Drug Resources

1
Drug Resources
Nancy Clark, MEd, Director Medical Informatics
Education Mark Strickland, MD, Informatics
Curriculum Director TLH
2
Objectives

• Find the Drug Reference Library web page
• Locate basic prescription, OTC and herbal drug
  information (dosage, indication, etc.) online and
  on the PDA
• Calculate a drug dosage using an electronic
  resource
• Identify if a drug is on a particular formulary
  and locate alternatives
• Identify a pill from its imprint or description
• Perform a drug interaction check
• Use an infectious disease/antibiotics guide
• Use an immunization schedule tool

3
Not Covering

• Patient Education Handouts on drugs
• Drug News recalls, dosing and delivery changes,
  safety issues, FDA approvals, etc.
• Research articles on clinical trials, drug
  toxicology, etc.

4
Handouts

• Evaluation and Consent form
• Presentation
• Drug References Handout
• Worksheet
• Instructions for email alerts

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Medication Errors

• Adverse Drug Events (ADEs) rash drop dead
• ADEs due to inappropriate prescribing pt
  noncompliance 3-28 hospitalizations
• 30 of pts who suffer ADEs die or are disabled
  for 6 months
• IOM 98,000 deaths per year from medication
  errors in hospitals
• Cost of drug related morbidity and mortality in
  US estimated 1.56-5.6 billion/yr

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Using the WorksheetIdentify drug questions you
have had in the last 2 weeks.
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Library Web Site
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Subscription Drug Resources

• Epocrates Online or Essentials (web and PDA)
• eFacts and Comparisons (web)
• PEPID
• Access Medicines Drugs (Lexi Drug) (web)
• Harrisons Practice (Lexi Drug) (web and PDA)
• MDConsult (Clinical Pharmacology) (web)
• Natural Medicines Database (web and in Epocrates
  PDA)
• Pediatric Care Online
• Journals, News and periodical databases
• Prescribers Letter
• Medical Letter (Handout on how to get alerts)

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PDA Drug Resources

• Epocrates Essentials
• Palm, Windows Mobile, iPhone
• PEPID
• Palm, Windows Mobile, iPhone
• Harrisons Practice
• Palm, Windows Mobile
• Pediatric Care Online
• Palm, Windows Mobile

Available free to all faculty
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Free Drug Resources

• Johns Hopkins Antibiotic Guide (web and PDA)
  http//hopkins-abxguide.org
• Shots (immunization schedules) (Web and PDA)
  http//www.immunizationed.org
• CDC Travelers' Health http//wwwn.cdc.gov/travel/
  
• Merck Medicus (PDR Library) (web)http//www.merck
  medicus.com
• Drugs.com http//www.drugs.com/
• Toxnet (poisons and toxic agents)http//toxnet.nl
  m.nih.gov/

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Who Has What?
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MonographsPrescription, Non-prescription and
Alternative Medications

• Epocrates Online
• Epocrates Essentials PDA
• Facts Comparisons Online

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Epocrates ONLINE
1. Pick a letter
2. Pick drug
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2. Pick sub category
1. Pick category
3. Pick drug
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1. Type
2. Pick drug
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Prescription Drug Monographs
1. Pick category
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Alt Meds Monographs
1. Pick category
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Natural Medicines Database
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Exercises for Practice

• Using Epocrates Online
• What is the starting dose of lisinopril to treat
  HTN if the patient is not on a diuretic? (dose)
• How much does one month supply of Cymbalta 30 mg
  cost?
• What is the off label indication for Ativan?(?
  indicates off label)

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Epocrates Essentials PDA
2. Pick drug
3. Pick category
1. Type
Prescription and Alt Meds are combined in same
list.
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Epocrates PDA - Searching
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Dosage Calculator in Epocrates PDA
3. Type Amt, Wt Freq
2. Click dose
4. Click Calculate
1. Peds Dosing

• Online Dosage Calculator
• http//www.medcalc.com/pedidose.html

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Exercises for Practice

• Using Epocrates PDA
• A little boy who is eight years old just ate a
  bottle of Childrens Tylenol tablets his mother
  had in the medicine cabinet. She thinks he ate
  forty or fifty of them. You search the Tables
  Toxicology Antidotes 1 and find that
  acetylcysteine is indicated for acetaminophen
  toxicity. Calculate the dosage of acetylcysteine
  for the child. He weighs 50 lbs.
• You have a patient with cystic fibrosis who
  presents with tinea corporis. What antifungal
  cannot be used? (Use Search tool for
  Contraindications.) 

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eFacts and Comparisons

• Resources

Browse Resources
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Search eFacts Comparisons
1. Type
2. Pick drug
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eFacts Comparisons Online

• Monograph in Drug Facts and Comparisons will come
  up
• To switch resource, select at top

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Tables in Facts and Comparisons
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Exercises for Practice

• Using Facts and Comparisons Online
• Is it possible that Wellbutrin causes tinnitus?
  (hint CTRL-F)
• Which of the proton pump inhibitors are use off
  label for GERD in children?

