Transcript Epocrates and Other PDA Reference Tools

Epocrates and Other PDA
Reference Tools
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NANCY CLARK, M.ED.
DIRECTOR OF MEDICAL INFORMATICS EDUCATION
FSU COLLEGE OF MEDICINE
Objectives for Workshop
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 Download and Install on the PDA
 Use Epocrates Rx
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find dosage, calculate dosages
Identify if drug on formulary
 Use MultiCheck to find interactions
 Use Sx to get a Differential
 Use Dx to find Disease information
 Use Lab to find Laboratory information
 Use ID to find recommended Antibiotics
 Use MedMath Medical calculators
 Use Tables for guidelines and algorithms
Handouts
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 PowerPoint
 Downloading instructions for Epocrates Essentials
(yellow)
 Using Epocrates Essentials
 UserID and Password sheet (blue)
 List of PDA software available and description of
uses
 Consent form and evaluations
Installing Software
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SEE HANDOUT
Links to Download Sites
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PDA Websites Page
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FSU Licensed PDA Software
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 Epocrates Essentials ($149/yr)
 Rx, Sx-Differential diagnosis, Dx-5MCC, ID, LAB, M-interactions,
tables, CME, tools and calculators
 InfoRetriever ($249/yr)
 5MCC, Cochrane, InfoPOEMs, calculators, guidelines, ICD-9 and E&M
coder
 POCKETConsult (FIRSTConsult) ($149/yr)
 Differential diagnosis, medical conditions
 Clinical Evidence ($99/yr)
- EBM treatment recommendations
 DynaMed ($200/yr)
 Disease and conditions reference
 Harrison’s Practice ($325/yr)
 Disease and conditions reference
Free PDA Software Used in Curriculum
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 Geriatrics at Your Fingertips (GAYF)*
 From AGS, tools and guidelines for care of older patient
 *free to students, $30 for faculty
 ePSS Tool
 From US Preventive Services Task Force (USPSTF) tool, enter
patient’s age, gender and get latest preventive services
recommendations
 Archimedes
 Numerous handy medical calculators free from Skyscape
Full Installation Instructions
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 Handout for Epocrates Essentials
 Other program instructions on Intranet – will
require you to sign in if off campus
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Login: med\firstname.lastname
College of Medicine UserID and Password
 Updated weekly
General Steps for All Installations
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1.
Go to the Library web page,
2. Log onto EZProxy
3. PDA Websites page: Follow link to product web site
4. Register and get an account
5.
Pick platform (Palm, Windows Mobile 5 or PocketPC)
6. Download software to desktop
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Run the software with the PDA connected (Serial #)
8.
Tell it where to put the software (device or SD)
9.
When it finishes, test the software
10. Register Product
Adding Applications
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PDA
App
3. Download
software
1. Go to Product
Web site
2. Register*
PDA
App
4. Run Software on
Computer
5. Install to PDA
Device Memory or SD card
Drug Information
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EPOCRATES ESSENTIALS RX
(ALSO ONLINE)
Prescription Drug Information
Alt Med Information
Epocrates Rx
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 Prescription drugs and alternative medicines
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combined in same list
Lookup by Drug or by Class
Search tool lets you look up drugs by indication,
adverse reactions, etc.
Dosage Calculator pops up for all drugs reported in
mg/kg
Formularies available with status of each drug
Navigation
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 App: Hide Alt Meds, Auto Update, Memory Mgmt
 Edit: find
 Tools: Abbreviations, Formulary Info, Preferences,
Update Email, Disclaimer and About
MultiCheck Drug Interactions
Search Tool
Home
Epocrates Essentials Rx
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Exercises for Practice
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 How should you prescribe acyclovir for the initial
episode of genital herpes? (dose)
 Is acyclovir indicated for children with Chicken Pox
under the age of 2?
 How much does one month supply of Glucophage
850 mg bid cost?
 What is the off label indication for Neurontin
(gabapentin) (* indicates off label)
Searching for a Drug
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Dosage Calculator in Epocrates Rx
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 Online Dosage Calculator
 http://www.medcalc.com/pedidose.html
Exercises for Practice
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 A little boy who is eight years old just ate a bottle of FeSo4
tablets his mother had in the kitchen. She thinks he ate
forty or fifty of them. You search indications and find that
desferol is indicated for iron intoxication. Calculate the
dosage of desferol for the child. He weighs 50 lbs.
 You have a patient that is on amitriptyline, Flonase,
Synthroid, Reglan, and Zyrtec. She comes in with tardive
dyskinesia. Which of these drugs might be causing this?
(Use Search tool for Adverse Reactions.)
Add Drug Formularies
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 Go to Epocrates.com
 Manage My Account
 Add Formularies
 Pick Formularies
 Sync to add
 Tap for Alternatives
Exercises for Practice
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 I have a depressed patient with BCBS of Georgia who needs
a low copay. Which of the SSRI are covered by BCBS low
copay?
Look up drugs By Class> psychiatric> SSRIs.
 I have a depressed patient with no health insurance who is
indigent. Which SSRI can they get assistance to pay for
(Needy Meds)?
