Download - Using Drug Resources
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USING DRUG RESOURCES
Nancy Clark, M.Ed, Director Medical Informatics Education
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Objectives
• Find the Drug Reference Library web page• Identify teaching opportunities for medical students around drug questions
• Locate basic prescription, OTC and herbal drug information (dosage, indication, etc.) online and on the PDA
• Identify the types of information and tools in the resources
• Utilize drug tools (interactions, calculators, pill ID, …)
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Handouts• Evaluations – please complete pre-workshop evaluation
• Drug References Handout• Worksheet
Top 200 Drugs Prescribed www.rxlist.com
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Library Web Site
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Subscription Drug Resources• Access Medicine’s Drugs (Lexi Drug) • Dynamed• Epocrates Online or App • Facts and Comparisons (web)• Harriet Lane• Johns Hopkins ABX guide • PEPID • Clinical Key (Clinical Pharmacology)• Natural Medicines• Pediatric Care Online • Journals, News and periodical databases
• Prescriber’s Letter• Medical Letter
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Mobile Drug Resources Apps
• Epocrates Essentials • Dynamed• Johns Hopkins ABX Guide (uCentral)• Harriet Lane (uCentral)• Medical Letter• Natural Medicines Comprehensive Database• Pediatric Care Online • PEPID Available free to all faculty
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Free Drug Resources• Medscape (App)• Micromedex (App) ($2.99)• CDC Vaccinations (App) • CDC Travelers' Health http://wwwn.cdc.gov/travel/
• Toxnet (poisons and toxic agents)http://toxnet.nlm.nih.gov/
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Student Issues• Taught generic names• Preceptors/clerkship faculty use brand names• Don’t learn dosing in Pharmacology. Get a little in D2.
• When do they learn how to write a prescription? D3
• Do not understand abbreviations (PO, PRN, etc.)• Renal and hepatic dosing introduced 2nd yr• What weakness do you see with students?• What kinds of questions do you ask students to look up regarding drugs?
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Who Has What?
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EPOCRATES
P Rx Monographs
P OTC Monographs
P Alt Meds Monographs
P Drug Interaction Tool
P Drug Costs
P Dosage Calculator
P Formulary Tool
P Pill Identifier
P Antibiotics Guide
P Immunizations
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Content Differences
Epocrates Online
• Drugs• Diseases• Interaction Checker• Medcalc 2000• Pill ID• Tables• Selected Patient
Education Resources
Epocrates App
• Drugs• Diseases• Interaction Checker• Limited Calculators• Pill ID• Tables• Lab Manual• Infectious Disease • ICD-9 and CPT codes• Guidelines
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Epocrates Drug Monographs• Rx – OTC – Alt• Costs provided• Patient Ed Handouts online only
• Dosage Calculator linked to dose/kg in app
• Pill pictures require internet connection on app
• Teaching opportunities:• Prescription writing• Pill pictures => patient’s
ability to swallow• Abbreviations – in Help
menu• Review pharmacology• Evaluating patient’s
adverse reactions
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Alt Meds OTCRx
Comparing Sub Categories
Add to Favorites
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Exercises for Practice
Using Epocrates • What is the starting dose of lisinopril to treat HTN if the patient is not on a diuretic? (dose)
• How much does one month supply of Cymbalta 60 mg (30-ea) cost?
• What are the off label indications for Ativan (adult)? ( indicates off label)
• How do you write a prescription for 750 mg PO q12 of ciprofloxacin for a patient that can’t swallow large pills?
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Dosage Calculators in Epocrates• Mobile and online Dosage Calculator
• http://www.medcalc.com/pedidose.html
• Teaching opportunity• Considerations
• Liquid vs tablet…• Forms available
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Epocrates MultiCheck• OTC, Alt meds, Rx and limited foods
• Teaching opportunity• Classifications
• Caution • Monitor• Avoid/Use Alternative• Contraindicated
• Include patient’s OTC, alt meds, & foods in check
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Exercises for Practice
• Epocrates PDA: lisinopril, metformin, Tylenol Cold and Flu Severe, and hydrochlorothiazide
• Add lithium
• Peds example: isoniazid, rifampin, ethambutol, acetaminophen
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Epocrates Formularies• All available online• Must select payers to put on mobile devices• Go to Epocrates.com• Manage My Account• Pick Formularies• Sync/update to add
• Teaching Opportunity• Find alternatives • Discuss considerations
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Another Formulary Option2015 22
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Medscape Mobile Version• Now contains formularies
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Exercises for Practice
• Using Formulary Tools on Epocrates online or app
• I have a patient with H. Pylori who has BCBS of GA 3 Tier who needs a low copay. Which of the treatments are covered by BCBS low copay? Look up drugs by class > gastrointestinal> H. Pylori.
