Nancy Clark, M'Ed'

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Epocrates and Other PDA Reference Tools

• Nancy Clark, M.Ed.
• Director of Medical Informatics Education
• FSU College of Medicine

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Objectives for Workshop

• Download and Install on the PDA
• Use Epocrates Rx
• find dosage, calculate dosages
• Identify if drug on formulary
• Use MultiCheck to find interactions
• Use Sx to get a Differential
• Use Dx to find Disease information
• Use Lab to find Laboratory information
• Use ID to find recommended Antibiotics
• Use MedMath Medical calculators
• Use Tables for guidelines and algorithms

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Handouts

• PowerPoint
• Downloading instructions for Epocrates Essentials
  (yellow)
• Using Epocrates Essentials
• UserID and Password sheet (blue)
• List of PDA software available and description of
  uses
• Consent form and evaluations

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Installing Software

• See Handout

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Links to Download Sites
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PDA Websites Page
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FSU Licensed PDA Software

• Epocrates Essentials (149/yr)
• Rx, Sx-Differential diagnosis, Dx-5MCC, ID, LAB,
  M?-interactions, tables, CME, tools and
  calculators
• InfoRetriever (249/yr)
• 5MCC, Cochrane, InfoPOEMs, calculators,
  guidelines, ICD-9 and EM coder
• POCKETConsult (FIRSTConsult) (149/yr)
• Differential diagnosis, medical conditions
• Clinical Evidence (99/yr)
• EBM treatment recommendations
• DynaMed (200/yr)
• Disease and conditions reference
• Harrisons Practice (325/yr)
• Disease and conditions reference

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Free PDA Software Used in Curriculum

• Geriatrics at Your Fingertips (GAYF)
• From AGS, tools and guidelines for care of older
  patient
• free to students, 30 for faculty
• ePSS Tool
• From US Preventive Services Task Force (USPSTF)
  tool, enter patients age, gender and get latest
  preventive services recommendations
• Archimedes
• Numerous handy medical calculators free from
  Skyscape

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Full Installation Instructions

• Handout for Epocrates Essentials
• Other program instructions on Intranet will
  require you to sign in if off campus
• Login med\firstname.lastname
• College of Medicine UserID and Password
• Updated weekly

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General Steps for All Installations

• Go to the Library web page,
• Log onto EZProxy
• PDA Websites page Follow link to product web
  site
• Register and get an account
• Pick platform (Palm, Windows Mobile 5 or
  PocketPC)
• Download software to desktop
• Run the software with the PDA connected (Serial
  )
• Tell it where to put the software (device or SD)
• When it finishes, test the software
• Register Product

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Adding Applications
PDA App
3. Download software

• Go to Product Web site
• Register

4. Run Software on Computer
PDAApp
5. Install to PDA Device Memory or SD card
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Drug Information

• Epocrates Essentials Rx
• (Also online)

Prescription Drug Information
Alt Med Information
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Epocrates Rx

• Prescription drugs and alternative medicines
  combined in same list
• Lookup by Drug or by Class
• Search tool lets you look up drugs by indication,
  adverse reactions, etc.
• Dosage Calculator pops up for all drugs reported
  in mg/kg
• Formularies available with status of each drug

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Navigation

• App Hide Alt Meds, Auto Update, Memory Mgmt
• Edit find
• Tools Abbreviations, Formulary Info,
  Preferences, Update Email, Disclaimer and About

MultiCheck Drug Interactions
Search Tool
Home
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Epocrates Essentials Rx
2. Pick drug
3. Pick category
1. Type
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Exercises for Practice

• How should you prescribe acyclovir for the
  initial episode of genital herpes? (dose)
• Is acyclovir indicated for children with Chicken
  Pox under the age of 2?
• How much does one month supply of Glucophage 850
  mg bid cost?
• What is the off label indication for Neurontin
  (gabapentin) ( indicates off label)

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Searching for a Drug
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Dosage Calculator in Epocrates Rx
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

• A little boy who is eight years old just ate a
  bottle of FeSo4 tablets his mother had in the
  kitchen. She thinks he ate forty or fifty of
  them. You search indications and find that
  desferol is indicated for iron intoxication.
  Calculate the dosage of desferol for the child.
  He weighs 50 lbs.
• You have a patient that is on amitriptyline,
  Flonase, Synthroid, Reglan, and Zyrtec. She
  comes in with tardive dyskinesia. Which of these
  drugs might be causing this? (Use Search tool
  for Adverse Reactions.) 

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Add Drug Formularies

• Go to Epocrates.com
• Manage My Account
• Add Formularies
• Pick Formularies
• Sync to add
• Tap for Alternatives

1. Pick formulary
2. Click Code
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Exercises for Practice

• I have a depressed patient with BCBS of Georgia
  who needs a low copay. Which of the SSRI are
  covered by BCBS low copay? Look up drugs By
  Classgt psychiatricgt SSRIs.
• I have a depressed patient with no health
  insurance who is indigent. Which SSRI can they
  get assistance to pay for (Needy Meds)?
• A 58 yr old female with osteoporosis is on
  Boniva. CHP Basic has stopped covering it.
  Which of the calcium metabolism class drugs do
  they cover?  

