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57 Cards in this Set
- Front
- Back
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First Drug Information Specialist
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-responsible for Drug Info. Center
-respond to specific questions -retrieve, select, evaluate, and disseminate answer |
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Contemporary Medication Information Services
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Support clinical services
Poison Information Adverse Drug Reaction & Medication Error Reporting Programs Publications Formulary Management Develop criteria/guidelines for medication use |
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Contemporary Medication Information Services participate in "Investigational Medication Control"
T/F? |
True
-Institutional Review Bored activities -Information for Practitioners on Research drugs -Management of a Pharmacy based Investigational Drug Service |
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Factors Contributing to the growth of drug information practice
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1975 Commission on Pharmacy Report
1990 To Err is human Growth of information technology Knowledgeable Patient Focus on Evidence-based Medicine Sophistication of Medication Therapy |
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Study Commission on Pharmacy Report (1975)
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review the state of practice and education of Pharmacists
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Medication Information Skills Required of a Pharmacist
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characterize the question
systematic data search evaluate data validity/ applicability develop, organize, summarize response Formulate a response Communicate clearly Anticipate questions |
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To Err is Human 1990
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new drug, evaluated for safety, adverse event profile is made
true ADE is seen in practice Role of Specialist; ID adverse drug reaction and prevent them in patients |
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Growth of information technology
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online resources
E-journals E-textbooks Registries of on going clinical trials |
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Change to Evidence-Based Medicine and Evaluation of Outcomes
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fee-for-service/inpatient --> capitated/managed/ambulatory
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Increased Sophistication of Medication Therapy
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Monitor drugs in development
Pharmacogenomics Designer drugs Gene therapy |
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DTCA
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Direct To Consumer Advertising
result = more knowledgeable patient |
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Systematic Approach to Answering DI Request
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step 1 - Classify question
step 2 - Background information step 3 - Systematic Search step 4 - Response step 5 - Reclassification |
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Modified Systematic Approach to answering DI Request
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Demographics of requester
Background information Determine the Ultimate question Conduct search Evaluation, analysis, and synthesis Formulate response Follow-up |
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When obtaining background information what should you ALWAYS ask?
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-contact information
-patient specific information -urgency of the question |
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When obtaining background information what kind of BOUNDARIES can you come across?
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-intermediate person
-lack of patient specific info -fear of asking something "dumb" |
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When faced with a DI request, what is the most important step?
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Determining the ultimate question
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Search Strategy
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Tertiary Sources --> Secondary Sources --> Primary Sources
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Responding to DI question
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1. Restate request and identify key problem(s).
2. Present findings based on patient specific information. 3. Reference citations 4. Conclusion and recommendations |
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Characteristic of Ideal Response
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- Appropriate & Accurate
- Timely - Logical and clear - Objective and balanced - Complete yet Concise -Addresses specific management of patient and situation |
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Follow-up
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- question was answered appropriately --> More info? Impact? Feedback?
- documentation --> decrease liability |
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When documenting a DI follow-up, what should be included?
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Ultimate question
References Response and Follow-up |
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What is the first place to search?
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Tertiary References
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What is the benefit of a tertiary reference?
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citations to primary literature
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Questions to consider when evaluating tertiary references:
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author expertise
information timely appropriate information citations relevancy of information bias of information |
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Prescribing Information
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"Package- insert"
published by manufacturer "on-label" information |
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Topics Covered in Tertiary Information
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Prescribing Information
Monographs Regulatory References Compounding Drug Identification Interaction/Evaluation/Management ADE Bioequivalence |
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Physician Desk Reference (PDR)
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package- inserts
directory of manufacturers and poison control centers product photos |
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AHFS Drug Information
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monographs
organized by drug class on- and off- label information |
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Drug Facts and Comparison
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organized by therapeutic class
Rx and non-Rx drugs All FDA approved products Orphan Drugs Excipient information |
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Handbook of Nonprescription drugs; Approach to self care
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-comparative efficacies of OTC meds
-drug interactions -Contraindications to self care |
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Adverse Drug Reaction Reference?
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Meyler's Side Effect of Drugs
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Drug Interaction References?
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Hensten and Horn's Drug Interaction Analysis and Management
Drug Interaction Facts Stockley's Drug Interactions |
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Drug Identification References?
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Ident-A-Drug
Physicians Desk Reference Electronic: Lexi-comp, Micromedex |
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Foreign Drug Identification References?
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-European Drug Index --> has a dictionary for translating dosage forms
-Index Nominum: International Drug Reference -Martindale: The complete Drug Reference |
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Disease state specific references
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Infectious Disease: Sanford Guide, Mandell's...
Cancer: Principles and Practice of Oncology (Devita Book) Nurition: A.S.P.E.N. Guidelines |
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Integrative Medicine References
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-Natural Medicine Comprehensive Database
-Review of Natural Products German Commission E-Monographs -PDR for Herbal Medicine -www.naturalstandard.com |
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Drug Pricing and Availability
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Red Book
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Bioequivalence
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Orange Book
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<3 's Pharmacy Reference Pharmacology
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-Goodman and Gilman's: the pharmacological basis of therapeutics
-Principles of Pharmacology -Basic and Clinical Pharmacology |
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<3 's Pharmacy Reference Therapeutics
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-Applied Therapeutics: Clinical use of drugs
-Pharmacotheraphy: Pathophysiologic approach -Harrison's Principles of Internal Medicine -Washington Manual of Medical Therapeutics |
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Common References Pharmacists Use
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USP/NF
The Remington Merck Index |
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Index Terms (search methods)
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MeSH (Medical Subject Headings)
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Boolean operators
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search methods
using "and" "or" "not" "with" "near".... |
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References ALL Pharmacy students should have
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-Medical Dictionary (Dorland's)
-Medical Abbreviations Booklet -Sanford Guide -Peripheral Brain |
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Handbook of Injectable Drugs
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-Administration, stability, chemical/physical data
-solution compatibility -drug in syringe compatibility -additional compatibility -Y-site compatibility |
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What is the most common reason for dose adjustments?
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Alterations in the elimination capacity of the kidneys and liver
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Pharmacokinetic changes in renal impairment
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Absorption
Distribution Metabolism Excretion |
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Modification of Diet in Renal Disease
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MDRD
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Dialysis
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-Hemodialysis (HD)
-Peritoneal Dialysis (PD) -Continuous renal replacement therapy (CRRT) |
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Drug Prescribing in Renal Failure
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a.k.a. the Bennette Book
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Factors that play into liver's ability to metabolize drugs
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- Blood flow
- Metabolism - Protein binding |
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Lab parameters to evaluate liver function
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-Damaged hepatocytes--> AST/ALT
-cholestasis/decreased conjugation --> Bilirubin/direct billirubin -change in synthetic function --> albumin and PT/INR |
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Dosage adjustments in liver disease
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- liver function lest
- bilirubin/direct bilirubin - serum albumin -child-Pugh score |
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Factors to consider when choosing geriatric drug therapy
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-renal function
-liver function -body composition -CNS |
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Geriatric Dosage Handbook
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-monographs
-adjustments are made based on liver/renal functions -adverse reaction risks |
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Beer's Criteria
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reference for geriatric patients
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Assessing care of Vulnerable Elders Project
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ACOVE
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