PHA 491 - Module # 3 Hospital Drug Info Resources

What are 9 ways drug information (DI) is used in hospital pharmacy practice?

1) Answer medication questions from healthcare professionals and patients/caregivers, 2) support P&T committee activity, 3) provide formulary decision-making information, 4) provide medication information/in-services/journal clubs, 5) develop medication-use criteria/guidelines, 6) assist with clinical decision support tools such as order sets and alerts, 7) manage medication-use evaluations and quality improvement, 8) manage drug shortages, and 9) coordinate adverse drug event (ADE) reporting and monitoring.

What 4 major categories of factors should be considered when formulating a quality DI response?

1) Background/special circumstances/other factors, 2) patient factors, 3) disease factors, and 4) medication factors.

What background/context factors should be considered for a DI question?

Context, the event prompting the question, acuity, and time constraints.

What patient factors should be considered when answering a DI question?

Demographics, past medical history/history of present illness, allergies/intolerances, and current medications.

What disease factors should be considered when answering a DI question?

Clinical findings such as signs, symptoms, and laboratory tests; diagnosis; and treatment (medical, surgical, or other).

What medication factors should be considered when answering a DI question?

Specific medication(s), availability, indication, pharmacokinetics, adverse effects, allergies, effects of age or organ-system function, and contraindications/precautions.

What major drug information resources are available through the Mercer Pharmacy Research Guide?

AccessPharmacy, ClinicalKey, DynaMedex, Facts and Comparisons, Micromedex, and UpToDate Lexidrug.

What was Lexidrug previously called?

Lexicomp.

What drug-specific information resources are available through Lexidrug?

Lexi-Drug, Pediatric and Neonatal Lexi-Drugs, AHFS Essentials, AHFS DI, Geriatric Lexi-Drugs, Infectious Diseases, Patient Education, Drug Allergy, Briggs Drugs in Pregnancy and Lactation, and Natural Products Database.

What additional clinical tools are available in Lexidrug?

MSDS (Materials Safety Data Sheet), Toxicology, Indexes, and other clinical links. UpToDate is not available through Mercer; use DynaMedex instead.

Which Lexidrug resource can be used for international medications?

Lexi-Drug International.

Which Lexidrug resource can be used for pharmacogenomics information?

The Pharmacogenomics index.

What are the 3 types of parenteral medication incompatibility?

Physical, chemical, and therapeutic incompatibility.

What is physical incompatibility?

The most easily detected incompatibility; visible changes may include particulate formation, haze, precipitation, or color change.

What is chemical incompatibility?

Decomposition of a drug resulting in >10% loss of potency; it can only be detected using a suitable analytic method.

What is therapeutic incompatibility?

A drug combination that results in undesirable antagonistic activity or undesirable synergistic pharmacologic activity.

What is the primary tertiary reference discussed for parenteral medication compatibility?

Handbook on Injectable Drugs (Trissel's).

What types of compatibility information are provided by Trissel's?

Solution compatibility, admixture compatibility, syringe compatibility, and Y-site compatibility.

What is solution compatibility in Trissel's?

Compatibility of a single drug in a solution.

What is admixture compatibility in Trissel's?

Compatibility of 2 drugs together in a solution.

What is syringe compatibility in Trissel's?

Compatibility of 2 drugs together in a syringe.

What is Y-site compatibility?

Compatibility when a drug is administered simultaneously at a Y-site with another drug in solution.

What major limitation of Trissel's should you remember?

It provides information on STABILITY only.

What factors must be considered when determining parenteral medication compatibility?

Concentration of both products, solution(s) used, and information in the remarks such as duration of tested stability and whether physical vs chemical stability was tested.

What information do parenteral compatibility resources NOT provide?

Information on sterility or clinical appropriateness.

What is Facts and Comparisons useful for?

It is associated with Lexi-Drugs and provides off-label information, comparison charts, drug monographs, and numerous specialized drug-information references.

