Using Drug Resources

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Using Drug Resources. Nancy Clark, M.Ed , Director Medical Informatics Education , M.D. Informatics Curriculum Director Regional Campus . Objectives. Find the Drug Reference Library web page Identify teaching opportunities for medical students around drug questions
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Using Drug ResourcesNancy Clark, M.Ed, Director Medical Informatics Education , M.D. Informatics Curriculum Director Regional Campus 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, …)
  • Handouts
  • Evaluations – please complete pre-workshop evaluation
  • Drug References Handout
  • Worksheet
  • Top 200 Drugs Prescribed www.rxlist.comLibrary Webpage
  • /
  • Library Web SiteSubscription Drug Resources
  • 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)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 facultyFree 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/
  • 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 2ndyr
  • What weakness do you see with students?
  • What kinds of questions do you ask students to look up regarding drugs?
  • Who Has What?Epocrates Content DifferencesEpocrates OnlineEpocrates Essentials AppDrugsDiseasesInteraction CheckerLimited CalculatorsPill IDTablesLab ManualInfectious Disease
  • Drugs
  • Diseases
  • Interaction Checker
  • Medcalc 2000
  • Pill ID
  • Tables
  • Selected Patient Education Resources
  • 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
  • Alt MedsComparing Sub CategoriesRxOTCAdd to FavoritesExercises for PracticeUsing 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?
  • Dosage Calculators in Epocrates
  • Mobile and online Dosage Calculator
  • http://www.medcalc.com/pedidose.html
  • Teaching opportunity
  • Considerations
  • Liquid vs tablet…
  • Forms available
  • 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
  • Exercises for Practice
  • Epocrates PDA: lisinopril, metformin, Tylenol Cold and Flu Severe, and hydrochlorothiazide
  • Add lithium
  • Peds example: isoniazid, rifampin, ethambutol, acetaminophen
  • 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
  • Another Formulary OptionMedscape Mobile Version
  • Now contains formularies
  • 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?
  • 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? 
  • 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
  • Exercises for Practice
  • What is this pill?
  • Epocrates Tables
  • Lots of teaching opportunities
  • Vaccinations
  • Toxicology/antidotes
  • Drug/dose comparisons: topical steroids, opiates, ACE
  • Give students time to look up
  • 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?
  • 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
  • PEPID Drug Information and toolsPEPID 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
  • 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)
  • 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?
  • 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 life-threatening interaction. Contraindicated unless benefits outweigh risks and no alternatives available.
  • 5-Never use combination.
  • Exercises for Practice
  • digoxin, furosemide, lisinopril, grapefruit
  • lisinopril, metformin, hydrochlorothiazide, alcohol
  • Peds example: isoniazid, rifampin, ethambutol, acetaminophen
  • ImmunizationsFacts andcomparisons Facts and Comparisons eAnswers
  • Online only
  • Detailed
  • For pharmacists
  • Research presented
  • Comparison tables
  • Nice tools
  • Browse Resources Facts and Comparisons eAnswersBrowse ResourcesSearch Facts and Comparisons
  • Use search box to get to drug or class monographs
  • Advanced search to select specific or all resources
  • 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.
  • ClassificationsTables in Facts and Comparisons
  • Teaching opportunities
  • Renal dosing
  • Compare drugs in class:
  • Adverse EffectsIndicationsDrug-PregnancyDrug-LactationContraindications/PrecautionsDrug-Drug InteractionsDrug-Food InteractionsDrug-Alcohol InteractionsExercises 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?
  • 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.
  • Exercises for Practice
  • digoxin, furosemide, lisinopril
  • lisinopril, metformin, and hydrochlorothiazide
  • Peds example: isoniazid, rifampin, ethambutol, acetaminophen
  • Johns Hopkins ABX uCentral Web and MobileJohns Hopkins ABX Guide
  • Look up by bug, drug or disease
  • Section on Vaccines includes vaccine/drug interactions, contraindications
  • Pathogen vs Condition vs AntibioticDynamed- Evidence basedDynamed 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
  • Dynamed
  • 1000 drug monographs
  • Evidence-based, reviews of efficacy, levels of evidence provided
  • Linked to disease content,
  • Dynamed Teaching Opportunities
  • Renal impairment dosing (Dosage: Special Populations)
  • Geriatric dosing
  • What is the evidence for using that drug?
  • Access MedicineLexiDrugs in Access Medicine
  • Access Medicine Lexi Drug Content (Rx and OTC)
  • Natural MedicinesDatabaseNatural Medicines Database
  • Online and mobile
  • Effectiveness Checker
  • Drug Interaction Checker
  • Nutrient Depletion Checker includes prescription drugs
  • Clinical management series offers CME
  • Natural Medicines Effectiveness
  • Select condition
  • Provides clinical evidence for natural therapies broken down by:
  • Likely effective
  • Possibly effective
  • Possibly ineffective
  • Likely ineffective
  • Insufficient evidence
  • Interaction Checker
  • Enter prescription meds, foods, OTC multi-ingredient products, and alt meds
  • Breaks down all ingredients
  • Lists all interactions
  • 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?
  • Pediatric care onlinePediatric Care Online
  • Antimicrobial Therapy Guide
  • Information by
  • Diagnosis
  • Agent
  • Class
  • Limited number of conditions
  • Harriet LaneIn uCentralHarriet Lane
  • Best resource for pediatric dosing drugs approved for children
  • Formulary includes dosing by indication for each age group including infants  adults
  • 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
  • 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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