• I have a depressed patient with no health insurance who is indigent. Which SSRI can they get for $4 at Target?
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Exercises for Practice
• A 65 year-old female with osteoporosis is on Boniva. She has recently changed to AARP Medicare Complete MA. Can she continue taking Boniva? Are there lower cost choices?
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Epocrates Pill Identifier• Brand names easy• Generics iffy• Teaching opportunity
• Sack of pills• Use different resources• Imprints work best• If Epocrates doesn’t
have it, try Pepid or Facts and Comparisons
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Exercises for Practice
• What is this pill?
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Epocrates Tables• Lots of teaching opportunities• Vaccinations• Drug/dose comparisons:
topical steroids, opiates, ACE
• Give students time to look up
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Exercises for Practice
• Using any of the Immunizations tools:• Patient has planned a mission trip to Central America. What immunizations does she need?
• Patient has a rash on hands, likely contact derm, but 1% OTC hydrocortisone not working. What topical steroid should we try next?
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Epocrates Infectious Disease (ID) Tool• Look up Dx only• Treatment choices:
• Empiric• Specific to bug• Other Info
• Linked to drug monographs (blue)
• Teaching opportunities:• Depends on level of student (Yr1
vs Yr2/3)• Emphasize allergies, side effects,
Pregnancy class
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PEPID Drug Information and tools
P Rx Monographs
P OTC Monographs
P Alt Meds Monographs
P Drug Interaction Tool
Drug Costs/Formulary
P Dosage Calculator
P Drug Allergy Checker
P Pill Identifier
P IV Compatibility
P Immunizations
P Beers List
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PEPID Drug Monographs• OTC, Alt and Rx• Adverse reactions include
%ages• Interactions not listed, must use
interaction tool.• Kinetics/Dynamics included • Include evidence-based inquiries• Tap dose to get dosage
calculator• Overdose mgmt included
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PEPID Drugs• Teaching Opportunities
• Generic/Brand names…Trade names listed for all generics.
• Getting a side effects history…Frequency of side effects
• Overdose management issues• Contraindication considerations (much more detail)
• Kinetics/Dynamics• Geriatric considerations (send to Beers List)
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Exercises for Practice
• Using PEPID online or PDA• What percentage of people will have dizziness while taking Topamax?
• What are the symptoms of a Prozac OD?• You have a child with otitis media for whom you need to give PO amoxicillin. The child weighs 62 Lbs. How many ml of 250 mg/5 ml should you prescribe per dose?
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PEPID Interaction Tool• 1 – 5 point system for severity
• 1-Minor or non-significant interaction• 2-Significant interaction possible,
monitor closely• 3-Possible serious or life-threatening
interaction. Monitor closely. Use alternatives if available.
• 4-High likelihood serious or life-threatening interaction. Contraindicated unless benefits outweigh risks and no alternatives available.
• 5-Never use combination.
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Exercises for Practice
• digoxin, furosemide, lisinopril, grapefruit
• lisinopril, metformin, hydrochlorothiazide, alcohol
• Peds example: isoniazid, rifampin, ethambutol, acetaminophen
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Immunizations2015 37
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FACTS andCOMPARISONS
P Rx Monographs
P OTC Monographs
P Alt Meds Monographs
P Drug Interaction Tool
Drug Costs
Dosage Calculator
Formulary Tool
P Pill Identifier
Antibiotics Guide
P Immunizations
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Facts and Comparisons eAnswers• Online only• Detailed• For pharmacists• Research presented• Comparison tables• Nice tools
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Browse Resources
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Facts and Comparisons eAnswers
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Browse Resources
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Search Facts and Comparisons• Use search box to get to drug or class monographs
• Advanced search to select specific or all resources
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Drug Facts and Comparisons Monographs• Collapsed when opened• Show All/Hide All buttons• Linked to Class Monograph and Tables and breadcrumbs
• Patient Handouts• Contain aftermarket adverse reactions• Evidence of efficacy• Patient Information includes advice to patient about this drug.
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Classifications2015 43
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Tables in Facts and Comparisons• Teaching opportunities
• Renal dosing• Compare drugs in class:
Adverse EffectsIndicationsDrug-PregnancyDrug-LactationContraindications/PrecautionsDrug-Drug InteractionsDrug-Food InteractionsDrug-Alcohol Interactions
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Exercises for Practice
• Using Facts and Comparisons Online
• Is it possible that Wellbutrin causes tinnitus? (hint: CTRL-F)
• Which of the proton pump inhibitors are used off label for GERD in children?