 A 58 yr old female with osteoporosis is on Boniva. CHP
Basic has stopped covering it. Which of the calcium
metabolism class drugs do they cover?
Drug Interactions
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EPOCRATES MULTICHECK
MultiCheck
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 Find all drugs patient is on
 Select one at a time
 Run the Drug Interaction
 Contraindicated
 Avoid/Use Alternatives
 Monitor
 Caution
 Also checks IV solubility
 Use Back to add more drugs
MultiCheck Drug Interactions
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3. Repeat until all drugs in list
Epocrates MultiCheck
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Exercises for Practice
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What interactions exist for the following combinations
of drugs?
 Lexapro, Lortab, Xanax and Zocor
 Nitrobid and Viagra
 Glucophage, Lopressor, itraconazole (Sporonox), and
simvastatin (Zocor)
Epocrates Essentials Sx
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DIFFERENTIAL DIAGNOSIS ENGINE
DxPlain
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 Included in ePocrates
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Essentials (Sx)
From Harvard
Age, gender and duration
Allows for multiple
symptoms and lab results
Results: in decreasing order
of likelihood
Online on library web page
Exercises for Practice
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 A 22 year old girl has a dry cough, chest pain, weight
loss, and erythema nodosum.
 She has been feeling “poorly” for over a month.
 What might she have?
Epocrates Essentials Dx
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DISEASE QUICK REFERENCE
5 Minute Clinical Consult
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 In Epocrates Essentials
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PDA under Dx tab
Not in Epocrates online
– in InfoRetriever online
Author: Mark R
Dambro, MD, updated
annually
600 common problems,
bottom line, quick info,
shallow content, ICD-9s
Treatment section linked
to Rx,
Exercises for Practice
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 What is the incidence and prevalence of and the
latest treatment recommendations for acute otitis
media?
 What imaging test is becoming procedure of choice
for kidney stones?
 What is the ICD-9 code for psoriatic arthritis?
 What OTC is drug of choice for sphincter
incompetence in urinary incontinence? (not
approved by FDA)
Epocrates Lab
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DIAGNOSTIC LABORATORY INFORMATION
Original Lab Content
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 View by Name,
Specimen Type or Panels
only.
 Interpretation: diseases
linked to Dx section,
drugs linked to Rx
section
 Cost/Billing tells ICD-9
codes to justify test
Exercises for Practice
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 A basic metabolic panel reveals that a 30 year old
man suffering from bipolar disorder has a serum
calcium level of 10.9 mg/dL. He is taking lithium and
valproate. Could his medications be a factor?
 Which ICD-9 codes would decrease your chances of
being denied payment for a Growth Hormone test?
Epocrates ID Tool
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ANTIBIOTICS GUIDE
ABX Guide
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 Look up by Bug, Drug or
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System
Antibiotics linked to Rx
section
Age and Gender specific
Emperic treatment before
culture
Specific treatment for
known pathogen
Exercises for Practice
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 Which antibiotics should be used for a neonate with
empyema, etiology unknown?
 The culture comes back with Haemophylius
influenzae in the same neonate. What antibiotic
should I use? Using the PDA, find the antibiotic,
calculate the dose for a 2.84 kg baby.
Epocrates MedMath
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MEDICAL CALCULATORS
MedMath
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 Small number of handy
calculators
 Many more in Epocrates
online
 Most in InfoRetriever
 Info gives you parameters
Exercises for Practice
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 Calculate your own Body Mass Index, Ideal Body
Weight, Basal Energy Expenditure, and Body Surface
Area.
 What is the predicted peak flow for a 60 year old
woman with asthma? She is 5’2”.
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Epocrates Tables
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ODDS AND ENDS
Tables
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 Text based content of
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value to clinicians
Online and PDA
Guidelines (HIV, HTN,
Vaccinations…)
Dosing equivalents
(ACE, insulins,
steroids…)
Algorithms (PALS,
ACLS…)
Exercises for Practice
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 Patient has planned a trip touring Mayan ruins in
the jungles of Belize. What immunizations does she
need?
 Patient walks in with an inhaler with no labels
attached. It is gray with a green cap. Which inhaled
steroid is this?
Epocrates Free Add-Ons
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MEDTOOLS
Manage Your Account
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 www.epocrates.com
 My Account
 Log in
 Free Add-ons
 Pick your tools, formularies
 Takes memory; puts in main
memory
 Includes free CME, international
drug name directory, clinical
decision calculators
Please Complete your
Evaluations
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CONTACT INFORMATION FOR HELP
Nancy Clark
[email protected] (850)644-9706
Kenneth Higgins
[email protected] (850)644-7473
CoM IT Help Desk
[email protected]
(850) 644-3664
FYI – What to Buy
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 Cell Phone/PDAs
 AT&T – Tilt (WM6, 128/256 memory, 802.11, BT)
 Sprint - Mogul
 Verizon – XV6800
 Pocket PC/Windows Mobile PDA
 HP iPAQ hx2795 PocketPC
 Palm PDA
 Palm T|X
 Most Important Features:
 Large screen, memory, speed
AT&T Tilt