Drug Information Resources

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Drug Information Resources

• Joe Pozdol, MLIS
• Norris Medical Library
• pozdol_at_usc.edu

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Learning Goals

• To understand the magnitude of health information
  available today
• To be able to classify questions as background or
  foreground
• To understand the differences between primary,
  secondary, and tertiary resources
• To be able to determine ultimate questions and
  classify them by drug information type
• To be able to use Drug Facts and Comparisons,
  Epocrates, Lexi-Comp, Micromedex, and Clinical
  Pharmacology

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The Growth of Medical Information
Indexed Citations Added to MEDLINE (i.e. PubMed)
by Fiscal Year
U.S. National Library of Medicine. National
Institutes of Health. Reviewed 25 March
2009.http//www.nlm.nih.gov/bsd/stats/cit_added.h
tml1
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How does one navigate the information overload
without getting overwhelmed and confused?
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Partner Introductions
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Pair Activity Assessing What You Already Know
For a drug information question, which would you
consult? List a pro and a con for each resource.
Journal
Textbook
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Background v. Foreground Questions
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Background Questions

• Question is broad in scope
• Answer is general knowledge in field
• Can best be addressed with tertiary resources
• E.g. Is a drug available in the U.S.?
• What is a drugs mechanism of action?
• When is a drug contraindicated?

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Foreground Questions
Question is narrow in scope Answer may require
examining new or conflicting evidence Can best
be addressed with secondary and primary
resources E.g. How
effective is a new drug when compared to
drugs that are already on the market? Are
there clinical trials supporting an off-label use
of a drug in a specific
population?
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Resource Types Primary Secondary Tertiary
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Primary Resources

• Scientific journals
• Provide original studies or reports
• E.g. Clinical trial, case series, case report
• Good for foreground questions
• Scope is narrow
• Good when topic is new or new data has been
  published

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Primary Resources

• Pros
• Most current evidence
• Provide data on new drugs
• Can personally assess validity of studies
• Cons
• May not lead one to best decision because of
  limited scope
• Data can be poor or controversial
• Every study has limitations
• Too complex for patients

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Secondary Resources

• Bibliographic databases that provide abstracts or
  full-text of studies
• Good for foreground questions

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Secondary Resources

• Pros
• Can construct searches to find specific
  information
• at high granularity
• Cons
• Often require more expertise to use than
  primary or tertiary
• resources
• Retrieved references must be filtered for
  quality
• Must track down resources before looking for
  answers
• Too complex for patients

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Tertiary Resources

• Compilations of knowledge in the field
• E.g. Textbooks, handbooks, online drug compendia
• Good for background questions
• Scope is broad

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Tertiary Resources

• Pros
• Provide comprehensive information
• Information reflects views of multiple experts
  in field
• Fast, easy to use, and may be good for patients
• Cons
• Usually at least 2 years out of date by
  publication
• High dependency on interpretation of authors
• Pharmacists can address this by consulting at
  least
• 2 tertiary resources to find corroborating
  information

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• When trying to answer a clinical question, the
  best strategy is often to consult resources in
  the following order
• Tertiary, Secondary, Primary
• Tertiary resources are good when
• The answer to a question is basic factual
  knowledge in the field
• The question was studied extensively and a
  conclusion was made
• Many experts have addressed the question and
  agree on answer
• Secondary and primary resources are good when
• A question is new and has never been studied
• There is no consensus among experts various
  opinions abound
• There is conflicting evidence and the question
  needs further study

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Resource Table
Primary Resources JAPhA JAMA Pharmacotherapy New England Journal of Medicine Annals of Internal Medicine AJHP
Secondary Resources PubMed/Ovid MEDLINE Cochrane Database of Systematic Reviews DARE TRIP National Guideline Clearinghouse
Tertiary Resources Access Pharmacy UpToDate Drug Facts and Comparisons Epocrates Lexi-Comp Micromedex Clinical Pharmacology
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Determining the Ultimate Question
Real Estate Agent Last Dec.

• 44 y.o. male
• High blood pressure
• Rx ACE inhibitor
• Develops dry cough

Ultimate Question
Is cough a side effect of ACE inhibitors?
Question Type
Background
Resource Type
Tertiary
Major Concepts (i.e. search terms)
ACE inhibitors, side effects, cough
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Categorizing the Ultimate Question

• Adverse effects
• Availability
• Compatibility/stability
• Compounding
• Dosing/administration
• Drug interaction
• Herbal

Identification Pharmacokinetics Pharmacology Poiso
ning/toxicology Pregnancy/lactation Therapeutic
use
Especially relevant for Medication Therapy
Review assignment
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Pair Activity
List 3 facts about Ambien (Zolpidem Tartrate) OR
Insomnia
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Drug Facts and Comparisons

• Search for information about Ambien (Zolpidem
  Tartrate)
• www.usc.edu/nml

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Pair Activity
List 3 facts about Proventil (Albuterol Sulfate)
OR Asthma
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Epocrates

• Search for information about Proventil (Albuterol
  Sulfate)
• www.usc.edu/nml

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Pair Activity
List 3 facts about Zoloft (Sertraline
Hydrochloride) OR Depression
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Lexi-Comp

• Search for information about Zoloft (Sertraline
  Hydrochloride)
• www.usc.edu/nml

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Pair Activity
List 3 facts about Aricept (Donepezil
Hydrochloride) OR Dementia
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Micromedex

• Search for information about Aricept (Donepezil
  Hydrochloride)
• www.usc.edu/nml

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Pair Activity
List 3 facts about Zyrtec (Cetirizine
Hydrochloride) OR Allergies
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Clinical Pharmacology

• Search for information about Zyrtec (Cetirizine
  Hydrochloride)
• www.usc.edu/nml

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Topic Recap

• Excess of Medical Info
• Background v. Foreground
• Tertiary, Secondary, Primary
• Ultimate Questions
• Drug Facts and Comparisons
• Epocrates
• Lexi-Comp
• Micromedex
• Clinical Pharmacology

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The Big Picture
Addressing a Drug Info Need

1. Obtain background info/understand context
2. Determine ultimate question
3. Select and search appropriate resources
4. Evaluate and analyze information found
5. Draw conclusion and formulate response

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Medication Therapy Review Assignment
Due Dec. 4

• References used to support recommendation

Student 1 Google Wikipedia
WRONG
Student 2 Drug Facts and Comparisons
Lexi-Comp
RIGHT
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• Please fill out an evaluation

Class Drug Info Resources Date
9/11/09 Instructor Joe Pozdol