Transcript 2- Tertiery Resources.

Tertiary Resource
1
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 computerized data bases.
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Introduction
professional literatures
Tertiary
Secondary
Primary Sources
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Introduction
Primary Resources
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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)
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Introduction
Primary Resources
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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 information
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Introduction
Secondary Resources
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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.
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Tertiary Resources
“Literatures”
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Definition
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Tertiary literature is core knowledge established via
primary literature or accepted as standard of practice
within the medical community.
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Introduction
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tertiary resources include textbooks, monographs,
compendia, handbooks, and published symposia.
They represent the condensation of basic facts
originally published in the primary literature.
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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
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Advantages
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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.
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Disadvantages
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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
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Disadvantages (cont.)
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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.
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Disadvantages (cont.)
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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.
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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-to-date are
they?
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Evaluation of tertiary
resources (cont.)
6.
7.
8.
To assess consistency, compare information presented in one
text to the same information presented in another text.
Is the reference likely to contain information relevant to the
subject being researched?
Is the reference clear, concise and easy to use?
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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.
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Classification of Tertiary
Resources
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Tertiary drug
information resources
Specialized
references
General references
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A. General References
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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.
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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.
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The most helpful of them to answer a
drug related questions are:
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Martindale’s The complete drug
reference
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Martindale’s The complete drug reference
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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.
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Drug Facts and Comparisons (F&C)
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Drug Facts and Comparisons (F&C)
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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
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Mosby’s Drug Consult
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Mosby’s Drug Consult
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Frequently used brand and generic drugs
Available at www.merckmedicus.com
Annual update
Additional information:
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Drug identification, look-alike/sound-alike
Manufacturer information, discontinued Products
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American Hospital Formulary
Service (AHFS) Drug Information
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American Hospital Formulary Service
(AHFS) Drug Information
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Arranged by AHFS classification number
Monographs listed alphabetically
Information in monograph:
 Chemistry, pharmacology, mechanism
 Dose, administration, pharmacokinetics
 Drug interactions, preparations, toxicity
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(AHFS) Drug Information
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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
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USP Dispensing Information (USP DI)
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USP Dispensing Information (USP DI)
Three volumes
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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:
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Monitoring
Adverse drug events
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USP Dispensing Information (USP DI)
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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
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USP Dispensing Information (USP DI)
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Off-label uses indexed by drug and by indication
Not referenced, lag time, only FDA-approved
uses, inconvenient to compare agents in the same
therapeutic class
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Drug Information Handbook (Lexi-Comp)
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Drug Information Handbook (Lexi-Comp)
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Pocket-sized; PDA & online versions are also available
Published annually
Drugs listed alphabetically by generic name
Useful charts and tables.
Specialty versions are available:
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Pediatric, psychiatric, geriatric
Not referenced
Lists all reported adverse events but does not always provide
the incidence
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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:
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DRUGDEX® - main drug information database
DISEASEDEX® - disease states
IDENTIDEX® - drug identification by imprint code
POISINDEX® - poisoning and toxicology
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Martindale’s – foreign drugs
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Physicians’ Desk Reference (PDR)
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Physicians’ Desk Reference (PDR)
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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
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Drug Topics Red Book
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Drug Topics Red Book
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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 annually with monthly updates
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B. Specialized References
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Pharmacotherapy
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Pharmacotherapy: A
Pathophysiologic Approach (Dipiro)
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Pharmacotherapy: A Pathophysiologic
Approach (Dipiro)
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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.
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Applied Therapeutics: The Clinical
Use of Drugs (Koda-Kimble)
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Applied Therapeutics: The Clinical Use
of Drugs (Koda-Kimble)
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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.
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The Washington Manual of Medical
Therapeutics
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Quick reference with many charts and tables.
Updated about every 2 to 3 years.
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Internal Medicine
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Harrison’s Principles of Internal
Medicine
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Gold standard for internal medicine
Published every 5 years, referenced
Pathophysiology, clinical presentation, diagnosis and treatment
guidelines
Little drug information & dosing recommendations
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The Merck Manual
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Used by many healthcare professionals
Also includes pediatrics, gynecology, psychiatry,
ophthalmology, otolaryngology, dental disorders
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Clinical Medicine (Kumar &Clark )
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Clinical Medicine (Kumar &Clark )
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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.
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Clinical Medicine (Kumar &Clark )
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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……
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Cardiology
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Textbook of Cardiovascular Medicine
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Published every 5 years.
Good illustrations.
Addresses modern-day issues such as medical economics and
assessing quality of care.
Well-referenced.
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Hurst’s The Heart
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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.
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Pediatrics
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Harriet Lane Handbook
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Harriet Lane Handbook
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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
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Pediatric Injectable Drugs (“Teddybear Book”)
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Alphabetical order by generic name
Formerly known as Guidelines for Administration of
Intravenous Medications to Pediatric Patients
Dose, concentration, rate, cautions
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Pediatric Dosage Handbook (Lexi-Comp)
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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
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Pregnancy
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Drugs in Pregnancy and Lactation (Briggs)
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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
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Infectious Diseases
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Mandell’s Principles and Practice of
Infectious Disease