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Drug Interactions

• Epocrates Multicheck

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MultiCheck

• Find all drugs patient is on
• Select one at a time
• Run the Drug Interaction
• Contraindicated
• Avoid/Use Alternatives
• Monitor
• Caution
• Also checks IV solubility
• Use Back to add more drugs

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MultiCheck Drug Interactions
2. Pick drug
1. Type
3. Repeat until all drugs in list
4. Click Drugs
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Epocrates MultiCheck
Click interaction
Use to add more
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Exercises for Practice

• What interactions exist for the following
  combinations of drugs?
• Lexapro, Lortab, Xanax and Zocor
• Nitrobid and Viagra
• Glucophage, Lopressor, itraconazole (Sporonox),
  and simvastatin (Zocor) 

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Epocrates Essentials Sx

• Differential Diagnosis Engine

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DxPlain

• Included in ePocrates Essentials (Sx)
• From Harvard
• Age, gender and duration
• Allows for multiple symptoms and lab results
• Results in decreasing order of likelihood
• Online on library web page

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Exercises for Practice

• A 22 year old girl has a dry cough, chest pain,
  weight loss, and erythema nodosum.
• She has been feeling poorly for over a month.
• What might she have?

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Epocrates Essentials Dx

• Disease Quick Reference

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5 Minute Clinical Consult

• In Epocrates Essentials PDA under Dx tab
• Not in Epocrates online in InfoRetriever online
• Author Mark R Dambro, MD, updated annually
• 600 common problems, bottom line, quick info,
  shallow content, ICD-9s
• Treatment section linked to Rx,

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Exercises for Practice

• What is the incidence and prevalence of and the
  latest treatment recommendations for acute otitis
  media?
•  What imaging test is becoming procedure of
  choice for kidney stones?
• What is the ICD-9 code for psoriatic arthritis?
• What OTC is drug of choice for sphincter
  incompetence in urinary incontinence? (not
  approved by FDA)

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Epocrates Lab

• Diagnostic Laboratory information

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Original Lab Content

• View by Name, Specimen Type or Panels only.
• Interpretation diseases linked to Dx section,
  drugs linked to Rx section
• Cost/Billing tells ICD-9 codes to justify test

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Exercises for Practice

• A basic metabolic panel reveals that a 30 year
  old man suffering from bipolar disorder has a
  serum calcium level of 10.9 mg/dL. He is taking
  lithium and valproate. Could his medications be a
  factor?
•  Which ICD-9 codes would decrease your chances of
  being denied payment for a Growth Hormone test?

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Epocrates ID Tool

• Antibiotics Guide

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ABX Guide

• Look up by Bug, Drug or System
• Antibiotics linked to Rx section
• Age and Gender specific
• Emperic treatment before culture
• Specific treatment for known pathogen

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Exercises for Practice

• Which antibiotics should be used for a neonate
  with empyema, etiology unknown?
• The culture comes back with Haemophylius
  influenzae in the same neonate. What antibiotic
  should I use? Using the PDA, find the antibiotic,
  calculate the dose for a 2.84 kg baby. 

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Epocrates MedMath

• Medical Calculators

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MedMath

• Small number of handy calculators
• Many more in Epocrates online
• Most in InfoRetriever
• Info gives you parameters

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Exercises for Practice

• Calculate your own Body Mass Index, Ideal Body
  Weight, Basal Energy Expenditure, and Body
  Surface Area.
• What is the predicted peak flow for a 60 year old
  woman with asthma? She is 52.
•  

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Epocrates Tables

• Odds and Ends

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Tables

• Text based content of value to clinicians
• Online and PDA
• Guidelines (HIV, HTN, Vaccinations)
• Dosing equivalents (ACE, insulins, steroids)
• Algorithms (PALS, ACLS)

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Exercises for Practice

•  Patient has planned a trip touring Mayan ruins
  in the jungles of Belize. What immunizations
  does she need?
• Patient walks in with an inhaler with no labels
  attached. It is gray with a green cap. Which
  inhaled steroid is this?

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Epocrates Free Add-Ons

• Medtools

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Manage Your Account

• www.epocrates.com
• My Account
• Log in
• Free Add-ons
• Pick your tools, formularies
• Takes memory puts in main memory
• Includes free CME, international drug name
  directory, clinical decision calculators

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Please Complete your Evaluations

• Contact Information for help
• Nancy Clark
• nancy.clark_at_med.fsu.edu [phone]
• Kenneth Higgins
• kenneth.higgins_at_med.fsu.edu [phone]
• CoM IT Help Deskhelp.desk_at_med.fsu.edu (850)
  644-3664

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FYI What to Buy

• Cell Phone/PDAs
• ATT Tilt (WM6, 128/256 memory, 802.11, BT)
• Sprint - Mogul
• Verizon XV6800
• Pocket PC/Windows Mobile PDA
• HP iPAQ hx2795 PocketPC
• Palm PDA
• Palm TX
• Most Important Features
• Large screen, memory, speed

ATT Tilt