1. Fiancee Lee A Banzon RPh.RN Mindanao Medical Foundation College
PHARMACY INFORMATICS
Fiancee Lee A Banzon RPh.RN
College of Pharmacy
Mindanao Medical Foundation College

2. PHARMACY INFORMATICS
A new field that integrates drug information, clinical information and toxicity information for use by pharmacists, health care providers and patients.

3. Pharmacy Informatics Clinical Information Toxicity Information
Drug information
Pharmacy Informatics
Informatics affects all three curricular areas of emphasis:
Our working model for the pharmacy informatics course is based on the idea that pharmacists must use information and technology skills to integrate information about drugs and information about patient-related issues from a variety of sources in order to achieve patient-centered care
Pharmacists
Health Care Providers
Patients

4. Uses and Application Support for clinical services
Pharmacy and Therapeutics activities
Publications
Education
Drug usage evaluation
Investigational drug research
Coordination of reporting programs
Poison information

5. Tasks in Informatics Access Search Information Retrieval Evaluation
Selection
Organization
Database Development

6. Types of relevant information in Pharmacy
Drug Information
Availability – strength, dosage forms, supplier
Identification
General Product Information
Laws & Policies
Cost
Foreign/Investigational
Stability/Compatibility
Drug Interactions
Pharmaceutics – compounding, formulations
Pharmacokinetics – ADME, levels
Therapy Evaluation/ Drug of Choice
Dosage/Regimen Recommendations
Adverse Effects
Poisoning/Toxicology
Teratogenicity/ Genetic Effects
Lactation/Infant Risks

7. Types of relevant information in Pharmacy
Medical Information
Pathophysiology
Symptomatology
Risk Factors
Causative Agents
Complications
Pharmacotherapy
Non-drug management
Lifestyle changes, etc.
Drug Development Process
Pharmacognosy
Pharmacopeial Information
Biotechnology
Pharmaceutical Chemistry
Pharmaceutical Technology
Behavioral Studies
Basic & Applied Research, etc.
Pathophysiology
it is the branch of medicine which deals with any disturbances of body functions, caused by disease or prodromal symptoms.

8. ACCESS RELEVANT RESOURCES ARE WITHIN REACH
AVAILABILITY OF RESOURCES FOR USE
FAMILIARITY WITH RELIABLE RESOURCES

9. SEARCH ABILITY TO LOOK FOR INFORMATION
FAMILIARITY ON HOW TO USE VARIOUS SOURCES OF INFORMATION
USE OF APPROPRIATE SEARCH STRATEGY

11. INFORMATION RETRIEVAL
ABILITY TO GET THE INFORMATION NEEDED
SKILL IN USING KEYWORDS, SYNONYMS, RELATED WORDS
USE OF BOOLEAN OPERATORS
Of or relating to a combinatorial system devised by George Boole that combines propositions with the logical operators AND and OR and IF THEN and EXCEPT and NOT

12. Example: Hierarchical Tree
GENERAL
CNS DRUGS
Antihypertensives
Calcium Channel Blocker
Nifedipine
SPECIFIC

13. Example: Synonyms, Keywords, Related Terms
PARENTERALS
Injectables
Sterile Products
IV Admixtures
IV Hyperalimentation
Total Parenteral Nutrition
Intramuscular
Intrathecal
Subcutaneous
Injection

14. BOOLEAN OPERATORS A B A B
A + B
A not B A B
(A + B) not C C

15. EVALUATION
ABILITY TO DETERMINE RELEVANCE AND QUALITY OF INFORMATION RETRIEVED
SKILL IN EVALUATING VARIOUS FORMS OF LITERATURE
KNOWLEDGE OF RESEARCH DESIGNS
STATISTICAL INTERPRETATION
CRITICAL ANALYSIS

16. Critical thinking has been described as "reasonable reflective thinking focused on deciding what to believe or do. Critical thinking is thinking that questions assumptions It is a way of deciding whether a claim is always true, sometimes true, partly true, or false.

17. SELECTION ? CHOICE OF THE BEST INFORMATION AVAILABLE
RATIONAL DECISION-MAKING
ADHERENCE TO CRITERIA OF QUALITY
"rationality" means "sane," "in a thoughtful clear-headed manner," or knowing and doing what's healthy in the long term.

