-line, via
Healthlinks
• medical abbreviations (eFacts) on-line, via
Healthlinks
5/9/2024
145
146. Tertiary Resources cont.
• Laboratory Tests
– Example of question you would use these
resources to answer: “What is the normal serum
concentration range for potassium?”
– Only the first reference will answer the following type
of question, however: “What might be the cause and
consequences of a serum potassium concentration
above the normal range?
• Basic Skills in Interpreting Laboratory Data book only;
in PCLC
• Laboratory test information (online)
• Normal laboratory values (eFacts) on-line, via
Healthlinks 5/9/2024
146
147. Tertiary Resources cont.
• Drug Identification
– Example of question you would use these
resources to answer: “I found a white tablet with M
23 stamped on it. What drug is this?”
– Martindale would help you answer the following
question: “When I was in England, a doctor gave
me an inhaler called salbutamol. What does this
drug do? Is it similar to any inhaler I normally use
for my asthma?”
• Identidex (Micromedex) on-line, via Healthlinks
• Drug/Imprint Index (eFacts) on-line, via Healthlinks
• Martindale (Micromedex) for non-US drugs on-line,
via Healthlinks 5/9/2024
147
148. Tertiary Resources cont.
Bioequivalence
Example of question you would use this resource
to answer: “Is there a generic form of Levoxyl that
is bioequivalent?”
• Orange book; on-line: www.fda.gov
5/9/2024
148
149. Tertiary Resources cont.
• Drug Prices
– Example of question you would use this resource
to answer: What is the AWP for a 30-day supply of
diltiazem 120mg XL capsules?” (Note that here
you might first have to look up the AWP in the
medical abbreviations book!)
• Redbook book only; in PCLC
• Mosby’s Drug Consult (MD Consult). This is also
general medication information on this site. on-
line, via Healthlinks
5/9/2024
149
150. Tertiary Resources cont.
Drug IV Compatibility
Example of question you would use this resource
to answer: “Can Lasix be given in the same line in
which dopamine is running?”
• Handbook on Injectable Drugs book only; in PCLC
5/9/2024
150
151. Tertiary Resources cont.
• Drug dosing in special populations
– Examples of questions you might use some of
these resources to answer:
• “Is it safe to use ibuprofen while I’m pregnant? While
I’m breastfeeding?”
• “How much acetaminophen should I give my 30-lb child
who is running a temperature of 103°F?”
• “What is a good starting dose for lisinopril in an 80
year-old patient?”
• “Does aztreonam cover Pseudomonas aeruginosa?”
• Drugs in Pregnancy and Lactation book only; in
PCLC 5/9/2024
151
152. Tertiary Resources cont.
• Pediatric Dosage Handbook book, PDA
versions available
• Drug Prescribing in Renal Failure book only; in
PCLC
• pharmacokinetic equation reference book only;
several different books available
• Geriatric Dosage Handbook book, PDA
versions available
• The Sanford Guide to Antimicrobial Therapy
book in PCLC; PDA version available
5/9/2024
152
153. Tertiary Resources cont.
Extemporaneous compounding
Example of question you would use these
resources to answer:
“What is the E-value of gentamicin sulfate?”
• Remington: the Science and Practice of
Pharmacy book only; in PCLC
• A Practical Guide to Contemporary Pharmacy
Practice book only; in PCLC
5/9/2024
153
154. Tertiary Resources cont.
• Patient Counseling
– You would use these to augment your verbal
medication information.
– Some pharmacy systems automatically print these,
but look them over carefully for information accuracy
before handing them out.
• Medline Plus (medications, medical conditions, trials)
on-line at medlineplus.gov
• Med Facts: Patient Counseling (eFacts): in English and
Spanish on-line, via Healthlinks
• CareNotes (Micromedex) on-line, via Healthlinks
5/9/2024
154
155. Tertiary Resources cont.
Toxicology
Example of question you would use this resource
to answer:
“My child just swallowed some of my iron tablets.
Could anything bad happen?”
• Poisindex (Micromedex) on-line, via Healthlinks
5/9/2024
155
156. Tertiary Resources cont.
• Clinical Guidelines
– Example of question you would use these resources to
answer:
– “What initial medications for treatment of a heart attack
do current American Heart Association guidelines
recommend?”
