Drug resources

Report
1
Summer/Fall 2014
USING DRUG RESOURCES
Nancy Clark, M.Ed, Director Medical Informatics Education
, M.D. Informatics Curriculum Director
Regional Campus
Summer/Fall 2014
2
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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Summer/Fall 2014
Handouts
• Evaluations – please complete pre-
workshop evaluation
• Drug References Handout
• Worksheet
Top 200 Drugs Prescribed www.rxlist.com
Summer/Fall 2014
Library Webpage
•/
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Summer/Fall 2014
Library Web Site
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Summer/Fall 2014
Subscription Drug Resources
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Access Medicine’s Drugs (Lexi Drug)
Dynamed
Epocrates Online or Essentials
Facts and Comparisons (web)
Harriet Lane
Johns Hopkins ABX guide
PEPID
MDConsult (Clinical Pharmacology)*
Natural Medicines Database
Pediatric Care Online
Journals, News and periodical databases
• Prescriber’s Letter
• Medical Letter
* Going away 7/31/2014)
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9
Summer/Fall 2014
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
Summer/Fall 2014
Free Drug Resources
• Shots (immunization schedules) (Web)
http://www.immunizationed.org
• Medscape (App)
• Rx Drugs (Skyscape App)
• Micromedex (App)
• CDC Travelers' Health
http://wwwn.cdc.gov/travel/
• Merck Medicus (PDR.net)
http://www.merckmedicus.com
• Toxnet (poisons and toxic agents)
http://toxnet.nlm.nih.gov/
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Summer/Fall 2014
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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?
Summer/Fall 2014
Who Has What?
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Summer/Fall 2014
EPOCRATES
P
P
P
P
P
P
P
P
P
P
Rx Monographs
OTC Monographs
Alt Meds Monographs
Drug Interaction Tool
Drug Costs
Dosage Calculator
Formulary Tool
Pill Identifier
Antibiotics Guide
Immunizations
14
Summer/Fall 2014
Content Differences
Epocrates Online
Epocrates Essentials App
• Drugs
• Drugs
• Diseases
• Diseases
• Interaction Checker
• Interaction Checker
• Medcalc 2000
• Limited Calculators
• Pill ID
• Pill ID
• Tables
• Tables
• Selected Patient
• Lab Manual
Education Resources
• Infectious Disease
15
Summer/Fall 2014
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
16
Summer/Fall 2014
Comparing Sub Categories
Rx
Alt Meds
Add to Favorites
OTC
Summer/Fall 2014
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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?
Summer/Fall 2014
Dosage Calculators in Epocrates
• Mobile and online
Dosage Calculator
• http://www.medcalc.com
/pedidose.html
• Teaching opportunity
• Considerations
• Liquid vs tablet…
• Forms available
18
Summer/Fall 2014
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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Summer/Fall 2014
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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
Summer/Fall 2014
Epocrates Formularies
• All available online
• Must select payors 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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Summer/Fall 2014
Another Formulary Option
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Summer/Fall 2014
Medscape Mobile Version
• Now contains formularies
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Summer/Fall 2014
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Exercises for Practice
• Using Formulary Tools on Epocrates online or PDA
• I have a patient with H. Pylori who has BCBS of
Florida 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?
Summer/Fall 2014
25
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?
Summer/Fall 2014
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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Summer/Fall 2014
Exercises for Practice
• What is this pill?
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Summer/Fall 2014
Epocrates Tables
• Lots of teaching
opportunities
• Vaccinations
• Toxicology/antidotes
• Drug/dose comparisons:
topical steroids, opiates,
ACE
• Give students time to
look up
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Summer/Fall 2014
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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?
Summer/Fall 2014
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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
31
Summer/Fall 2014
PEPID Drug
Information
and tools
P
P
P
P
Rx Monographs
OTC Monographs
Alt Meds Monographs
Drug Interaction Tool
Drug Costs/Formulary
P
P
P
P
P
P
Dosage Calculator
Drug Allergy Checker
Pill Identifier
IV Compatibility
Immunizations
Beers List
Summer/Fall 2014
PEPID Drug Monographs
• OTC, Alt and Rx
• Adverse reactions include
%ages
• Interactions not listed, must
use interaction tool.
• Include evidence-based
inquiries
• Tap dose to get dosage
calculator
• Overdose mgmt included
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Summer/Fall 2014
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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)
Summer/Fall 2014
34
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?
Summer/Fall 2014
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 lifethreatening interaction.
Contraindicated unless benefits
outweigh risks and no alternatives
available.
• 5-Never use combination.
