Transcript Othman Ali Gubara. BPh, Msc. Sources of Drug Information

Drug Information Resources
PHCL 312
Objectives
Define the term drug information, use it in different contexts, and relate it
to the term medication information.
Describe the importance of drug information centers in the evolution of
pharmacy practice.
Identify the services provided by drug information centers.
Identify medication information functions performed by individual
pharmacists.
Describe the skills needed by pharmacists to perform medication
information functions.
Identify major factors that have influenced the ability of pharmacists to
provide medication information.
Describe practice opportunities for a medication information specialist
A quick history of drug
information services
•
1864 – 1876: John Shaw Billings, a Civil War surgeon, is put in charge of expanding
the Surgeon General’s library. In 1876 he declares that it can now be called the
National Library of Medicine (NLM).
•
1876-1879: Billings begins to catalog the contents of the library by overall medical
subject addressed. The term Medical Subject Headings (MeSH) is used to describe
the catalog headings. In 1879 the first Index Medicus, the NLM catalog of holdings, is
published. It continues to be updated monthly and a new edition circulated annually.
Information is catalogued by the overall subject addressed.
A quick history of drug
information services
•
1890s: Billings develops an idea for organizing US Census data by using a series of
punched cards. Herman Hollerith, a young engineer, helps him develop the punch
card system and a machine for sorting them. They apply this technology to the NLM
catalog to facilitate retrieval of medical information. In 1896 Hollerith creates a
company called the Tabulating Machine Company, so that businesses can purchase
and use the punch card technology. This company is eventually absorbed into a
corporation called International Business Machines.
A quick history of drug
information services
•
1900-1960: The number of available drugs and journal articles expands. It becomes
more difficult for physicians to keep abreast of the medical literature. After World War
II, a need is seen for information retrieval and not just cataloging. Development of
such a system begins in the 1950s and uses Boolean search terms AND, OR, and
NOT.
•
1962: The first drug information center opens at the University of Kentucky Medical
Center.
•
1960s: Pharmacist-staffed drug information centers open around the country.
Pharmacists are prohibited from giving patients any information about dispensed
medications in early part of decade.
A quick history of drug
information services
•
Around 1963, the practice act in Washington state is changed to permit pharmacists
•
to provide information about legend drugs. The Medical Literature Analysis and
Retrieval System (MEDLARS) is developed by the NLM; this system uses
computerized searches but information requests are submitted by telephone and
results mailed to the requester.
•
1971: the ability to transmit information over telephone lines is applied to MEDLARS;
the resulting database searching technology is called MEDLARS ON-LINE and soon
shortened to MEDLINE. Searches of journal articles published in 1966 and after
began to be done via computer/modem by a medical librarian trained to perform the
searches
•
1973: a formal survey counts 54 pharmacist-operated drug information centers in the
United States.
A quick history of drug
information services
•
1975: A report issued by an external review board strongly recommends that all
pharmacy students be trained to use drug information resources.
•
1980s and early ‘90s: The number of drug information centers peaks. In 1988, the
National Center for Biotechnology Information (NCBI) database of biotechnology is
created to facilitate information access for scientists working on the Human Genome
Project.
•
mid-‘90s: Formal drug information centers begin to close due to budget cuts.
Individual pharmacists take over the role of providing drug information. MEDLINE
available after 1992 on the Web through portals such as Grateful Med. but for a fee.
A quick history of drug
information services
•
1997: By congressional decree, Web access to MEDLINE information is made free
to the public. The NLM partners with NCBI to develop PubMed, a Web portal to
access biomedical information from many databases, not just MEDLINE. Web sites
with drug and disease information of varying quality are burgeoning.
•
2001: Publishers begin increasingly making available the electronic full-text version
of medical study reports.
•
2004: You are beginning your training as a pharmacist. You will be expected to know
how to access quality drug information resources and summarize and interpret for
patients and health care colleagues the information you find in those resources. This
class is the first in a series designed to help you learn these skills, which will allow
you to practice evidence-based medicine.
Evidence-based Medicine
(EBM)
•
from medical research in addition to the clinician’s/team’s experience and the
patient’s preferences. The best decisions will consider each component in this triad of
factors leading to decisions about a patient’s drug therapy.
•
Information from medical research means results from studies of drugs that identify
treatment effects. Treatment effects mean therapeutic outcomes, good and bad, and
side effects and drug interactions, good and bad. Information about treatment effects
can also come from an individual’s (clinician and patient) personal experience with
the use of that drug. Patient preferences will play an important role in the decisionmaking process.
•
You will use EBM both in your own therapeutic decision-making, but also in your
support of therapeutic decision-making by other individuals and policy-making
groups. In these situations, you yourself will act as a drug information resource when
they pose to you drug information questions
Answering Drug Information
Questions
•
These are the steps you should go through when you are asked a question:
•
Step 1: Identify the requester. This will help you get an idea of the depth and detail of
information the requester is probably expecting.
•
Step 2: Determine and categorize the “real” question. It is remarkably common for the
question you are asked to not be the requester’s “real” question. Determining the true
question involves answering the question with some questions.
•
Ask for background information. Examples:
•
“I want to make sure I answer (or understand) your question adequately, so tell me a
little more about what led you to ask me this question.”
•
“There are several different answers to that question. To make sure I give you the
right answer, I’d like you to describe in more detail what it is you wish to better
understand.” “Tell me how you want to use this information
.
Answering Drug Information
Questions
•
history of current question (is this a general question or specific to a person or
situation?) other disease states that might affect the answer to the question, including
potential disease states, i.e., signs or symptoms that have not been diagnosed
(pharmacokinetic, pharmacodynamic, adverse reaction masquerade)
•
other medications (Rx, OTC, herbal, illicit) that might affect the answer to the
question(drug interactions pertinent social or family history (financial, medical, or
belief issues) desired detail of response
•
Questions you receive will usually be in one of the following categories:
•
proper use of drugs: efficacy for specified disease state, dosing, compatibility, use
inpregnancy or lactation, monitoring parameters, drug identification,
pharmacokinetics,pharmacodynamics, storage conditions, stability
Answering Drug Information
Questions
•
adverse reactions: side effects, drug interactions, allergic reactions, toxicity,
poisoning,contraindications, warnings product queries: formulary status, cost,
availability
•
Once you think you know the real question, repeat it to the requester to confirm you
have identified the appropriate question
.
•
Step 3: Choose an appropriate resource (or resources) to consult.
•
Classification of drug information resources:
•
type of literature main benefit main problem
•
Tertiary literature provides an interpretation and summary of the primary literature by
someone other than the original authors of the primary literature
The pharmacist’s role in providing information on drugs and medicines is
not new. When drugs were few in number and generally of relatively low
potency the number of inquiries was small and could usually be answered
quickly by reference to pharmacopoeias and formularies. In recent years,
the number of drugs and medicines has increased enormously which are
usually more potent and more selective and also the literature relating to
drugs has expanded at a staggering rate. The literature covers a wealth of
information on these newer drugs, their actions, clinical uses, unwanted
effects, interactions with other drugs, comparative efficacy, etc. A quick
reference to pharmacopoeia and formularies is no longer sufficient, in
many cases, to provide an adequate answer.
.
The term drug information developed in the early 1960s when used in conjunction
with the words center and specialist. In 1962, the first drug information center was
opened at the University of Kentucky Medical Center. An area separated from the
pharmacy was dedicated to provide drug information. The center was to be "a
source of selected, comprehensive drug information for staff physicians and dentists
to evaluate and compare drugs" as well as to provide for the drug information needs
of nurses. The center was expected to take an active role in the education of health
professional students including medicine, dentistry, nursing, and pharmacy. A
stated goal was to influence pharmacy students in developing their role as drug
consultants.
Several other drug information centers were established shortly thereafter. Different
approaches to providing drug information services included decentralizing
pharmacists in the hospital, offering a clinical consultation service, and providing
services for a geographic area through a regional center. The first formal survey,
conducted in 1973, identified 54 pharmacist operated centers in the United States.
Drug Information
Availability of authentic drug information is the key to promote rational use of drugs, a wellaccepted concept in clinical practice in the developed world. The concept is fast catching up in
several developing countries because of the sharp rise in the medical costs and increasing
instances of medication errors. An important reason for the rising costs of medical costs in
developed countries is the marketing exclusivity enjoyed by pharmaceutical companies for their
latest life threatening drugs. And the drugs continue to be the major part of the total healthcare
costs. With high prices of patented drugs and the strong influence of pharmaceutical companies
on medical practitioners, the healthcare costs can only rise in future. Both pharmaceutical
companies and the medical practitioners contribute to creating a situation like this. For
pharmaceutical companies, pushing up their sales is the sole aim whereas a large majority of the
physicians can be easily coaxed into indulges in irrational prescription to serve the interests of
these companies.
The absence of insurance cover for a large number of poor people both in the undeveloped and
developing world also adds to overall healthcare costs. Medication errors by the physicians
is another serious problem confronting the patient community today as knowledge level about
new drugs and adverse drug reactions (ADR) is extremely poor amongst physicians.
Thus, several hundreds of cases of complications and deaths are being reported every year in
various parts of the world on account of medication errors. One way to control medical costs and
medication errors is to promote the concept of rational use of drugs by providing authentic drug
information to doctors, pharmacists, nurses, researchers, other professionals in health care,
committees and patients
Drug information is an essential element in achieving health goals and should, therefore, form a part
of any national drug policy. Information is an aid to decision making.
As mentioned before the first information center to be set up was at the University of Kentucky
Medical Center, USA, its objectives were to collect information, to evaluate and compare drugs, to
provide an education and teaching aid for health care personnel, to assist clinicians in the selection
of safe and effective medication and to enable pharmacists and pharmacy students to develop their
abilities in providing information on drugs and medicines.
Large hospitals have developed and staffed a new division of the department of pharmacy which is
commonly referred to as ‘Drug Information Center”.
This new concept in hospital pharmacy operation is usually located in a separate section of
pharmacy, containing large number of reference texts, journals, reprints and brochures. They are
also equipped with electronic data processing equipments and have a full time director and
adequate secretarial assistance. Now computers have possible networking of regional drug
information centers made located in different hospitals. Networking on regional, national, sub
continentals, intercontinental levels had placed Drug Information Services at a global level.
The description of pharmacy practice was expanded from that of pharmacy as a “knowledge
system” to “a system (framework) of concepts dealing with the acquisition, translation,
transmission, and utilization of drug knowledge”. As a specific component of pharmacy, the
drug information role is characterized by the ability of the pharmacist to perceive, assess, and
evaluate drug information needs and retrieve, evaluate, communicate, and apply data from the
published literature and other sources as an integral component of pharmaceutical care
[Troutman]. The ability to fulfill the drug information role is essential to successful pharmacy
practice.
Drug information is both a body of data and information about medications and a set of skills
and tools that provide pharmacy professionals with the ability to find, access, understand,
interpret, apply and communicate information and acquire knowledge. The body of facts and
information pertaining to medications is generally referred to as “the drug literature”. The
literature of pharmacy and pharmaceutics encompasses all aspects of drugs, beginning with
isolation or synthesis, including physical analysis, bioactivity, toxicology, clinical research,
market research, and economic and social considerations. The drug literature, reflecting all
the individuals who create it and use it, such as chemists, biomedical scientists, all the various
health care professionals, attorneys, and patients, is vast and complex. Different kinds of
publications are available in the library like journals, abstracting and indexing publications,
books, compendia, monographs, patents proceedings, reviews, FDA-approved labeling
(package inserts), house organs, newsletters, promotional literature, government documents,
and analysis by consulting services.
Drug information skills coupled with the processes and technology offered by informatics are
part of the solution to mastering information overload and maintaining the knowledge system
that improves patient care outcomes
Information Needs
The growth in the role played by science in medicine as reflected in the amount of published
work, the number of journals and the vast range of drug products in the market, has meant
that practioners of medicine and pharmacy, in common with other scientific disciplines, have
experienced difficulty in keeping up with advances in knowledge. The doctor’s response,
increasingly, has been to turn to the pharmacist for help. Most problems presented by the
doctor are concerned with a particular patient, his disease-state and therapy. The information
requested is usually required within few hours, so that treatment may be changed or started
and is needed in the form of data, rather than lists of references or paper reprints. Production
of an answer therefore involves selection, interpretation and evaluation of information. The
type of information requested may include any of the chemical or biological properties of a
compound or a comparison of the suitability of several compounds for a specific case, where
for instance, renal or hepatic disease may complicate choice.
The pharmacist too, may require immediate information on drugs. This may concern
straightforward matters such as dosage or availability but also involve formulation or
availability data which may not be found in the manufacturer’s literature. Quality controllers
may require an alternative assay or stability data. Nurses need to know the effects and
dangers of drug therapy so as to be able to assess the appearance of adverse effects, they must
also know enough about preparations to teach patients to use them. Researchers need to
retrieve a particular report, or search the literature. Committees need information to help them
decide policies, produce 4 hospital formularies and award contracts. Patients need to know
how to take the medicines they are given, what they will feel if the drug works, likely adverse
effects and what to do about them. Measuring and accurately identifying the nature of the
need is, however, not easy.
