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49 Cards in this Set
- Front
- Back
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systematic approach -- 5 steps
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1. classify request
2. obtain bg info 3. systematic search 4. response 5. reclassification |
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Modified system approach 7 steps
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PBUSAFF
1. get personal info from requestor 2. bg info 3. categorize ultimate question 4. develop strategy & search 5. evaluate, analyze literature 6. formulate response 7. follow up & document |
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Requestor's Demographics incl?
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1. contact info
2. requestor's training/knowledge: ie MD, RN, pt? |
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Obtain bg info incl?
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-contact info
-pt related or in general? -urgency -affiliation (formulary) -pt specific info (med hx, allergy, concomitant meds) |
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Most imp step in process? incl what?
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Determining ultimate question
-dictates entire process of answering the question. |
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Categorize question
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useful to devise search strategy incl:
- dosing/administration rec - clinical rec - general product info - adverse effects - drug interactions |
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Tertiary literature incl?
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textbooks, computer databases, review articles
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2ndary lit?
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resources that index or abstract primary literature
- micromedex; uptodate; lexi-comp |
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Primary lit
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original scientific investigational studies
large randomized drug trials are GOLD STANDARD |
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How to conduct search using 1, 2, 3 lit?
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always start with 3rd --> 2ndary --> primary
Always verify with a second source |
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responding to question
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restate request, identify key problems
- present specific findings - incl references -conclusion & recommendation |
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characteristics of an ideal response
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appropriate & accurate
given in a timely manner complete and concise well-referenced clear/logical objective/balanced answers related questions addresses specific management of pt and situation |
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Follow up & Documentation incl?
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verify that the question asked was answered appropriately
-helps det if more info is needed -enables feedback -can track intervention |
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Prescribing info incl?
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aka Package Insert
- general info from manufacturer - "on label" - incl: dosing, admin, chem structure, MoA, ADR, ingredient info |
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General product info --- references?
PDR & AHFS |
PDR: compliation of package inserts; product photos; directory of manufacturers
AHFS: Gold standard! drug monographs; organized by drug class; extensive info for on & off label usage |
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Drugs facts & comparison
DI handbook |
Drug facts & comp: organized by therapeutic class; incl: all FDA approved products; Rx & OTC; brand/generic; orphan drugs; excipient info
DI handbook: general drug info; tables for references |
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General Drug info ELECTRONIC incl?
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Clinical pharmacology; Lexi-comp online; Drugdex system; Uptodate
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Non Rx Ref
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Handbook of nonRx drugs: efficacy of OTC meds; drug interactions; contraindications to self-treatment
-Excipient info might be unclear |
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ADR ref?
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Meyler's Side effects of drugs:
info organized by generic name and class (ie statins, NSAIDS) |
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Drug Interactions sources
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1. Hansten & Hom's Drug Interaction Analysis and Management
2. Drug Interaction Facts 3. Stockley's Drug Interactions ALL incl severity of interaction; references; actions to minimize risk May incl data on likelihood of interaction |
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Drug ID ref
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Ident-A-Drug
PDR Micromedex Identi-dex Lexicomp European drug index: principle info; conversion for dosage forms Index Nominum: has chem structure, class, names of intl meds Martindale: intl |
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Infectious Dz Ref
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Sanford Guide- GOLD STANDARD
Mandell's Principles & Practices of Infectious Dz |
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Cancer Ref
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Cancer: principles & practices of Oncology (Devita)
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Nutrition Ref
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A.S.P.E.N guidelines
american society for parenteral and enteral nutrition |
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Integrative Med Ref
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Natural Med Comprehensive Database
Review of natural products Complete German commission E-monographs PDR for herbal meds naturalstandard.com |
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Drug price & availability Ref
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Red Book
---> Incl AWP; describes availability of each dose |
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What is bioequivalence?
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if RATE and extent of ABSORPTION of test drug does not show signif diff from reference drug.when given at the same molar dose of therapeutic ingredient under similar experimental conditions.
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Standard ref for bioequiv?
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The ORAnGE book or Bioequiv book
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USP/NF used for?
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US Pharmacopeia National Formulary
Has official substance & product standards |
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Remington used for?
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incl basic of pharmaceutics and manufacturing
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merck index used for?
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chem structure; MW; physical data
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What are secondary references?
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Index or abstracts of primary lit.
Index: biblio citation info Abstract: brief description of study |
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Examples of 2ndary Ref
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Biologic Abstracts
Cancer today cancer lit Intl pharm abstracts Google scholar EMBASE / CINAHL Medline / Cochrane |
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What is included in an Abstract?
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snapshot of clinical trials;
incl bg; materials/method; results; conclusion; discussion BEWARE cannot read only abstracts! |
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Methods to searching 2ndary ref
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Index terms: MeSH; Intl classification of Dz; US adopted name
Boolean Operators: ex: AND, OR, NOT, With or Near |
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Searching 2ndary Ref electronically (2)
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Micromedex; Uptodate.
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Ref for Drug compatibility & its 5 components
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Handbook of Injectable Drugs
5 components: 1. Admin; stability; chem data 2. Soln compatibility 3. drug in syringe compatibility 4. Add' compatibility 5. Y-site compatibility |
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What is the kidney's function? effects on pharmacology?
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Regulates fluid balance
modifications can cause 1. dehydration or 2. fluid overload |
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Pharmacokinetic changes in renal impairment?
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ADME
Absorption: Bioavail. reduced Distribution: altered vol. Metabolism: changes in reduction and hydrolysis Excretion: Glomerular; tubular; reabsorption |
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Info to collect for calc glomerular filtration
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physical exam: edema, ascites, dehydration
height; weight; sex; age; SCr |
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GFR eq? CrCl
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24hr urine collection
CrCl = 140 - age (IBW) / 72SCr * 0.85 for females IBW: female: 45.5kg + 2.3/#inch male: 50kg + 2.3/#inch |
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What is extracorporeal removal?
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Dialysis 3 types:
Hemodia. Peritoneal dia. continuous renal replacement therapy (CRRT) |
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Factors that alter drug excretion
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MW; lipid solubility; protein binding; dialysis membrane
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Ref for Renal failure/Dz
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Drug Prescribing in Renal Failure aka BENNETT book
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what is the function of liver?
factors that influence function? |
metabolism of meds and formation of active/inactive metabolites
liver blood flow; activity of metabolizing enzymes; protein binding |
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Changes in liver blood flow due to?
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1. acute blood loss
2. cirrhosis/history of alcoholism Decr liver blood flow may: - incr systemic bioavail - incr ADR/toxicity |
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Metabolizing enzymes
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CYP450
isoenzymes: 3A4; 2C19; 2D6 glucuronidation; oxidation; conjugation |
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imp of Protein binding
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det. distribution of meds
changes in binding may affect efficacy; toxicity; ie. oral chemo agents; phenytoin |
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Lab parameters for liver function
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Hepatocytes: AST/ALT
Cholestasis: Bilirubin/direct bili changes in synthetic func: Albumin; PT/INR |