• National Guideline Clearinghouse on-line at
www.guideline.gov
• Cochrane Library on-line, via Healthlinks This resource is
unique and designed to support practitioners of
“evidence-based medicine” (EBM), which is when
evidence from studies is combined with practitioner
expertise and patient preference to provide the best care
5/9/2024
156
157. Formulating effective responses
Pharmacists are asked to provide responses to
a variety of drug information questions every
day.
While the type of requestor, query, and setting can
vary, the process of formulating responses
remains constant.
5/9/2024
157
158. Accepting Responsibility and
Eliminating Barriers
Pharmacists should recognize that their responsibility extends
beyond simply providing an answer to a question.
Rather, it is to assist in resolving therapeutic dilemmas or managing
patients' medication regimens.
Knowledge of pharmacotherapy alone does not ensure success.
Moreover, isolated data or information do not provide answers to
questions or ensure proper patient management.
In fact, it is uncommon to find comprehensive answers in the literature
that completely and effectively address specific situations or
circumstances that clinicians face in their daily practices.
Responses and recommendations must often be thoughtfully
synthesized using information and knowledge gathered from a number
of diverse sources.
To effectively manage the care of patients and resolve complex
situations, pharmacists also need added skills and competence in
problem solving and direct patient care.
5/9/2024
158
159. Identifying the Genuine Need
Most queries that pharmacists receive are not
purely academic or general in nature.
They often involve specific patients and unique
circumstances.
For example, a physician who asks about the
association of lovastatin and liver toxicity is probably
not asking this question whimsically or out of curiosity.
He or she most likely has a patient who has
developed hepatic impairment that may be associated
with the use of this medication.
Of course, other reasonable scenarios, albeit less
likely, also could have prompted such a question.
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160. Cont…
Even questions that are not related to patient care
must be viewed in their proper context.
Requestors of information are typically vague in
verbalizing their needs and provide specific
information only when asked.
Although these requestors may seem confident about
their perceived needs, they may be less certain after
further probing by the pharmacist.
Requestors, regardless of background, are often
uncertain about what the pharmacist needs to know to
assist them optimally.
Therefore, critical information that defines the problem
and elucidates the context of the question is not
readily volunteered, but must be expertly elicited
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161. Questions to Consider before
Formulating a Response
Do I know the requestor's name, profession, and
affiliation?
Does the question pertain to a specific patient?
Do I have a clear understanding of the question or
problem?
Do I know if the correct question is being asked?
Do I know why the question is being asked?
Do I understand the requestor's expectations?
Do I know pertinent patient history and background
information?
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162. Cont…
Do I know about the unique circumstances that
generated the question?
Do I know what information is really needed?
Do I know when the information is needed and
in what format?
Do I have insight about how the information I
provide will actually be used?
Do I know how the problem or situation has
been managed to date?
Do I know about alternative explanations or
management options that have been
considered or should be further explored?
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163. Important Questions Not Posed by
the Requestor
Initial query posed by requestor: Can ranitidine cause
thrombocytopenia?
What is the incidence of ranitidine-induced
thrombocytopenia?
Are there any known predisposing factors?
Is the pathogenesis of this adverse effect understood?
How does the thrombocytopenia typically present?
Are there any characteristic subjective or objective
findings?
Does thrombocytopenia due to ranitidine differ from that
caused by other histamine-2 (H2) receptor antagonists,
other medications, or other etiologies?
Is the thrombocytopenia dose related?
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164. Cont…
How severe can it become?
How soon after discontinuing the drug does it
reverse?
How is it usually managed?
What is the likelihood of cross-reactivity with other
histamine-2 receptor antagonists? How risky is
rechallenge with ranitidine?
Are there treatments available that can be used in
place of ranitidine?
Are there alternative explanations for the
thrombocytopenia in this patient (including other
medications, medication combinations, or
underlying medical conditions)?
What complications, if any, can be expected?
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165. Formulating the Response
Building a Database and Assessing Critical
Factors
Formulating a response involves a series of steps
that must be performed completely, objectively,
and in a logical sequence.
