Transcript Wk1_Stud_729__1_lecture

Drug Information Science
Week #1
Systematic Approach to Drug
Information
Types of Resources
Functions of a Drug Information
Specialist, ie. Pharmacist
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Pharmacists must know how to:
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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
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Systematic Approach to Answer
Drug Questions
• 1. Secure demographics of requestor.
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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
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Find ________________________
How _________________________
Use __________________________
Determine _______________________
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Categories of Questions
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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...
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Therapy evaluation-- picking drug of choice
Dosage, regimen, recommendations
Adverse effects
Poisoning, toxicology
Pregnancy, Teratogenicity
Lactation/ infant risks
4. Develop Strategy and Conduct
Research
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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)?
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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)
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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:
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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
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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
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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….
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Important Rules for Drug
Information
• Be _______________ with information
• Be _______________ with information
• Be _______________ with information