18. ABILITY TO INTEGRATE CHOSEN INFORMATION LOGICALLY
ORGANIZATION
ABILITY TO INTEGRATE CHOSEN INFORMATION LOGICALLY
WRITING SKILL
LOGICAL THINKING

19. Logical reasoning
In logic, three kinds of logical reasoning can be distinguished: deduction, induction and abduction.
Deduction means determining the conclusion. It is using the rule and its precondition to make a conclusion. Example: "When it rains, the grass gets wet. It rained today. Therefore, the grass is wet." Mathematicians are commonly associated with this style of reasoning.
Induction means determining the rule. It is learning the rule after numerous examples of the conclusion following the precondition. Example: "The grass has been wet every time it has rained. Therefore, if it rains tomorrow, the grass will get wet." Scientists are commonly associated with this style of reasoning.
Abduction means determining the precondition. It is using the conclusion and the rule to support that the precondition could explain the conclusion. Example: "When it rains, the grass gets wet. The grass is wet, therefore, it may have rained." Diagnosticians and detectives are commonly associated with this style of reasoning.

20. Application of Pharmacy Informatics

21. Drug Information Service (DIS)
Refers to the access, evaluation, selection and organization of drug literature for the use of health professionals, patients and the public
Also involves the interpretation & application of drug information to patient care problems

22. Drug Literature
Is comprised of primary, secondary & tertiary literature that can be used as basis for optimizing the use of drugs in patients

23. Why the need for it? Vast drug literature
Increasing drug therapy problems
Growth of clinical pharmacy practice

24. THE DIS PROCESS 1. Determining the primary question
2. Developing an appropriate strategy
3. Choosing sources of information
4. Accessing printed sources of information
5. Critical Appraisal of information sources
6. Formulating a response
7. Communicating a response
Documentation and follow-up

25. 1. Primary Question Ask clarifying questions Restate the question
Ask when and whom to contact when answer becomes available

26. Types of DI Questions ADRs (eg. description, allergies)
Drug administration (dosage form, methods, compatibility, stability)
Indications & therapeutic use
Product-specific Concerns
Dosing
Drug interactions
Poisoning & toxicology
Miscellaneous

27. 2. Appropriate Strategy Match question w/ sources of information
Determine if question is for approved, investigational or unapproved drugs
Identify appropriate search keywords, terms, synonyms
Be flexible in searching

28. 3. Sources of Information
Oral
Written or Printed
Primary literature
original article, research or case reports published in journals, presentations and proceedings
Secondary literature
abstracting and indexing services
Tertiary literature
textbooks, compendia, full-text databases & review articles
Secondary sources involve generalization, analysis, synthesis, interpretation, or evaluation of the original information.

29. Tertiary source
A tertiary source is an index and/or textual condensation of primary and secondary sources.
Some examples of tertiary sources are almanacs, guide books, survey articles, timelines, and user guides. Depending on the topic of research, a scholar may use a bibliography, dictionary, or encyclopedia as either a tertiary or a secondary source.
As tertiary sources, encyclopedias and textbooks attempt to summarize and consolidate the source materials into an overview, but may also present subjective commentary and analysis (which are characteristics of a secondary source).

30. secondary source
is a document or recording that relates or discusses information originally presented elsewhere.
A secondary source contrasts with a primary source,
Secondary sources involve generalization, analysis, synthesis, interpretation, or evaluation of the original information.
Examples; review article or meta-analysis, academic journals, medical peer reviewed

31. Primary source Primary sources are original materials.
It serves as an original source of information about the topic.
From a letter of Philip II, King of Spain, 16th century

32. 4. Printed Info Sources Textbooks Journals Individual Files
Manual Indexes
Computerized databases
Internet

33. Biomedical Journals Lancet Journal of American Medical Association
British Medical Journal
Annals of Internal Medicine
Archives of Internal Medicine
New England Journal of Medicine
Am J Health Sys Pharm, Am J Pharm Ed
Annals of Pharmacotherapy
Clinical Pharmacy & Therapeutics

34. Computerized databases
CD FORMAT
MicroMedex
Current Contents
Iowa Drug Information Service (IDIS)
Intl Pharm Abstracts
Medline
Clinical Pharmacology
Mayo Family Pharmacist
ONLINE FORMAT
Medline
MicroMedex
Medscape Fulltext
OVID
Health Notes Online
WEBSITES

35. Specific Sources of Info
Pharmacotherapy
Pediatric Dosing
Pharmacokinetics
General Drug Information
Pharmacology
Patient Counseling
Medical Info
Geriatric Dosing

