Drug Information Resources PDF

Drug information resources Moetaza Soliman, PhD  Introduction Pharmacy is an “information-heavy profession” Pharmacists (chemists or druggists), are healthcare professionals who practice in pharmacy, the field of health sciences focusing on safe and effective medicat...

Drug information resources Moetaza Soliman, PhD  Introduction Pharmacy is an “information-heavy profession” Pharmacists (chemists or druggists), are healthcare professionals who practice in pharmacy, the field of health sciences focusing on safe and effective medication use. Pharmacists are drug information experts.  Drug information Drug information is the process of providing information on the safe and effective use of therapeutic and diagnostic pharmaceuticals. It is the provision of providing unbiased, well- referenced, and critically evaluated information on any aspect of pharmacy practice. There are many drug information resources, the selection of the resource depends on the question asked.  Functions of a Pharmacist as a drug information source Provide drug information by: – answering information requests – writing patient specific consultations – communicating information that wasn’t requested, but is necessary – developing criteria/guidelines for drug use  Types of drug information resources Primary resources Primary Secondary resources Secondary Tertiary resources Tertiary  Generally, the best method to find drug- related information Tertiary includes a stepwise approach moving first through: Secondary Tertiary References Then Secondary References and Primary Finally Primary References  Primary Resources Original research articles – Clinical trials – Cohort studies Conference Papers/Posters Dissertations/thesis Patents  Secondary Resources Review articles – Literature reviews – Meta-analyses Guidelines Indexing sources Abstracting sources  Tertiary resources Textbooks Handbooks Drug Compendia Reference books  Which ones to use? Use in backwards order. Tertiary Secondary Primary Tertiary resources when: – The answer to a question is basic factual knowledge – The question was studied extensively and a conclusion was made Secondary and primary resources when: – A question is new and has never been studied – There is agreement among experts; various opinions are found  Drug information centre (DIC) Drug information centre is a centre to provide drug information. The service should include collecting, reviewing, evaluating, indexing and distributing information on drugs to health workers. Types of DIC – Hospital-based – Industry-based – Community-based  Functions of DIC Answering health care professionals’ questions: – One of the 5 R’s: - Right drug, Right dose, Right dosage form, Right route, Right patient). – Drug Interaction – Availability / Substitute – Drug Identification – Formulary Decision – Adverse Drug Reaction – Investigational Drug Program – Education and Training  Poison control centre Toxicology services provide information and advice on the diagnosis and treatment of poisonings. Poison centres are similar to drug information centres but differ in: – need more rapid response – need clinician beside pharmacist (to treat patients with poisoning) – are best located within hospitals Function of poison control centres They must be able to respond to requests for information on the acute management of poisoning and know when to refer potentially severe cases. Study the causes and incidence of poisoning in the population. General aim to reduce the incidence of poisoning in the population.  Answering a medication related question There a variety of information resources to help you answer questions about drugs and pharmacy practices. Basics steps: 1. Identify ultimate questions 2. Classify questions to make retrieval easier 3. Use resources to answer questions A seven step approach to address a medication related question Step 1 Obtain requester demographics Step 2 Obtain patient background information Step 3 Identify and classify the ultimate question Step 4 Systematic search for information Step 5 Evaluate and analyse information found Step 6 Provide response Step 7 Follow up and document  1. Requester demographics Allows you to assess the level of understanding of the requester. Other health care provider or lay public. Further questions are needed to assess the background level of a health care provider. How best to communicate phone, fax, email. Assess urgency of the request (verbal or written response). 2. Patient background information Age, gender, weight Specific medical diagnosis Relevant laboratory data Relevant past medical history, family and social history Current medication list (prescription, non- prescription, herbal, natural) Allergies.  Why patient information? Suppose a dentist contacts a pharmacist to ask if carvedilol (a beta-blocker used to treat heart failure and hypertension) is associated with development of gingival hyperplasia (gums overgrowth). The pharmacist looked up carvedilol in a tertiary recourse and he does not found gingival hyperplasia listed as an adverse effect for carvedilol and provided this information to the dentist. The dentist accepted the response.  Is there a potential problem? The pharmacist provided correct information. But the patient problem is not solved. The pharmacist should have asked about patient information to meet the dentist needs. The following dialogue represent important patient information questions.  How long has the patient had gingival hyperplasia? Not sure, but in the patient last visit one year ago there was no signs of gingival hyperplasia. How long has the patient been taking carvedilol? Six months. What other medication is the patient taking? Amlodipine. How long has the patient been taking amilodipine? Over a year. how old is the patient? 54 years old? The pharmasist checked amilodipine and found that is linked to gingival hyperplasia and could be the cause of the patient problem. (The patient problem solved).  3. Identify the ultimate question The Ultimate Question is the actual question for which you are seeking an answer. In the previous case the ultimate question was: – Is any of carvedilol and/or Amlodipine associated with development of gingival hyperplasia?  Scenario: This patient is taking drug A and drug B. Does that seem curious or unusual to you? There are many preliminary questions arise in this scenario: – What is drug A? how does it work? – How is drug A administered? – Is drug A a brand name or a generic? – How is drug A absorbed by the body? – The same questions for drug B  You need to answer these questions first so you can answer the ultimate question. You found drug A was Alendronate which is a bisphosphonate. It works by slowing bone loss. Drug B was calcium carbonate. The ultimate question is: – Are there any known interactions between alendronate and calcium carbonate?  3. Classify the ultimate question Once the ultimate question was identified, it should be classified so we know where to find the answer. Common classification: – Adverse effects – Therapeutic use – Pharmacokinetics – Dosing/administration – Drug interaction – Availability  4. Systematic search for information At least 2 (if not more) tertiary resources should be consulted. There is no grantee that the information in a tertiary recourse is accurate or complete. Check for the most updated resource. There is lag time between the prepared and published information.  5. Evaluate and analyse information found Before giving your response evaluate the information you found: – Was the appropriate resource used? – Was the resource updated? – Is this information found covering the needs of the requester? – Will this information be fully understood? – Is the patient problem solved?  6. Provide response Response should consider the level of the requester. Good communication skills should be applied. Verbal response: confident, clear, correct pronunciation. Keep a dialogue in delivering the response to allow any new rising questions to appear and then try to answer them following the same way.  7. Follow up and document Follow up is necessary especially if you used a primary resource and new publication arose then you must update the requester. Documentation is necessary as clinician responsibility and patient care provision. Document the question, the requester contact information, the response, the reference used.  Practice questions 1. You are asked the following question by a clinician: "What is the risk of taking lisinopril during pregnancy?" What additional background questions should be asked to clarify this question? Additional questions should be asked such as: – Is the patient currently pregnant or planning on becoming pregnant? – What is the lisinopril being used to treat (e.g., hypertension, proteinuria, heart failure)? – What trimester is the patient in and when during the pregnancy did she receive lisinopril? – How long did the patient receive lisinopril and at what dose? 2. A physician has a patient taking insulin. He wants to know what the incidence is of a hypersensitivity reaction to insulin. What additional questions would you ask this physician to clarify the information need further? – Did this patient experience a hypersensitivity reaction while using insulin? – What other medications was the patient taking when the hypersensitivity reaction occurred? – What type of insulin is the patient taking? – How long has the patient been taking the insulin and any other medications? – What dose of insulin and any other medications is the patient taking? – what at the temporal relationship with insulin and any other medications – What were the characteristics of the hypersensitivity reaction? – Has the patient ever experienced a similar type of reaction previously? Thank you