DRUG INFORMATION Dr. Samah Al-Jabi 1. Definition Drug information Current, critically examined,...

DRUG INFORMATION

Dr. Samah Al-Jabi1

Definition

Drug information

Current , critically examined, relevant data about drugs and drug use in a given patient or situation.

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Drug information• Current information uses the most recent, up- to-date sources

possible.

• Critically examined information should meet the following criteria:

1. More than one source should be used when appropriate.

2.The extent of agreement of sources should be determined; if sources do not agree, good judgment should be used.

3. The plausibility of information, based on clinical circumstances, should be determined.

• Relevant information must be presented in a manner that applies directly to the circumstances under consideration (e.g. , patient parameters, therapeutic objectives, alternative approaches) . 3

Drug information resourcesPrimary sources : Journals

Benefits:a. Keep abreast of professional news (side by side to new information).

b. Learn how another clinician handled a particular problem

c. Keep up with new developments in pathophysiology, diagnostic agents, and therapeutic regimens

d. Distinguish useful from useless or even harmful therapy

e. Enhance communication with other healthcare professionals and consumers

f. Share opinions with other healthcare professionals through letters to the editor

g . Obtain continuing education

h. Prepare for the board certification examination. 4

Drug information resourcesPrimary sources : Journals

Limitations.

- Although publication of an article is well known, respected journal enhances the credibility of information contained in an article, this does not guarantee that the article is accurate.

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Drug information resources

Primary sources : Journals

All material included in a journal is not considered a primary resource.

- Original clinical trials are considered primary literature.

however

Review articles (systematic reviews, and meta-analyses), articles of opinion (editorials and letter to editor), special and short reports are not

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- Systematic reviews: literature review on certain research question.

- Meta-analyses: Combine the results of several studies that address a set of research hypothesis.

- A letter to the editor is a letter sent to editor for publication about issues of concern from its readers. Usually, letters are intended for publication.

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Primary sources : Journals

Home work: name 5 journals related to clinical pharmacy or pharmacology

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Drug information resourcesSecondary sources : Indexing and abstracting services

• Benefit: valuable tools for quick and selective screening of the primary literature for specific information, data, citation, and articles.

• Sometimes the sources provide a sufficient information to answer a question.

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Examples:

Medline/PubMedPharmaceutical News IndexInternational Pharmaceutical AbstractsClinAlertIowa drug informationScopusWeb of ScienceGoogle Scholar

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Secondary sources : Indexing and abstracting services

Limitation

• Each indexing or abstracting service reviews a finite number of journals --- Therefore, relying on only one service can greatly hinder the thoroughness of a literature search.

- The substantial difference in lag time (i .e. , the interval between the publication of an article and the citation of that article in an index).

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Pubmed

Home - PubMed - NCBIwww.ncbi.nlm.nih.gov/pubmed

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Secondary sources : Pubmed

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Tertiary sources : Textbooks

• Provide easy and convenient access to a broad spectrum of related topics

• Background information on drugs and diseases is often available.

Limitations:

1) It could take several years to publish a text book. (so recent information may not be included).

2) The author of a textbook might not have conducted a thorough search of the literature. 21


Tertiary sources : Textbooks

• Reference citations should be available to verify the validity and accuracy of the data.

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Drug information resourcesTertiary sources : Databases

• Computer databases are convenient, easy to use, and referenced.

• These resources are similar to textbooks, but are typically updated more frequently.

• Useful resources for drug monographs, pill identifications, drug interactions, and various therapeutic calculations

Examples

• Micromedex, Clinical Pharmacology On Hand, Clinical Xpert, Lexi-Comp On-Hand.

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Drug information resourcesTertiary sources :

General considerations when examining and using textbooks and/or databases as sources of drug information include the following:

a. The author , publisher , or both

b. The year of publication (copyright date) or last revision date.

c. The edition of the text.

d. The presence of a bibliography.

e. The scope of the textbook or database.

f. Alternative resources that are available.

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Internet

• The Internet expands the ability to search therapies that have been recently published or discussed in the media.

Limitations:

- Information may not be peer reviewed or edited before release.

- Information may be only as reliable as the person who posted it and the users who read and comment on its content.


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Internet

• Traditional literature evaluation skills to determine whether information on Web site is clear , concise, unbiased, relevant, and referenced.


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Internet : Some clinical websites


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STRATEGIES FOR EVALUATING INFORMATION REQUESTS

• It is important to obtain as much information as possible about drug information requests before beginning a literature search.