This mandates the use of a structured, organized
approach whereby critical factors are
systematically considered and thoroughly
evaluated.
The steps in this process include assembling and
organizing a patient database, gathering
information about relevant disease states,
collecting medication information, obtaining
pertinent background information, and identifying
other relevant factors and special circumstances.
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166. Factors to Be Considered When
Formulating a Response
Patient Factors
Demographics (e.g., name, age, height, weight,
gender, race/ethnic group, and setting)
Primary diagnosis and medical problem
list Allergies/intolerances
End-organ function, immune function, nutritional
status
Chief complaint
History of present illness
Past medical history (including surgeries, radiation
exposure, immunizations, psychiatric illnesses,
and so forth)
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167. Cont…
Family history and genetic makeup Social history
(e.g., alcohol intake, smoking, substance abuse,
exposure to environmental or occupational toxins,
employment, income, education, religion, travel,
diet, physical activity, stress, risky behavior, and
compliance with treatment regimen)
Review of body systems
Medications (prescribed, over-the-counter, and
complementary/alternative)
Physical examination Laboratory tests Diagnostic
studies or procedures
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168. Disease Factors
Definition
Epidemiology (including incidence and prevalence)
Etiology
Pathophysiology (for infectious diseases, consider site
of infection, organism susceptibility, resistance
patterns, and so forth)
Clinical findings (signs and symptoms, laboratory
tests, diagnostic studies)
Diagnosis
Treatment (medical, surgical, radiation, biologic and
gene therapies, other)
Prevention and control
Risk factors Complications Prognosis
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169. Medication Factors
Name of medication or substance (proprietary,
nonproprietary, other)
Status and availability (investigational, over-the-counter,
prescription, orphan, foreign, complementary/alternative)
Physicochemical properties
Pharmacology
pharmacodynamics
Pharmacokinetics (liberation, absorption, distribution,
metabolism, and elimination)
Pharmacogenetics
Uses (Food and Drug Administration [FDA] approved and
unlabeled)
Adverse effects
Allergy
Cross-allergenicity or cross-reactivity
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170. Medication Factors
Contraindications and precautions
Effects of age, organ system function, disease,
pregnancy, extracorporeal circulation, or other
conditions or environments
Mutagenicity and carcinogenicity
Effect on fertility, pregnancy, and lactation
Acute or chronic toxicity
Drug interactions (drug-drug or drug-food)
Laboratory test interference (analytical or
physiologic effects)
5/9/2024
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171. Cont…
Administration (routes, methods)
Dosage and schedule
Dosage forms, formulations, preservatives,
excipients, product appearance, delivery systems
Monitoring parameters (therapeutic or toxic)
Product preparation (procedures, methods)
Compatibility and stability
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172. Pertinent Background Information, Special
Circumstances, and Other Factors
Setting
Context
Sequence and timeframe of events
Rationale for the question
Event(s) prompting the question
Unusual or special circumstances (including medical
errors)
Acuity and time constraints
Scope of question
Desired detail or depth of response
Limitations of available information or resources
Completeness, sufficiency, and quality of the
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173. Analysis and Synthesis
Analysis and synthesis of information are the most
critical steps in formulating responses and
recommendations.
Together they assist in forming opinions, arriving at
judgments, and ultimately drawing conclusions.
Analysis is the critical assessment of the nature, merit,
and significance of individual elements, ideas, or
factors.
Functionally, it involves separating the information into
its isolated parts so that each can be critically
assessed.
Analysis requires thoughtful review and evaluation of
the weight of available evidence.
While this process requires consideration of all
relevant positive findings, pertinent negative finidings
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174. Cont…
Once the information has been carefully
analyzed, synthesis can begin.
Synthesis is the careful, systematic, and orderly
process of combining or blending varied and
diverse elements, ideas, or factors into a coherent
response through the use of logic and deductive
reasoning.
This process relies not only on the type and
quality of the data gathered, but also on how they
are organized, viewed, and evaluated
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175. Responses and Recommendations
An effective response obviously must answer the
question.
Other characteristics of effective responses and
recommendations are outlined bellow.
The response to a question must include a
restatement of the request and clear identification of
the problems, issues, and circumstances.