Drug Literature
The concept of drug information service or drug information center is an attempt to document
drugs by abstracting information about them. The information about drugs is collected from
various sources which are available. In 1972 Walton and colleages modeled the drug
literature as a pyramid with the primary literature forming the base of the pyramid, the
secondary literature interfacing and serving as a bridge from the primary literature to
reference works (tertiary literature).
1. Primary Literature
Primary literature contains the first written accounts of original research. In terms of size, the
primary literature is probably larger than either the secondary or tertiary literature. It is the
original information presented by the author without any evaluation by the second party, for
example, articles published in journals, dissertations, conferences, etc.
(i) Prepublication literature: The first communication of research data and ideas may or may
not be private. If there is a financial or proprietary interest in the research, the first
communication may be in the form of a patent application. Prior to formal publication of the
research, the work may be presented as a paper or poster at a professional meeting or
conference.
(ii) Journal or serial literature: The current evolution or transition of the journal from a paperonly publication to a paper-and-electronic publication is a second, relatively recent, major
change in the journal literature. In the electronic format, the lag time between the submission
of a written research report and its publications can be shortened considerably. Electronic
preprint, either from the author or from the journal publisher, places as article before the
reader several months ahead of paper publication release, albeit without benefit of traditional
full peer review
(1) Preclinical Drug information
At this point a compound is recognized and then considered for potential pharmaceutical or
therapeutic usefulness; researchers will be both consumers of and contributors to the datainformation-knowledge cycle that characterizes science. Initially, in the synthesis and
purification phase of drug development, information about the compound’s chemistry and
physical properties may be both sought and created. Whether or not the compound has been
of interest to other researchers may be determined by searching public records of grant and
contract awards and also by searching resources that cover preliminary and early research
results. The patent status of the compound may need to be established.
(a)Physical and chemical data:
i) AIDSDRUGS: Published by the US National Library of Medicine, AIDSDRUG is a
dictionary of chemical and biological agents currently being evaluated in the AIDS
clinical trials covered in the companion AIDSTRIALS database.
ii) Beilstein: Beilstein, a structure and factual database covering organic chemistry.
iii) CAS Registry: CAS Registry, is a substance database containing structures and chemical
names.
iv) Chemcyclopedia: It is an annual supplement to Chemical and Engineering News (C&EN),
provides a listing of chemicals, trade names, packaging, special shipping requirements,
potential applications and CAS Registry Numbers.
v) ChemFinder: ChemFinder WebServer is a WWW search engine that works from a
single master list of chemical compounds covering all areas of chemistry and also
provide information on physical property and two-dimensional chemical structures.
vi) Chemical Abstracts: Chemical Abstracts is a collection of chemical information with
nearly 16 million abstracts of journal articles, patents, and other documents.
vii) ChemIDplus: Published by the US National Library of Medicine, it’s a web based
search engine, http://chem.sis.nlm.nih.gov/chemidplus/, that provides free access to
structure and nomenclature authority files used for identification of chemical
substances cited in National Library of Medicine databases.
viii) Chemindex plus: Database contains 8000 pharmaceutical ingredients linked to
300,000 preparations.
ix) Ei CompendexWeb: It’s a comprehensive bibliographic database of engineering research
literature containing references to over 5000 engineering journals and conferences.
x) The Merck Index: The Merck Index is an encyclopedia of chemicals, drugs, and
biological that contains more than 10,000 monographs.
xi) NIST Chemistry WebBook: The National Institute of Standards and Technology (NIST)
Chemistry WebBook provides free access to chemical and physical property data for
chemical species via the internet, http://webbook.nist.gov/chemistry/.
xii) RTECS: The Registry of Toxic Effects of Chemical Substances (RTECS) is a database of
toxicological information compiled, maintained, and updated by the National Institute for
Occupational Safety and Health (NIOSH).
xiii) The USP Dictionary of USAN (U.S. Adopted Names) and International Drug Names:
The USP Dictionary provides comprehensive information on chemical and brand names of
drugs. It includes USAN and International Nonproprietary Names (INN). It also lists drug
manufacturers, therapeutic uses, and molecular and graphic formulas.
(b) Patents:
Through the granting of a patent the U. S. Patent and Trademark Office (PTO) provides
intellectual property protection to the inventor for 20 years. U. S. Patent and Trademark
Office Web Patent Databases offer free WWW access,
http://www.uspto.gov/main/patents.htm, to a bibliographic patent database that uses the most
current patent classification system.
The Delphion Intellectual Property Network (IPN) is a research tool for patent information.
Derwent World Patents Index (DWPI) is a comprehensive database of patent documents
published worldwide. IMSworld Drug Patents International database provides access to the
patent status of over 1200 molecules. The database contains information on patents due to
expire (over a given time period), patents by therapy class, and patents by country.
(2) Phase IV Studies and Post Marketing Drug Information
During the Phase IV Studies and Post Marketing Drug Information stages a thorough
literature search is required to find material relevant to the clinical use of the drug. This will
require not only searching the basic bibliographic databases such as Biological Abstracts,
EMBASE, IDIS, IPA, MEDLINE, and Science Citation Index, but also searching the patent
literature, using Patent and Trademark Office Web Patent Databases. The following
bibliographic databases provide access to the full span of life-science periodical literature,
including all stages of a compound’s development from early brief reports to comprehensive
assessments after years of clinical use.
(i)BIOSIS: BIOSIS processes approximately 5,50,000 items each year, from primary research
and review journals, books, monographs and conference proceedings. It is available in several
formats. These include Biological Abstracts/RRM (Reports, Reviews, Meetings), the
companion reference to Biological Abstracts
2. Secondary Literature
In this original information is modified, condensed, commented upon by other persons like
review articles, abstracts, text books, etc.
(i) Indexing and Abstracting services: The National Library of Medicine’s service, Index
Medicus, was first published in 1879 . Given its size and free availability, it is probably the
most used index/abstract service worldwide. Other secondary databases that complement one
another’s coverage in the chemical, pharmaceutical, and medical areas include Chemical
Abstracts, Biological Abstracts, EMBASE, IDIS, IPA, MEDLINE, and Science Citation
Index. Each of these bibliographic databases was originally available to the user in a nonelectronic format, such as paper or microform. In the mid-1960s the services began appearing
in digitized, computer-searchable format from online reference retrieval vendors such as
Lockheed information Systems’ DIALOG, System Development Corporation’s ORBIT, and
Bibliographic Retrieval Services (BRS). CD-ROM technology in the 1980s allowed users to
search the index/abstract databases in-house via personal computers. Internet access to these 5
same bibliographic databases is now enhancing the search-and retrieval process by providing
linkage to full text articles.
(ii) Evaluated Secondary Resources: Choosing or limiting the search retrieval to meta-analysis,
guidelines, or systematic reviews will also identify citations with the strongest research
methods and design. The goal of guidelines and systematic reviews is to identify relevant
research and in addition to classifying the research by strength, also combine the research
results statistically to provide a new, global research result. Currently available evaluated
bibliographic databases (like ACP Journal Club, Best Evidence, Cochrane Library, EvidenceBased Medicine) depend upon human experts to identify the best citations
.
(iii) Internet search engines: Search engines available on the internet function like the traditional
index/abstract services discussed above, in that they search and retrieve information to answer
questions. They provide access to a staggeringly large number of electronic documents
available on the World Wide Web (WWW). Traditional index/abstract
database services (DIALOG, MEDLINE, IDIS) search with Boolean
logic. Boolean searching matches the terms in the user’s search statement
with terms appearing in the database. The search is precise, but it is dependent upon the searcher
choosing the correct search term to use in
the search statement. WWW search engines have made extensive use of
probabilistic/statistical search methodologies and natural language processing systems.
Probabilistic/statistical methods use the frequency with which the search term(s) appear in
the documents and the comparative frequency with which the search term(s) appear in the
documents compared to the rest of the database to establish relevance of
the document to the search statement .
Contrasted to traditional index/abstract database searching WWW searching requires less training
and retrieves a broader selection of search results. While many of the documents found on the
WWW are free, some search engines direct the user to fee-based resources. WWW search
engines are generally free to user. The documents indexed by the major search engines are
primarily those available in hypertext markup language (HTML) or plain text format.
Documents and files available in other formats, such as Flash, Word, WordPerfect, and
Adobe’s Portable Document Format (pdf), are generally not indexed.
Specialized search engines concentrate their indexing activity on a specific subject. In addition to
user submissions and automated robot indexing, content specialists may verify, enhance, and
add sites to the specialty database. Specialized search engines are available in the areas of
health, medicine, and the sciences and can be found by scanning pointer sites that index the
specialized indexes, such as Search Engine Guide, www.searchenginewatch.com/.
3. Tertiary Literature
In this information is gathered from primary and secondary sources and arranged in such a
manner to give coupled information. The tertiary literature is a distillation and evaluation of
data and information first presented in such primary literature sources as research reports,
meeting presentations, and journal articles. Being furthest removed from the primary report,
the tertiary literature characteristically is the least current and the most vulnerable to
misinterpretations, biases, and inaccuracies. But just as characteristic, the tertiary is the most
accessible, easiest to use, and perhaps the most used of all information resources. Information
searches generally start with a perusal of books, reviews, and handbooks. Review articles 6
even though they appear in the “primary’ journal literature, belong to the tertiary literature as
they present a summarized, organized, and sometimes even an evaluated picture of original
research data.
4. Aggregated and linked references:
The computer and subsequent evolution of library resources to an electronic format has
spawned a new generation of drug information resources, i.e. aggregated and linked
resources. Practioners and researchers have always needed access to multiple references,
regardless of their professional practice site. Digital media allows the aggregation of drug
information references that complement one another into single product. The ability of search
each reference using the same software and the ability to search all the references (cross
search) with a single search statement adds value to the aggregate. Electronic linkages
between resources have immeasurably increased the functionality of information resources.
The text books is being linked to full text of their references, research article text is linking to
the original data of the study; index/abstract databases are linking to the full text articles they
index.
(a) MICROMEDEX Systems: MICROMEDEX integrates over 25 texts, monographs, and
product databases in the fields of health care, toxicology, and regulatory information.
MICROMEDEX and other publishers produce the resources. This system is commercially
available in a variety of combinations and formats.
(b) Stat!Ref: Stat!Ref combines more than 30 medical and drug information textbooks from
several publishers and allows both individual and cross searching. The texts are commercially
available in a variety of electronic combinations.
The compiled information is available for reference purpose and it helps in answering specific
queries regarding both old and new drugs from doctors and patients. The information can also
be compiled to meet the needs of the deliberations or the training programmes arranged or
research projects undertaken. The compiled information also contribute especially in its
clinical role.
Information Retrieval Systems
As a drug moves along the path from discovery to the market and into worldwide use, data
and information about the agent are created and accumulate. When this information is
published, its value and usefulness to scientific, professional, and patient communities
becomes known. Publication of research results at each step of the path is essential. There is
tendency particularly in clinical research, not to publish “negative” results. When this
happens we are left with only research that is favorable to the drug, resulting in a skewed
picture of the drug’s place in therapy. The path of drug development and marketing offers a
structure that is useful to scientists and practioners concerned with compounds of potential
therapeutic value. The resources themselves are classified as primary (original research),
secondary (indexing and abstracting services), and tertiary (textbooks and evaluated
information). Individual resources are now generally available in more than one physical
format; for example, a journal may be available as a paper publication or as an electronic
publication (either individually or as part of a publisher’s electronic journal collection or
content collection). Primary, secondary, and tertiary resources are available for each step in
the path of drug development, but reporting time increases from each step to the next.
(ii)EMBASE: EMBASE, the Excerpta Medica database is a biomedical and pharmacological
bibliographical database that provides access to medical and drug related subjects from over
4000 biomedical journals from 70 countries. The EMBASE database combined with unique
MDLINE records back to 1966 are available in EMBASE.com.
(iii)International Pharmaceutical Abstracts: IPA published semimonthly, is an
abstracting/indexing publication which covers all pharmaceutical literature.
(iv)MEDLINE: MEDLINE (Medical Literature Analysis, and Retrieval System Online)
contains over 11 million references to journal articles in life sciences with a concentration on
biomedicine from 1966 to the present. MEDLINE is available on internet through the
National Library of Medicine (NLM) home page at http://www.nlm.nih.gov and can be
searched free of charge.
(v)Pubmed Central: Pub med Central (PMC) which encompasses Medline is a web-based
archive of journal literature for all of the life sciences. Access to PMC is free and unlimited.
(vi)Science Citation Index: Science Citation Index (SCI) provides access to current and
retrospective bibliographical information, author abstracts, and cited references found in
various scholarly science and technical journals covering mare than 150 disciplines
Disease Treatment
Treatment of disease in the affected individual is twofold in nature, being directed (1) toward
restoration of a normal physiological state and (2) toward removal of the causative agent. The
diseased organism itself plays an active part in both respects, having the capacity for tissue
proliferation to replace damaged tissue and to surround and wall off the noxious agent, as
well as defense and detoxification mechanisms that remove the causative agent and its
products or render them harmless. Therapy of disease supplements and reinforces these
natural defense mechanisms. Metabolic faults also may sometimes be corrected—for
example, by the use of insulin in the treatment and control of diabetes—but more often
specific therapeutic measures for idiopathic diseases are lacking. However, advances in gene
therapy may be able to correct defective genes that result in disease.
