1. DRUG INFORMATION
Dr. Samah Al-Jabi

2. Definition Drug information
Current , critically examined, relevant data about drugs and drug use in a given patient or situation.

3. Drug information
Current information uses the most recent, up- to-date sources possible.
Critically examined information should meet the following criteria:
1. More than one source should be used when appropriate.
2.The extent of agreement of sources should be determined; if sources do not agree, good judgment should be used.
3. The plausibility of information, based on clinical circumstances, should be determined.
Relevant information must be presented in a manner that applies directly to the circumstances under consideration (e.g. , patient parameters, therapeutic objectives, alternative approaches) .

4. Drug information resources
Primary sources : Journals
Benefits:
a. Keep abreast of professional news (side by side to new information).
b. Learn how another clinician handled a particular problem
c. Keep up with new developments in pathophysiology, diagnostic agents, and therapeutic regimens
d. Distinguish useful from useless or even harmful therapy
e. Enhance communication with other healthcare professionals and consumers
f. Share opinions with other healthcare professionals through letters to the editor
g . Obtain continuing education
h. Prepare for the board certification examination.

5. Drug information resources
Primary sources : Journals
Limitations.
Although publication of an article is well known, respected journal enhances the credibility of information contained in an article, this does not guarantee that the article is accurate.

6. Drug information resources
Primary sources : Journals
All material included in a journal is not considered a primary resource.
Original clinical trials are considered primary literature.
however
Review articles (systematic reviews, and meta-analyses), articles of opinion (editorials and letter to editor), special and short reports are not

7. Drug information resources
- Systematic reviews: literature review on certain research question. - Meta-analyses: Combine the results of several studies that address a set of research hypothesis. - A letter to the editor is a letter sent to editor for publication about issues of concern from its readers. Usually, letters are intended for publication.

8. Drug information resources
Primary sources : Journals
Home work: name 5 journals related to clinical pharmacy or pharmacology

9. Drug information resources
Secondary sources : Indexing and abstracting services
Benefit: valuable tools for quick and selective screening of the primary literature for specific information, data, citation, and articles.
Sometimes the sources provide a sufficient information to answer a question.

10. Drug information resources
Secondary sources : Indexing and abstracting services Examples: Medline/PubMed Pharmaceutical News Index International Pharmaceutical Abstracts ClinAlert Iowa drug information Scopus Web of Science Google Scholar

11. Drug information resources
Secondary sources : Indexing and abstracting services
Limitation
Each indexing or abstracting service reviews a finite number of journals --- Therefore, relying on only one service can greatly hinder the thoroughness of a literature search.
The substantial difference in lag time (i .e. , the interval between the publication of an article and the citation of that article in an index).

12. Drug information resources
Secondary sources : Indexing and abstracting services

13. Drug information resources
Secondary sources : Indexing and abstracting services
Pubmed
Home - PubMed - NCBI

14. Secondary sources : Pubmed

15. Secondary sources : Pubmed

16. Secondary sources : Pubmed

17. Secondary sources : Pubmed

18. Secondary sources : Pubmed

19. Secondary sources : Pubmed

20. Secondary sources : Pubmed

21. Drug information resources
Tertiary sources : Textbooks
Provide easy and convenient access to a broad spectrum of related topics
Background information on drugs and diseases is often available.
Limitations:
It could take several years to publish a text book. (so recent information may not be included).
The author of a textbook might not have conducted a thorough search of the literature.

22. Drug information resources
Tertiary sources : Textbooks
Reference citations should be available to verify the validity and accuracy of the data.

23. Drug information resources
Tertiary sources : Databases
Computer databases are convenient, easy to use, and referenced.
These resources are similar to textbooks, but are typically updated more frequently.
Useful resources for drug monographs, pill identifications, drug interactions, and various therapeutic calculations
Examples
Micromedex, Clinical Pharmacology On Hand, Clinical Xpert, Lexi-Comp On-Hand.

24. Drug information resources
Tertiary sources : Databases

25. Drug information resources
Tertiary sources : Databases

26. Drug information resources
Tertiary sources : Databases

27. Drug information resources
Tertiary sources : Databases

28. Drug information resources
Tertiary sources : Databases

29. Drug information resources
Tertiary sources : Databases

30. Drug information resources
Tertiary sources : Databases

31. Drug information resources
Tertiary sources :
General considerations when examining and using textbooks and/or databases as sources of drug information include the following:
The author , publisher , or both
The year of publication (copyright date) or last revision date.
The edition of the text.
The presence of a bibliography.
The scope of the textbook or database.
Alternative resources that are available.

32. Drug information resources
Internet
The Internet expands the ability to search therapies that have been recently published or discussed in the media.
Limitations:
Information may not be peer reviewed or edited before release.
Information may be only as reliable as the person who posted it and the users who read and comment on its content.

33. Drug information resources
Internet
Traditional literature evaluation skills to determine whether information on Web site is clear , concise, unbiased, relevant, and referenced.