The response should begin with an introduction to the
topic and systematically present the specific findings.
Pertinent background information and patient data
should be succinctly addressed.
Conclusions and recommendations are also included
in the response along with pertinent reference citations
from the literature.
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176. Desired Characteristics of a
Response
Timely
Current
Accurate
Complete
Concise
Well referenced
Clear and logical
Objective and balanced
Free of bias or flaws
Applicable and appropriate for specific
circumstances
Answers important related questions
Addresses specific management of patients or
situations
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177. Electronic information
management
In 1981 drug information was revolutionized
when it suddenly became possible for
nonlibrarians to access MEDLINE® directly.
Those who first had access were required to
participate in a week-long training class and then
could only access the information via dumb
terminals using a 300 bits per second (bps)
modem.
Little did practitioners realize that they were
starting down a technologic road that would
quickly accelerate.
A few years later some of the first pharmacy uses
of what was to become the Internet were seen.
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178. Electronic info…
Information Via the Internet
Information can be communicated over the
Internet in many ways.
It is nearly impossible to live in the United States
these days without having heard of the world wide
web (www).
It is a very popular source of information, including
health information.
It has been proposed that there should be universal
access to the Internet for health-related information,
to help improve the information reaching underserved
populations.
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179. Electronic info…
Internet WWW browsing is likely to be farther down the list after books
or other resources—perhaps even after MEDLINE® searching, except
in certain circumstances, such as the following:
When a reference to the Internet is found (e.g., advertisement and
citation).
Situations where company-specific information is necessary (e.g.,
product package inserts).
Items currently in the news
When U.S. government information is required (e.g., Food and
Drug Administration [FDA]- or CDC-specific subjects—including
clinical information and new drug approvals).
The U.S. government has been very active in putting a great deal of
information on the web.
When the information is not likely to be contained in other available
sources of information (e.g., alternative medicine and tropical
diseases).
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180. Electronic info…
Once the decision to search the web is made, the
pharmacist needs to log onto a computer attached to
Internet and run the web browser.
To obtain information, the user simply needs to put the
address (referred to as a URL [uniform resource
locator]) of that information in the browser, which will then
find it automatically.
An example of an address is
http://druginfo.creighton.edu, which was the address of
the author's main website.
The first term in an address, which will be followed by a //,
indicates the type of information provided at that site.
In this case, http stands for hypertext transfer protocol,
which is the technical term for the information generally
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181. Electronic info…
Common types of information are as follows :
http: hypertext transfer protocol—normal web
information
https: a secure form of http, used for confidential
information (e.g., credit card numbers)
telnet: a site that requires your computer to act like a
dumb terminal
ftp: file transfer protocol—allows you to transfer
software or a file of information in various formats
news: USENET News group
mailto: Internet e-mail address
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182. Electronic info…
The second term in the address (druginfo) is
often the name of the web server that you are
accessing.
The next item in this address is the organization's
general address name.
These servers are at Creighton University.
Finally, you will notice a three-letter extension at
the end of the URL.
In this case, it is .edu, which indicates that the
address is that of an educational institution
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183. Electronic info…
Common three-letter extensions seen in the United
States include:
.biz: business
.com: commercial (e.g., http://www.microsoft.com or
http://www.netscape.com)
.edu: education
.gov: government (e.g., http://www.cdc.gov for the CDC)
.info: information
.mil: military
.org: organization (e.g., http://www.ashp.org for
American Society of Health-System Pharmacists)
.net: network (network provider)
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184. Electronic info…
Links to Internet Sites
In many cases, the URL of a company or an
organization's website may be known; after all, such
addresses seem to be printed on everything now.
If the URL is unknown, often a correct guess may be
made.
For example, the American Society of Health-System
Pharmacists is commonly known as ASHP and it is an
organization.
Therefore, http://www.ashp.org would be a logical
guess of its web address, which happens to be correct.
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185. Electronic info…
A second easy way to find sites is to find cross
references from similar sites or sites that would
have an interest in the site.
For example, a logical guess of the web address for
the American Pharmaceutical Association would be
http://www.apha.org, but this produces the website
for the American Public Health Association.