When disease is produced by environmental factors, there is commonly no specific treatment;
only removal of the affected individual from exposure to the agent generally allows normal
detoxification responses to take over. Again, there are notable exceptions, as in the treatment
of lead poisoning with ethylenediaminetetraacetic acid, an agent that forms complexes with
lead that are excreted by the kidney.
Treatment of infectious diseases is more effective in general; it assumes several different
forms. Treatment of diphtheria with antitoxin, for example, neutralizes the toxin formed by
the microorganisms, and host defense mechanisms then rid the body of the causative
microorganisms. In other diseases, treatment is symptomatic in the sense of restoring normal
body function. An outstanding example of this is in cholera, in which disease symptoms
result from a massive loss of fluid and salts and from a metabolic acidosis; the highly
effective treatment consists of restoring water and salts, the latter including bicarbonates or
lactates to combat acidosis. More often, however, therapy is directed against the infecting
microorganism by administration of drugs such as sulfonamides or antibiotics. While some of
these substances kill the microorganisms, others do not and instead inhibit proliferation of the
microorganism and give host defenses an opportunity to function effectively. For other
infectious diseases there is no specific therapy. There are, for example, very few antiviral
chemotherapeutic agents; treatment of viral diseases is mainly directed toward relief of
discomfort and pain, and recovery, if it ensues, is largely a matter of an effective cellular
immune response mounted against the invading virus by the host.
Modified Systemic Approach to answering
Drug Information questions
The modified systemic approach to answering
drug information questions consists of the
following steps:
1- Secure demographic data of the 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.
Procedure and Documentation
A standard procedure for enquiry processing should be
developed.
1- Identification of the enquirer
The pharmacist receiving the query is to obtain the
caller’s name, address, phone number and profession.
2- Obtain the necessary background information.
If the request is patient specific, obtain the patient's:
i. name, age, weight and sex.
ii. medical history (including allergies).
iii. Major organ function (cardiac, liver, kidney).
iv. Drug history (name, dose, regimen, duration
and indication).
3- Establish whether the caller has consulted any
references.
4- Assign priority to the request according to
the urgency of the problem or query.
Cases may be clinically urgent and the physician may
have a patient waiting. To enhance the credibility of
the unit, it is essential that the caller be provided with
some sort of time frame within which they can expect
an answer. It is important to maintain contact with the
caller and follow up if agreed upon deadline cannot be
met.
5- Clarify the request if not clear. If it is clear go ahead
6- Classification of the request. Notice that there may be
more than one classification.
7- Systemic search
Search the available reference. Evaluate and interpret
the information that has been sourced.
8- Formulation the appropriate response:
All statements made should be traceable to the
literature. Statements where you think the
answer is correct (but are not sure) are
dangerous and must not be made. Always
check with at least two reference sources. Only
the information that is pertinent to the request.
9- Communication of the response
This must be clearly and concisely given. It must be
established that the caller fully understands the
answer.
a- Oral response
Most suited to conveying response to a simply
uncomplicated query. Can assess whether a written
response is required following the verbal reply.
b- Written response
May be more appropriate for a more complex enquiry.
The following format may be used as a guideline.
i- Request and background information.
ii- Response: in some cases a brief introductory
paragraph is necessary clarification of the
terminology and issues at hand. Summarize
what the literature says about the problem,
pointing out inadequacies or deficiencies
In the references. Be concise, unbiased and above all
accurate.
iii- Conclusion.
Summarize the information together with
the appropriate conclusion.
iv- References
The query should be appropriately
referenced.
10- Follow-up
This should be done by phone, in person or
by mail to ascertain whether the
information provided was appropriate.
11- Documentation
All query information should documented on a Query
form on the computer for legal purposes and for
future enquiries
Introduction
•
consists of research studies published in biomedical journal
•
the most current resource for information.
•
provides details research methodology and scientific results that lead to therapeutic
conclusions.
•
to determine whether the study are sound based on the strength of the research
techniques and scientific results of the study.
Primary Resource
47
Introduction
•
The primary literature is growing at an exponential rate.
•
Over 20,000 biomedical journals are published annually.
•
An abbreviated list of journals useful to the practice pharmacy is provided below.
Primary Resource
48
Introduction
•
Most of these journals publish a combination of primary research studies and
secondary review articles.
•
The journals available in a particular practice setting will depend on the focus of the
practice and the interests of the practitioner .
Primary Resource
49
Journal Contents
•
•
•
•
•
•
•
•
•
•
Clinical Trials
Editorials
Letter to the editor
Meta-Analysis (systemic
review)
Practice Guideline(s)
Randomized Controlled Trials
Review articles
Comments
Comparative Studies
News
•
•
•
•
•
•
Addresses
Bibliography
Case Reports
Clinical Trial, Phase I, II, III&IV
Controlled Clinical Trial
Corrected and Republished
Article
• Evaluation Studies
• Government Publications
Primary Resource
50
The Basic Structure of an article
 Abstract/ Summary


Overview or summary of the work highlighting of results
General statement of significance
 Introduction




Background information: history, pathophysiology ,clinical presentation
Review of the work of others
Rationale for present study
aim of the study
 Methods/materials & methods/patients & methods




Study design
Subject selection procedures
Methods of measurement
Description of analytic techniques
 Results


What happened ?
Graphics-tables , charts, figures –that summarize findings
Primary Resource
51
The Basic Structure of an article
 Discussion/comment/conclusion
– Meanings, significance of work
– critique of study: discussion of limitations as will as
strengths, further analysis
– Comparison with work if others
– Disclaimers, equivocation apologies, chest thumping,
speculation, instruction, fantasy, and so on
 References/bibliography
– Evidence that work of others has been considered
– Leads to further exploration of the subject
Primary Resource
52
Definition
Randomization:
– It is an and important aspect of study design
– It is equivalent to flipping a coin and helps ensure that
treatment group are similar in regard to clinical and
socioeconomic factors that may affect treatment
outcome
– Diminish bias
Primary Resource
53
Types of Blinding
Single-blind
Either subjects or investigators are
unaware of assignment of subjects to
active or control groups.
Double-blind
Both subjects and investigators are
unaware of assignment of subjects to
active or control groups.
Primary Resource
54
Meta-Analysis (systemic review)
–
A statistical technique used to combine the results from different studies to obtain
a quantitative estimate of the overall effect of a particular intervention or
exposure on a defined outcome.
Primary Resource
55
Definition
 Editorial
– an article in a newspaper or other periodical presenting the opinion of the
publisher, editor, or editors.
Primary Resource
56
Definition
 Bibliography
 It is a list of resources about a particular topic.
 Bibliographies are often found at the ends of scholarly books and journal articles.
 An entire book can be a bibliography, too.
Primary Resource
57
Definition
 Guideline
– A statement or other indication of policy or procedure by which to determine a
course of action: guidelines for the completion of tax returns
– Guidance relative to setting standards or determining a course of action
Primary Resource
58
Definition
 Letter to the Editor
 It is statement that represent new results, likely to stimulate further research and
be of interest to the wider range of knowledge all the results should be
sufficiently new and important to merit rapid publication as a Letter, which implies
accelerated refereeing procedures.
 This should be made clear either in the body of the Letter, if appropriate, or with
a supporting cover letter from the author on submission to the journal.
Primary Resource
59
Alternative Medicine Alert
• American Health Consultants, Atlanta, GA.
• A newsletter dealing with alternative
medicines.
• Published monthly.
Primary Resource
61
American Druggist
American Druggist
•
• The Hearst Cooperation , New York
• A pharmacy magazine with a community
pharmacy focus that provides information
on issues relevant to this practice setting.
• Rarely are primary research articles
published in this journal.
• Published monthly.
Primary Resource
62
American Journal of Cardiology
• Exceri-pta Medica, Inc., Riverton, NJ.
• A journal dedicated to the specialty of
cardiology.
• Published weekly.
<<http://www.cardiosource.com>>
Primary Resource
63
American Journal of HealthSystem Pharmacy
• American Society of Health-System
Pharmacists, Bethesda, MD.
• A journal focused on clinict1 and
managerial aspects of pharmacy practice
in health systems.
• Published twice monthly.
<<http://www.ashp.org>>
Primary Resource
64
American Journal of
Pharmaceutical Education
• American Association of Colleges of
Pharmacy, Alexandria, VA.
• The official publication of the American
Association of Colleges of Pharmacy that
is dedicated to the documentation and
advancement of pharmaceutical
education.
• Published quarterly.
Primary Resource
65
American Journal of
Therapeutics
• Lippincott Williams & Wilkins, Philadelphia.
• A journal that provides clinical and
pharmacoeconomic perspectives on
pharmacotherapeutic advances.
Primary Resource
66
American’s Pharmacist
• National Community Pharmacists
Association, Alexandria, VA.
• The official journal of the National
Community Pharmacists Association
• Published monthly.
Primary Resource
67
Annals of Internal Medicine
• American College of Physicians,
Philadelphia.
• A highly regarded medical journal of the
American College of Physicians that
focuses on internal medicine, including
pharmacotherapeutic
• management of disease states.
• Published twice monthly
http://www.acponline.org/journals/annaltoc.htm?wni
Primary Resource
68
The Annals of Pharmacotherapy
• Harvey Whitney Books Company,
Cincinnati, OH.
• A well-respected journal pertaining to safe,
effective, and economical use of
pharmacotherapeutic agents.
• Published monthly.
Primary Resource
69
Archives of Internal Medicine
• American Medical Association, Chicago.
• A journal specializing in the practice of
internal medicine, including diagnosis and
treatment of diseases.
• Published monthly.
<<http://www.ama-assn.org/>>
Primary Resource
70
BioDrugs
• Adis International, Ltd., Auckland, New
Zealand.
• A journal that publishes review articles on
clinical immunotherapeutics,
biopharmaceutjcals, and gene therapy
• Published monthly.
Primary Resource
71
Cancer
• An Interdisciplinary International Journal of
the American Cancer Society. John Wiley
& Sons, Inc., New York
• A journal that publishes research and
information from all disciplines of oncology
and supports the mission of the American
Cancer Society.
• Published 30 times a year.
<<http://www.cancer.org>>
Primary Resource
72
Chest. The Cardiopulmonary and
Critical Care Journal
• The American College of Chest
Physicians, Northbrook, IL.
• The official publication of The American
College of Chest Physicians that focuses
on pulmonology, cardiology, critical care,
and other related areas.
• Published monthly.
Primary Resource
73
Clinical Drug Investigation
• Adis International, Ltd., Auckland, New
Zealand.
• A journal that publishes primary literature
related to pharmacoeconomic and
outcomes research.
• Published monthly.
Primary Resource
74
Clinical Infectious Diseases
• The University of Chicago Press, Chicago.
• The official publication of the Infectious
Diseases Society of America
• Published monthly.
Primary Resource
75
Clinical Pharmacokinetics
•
•
Adjs International, Ltd., Auckland, New Zealand.
A journal that provides review articles relating to the following areas of
clinical pharmacokinetics:
–
–
–
–
–
–
–
pharmacokinetic—pharmacodynamic relationships,
pharmacokinetic properties of drugs
therapeutic drug monitoring
the effect of age and disease states on pharmacokinetics,
pharmacokinetic optimization of drug therapy,
pharmacokinetic principles of drug interactions, bio availability
regulatory aspects of pharmacokinetics.
Primary Resource
76
Clinical Pharmacokinetics
• Published monthly.
• Internet access available for a fee.
Primary Resource
77
Clinical Pharmacology and
Therapeutics
• Mosby, St. Louis, MO.
• The official publication of the American
Society for Clinical Pharmacology and
Therapeutics and the American Society for
Pharmacology and Experimental
Therapeutics that publishes articles
describing actions of drugs on the human
body.
• published monthly.
Primary Resource
78
Clinical Therapeutics
• Elsevier Science, New York.
• An international journal of drug therapy
including review articles, new drug
therapy, clinical studies, and
pharmaceutical economics and health
policy.
• Published six times per year.
Primary Resource
79
CNS Drugs
• Adis International, Ltd., Auckland, New
Zealand.
• A journal that publishes review articles on
pharmacotherapeutic aspects in the
management of psychiatric and
neurological disease.
• Published monthly.
Primary Resource
80
Community Pharmacist
• E.L.F. Publications, Inc. Lakewood, CO.
• A journal published to meet the
professional and educational needs of
today’s practitioner.
• Published bimonthly.
• Internet access available for a fee.
Primary Resource
81
The Consultant Pharmacist
• American Society of Consultant
Pharmacists (ASCP), Alexandria, VA.