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Summer/Fall 2014
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Exercises for Practice
• digoxin, furosemide, lisinopril, grapefruit
• lisinopril, metformin, hydrochlorothiazide,
alcohol
• Peds example: isoniazid, rifampin,
ethambutol, acetaminophen
Summer/Fall 2014
Immunizations
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Summer/Fall 2014
P
P
P
P
Rx Monographs
OTC Monographs
Alt Meds Monographs
Drug Interaction Tool
Drug Costs
FACTS and
COMPARISONS
Dosage Calculator
Formulary Tool
P
Pill Identifier
Antibiotics Guide
P
Immunizations
Summer/Fall 2014
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Facts and Comparisons eAnswers
• Online only
• Detailed
• For pharmacists
• Research presented
• Comparison tables
• Nice tools
Browse Resources
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Summer/Fall 2014
Facts and Comparisons eAnswers
Browse Resources
Summer/Fall 2014
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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
Summer/Fall 2014
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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.
Summer/Fall 2014
Classifications
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Summer/Fall 2014
Tables in Facts and Comparisons
• Teaching opportunities
• Renal dosing
• Compare drugs in class:
Adverse Effects
Indications
Drug-Pregnancy
Drug-Lactation
Contraindications/Precautions
Drug-Drug Interactions
Drug-Food Interactions
Drug-Alcohol Interactions
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Summer/Fall 2014
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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?
Summer/Fall 2014
46
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.
Summer/Fall 2014
Exercises for Practice
• digoxin, furosemide, lisinopril
• lisinopril, metformin, and
hydrochlorothiazide
• Peds example: isoniazid, rifampin,
ethambutol, acetaminophen
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Summer/Fall 2014
JOHNS
HOPKINS ABX
uCentral
Web and Mobile
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Summer/Fall 2014
Johns Hopkins ABX Guide
• Look up by bug, drug or
disease
• Section on Vaccines
includes vaccine/drug
interactions,
contraindications
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Summer/Fall 2014
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Pathogen vs Condition vs Antibiotic
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Summer/Fall 2014
P
P
P
Rx Monographs
OTC Monographs
Alt Meds Monographs
Drug Interaction Tool
DYNAMED-
P
Drug Costs
Dosage Calculator
EVIDENCE BASED
Formulary Tool
P
Patient Ed Handouts
Antibiotics Guide
Immunizations
Summer/Fall 2014
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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Summer/Fall 2014
Dynamed
• 1000 drug monographs
• Evidence-based,
reviews of efficacy,
levels of evidence
provided
• Linked to disease
content,
Summer/Fall 2014
Dynamed Teaching Opportunities
• Renal impairment
dosing (Dosage:
Special Populations)
• Geriatric dosing
• What is the evidence
for using that drug?
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Summer/Fall 2014
P
P
Rx Monographs
OTC Monographs
Alt Meds Monographs
Drug Interaction Tool
P
ACCESS MEDICINE
Drug Costs
Dosage Calculator
Formulary Tool
Pill Identifier
Antibiotics Guide
Immunizations
Summer/Fall 2014
LexiDrugs in Access Medicine
• Access Medicine Lexi Drug Content (Rx and OTC)
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Summer/Fall 2014
Rx Monographs
OTC Monographs
P
P
Alt Meds Monographs
Drug Interaction Tool
Drug Costs
NATURAL MEDICINES
DATABASE
Dosage Calculator
Formulary Tool
Pill Identifier
Antibiotics Guide
Immunizations
Summer/Fall 2014
58
Natural Medicines Database
• Online and mobile
• Effectiveness Checker
• Drug Interaction Checker
• Nutrient Depletion Checker includes
prescription drugs
• Clinical management series offers CME
Summer/Fall 2014
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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
Summer/Fall 2014
Interaction Checker
• Enter prescription
meds, foods, OTC
multi-ingredient
products, and alt meds
• Breaks down all
ingredients
• Lists all interactions
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Summer/Fall 2014
61
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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Summer/Fall 2014
Rx Monographs
OTC Monographs
Alt Meds Monographs
Drug Interaction Tool
Drug Costs
PEDIATRIC
CARE ONLINE
Dosage Calculator
Formulary Tool
Pill Identifier
P
Antibiotics Guide
Immunizations
Summer/Fall 2014
Pediatric Care Online
• Antimicrobial Therapy Guide
• Information by
 Diagnosis
 Agent
 Class
 Limited number
of conditions
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Summer/Fall 2014
Harriet Lane
In uCentral
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Summer/Fall 2014
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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
Summer/Fall 2014
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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Summer/Fall 2014
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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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