However, by going to the ASHP website, it is possible
to easily find a link to the APhA website at
http://www.aphanet.org.
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186. Electronic info…
Using Search Engines
In many cases, the URL of a likely source of
information is not known and a method of searching for
the information is necessary.
Fortunately, a variety of search engines have been
developed for this purpose; some are general and
some are specific to medically related topics, even
medical specialties.
Once the decision is made to use one of these search
engines, it is then up to the user to decide which is
most appropriate for his or her needs.
Unfortunately, there does not seem to be a truly
excellent search engine specific to pharmacy.
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187. Electronic info…
Google Scholar (http://scholar.google.com) is a
good way to access professional information
including:
medicine and pharmacy
whereas, if the need is for information that might not be
supported by the medical literature (e.g., finding what is
being claimed by alternate medicine marketers and
finding "street information" about illegal medications), it
might be better to go to one of the general search
engines.
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188. Electronic info…
Even though the general search engines index a great
number of websites, they are not all inclusive.
Therefore, searching for more than one search engine is
important.
The frequency of adding new pages and deleting
"dead links" should be at least once a month, with
some engines being rather dated.
Other web technology, such as dynamically prepared
pages and frames (screens on a web browser may
consist of several frames), may not be appropriately
indexed by search engines.
This material and other things are even referred to as
the hidden Internet, which is estimated to be 500 times
bigger than the normally searchable web.
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189. Electronic info…
Search engines, such as:
OAIster at the University of Michigan
(http://oaister.umdl.umich.edu/o/oaister/)
Find Articles (http://www.findarticles.com/)
Library Spot (http://www.libraryspot.com/)
FirstGov.gov (http://firstgov.gov/)
infoplease (http://www.infoplease.com/)
Director of Open Access Journals
(http://www.doaj.org/)
Scirus for Scientific Information Only
(http://www.scirus.com/srsapp/)
Combined Health Information Database
(http://chid.nih.gov/)
can be useful for the pharmacist trying to access
material on this hidden Internet.
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190. Electronic info…
Techniques to narrow a search should be used ease of
searching.
These techniques may include the use of logical operators (i.e.,
AND, OR, and NOT) or other methods (e.g., putting a phrase in
quotations).
Unfortunately, the various search engines implement these
search methods differently.
For example, in some you might put in the word "and," in
others it will need to be "AND" ("and" is just treated as a text
word), and in some you might have to use "+" or "&.“
Also, features such as truncation, phrase searching, field
searching (e.g., date, URL, and language), case sensitivity
(e.g., finding AIDS instead of aids), and additional logical
operators (e.g., "NEAR," "WITH," and "BEFORE") may be
available.
On some search engines it is possible to search for non textual
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191. Electronic info…
Google Search Commands ,
....DesktopDI Google Search
Commands.docx
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192. Professional writing
A common thought when considering the topic of
professional writing is "That doesn't apply to me, I'm
not writing for a journal."
But professional writing is certainly not limited to journal
articles or books.
It includes:
writing evaluations of medications for consideration on a
hospital formulary
preparing written policies and procedures for the preparation
of an intravenous admixture
reporting the results of the latest sale to the home office
preparing a written evaluation of a technician or clerk
writing in a chart
writing a term paper for a class
preparing slides or posters for presentation, and many other
things. 5/9/2024
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193. Professional writing…
Essentially any time a professional takes pen, pencil,
chalk, typewriter, word processor, or any other writing
implement in hand to fulfill professional duties, it is
considered professional writing.
Although the format changes, the general principles
remain the same.
So whether the object is to write the ultimate book on
the practice of pharmacy or to type a label, a
pharmacist must know how to write professionally.
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194. Professional writing…
Steps in Writing
Preparing to Write
The first step in writing is to know the purpose—why
something needs to be written in the first place.
It is necessary at this time to have a good idea of the
expected endpoint, which is a good idea, no matter
what is being done.
For example, someone learning to plow a field with a
tractor may be concentrating on the ground near the
tractor and end up wandering all over the field,
thinking he or she was going straight.
However, by concentrating on going to a specific point
on the far end of the field, rather than looking just in
front of the tractor, the row will probably be plowed
fairly straight
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195. Professional writing…
General Rules of Writing
Once the preparation is completed, it is time to start
writing.
