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35 Cards in this Set
- Front
- Back
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7 Steps to Answering Drug Info Requests
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Requestor demographics
Background Info Determine, categorize ultimate question Determine strategy, conduct search Evaluation, Analysis, Synthesis Formulate, Provide Response Follow-up, Documentation |
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Background information to always obtain
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-contact number
-urgency -patient related or informational |
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General Product Info sources
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PDR
AHFS Drug Info Drug Facts and Comparisons Drug Info Handbook |
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Electronic Databases for General Product Info
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Clinical Pharmacology
Lexi-Comp Up to Date Drugdex |
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Pregnancy and Lactation Resources
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Briggs
Weiner Reprorisk (Shephards, Teris, Reprotex, Reprotox lactation info) |
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Fetal Risk Factors
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state of pregnancy when med taken
drug concentration in mother MW of drug lipid solubility ionization protein binding placental blood flow, surface area |
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Pregnancy Risk Categories--FDA
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Category A, Category B, Category C, Category D, Category X
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Fetal Risks and Pregnancy Category--Briggs
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Compatibility
Risk Contraindication |
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Lactation Resources
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Medication + Mother's Milk
Briggs--Drugs in Pregnancy and Lactation TOXNET |
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Dr. Hale's Lactation Risk Categories
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L1--> L5
(proven to not have risk--> significant risk) L3 = no controlled studies, risk possible (where all new drugs are placed) |
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Briggs Lactation Reccommendation
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Compatible
Hold Breast Feeding No (limited) human data Probably Compatible Potential Toxicity Contraindicated |
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"Teddy Bear" Book
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Pediatric Injectable Drugs
neonates--> adolescents |
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Pediatric Dosage Handbook
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good for relevant doses, compounding
as of 2009, has breastfeeding info Appendices: immunization guidelines, oral meds that can't be crushed, pediatric HIV |
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Pediatric Dosage Formulations
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recipes for preparation of adult drug dose for pediatric formulation (tabs, caps--> liquid)
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pediatric dosages must be individualized by
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weight
age BSA (mg/m2) |
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factors that affect drug excretion/removal
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MW
lipid solubility protein binding dialysis membrane |
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Resource for Dose Adjustment for Renal Function
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Bennett Book (Drug Prescribing in Renal Failure)
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liver metabolic activity affected by
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liver blood flow
activity of metabolizing enzymes protein binding |
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liver blood flow affected by
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acute blood loss
cirrhosis/alcoholism decreased liver blood flow--> decreased first pass effect--> increased bioavailability |
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Labs to evaluate liver function
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AST, ALT (damage to hepatocytes)
BR, direct BR (cholestasis/decreased conjugation) Albumin, PT/INR (change in synthetic function) |
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factors to consider when choosing drug therapy for geriatric patients
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renal function
liver function CNS function body composition CNS inability to tolerate certain formulations co-morbidities polypharmacy nonadherence |
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Assuring Appropriate Med Use in Geriatrics
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BEERS
START- what geriatric patients should be getting STOP- drug disease interactions |
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Resources for Geriatric Patients
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Geriatric Dosage Handbook (dosage based on renal/liver function)
Fundamentals of Geriatric Pharmacotherapy (polypharmacy) |
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Monitoring for Geriatrics
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appropriate med dosing
therapeutic duplication improper drug selection ADRs |
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Treating Geriatric Patients
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Start Low--id, address change in volume distribution, protein binding, PD
Go slow when increase dose--id change in metabolism, excretion |
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Pediatric Pharmacy Concerns
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drugs may be marketed for use in children w/o being tested extensively
ped dosage forms may not be commercially available individualized doses ensure pts/caregivers have all info needed to measure, administer dose ensure appropriate equipment available to administer dose importance of pt counseling |
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information on immunization schedules
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CDC website
Harriet Lane handbook Pediatric Dosage handbook |
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CAM resources
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Stockley's Herbal Med Interactions (food items, synonyms)
German Commission E Natural Standard Natural Medicines Comprehensive Database (safety, effectiveness) Handbook of Drug-Nutrient Interaction Review of Natural Products (folkloric uses, pregnancy + lactation info) |
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CAM internet resources
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NCCAM
Office of Cancer and CAM Office of Dietary Supplements Natural Standard Collaboration AltMedDex |
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Drug Lab Interaction Qs to ask (5)
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When did lab test change in relation to starting drug?
Other drugs or conditions that could be responsible? If drug was stopped, did lab test return to expected value? If different test method used, is same result obtained? |
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In Vivo Drug-Lab Interactions
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assay measurement correct
interference via direct extension of pharmacologic activity, toxicology effect |
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In Vitro Drug-Lab Interactions
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direct interference w/ lab test during analysis
dependent on assay methodology |
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When to Suspect Drug-Lab InteractionI
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-test results don't agree with patient's condition
-results of different tests assessing same or similar info in contact -results from same tests vary over short amount of time -results from series of tests of same info inconsistent |
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Resources for Drug-Lab Interaction
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1. Effect of Herbs and Natural Products on Clinical Lab Tests
2. Interpreting Lab Data (organ systems or targeted populations) |
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Resource for bioequvalence
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Orange Book
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