• The official journal of the ASCP devoted
to pharmacists who provide consultative
services in various environments,
including nursing home facilities.
• Published monthly.
<<http://www.ascp.com>>
Primary Resource
82
Critical Care Medicine
• LippincOtt Williams & Wilkins,
Philadelphia.
• The official journal of the Society of Critical
Care Medicine.
• Published monthly.
Primary Resource
83
Current Therapeutic Research
• Elsevier Science, New York.
• This journal provides rapid publication of
original reports of recent developments in
drug therapy.
• Published monthly.
Primary Resource
84
Disease Management & Health
Outcomes
• Adis International, Ltd., Auckland, New
Zealand.
• A journal that publishes review articles on
optimizing clinical outcomes and their
economic consequences.
• Published monthly.
• Internet access available for a fee.
Primary Resource
85
Drug Information Journal
• Drug Information Association, Inc., Fort
Washington, PA.
• The official publication of the Drug
Information Association that focuses on
technology related to information
dissemination and data processing.
• The journal promotes cooperation
between academia, pharmaceutical
industry, and government.
• Published quarterly.
Primary Resource
<<http://www.diahome.org>>
86
Drugs
• Adis International, Ltd., Auckland, New
Zealand.
• A journal that publishes review articles on
pharmacotherapeutic aspects of both new
and established drugs.
• Published monthly.
• Internet access available for a fee.
Primary Resource
87
Drugs and Aging
• Adis International, Ltd., Auckland, New
Zealand.
• A journal that publishes review articles on
pharmacotherapeutic aspects as it relates
to the elderly.
• Published monthly.
• Internet access available for a fee.
Primary Resource
88
Drugs in R & D
• Adis International, Ltd., Auckland, New
Zealand.
• A journal that publishes review articles on
the therapeutic potential and impact of
pharmaceutical compounds in
development.
• Published monthly.
• Internet access available for a fee.
Primary Resource
89
Drug Safety
• Adis International, Ltd., Auckland, New
Zealand.
• A journal that provides review articles
related to epidemiology, diagnosis,
management, and prevention of acute
poisonings and adverse drug reactions.
• Published monthly.
• Internet access available for a fee.
Primary Resource
90
Drug Topics
• Medical Economics, Co., Montvale, NJ.
• A pharmacy news magazine with a
community pharmacy focus useful for
keeping up on new drug therapies and
issues relevant to community pharmacy
practice.
• Rarely are primary research articles
published in this journal.
• Published twice a month.
<<http://www.drugtopics.com>>
Primary Resource
91
FDA Medical Bulletin
• Department of Health, Education and
Welfare, Public Health Service, Food and
Drug Administration, Rockville, MD.
• A publication of the Food and Drug
Administration (FDA) that provides
information on the safe and effective use
of drugs and summarizes FDA rulings
concerning drug products.
• Published irregularly.
<<http://www.fda.gov>>
Primary Resource
92
F-D-C Reports (“The Pink
Sheet”)
• F-D-C Reports, Inc., Chevy Chase, MD.
• A newsletter aimed at executives in the
pharmaceutical industry that provides
information pertinent to the pharmaceutical
industry such as FDA rulings, new drug
approvals, drug withdrawals, ongoing
clinical trials and financial information.
• Published weekly.
<<http://www.fdc reports.com>>
Primary Resource
93
F-D-C Reports (“The Tan
Sheet”)
• F-D-C Reports, Inc., Chevy Chase, MD.
• A newsletter aimed at executives in the
pharmaceutical industry that provides
information pertinent to the over-thecounter and herbal products.
• Published weekly.
<<http://www.fdcreports.com>>
Primary Resource
94
Food and Drug Law Journal
• The Food and Drug Law Institute,
Washington D.C.
• A journal dedicated to legislative,
regulatory, legal, and public policy issues
regarding the use of foods, drugs,
biologics, cosmetics, and medical devices.
• Published quarterly.
Primary Resource
95
Formulary
• (Formerly known as Hospital Formulary).
Advanstar Communications, Inc.,
Cleveland, OH.
• A journal directed at hospital and
managed care decision makers that
focuses on current issues in
pharmacotherapy and drug policy
management.
• Published monthly.
Primary Resource
96
HerbalGram
• American Botanical Council, Austin, TX.
• The official journal of the American
Botanical Council and the Herb Research
Foundation, which is published quarterly.
• The mission is to educate the public on the
use of herbs and phytomedicines.
<<http://www.healthy.net/hwlibraryjournals/HerbalGram/index.html>>.
Primary Resource
97
The Herb and Dietary
Supplement Report
• Interpretive Medicine Communications,
Newton, MA.
• A newsletter that provides news and
commentary on herbs and supplements.
• Published monthly.
Primary Resource
98
Hospital Pharmacy
• Facts and Comparisons, St. Louis, MO.
• A journal devoted to the practice of
pharmacy in institutional settings.
• Published monthly.
Primary Resource
99
International Journal of
Pharmaceutical Compounding
• IFPC, Edmond, OK.
• The official journal of the International
Federation of Pharmaceutical
Compounding.
• Published bimonthly.
Primary Resource
100
JAMA.
• The Journal of the American Medical
Association American Medical
Association, Chicago.
• One of the premier medical journals that
publishes investigations and review
information of key importance to health
care.
• Published weekly.
<<http://jama.ama-assn.org>>
Primary Resource
101
Journal of the American Medical
Informatics Association (JAMIA)
• Hanley & Belfus, Inc., Philadelphia.
• The official publication of the American
Medical Informatics Association that
covers electronic management of medical
information.
• Published every 2 months.
<<http://www.amiaorg/ pubs/jamia/default.html>>
Primary Resource
102
Journal of the American
Pharmaceutical Association
• (Formerly known as American Pharmacy).
American Pharmaceutical Association,
Washington, DC, The official journal of the
American Pharmaceutical Association that
publishes news, information, and research in the
areas of pharmacotherapeutic management of
diseases, trends in pharmacy practice, and the
provision of pharmaceutical care.
• Published monthly.
Primary Resource
103
Journal of Applied Therapeutic
Research
• Harwood Academic Publishers, Gardia
and Breach Publishing Group, Newark, NJ
• A journal that focuses on the efficacy,
safety, and rational use of drugs following
approval by regulatory authorities for
general marketing.
• Published monthly.
Primary Resource
104
Journal of Clinical Oncology
• Lippincott Williams & Wilkins, Philadelphia.
• The official journal of the American Society
of Clinical Oncology.
• Published monthly.
Primary Resource
105
The Journal of Clinical
Pharmacology
• Sage Science Press, Thousand Oaks, CA.
• The official journal of the American
College of Clinical Pharmacology.
• Published monthly.
Primary Resource
106
Journal of Herbs, Spices, &
Medicinal Plants
• Haworth Food Products Press,
Binghamton, NY.
• Information on medicinal uses of plants.
• Published quarterly.
Primary Resource
107
Journal of Managed Care
Pharmacy
• Academy of Managed Care Pharmacy,
Alexandria, VA.
• The official journal of the Academy of
Managed Care Pharmacy.
• published bimonthly.
<<http://www.amcp.org>>
Primary Resource
108
The Journal of the National
Cancer Institute
• Oxford University Press, New York.
• A journal that publishes news, information,
and research pertaining to cancer
treatment, prevention, and control.
• Published twice monthly.
<<http://www.jnci.oupjournals.org>>
Primary Resource
109
Journal of Parenteral and
Enteral Nutrition
• ASPEN, Silver Spring, MD.
• The official journal of the American
Society for Parenteral and Enteral
Nutrition.
• Published bimonthly.
Primary Resource
110
The Journal of Pediatric
Pharmacy Practice
• Pediatric Pharmacy Concepts, Inc., St.
Petersburg, FL.
• The official bimonthly journal of the
Pediatric Pharmacy Advocacy Group, Inc.
Primary Resource
111
Journal of Pharmaceutical Care
in Pain & Symptom Control
• Pharmaceutical Products Press, The
Haworth Press, Inc., Binghamton, NY.
• This journal is an interdisciplinary
publication focusing on rational drug
therapy in the management of pain and
related symptoms.
• Published quarterly.
Primary Resource
112
Journal of Pharmaceutical
Sciences
• John Wiley & Sons, Inc. and American
Pharmaceutical Association, Washington,
D.C.
• A journal that focuses on the application of
physical and analytical chemistry to the
pharmaceutical sciences and
technologies.
• Published monthly.
<<http://www. interscience.wiley.com/jpages/0022-3549/>>.
Primary Resource
113
Journal of Pharmacy Practice
• Technomic Publishing Company, Inc.
Lancaster, PA.
• A journal dedicated to providing practicing
pharmacists with topical, important, and
useful information to support pharmacy
practice and pharmaceutical care, and to
expand the pharmacist’s professional
horizons.
Primary Resource
114
Journal of Pharmacy Teaching
• Pharmaceutical Products Press,
Binghamton, NY.
• A journal dedicated to issues relevant to
pharmaceutical education.
• Published quarterly.
Primary Resource
115
The Journal of Pharmacy
Technology
• Harvey Whitney Books Company,
Cincinnati, OH.
• A journal that accepts publications related
to pharmacy practice and pharmacy
technology.
• Published bimonthly.
Primary Resource
116
Journal of Social and
Administrative Pharmacy
• Swedish Pharmaceutical Press,
Stockholm, Sweden.
• A publication focusing on issues of
importance to pharmacy practice in all
settings.
• Published quarterly.
Primary Resource
117
The Medical Letter on Drugs
and Therapeutics
• The Medical Letter, Inc., New Rochelle,
NY.
• A newsletter that provides review
information on new drug therapies and
lists drugs of choice for various disease
states.
• Published biweekly.
• available as part of STAT!-Ref CD-ROM.
<<http://www.medletter.com>>
Primary Resource
118
Morbidity and Mortality Weekly
Report
• U.S. Department of Health and Human
Services, Centers for Disease Control,
Atlanta, GA.
• A publication of the Centers for Disease
Control (CDC) that provides statistics and
recommendations for treatment of
infectious diseases.
<<http://www2.cdc.gov/mmwr>>
Primary Resource
119
The New England Journal of
Medicine
• Massachusetts Medical Society, Boston.
• One of the premier medical journals that
publishes original investigations and
review information considered of
significant importance to physicians and
other health care professionals.
• Published weekly.
<<http://www.nejm.org>>
Primary Resource
120
Paediatric Drugs
• Adis International, Ltd., Auckland, New
Zealand.
• A journal that publishes review articles on
the evaluation of drug therapy and disease
management in children.
• Published quarterly
• Internet access available for a fee.
Primary Resource
121
Pediatrics
• American Academy of Pediatrics, Elk
Grove Village, IL.
• Official publication of the American
Academy of Pediatrics. Published monthly.
<<http://www.pediatrics.org>>
Primary Resource
122
Pharmacist’s Letter
• Pharmacist’s Letter, Stockton, CA.
• A newsletter that briefly covers a number
of new therapeutic issues that may be of
interest to pharmacists.
• Published monthly.
Primary Resource
123
PharmacoEconomics
• Adis International Limited, Auckland, New
Zealand.
• A publication focused on economic
aspects of rational drug therapy and drug
development.
• Internet access available for a fee.
• Published monthly.
Primary Resource
124
Pharmacotherapy. The Journal of
Human Pharmacology and Drug
Therapy
• Pharmacotherapy Publications, Inc.,
Boston.
• A publication of the American College of
Clinical Pharmacy focused on
pharmacotherapeutic aspects of disease
state management including
pharmacokinetics, bioavailability, drug
interactions, clinical trials, and
pharmacology.
Resource
125
• Published every Primary
2 months.
Pharmacy Practice
Management Quarterly
• (Formerly called Topics in Hospital
Pharmacy Management).
• Aspen Publishers, Frederick, MD.
• A journal focused on management issues
pertinent to pharmacy departments in
hospitals.
• Published quarterly.
Primary Resource
126
Pharmacy Times
• Romaine Pierson Publishers, Inc.,
Jamesburg, NJ.
• A pharmacy magazine with a community
practice focus that provides information on
new drug therapies, patient counseling
and management, and issues relevant to
pharmacy practice.
• Original investigations are not commonly
published in this journal
• Published monthly.
Primary Resource
127
<<http://www.pharmacytimes.com>>
Psychopharmacology Bulletin
• Division of Clinical and Treatment
Research,
• National Institute of Mental Health,
Rockville, MD.
• A journal dedicated to dissemination of
research and information related to
pharmacotherapy of mental illnesses.
• Published quarterly.
Primary Resource
128
The Scientific Review of
Alternative Medicine
• Prometheus Books, Amherst, NY.
• A journal dedicated to the scientific review
of alternative medical practices
• Published biannually.
Primary Resource
129
Scrip. World Pharmaceutical
News
• PJB Publications, Ltd., Richmond, Surrey,
England.
• A newsletter that provides updates on
worldwide news regarding the
pharmaceutical industry.
• Published twice weekly.
<<http://www.pjbpubs.co.uk/scrip/>>
Primary Resource
130
Sports Medicine
• Adis International, Ltd., Auckland, New
Zealand.