34. Drug information resources
Internet : Some clinical websites

35. Drug information resources
Internet : Some clinical websites

36. Drug information resources
Internet : Some clinical websites

37. Drug information resources
Internet : Some clinical websites

38. STRATEGIES FOR EVALUATING INFORMATION REQUESTS
It is important to obtain as much information as possible about drug information requests before beginning a literature search.
Both time and money can be lost doing a vast search.
So, important questions should be asked to the inquirer or to evaluate before a manual or computerized search.

39. STRATEGIES FOR EVALUATING INFORMATION REQUESTS
1. Converse with the inquirer
Before spending time searching for information --- talk to the person who is requesting the information and acquire any necessary additional information.
The information taken may narrow the search if products with similar names are found, or if the drug’s name in request is not fully known.

40. STRATEGIES FOR EVALUATING INFORMATION REQUESTS
Converse with the inquirer
Determine the reason for the inquiry.
Find out where the inquirer heard or read about the drug.
Is he or she taking the medication? If so, why? (Because the search can be done by the drug or disease name).
Ascertaining the reason for the inquiry helps determine what additional information should be provided.
For example, if the inquiry concerns a foreign drug, the inquirer might ask for a domestic equivalent .

41. STRATEGIES FOR EVALUATING INFORMATION REQUESTS
Converse with the inquirer
Clarify the drug's identification
a. The correct spelling of the drug's name
b. Whether it is a generic or brand name drug
c. What pharmaceutical company manufactures the drug and in what country the drug is manufactured
d. Whether the drug is prescription or OTC
e . The dosage form of the drug
f. The purpose of the drug (especially, if products with similar names are found)

42. STRATEGIES FOR EVALUATING INFORMATION REQUESTS
2. Identify or assess product availability
For drugs manufactured in the US (American drug index, physician desk reference “PDR”, Martindale, Thomson health care series “Micromedex”).
For drugs manufactured in foreign countries (Martindale, USP Dictionary of United States Adopted Names (USAN)”.
For investigational drugs (Martindale, Drug Facts and Comparisons/Facts and Comparison).

43. STRATEGIES FOR EVALUATING INFORMATION REQUESTS
2. To identify or assess product availability - For orphan drugs: drugs that are used to prevent or treat a rare disease (affects < 200,000 people in the United States)--- (The FDA Office of Orphan Products Development (OOPD), The National Institutes of Health (NIH) Office of Rare Diseases). - For Unknown drug: one that is in hand but not identified (PDR, Micromedex). -For Natural products (Natural medicine comprehensive database).

44. Search Strategies
To develop an effective search strategy for locating drug information literature, the following tactics should be followed after determining whether primary or secondary sources are desired.

45. Search Strategies
A. Determine the question asked - Define the question as specifically as possible - Identify appropriate index terms (keywords or descriptors) with which to search for the information.

46. Search Strategies
B. Determine the type of information and how much is needed (one fact , the most recent journal articles, review article ..)

47. Determine the answers to the following questions
Search Strategies
C. Ascertain as much information as possible about the drug being questioned and the inquirer 's association with it.
Determine the answers to the following questions

48. Search Strategies
1. What is the indication for the prescribed drug? 2. Is the drug's use approved or unapproved? a. Approved use of drugs: ( AHFS Drug Information, PDR, USP Drug Information, Drugdex (Micromedex) b. Unapproved uses of drugs ( AHFS Drug Information, Drug Facts and Comparisons/Facts and Comparison 4.0 (online), Martindale: The Complete Drug Reference, Medline)

49. Search Strategies
3. What are the age, sex, and weight of the patient in question? 4. Does the patient have renal or hepatic disease? 5. Does the patient have any underlying diseases? 6. What is the patient 's current medication status? 7. Is the patient taking any other medications? 8. What drugs has the patient taken during the past 6 months, and what were the dosages?

50. Search Strategies
9. Did the patient experience any signs or symptoms of a possible adverse drug reaction? (Severity, time, past ADR). 10. Did the patient experience any signs or symptoms of a drug interaction? (medications, duration of therapy, details of events, consult certain resource for more information). 11. How has the patient been managed so far? 12. What is the stability of the drug? How is compatibility of the drug with other drugs?

51. General guidelines for responses to drug information requests
A. Do not guess! B. Responses to a member of the public must take several ethical issues into account 1. Patient privacy must be protected. 2. Professional ethics must be maintained. 3. The patient-physician relationship cannot be breached. 4. Response is not necessary if the inquirer intends to misuse or abuse information that is provided.

52. General guidelines for responses to drug information requests
C. Organize information before response to the inquirer (concise and succinct). D. Tailor the response to the inquirer 's background. E. Tell the inquirer where the information was found. F. Use extreme caution when making statements such as, “ I recommend …”, and Do not hesitate to refer consumers to their physicians. G. Use more than abstracts to answer drug information questions. H. Alert the inquirer of a possible delay to answer the question.