36. Specific Sources of Info
Pharmacotherapy
Clinical Pharmacy and Therapeutics
Applied Therapeutics
Washington’s Manual of Medical Therapeutics
Pediatric Dosing
Pediatric Dosage Handbook
Harriet Lane Handbook
Nelson Textbook of Pediatrics
Pharmacokinetics
Basic Clinical Pharmacokinetics
SIMKIN Handbook of Therapeutic Monitoring
Applied Pharmacokinetics

37. General Drug Information
AHFS Drug Information
Physician’s Desk Reference
USP Dispensing Information
MicroMedex - DrugDex
Drug Facts & Comparisons
Pharmacology
Goodman & Gilman’s Pharmacological Basis of Therapeutics
Principles of Pharmacology
Basic and Clinical Pharmacology by Katzung

38. The Internet- WWW servers
These are computers connected to the to the Internet to provide a graphical interface to a variety of information that is available as text, pictures, databases & other electronic files.
Makes use of Web browsers such as Microsoft Explorer and AOL Netscape
Some websites allow downloading of files for free or fee
Quality & quantity of information vary per website

40. Good Websites
American Diabetes Association
American Heart Association
American Society of Health-System Pharmacists
Drug Info Net
American Healthfinder
Healthline
Medical Matrix
Onhealth
RxList

41. American Pharmaceutical Association www.aphanet.org
National Consumers League vm.cfsan.fda.gov/~lrd/fdinter.html
Drug Facts & Comparisons
US Food and Drug Administration
Sunnybrook Health Sciences
Pharmaceutical Technology Journal
The Merck Manual
Pub Med
NIAAA
Safe Medication
US Pharmacist
Web MD my.webmd.com

42. Alternate Sources of Information
Electronic Bulletin Boards
List Servers
Local, National & International Organizations
Pharmaceutical Manufacturers
Drug Information and Poison Control Centers
It is similar to a traditional mailing list — a list of names and addresses — as might be kept by an organization for sending publications to its members or customers, but typically refers to four things — a list of addresses, the people ("subscribers")

43. 5. Appraisal of Info Sources
Textbooks: date of publication, authorship, agreement with other sources
Literature Reviews: same as those for textbooks’ methods of selection
Original Research: abstract, basic research design, setting, participants, outcome measures & results

44. Categories of Drug Literature
I. PRIMARY
A. Evaluative studies
1. Experimental
- Clinical trial
- Pharmaceutical Research
- Educational Assessment
2. Observational
- Case Control
- Cohort
- Follow-up
- Cross-sectional
Cohort (biology)

45. B. Descriptive Reports
1. Case reports or series
2. Pharmaceutical practice
3. Clinical series
4. Program
5. Population
II. SECONDARY
A. Manual retrieval systems
B. Computerized retrieval systems

46. Secondary Resources
Indexing- consist of providing bibliographic citation information (eg. Title, author and citation of the article)
Abstracting- includes a brief description (or abstract) of the information provided by the article or resource cited.

47. Availability of Secondary resources

48. III. TERTIARY
A. Reference text or databases
B. Reviews
C. Compendia
D. Practice Guidelines
IV. OTHER SOURCES
A. Expert Communication
B. Investigator’s brochures
C. Pharmaceutical Manufacturers

49. EVALUATIVE STUDIES Experimental
the study is designed to answer a question or a hypothesis in a prospective manner
involves a measurement of an intervention
requires control of variables

50. EVALUATIVE STUDIES Observational
the study records the results from an observation of subjects or a specific set of data
shows an association between an event and the environment or other factors
answers a question from what has already occurred (retrospective)

51. EVALUATIVE STUDIES Observational
Case Control Studies - evaluates a specific event and its association with some factors
Ex. Ca Px who took OC vs. Ca Px who did not take OC
Cohort studies - observe the effects of the exposure to an agent over time
Ex. Px taking OC vs. Px not taking OC

52. EVALUATIVE STUDIES Observational Follow-up Studies
evaluate the effect of an agent over time but is not compared with a control
a large number of patients taking a drug may be observed over a longer period of time (i.e. 10 years)
Ex. NSAID users and future hospitalization

53. EVALUATIVE STUDIES Observational Follow-up Studies
evaluate the effect of an agent over time but is not compared with a control
a large number of patients taking a drug may be observed over a longer period of time (i.e. 10 years)
Ex. NSAID users and future hospitalization

54. Components of Evaluative Studies
Title
Author
Abstract
Introduction
Methods
Results
Discussion of results
Conclusions
References

55. Title- tells about the topic of the article
Author- who conducted the study
Abstract- identifies the purpose, design and methodology of the study and briefly reviews the results and the conclusions
Introduction- lays the framework for the purpose of the study & provides an overview of the literature that support the purpose of the study

