Drug Information Science Week #1 Systematic Approach to Drug Information Types of Resources.

Drug Information Science

Week #1

Systematic Approach to Drug Information

Types of Resources

Functions of a Drug Information Specialist, ie. Pharmacist

• Pharmacists must know how to:

• 1_____________________

• 2_____________________

• 3_____________________

Functions of a Pharmacist as an Information Source

• Provide drug information by:– answering information requests– writing patient specific consultations– communicating information that wasn’t

requested, but is necessary– developing criteria/guidelines for drug use

Functions...

• Provide drug evaluations

• Develop policies for dept., P&T comm.. Bulletins, newsletters, journal columns, education for practitioners.

• Be involved with:– ADR reporting, DUE’s, publishing, developing

protocols, IRB, Poison Control Center information.

Information Sources Utilized by Pharmacists

• ________________________________

• ________________________________

• ________________________________

• ________________________________

Systematic Approach to Answer Drug Questions

• 1. Secure demographics of requestor.

• 2. Obtain background information.• 3. Determine and categorize ultimate question.• 4. Develop strategy and conduct search.• 5. Perform evaluation, analysis, and synthesis.• 6. Formulate and provide response• 7. Conduct follow-up and documentation

1. Request Demographics

• Obtain requestor’s knowledge base and position, training and knowledge of medicine.

• Obtain telephone #, address, fax, etc for follow-up later.

• Determine approximate age (elderly, adolescent, etc.) (usually no need to directly ask)

2. Background Information

• Think, “Why is requestor asking for this information?”

• Weigh time involved to get background info.• Use tact, politeness and assertiveness• Background questions should be specific for the

nature of the request.• Ask, “What sources have already been used?”• Useful info: age, gender, weight, allergies, other

disease states, other meds, lab values, etc

3. Determine and Categorize Ultimate Question

• Find ________________________

• How _________________________

• Use __________________________

• Determine _______________________ ___________________________________

Categories of Questions

• Strength, manuf, availability of product, approval • Tablet identification, general product information• Laws/policies/procedures, Cost, Foreign products• Compatibility, stability, administration rate\• Drug interactions (drug, lab, disease,food)• Pharmaceutics (compounding, formulations)• Pharmacokinetics (ADME/levels)• Nutrition support

Categories of Questions...

• Therapy evaluation-- picking drug of choice• Dosage, regimen, recommendations• Adverse effects• Poisoning, toxicology • Pregnancy, Teratogenicity• Lactation/ infant risks

4. Develop Strategy and Conduct Research

• 1.

• 2.

• 3.

Resources Available: Primary Literature Resources

• Research studies published in biomedical journals.

• Provide details of research methodology and scientific results that lead to therapeutic conclusions.

• Advantages: Most current resource for information. Least biased, so most accurate

Primary Literature Examples:• New England Journal of Medicine

• Archives of Internal Medicine

• JAMA (Journal of the American Medical Association)

• CHEST (from the American College of Chest Physicians)

• Clinical Pharmacy and Therapeutics

• Annals of Pharmacotherapy

• British Medical Journal

What do we find in Primary Resources (journals)?

• Advertisements

• Abstracts

• Letters to the Editor, Correspondence

• Review articles (considered tertiary resource)

• Meta analysis (considered tertiary resource)

What do we find in Primary Resources (journals)?

• Primary journal articles: clinical drug trials– *** These articles are the primary resources we

are talking about ****

• Clinical trial types:– Intervention types (highly rated)

• Randomized controlled trial– Parallel

– Crossover

– Before and After (time series)

Primary journal article resources

• Observational (weaker than interventional studies)– Cohort (strongest in class)– Case control– Cross sectional– Case series, Case report, descriptive

Secondary Literature Resources

• Indexing and Abstracting Services• Indexing service: provides only bibliographic

information that is indexed by topic.• Abstracting service: also provides a brief description

or “abstract” of information contained in a specific citation.

• Both provide access to primary literature • Each can cover different journals, texts, publicat.• Cost will vary from $150 to $60,000 / year

Secondary Literature Resources:

• Medline- largest 380,000 ref, 4000 journals

• BIOSIS

• Embase

• Index Medicus

• IDIS (Iowa Drug Information System)

• PUBMED (access to Medline)

Tertiary Literature Resources• Textbooks (Goodman and Gilman, Handbook of

Non-Prescription Drugs, etc) • Drug Encyclopedias (Martindales, Merck Index,

etc) • Review articles in primary journals, Meta

Analysis articles in primary journals • Drug Compendia (Facts and Comparisons, AHFS,

PDR

• Full Text Computer Database(Micromedex)

Tertiary Literature Resources

• Advantages: – provide rapid access to information

– detailed sufficiently for quick reference

– good general information condensed into easy to read format

• Disadvantages:– Outdated quickly, may not reflect current standards

of practice, incomplete, human bias, incorrect interpretation of research or lack of expertise by author

Alternate Sources for Drug Information

• Internet Sites

• Electronic Bulletin Boards (EBB’s): FIX, FDA, Helix, Pharmnet, Pharmline

• Local and National Professional Organizations

• Pharmaceutical Manufacturers

• Drug Information Centers, Poison Control Centers

5. Data Evaluation, Analysis, Synthesis

• 1.

• 2.

• 3.

6. Formulate and Provide Response

7. Follow Up and Follow Through

• Verify the appropriateness, correctness, and completeness of a response.

• Essential when judgement calls used.

• Essential when new data found or circumstances changed from original request.

• Document everything!

Ethical and Moral Responsibility

• How will they use your information?

• Are they asking for lethal dose of drug?

• Are they suicidal or homicidal?

• Are they seeking information for making illicit drugs?

• Are they trying to forge a prescription?

• Are they in serious need of an ER?

Ethical and Moral Responsibility….

• 1.

• 2.

• 3.

Important Rules for Drug Information

• Be _______________ with information

• Be _______________ with information

• Be _______________ with information