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Other Drug Monographs Available

• MDConsult
• Gold Standards Clinical Pharmacology
• Thorough
• Access Medicine and Harrisons Practice
• Lexi Drug Content

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Epocrates ONLINE Formulary
1. Pick formulary
2. Click to see meaning
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Epocrates ONLINE Formulary
1. Click Code
2. Under View Alternatives, click class
Alternatives
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Finding Substitutes
Codes
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Epocrates PDA

• Go to Epocrates.com
• Manage My Account
• Pick Formularies
• Sync to add

1. Pick formulary
2. Click Code
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Exercises for Practice

• Using Formulary Tools on Epocrates online or PDA
• I have a patient with H. Pylori who has BCBS of
  Florida 3 Tier who needs a low copay. Which of
  the treatments are covered by BCBS low copay?
  Look up drugs by class gastrointestinal H.
  Pylori.
• I have a depressed patient with no health
  insurance who is indigent. Which SSRI can they
  get for 4 at Target?
• A 65 yr old female with osteoporosis is on
  Boniva. She has recently changed to AARP Medicare
  Complete MA. Can she continue taking Boniva? Are
  there lower cost choices?  

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Drug Interaction Tools

• Epocrates Online
• Epocrates PDA
• eFacts Online
• PEPID Online and PDA

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Epocrates ONLINE MultiCheck Tool
1. Type
2. Click drug
Interactions appear as found
Repeat until all drugs in list
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Epocrates PDA MultiCheck
2. Pick drug
1. Type
3. Repeat until all drugs in list
4. Click Drugs
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Epocrates PDA MultiCheck
Click interaction
Use to add more
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eFacts Drug Interactions
Type in patients drugs, food and herbals and
click Add
Check list, add more if needed then click GO
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eFacts Drug Interactions
Click on Interaction to see monograph
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PEPID Interaction Tool
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Exercises for Practice

• Epocrates Online digoxin, furosemide, lisinopril
• Epocrates PDA lisinopril, metformin, and
  hydrochlorothiazide
• Peds example isoniazid, rifampin, ethambutol,
  acetaminophen
• Now look up one of these cases in Facts and
  Comparisons and compare results

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Pill Identifiers

• Epocrates Online and iPhone version
• eFacts Online

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Epocrates ONLINE Pill Identifier
Scroll through results until you find your pill.
Click name to go to monograph.
Pick shape, color, etc. If imprint readable, type
it in and click Identify Pills
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eFacts Pill Identifier
1. Type in imprint and click Go
2. Click on underlined drug name
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Antibiotics/Infectious Disease Tools

• Epocrates ID PDA
• Johns Hopkins ABX Guide Online
• Pediatric Care Online

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Epocrates PDA ID Tool
By System
2. Pick diagnosis
1. Pick System
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Epocrates ID Tool
Pick Specific Tx to see pathogens
Pick drug to go to monograph
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Epocrates PDA ID Tool
By Bug
1. Pick Bug
2. Pick disease
Pick drug to go to monograph
Switch to Specific Tx for bugs
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Johns Hopkins ABX Guide Online

• Free resource online
• PDA version .
• Look up by Disease, Drug or Pathogen
• Requires registration, creation of userID and
  password worth the effort

(http//www.hopkins-abxguide.org)
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Johns Hopkins ABX Guide Online
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Johns Hopkins ABX

• Free
• Register for UserID and Password
• Warning PDA version crashed PocketPC but in
  Epocrates Pro, so unnecessary to load

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Pediatric Care Online

• Antimicrobial Therapy Guide
• Information by
• Diagnosis
• Agent
• Class

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Exercises for Practice

• Using Epocrates ID
• Which antibiotics should be used for a 17 year
  old outpatient female with PID, etiology unknown?
• The culture comes back with Bacteroides fragilis
  in the same patient. What antibiotic should I
  use? Using the PDA, find the antibiotic.
• What other treatment recommendations for this
  patient are found in ID? (choose other info
  from menu at lower left corner)

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Immunization Tools

• Epocrates Online and PDA
• InfoRetriever (Web and PDA)
• Shots (Web and PDA)
• Pediatric Care Online

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Epocrates Vaccinations
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Essential Evidence Immunizations
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EE Immunizations - PDA
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Shots on the Web
www.immunizationED.org
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Shots on the PDA
Free Resource
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Pediatric Care Online
Interactive Periodicity Schedule includes
Childhood Immunizations
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Exercises for Practice

• Using any of the Immunizations tools
• Patient has planned a mission trip to Central
  America. What immunizations does she need?
• The news of a meningitis outbreak brings in a 53
  yr old man with a history of TB but otherwise
  healthy who is worried that he might be exposed.
  Should we give him Menactra?

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Look up the drug questions on your worksheet.
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Summary

• Epocrates on PDA better than online. Has ID, Dx,
  other resources,
• PEPID competes well with Epocrates as a one-stop
  shop
• Facts and Comparisons more detailed monographs
  and interactions but only online
• Many other resources have good drug information
  but without tools (formularies, interaction
  tools, dosage calculators)