Unfortunately, there is no easy way to learn how to write
professionally; it just requires a lot of practice.
However, a number of rules can be followed.
The first step is to organize the information before starting to
write.
At the risk of sounding like a high school English teacher, it is
still true that this step should include preparing an outline
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196. Professional writing…
Checklist in Preparation of Written Materials
Do research first.
Put yourself in the reader's position.
Use proper grammar and spelling.
Make the document look "professional."
Keep things simple and direct.
Keep the document short.
Avoid abbreviations and acronyms.
Avoid the first person (e.g., I, we, and us).
Use active sentences.
Avoid slash construction (e.g., he or she and him or her).
Avoid contractions.
Cite other references wherever appropriate (and get permission to do so
where appropriate).
Cover things in whatever order is easiest.
Get everything down on paper before revising.
Edit, Edit, Edit!
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197. Professional writing…
Specific Document Sections
A typical document consists of three main
parts—
1. the introduction
2. body
3. conclusion
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198. Professional writing…
1. Introduction
With the probable exception of policy and procedure
documents, the two most important paragraphs in any
document are the first and last.
It is vital to start out strong, to encourage the reader to continue
reading.
Otherwise, the work will end up in that stack of articles
everyone has that they "intend to read someday."
That first paragraph should also inform the reader of what they
can expect in the rest of the document; it should be similar to a
road map that shows what is to be accomplished in the
document.
The introduction should have a clear objective for the existence
of the document.
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199. Professional writing…
2. Body
The body of the document contains all of the details.
In a research article, the body may be divided into the
methods, results, and, possibly, discussion sections,
although the latter section may be incorporated into the
conclusion.
Details of what should be included are covered in .
In other documents, the body will probably be divided
into whatever sections are appropriate or logical.
A number of rules can be followed in preparing the body
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200. Professional writing…
The first rule is that while it is important to be
concise, all necessary information must be
presented.
Again, keep an eye on the desired endpoint, and
do not stray from the subject unless it is
absolutely necessary.
Including unnecessary information, even if it is
interesting, will tend to confuse or obscure the
important points.
Also, be sure to provide a balanced coverage of
the material and avoid unsupported bias.
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201. Professional writing…
It is important to cover the information in a
logical order, so that it flows easily from one
point to another.
A common mistake, when learning to write
professionally, is to skip back and forth
between subjects.
For example, someone might insert a point
about dosing in the middle of indications, when
dosing is discussed at another point in the
document.
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202. Professional writing…
3. Conclusion
A conclusion should be placed at the end of the
body of the document, except for certain
documents (e.g., policy and procedures).
This conclusion should follow logically from the
information presented and should serve to
summarize that information.
Remember, the conclusion should also
correspond with the objective stated in the
introduction.
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203. Professional writing…
It is also worth noting that in clinical consultations,
a common mistake is to write the conclusion in a
general manner, rather than addressing the
specific patient in question, which is what the
reader wants to hear about.
The author must remember to address the
specific patient's situation.
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204. Legal aspect of drug informatics
An understanding of the legal aspects of DI
can help the practitioner in day-to-day practice,
as well as provide some possible ways to
protect himself or herself in the legal system.
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205. Legal aspect…
Tort Law
DI practice is a specialized discipline of
pharmacy.
Despite the clear prevalence of pharmacist-
staffed DICs, the legal obligations of the DI
specialist remain unclear.
Specialists are held to the highest degree of care
by the law.
Because of the DI pharmacists' greater expertise
in the area of DI, it is likely that the courts would
expand their legal and professional liability
beyond that of other pharmacists.
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206. Legal aspect…
The liability of the DI specialist versus
generalist differs for a number of reasons, the
most obvious of which are the nature of the
information provided and the recipients of the
information.
In the provision of pharmaceutical care,
pharmacists are providing information to
patients, whereas the DI specialist is often
providing DI to other health professionals.
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207. Legal aspect…
Functions such as online searching, monitoring
or recommending drug therapy, patient
counseling, participation in clinical studies and
pharmacy and therapeutics (P&T) committees,
drug use evaluation, and identifying adverse
drug experiences entail legal obligations of
proper performance.
