Amy Chatfield, MLS Norris Medical Library

Objectives  Identify preliminary and ultimate questions  Classify questions to aid retrieval in information resources  Differentiate between primary, secondary, and tertiary resources  Identify five major resources to answer questions on drugs  Identify major resources to locate guidelines and patient education materials

Pharmacy and Information  Information-heavy profession  Textbooks  Reference Books  Journal articles  Databases  Web pages  Clinical guidelines  Patient information  Government-produced web pages  Abstracting sources Information resources available to pharmacy students:

The Ultimate Question The actual question for which you are seeking an answer UQ

Scenario This patient is taking fosamax and Tums. Does that seem curious or unusual to you? Your preceptor

Questions!  What is fosamax used for?  How is fosamax administered?  Is fosamax a brand name or a generic?  How is fosamax absorbed by the body?  What is Tums?  What chemicals constitute Tums?  How does Tums work?

Ultimate question  Other questions: preliminary questions which permit us to create the ultimate question.  You may need to answer multiple preliminary questions before you can start answering the ultimate question- especially when new to a profession Are there known interactions between alendronate and calcium carbonate? UQ

Categorizing questions Adverse effects Availability Compatibility/stability Compounding Dosing/administration Drug interaction Herbal Identification Nomenclature Pharmacokinetics Pharmacology Poisoning/toxicology Pregnancy/lactation Therapeutic use

Categorizing questions  Therapeutic Use  Dosing/administration  Nomenclature  Pharmacokinetics  What is fosamax used for?  How is fosamax administered?  Is fosamax a brand name or a generic?  How is fosamax absorbed by the body? Categorizing your questions makes it easier to find information to answer each question

Three Types of Resources: Primary Secondary Tertiary

Primary Resources  Original research articles Many kinds of study designs Clinical trials Cohort studies  Conference Papers/Posters  Dissertations  Patents Advantages of primary sources: Current information May be only source of info on a new drug Narrow in scope Disadvantages of primary sources: Limited in scope Complex, hard to interpret

Secondary Resources  Review articles Literature reviews Meta-analyses  Guidelines  Indexing sources  Abstracting sources

Secondary Resources  Literature ReviewsAdvantages: Many primary resources consulted to write 1 article Disadvantages: Need to examine sources included closely Potential for bias in selection

Secondary Resources  Meta-AnalysesAdvantages: Many primary resources consulted to write 1 article All relevant studies must be included Disadvantages: Can only be created when a critical mass of primary studies are available

Secondary Resources  GuidelinesAdvantages: Many primary resources consulted to write 1 guideline Functionally oriented for clinical work (bullet points, not narrative) Disadvantages: Can only be created when a critical mass of primary studies are available

Secondary Resources  Indexing sources International Pharmaceutical Abstracts  Abstracting sources FDA’s MedWatch Advantages: Indexing sources create computerized records with additional information to make primary sources easier to find Abstracting services provide up- to-date information Disadvantages: Need to pay for access (for most) Don’t include full-text of the primary source

Tertiary Resources  Textbooks  Handbooks  Drug Compendia  Reference books Advantages of tertiary sources: Comprehensive information from a variety of sources Citations to primary and secondary sources Fast, easy to use Disadvantages of tertiary sources: Older, less current information Not sure if authors looked at the “right” sources Hint: Pro pharmacists consult two or more tertiary resources to check their answer!

Which ones do I use? Consult in backwards order! PrimarySecondaryTertiary Tertiary resources 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 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

Resource Categories v Question Categories Many tertiary resources include these categories as chapter titles or section titles Secondary sources use these categories when they index primary sources Question categories Adverse effects Availability Compatibility/stability Compounding Dosing/administration Drug interaction Herbal Identification Nomenclature Pharmacokinetics Pharmacology Poisoning/toxicology Pregnancy/lactation Therapeutic use Lexi-Comp Table of Contents

Resource Categories v Question Categories Many tertiary resources include these categories as chapter titles or section titles Secondary sources use these categories when they index primary sources Question categories Adverse effects Availability Compatibility/stability Compounding Dosing/administration Drug interaction Herbal Identification Nomenclature Pharmacokinetics Pharmacology Poisoning/toxicology Pregnancy/lactation Therapeutic use Micromedex

Tertiary Resources  Epocrates  Drug Facts & Comparisons  Lexi-Comp  Micromedex  Clinical Pharmacology Things to think about when you use tertiary resources:  Availability of the resource  “Extra features” vary  How is it created, who creates it, and how frequently is it updated?