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Facts Drug Interactions• Can enter patient age, gender, drugs, allergies, and condition
• Information very detailed• Each interaction linked to a monograph• Each monograph included Significance, Onset, Severity (3 levels) and the level of documentation of this interaction.
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Exercises for Practice
• digoxin, furosemide, lisinopril• lisinopril, metformin, and hydrochlorothiazide
• Peds example: isoniazid, rifampin, ethambutol, acetaminophen
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JOHNS HOPKINS ABX uCentral Web and Mobile
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Johns Hopkins ABX Guide• Look up by bug, drug or disease
• Section on Vaccines includes vaccine/drug interactions, contraindications
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Pathogen vs Condition vs Antibiotic
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DYNAMED- EVIDENCE BASED
P Rx Monographs
P OTC Monographs
P Alt Meds Monographs
Drug Interaction Tool
P Drug Costs
Dosage Calculator
Formulary Tool
P Patient Ed Handouts
Antibiotics Guide
Immunizations
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Dynamed Drug Topics• Like disease topics, reviews of
current literature• Reviews linked to Pubmed with
FSU Button to full text articles• Dates of updates posted• Linked to Patient Education
Reference Center Handouts• Comparative pricing under
Preparations
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Dynamed• 1000 drug monographs
• Evidence-based, reviews of efficacy, levels of evidence provided
• Linked to disease content,
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Dynamed Teaching Opportunities• Renal impairment dosing (Dosage: Special Populations)
• Geriatric dosing• What is the evidence for using that drug?
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ACCESS MEDICINE
P Rx Monographs
P OTC Monographs
Alt Meds Monographs
Drug Interaction Tool
P Drug Costs
Dosage Calculator
Formulary Tool
Pill Identifier
Antibiotics Guide
Immunizations
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LexiDrugs in Access Medicine• Access Medicine Lexi Drug Content (Rx and OTC)
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ClinicalKey
P Rx Monographs
P OTC Monographs
P Alt Meds Monographs
Drug Interaction Tool
Drug Costs
Dosage Calculator
Formulary Tool
Pill Identifier
Antibiotics Guide
Immunizations
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ClinicalKey Drug Monographs• From Gold Standard
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NATURAL MEDICINES
Rx Monographs
OTC Monographs
P Alt Meds Monographs
P Drug Interaction Tool
Drug Costs
Dosage Calculator
Formulary Tool
Pill Identifier
Antibiotics Guide
Immunizations
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Natural Medicines• Online and mobile• Effectiveness Checker• Drug Interaction Checker• Nutrient Depletion Checker includes prescription drugs
• Clinical management series offers CME
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Natural Medicines Effectiveness • Select condition• Provides clinical evidence for natural therapies broken down by:• Likely effective• Possibly effective• Possibly ineffective• Likely ineffective • Insufficient evidence
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Interaction Checker• Enter prescription meds, foods, OTC multi-ingredient products, and alt meds
• Breaks down all ingredients• Lists all interactions
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Exercises for Practice
• Drug interactions: lisinopril, metformin, hydrochlorothiazide and Airborn
• What is the evidence of effectiveness for St. John’s Wort for depression? What other alternative therapies are effective for depression?
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PEDIATRIC CARE ONLINE
Rx Monographs
OTC Monographs
Alt Meds Monographs
Drug Interaction Tool
Drug Costs
Dosage Calculator
Formulary Tool
Pill Identifier
P Antibiotics Guide
Immunizations
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Pediatric Care Online• Antimicrobial Therapy Guide
• Information by Diagnosis, Agent, ClassLimited number of conditions
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Harriet LaneIn uCentral
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Harriet Lane• Best resource for pediatric dosing drugs approved for children
• Formulary includes dosing by indication for each age group including infants adults
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Renal, Hepatic, Geriatric Dosing• Epocrates limited• Some in Pepid• Best resources:
• Dynamed (Dosing: Special Populations)• Facts and Comparisons• Harriet Lane (Chapter 31 – Drugs in Renal Failure) Tables
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Summary• PEPID competes well with Epocrates as a one-stop quick shop
• Facts and Comparisons and Dynamed for detail• Infectious disease: Johns Hopkins over all others
• Peds dosing: Harriet Lane• Look for opportunities to increase students clinical reasoning and patient centered implications in regards to the drug information they find
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