What specialized references are available through Facts and Comparisons?

Natural Products Database, Comparative Efficacy, Drug Use Evaluations, Formulary Reviews, Boxed Warnings, Laboratory Values, Don't Crush Don't Chew, Patient Assistance Programs, and others.

What does AHFS stand for?

American Hospital Formulary Service.

What is AHFS?

A comprehensive evidence-based drug information source and a CMS nationally recognized compendium.

What makes AHFS particularly useful to pharmacists?

It provides in-depth medication reviews with references, well-supported off-label indications, dose conversions, clinical/pharmacological differences between formulations, unusual monitoring issues, and considerations for alternative routes.

How can AHFS be accessed through Lexidrug?

Through the Lexidrug Index.

What is the gold-standard resource for information on fetal and neonatal medication risk?

Drugs in Pregnancy and Lactation (Briggs).

What information does Briggs Drugs in Pregnancy and Lactation provide?

Impact of maternal medication use on the fetus and breastfeeding infant, including a summary statement, pregnancy risk, lactation risk, and review of data with references.

Where is Briggs Drugs in Pregnancy and Lactation embedded?

Lexidrugs and Facts and Comparisons.

What is LactMed?

A free online resource from the National Library of Medicine that provides medication information related to lactation.

What information does LactMed provide?

Summary of use in lactation, drug levels in breast milk, effects on breastfed infants, effects on lactation, possible alternatives, and an extensive list of references.

Which resources are specifically identified for pediatric drug management?

Pediatric and Neonatal Lexi-Drugs and Micromedex NeoFax/Pediatrics.

What information does Pediatric and Neonatal Lexi-Drugs provide?

General drug information focused on pediatrics, pediatric warnings/considerations, dosing for multiple ages and weights when available, and compounding recipes.

What important caution should you remember when using Pediatric and Neonatal Lexi-Drugs?

It also contains adult dosing, so make sure you are reviewing the correct dosing section.

What pediatric warning example is given in the lecture?

Do not give tetracycline to children <8 years old due to teeth discoloration and skeletal development impairment.

What is the Teddy Bear Book?

Pediatric Injectable Drugs, a resource providing guidance for parenteral medication administration in pediatric patients.

What information does the Teddy Bear Book provide?

Usual injectable doses by indication and age/weight, maximum doses, product additives and their possible clinical impact, and compatibility with parenteral nutrition; some information can also be applied to adults.

What is the Harriet Lane Handbook?

A pediatric reference written by resident physicians at Johns Hopkins and revised every 3 years, focusing on diagnosis and treatment of pediatric patients by disease state.

What information is available in the Harriet Lane Handbook?

Pediatric diagnosis/treatment information, normal pediatric lab values, formulary information including indications and pediatric doses, situations where products should not be used, and renal dose adjustments.

What caution should be remembered about doses in the Harriet Lane Handbook?

Doses may reflect practices at Johns Hopkins rather than evidence-based information.

What is the Red Book primarily used for?

Infectious disease information with an emphasis on pediatric patients.

What information does the Red Book contain?

Epidemiology, pathophysiology, diagnosis and management of infectious diseases; common, uncommon, and tropical infections; pediatric treatment; immunity/vaccination; and patient isolation requirements.

What is one unique feature of the Red Book?

It is one of the few resources that describes patient isolation requirements.

Which resource should be used for herbals and supplements?

Natural Medicines.

What information does Natural Medicines provide?

Professional monographs on herbals/supplements, product background and uses, safety and efficacy data with references, dosing/administration, adverse effects/toxicology, interaction checker, graded product reviews, and patient education.

What is DynaMedex?

A point-of-care clinical reference providing literature summaries for more than 3,200 topics with in-depth information on diseases and conditions.

How current is DynaMedex?

It monitors content from over 500 medical journals and is updated daily.

What additional features are available in DynaMedex?

