Drug Information Drug Information Resources Resources Joe Pozdol, MLIS Joe Pozdol, MLIS Norris Medical Library Norris Medical Library [email protected] [email protected]
Dec 17, 2015
Drug Information Drug Information ResourcesResources
Joe Pozdol, MLISJoe Pozdol, MLIS
Norris Medical LibraryNorris Medical Library
[email protected]@usc.edu
Learning GoalsLearning Goals
To understand the magnitude of health information To understand the magnitude of health information available todayavailable today
To be able to classify questions as background or To be able to classify questions as background or foregroundforeground
To understand the differences between primary, To understand the differences between primary, secondary, and tertiary resourcessecondary, and tertiary resources
To be able to determine ultimate questions and To be able to determine ultimate questions and classify them by drug information typeclassify them by drug information type
To be able to use Drug Facts and Comparisons, To be able to use Drug Facts and Comparisons, Epocrates, Lexi-Comp, Micromedex, and Epocrates, Lexi-Comp, Micromedex, and Clinical PharmacologyClinical Pharmacology
The Growth of Medical InformationThe Growth of Medical InformationIndexed Citations Added to MEDLINE (i.e. PubMed) by Fiscal Year
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U.S. National Library of Medicine. National Institutes of Health. Reviewed 25 March 2009.http://www.nlm.nih.gov/bsd/stats/cit_added.html#1
How does one navigate the information overload How does one navigate the information overload without getting overwhelmed and confused?without getting overwhelmed and confused?
Pair Activity: Assessing What You Already KnowPair Activity: Assessing What You Already Know
For a drug information question, which would you consult?For a drug information question, which would you consult?
List a pro and a con for each resource.List a pro and a con for each resource.
Journal Textbook
Background QuestionsBackground Questions
Question is broad in scopeQuestion is broad in scope
Answer is general knowledge in fieldAnswer is general knowledge in field
Can best be addressed with tertiary resourcesCan best be addressed with tertiary resources
E.g. Is a drug available in the U.S.?E.g. Is a drug available in the U.S.?
What is a drug’s mechanism of What is a drug’s mechanism of action?action?
When is a drug contraindicated?When is a drug contraindicated?
Foreground QuestionsForeground Questions
Question is narrow in scopeQuestion is narrow in scope
Answer may require examining new or conflicting evidenceAnswer may require examining new or conflicting evidence
Can best be addressed with secondary and primary resourcesCan best be addressed with secondary and primary resources
E.g. How effective is a new drug when compared to E.g. How effective is a new drug when compared to
drugs that are already on the market?drugs that are already on the market?
Are there clinical trials supporting an off-label Are there clinical trials supporting an off-label use of a use of a
drug in a specific population?drug in a specific population?
Primary ResourcesPrimary Resources
Scientific journalsScientific journals
Provide original studies or reportsProvide original studies or reports
E.g. Clinical trial, case series, case reportE.g. Clinical trial, case series, case report
Good for foreground questionsGood for foreground questions
Scope is narrowScope is narrow
Good when topic is new or new data has Good when topic is new or new data has been publishedbeen published
Primary ResourcesPrimary ResourcesPros:Pros:
Most current evidenceMost current evidence
Provide data on new drugsProvide data on new drugs
Can personally assess validity of studiesCan personally assess validity of studies
Cons:Cons:May not lead one to best decision because of limited scopeMay not lead one to best decision because of limited scope
Data can be poor or controversialData can be poor or controversial
Every study has limitationsEvery study has limitations
Too complex for patientsToo complex for patients
Secondary ResourcesSecondary Resources
Bibliographic databases that provide abstracts or Bibliographic databases that provide abstracts or full-text of studies full-text of studies
Good for foreground questionsGood for foreground questions
Secondary ResourcesSecondary Resources
Pros:Pros:Can construct searches to find specific information Can construct searches to find specific information
at high granularityat high granularity
Cons:Cons:Often require more expertise to use than primary or Often require more expertise to use than primary or
tertiary tertiary resourcesresources
Retrieved references must be filtered for qualityRetrieved references must be filtered for quality
Must track down resources before looking for answersMust track down resources before looking for answers
Too complex for patientsToo complex for patients
Tertiary ResourcesTertiary Resources
Compilations of knowledge in the fieldCompilations of knowledge in the field
E.g. Textbooks, handbooks, online drug compendiaE.g. Textbooks, handbooks, online drug compendia
Good for background questionsGood for background questions
Scope is broadScope is broad
Tertiary ResourcesTertiary ResourcesPros:Pros:
Provide comprehensive information Provide comprehensive information
Information reflects views of multiple experts in fieldInformation reflects views of multiple experts in field
Fast, easy to use, and may be good for patientsFast, easy to use, and may be good for patients
Cons:Cons:Usually at least 2 years out of date by publicationUsually at least 2 years out of date by publication
High dependency on interpretation of authors**High dependency on interpretation of authors**
**Pharmacists can address this by consulting at least **Pharmacists can address this by consulting at least 2 tertiary resources to find corroborating information2 tertiary resources to find corroborating information
When trying to answer a clinical question, the best strategy is often to When trying to answer a clinical question, the best strategy is often to consult resources in the following order:consult resources in the following order:
Tertiary, Secondary, PrimaryTertiary, Secondary, Primary
Tertiary resources are good when:Tertiary resources are good when:
The answer to a question is basic factual knowledge in the fieldThe answer to a question is basic factual knowledge in the field
The question was studied extensively and a conclusion was madeThe question was studied extensively and a conclusion was made
Many experts have addressed the question and agree on answerMany experts have addressed the question and agree on answer
Secondary and primary resources are good when:Secondary and primary resources are good when:
A question is new and has never been studiedA question is new and has never been studied
There is no consensus among experts; various opinions aboundThere is no consensus among experts; various opinions abound
There is conflicting evidence and the question needs further studyThere is conflicting evidence and the question needs further study
Resource TableResource Table
Primary
Resources
JAPhA JAMA Pharmacotherapy
New England Journal of Medicine
Annals of Internal Medicine AJHP
Secondary
Resources
PubMed/Ovid MEDLINE
Cochrane Database of Systematic Reviews
DARE TRIP
National Guideline Clearinghouse
Tertiary
Resources
Access Pharmacy UpToDate
Drug Facts and Comparisons
Epocrates Lexi-Comp Micromedex
Clinical Pharmacology
Determining the Ultimate QuestionDetermining the Ultimate Question
44 y.o. male44 y.o. male
High blood pressureHigh blood pressure
Rx ACE inhibitorRx ACE inhibitor
Develops dry coughDevelops dry cough
Ultimate Question:
Question Type:
Resource Type:
Major Concepts (i.e. search terms):
Is cough a side effect of ACE inhibitors?
