Drug Information Drug Information ResourcesResources

Joe Pozdol, MLISJoe Pozdol, MLIS

Norris Medical LibraryNorris Medical Library

pozdol@usc.edupozdol@usc.edu

Learning GoalsLearning Goals

To understand the magnitude of health information To understand the magnitude of health information available todayavailable today

To be able to classify questions as background or To be able to classify questions as background or foregroundforeground

To understand the differences between primary, To understand the differences between primary, secondary, and tertiary resourcessecondary, and tertiary resources

To be able to determine ultimate questions and To be able to determine ultimate questions and classify them by drug information typeclassify them by drug information type

To be able to use Drug Facts and Comparisons, To be able to use Drug Facts and Comparisons, Epocrates, Lexi-Comp, Micromedex, and Epocrates, Lexi-Comp, Micromedex, and Clinical PharmacologyClinical Pharmacology

The Growth of Medical InformationThe Growth of Medical InformationIndexed Citations Added to MEDLINE (i.e. PubMed) by Fiscal Year

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U.S. National Library of Medicine. National Institutes of Health. Reviewed 25 March 2009.http://www.nlm.nih.gov/bsd/stats/cit_added.html#1

How does one navigate the information overload How does one navigate the information overload without getting overwhelmed and confused?without getting overwhelmed and confused?

Partner IntroductionsPartner Introductions

Pair Activity: Assessing What You Already KnowPair Activity: Assessing What You Already Know

For a drug information question, which would you consult?For a drug information question, which would you consult?

List a pro and a con for each resource.List a pro and a con for each resource.

Journal Textbook

Background v. Foreground QuestionsBackground v. Foreground Questions

Background QuestionsBackground Questions

Question is broad in scopeQuestion is broad in scope

Answer is general knowledge in fieldAnswer is general knowledge in field

Can best be addressed with tertiary resourcesCan best be addressed with tertiary resources

E.g. Is a drug available in the U.S.?E.g. Is a drug available in the U.S.?

What is a drug’s mechanism of What is a drug’s mechanism of action?action?

When is a drug contraindicated?When is a drug contraindicated?

Foreground QuestionsForeground Questions

Question is narrow in scopeQuestion is narrow in scope

Answer may require examining new or conflicting evidenceAnswer may require examining new or conflicting evidence

Can best be addressed with secondary and primary resourcesCan best be addressed with secondary and primary resources

E.g. How effective is a new drug when compared to E.g. How effective is a new drug when compared to

drugs that are already on the market?drugs that are already on the market?

Are there clinical trials supporting an off-label Are there clinical trials supporting an off-label use of a use of a

drug in a specific population?drug in a specific population?

Resource Types:Resource Types:

Primary Primary

SecondarySecondary

TertiaryTertiary

Primary ResourcesPrimary Resources

Scientific journalsScientific journals

Provide original studies or reportsProvide original studies or reports

E.g. Clinical trial, case series, case reportE.g. Clinical trial, case series, case report

Good for foreground questionsGood for foreground questions

Scope is narrowScope is narrow

Good when topic is new or new data has Good when topic is new or new data has been publishedbeen published

Primary ResourcesPrimary ResourcesPros:Pros:

Most current evidenceMost current evidence

Provide data on new drugsProvide data on new drugs

Can personally assess validity of studiesCan personally assess validity of studies

Cons:Cons:May not lead one to best decision because of limited scopeMay not lead one to best decision because of limited scope

Data can be poor or controversialData can be poor or controversial

Every study has limitationsEvery study has limitations

Too complex for patientsToo complex for patients

Secondary ResourcesSecondary Resources

Bibliographic databases that provide abstracts or Bibliographic databases that provide abstracts or full-text of studies full-text of studies

Good for foreground questionsGood for foreground questions

Secondary ResourcesSecondary Resources

Pros:Pros:Can construct searches to find specific information Can construct searches to find specific information

at high granularityat high granularity

Cons:Cons:Often require more expertise to use than primary or Often require more expertise to use than primary or

tertiary tertiary resourcesresources

Retrieved references must be filtered for qualityRetrieved references must be filtered for quality

Must track down resources before looking for answersMust track down resources before looking for answers

Too complex for patientsToo complex for patients

Tertiary ResourcesTertiary Resources

Compilations of knowledge in the fieldCompilations of knowledge in the field

E.g. Textbooks, handbooks, online drug compendiaE.g. Textbooks, handbooks, online drug compendia

Good for background questionsGood for background questions

Scope is broadScope is broad

Tertiary ResourcesTertiary ResourcesPros:Pros:

Provide comprehensive information Provide comprehensive information

Information reflects views of multiple experts in fieldInformation reflects views of multiple experts in field

Fast, easy to use, and may be good for patientsFast, easy to use, and may be good for patients

Cons:Cons:Usually at least 2 years out of date by publicationUsually at least 2 years out of date by publication

High dependency on interpretation of authors**High dependency on interpretation of authors**

**Pharmacists can address this by consulting at least **Pharmacists can address this by consulting at least 2 tertiary resources to find corroborating information2 tertiary resources to find corroborating information

When trying to answer a clinical question, the best strategy is often to When trying to answer a clinical question, the best strategy is often to consult resources in the following order:consult resources in the following order:

Tertiary, Secondary, PrimaryTertiary, Secondary, Primary

Tertiary resources are good when:Tertiary resources are good when:

