Drug Information Resources

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Drug Information Resources "Tertiary literature
Prepared by Rajab I.M. Saeed B.Sc.pharm.Instruc
tor for Phcl 451Drug Poison Information
Provider
2

• Introduction
• Drug Information
• Resources
• Objectives
• Describe the attributes and the differences
  between tertiary, secondary and primary resources
• Identify the most appropriate resources for a
  given drug information inquiry and use them
  effectively.
• Recognize that primary, secondary and tertiary
  resources may be available in hard copy, CD-ROM,
  ON-LINE and/or other Format.
• Describe how to search computerized data bases.

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Introduction
professional literatures
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Introduction Primary Resources

• They are the research studies published in
  biomedical
• journals.
• It is the most current information about drugs.
• It is not easy job to use journals to answer a
  drug
• related question because of its huge growing
  number
• (gt20000 biomedical journals available)

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Introduction Primary Resources

• Primary recourse provides the broad base for
  development of the rest of the professional
  literature.
• It contains original reports of scientific
  studies on which the knowledge of drugs and
  therapeutics is built.
• Current of the information sources, and
  periodical journals are its most common format.
• Providing access to the original data from a
  study as well, having the most current information

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Introduction Secondary Resources

• They are indexes and abstracts for primary
  resources.
• They are valuable tools for quick and selective
  screening for primary resources.
• They provide the user with concise tools for
  gaining access to the primary literatures.
• Any single indexing or abstracting service can
  not cover all published articles beside the lag
  time are the limitations to use secondary
  resources.

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Tertiary Resources Literatures
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Definition

• Tertiary literature is core knowledge established
  via primary literature or accepted as standard of
  practice within the medical community.

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Introduction

• tertiary resources include textbooks, monographs,
  compendia, handbooks, and published symposia.
• They represent the condensation of basic facts
  originally published in the primary literature.

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Types
Textbooks
On various drug or disease topics
Compendia
A vast array of information about many Drugs such
as the physician's desk reference
Full-text databases
Including the internet, MICROMEDEX and LEXI
Review articles
Summarize a particular topic Contain more current
information
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Advantages

• Tertiary resources are the most commonly used
  sources of information because they are easy to
  use, concise and compact.
• Often they provide a review of the literature by
  an expert in the field.
• Tertiary references (textbooks, CD-ROMs) are
  convenient and in general, fairly accessible.
• Drug information references may be divided into
  specific subjects to make them easier to use..
• Usually the information contained in tertiary
  literature is well accepted in medical practice.

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Disadvantages

• lag time . outdated even in "new" editions
• Space limitations within a text may prevent
  extensive discussion of a drug or topic
• Authors may emphasize limited information about a
  topic or drug
• Authors may present information that is based on
  a less thorough review of the primary literature

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Disadvantages (cont.)

• It may not be referenced appropriately thus
  preventing a proper check of the primary
  literature
• If the information presented in the tertiary
  literature is based on flawed primary literature
  (i.e. Poorly done studies are referenced) then
  the tertiary information may be suspicious.

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Disadvantages (cont.)

• Any updated or new information cannot be inserted
  into the printed (hard copy) tertiary literature
  in a timely fashion.
• Human bias, error transcription, incorrect
  interpretation of data and lack of expertise by
  the author.

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• Evaluation of tertiary
• resources
• Several points should be considered in evaluating
  tertiary resources as follows
• Does the author has sufficient experience and
  expertise to write on the topic?
• What credentials do the authors/contributors
  have?
• Assess the text for timeliness (i.e. when was the
  last edition published?)
• Is this the most recent edition of the tertiary
  reference?
• Are statements of fact appropriately supported by
  references?
• How many references does each section have and
  how up-to-date are they?

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Evaluation of tertiary resources (cont.)

• To assess consistency, compare information
  presented in one text to the same information
  presented in another text.
• Is the reference likely to contain information
  relevant to the subject being researched?
• Is the reference clear, concise and easy to use?
  

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• Availability of Tertiary
• Resources
• Tertiary resources are available in many formats,
  including hard copy, microfiche, and computerized
  versions. Computerized resources may be available
  on floppy disks, or CD-ROMs for use in a single
  personal computer or computer network, a main
  frame system or via internet.