• A journal that publishes practical reviews
of exercise science and sports medicine.
• Published monthly.
• Internet access available for a fee.
Primary Resource
131
Therapeutic Drug Monitoring: A Journal
Devoted to Therapeutic Drug Monitoring and
• Clinical Drug Toxicology Lippincott
Williams & Wilkins, Philadelphia.
• An official journal of the International
Association of Therapeutic Drug
Monitoring and Clinical Toxicology.
Primary Resource
132
U.S. Pharmacist
• Jobson Publishing L.L.C., New York.
• A pharmacy magazine focused on the
practice of community pharmacy and
issues pertinent to this setting.
• Original investigations are not commonly
published in this journal.
• Published monthly.
<<http://www.uspharrnacist corn>>
Primary Resource
133
135
Secondary Literature
Introduction
Secondary literature
indexing
abstracting
Primary literature services
136
Secondary Literature
Introduction
•
An indexing
System provides only bibliographic information that is indexed by topic
•
An abstracting
Service provides a brief description (abstract) of information contained in a
specific citation
137
Secondary Literature
Introduction
•
138
Indexing and abstracting provide access to primary literature each covers
– different biomedical journals,
– meeting abstracts
– newsletters
– textbooks
– other publications
therefore, use of more than one of these resources
often allows for more thorough information retrieval.
Secondary Literature
Availability
•
CD-ROM format (IDIS)
•
Internet, such as Grateful Med or PubMed from the National Library of
Medicine (<<http://www.nlm.nih.gov>>).
139
Secondary Literature
Indexing:
•
achieve rapid access to literature information (any accumulated data..)
•
literature source are organized by subject headings(… search the system
and recover data pertaining directly to the information needed)
•
key indexing terms … consists of the following:
– Primary indexing terms
– Descriptive modifying terms
– Access numbers
140
Secondary Literature
Primary indexing terms
•
Constitute the appropriate key term under which the information is filled in
the relevant literature sources.
•
It provides the searcher with an efficient method to identify and locate
information or answers pertaining directly to the type of information needed.
141
Secondary Literature
Primary indexing terms(cont.)
•
……..primary indexing term being as specific as possible and use the
generic name of the drug where feasible.
•
Depending on the origin in addition to the generic name of drug or other
key indexing terms may be used, the most common terms frequently
used are listed as follows:
142
Secondary Literature
Primary indexing terms
•
Trade name, this used only, if the drug under which the information required
to be filled is a combination product ( e.g. MAALOX
•
The name of therapeutic or chemical class of drugs, if the information
concerning a class of drugs rather than a single drug (e.g. Corticosteroids
and Anti-inflammatory agents).
•
The name of specific disease when the question or the information pertains
to a drug related aspects of disease states (e.g. Leukemia and
Hypertension).
143
Secondary Literature
Primary indexing terms(cont.)
•
In case that the information is about investigational drugs, letters and/or
numbers can be used as primary index, e.g. A-56258.
•
Information related to specific subject rather than a specific drug, a name of
noun can be used as a primary index. For example information about insulin
pump is indexed under pump, insulin.
144
Secondary Literature
Primary indexing terms
•
In certain situations information are difficult or not suitable for indexing
under one of the previously mentioned primary indexing terms.
•
In order to provide uniformity in assigning primary indexing terms a more
specific term can be used in indexing of these information as the following
:
examples
145
Secondary Literature
Primary indexing terms
– Availability of particular drug.
– General information concerning drug abuse.
– Drug packaging information, this is usually indexed under drug
container and closures name in accordance to terms used by Index
Medicos.
– Legal matters dealing with drugs (e.g. regulation).
146
Secondary Literature
Descriptive modifying term
•
•
Is a term used to modify or describe the primary indexing term. It should be
specific and concise as possible to be accessible one.
It is usually consists of one or two word phrases describing briefly the nature
of the requested information. It is often includes terms such as:
– Dose:
Mefinamic acid- dosage, normal adults -Descriptive modifying terms
– Pharmacokinetics:
Bacoarnpicillin - Drug concentration level, therapeutics,
– Interaction:
Becampicillin - Erythromycin, interaction --- Erythromycin - Bacompicillin,
interaction
147
Secondary Literature
Access number
•
Used to locate the information or request pertaining to the modifying term.
• Example:
– A question was received in a drug information center regarding the
adult dose of Ibuprofen to be used by a patient with renal failure.
– Such question will be indexed as follows:
– Ibuprofen- Renal Failure, dosage (Adult) ….464
number
– Primary indexing term
indexing term
148
Access
Hyphen Descriptive modifying
Secondary Literature
Abstracting
•
Abstracts are summaries of the content of information appearing in published articles,
constructed to be a major device for information storage, or retrieval system.
•
main types of abstracts:
1.
Indicative abstracts (Non-evaluative or Descriptive abstracts)
These are brief outlines of the subjective materials in an articles in which details are omitted.(50100 wards)
2.
Informative Abstracts (evaluative abstracts)
These should contain all key concepts and important information mentioned in the article. (about
250 wards)
149
Secondary Literature
Purposes Of Abstract
•
To indicate to readers quickly whether the full article would be useful to read
•
To be extracted (or abstracted) from the article for separate publication
(e.g., by Biological Abstracts or Chemical Abstracts)
•
To provide terminology to assist in literature searches by individuals or by
literature retrieval specialists for indexes and computer banks.(Key Words)
150
Secondary Literature
Ideal Abstract
• Informative
• self-explanatory without referring to the main text.
• generally restricted in length (not exceeds 250 words)
• complete abstract should state clearly the objective of the study and
summarizing the procedure results and author’s conclusion.
Materials to be abstracts usually falls into •
one of the following classes:
151
Secondary Literature
1-Research Report
• Concisely state the objectives, method
(procedure) main results (including
specific data and their significance if
possible) and principal conclusion.
152
Secondary Literature
2-Clinical and Comparative
Studies
• Concisely state the purpose of the study (if not clear from the
title) type of the study (double blind, cross over etc.---) And its
duration
• Number of subjects and ages, if stated, number of those
completing the study
• Reasons for withdrawals
• Disease (s), drug (s) used
• Dose
• Route of administration and formulations
• Clinical results
• Adverse effects and interactions
• Method of statistical analysis (if relevant) and author’s
conclusion.
153
Secondary Literature
3-Case Reports
Concisely state number of subjects and age
(if stated)
•
•
•
•
•
•
•
154
Drug (s) used
Dose
Route of administration
Formulation
Disease
Clinical results
Adverse effects and author’s conclusion.
Secondary Literature
4-Descriptive Reports
Concisely state the purpose of the programs, how
the program work and conclusion.
5-letters
One should state briefly what was done followed
by the main results. A brief conclusion should
also be included.
155
Secondary Literature
6-Review Articles and
Editorials
Concisely identifies the main topic
covered in the review (if not clear from the
title)
•
•
•
•
•
•
•
156
Type (e.g. Literature evaluation)
Historical
Coverage (e.g. Subheadings)
Data covered
Number of references
Summary of the major points
Author’s conclusion (if any) and critical comments etc....
Secondary Literature
Key Words
• Keywords are used in referencing and
indexing. Usually not more than 10 words
are included. Keywords generally appear
immediately below the abstract.
157
Secondary Literature
Examples of indicative and informative
absttacts
REPORT
•
SINGLE DOSE PREOPERATIVE PROPHYLAXIS IN TRANSURETHRAL
SURGERY:
CIPROFL0XACrN VERSUS CEFOTAXIME
Christensen, M.M., Nielsen, K.T., Knes, J. and Madsen, P.O. Am. J. Med.
87:258S-260S (Nov 30 Supply) 1989.
•
158
Indicative Abstract
Single dose intravenous (IV) ciprofloxacin (I) and cefotaxime (II) are
evaluated in a double blind study in male patients, 37 receiving, (1),300 mg,
and 39 receiving II, 1 .0 g, for preoperative prophylaxis in transurethral
surgery.
Secondary Literature
Informative Abstract (example)
•
Single dose intravenous (JV) ciprofloxacin (I) and cefotaxime (II) are
evaluated in a double blind study in male patients, 37 receiving, 1,300 mg,
and 39 receiving II, 1.0 g, for preoperative prophylaxis in transurethral
surgery. There were no symptomatic urinary tract infections or other
infections after prostate and bladder surgery and no serious post surgery
complications in any of the patients. Serum and prostatic tissue levels, as
well as the tissue/serum ratios are included for 13 I patients. The most
common side effect was postoperative nausea in 15 patients, 111 and 4 II
patients. It is concluded that both drugs are effective and safe in reducing
tree frequency of bacteriuria following transurethral surgery; there is no
significant different between the 2 groups. (13 references).
159
Secondary Literature
Guidelines For Informative Abstracts
160
Secondary Literature
Clinical Trials And Comparative
Studies
–
–
–
–
–
–
–
–
–
–
–
161
Purpose of study (if not clear from title).
Type of study (double—blind, cross—over, etc.) and duration.
Number of subjects (age, if stated).
Number of completers of the study.
Reasons for withdrawals.
Diseases.
Drug (s) used — dose, route of administration, formulation.
Clinical results.
adverse effects and interactions.
Statistical methods of analysis (if relevant).
Author’ s conclusions.
Secondary Literature
Case Report
– Number of subjects (age if stated).
– Drug (s) used — dose, route of
administration, formulation.
– Disease.
– Clinical results.
– Adverse effects.
– Author’ s conclusions.
162
Secondary Literature
Reviews And Editorials
– Subject (if not clear from title).
– Type, e.g. Literature evaluation, historical.
– Coverage, e.g. subheadings.
– Dates covered (references).
– Number of references.
– Author’s conclusions (if any).
– Critical comments — Author’ s bias,
omissions, etc.
163
Secondary Literature
abstract (original
study)
164
Secondary Literature
Report
abstract.
165
Secondary Literature
Writing Informative Abstracts
(Journal Articles)
1. Objective(s).
• State an objective, not necessarily a
hypothesis.
• Hypothesis testing does not fit the design of
many studies and sometimes leads to simplistic
thumbs-up or
“To determine whether drug A, a new antiviral
agent, reduced morbidity related to the common
cold.”
166
Secondary Literature
Writing Informative Abstracts
(Journal Articles)
2. Design.
“Case-control study.”
“Randomized controlled trial.”
“Prospective cohort study.”
• Not every study can be neatly summarized by a
widely understood label; a brief description of
what you did may be necessary.
167
Secondary Literature
Writing Informative Abstracts
(Journal Articles)
3. Setting.
place and time; where and when the study
participants were selected.
• Try to be specific without being wordy.
“Three general pediatric practices in
Kansas City, Mo, from January 1990 to
December 2001.”
168
Secondary Literature
Writing Informative Abstracts
(Journal Articles)
4. Participants.
Who was studied, and how many were studied?
Describe important eligibility criteria.
• Refusal to participate, dropouts, and missing
information are potential sources of bias.
“A random sample of children admitted to
the intensive care unit for bronchiolitis (N=201).”
169
Secondary Literature
Writing Informative Abstracts
(Journal Articles)
5. Intervention (s) or Main exposure (s).
It includes interventions that were •
controlled by the investigators or
exposures.
“Oral acyclovir, 15 mg/kg 5 times per day for
5 days.”
170
Secondary Literature
Writing Informative Abstracts
(Journal Articles)
6. Main outcome measure (s). •
” Given this objective, the main outcome
was death prior to hospital discharge”
171
Secondary Literature
Writing Informative Abstracts
(Journal Articles)
7. Results.
• Give the main numerical results with
estimates of precision, such as confidence
intervals.
“The intervention arm had better outcomes;
P=.01 for all comparisons,”
172
Secondary Literature
Writing Informative Abstracts
(Journal Articles)
8. Conclusion(s).
“The risk of drowning was less among children wearing life
vests, compared with those without vests (adjusted risk
ratio, 0.5; 95% confidence interval, 0.3-0.6).”
“If the association estimated in our study is causal, our
results provide evidence that about half of child
drowning’ s can be prevented if children wear life vests.”
173
Secondary Literature
Sources
174
Secondary Literature
Anti-infectives Today
• Adis International, Inc., Langhorne, PA.
• An indexing and abstracting service that
summarizes current Literature on drug
therapy and management of infections.
• Available as newsletter and a variety of
electronic formats.
• Published monthly.
175
Secondary Literature
BIOSIS Previews
• BIOSIS, Philadelphia.
• A major comprehensive resource that
covers all areas of biological research,
including the biomedical sciences.
• Meeting and conference citations include
the basic sciences; may be more
comprehensive than MEDLINE.
176
Secondary Literature
Cancer Today
• Adis International, Inc., Langhorne, PA.
• An indexing and abstracting service that
summarizes current literature on the use
of drugs in the management of cancer.
• Available as newsletter and a variety of
electronic formats.
• Published monthly.
177
Secondary Literature
ClinAlert
• Technomic Publishing Company, Lancaster, PA.
• A secondary system of adverse drug reaction
case reports including herbal products and
literature citations including herbal products.