Browsing by specialty, clinical-condition overviews, specialty-based articles, monthly topics, calculators, guidelines, resources, and recent guideline alerts.

How can DynaMedex help locate clinical guidelines?

Select "Guideline" for a link to the PubMed abstract and check "Recent Alerts" for new guideline summaries.

What are clinical guidelines used for?

To provide evidence-based care of disease states and/or drug management.

Where can clinical guidelines be located?

PubMed, Guideline Central, and organizations specializing in specific areas of practice.

Which organizations are examples of sources for infectious disease guidelines?

Infectious Diseases Society of America (IDSA) and CDC.

Which organization is an example of a source for cardiology guidelines?

American Heart Association (AHA).

Which organization is an example of a source for diabetes guidelines?

American Diabetes Association (ADA).

Which organization is an example of a source for kidney disease guidelines?

Kidney Disease Improving Global Outcomes (KDIGO).

What is tertiary literature?

A distillation and collection of primary and secondary sources, such as textbooks, handbooks, and databases.

What are examples of tertiary drug information resources?

UpToDate Lexidrug, Micromedex, Natural Medicines (NatMed Pro), DailyMed, textbooks, and handbooks.

What is secondary literature?

Interpretations and evaluations derived from or referring to primary sources.

What are examples of secondary literature resources?

Indexing/abstracting services such as PubMed, Cochrane Library, and Web of Science.

What is primary literature?

Original research authored by researchers that contains original data and is usually published in peer-reviewed journals.

What are examples of primary literature?

Articles in journals such as New England Journal of Medicine (N Engl J Med), JAMA, and American Journal of Health-System Pharmacy (AJHP).

When may secondary or primary literature be needed for a DI question?

When tertiary resources do not adequately answer the question or when more detailed/current evidence or original research is needed.

What is the general hierarchy of drug information literature?

Tertiary = summarized/compiled information; Secondary = indexing, interpretations, or evaluations that lead to or refer to primary literature; Primary = original research and original data.

What format should be used for P2 drug information responses?

Summary of Question; Response; References (minimum of 2).

How many references are required for a P2 drug information response?

Minimum of 2 acceptable references.

What citation style is required for drug information responses?

AMA 11th edition.

What is the AMA 11th edition format for a database drug monograph?

Title of Monograph/Entry. Title of Database. Publisher/Owner. URL. Accessed Date.

What is the lecture's AMA citation example for a Lexidrug monograph?

Lisinopril. Lexi-Drugs. UpToDate Lexidrug. UpToDate Inc. [URL]. Accessed August 15, 2026.

What is the lecture's AMA citation example for a Micromedex monograph?

Lisinopril. Micromedex. Merative. [URL]. Accessed August 15, 2026.

Which resource would you use for an IV Y-site compatibility question?

Trissel's Handbook on Injectable Drugs.

Which resource would you use for fetal/neonatal medication risk during pregnancy?

Briggs Drugs in Pregnancy and Lactation.

Which resource would you use to determine drug levels in breast milk and effects on a breastfed infant?

LactMed.

Which resource would you use for pediatric/neonatal medication dosing?

Pediatric and Neonatal Lexi-Drugs or Micromedex NeoFax/Pediatrics.

Which resource would you use specifically for pediatric injectable medication administration?

Pediatric Injectable Drugs (Teddy Bear Book).

Which resource would you use for pediatric infectious diseases, vaccinations, and isolation requirements?

Red Book.

Which resource would you use for herbal or supplement safety, efficacy, dosing, and interactions?

Natural Medicines.

Which resource would you use for an international medication?

Lexi-Drug International.

Which resource would you use for an in-depth evidence-based medication review including well-supported off-label uses?

AHFS.

Which resource would you use for point-of-care disease information and current guideline summaries?

DynaMedex.

Which resource would you use to locate original research articles?

A secondary resource such as PubMed can be used to locate primary literature.