Drug Information Resources

1. Drug Information Resources Joe Pozdol, MLIS Norris Medical Library pozdol@usc.edu

2. Learning Goals To understand the magnitude of health information available today To be able to classify questions as background or foreground To understand the differences between primary, secondary, and tertiary resources To be able to determine ultimate questions and classify them by drug information type To be able to use Drug Facts and Comparisons, Epocrates, Lexi-Comp, Micromedex, and Clinical Pharmacology

3. The Growth of Medical Information ?? Indexed Citations Added to MEDLINE (i.e. PubMed) by Fiscal Year 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

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

5. Partner Introductions

6. Pair Activity: Assessing What You Already Know For a drug information question, which would you consult? List a pro and a con for each resource. Journal Textbook

7. Background v. Foreground Questions

8. Background Questions Question is broad in scope Answer is general knowledge in field Can best be addressed with tertiary resources E.g. Is a drug available in the U.S.? What is a drug’s mechanism of action? When is a drug contraindicated?

9. Foreground Questions Question is narrow in scope Answer may require examining new or conflicting evidence Can best be addressed with secondary and primary resources E.g. How effective is a new drug when compared to drugs that are already on the market? Are there clinical trials supporting an off-label use of a drug in a specific population?

10. Resource Types: Primary Secondary Tertiary

11. Primary Resources Scientific journals Provide original studies or reports E.g. Clinical trial, case series, case report Good for foreground questions Scope is narrow Good when topic is new or new data has been published

12. Primary Resources Pros: Most current evidence Provide data on new drugs Can personally assess validity of studies Cons: May not lead one to best decision because of limited scope Data can be poor or controversial Every study has limitations Too complex for patients

13. Secondary Resources Bibliographic databases that provide abstracts or full-text of studies Good for foreground questions

14. Secondary Resources Pros: Can construct searches to find specific information at high granularity Cons: Often require more expertise to use than primary or tertiary resources Retrieved references must be filtered for quality Must track down resources before looking for answers Too complex for patients

15. Tertiary Resources Compilations of knowledge in the field E.g. Textbooks, handbooks, online drug compendia Good for background questions Scope is broad

16. Tertiary Resources Pros: Provide comprehensive information Information reflects views of multiple experts in field Fast, easy to use, and may be good for patients Cons: Usually at least 2 years out of date by publication High dependency on interpretation of authors** **Pharmacists can address this by consulting at least 2 tertiary resources to find corroborating information

17. When trying to answer a clinical question, the best strategy is often to consult resources in the following order: Tertiary, Secondary, Primary Tertiary resources are good when: The answer to a question is basic factual knowledge in the field The question was studied extensively and a conclusion was made Many experts have addressed the question and agree on answer Secondary and primary resources are good when: A question is new and has never been studied There is no consensus among experts; various opinions abound There is conflicting evidence and the question needs further study

18. Resource Table

19. Determining the Ultimate Question 44 y.o. male High blood pressure Rx ACE inhibitor Develops dry cough Real Estate Agent Last Dec. Ultimate Question: Is cough a side effect of ACE inhibitors? Question Type: Background Resource Type: Tertiary Major Concepts (i.e. search terms): ACE inhibitors, side effects, cough

20. Categorizing the Ultimate Question **Adverse effects Availability Compatibility/stability Compounding **Dosing/administration **Drug interaction Herbal Identification Pharmacokinetics Pharmacology Poisoning/toxicology Pregnancy/lactation **Therapeutic use **Especially relevant for Medication Therapy Review assignment

21. Pair Activity List 3 facts about Ambien (ZolpidemTartrate) OR Insomnia

22. Drug Facts and Comparisons Search for information about Ambien (ZolpidemTartrate) www.usc.edu/nml

23. Pair Activity List 3 facts about Proventil (Albuterol Sulfate) OR Asthma

24. Epocrates Search for information about Proventil (Albuterol Sulfate) www.usc.edu/nml

25. Pair Activity List 3 facts about Zoloft (Sertraline Hydrochloride) OR Depression

26. Lexi-Comp Search for information about Zoloft (Sertraline Hydrochloride) www.usc.edu/nml

27. Pair Activity List 3 facts about Aricept (Donepezil Hydrochloride) OR Dementia

28. Micromedex Search for information about Aricept (Donepezil Hydrochloride) www.usc.edu/nml

29. Pair Activity List 3 facts about Zyrtec (Cetirizine Hydrochloride) OR Allergies

30. Clinical Pharmacology Search for information about Zyrtec (Cetirizine Hydrochloride) www.usc.edu/nml

31. Topic Recap Excess of Medical Info Background v. Foreground Tertiary, Secondary, Primary Ultimate Questions Drug Facts and Comparisons Epocrates Lexi-Comp Micromedex Clinical Pharmacology

32. The Big Picture Obtain background info/understand context Determine ultimate question Select and search appropriate resources Evaluate and analyze information found Draw conclusion and formulate response Addressing a Drug Info Need

33. Medication Therapy Review Assignment References used to support recommendation: Due Dec. 4 WRONG Student 1 Google Wikipedia RIGHT Student 2 Drug Facts and Comparisons Lexi-Comp

34. Please fill out an evaluation: Class: Drug Info Resources Date: 9/11/09 Instructor: Joe Pozdol