• Available as a newsletter, CD-ROM, and on
the Internet.
• Published semimonthly.
• Reviews about 100 journals; about $lOO/year
178
Secondary Literature
CNS Disorders Today
• Adis International, Inc., Langhorne, PA.
• An indexing and abstracting service that
summarizes current literature on all aspects
of drug therapy and disease management
of psychiatric and neurologic disorders.
• Available as newsletter and a variety of
electronic formats.
• Published monthly.
179
Secondary Literature
Current Contents
• Institute for Scientific Information, Philadelphia.
• A system that provides tables of contents for numerous medical
and life sciences publications.
• Two versions useful to pharmacists, Current Contents Life Sciences
and Current Contents Clinical Medicine, are available.
• Author abstracts and author reprint addresses for journal articles also
provided.
• Use of specific search terms enables specific information retrieval.
• Available as index ($442/year), CD-ROM $I,OOO/year, online, and
Internet formats.
• Published weekly.
• Provides table of contents for more than 7500 different journals;
180
Secondary Literature
Embase
• Elsevier, Amsterdam, The Netherlands.
• A very complete abstracting source for the medical
literature.
• Covers approximately 4500 periodicals.
• This publication is in many ways similar to Medline,
however, it covers more international journals and
meeting abstracts.
• Available in CD-ROM, network, and on-line formats.
(Printed version is called Excerpta Medica.)
• Drugs and Pharmacology, a subset of this database, is
of particular interest to pharmacists.
181
Secondary Literature
Index Medicus
• U.S. Government Printing Office,
Washington, D.C.
• An index to the biomedical literature that
references over 3000 journals.
• Note that this is a printed subset of
MEDLINE
182
Secondary Literature
InPharma Weekly
• Adis International, Inc., Langhorne, PA.
• An indexing and abstracting service that
summarizes current literature related to
pharmacotherapy.
• Available in newsletter, CD-ROM, on-line,
Intranet, and Internet formats.
• Published weekly.
• Reviewing about 1500 journal.
• Lag time 2weeks-2 months.
183
Secondary Literature
International Pharmaceutical
Abstracts
• American Society of Health-System Pharmacists,
Bethesda, MD.
• The most comprehensive abstracting service for
international information relevant to pharmacy and
pharmaceutical sciences.
• Provides access to both journal articles and pharmacy
meeting abstracts.
• Available as a print index, CD-ROM formats, and as an
on-line service.
• Published twice a month or updated monthly.
• Covers about 800 journals
184
Secondary Literature
Iowa Drug Information System (IDIS)
• College of Pharmacy, The University of Iowa,
Iowa City.
• An indexing service that allows retrieval of
complete articles from over 180 biomedical
journals.
• Information can be searched by keywords,
generic drug name, disease classification,
journal of publication, year of publication,
authors, title, and type of study design.
185
Secondary Literature
Iowa Drug Information System (IDIS)
• Available in microfiche, CDROM, and on-line
formats.
• Articles published prior to 1998 are only
available in microfiche format.
• After 1998, the articles are available in a
microfiche format and a CD-ROM full-text
version.
• Updated monthly.
• We have the system starting from Jan 1998.
186
Secondary Literature
Journal Watch
• Massachusetts Medical Society, Waltham, MA.
• An abstracting service by the publishers of New
England Journal of Medicine that includes
recent citations from general medicine literature
• This newsletter is published semimonthly.
• Additional newsletters are available in specialty
areas such as psychiatry, infectious disease,
women’s health, and AIDS.
187
Secondary Literature
LEXIS-NEXIS
• Academic Universe, Dayton, OH.
• This indexing/abstracting service with
some full-text features provides access
to a wide range of news, business, legal,
and reference information.
188
Secondary Literature
LEXIS-NEXIS
• This service includes coverage of government,
business, communications, law, finance, health
care and medical information news, medical and
health care journals, Joint Commission for
Accreditation of Healthcare Organization
publications, and FDC publications including
The Tan Sheets, The Pink Sheets, and
Pharmaceutical Approvals Monthly. Available for
a fee at
<<http://web.lexis-nexis.com/universe>>
189
Secondary Literature
MEDLINE
• National Library of Medicine, Bethesda, MD.
• Medline is bibliographic database containing more than
12 million citations and author abstracts from over 4800
biomedical journals published in the United States and
70 other countries.
• Medline covering extends back to the early 1950’s and
up to now with new data added weekly..
Available on CD-ROM or via on-line services including •
the Internet as Grateful Med or part of PubMed
190
<<http://w.nlm.mh.g0v>>
Secondary Literature
Pediatrics Today
• Adis International, Inc., Langhorne, PA.
• An indexing and abstracting service that
summarizes current literature on the use
of drugs in children.
• Available as newsletter and a variety of
electronic formats.
• Published monthly.
191
Secondary Literature
PharmacoEconomics & Outcomes
News Weekly
• Adis International, Inc., Langhorne, PA.
• An indexing and abstracting service that
summarizes current literature on
economic issues related to medicine,
pharmacy, and health care.
• Available in newsletter, CD-ROM, and
on-line formats.
• Published weekly.
192
Secondary Literature
Reactions Weekly
• Adis International, Inc., Langhorne, PA.
• An indexing and abstracting service that summarizes
current literature on adverse drug reactions, drug
interactions, herbal products, drug dependence, and
toxicology.
• Available in newsletter, CD-ROM, on-line, Intranet,
and Internet formats.
• Published weekly.
• An annual compilation is also published.
• Reviewing about 1500 journal.
• Lag time 1-2 months.
193
Secondary Literature
Science Citation Index
• Institute for Scientific Information,
Philadelphia.
• An index that notes citation frequency of
authors and journal articles.
• Available in network, CD-ROM, on-line,
and Internet formats.
194
Secondary Literature
195
Tertiary Resource
Introduction
Drug Information
Resources
Objectives:
1. Describe the attributes and the differences between
tertiary, secondary and primary resources
2. Identify the most appropriate resources for a given
drug information inquiry and use them effectively.
3. Recognize that primary, secondary and tertiary
resources may be available in hard copy, CD-ROM,
ON-LINE and/or other Format.
4. Describe how to search 196
computerized dataTertiary
bases
.
Resource
Introduction
professional literatures
Tertiary
Secondary
Primary Sources
197
Tertiary Resource
Introduction
Primary Resources
• They are the research studies published in
biomedical
journals.
• It is the most current information about drugs.
• It is not easy job to use journals to answer a
drug
related question because of its huge growing
number
(>20000 biomedical journals available)
198
Tertiary Resource
Introduction
Primary Resources
• Primary recourse provides the broad base for
development of the rest of the professional
literature.
• It contains original reports of scientific studies on
which the knowledge of drugs and therapeutics
is built.
• Current of the information sources, and
periodical journals are its most common format.
• Providing access to the original data from a
study as well, having the most current
199
Tertiary Resource
information
Introduction
Secondary Resources
• They are indexes and abstracts for primary
resources.
• They are valuable tools for quick and selective
screening for primary resources.
• They provide the user with concise tools for
gaining access to the primary literatures.
• Any single indexing or abstracting service can
not cover all published articles beside the lag
time are the limitations to use secondary
resources.
200
Tertiary Resource
Tertiary Resources
“Literatures”
201
Tertiary Resource
Definition
• Tertiary literature is core knowledge
established via primary literature or
accepted as standard of practice within the
medical community.
202
Tertiary Resource
Introduction
• tertiary resources include textbooks,
monographs, compendia, handbooks, and
published symposia.
• They represent the condensation of basic
facts originally published in the primary
literature.
203
Tertiary Resource
Types
Textbooks
Compendia
Full-text databases
Review articles
On various drug or disease topics
A vast array of information about many
Drugs such as the physician's desk reference
Including the internet, MICROMEDEX and LEXI
Summarize a particular topic
Contain more current information
204
Tertiary Resource
Advantages
•
•
•
•
•
Tertiary resources are the most commonly used
sources of information because they are easy to use,
concise and compact.
Often they provide a review of the literature by an
expert in the field.
Tertiary references (textbooks, CD-ROMs) are
convenient and in general, fairly accessible.
Drug information references may be divided into
specific subjects to make them easier to use..
Usually the information contained in tertiary literature is
well accepted in medical practice.
205
Tertiary Resource
Disadvantages
• lag time ……. outdated even in "new"
editions
• Space limitations within a text may prevent
extensive discussion of a drug or topic
• Authors may emphasize limited
information about a topic or drug
• Authors may present information that is
based on a less thorough review of the
primary literature
206
Tertiary Resource
Disadvantages (cont.)
• It may not be referenced appropriately
thus preventing a proper check of the
primary literature
• If the information presented in the tertiary
literature is based on flawed primary
literature (i.e. Poorly done studies are
referenced) then the tertiary information
may be suspicious.
207
Tertiary Resource
Disadvantages (cont.)
• Any updated or new information cannot be
inserted into the printed (hard copy)
tertiary literature in a timely fashion.
• Human bias, error transcription, incorrect
interpretation of data and lack of expertise
by the author.
208
Tertiary Resource
Evaluation of tertiary
resources
Several points should be considered in evaluating tertiary
resources as follows:
1. Does the author has sufficient experience and expertise to
write on the topic?
2. What credentials do the authors/contributors have?
3. Assess the text for timeliness (i.e. when was the last edition
published?)
4. Is this the most recent edition of the tertiary reference?
5. Are statements of fact appropriately supported by references?
6. How many references does each section have and how up-todate are they?
209
Tertiary Resource
Evaluation of tertiary
resources (cont.)
6. To assess consistency, compare information presented
in one text to the same information presented in
another text.
7. Is the reference likely to contain information relevant to
the subject being researched?
8. Is the reference clear, concise and easy to use?
210
•
Tertiary Resource
Availability of Tertiary
Resources
Tertiary resources are available in many formats, including hard
copy, microfiche, and computerized versions. Computerized
resources may be available on floppy disks, or CD-ROMs for
use in a single personal computer or computer network, a main
frame system or via internet.
211
Tertiary Resource
Classification of Tertiary
Resources
212
Tertiary Resource
Tertiary drug
information resources
Specialized
references
General references
213
Tertiary Resource
General References .A
214
Tertiary Resource
General features
1- They are referral books.
2- Their formats are either monographs or
monographs plus chapters.
3- Used through their indexes NOT through
their contents lists.
215
Tertiary Resource
Textbooks.
Different from the general references in:
1- Their formats are chapters.
2- One can read them from cover to cover.
3- One can use their contents list Not necessary to go to
index.
216
Tertiary Resource
The most helpful of them to answer
a drug related questions are:
217
Tertiary Resource
Martindale’s The complete drug
reference
218
Tertiary Resource
Martindale’s The complete drug
reference
• European and investigational drugs
• Published by the Royal Pharmaceutical
Society of Great Britain every 4 years
• Has a manufacturer directory and index
by clinical use (typical European style of
indexing)
• Lists other pharmacopeias the drug is
found in.
219
Tertiary Resource
Drug Facts and Comparisons
(F&C)
220
Tertiary Resource
Drug Facts and Comparisons
(F&C)
–
–
–
–
–
–
Updated monthly (loose-leaf version)
Lag time 3 months
Arranged by therapeutic class
Prescription and OTC listings
Helpful summary/comparison tables
Contains information about investigational,
orphan, and discontinued products and off
label uses
– Not referenced, cumbersome
221
Tertiary Resource
Mosby’s Drug Consult
222
Tertiary Resource
Mosby’s Drug Consult
•
•
•
•
Frequently used brand and generic drugs
Available at www.merckmedicus.com
Annual update
Additional information:
– Drug identification, look-alike/sound-alike
– Manufacturer information, discontinued
Products
223
Tertiary Resource
American Hospital Formulary
Service (AHFS) Drug
Information
224
Tertiary Resource
American Hospital Formulary
Service (AHFS) Drug Information
– Arranged by AHFS classification number
– Monographs listed alphabetically
– Information in monograph:
•
•
•
Chemistry, pharmacology, mechanism
Dose, administration, pharmacokinetics
Drug interactions, preparations, toxicity
225
Tertiary Resource
(AHFS) Drug Information
–
–
–
–
FDA-approved and off-label uses
Published annually with quarterly updates
More clinically oriented
References are not available in the hard copy
but may be available online or with software
CD-ROMS
– Not comprehensive, significant lag time
226
Tertiary Resource
USP Dispensing Information (USP
DI)
227
Tertiary Resource
USP Dispensing Information (USP
DI)
•
•
•
•
•
Three volumes
I. DRUG Information for the Healthcare
Professional
II. Drug Information for the Patient (in lay
language)
III. Legal Requirements
Monographs in alphabetical order in Volume I
Published annually
Also contains some Canadian drug names
Most thorough information on:
•
Monitoring
•
Adverse drug events
228
Tertiary Resource
USP Dispensing Information (USP
DI)
• Useful Appendices: (typical American
style of indexing)
•
•
•
•
•
Selected List of Drug-Induced Effects
Therapeutic Guidelines
Poison Control Center Listing
Veterinary Medication Classification
Excluded Monograph Listing
229
Tertiary Resource
USP Dispensing Information (USP
DI)
• Off-label uses indexed by drug and by
indication
• Not referenced, lag time, only FDAapproved uses, inconvenient to
compare agents in the same
therapeutic class
230
Tertiary Resource
Drug Information Handbook (Lexi-Comp)
231
Tertiary Resource
Drug Information Handbook (LexiComp)
•
•
•
•
•
•
•
Pocket-sized; PDA & online versions are also available
Published annually
Drugs listed alphabetically by generic name
Useful charts and tables.
