Clinical Drug Information

Julie Whelan

Fall 2007

Objectives• Drug Names --Discuss the importance of drug nomenclature.• Looks• What resources will help in selecting the best drug for this particular

patient?• Where can I find detailed dosing information including pediatric,

geriatric, renal and hepatic failure? • Calculators and nomograms.• Interactions--Describe sources for drug/drug interaction information?

Drug/lab, drug food, drug ethanol, drug disease interactions?• Where can you find adverse drug reaction ADR) and toxicity

information? • Safety in pregnancy & lactation?• Where to find warnings and how to report an ADR.• Describe PDA programs useful for quick ready reference.

Name Game

One Drug

• 51146-56-6 • Deltaran, Dolomin, Amersol, Menadol • RD-13621, U-18573 • 2-(4-Isobutylphenyl)propionic acid • C13H18O2 • Anti-inflammatory• NSAID• ibuprofen

PubChem

• Three Databases PubChem Substance, (Compound and BioAssay)

• search by common name, systematic name, molecular weight and more.

• Be as specific as possible. • Compounds not in PubMed database, have matches. • Duplicates exist so look for a record with some detail and

especially with the literature link on the right-hand side. • This means there are PubMed citations link to do this

substance. • Identify the common name. Search for it in PubMed using the

links menu off of literature.

Sources for Names• Brand names

– Micromedex, formulary, PDR, Clinical Pharmacology, USPDI, Mosby’s Drug Consult

• Generic names- all of above + F&C, ADI, MI• Registry #- Merck Index, ChemID, CAS• Molecular Forumula- Merck Index, ChemID,

SciFinder• NDC#- Orange Book, Mosby’s• Foreign Names- Martindales (Mmdx), EMBASE,

Index Nominum• Laboratory names,Investigational #-USAN

dictionary, PubMed/EMBASE, Merck Index

Tour of Major Resources

• Micromedex

• AHFS

• Clinical Pharmacology

• Dynamed

Non-subscription Resources

• LactMed

• http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT

• MassMedline http://www.massmedline.com

• Needy Meds http://www.needymeds.com

More Resources

• Med Watch http://www.fda.gov/medwatch/safety.htm

• RSS feed possible

• Weekly Morbidity and Mortality Reports http://www.webmm.ahrq.gov/

• Sermo.com http://www.sermo.com

PDA- Quick References

• Available to you– ePocrates Pro - HMS– Mobile Micromedex -

HMS– LexiDrugs- Partners– CPOnHand- HMS

How do they perform?

• Knollmann, BC et.al. Personal digital assistant-based drug reference software as tools to improve rational prescribing: benchmark criteria and performance– Clin Pharmacol Ther 2005; 78:7-18.

• Galt KA et.al. Personal digital assistant-based drug information sources: potential to improve medication safety– J Med Libr Assoc 93(2) April 2005. 229-236

Results

• Both compared 11 products– Galt eliminated all but 3 for detailed analysis

• Assigned points for meeting quality benchmarks• Benchmarks included:

– Currency, EB dosing, dosage forms, side effects, ADRs, interactions, H/DS, comprehensiveness, accuracy, mechanism

– Special features-calculators, cost, ID, pharmacokinetics, IV compatibility

• Used specific DI queries to develop ratings

The Winners Are!

• For Safety– Lexi-Drugs– Mobile MDX– ePocrates RxPro

• For Rational Prescribing– Lexi Drugs– CP onHand– PDRDrugs– A2ZDrugs– Pepid PDC– ePocrates RxPro – DRDrugs– Mobile MDX