Lecture 8 - Drug Information: Systematic Approach & Resources

systematic approach to drug information meaning

structured and organized method for finding, evaluating, and providing accurate answers to drug-related questions; developed and modified for contemporary practice that improves efficiency

steps in systematic approach to drug information

1. Identify the requestor

2. Obtain background information

3. Define the true question

4. Categorize the question

5. Perform a systematic search

6. Analyze the information

7. Disseminate the information

8. Document

9. Follow-up

Identify the requestor

is it a health care professional? if so, what type? is it a patient or the media?

clarify when response is needed (immediate or later) and method of response (verbal, email, note, etc.)

Obtain background information

patient specific or general information; gather context surrounding the question

Questions to consider in systematic approach

Place the question into a drug information category

• Patient-specific

– Age

– Weight/height

– Kidney/liver function

– Allergies

– Medical conditions

– Medications

• Patient Medical Record/DOB

Probing Based on Type of Question

availability, drug interaction, compatibility with other drugs or medical devices, adverse drug reactions, pregnancy, lactation, drug ID

Categorize the Question

• Adverse Drug Reactions

• Availability

• Dosage/Administration

• Drug Interactions

• Drugs in Pregnancy/Lactation

• General Information

• Identification

• Pharmaceutics

• Pharmacoeconomics

• Pharmacokinetics

• Physical Stability/Compatibility

• Therapeutic Use

• Toxicology

Perform a Systematic Search

based on background information gathered and category of question, consult multiple tertiary sources and primary/secondary as appropriate

Analyze the Information

using clinical judgement and considering background information gained via quality sources

disseminate information through…

text, verbal, email

document systemic information

Record your work (the question, sources consulted, response provided) for medical records and notes in profile

resource types

tertiary, secondary, primary

tertiary resources

textbooks (like DiPiro’s pharmacotherapy), review articles, clinical guidelines, databases (like lexidrug and micromedex)

pros and cons of tertiary resources

• Pro: Comprehensive, concise, great for general background, easy to use, familiar, convenient

• Con: Published less frequently (dated), bias?

secondary resources

searchable databases (like pubmed, EMBASE, MEDLINE) that are used to find primary literature or tertiary review articles

pros and cons of secondary resources

• Pro: Efficient search

• Con: Skill dependent

primary resources

original findings (e.g., research studies)

pros and cons of primary resources

• Pros: In-depth, Current (✓ date)

• Cons: Time, Need strong literature evaluation skills

Top 10 Reasons to Use Tertiary Resources

1. Learn about a disease state

2. Learn about a treatment guidelines

3. Specifics about a drug (indication, dose, dose kidney dysfunction, peds)

4. Find a drug interaction

5. Check commercial availability of drug/dosage form

6. Find the cost of a drug

7. Check drug compatibility

8. Determine safety in pregnancy/lactation

9. Drug identification

10. Brand/generic name

Evaluating Tertiary Literature

• analyze author/editor experience

• relevance to topic

• referenced

• updates (current vs old)

• error free

• user friendly

Common Textbooks

• DiPiro’s Pharmacotherapy

• Applied Therapeutics: Clinical Use of Drugs

• Harrison’s Principles of Internal Medicine

• Handbook of Non-Prescription Drugs

where can you find prescribing information (PI)?

• Product/packaging

• Manufacturer’s Website

• FDA Website: Drugs@FDA

• Daily Med

Common General Medication Information Resources

UpToDate Lexidrug, Micromedex

UpToDate Lexidrug vs Micromedex

toxicology: uptodate = lexi-tox, micromedex=poisindex

pregnancy/lactation: uptodate=Briggs' Drugs in Pregnancy & Lactation, micromedex=reprorisk

Pregnancy/Lactation resouces

• Briggs’ Drug use in Pregnancy and Lactation

– Available in UpToDate Lexidrug

• Hale’s Medication and Mother’s Milk

Pediatrics/Neonatology resources

• UpToDate Lexidrug

– Compounding recipes

– Preparation for administration

• Neofax (Micromedex)

• Textbook:

– Nelson Textbook of Pediatrics

• AAP Red Book

– Charts/Tables

– Infections Diseases

– Vaccines/Antibiotics

IV compatibility resources

• Trissel’s

– Lexidrug and Micromedex

• ASHP Injectable Drug Information

compounding resources

• UpToDate Lexidrug

• ASHP Extemporaneous Formulations

vet pharm resources

Plumb’s Veterinary Drug Handbook

Drug Safety Recalls & Shortages inffo

• Recalls, Market Withdrawals & Safety Alerts

– FDA Website

• Drug Shortages

– ASHP Resources (shows current and resolved)

Dietary and Herbal Supplements resources

NIH Office of Dietary Supplements and National Center for Complementary and Integrative Health, natural products database (in lexidrug), NatMedPro

foreign drugs resources

• UpToDate Lexidrug

– Martindale

• Micromedex

– Martindale

– Index Nominum

FDA orange book

lists drug products approved based on safety and effectiveness, comparing brand and generic

FDA purple book

lists all FDA-licensed biological products, including information about both reference products and their corresponding biosimilar and interchangeable products

FDA green book

list of all FDA-approved and conditionally approved animal drug products

CDC pink book

vaccines

CDC yellow book

international travel health and vaccines

red book

drug pricing, manufacturer availability (in micromedex)

AAP red book

comprehensive guide for healthcare professionals on pediatric infectious diseases