Drug Information Resources

Objectives: Describe the role of Internet and personal digital assistant (PDA) resources in the provision of drug information. Differentiate between primary, secondary, and tertiary sources of information. Select resources relevant to different pharmacy practice areas. Identify the most appropriate resource for a specific drug information request.

Medical Information Explosion The quantity of medical information and medical literature available is growing at an astounding rate

Different access....same Process! The introduction of PDAs and Internet resources has to some extent changed the methods by which information is accessed, but not the process of providing drug information.

How to find ? Generally, the best method to find information includes a stepwise approach moving first through tertiary then secondary and finally primary literature.

What is needed? Often, a search for information will not employ all of these steps or require the use of all three types of resources. A question regarding commercial availability of a product formulation or mechanism of action can be found quickly in a tertiary resource. However, a question regarding the clinical trials supporting off-label use in a specific population may require a search of primary literature.

Tertiary Resources Tertiary resources consist of textbooks, compendia, review articles in journals, and other general information, such as may be found on the Internet. These references may often serve as an initial place to identify information due to the fact that they provide a fairly complete and concise overview of information available on a specific topic.

Drawbacks of Tertiary Resources The major drawback to tertiary resources is the lag time associated with publication, resulting in less current information. It is also possible that information in a tertiary text may be incomplete due either to space limitations of the book or incomplete literature searches by the author.

Drawbacks of Tertiary Resources Other problems that can be seen with tertiary information include errors in transcription, human bias, incorrect interpretation of information, or a lack of expertise by authors. For these reasons readers must judge the quality of tertiary references.

Evaluation of Tertiary Literature Does the author have appropriate experience/expertise to publish in this area? Is the information likely to be timely based on publication date? Is the information supported by appropriate citations? Does the resource contain relevant information?

Sources For general product information, Adverse effects, dosage recommendations

Sources For Dosage recommendations (Renal failure)

Sources For Availability of dosage forms

Sources For Pharmaceutical Compounding

Sources For Drug interactions

Sources For drugs in pregnancy and lactation

Sources for foreign drug identification

Sources for Geriatric Dosage

Sources for Investigational drug information FDA website Clinicaltrials.gov

Sources for Incompatibility/stability

Sources for Pediatric dosage recommendations

Sources for Therapy evaluation/recommendations

Secondary Literature References that either index or abstract the primary literature with the goal of directing the user to the primary literature. Indexing consists of providing bibliographic citation information (e.g., title, author, and citation of the article) Abstracting includes a brief description (an abstract) of the information provided by the article or resource cited.

Secondary Literature

Primary Literature Primary literature consists of clinical research studies and reports, both published and unpublished. Not all literature published in a journal is classified as primary literature, for example, review articles or editorials are not primary literature. There are several types of publications considered primary, including controlled trials, cohort studies, case series, and case reports.

Primary Literature Advantages Advantages of the use of primary literature include access to detailed information about a topic and the ability to personally assess the utility and validity of study results. Additionally, primary literature tends to be more recent than tertiary or secondary literature.

Primary Literature Disadvantages Misleading conclusions based on only one trial without the context of other researches, the need to have good skills in medial literature evaluation, and the time needed to evaluate the large volume of literature available.

Let us practice!

What is the dose of tiotropium bromide (Spiriva) for a patient with chronic obstructive pulmonary disease?? Category of Question: Dosing Possible 3ry sources: Drug information Handbook, AHFS, Handbook of Clinical Drugs Data Possible websites: Lexi-comp, Micromedex

What medication is recommended for the initial management of fibromyalgia syndrome? Category of Question: Therapeutic Management/Recommendation/Guidelines Possible 3ry sources: Uptodate, Evidence based Medicine Guidelines…………… Possible websites: Guidelines.gov, Tripdatabase.com

What topical medication is recommended for the initial management of uncomplicated catheter exit site infection in Haemodialysis patients? Category of Question: Therapeutic Management/Recommendation/Guidelines Possible 3ry sources: Uptodate, Evidence based Medicine Guidelines……… Possible websites: Guidelines.gov, Tripdatabase.com