Willing has stated:
If you voluntarily offer and create a higher
standard of careful practice, the public has a legal
right to assume that pharmacists can and will
consistently perform according to that standard.
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208. Legal aspect…
Minimal standards of performance and a
consistent level of competence must be
assured by pharmacists promoting or offering
this service regardless of the practice site.
Although there are no standards to accredit
DICs, professional standards of performance
may be used by courts as an objective
measuring tool for the standard of care.
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209. Legal aspect…
In addition to the DI specialist, the pharmacy
profession is assuming an increased legal
responsibility to provide DI in the daily practice
of pharmaceutical care.
Although the physician has been considered the
learned intermediary, responsible for
communicating the manufacturer's warnings to
the patient, the Omnibus Budget Reconciliation
Act of 1990 (OBRA '90) may be shifting this
responsibility to the pharmacist.
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210. Legal aspect…
Failure to counsel or warn cases are showing an
increasing trend in pharmacist liability.
Recent cases demonstrate the pharmacist's duty
to warn of foreseeable complications of drug
therapy is becoming a recognized part of the
expanded legal responsibility of pharmacists.
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211. Legal aspect…
Where the patient is at higher risk than the
general population, the courts have uniformly
found liability.
There are many such cases against physicians for
failure to disclose material risks of medical
procedures or treatments to their patients.
Today, there is some question as to when a
pharmacist provides DI, whether they be
generalists or DI specialists, are held to the same
standards as physicians when determining
standard of care.
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212. Legal aspect…
Traditionally, physicians remain responsible for
their patients and must exert "due care"; that
is, a physician who knows or should have
known that information provided was improper
may be held liable for negligence.
Currently, most litigation concerning pharmacists
involves negligence.
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213. Legal aspect…
Therefore, it is safe to assume that a legal
cause of action pertaining to the provision of DI
will be founded on the theory of negligence as
the direct or proximate cause of personal injury
or death.
Malpractice liability based on negligence refers to
failure to exercise the degree of care that a
prudent (reasonable) person would exercise under
the same circumstances.
Elements of negligence include the four Ds:
(1) duty breached, (2) damages, (3) direct
causation, and (4) defenses absent.
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214. Legal aspect…
Incomplete Information
Is the pharmacist liable when the DI provided is
incomplete?
Should the pharmacist provide all the medication
information via a DI sheet or patient package
insert (PPI)?
There have been several cases against
pharmacists for failure to dispense mandatory
PPIs for certain drugs that later caused harm.
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215. Legal aspect…
• In Parkas v. Saary, the court addressed the issue of
whether the pharmacist's failure to dispense the
Food and Drug Administration (FDA)-mandated PPI
for progesterone was the proximate cause of the
congenital eye defect that occurred.
Because congenital defects, but not eye
deformities, were specified in the PPI, failure to
provide the PPI could not be proven to be the
proximate cause.
Therefore, judgment was in favor of the
pharmacy.
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216. Legal aspect…
In Frye v. Medicare-Glaser Corporation, the
pharmacist counseled the patient regarding
drowsiness with Fiorinal®, but failed to provide
a warning not to consume alcohol.
The patient died, presumably as a result of
combining the drug with beer.
Here, the DI provided was incomplete.
The trial court did not find the pharmacist had a
duty to warn in this instance.
However, it is important to realize that this case
was decided before OBRA '90 was in effect.
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217. Legal aspect…
More recent cases are finding pharmacists
have a responsibility for patient counseling
and drug therapy monitoring. In Sanderson v.
Eckerd Corporation, the pharmacist was liable
for "voluntary undertaking" to act in the
absence of a duty, where the pharmacy's
computer was inappropriately used by the
pharmacist in detection of an adverse reaction
and the pharmacist failed to warn the patient of
the potential for an adverse reaction
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217
218. Legal aspect…
In Horner v. Spalitto, the court imposed a duty on
a pharmacist to alert the prescriber when the dose
prescribed is outside the therapeutic range.