56. Methods
most important part of an evaluative study & should be appropriate to address the hypothesis and purpose of the study
contains description of experimental design and its controls, # of subjects, exclusion and inclusion criteria, type of blinding, data analysis method, data collection method, outcome criteria or expected results of intervention
Results- organizes and simplifies the raw data emanating from the study

57. Discussion of Results
the author compare his/her finding with similar studies from the literature
interprets the data and state significance of the findings
explains inadequacies, limitations, anomalies in the study and explains them
Conclusions- provides a few sentences summary of the study’s purpose and results
References- lists of literature cited in the study

58. DESCRIPTIVE REPORTS
explain individual experiences, new programs, new therapies, or adverse events
do not involve an experimental procedure or address a specific hypothesis
just explain what happened and the perceived outcomes
may be used as basis for evaluative studies

59. CASE REPORT
- talks of an individual patient & his/her experience with a drug
PHARMACEUTICAL PRACTICE
- usually describes a new procedure or analytical method
CLINICAL SERIES
- collection of reports on a similar topic or treatment

60. Descriptive Report of a PROGRAM
- new pharmacy program instituted
Descriptive Report of a POPULATION
- describes a specific preference or characteristic of a population

61. Components of Descriptive Reports
Title
Author
Abstract
Introduction
Observations- where the details of the project is described
Discussion- clinical relevance
Conclusions
References

62. TERTIARY LITERATURE
provides a scholarly overview of a particular topic at a specific time
used to find factual information
they compile primary literature in a user-friendly format
highlights the widely accepted information from the primary literature

63. Components of Review Articles
Title
Author
Abstract
Introduction - explains why the review is made
Body- examination of the literature
Conclusions
References

64. Characteristics of other Sources
Expert report - unpublished report from an expert, maybe opinion or data from unpublished evaluative study
Investigator’s brochure - unpublished information about an investigational drug
Pharmaceutical manufacturer- available data from the manufacturer which may be published or unpublished

65. 6. Formulating the Response
Summary of information or evidence
Recommendations
References
7. Communicating the Response
Oral
Written

66. Practical Checklist in the Preparation of Written Materials
Do research first
Put yourself in the reader’s position
Use proper grammar and spelling
Make the document look professional
Keep things simple & direct
Avoid abbreviations & acronyms
Avoid writing in the first person

67. Practical Checklist in the Preparation of Written Materials
Avoid using passive sentences
Avoid slash construction (he/she)
Avoid contractions
Cite references when appropriate
Use the easier order of ideas
Get everything down on paper before revising
Edit, edit, edit!
A contraction is a shortened version of the written and spoken forms of a word, For example, "can't" is the contraction for "can" and "not".

68. 8. Documentation & Follow-up
Document: drug information, the recommendations and sources of information
Follow-up the outcomes of recommendations

69. Basic DIS Record
Requestor Info (name, status/occupation, address, contact no., when response is needed)
Date and time request is made
Patient Background Info (name, age, sex, race, height, weight, test results, chronic conditions, acute conditions, medications- name, dose, freq, start & end)
Question (Initial & Primary)
Search Strategy
Index (drug, disease, descriptors)
Response (content, date, time required, references)
Researcher

70. Ethics (in Pharmacy Informatics)
A generic term for “several ways of examining the moral life”
It is a process of deliberation & justification that is necessary when confronted with a moral dilemma

71. Analytical Approach to PARTICULAR JUDGMENTS OR ACTIONS
Ethical Dilemmas
ETHICAL THEORIES
PRINCIPLES
RULES
PARTICULAR JUDGMENTS OR ACTIONS

72. Ethical Theories – integrated bodies of principles & rules that may include mediating rules that govern cases of conflicts
Rules and Principles are action - guides
“Often, there is no straightforward application of theory in particular judgments”
“Theory is invoked to help develop action-guides that are more specific and that fit the context”

73. Specific Ethical Rules & Principles frequently Applied in Medical Ethics Inquiry
Respect for autonomy
Consent
Confidentiality
Privacy
Respect for Persons
Veracity
Fidelity
Nonmaleficence
Beneficence
Justice
Respecting Patient-professional relationship

74. Selling of Drug Samples?
Euthanasia
Capital Punishment by
Lethal Injection
Selling of Drug Samples

75. How do we start? Build up your resources
Be systematic in answering drug info questions
Develop good search strategies
Update yourself regularly

76. “An effective pharmacist is a good provider of drug information regardless of the area of practice.”