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Classification of Tertiary Resources
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(No Transcript)
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General References
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General features

• 1- They are referral books.
• 2- Their formats are either monographs or
  monographs plus chapters.
• 3- Used through their indexes NOT through their
  contents lists.

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Textbooks.

• Different from the general references in
• 1- Their formats are chapters.
• 2- One can read them from cover to cover.
• 3- One can use their contents list Not necessary
  to go to index.

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The most helpful of them to answer a drug related
questions are
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Martindales The complete drug reference
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Martindales The complete drug reference

• European and investigational drugs
• Published by the Royal Pharmaceutical Society of
  Great Britain every 4 years
• Has a manufacturer directory and index by
  clinical use (typical European style of indexing)
• Lists other pharmacopeias the drug is found in.

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Drug Facts and Comparisons (FC)
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Drug Facts and Comparisons (FC)

• Updated monthly (loose-leaf version)
• Lag time 3 months
• Arranged by therapeutic class
• Prescription and OTC listings
• Helpful summary/comparison tables
• Contains information about investigational,
  orphan, and discontinued products and off label
  uses
• Not referenced, cumbersome

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Mosbys Drug Consult
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Mosbys Drug Consult

• Frequently used brand and generic drugs
• Available at www.merckmedicus.com
• Annual update
• Additional information
• Drug identification, look-alike/sound-alike
• Manufacturer information, discontinued Products

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American Hospital Formulary Service (AHFS) Drug
Information
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American Hospital Formulary Service (AHFS) Drug
Information

• Arranged by AHFS classification number
• Monographs listed alphabetically
• Information in monograph
• Chemistry, pharmacology, mechanism
• Dose, administration, pharmacokinetics
• Drug interactions, preparations, toxicity

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(AHFS) Drug Information

• FDA-approved and off-label uses
• Published annually with quarterly updates
• More clinically oriented
• References are not available in the hard copy but
  may be available online or with software CD-ROMS
• Not comprehensive, significant lag time

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USP Dispensing Information (USP DI)
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USP Dispensing Information (USP DI)

• Three volumes
• DRUG Information for the Healthcare Professional
• Drug Information for the Patient (in lay
  language)
• Legal Requirements
• Monographs in alphabetical order in Volume I
• Published annually
• Also contains some Canadian drug names
• Most thorough information on
• Monitoring
• Adverse drug events

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USP Dispensing Information (USP DI)

• Useful Appendices (typical American style of
  indexing)
• Selected List of Drug-Induced Effects
• Therapeutic Guidelines
• Poison Control Center Listing
• Veterinary Medication Classification
• Excluded Monograph Listing

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USP Dispensing Information (USP DI)

• Off-label uses indexed by drug and by indication
• Not referenced, lag time, only FDA-approved
  uses, inconvenient to compare agents in the same
  therapeutic class

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Drug Information Handbook (Lexi-Comp)
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Drug Information Handbook (Lexi-Comp)

• Pocket-sized PDA online versions are also
  available
• Published annually
• Drugs listed alphabetically by generic name
• Useful charts and tables.
• Specialty versions are available
• Pediatric, psychiatric, geriatric
• Not referenced
• Lists all reported adverse events but does not
  always provide the incidence

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MICROMEDEX

• CD-ROM
• Access information by brand or generic name of
  drug
• Referenced, quick and easy to use
• Expensive, uses other tertiary references
• Databases available
• DRUGDEX - main drug information database
• DISEASEDEX - disease states
• IDENTIDEX - drug identification by imprint code
• POISINDEX - poisoning and toxicology
• Martindales foreign drugs

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Physicians Desk Reference (PDR)
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Physicians Desk Reference (PDR)

• Updated annually
• Color pictures and markings for drug
  identification
• Has FDA-approved product information only
• Manufacturers pay to have product information
  Included
• Contains section on diagnostics
• May not contain the complete package insert
• Not referenced

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Drug Topics Red Book
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Drug Topics Red Book

• Cost data average wholesale prices (AWP) and NDC
  numbers. (The National Drug Code)
• Alphabetical listing of manufacturers with
  contact information
• Prescription and OTC products
• List of drugs that should not be crushed or
  chewed
• Published annually with monthly updates

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Specialized References
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Pharmacotherapy
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Pharmacotherapy A Pathophysiologic Approach
(Dipiro)
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Pharmacotherapy A Pathophysiologic Approach
(Dipiro)

• Well-written and referenced with helpful tables.
• Pocket version is available.
• Focuses on drug therapy, good background
  information.
• Also covers non-drug treatment options.
• Updated edition about every 4 years.

