Answering Drug Information Questions

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Answering Drug Information Questions
Presented by Andrew Hamilton
Date November 7, 2008
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Answering Drug Information Questions
Subtitle

• Drug Information questions can be broken down
  into the following elements
• Nomenclature Identification
• Therapeutic Usage
• Adverse Effects
• Business Economics
• Governmental Regulation

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Answering Drug Information Questions

• Nomenclature Identification
• Identifying the name of a drug
• Finding synonymous names codes for a drug
• Determining the chemical composition and physical
  properties of a drug
• Identifying other drugs that possess a similar
  chemical structure or mode of action

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Answering Drug Information Questions

• Therapeutic usage
• Determining which diseases are approved to be
  treated by a drug
• Discovering how a drug works to achieve its
  therapeutic activity
• Finding the recommended dosage and route
  administration of a drug
• Learning how a drug is absorbed, distributed,
  metabolized, and excreted

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Answering Drug Information Questions

• Adverse Effects
• Side effects
• Interactions
• Drug/Drug
• Drug/Food
• Drug/Herb
• Toxic potential
• Contraindications
• Teratogenicity

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Answering Drug Information Questions

• Business Economics
• Drug prices
• Drug sales
• Drug companies
• Drug Manufacturers
• Drug Stores
• Most commonly prescribed drugs

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Answering Drug Information Questions

• Government regulation
• Drug approval process
• Identifying which countries have approved the
  usage of a specific drug
• The restriction or prohibition of the usage of
  specific drugs (controlled substances)
• Policies and codes regulating the manufacture,
  distribution, and sales of pharmaceutical agents

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Answering Drug Information Questions

• Names Classifications of Drugs
• Drugs can be referred to by a number of
  synonymous names and codes.
• These terms fall into three basic categories
• Names
• Codes
• Classifications
• Using Nitroglycerin as an example, well examine
  the different terms that refer to it

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Answering Drug Information Questions

• Names
• Chemical
• 1,2,3-Propanetriol trinitrate
• Glycerol trinitrate
• Nitroglycerin
• Approved Name (USAN,INN,BAN,JAN)
• Nitroglycerin
• CAS
• 55-63-0

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Answering Drug Information Questions

• Names
• Trade Names
• 200 proprietary names for Nitroglycerin are
  listed in ChemIDplus
• NDC
• 177 different NDC codes exist for Nitroglycerin
  formaulations
• Molecular formula
• C3H5N3O9

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Answering Drug Information Questions

• Names
• Structural formula
• Where are the five hydrogen atoms?
• H atoms are often not shown in structural formulas

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Answering Drug Information Questions

• Classifications
• Classifications serve to organize drugs into
  groups. In pharmacology, they fall into three
  categories based on the following criteria
• Chemical structure
• Pharmacologic action
• Therapeutic use

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Answering Drug Information Questions

• Classifications
• Nitroglycerin is classified in the following ways
• Chemical
• Nitrate
• Pharmacologic action
• Vasodiltor
• Therapeutic use
• Anti-anginal agent
• Nitroglycerin is also industrially classified as
  an explosive agent

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Answering Drug Information Questions

• What is the difference between pharmacologic
  action therapeutic use?
• Pharmacologic action refers to what the drug does
• Beta adrenergic blocker, Serotonin uptake
  inhibitor
• Therapeutic use refers to the condition that the
  drug is treating
• Antihypertensive, Anti-depressive agent

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Answering Drug Information Questions

• Adverse Drug Reactions (ADR)
• ADRs are the greatest cause of patient
  non-compliance with therapeutic interventions
• At least 1.5 million Americans are sickened,
  injured or killed each year by ADRs
• ADRs are 4th leading cause of death in the United
  States
• Estimated annual cost of ADRs is 136 billion

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Answering Drug Information Questions

• Adverse Drug Reaction
• Refers to any harmful/undesired/irrelevant effect
  of a drug
• Categories of ADR include
• Side effect
• Interaction
• Toxicity
• Teratogenicity
• Contraindication
• Precautions

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Answering Drug Information Questions