Background
Tertiary
ACE inhibitors, side effects, cough
Real Estate Agent Last Dec.
Categorizing the Ultimate QuestionCategorizing the Ultimate Question
**Adverse effects**Adverse effects
AvailabilityAvailability
Compatibility/stabilityCompatibility/stability
CompoundingCompounding
**Dosing/administration**Dosing/administration
**Drug interaction**Drug interaction
HerbalHerbal
IdentificationIdentification
PharmacokineticsPharmacokinetics
PharmacologyPharmacology
Poisoning/toxicologyPoisoning/toxicology
Pregnancy/lactationPregnancy/lactation
**Therapeutic use**Therapeutic use
**Especially relevant for Medication Therapy Review assignment**Especially relevant for Medication Therapy Review assignment
Pair ActivityPair Activity
List 3 facts about Ambien (Zolpidem Tartrate) OR InsomniaList 3 facts about Ambien (Zolpidem Tartrate) OR Insomnia
Drug Facts and ComparisonsDrug Facts and Comparisons
Search for information about Ambien (Zolpidem Tartrate)Search for information about Ambien (Zolpidem Tartrate)
www.usc.edu/nmlwww.usc.edu/nml
Pair ActivityPair Activity
List 3 facts about Proventil (Albuterol Sulfate) OR AsthmaList 3 facts about Proventil (Albuterol Sulfate) OR Asthma
EpocratesEpocratesSearch for information about Proventil (Albuterol Sulfate)Search for information about Proventil (Albuterol Sulfate)
www.usc.edu/nmlwww.usc.edu/nml
Pair ActivityPair Activity
List 3 facts about Zoloft (Sertraline Hydrochloride) OR DepressionList 3 facts about Zoloft (Sertraline Hydrochloride) OR Depression
Lexi-CompLexi-Comp
Search for information about Zoloft (Sertraline Hydrochloride) Search for information about Zoloft (Sertraline Hydrochloride)
www.usc.edu/nmlwww.usc.edu/nml
Pair ActivityPair ActivityList 3 facts about Aricept (Donepezil Hydrochloride) OR DementiaList 3 facts about Aricept (Donepezil Hydrochloride) OR Dementia
MicromedexMicromedex
Search for information about Aricept (Donepezil Hydrochloride)Search for information about Aricept (Donepezil Hydrochloride)
www.usc.edu/nmlwww.usc.edu/nml
Pair ActivityPair Activity
List 3 facts about Zyrtec (Cetirizine Hydrochloride) OR AllergiesList 3 facts about Zyrtec (Cetirizine Hydrochloride) OR Allergies
Clinical PharmacologyClinical Pharmacology
Search for information about Zyrtec (Cetirizine Hydrochloride) Search for information about Zyrtec (Cetirizine Hydrochloride)
www.usc.edu/nmlwww.usc.edu/nml
Topic RecapTopic Recap
Excess of Medical InfoExcess of Medical Info
Background v. ForegroundBackground v. Foreground
Tertiary, Secondary, PrimaryTertiary, Secondary, Primary
Ultimate QuestionsUltimate Questions
Drug Facts and ComparisonsDrug Facts and Comparisons
EpocratesEpocrates
Lexi-CompLexi-Comp
MicromedexMicromedex
Clinical PharmacologyClinical Pharmacology
The Big PictureThe Big Picture
1.1. Obtain background info/understand contextObtain background info/understand context
2.2. Determine ultimate questionDetermine ultimate question
3.3. Select and search appropriate resourcesSelect and search appropriate resources
4.4. Evaluate and analyze information foundEvaluate and analyze information found
5.5. Draw conclusion and formulate responseDraw conclusion and formulate response
Addressing a Drug Info NeedAddressing a Drug Info Need
Medication Therapy Review AssignmentMedication Therapy Review Assignment
References used to support recommendation:References used to support recommendation:
Student 1 GoogleStudent 1 Google
WikipediaWikipedia
Student 2 Drug Facts and ComparisonsStudent 2 Drug Facts and Comparisons
Lexi-CompLexi-Comp
WRONG
RIGHT
Due Dec. 4Due Dec. 4