Drug Information PDF

DRUG INFORMATION DR. WILKINS ON LEARNING OBJECTIVES 1. Develop a consistent approach to answering drug information questions. 2. Collect accurate and comprehensive drug information from appropriate sources to make informed, evidence-based, patient-specific, or population-based decisions. 3.A...

DRUG INFORMATION DR. WILKINS ON LEARNING OBJECTIVES 1. Develop a consistent approach to answering drug information questions. 2. Collect accurate and comprehensive drug information from appropriate sources to make informed, evidence-based, patient-specific, or population-based decisions. 3.Assess the quality of the information available to answer the question. 4. Use effective written and verbal communication skills to accurately respond to drug information questions. 5. Recognize the types and examples of tertiary resources used by pharmacists. SAMPLE QUESTIONS What is the recommended treatment for otitis media in a 3-year-old? Are there boxed warnings for isotretinoin? Identify a blue oval tablet, F 8 on one side, 3 on the other side What is the correct needle length and gauge for Shingrix? What is the AWP for Clomid? How should an unused 500 mL chemotherapy infusion bag be disposed? T H E F I RST QUESTION IS NOT T H E RE AL QUESTION WO R K O N YO U R D E T E C T I V E S K I L L S BACKGROUND QUESITONS Who is asking? What are the unique Is this for a patient? circumstances? What information is needed? What is the problem? What format of reply is needed? Why is the question being asked? How will the information be used? How has the problem been What is the time factor? managed so far? What are the requestor’s Are there alternative options to expectations? explore? What is the history of the problem? CASE STUDY “Can you tell me the recommended dose of azithromycin for gastroparesis?” – Azithromycin is similar to erythromycin, a macrolide antibiotic Potential search strategy without background information – Treatment guidelines do not include azithromycin – Use tertiary first – Go to secondary to find primary Background info: – Internal medicine physician managing a patient with diabetic gastroparesis – Erythromycin national shortage – Patient factors: Complaints of abdominal pain, nausea, vomiting, decreased appetite, flatulence Taking metoclopramide 10 mg PRN 10 minutes after meals, insulin glargine at bedtime, insulin lispro at meals, lisinopril, HCTZ, atorvastatin, acetaminophen, multivitamin Type 2 DM for 13 years, peripheral neuropathy for 5 years, gastroparesis for 2 years, HTN for 8 years SH: negative for alcohol, tobacco, or other drugs Labs and vitals: 151/84 mmHg, SCr 1.3 mg/dL, A1c 9.4%, LDL 126 mg/dL, HDL CASE STUDY Disease factors – Gastroparesis involves impairment of gastric emptying caused by diabetes – Nausea, vomiting, abdominal pain and fullness – Dietary modification, medications including prokinetics and antiemetics Medication factors – Erythromycin is a macrolide antibiotic that stimulates motilin receptors leading to prokinetic effect in the gastrointestinal tract – Azithromycin is a macrolide antibiotic with fewer drug interactions and a longer half-life – Azithromycin is not included in the practice guidelines for gastroparesis – More current tertiary sources include its use with limited data to support it Analysis and synthesis – Metoclopramide is a first-line agent – Recommended dosing 10 mg up to four times daily before meals and at bedtime  STEPS TO TAKE 1. Identify the requestor with name, role, and contact information 2. Obtain background information 3. Determine the ultimate question 4. Develop a strategy and gather data to respond 5. Analyze and synthesize information 6. Provide a response and recommendation 7. Follow-up and document  CLASSIFY THE ULTIMATE QUESTION Adverse drug Drug substitution IV drug compatibility Pregnancy and reactions and stability lactation Compounding and Geriatrics Medication safety Psychiatry pharmaceutics Drug identification Immunizations Natural products Regulatory Drug interactions Infectious diseases Overdoses, poisoning, Therapeutics toxicology Drug pricing International drug Pediatrics Travel medicine information Drug shortages Investigational Pharmacology drugs DESIRED CHARACTERISTICS OF RESPONSE Timely Clear and logical Current Objective and balanced Accurate Free of bias or flaws Complete Applicable and appropriate for specific Concise circumstances Supported by the best available Answers important related questions evidence Addresses specific management of Well-referenced patients or situations (Table 2-4) TYPES OF INFORMATION LEVELS OF EVIDENCE Meta-analysis Systematic review Randomized controlled trials Cohort and Case-control studies