In Happel v. Wal-Mart Stores, the pharmacy's
computer system was overridden, and the pharmacist
failed to warn a patient allergic to aspirin and ibuprofen
of the potential for cross-allergenicity with ketorolac.
The court found the pharmacist has a duty to warn
when a contraindicated drug is prescribed.
In Morgan v. Wal-Mart Stores, the court held that
pharmacists have a duty beyond accurately filling a
prescription "based on known contraindications, that
would alert a reasonably prudent pharmacist to a
potential problem.
" However, the court did not find for the plaintiff(ከሳሽ)
opining that pharmacists do not have knowledge that
desipramine may cause hypereosinophilic syndrome.
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219. Legal aspect…
Clearly, these cases demonstrate an
expansion of pharmacists' duties from the
nondiscretionary standard of technical
accuracy to a discretionary standard which
requires pharmacists to perform professional
functions, that is, from a technical model to a
pharmaceutical care model.
Knowledge of or access to DI is becoming an
important factor that courts consider in
determination of the pharmacist's duty to warn.
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220. Legal aspect…
Inappropriate Quality Information
It has long been recognized by law that false
information provided to another could result in
harm to the recipient if the recipient acted relying
on the false information.
Although negligent misrepresentation has not
been applied to DI, there is no guarantee that it
will not be in the future.
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221. Legal aspect…
• The relevant law is the Restatement (Second) of
Torts, Negligent Misrepresentation Involving Risk of
Physical Harm, which states:
One who negligently gives false information to
another is subject to liability for physical harm
caused by action taken by the other in reasonable
reliance upon such information . . .. Such
negligence may consist of failure to exercise
reasonable care in ascertaining accuracy of the
information, or in the manner in which it is
communicated.
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222. Ethical aspect of DI
The Ethics Course Content Committee of the
American Association of Colleges of Pharmacy
(AACP) described ethics as "the philosophical
inquiry of the moral dimensions of human
conduct".
They mentioned that Aristotle taught ethics as "an
eminently practical discipline". . .dealing. . . "with
concrete judgments in situations in which action
must be taken despite uncertainty.
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223. Ethical aspect…
" These authors indicated that the term ethical
is often used synonymously with the term
moral to describe an action or decision as
"good" or "right.
" They further stated that ethics is not values
clarification, it is not the study of moral
development, and it is not the law.
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224. Ethical aspect…
Veatch stated that "an ethical, or moral, issue
involves judgments between right and wrong
human conduct or praiseworthy and blameworthy
human character.
" This author indicated that an ethical deliberation may
be differentiated from other endeavors by three
characteristics:
1) it is ultimate or fundamental, there is no higher standard
against which to measure the rightness of the decision
or action
2) the issue is universal, the parties in disagreement do not
consider it simply a difference of opinion or taste “each
party believes there is a right or wrong answer” even if
they're not sure what the answer is
3) the deliberation takes into account the welfare of all
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225. Ethical aspect…
Law might be defined as rules of conduct
imposed by society on its members.
By contrast, professional ethics has been
defined as "rules of conduct or standards by
which a particular group in society regulates its
actions and sets standards for its members.
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226. Ethical aspect…
" Law involves written rules set by the whole
society (or its representatives) that address
responsibilities of that society's members.
Professional ethics focuses on explicit or
implicit rules and standards set by a
professional subgroup of society, and
addresses the responsibilities of only those
who are members of that subgroup.
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227. Ethical aspect…
All pharmacists will be called on to provide
drug information.
On occasion they will encounter ethical dilemmas
regarding what information, if any, should be
provided.
It is important that the pharmacy professional
approach such moments prepared to (often
quickly) identify the pertinent facts, analyze
relevant points of the situation, and rank or
balance the pertinent ethical rules and principles
that are involved.
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228. Ethical aspect…
The individual pharmacist must recognize his
or her rights and responsibilities relative to the
client, to other involved individuals, to society
as a whole and to any higher power to whom
the pharmacist feels accountable.
Organizations can assist the employee
pharmacist by formal recognition of certain
implicit and explicit policies
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229. Ethical aspect…
Furthermore, opportunities for deliberate study
and rehearsal of important analytic steps are
important to help pharmacists be prepared to
address ethical dilemmas that arise when
providing drug information.
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