Specialty versions are available:
– Pediatric, psychiatric, geriatric
Not referenced
Lists all reported adverse events but does not always
provide the incidence
232
Tertiary Resource
MICROMEDEX®
•
•
CD-ROM
Access information by brand or generic
name of drug
Referenced, quick and easy to use
Expensive, uses other tertiary references
Databases available:
•
•
•
•
•
•
•
DRUGDEX® - main drug information database
DISEASEDEX® - disease states
IDENTIDEX® - drug identification by imprint code
POISINDEX® - poisoning and toxicology
•
Martindale’s – foreign drugs
233
Tertiary Resource
Physicians’ Desk Reference
(PDR)
234
Tertiary Resource
Physicians’ Desk Reference (PDR)
•
•
•
•
•
•
•
Updated annually
Color pictures and markings for drug
identification
Has FDA-approved product information only
Manufacturers pay to have product information
Included
Contains section on diagnostics
May not contain the complete package insert
Not referenced
235
Tertiary Resource
Drug Topics Red Book
236
Tertiary Resource
Drug Topics Red Book
•
•
•
•
•
Cost data: average wholesale prices
(AWP) and NDC numbers. (The National
Drug Code)
Alphabetical listing of manufacturers with
contact information
Prescription and OTC products
List of drugs that should not be crushed
or chewed
Published annually237with monthly updates
Tertiary Resource
Specialized References .B
238
Tertiary Resource
Pharmacotherapy
239
Tertiary Resource
Pharmacotherapy: A
Pathophysiologic Approach
(Dipiro)
240
Tertiary Resource
Pharmacotherapy: A
Pathophysiologic Approach (Dipiro)
•
•
•
•
•
Well-written and referenced with helpful
tables.
Pocket version is available.
Focuses on drug therapy, good
background information.
Also covers non-drug treatment options.
Updated edition about every 4 years.
241
Tertiary Resource
Applied Therapeutics: The
Clinical Use of Drugs (KodaKimble)
242
Tertiary Resource
Applied Therapeutics: The Clinical
Use of Drugs (Koda-Kimble)
•
•
•
•
Well-written with focus on drug therapy.
Updated every 4 years.
Useful summary tables.
Case presentation format, may be more
difficult to use as a quick reference.
243
Tertiary Resource
The Washington Manual of Medical
Therapeutics
•
•
Quick reference with many charts and
tables.
Updated about every 2 to 3 years.
244
Tertiary Resource
Internal Medicine
245
Tertiary Resource
Harrison’s Principles of Internal
Medicine
•
•
•
•
Gold standard for internal medicine
Published every 5 years, referenced
Pathophysiology, clinical presentation, diagnosis and treatment
guidelines
Little drug information & dosing recommendations
246
Tertiary Resource
The Merck Manual
•
•
Used by many healthcare professionals
Also includes pediatrics, gynecology, psychiatry,
ophthalmology, otolaryngology, dental disorders
247
Tertiary Resource
Clinical Medicine (Kumar &Clark )
248
Tertiary Resource
Clinical Medicine (Kumar &Clark )
• comprehensive and authoritative single-volume
textbook of internal medicine.
• Explains the management of disease, based on
an understanding of scientific principles and
including the latest developments in treatment.
• Colour-coded chapters are attractive and make
the book easy to navigate.
• Comprehensive index, clearly displayed,
pinpoints information rapidly.
249
Tertiary Resource
Clinical Medicine (Kumar &Clark )
• Boxes and tables pull out and display important
information.
• Drawings and photographs.
• Carefully structured headings provide a useful
outline for study and quick reference.
• Gastrointestinal, Rheumatology, Renal,
Cardiovascular,
Respiratory ,Intensive care medicine, Drug
Therapy and poisoning……
250
Tertiary Resource
Cardiology
251
Tertiary Resource
Textbook of Cardiovascular
Medicine
•
•
•
•
Published every 5 years.
Good illustrations.
Addresses modern-day issues such as medical
economics and assessing quality of care.
Well-referenced.
252
Tertiary Resource
Hurst’s The Heart
•
•
•
Organized by condition
Comprehensive information on drug therapies and
regimens
Rapid Interpretation of EKG’s
(Electrocardiogram
•
•
(EKG or ECG))
Best guide to learning EKG’s
User-friendly format.
253
Tertiary Resource
Pediatrics
254
Tertiary Resource
Harriet Lane Handbook
255
Tertiary Resource
Harriet Lane Handbook
•
•
•
•
•
•
Useful pocket guide published every 3 years
Has dosing information
Electronic version updated annually
Four sections: emergency management,
diagnostic, formulary, and therapeutic data
Some information on pregnancy and lactation
Not referenced, not frequently updated,
confusing organization, not complete
256
Tertiary Resource
Pediatric Injectable Drugs (“Teddybear
Book”)
•
•
•
Alphabetical order by generic name
Formerly known as Guidelines for Administration of
Intravenous Medications to Pediatric Patients
Dose, concentration, rate, cautions
257
Tertiary Resource
Pediatric Dosage Handbook (LexiComp)
•
•
•
•
Pediatric version of the Drug Information Handbook
Dose, administration, how supplied, contraindications,
adverse effects, drug interactions, antidotes
Also contains adult doses
May sometimes have information on extemporaneous
formulations
258
Tertiary Resource
Pregnancy
259
Tertiary Resource
Drugs in Pregnancy and Lactation
(Briggs)
•
•
•
•
•
Excellent reference, gold standard
Updated every 4 years
Alphabetical by generic name
Generic name, class, & pregnancy risk factor
Summaries of risk to fetus and risk during
breastfeeding
• Editors assign categories for drugs not classified
by the manufacturer
• Referenced
260
Tertiary Resource
Infectious Diseases
261
Tertiary Resource
Mandell’s Principles and Practice of
Infectious Disease
• Gold standard reference
• Infection, diagnosis, treatment and useful
background information
262
Tertiary Resource
Sanford Guide to Antimicrobial
Therapy
•
•
•
Published annually
Pocket-sized and easy to use
Includes: dosing in renal impairment, brand & generic
names, empiric therapy guidelines, antimicrobial
spectra of the agents
•
Not well-referenced
263
Tertiary Resource
Oncology
264
Tertiary Resource
Cancer: Principles and Practice of
Oncology (devita)
•
•
•
Gold standard, published every 3 to 4 years
Pathology, treatment options, & adverse effects
Referenced
265
Tertiary Resource
Cancer Chemotherapy
Handbook
•
•
•
•
Useful index, introduction on malignancies
Pharmacology and use of chemotherapeutic
agents
Lists investigational drugs and combinations
Well-referenced
266
Tertiary Resource
Pharmacology
267
Tertiary Resource
•
•
•
•
Goodman & Gilman’s
Pharmacological Basis of
Therapeutics
Gold standard pharmacology text
Grouped by therapeutic class
Mechanism, absorption, distribution, and metabolism
Contains review of pharmacokinetics, therapeutics, and
toxicology
• Well-referenced, very thorough
• Updated every 5 years (infrequent)
268
Tertiary Resource
Drug Interactions
269
Tertiary Resource
Hansten and Horn's Drug Interactions
Analysis and Management
•
•
•
•
•
Loose-leaf format, updated
Introductory chapter discusses mechanisms of
interactions
Rates significance of interaction and recommends
management
Referenced
Not complete, subjective rating system
270
Tertiary Resource
Drug Interaction Facts
•
•
•
•
•
Published by F&C
Alphabetical by drug name
Referenced
Provides information regarding:
• Significance and severity
• Onset of interaction
• Documentation
Not complete, subjective rating scale
271
Tertiary Resource
Stockley's Drug Interactions
• A typical monograph contains a summary, clinical
evidence for the interactions under discussion, the
probable mechanism, clinical importance and
management
• Covers interactions between therapeutic drugs,
proprietary medicines, herbal medicines, foods, drinks,
pesticides and some drugs of abuse
272
Tertiary Resource
Stockley's Drug Interactions
• Based on published sources and fully referenced
• Covers over 14,000 drug interactions
• Contains over 2,800 monographs
• Includes 17,600 references
• Book & CD-ROM
273
Tertiary Resource
Adverse Drug Reactions
274
Tertiary Resource
Meyler’s Side Effects of Drugs
275
Tertiary Resource
Meyler’s Side Effects of Drugs
•
•
•
•
•
•
Indexed by drug and by adverse event
Most comprehensive
Published every 4 years with annual updates
Contains tables and lists
References for some side effects not included
Information provided:
– Effects on organs and systems, lab/diagnostic
interference, withdrawal and overdose
• May not be complete, references for widely known
effects are not included
276
Tertiary Resource
Compatibility and Stability
277
Tertiary Resource
Handbook on Injectable Drugs
(Trissel’s)
278
Tertiary Resource
Handbook on Injectable Drugs
(Trissel’s)
•
•
•
•
•
•
•
Gold standard reference
Updated every 2 years with annual supplements
Drugs organized alphabetically by generic name
Information on compatibility and stability with diluents
and drugs
Solution, Y-site, syringe, and additive compatibility
Table format, very useful
Not complete, lag time
279
Tertiary Resource
King Guide to Parenteral
Admixtures
• Chart format, loose-leaf
• Alphabetical listing by generic name
• May have information not available in
Trissel’s
• Pages are not numbered
280
Tertiary Resource
IV INDEX®
• Component of MICROMEDEX®
• Easy to use
• Information taken mostly from Trissel’s
281
Tertiary Resource
Compounding and Pharmaceutics
282
Tertiary Resource
Remington’s The Science and
Practice of Pharmacy
• Helpful for extemporaneous
compounding
• Pharmaceutical calculations, chemistry,
radioisotopes
• New edition every 5 years
283
Tertiary Resource
Merck Index
• Chemical name, formula, & structure
• Physical data, therapeutic category
• Published every 6 to 10 years
284
Tertiary Resource
United States Pharmacopeia –
National Formulary (USP-NF)
•
•
•
•
•
•
Official monographs for preparation and assay of
pharmaceutical products
Published every 5 years with periodic supplements
Information on storage, packaging, labeling, reference
standards, & assays
USP: drug substances & dosage forms
NF: pharmaceutical ingredients
Not a very useful reference since most pharmaceuticals
are mass-produced
285
Tertiary Resource
Pharmacokinetics
286
Tertiary Resource
Basic Clinical Pharmacokinetics
(Winters)
•
•
•
•
Case-study format
Includes principles of monitoring therapy, basic
pharmacokinetics, & clinical applications
Appendix of commonly used equations
Mostly theory, little patient integration
287
Tertiary Resource
Applied Pharmacokinetics:
Principles of Therapeutic Drug
Monitoring
–
–
–
–
Published by Applied Therapeutics
Most advanced reference
More specific drug information than Winter’s
Includes analytical methods and clinical
applications
288
Tertiary Resource
Toxicology
289
Tertiary Resource
Toxicologic Emergencies (Goldfrank’s)
• Poison management guidelines
• Useful tables and case studies
• Practice multiple-choice questions
290
Tertiary Resource
Casarett & Doull's Toxicology:
The Basic Science of Poisons
• gold standard in toxicology field
• basic concepts and fundamental
principles needed to grasp current issues
in modern toxicology
• The text is organized and presented in a
logical progression of general principles
to specific topics such as organ system
toxicology, specific agent toxicology, and
environmental toxicology.
291
Tertiary Resource
POISINDEX®
• Toxicology component of
MICROMEDEX®
• Search by brand or generic name
• Describes what substance looks like, any
imprint codes, management of toxicity
292
Tertiary Resource
Other Toxicology Books
• Toxic Emergencies: Clinics in
Emergency Medicine (Clinics in
emergency medicine) by William
Hanson
• Current Approaches in Toxicology by
Bryan Ballantyne
• Handbook on the Toxicology of Metals
(Hardcover) by Lars Friberg Lars
293
Tertiary Resource
Other Toxicology Books
• Toxicology of the Eye: by W.Morton
Grant. Joel S. Schuman
• Effects on the Eyes and Visual System
from Chemicals, Drugs, Metals and
Minerals, Plants, Toxins, and Venoms;
Also, Systemic Side Effects from Eye
med (Hardcover)
294
Tertiary Resource
Other Toxicology Books
• Clinical Toxicology of Commercial
Products (Hardcover) by Robert E.