The answer to a question is basic factual knowledge in the fieldThe answer to a question is basic factual knowledge in the field

The question was studied extensively and a conclusion was madeThe question was studied extensively and a conclusion was made

Many experts have addressed the question and agree on answerMany experts have addressed the question and agree on answer

Secondary and primary resources are good when:Secondary and primary resources are good when:

A question is new and has never been studiedA question is new and has never been studied

There is no consensus among experts; various opinions aboundThere is no consensus among experts; various opinions abound

There is conflicting evidence and the question needs further studyThere is conflicting evidence and the question needs further study

Resource TableResource 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

Determining the Ultimate QuestionDetermining the Ultimate Question

44 y.o. male44 y.o. male

High blood pressureHigh blood pressure

Rx ACE inhibitorRx ACE inhibitor

Develops dry coughDevelops dry cough

Ultimate Question:

Question Type:

Resource Type:

Major Concepts (i.e. search terms):

Is cough a side effect of ACE inhibitors?

Background

Tertiary

ACE inhibitors, side effects, cough

Real Estate Agent Last Dec.

Categorizing the Ultimate QuestionCategorizing the Ultimate Question

**Adverse effects**Adverse effects

AvailabilityAvailability

Compatibility/stabilityCompatibility/stability

CompoundingCompounding

**Dosing/administration**Dosing/administration

**Drug interaction**Drug interaction

HerbalHerbal

IdentificationIdentification

PharmacokineticsPharmacokinetics

PharmacologyPharmacology

Poisoning/toxicologyPoisoning/toxicology

Pregnancy/lactationPregnancy/lactation

**Therapeutic use**Therapeutic use

**Especially relevant for Medication Therapy Review assignment**Especially relevant for Medication Therapy Review assignment

Pair ActivityPair Activity

List 3 facts about Ambien (Zolpidem Tartrate) OR InsomniaList 3 facts about Ambien (Zolpidem Tartrate) OR Insomnia

Drug Facts and ComparisonsDrug Facts and Comparisons

Search for information about Ambien (Zolpidem Tartrate)Search for information about Ambien (Zolpidem Tartrate)

www.usc.edu/nmlwww.usc.edu/nml

Pair ActivityPair Activity

List 3 facts about Proventil (Albuterol Sulfate) OR AsthmaList 3 facts about Proventil (Albuterol Sulfate) OR Asthma

EpocratesEpocratesSearch for information about Proventil (Albuterol Sulfate)Search for information about Proventil (Albuterol Sulfate)

www.usc.edu/nmlwww.usc.edu/nml

Pair ActivityPair Activity

List 3 facts about Zoloft (Sertraline Hydrochloride) OR DepressionList 3 facts about Zoloft (Sertraline Hydrochloride) OR Depression

Lexi-CompLexi-Comp

Search for information about Zoloft (Sertraline Hydrochloride) Search for information about Zoloft (Sertraline Hydrochloride)

www.usc.edu/nmlwww.usc.edu/nml

Pair ActivityPair ActivityList 3 facts about Aricept (Donepezil Hydrochloride) OR DementiaList 3 facts about Aricept (Donepezil Hydrochloride) OR Dementia

MicromedexMicromedex

Search for information about Aricept (Donepezil Hydrochloride)Search for information about Aricept (Donepezil Hydrochloride)

www.usc.edu/nmlwww.usc.edu/nml

Pair ActivityPair Activity

List 3 facts about Zyrtec (Cetirizine Hydrochloride) OR AllergiesList 3 facts about Zyrtec (Cetirizine Hydrochloride) OR Allergies

Clinical PharmacologyClinical Pharmacology

Search for information about Zyrtec (Cetirizine Hydrochloride) Search for information about Zyrtec (Cetirizine Hydrochloride)

www.usc.edu/nmlwww.usc.edu/nml

Topic RecapTopic Recap

Excess of Medical InfoExcess of Medical Info

Background v. ForegroundBackground v. Foreground

Tertiary, Secondary, PrimaryTertiary, Secondary, Primary

Ultimate QuestionsUltimate Questions

Drug Facts and ComparisonsDrug Facts and Comparisons

EpocratesEpocrates

Lexi-CompLexi-Comp

MicromedexMicromedex

Clinical PharmacologyClinical Pharmacology

The Big PictureThe Big Picture

1.1. Obtain background info/understand contextObtain background info/understand context

2.2. Determine ultimate questionDetermine ultimate question

3.3. Select and search appropriate resourcesSelect and search appropriate resources

4.4. Evaluate and analyze information foundEvaluate and analyze information found

5.5. Draw conclusion and formulate responseDraw conclusion and formulate response

Addressing a Drug Info NeedAddressing a Drug Info Need

Medication Therapy Review AssignmentMedication Therapy Review Assignment

References used to support recommendation:References used to support recommendation:

Student 1 GoogleStudent 1 Google

WikipediaWikipedia

Student 2 Drug Facts and ComparisonsStudent 2 Drug Facts and Comparisons

Lexi-CompLexi-Comp

WRONG

RIGHT

Due Dec. 4Due Dec. 4

Please fill out an evaluation:Please fill out an evaluation:

Class: Drug Info ResourcesClass: Drug Info Resources

Date: 9/11/09Date: 9/11/09

Instructor: Joe PozdolInstructor: Joe Pozdol