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40 Cards in this Set

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  • Back
Give an example of primary literature
Clinical Trials
Explain what secondary literature is and give an example
indexing or abstracting databases (guides you to primary literature)- pubmed, medline, ovid
Explain what tertiary literature is and give an example
textbooks, review articles- facts and comparisons, micromedex
What are some characteristics of tertiary resources?
o Easily accessible, easy to use, complete and concise
o Outdated, not well edited, incorrect interpretation, lack of expertise of authors
What questions do you need to ask when evaluating tertiary literature?
is person qualified,
where are they getting their information from,
is it biased,
is the information appropriately cited by relevant sources
What factors are important when choosing a tertiary resource?
do you know how to use it, easy to use, relevant, have sections you need, is it expensive
Where could General drug information be found?
In general compendium
What are some characteristics of Drugdex?
aka Micromedex
FDA approved and off label uses
Pharmokinetic data
Safety information
Pharmacology
Comparative efficacy
What is a disadvantage of the Physicians Desk Reference?
It is biased
Where would I look for information on adverse effects of a drug?
Drugdex
Meyler's Side Effects of Drugs
Major Compendia
Where would I look for information on available dosage forms?
American Drug index
Red Book
Major Compendia
where would you find information about use of a drug for treatment of a disease that it is not approved for?
Off label use
Drugdex
where would you find the name of a drug only using its physical characteristics (shape, color, imprinting, etc.)
Clinical Pharmacology
efacts
Identidex
Ident-A-Drug
Where would you find the route of administrations of a drug and pediatric dosing?
a)Available dosage forms: American Drug Index, Mjor compendia

b) Pediatric dosing: Neofax, Pediatric dosing handbook, Major Compedia
Where would you find the US equivalent to a foreign medication?
Foreign drug indetification
Drugdex, Martidale: the complete drug reference, European Drug index
What is a drug formulary?
continually revised list of medications that are readily available to use in an institution
What is important when determining a drug formulary?
(List in order of importance)
oDrugs should be: most effective, fewest side effects and lowest cost. Cost does not come first!
How many medications from each class are in a formulary?
2-4 medications
What is an open formulary?
not really used, has a list of “recommended” drugs but no requirements or restrictions placed on them. Any drug available.
What is a closed formulary?
more common, only a limited number of drugs available, strictly enforced, restrictions/guidelines on how they should be used
When is it okay to use a non-formulary drug?
When rare disease state, patient is not responding to formulary medications, patient has adverse effects to formulary meds, patient stabilized on non-formulary medication, formulary medication not available
What is a P&T Committee?
Pharmacy and Therapeutics Committee
What formulary status' are there?
not added/deleted from formulary, added to formulary, added with monitored use, added with restrictions (who may prescribe, how it can be used, how long it can be used, what it can be used for)
What is JAHcO?
Joint Commission on Accreditation of Health Care Organizations, evaluates quality and safety of patient care, on site review once every 3 years, important for maintaining eligibility for medicare and medicaid reimbursement, no advance notice anymore, focus on quality improvement, everyone involved
What are 4 factors that should be considered when formulating a response to a drug information request
o Patient factors: demographics, past medical history, allergies, medication history, organ function
o Disease factors: definition, prevention, risk factors, complications, clinical findings, pathophysiology etc.
o Medication factors: name, availability, properties, adverse effects, drug interactions, dosage, indications etc.
-Other factors: setting (hospital, icu, acute setting etc.) and context
what are the 7 steps in a systematic approach to drug information requests
1) Obtain requestor demographics
2) Obtain background information
3) Determine the clinical question
4) Develop a search strategy and conduct your search
5) Perform evaluation, analysis, and synthesis
6) Formulate and provide a response
7) conduct follow-up and documentation
What should you find out when determining requestor demographics
-Name
-contact info
-has person completed previous research
- patient specific or academic request
-timeline for respons
What should you do when determining background information?
Identify the need (always ask at least one question back)

Consider:
-who is asking
-does it pertain to a specific question
-do I understand the question
-do I know why the question is being asked
-do I understand expectations of requstor
-Do I know pertinent pt history
-Do I know when info is needed
what should you do when determining the question
- Identify the question
-Categorize the question (provider, pt education)
What should you examin when looking at your search strategy?
-tertiary research
-secondary databases
-primary literature
Once you have found an answer to your question, how should you analyze the literature?
To ways:
-statisical analysis
-clinical analysis
What are four factors to consider when formulating a response to a question
-Patient Factors
-Disease Factors
-Medication Factors
-Other Factors
What are four factors to consider when formulating a response to a question
-Patient Factors
-Disease Factors
-Medication Factors
-Other Factors
What are some important patient factors?
Demographics
past medical history
ROS
Family history
social history
allergies
physical exam
etc
what are some imporant disease factors?
Definition
Epidemiology
etiology
Pathophysiology
Diagnosis
treatment
prevention
risk factors
complications
prognosis
What are some impt medication factors?
Name,
availability
properties
pharmacology
indications
Adverse effects
allergies
contraindications
toxicity
monitoring parameters
etc
what are some other factors to consider when formulating a response to a question?
-setting (ICU, Acute care)
- Context
How should you formulate a response?
-form opinion based on the best evidence available
-arrive at a judgement
-draw a conclusion
provide a recomendation
what is important to consider when following up to a question
-what did requestion do with info provided?
-Was your recomendation accepted?
What feedback can the requestion provide you with for improvement?
What should you document about a question?
-Request
-Requestor
-Response
-Outcomes