Case series and case reports Editorials, opinions, ideas Animal research In Vitro research  TERTIARY SOURCES Compiled and summarized by an author Summary of a topic Information originates from other sources Communication about a topic to promote accessibility for the intended audience Textbooks Review articles Online resources – Micromedex, Clinical Pharmacology, Lexicomp  SECONDARY SOURCES Searchable database Catalogs information found in other sources Scaffolding to organize and locate information Specific types of source data, indexing strategies, timelines, interfaces PubMed, International Pharmaceutical Abstracts (IPA), EMBASE  PRIMARY SOURCES New knowledge Research reports Case reports Articles in medical journals that report new findings Data presented at scientific meetings TERTIARY RESOURCES BE N E F I T S L I M I TAT I O N S CHOICE Convenient Open to bias Category of information needed Accessible Out of date Peer-review Readable Errors in author Citation of evidence Speed interpretation Ease of use GENERAL DRUG REFERENCES Lexicomp Index Nominum: International Drug Micromedex Directory (names used in >130 countries) Clinical Pharmacology Martindale: The Complete Drug Reference American Hospital Formulary Service Physician’s Desk Reference/ Prescribers’ (AHFS) General Reference (PDR) Facts and Comparisons United States Pharmacopeia DRUG MONOGRAPH Compiles information about a drug Cites evidence and sources Follows a standard layout with categories of information Drug products available, dosing, indications, interactions, adverse effects, monitoring parameters, clinical studies, use in special populations, storage Examples: – Lexicomp, Micromedex OFFICIAL PRESCRIBING INFORMATION Boxed warning Drug abuse and dependence Indications and useage Overdosage Dosage and administration Description of product Dosage forms and strengths Clinical pharmacology Contraindications Toxicology Warnings and precautions Clinical studies Adverse reactions References Drug interactions How supplies/storage and handling Use in special populations Patient counseling information OFFICIAL PRESCRIBING INFORMATION Also called package insert, PI, product label, official labeling Information approved by the FDA Available in the package, on the manufacturer’s website – Drugs@FDA – Dailymed.nlm.nih.gov What about off-label indications? – Major compendia include this information  CLASSIFY THE ULTIMATE QUESTION Adverse drug Drug substitution IV drug compatibility Pregnancy and reactions and stability lactation Compounding and Geriatrics Medication safety Psychiatry pharmaceutics Drug identification Immunizations Natural products Regulatory Drug interactions Infectious diseases Overdoses, poisoning, Therapeutics toxicology Drug pricing International drug Pediatrics Travel medicine information Drug shortages Investigational Pharmacology drugs CATEGORIES Adverse effects Meyler’s Side Effects of Drugs FDA Adverse Event Reporting System (FAERS) Vaccine Adverse Event Reporting System (VAERS) Dietary and herbal National Institutes of Medicine Office of Dietary Supplements database supplements Natural Medicines Drug identification Ident-a-drug (based on product Identidex description) Lexi-Drug ID Drug interactions Hansten and Horn Drug Interaction Facts Stockley’s Drug Information IV compatibility Handbook on Injectable Drugs King Guide Trissel’s Stability of Compounded Formulations CATEGORIES Pregnancy and Briggs Drugs in Pregnancy and Lactation Lactation LactMed Drugs and Lactation Database Reprotox, Reprorisk within Micromedex Pediatric Harriet Lane Handbook Therapeutics – Applied Therapeutics organized by disease Harrison’s Principles of Internal Medicine The Merck Manual of Diagnosis and Therapy Pharmacotherapy: A Pathophysiological Approach (Dipiro) UpToDate Dynamed Toxicology Casarett & Doull’s Toxicology: The Basic Science of Poisons Goldfrank’s Toxicologic Emergencies Veterinary Medicine American Veterinary Medical Association Animal Poison Control Center FDA Green Book Plumb’s Veterinary Drug Handbook PATIENT QUESTION “Do you think Adderall is causing my headache? I can’t stop taking it, so will Tylenol PM help me get some sleep?” DI QUESTION This 26 YO white male patient lists a medical history of Adderall XR 20 mg once daily for 2 weeks. Social history includes stress related to his work that requires long hours of concentration, alcohol intake of 2-5 drinks per day, caffeine intake of 2-4 drinks per day. “Do you think Adderall is causing my headache? I can’t stop taking it, so will Tylenol PM help me get some sleep?” Classify the types of information needed Identify sources to use Write out relevant information Begin to formulate a response