• Both time and money can be lost doing a vast search.

• So, important questions should be asked to the inquirer or to evaluate before a manual or computerized search.

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1. Converse with the inquirer

• Before spending time searching for information --- talk to the person who is requesting the information and acquire any necessary additional information.

• The information taken may narrow the search if products with similar names are found, or if the drug’s name in request is not fully known.

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Determine the reason for the inquiry.

• Find out where the inquirer heard or read about the drug.

• Is he or she taking the medication? If so, why? (Because the search can be done by the drug or disease name).

• Ascertaining the reason for the inquiry helps determine what additional information should be provided.

• For example, if the inquiry concerns a foreign drug, the inquirer might ask for a domestic equivalent . 40



Clarify the drug's identification

a. The correct spelling of the drug's name

b. Whether it is a generic or brand name drug

c. What pharmaceutical company manufactures the drug and in what country the drug is manufactured

d. Whether the drug is prescription or OTC

e . The dosage form of the drug

f. The purpose of the drug (especially, if products with similar names are found)

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2. Identify or assess product availability

- For drugs manufactured in the US (American drug index, physician desk reference “PDR”, Martindale, Thomson health care series “Micromedex”).

- For drugs manufactured in foreign countries (Martindale, USP Dictionary of United States Adopted Names (USAN)”.

• For investigational drugs (Martindale, Drug Facts and Comparisons/Facts and Comparison). 42


2. To identify or assess product availability

- For orphan drugs: drugs that are used to prevent or treat a rare disease (affects < 200,000 people in the United States)--- (The FDA Office of Orphan Products Development (OOPD), The National Institutes of Health (NIH) Office of Rare Diseases).

- For Unknown drug: one that is in hand but not identified (PDR, Micromedex).

-For Natural products (Natural medicine comprehensive database). 43

Search Strategies

To develop an effective search strategy for

locating drug information literature, the

following tactics should be followed after

determining whether primary or secondary

sources are desired.44

Search Strategies

A. Determine the question asked

- Define the question as specifically as possible

- Identify appropriate index terms (keywords or descriptors) with which to search for the information.

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Search Strategies

B. Determine the type of information and how much is needed

(one fact , the most recent journal articles, review article ..)

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Search Strategies

C. Ascertain as much information as possible about the drug being questioned and the inquirer 's association with it.

Determine the answers to the following questions

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Search Strategies1. What is the indication for the prescribed drug?

2. Is the drug's use approved or unapproved?

a. Approved use of drugs: ( AHFS Drug Information, PDR, USP Drug Information, Drugdex (Micromedex)

b. Unapproved uses of drugs ( AHFS Drug Information, Drug Facts and Comparisons/Facts and Comparison 4.0 (online), Martindale: The Complete Drug Reference, Medline)

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Search Strategies3. What are the age, sex, and weight of the patient in

question?

4. Does the patient have renal or hepatic disease?

5. Does the patient have any underlying diseases?

6. What is the patient 's current medication status?

7. Is the patient taking any other medications?

8. What drugs has the patient taken during the past 6 months, and what were the dosages? 49

Search Strategies9. Did the patient experience any signs or symptoms of

a possible adverse drug reaction? (Severity, time, past ADR).

10. Did the patient experience any signs or symptoms of a drug interaction? (medications, duration of therapy, details of events, consult certain resource for more information).

11. How has the patient been managed so far?

12. What is the stability of the drug? How is compatibility of the drug with other drugs? 50

General guidelines for responses to druginformation requests

A. Do not guess!

B. Responses to a member of the public must take several ethical issues into account

1. Patient privacy must be protected.

2. Professional ethics must be maintained.

3. The patient-physician relationship cannot be breached.

4. Response is not necessary if the inquirer intends to misuse or abuse information that is provided.

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General guidelines for responses to druginformation requests

C. Organize information before response to the inquirer (concise and succinct).

D. Tailor the response to the inquirer 's background.

E. Tell the inquirer where the information was found.

F. Use extreme caution when making statements such as, “ I recommend …”, and Do not hesitate to refer consumers to their physicians.

G. Use more than abstracts to answer drug information questions.

H. Alert the inquirer of a possible delay to answer the question. 52

DRUG INFORMATION Dr. Samah Al-Jabi 1. Definition Drug information Current, critically examined,...

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Transcript of DRUG INFORMATION Dr. Samah Al-Jabi 1. Definition Drug information Current, critically examined,...