Gosselin, Roger P. Smith, Harold C
Hodge, Jeannet Braddock
295
Tertiary Resource
Drug Identification
296
Tertiary Resource
1. American Drug Index
– Cross-referenced by brand, generic, and
chemical names
2. The Pill Book
3. IDENTIDEX®
– Component of MICROMEDEX®
– Identify drug by imprint code
297
Tertiary Resource
British National Formulary .4
–
–
–
–
–
BMJ Publishing, London, United Kingdom.
The standard reference for prescribing and dispensing drugs
in Britain.
Included are notes on the different drug groups to help in the
choice of appropriate treatment.
The BNF is updated in March and September of each year
available on disk and CD-ROM as the Electronic British
National Formulary and An electronic web-based format is
also available.
298
Tertiary Resource
Saudi National Formulary .5
–
–
–
–
–
It is a joint publication of the Saudi pharmaceutical
society & Ministry of Health, Riyadh, KSA
The standard reference for prescribing and
dispensing drugs in Saudi Arabia.
Included are notes on the different drug groups to
help in the choice of appropriate treatment.
The SNF is only one edition published in 1424 H
(previous two editions were directory formats).
Available as hardcopy only.
299
Tertiary Resource
Saudi National Formulary .5
(cont.)
– Having guidelines appendix.
– Drug interactions appendix.
– Drug information links appendix.
– List of community pharmacies all over the
kingdom
– Containing different indexes like:
- Vendors index.
- Manufacturers index.
- Alphabetical drug index
- Therapeutic index
300
Tertiary Resource
Index Nominum: .5
International Drug Directory
•
•
•
•
•
Edited by the Swiss Pharmaceutical Society
Alphabetical by generic and brand name
Drug name, structure, therapeutic class,
synonyms, and manufacturer
Cross-referenced by all trade names and
substances
Not much information is provided
301
Tertiary Resource
Index Nominum: .5
International Drug Directory
•
•
•
•
•
Drugs Available Abroad
Alphabetical by generic name
Drug manufacturer, when it became available,
dosage forms, where it is approved
Indexed by disease, country of use, drug
category
Appendices with information on manufacturers
and drug regulatory authorities in other
countries
302
Tertiary Resource
Non-Prescription Products
303
Tertiary Resource
PDR for Nonprescription Drugs and
Dietary Supplements
• Format similar to PDR, updated every
year
• Indexed by product name, category,
manufacturer, & active ingredient
• Includes color pictures of products
• Information: indications, cautions, dose,
administration, patient instructions,
precautions, how supplied
304
Tertiary Resource
Handbook of Nonprescription
Drugs
•
•
Useful tables and comparisons
Includes:
– Patient assessment and counseling guidelines
– Pathophysiology and treatment options
– Dosing, adverse events, & interactions
305
Tertiary Resource
Natural Products
306
Tertiary Resource
Lawrence Review of Natural
Products
• Comprehensive and up-to-date
information
• Published by F&C
• Monthly updates
• Provides uses, toxicity, & patient info
• Scientific approach to herbal products
307
Tertiary Resource
Electronic Tertiary
Resources
308
Tertiary Resource
A. Multipurpose Resources
(disease and drug information)
309
Tertiary Resource
Access Medicine
(http://www.accessmedicine.com/)
•
•
•
•
Collection of textbooks, clinical practice guidelines,
news
Includes: Goodman & Gilman, Harrison’s, Current
Medical Diagnosis & Treatment, and the Lange series.
Drug monographs (include images, chemical
structures, patient education materials) provided by
Gold Standard™
Patient education handouts on common medical
problems provided by Postgraduate medicine
310
Tertiary Resource
ClinicalResource@Ovid
(http://clinicalresource.ovid.com/autologin.ht
ml)
• Collection of books, clinical practice
guidelines, patient education materials
and links to databases
• Includes: Clin-eguide, Facts and
Comparisons and 5-Minute Consult
series
311
Tertiary Resource
MD Consult
http://home.mdconsult.com/groups/uwash8783.ht
ml)
• Collection of textbooks, journals, drug
information, guidelines, patient education
handouts, news and updates
• Drug information and updates from Mosby’s
drug Consult, package insert information, FDA
information
• Customizable patient handouts – diseases and
drugs
312
Tertiary Resource
MedlinePlus
(http://medlineplus.gov)
• NLM’s database aimed at consumers for
health and wellness information
• English and Spanish versions as well as
“large print” and audio
• Includes health topics, drug information,
dictionaries, interactive tutorials,
directories and links to other resources
313
Tertiary Resource
MedlinePlus
• Especially good for quick overview,
including statistics, of topics and
illustrations
• Drug information includes MedMaster from
ASHP, USP DI Advice for Patients,
Natural Standard Online (for natural
products) and links to FDA and
ClinicalTrials.gov
314
Tertiary Resource
Micromedex Healthcare series
(http://www.thomsonhc.com/hcs/librarian/)
• Collection of databases that can be
searched individually or all together
contents of collection depends on your
subscription
• Includes DrugDex and Drug Consults, IV
Compatibility, PoisIndex, AltMedDex,
Martindale, Reproprisk, TOMES and
CareNotes
315
Tertiary Resource
Micromedex Healthcare series
• Use for detailed information about
medications (US and foreign) and natural
products as well as exposures to
chemicals, toxins and poisonous animals
and plants
• Lengthy bibliographies
• Instructions for citing under Warranties a&
Disclaimers link
316
Tertiary Resource
UpToDate
(http://www.uptodateonline.com/)
• Evidence-based electronic textbook of
medicine
• Lexi-Interact Drug Interactions program from
Lexi-Comp for drug interactions
• Links from drug names to Lexi-Comp drug
information within monographs
• Provides recommendations for good practice
• Graphs and tables that may be exported to
personal documents 317
Tertiary Resource
Drug and Natural Products .B
Information Resources
318
Tertiary Resource
Facts & Comparisons
(http://online.factsandcomparisons.com/)
• Collection of resources that can be
searched individually or all together –
drugs and natural products
• Includes Drug Facts & Comparisons,
Nonprescription Drug therapy, Drug
Interaction Facts, Review of Natural
Products, MedFacts Patient information
319
Tertiary Resource
Facts & Comparisons
• Print version has been gold standard for
drug information for years
• Includes comparison tables for drugs by
class or pharmacological action
• In general, references are included in the
Drug Interactions section and in drug class
monographs but not in individual drug
monographs
320
Tertiary Resource
Natural Medicines Comprehensive
Database
(http://www.therapeuticresearch.net/nd/Search.aspx?s=ND
)
• Comprehensive, evidence-based
information about herbal and dietary
supplements used in the US and Canada
• Produced by publishers of Prescribers'
Letter and Physicians' Letter
• Many products have patient handouts
321
Tertiary Resource
Natural Medicines Comprehensive
Database
• Updated daily
• Several entry points, e.g. product or
common name, scientific name, people
use
• this for, interactions with foods, herbs,
dietary supplements, lab tests, diseases or
conditions
322
Tertiary Resource
Objectives
1. List the information required to make the initial
assessment regarding the substance involved,
symptoms and previous treatment.
2. List the components of the history and describe
the techniques for obtaining this information.
A. Substance
B. Amount
C. Present medical condition
324
Objectives
3. List and describe the references used to answer
poison calls.
4. Describe the possible treatment plans.
5. Outline the follow-up to the poison call.
325
Analyzing A Poisoning Situation
V. Follow-up
IV. Treatment
Plan
III. Assessment
II. History
I. Initial
Assessment
326
I. Initial Assessment
To determine relatively quickly how serious is th
situation.
in order to set priorities and determine if
immediate first aid or referral is necessary.
There are three main aspects of this assessment:
327
I. Initial Assessment
A. Substance involved:
inherent toxicity, e.g. caustics-drain cleaner, lye.
B. Are symptoms present?
1.
2.
3.
4.
irritated, discolored or
swollen lips, gums, tongue;
coughing, convulsions,
acting unusual, can't wake up, etc.
328
I. Initial Assessment
C. What has been done?
1. is immediate first aid necessary e.g. dilution,
washing area.
2. has incorrect first aid been done e.g. salt water as
emetic.
3. is immediate ER referral indicated?
329
II. History
Complete and detailed history as possible is one
of most important factors in the assessment of
the severity of the poisoning.
In absence of symptoms, decision to initiate
treatment based on history of exposure.
330
II. History
A. Basic Information
1. Name of caller
relationship of caller to victim - parent, friend,
babysitter, MD, RN (registered nurse).
331
II. History
A.
2.
3.
4.
5.
Basic Information
Name and age of victim.
Weight of victim
Phone number
Time of exposure
how long has it been?
332
II. History
A. Basic Information
5. Time of exposure
how long has it been?
By knowing about the onset and duration of action
of the substance, one can determine whether the
symptoms are consistent with the history of the
amount and the time since exposure.
In addition, treatment recommendations, such as
whether or not to empty the stomach, may be
influenced by the length of time since ingestion. .
333
II. History
A. Basic Information
6. Route of exposure
ingestion, inhalation, percutaneous, ocular.
334
II. History
B. Substance
This information should include ingredients and
their percentages.
The substance involved may be unknown in
patients who are comatose or who ingest tablets or
capsules from an unmarked container, or who
ingest an unidentified plant.
335
II. History
B. Substance
1. Brand name and other identification nonphosphate.
warning label
formulating, e.g. phosphate.
Form, e.g. solid, liquid, gas.
concentration, e.g. industrial or household
strength.
ingredients listed.
when/where purchased?
336
II. History
B. Substance
2. Medication:
read prescription label.
is there a drug imprint code?
what was it supposed to do?
337
II. History
B. Substance
3. Plant:
which part?
has it recently been sprayed?
is nursery nearby for ID?
338
II. History
B. Substance
4. Is it possible anything else is also involved?
look around for any other open bottles, broken
plants, etc.
339
II. History
C. Amount
If an accurate determination of the amount
ingested is impossible, and the product is
potentially toxic, one must assume that a
potentially toxic amount was ingested, or that
the total amount originally in the container was
ingested.
340
II. History
C. Amount
1. Describe situation
tell me exactly what happened?
did you see him/her swallow?
2. Extract quantitative details.
how many/much was there originally?
count/measure how much is left?
when was it purchased?
used often?
341
II. History
D. Symptoms
Determine whether symptoms are consistent with the
substance involved; if not, determine what other
substances or medical conditions may be responsible
for these symptoms.
Severe signs and symptoms, such as respiratory and
cardiovascular collapse, may necessitate immediate
treatment.
Some treatment modalities are contraindicated when
certain signs or symptoms are present (e.g., emetics in
the comatose patient).
342
II. History
D. Symptoms
Present Medical condition.
does he/she take any medicine regularly?
has he/she been sick lately?
•
•
The patient's medical history may influence the
severity of the intoxication or treatment.
Some home remedies may complicate therapy whereas
other prior treatment may influence subsequent
recommendations.
343
III. Assessment
The prediction of the severity of the exposure
and the formulation of the treatment plan is
based on
• the toxicity of the substance
• the amount and mode of exposure when applied
to the specific age, weight and condition of the
victim and the circumstances of exposure.
344
III. Assessment
A. Toxicity of substance.
Consult one of the following:
poisindex
Reference texts and articles.
Manufacturer emergency number
Consultants and experts.
345
III. Assessment
B. Circumstances of Exposure
Suicide
Accidental
occupational
Environmental
Drug abuse.
346
III. Assessment
C. Competency of caller.
will they be able to carry out instructions and make
observations?
How important does caller consider exposure to be?
347
IV. Treatment Plan
The plan should consist of simple, explicit
instructions and be communicated in a clear
manner.
It is a good idea to have the caller write the
instructions down and repeat the details back to
you.
348
IV. Treatment Plan
A. No treatment necessary.
B. First aid and observe at home.
Will they be available for follow-up?
Do they understand what to watch for?
349
IV. Treatment Plan
C. Syrup of Ipecac and observe at home?
Is syrup of Ipecac available?
Is caller competent and com?
Will they be available for follow-up?
Do they understand what to watch for?
350
IV. Treatment Plan
D. Refer to MD, ER or clinic in case of
highly toxic substance; unknown substance;
unknown amount; signs symptoms not
obvious, e.g. EKG changes; unstable situation.
Arrange transportation
Call ahead.
Have they bring container, plant, etc. with them.
351
V. Follow-up:
Careful follow-up is vital to telephone
management of a poison.
Calls should be made at 1/2 hour, 2-4 hours, 12
hours or 24 hours. based on the assessment of
the poisoning and the treatment recommended:
352
V. Follow-up:
A. Has the victim remained asymptomatic?
Anything at all unusual?
Sleeping, eating, etc. normally
353
V. Follow-up:
B. Were instructions followed?
How much Ipecac did you give?
Did you give water afterward?
How long did you wash the eye?
354
V. Follow-up:
C. Was treatment effective?
Did victim vomit?
How many times?
Were pill fragments present?
Is he/she eating all right now?
355
V. Follow-up:
D. Poison prevention teaching.
Education and first aid.
Poison proof now-low the odds of a repeat.
356
V. Follow-up:
E. Referral
Public health nurse
Workers clinic
Suicide prevention
357