• Side Effect
• Secondary effect of a drug that sometimes
  accompany the desired therapeutic effect
• Side effects are seen when the drug is being
  given at the normal therapeutic dose
• Side effects are not necessarily harmful
• Both Rogaine Viagra started off being used as
  Anti-hypertensives

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Answering Drug Information Questions

• Drug interaction
• An alteration in the properties of a drug that
  manifests itself only in the presence of a
  another drug (or class of drugs)
• Interactions involve a precipitant drug affecting
  the effects of the object drug
• Effects can range from being life-threatening to
  clinically insignificant

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Answering Drug Information Questions

• Interactions Nitroglycerin
• Aspirin increases serum levels of NG which
  results in the increase of its effect relative to
  the administered dosage
• NG causes a decrease in the activity of a common
  anti-coagulant, Heparin
• Interactions are common when two drugs compete to
  be metabolized via the same enzymatic pathway

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Answering Drug Information Questions

• Other interactions
• Drug/Test
• NG interferes with the reaction used in the lab
  test that measures serum cholesterol resulting in
  the underestimation of a patients cholesterol
  level
• Drug/Food drink
• Alcohol potentiates the effect of NG, possibly
  triggering a hypotensive crisis and
  cardiovascular collapse

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Answering Drug Information Questions

• Other interactions
• Drug/Equipment
• NG is actively absorbed by PVC tubing with the
  degree of absorption determined by
• The rate of flow
• The concentration of NG
• The length of the tube
• Only glass bottles non-PVC tubing can be used
  to deliver NG intravenously

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Answering Drug Information Questions

• Toxicity
• Describes effects seen when a drug is
  administered at a dosage greater than that
  normally used for therapy or has been used for an
  extended period of time
• Acetaminophen unintentional ingestion of more
  than recommended maximum daily dose may result in
  liver injury abdominal pain.

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Answering Drug Information Questions

• Poisoning
• Refers to the administration or ingestion of a
  life-threatening dose of drug
• Acetaminophen normal dose is 650-1000mg, but
  permanent liver failure can occur at 10x the
  normal dose

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Answering Drug Information Questions

• Contraindication
• A circumstance or condition that causes the
  administration of the drug to become inadvisable
  or inappropriate
• Xanax is contraindicated in patients with narrow
  angle glaucoma
• Morphine is contraindicated in patients with
  severe asthma

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Answering Drug Information Questions

• Precaution
• Indicates situation where greater caution must be
  exercised with the use of the drug
• Propranolol must be used with caution in
  diabetics due to its ability to mask hypoglycemia
  and in patients w/ impaired liver function due to
  their reduction of the ability to metabolize it
• A precaution does not preclude the use of the
  drug in indicated cases but does require greater
  vigilance to monitor the patient

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Answering Drug Information Questions

• Teratogen
• A drug capable of producing developmental
  abnormalities in an embryo, fetus, or postnatal
  individual
• Thalidomide When introduced as a sleep aid in
  the early 1960s it caused a number of limb
  deformities due to its teratogenic properties
• Accutain Used to treat acne, it carries a high
  risk of causing deformities if a developing
  embryo/fetus is exposed to it

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Answering Drug Information Questions

• Printed Drug Reference Sources
• IDENTIFICATION US DRUG NAMES
• USP Dictionary of USAN and International Drug
  Names.
• American Drug Index.
• Merck Index.

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Answering Drug Information Questions

• Printed Drug Reference Sources
• IDENTIFICATION FOREIGN DRUG NAMES
• Index Nominum
• International Nonproprietary Names (INN) for
  pharmaceutical substances
• Martindale the complete drug reference (Warning
  Does not provide an A-Z name index)

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Answering Drug Information Questions

• Printed Drug Reference Sources
• THERAPEUTIC USAGE ARRANGED BY DRUG CLASS
• AHFS Drug Information
• Drug Facts and Comparisons
• Martindale the complete drug reference
• THERAPEUTIC USAGE ARRANGED BY NAME
• USP DI Volumes I-II

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Answering Drug Information Questions

• Printed Drug Reference Sources
• THERAPEUTIC USAGE ARRANGED BY DISEASE
• Harrisons Principles of Internal Medicine
• Applied Therapeutics The Clinical use of Drugs.
  Author Mary Anne Koda-Kimble
• THERAPEUTIC USAGE ARRANGED BY MANUFACTURER
• Physicians Desk Reference PDR.