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Gold standard reference
Infection, diagnosis, treatment and useful background
information
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Sanford Guide to Antimicrobial Therapy
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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
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Oncology
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Cancer: Principles and Practice of
Oncology (devita)
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Gold standard, published every 3 to 4 years
Pathology, treatment options, & adverse effects
Referenced
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Cancer Chemotherapy Handbook
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Useful index, introduction on malignancies
Pharmacology and use of chemotherapeutic agents
Lists investigational drugs and combinations
Well-referenced
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Pharmacology
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Goodman & Gilman’s Pharmacological
Basis of Therapeutics
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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)
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Drug Interactions
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Hansten and Horn's Drug Interactions
Analysis and Management
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Loose-leaf format, updated
Introductory chapter discusses mechanisms of
interactions
Rates significance of interaction and recommends
management
Referenced
Not complete, subjective rating system
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Drug Interaction Facts
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Published by F&C
Alphabetical by drug name
Referenced
Provides information regarding:
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Significance and severity
Onset of interaction
Documentation
Not complete, subjective rating scale
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Stockley's Drug Interactions
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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
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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
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Adverse Drug Reactions
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Meyler’s Side Effects of Drugs
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Meyler’s Side Effects of Drugs
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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:
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Effects on organs and systems, lab/diagnostic interference,
withdrawal and overdose
May not be complete, references for widely known
effects are not included
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Compatibility and Stability
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Handbook on Injectable Drugs
(Trissel’s)
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Handbook on Injectable Drugs (Trissel’s)
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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
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King Guide to Parenteral Admixtures
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Chart format, loose-leaf
Alphabetical listing by generic name
May have information not available in Trissel’s
Pages are not numbered
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IV INDEX®
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Component of MICROMEDEX®
Easy to use
Information taken mostly from Trissel’s
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Compounding and Pharmaceutics
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Remington’s The Science and Practice
of Pharmacy
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Helpful for extemporaneous compounding
Pharmaceutical calculations, chemistry, radioisotopes
New edition every 5 years
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Merck Index
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Chemical name, formula, & structure
Physical data, therapeutic category
Published every 6 to 10 years
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United States Pharmacopeia – National
Formulary (USP-NF)
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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
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Pharmacokinetics
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Basic Clinical Pharmacokinetics (Winters)
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Case-study format
Includes principles of monitoring therapy, basic
pharmacokinetics, & clinical applications
Appendix of commonly used equations
Mostly theory, little patient integration
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Applied Pharmacokinetics: Principles of
Therapeutic Drug Monitoring
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Published by Applied Therapeutics
Most advanced reference
More specific drug information than Winter’s
Includes analytical methods and clinical
applications
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Toxicology
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Toxicologic Emergencies (Goldfrank’s)
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Poison management guidelines
Useful tables and case studies
Practice multiple-choice questions
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Casarett & Doull's Toxicology: The
Basic Science of Poisons
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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.
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®
POISINDEX
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Toxicology component of MICROMEDEX®
Search by brand or generic name
Describes what substance looks like, any imprint
codes, management of toxicity
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Other Toxicology Books
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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
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Other Toxicology Books
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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)
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Other Toxicology Books
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Clinical Toxicology of Commercial Products
(Hardcover) by Robert E. Gosselin, Roger P.
Smith, Harold C Hodge, Jeannet Braddock
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Drug Identification
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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
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4. British National Formulary
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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.
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5. Saudi National Formulary
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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.
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5. Saudi National Formulary (cont.)
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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
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5. Index Nominum: International
Drug Directory
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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
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5. Index Nominum: International
Drug Directory
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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
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Non-Prescription Products
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PDR for Nonprescription Drugs and
Dietary Supplements
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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
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Handbook of Nonprescription Drugs
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Useful tables and comparisons
Includes:
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Patient assessment and counseling guidelines
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Pathophysiology and treatment options
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Dosing, adverse events, & interactions
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Natural Products
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Lawrence Review of Natural Products
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Comprehensive and up-to-date information
Published by F&C
Monthly updates
Provides uses, toxicity, & patient info
Scientific approach to herbal products
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Electronic Tertiary
Resources
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A. Multipurpose Resources
(disease and drug information)
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Access Medicine
(http://www.accessmedicine.com/)
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Collection of textbooks, clinical practice guidelines,
news
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Includes: Goodman & Gilman, Harrison’s, Current
Medical Diagnosis & Treatment, and the Lange series.
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Drug monographs (include images, chemical
structures, patient education materials) provided by
Gold Standard™
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Patient education handouts on common medical
problems provided by Postgraduate medicine
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ClinicalResource@Ovid
(http://clinicalresource.ovid.com/autologin.html)
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Collection of books, clinical practice guidelines,
patient education materials and links to databases
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Includes: Clin-eguide, Facts and Comparisons and 5Minute Consult series
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MD Consult
http://home.mdconsult.com/groups/uwash8783.html)
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Collection of textbooks, journals, drug information,
guidelines, patient education handouts, news and
updates
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Drug information and updates from Mosby’s drug
Consult, package insert information, FDA
information
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Customizable patient handouts – diseases and drugs
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118
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
Tertiary Resource
119
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
Tertiary Resource
120
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
Tertiary Resource
121
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
Tertiary Resource
122
UpToDate
(http://www.uptodateonline.com/)

Evidence-based electronic textbook of medicine

Lexi-Interact Drug Interactions program from LexiComp 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
Tertiary Resource
123
B. Drug and Natural Products
Information Resources
Tertiary Resource
124
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
Tertiary Resource
125
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
Tertiary Resource
126
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
Tertiary Resource
127
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
Tertiary Resource
128