Student Portal  Links to all resources on pharmacy student year 1 portal page   Drug Information tab

Drug Facts and Comparisons Pocket Version  Online is ABRIDGED version of print  Print copy available in Norris How is it created? -Team of Pharm Ds and MDs -Monitor primary literature and clinical guidelines -Updated annually/once a year -Most frequently used drugs in American hospitals are included in the online version Let’s search for Ambien

Drug Facts and Comparisons  Browse by category  Includes most popular drugs used in US  Functional, aimed at the practicing clinician

ePocrates Online Premium  Two versions available: ePocrates Online Premium- via computer ePocrates: FREE version to download onto your PDA Free version provides less detailed information How is it created? - Team of Pharm Ds and MDs - Monitor primary literature, clinical guidelines, manufacturer labels, and FDA drug safety alerts - Updated weekly (more frequently if safety problems are identified) Let’s search for Proventil

ePocrates Online Premium  Browse feature  Includes drugs and herbals  Patient education material, English and Spanish  Pictures  Downloadable version for PDA

Lexi-Comp  Includes several sources of drug monographs How is it created? -Lexi-Drugs: Two in-house teams: one monitors FDA drug safety alerts and manufacturer labels, the second monitors primary literature and guidelines -All material vetted by editorial team comprised of Pharm Ds, MDs, PhDs, and DDSs -Updated weekly (more frequently if safety problems are identified) Let’s search for Zoloft

Lexi-Comp  Audio Pronunciation  Patient education materials  Pearls and related info section cites guidelines

Micromedex  FREE version to download to your PDA or mobile device  Includes PoisonDEX and Clinical Points modules with additional information How is it created? -“Team of experts” who review primary literature - Update schedule - ?? Let’s search for Aricept

Micromedex  Patient education materials  Photos  Foreign brand names  Free download onto PDA

Clinical Pharmacology  ONLY for School of Pharmacy How is it created? - Team of editors, Pharm Ds, and MDs - Monitor primary literature, clinical guidelines, textbooks, other tertiary sources, trade magazines from the pharmacy industry, major abstracting sources. - Every monograph reviewed annually (at a minimum) - Includes dates of update in each section Let’s search for Zyrtec

Clinical Pharmacology  Global trade names  Chemical structure drawings  Interactions- sort by severity  How Supplied– photos, plus full formulation details (active and inactive ingredients)  Patient Education- English and Spanish Additional features! Reports- drug interactions, adverse reactions, more Find/List- by criteria; CAM, investigational monographs; access MedGuides Includes monographs on vaccines

Guidelines  Gather primary and secondary literature  Analyze, assess literature  Outline “best practices” for any aspect of clinical work (diagnosis, prevention, screening, treatment, etc.)  Write as steps or bullet points  Made for all health care professionals  May need to broaden search: beyond simply a drug name

Guidelines  Guidelines are produced by groups of health care professionals  Professional organizations, nonprofit organizations, government groups: coordinate the writing of guidelines

Guidelines  Guidelines can be referenced in drug monographs  Centers for Disease Control and Prevention (CDC) Centers for Disease Control and Prevention  American Pharmacists’ Association American Pharmacists’ Association  Pharmacists’ Letter Pharmacists’ Letter  National Guidelines Clearinghouse: Guideline.gov (part of AHRQ) National Guidelines Clearinghouse: Guideline.gov  EpSS- Electronic Preventive Services Selector (AHRQ- created) EpSS- Electronic Preventive Services Selector

Takeaways  The Big Picture: USC subscribes to a variety of information resources to help you answer questions about drugs and pharmacy practices Basics today: ○ Identify preliminary and ultimate questions ○ Classify questions to make retrieval easier ○ Using tertiary resources to answer questions

Takeaways  All the tertiary resources we used today are linked on your Blackboard site and on the Year 1 Pharmacy student portalYear 1 Pharmacy student portal  You will have assignments that require you to use and cite information resources Wikipedia Free websites found through Google

Questions? Contact us!  Contact Norris Library reference service (M-F, 9-5)  Contact Amy Chatfield, pharmacy liaison librarian