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Answering Drug Information Questions

• Printed Drug Reference Sources
• THERAPEUTICS NONAPPROVED INDICATIONS
• Drug Facts Comparisons
• Martindale The complete drug reference
• THERAPEUTIC USAGE PEDIATRICS
• The Harriet Lane Handbook a manual for
  pediatric house officers.

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Answering Drug Information Questions

• Printed Drug Reference Sources
• ADVERSE EFFECTS
• Meyler's Side Effects of Drugs/Dukes Annual.
• AHFS Drug Information
• Facts Comparisons
• ADVERSE EFFECTS INTERACTIONS
• Drug Interactions Analysis and Management.
  Authors Philip D. Hansten John R. Horn.

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Answering Drug Information Questions

• Printed Drug Reference Sources
• ADVERSE EFFECTS DERMATOLOGIC
• Litts Drug Eruption Reference Manual. Author
  Jerome Z. Litt
• ADVERSE EFFECTS TERATOLOGY
• Drugs in Pregnancy and Lactation. Author Gerald
  Briggs.

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Answering Drug Information Questions

• Printed Drug Reference Sources
• ADVERSE EFFECTS IN VITRO COMPATIBILITY
• Handbook on Injectable Drugs. Author Lawrence A.
  Trissel.
• OTC DRUG INFORMATION
• Handbook of Non-prescription Drugs.
• PHARMACOLOGY (HOW DRUGS WORK)
• Goodman Gilman's the Pharmacological Basis of
  Therapeutics.

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Answering Drug Information Questions

• Printed Drug Reference Sources
• BUSINESS ECONOMICS
• Red book Pharmacy's Fundamental Reference.
• Remington the Science and Practice of Pharmacy.
• REGULATORY INFORMATION
• USP DI Vol III.
• Remington the Science and Practice of Pharmacy.
  

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Answering Drug Information Questions

• Printed Drug Reference Sources
• INFORMATION FOR THE PATIENT
• USP DI Vol II.
• Essential Guide to Prescription Drugs. Author
  James Rybacki
• Complete Guide to Prescription Nonprescription
  drugs. Author H. Winter Griffith, Updated by
  Stephen Moore.

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Answering Drug Information Questions

• Printed Drug Reference Sources
• TOXICOLOGY
• Pattys Toxicology
• Sax's Dangerous Properties of Industrial
  Materials
• Disposition of Toxic Drugs and Chemicals in Man.
  Author Randall C. Baselt

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Answering Drug Information Questions

• Printed Drug Reference Sources
• SUBJECT GUIDES
• Drug Information. Author Bonnie Snow
• Using the Pharmaceutical Literature. Author
  Sharon Srodin
• Information Resources in Toxicology. Editor
  Philip Wexler

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Answering Drug Information Questions

• Online Drug Reference Sources
• Comprehensive resources
• AHFS Drug Information
• Facts Comparison
• Micromedex
• Gold Standard Clinical Pharmacology

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Answering Drug Information Questions

• Online Drug Reference Sources
• Name Identification
• Rxlist.com (fuzzy logic spellchecker)
• ChemIDPlus.gov
• Drugs_at_fda.gov
• Drugs.com (phonetic search)

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Answering Drug Information Questions

• Online Drug Reference Sources
• Pill Identification
• Drugs.com
• Rxlist.com
• Drugdigest.com
• WebMD.com

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Answering Drug Information Questions

• Online Drug Reference Sources
• New Drugs
• Drugs_at_fda.gov
• Centerwatch.com
• Drugs.com

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Answering Drug Information Questions

• Online Drug Reference Resources
• Manufacturers
• Druginfonet.com
• Medilexicon.com

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Answering Drug Information Questions

• Online Drug Reference Sources
• Toxicology
• TOXNET.gov
• Includes HSDB, LactMed, Household products
  databank
• Consumer Health
• MedlinePlus
• NOAH