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Applied Therapeutics The Clinical Use of Drugs
(Koda-Kimble)
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Applied Therapeutics The Clinical Use of Drugs
(Koda-Kimble)

• Well-written with focus on drug therapy.
• Updated every 4 years.
• Useful summary tables.
• Case presentation format, may be more difficult
  to use as a quick reference.

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The Washington Manual of Medical Therapeutics

• Quick reference with many charts and tables.
• Updated about every 2 to 3 years.

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Internal Medicine
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Harrisons Principles of Internal Medicine

• Gold standard for internal medicine
• Published every 5 years, referenced
• Pathophysiology, clinical presentation, diagnosis
  and treatment guidelines
• Little drug information dosing recommendations

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The Merck Manual

• Used by many healthcare professionals
• Also includes pediatrics, gynecology, psychiatry,
  ophthalmology, otolaryngology, dental disorders

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Clinical Medicine (Kumar Clark )
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Clinical Medicine (Kumar Clark )

• comprehensive and authoritative single-volume
  textbook of internal medicine.
• Explains the management of disease, based on an
  understanding of scientific principles and
  including the latest developments in treatment.
• Colour-coded chapters are attractive and make the
  book easy to navigate.
• Comprehensive index, clearly displayed, pinpoints
  information rapidly.

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Clinical Medicine (Kumar Clark )

• Boxes and tables pull out and display important
  information.
• Drawings and photographs.
• Carefully structured headings provide a useful
  outline for study and quick reference.
• Gastrointestinal, Rheumatology, Renal,
  Cardiovascular, Respiratory ,Intensive care
  medicine, Drug Therapy and poisoning

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Cardiology
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Textbook of Cardiovascular Medicine

• Published every 5 years.
• Good illustrations.
• Addresses modern-day issues such as medical
  economics and assessing quality of care.
• Well-referenced.

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Hursts The Heart

• Organized by condition
• Comprehensive information on drug therapies and
  regimens
• Rapid Interpretation of EKGs (Electrocardiogram
  (EKG or ECG))
• Best guide to learning EKGs
• User-friendly format.

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Pediatrics
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Harriet Lane Handbook
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Harriet Lane Handbook

• Useful pocket guide published every 3 years
• Has dosing information
• Electronic version updated annually
• Four sections emergency management, diagnostic,
  formulary, and therapeutic data
• Some information on pregnancy and lactation
• Not referenced, not frequently updated, confusing
  organization, not complete

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Pediatric Injectable Drugs (Teddybear Book)

• Alphabetical order by generic name
• Formerly known as Guidelines for Administration
  of Intravenous Medications to Pediatric Patients
• Dose, concentration, rate, cautions

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Pediatric Dosage Handbook (Lexi-Comp)

• Pediatric version of the Drug Information
  Handbook
• Dose, administration, how supplied,
  contraindications, adverse effects, drug
  interactions, antidotes
• Also contains adult doses
• May sometimes have information on extemporaneous
  formulations

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Pregnancy
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Drugs in Pregnancy and Lactation (Briggs)

• Excellent reference, gold standard
• Updated every 4 years
• Alphabetical by generic name
• Generic name, class, pregnancy risk factor
• Summaries of risk to fetus and risk during
  breastfeeding
• Editors assign categories for drugs not
  classified by the manufacturer
• Referenced

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Infectious Diseases
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Mandells Principles and Practice of Infectious
Disease

• Gold standard reference
• Infection, diagnosis, treatment and useful
  background information

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Sanford Guide to Antimicrobial Therapy

• Published annually
• Pocket-sized and easy to use
• Includes dosing in renal impairment, brand
  generic names, empiric therapy guidelines,
  antimicrobial spectra of the agents
• Not well-referenced

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Oncology
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Cancer Principles and Practice of Oncology
(devita)

• Gold standard, published every 3 to 4 years
• Pathology, treatment options, adverse effects
• Referenced

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Cancer Chemotherapy Handbook

• Useful index, introduction on malignancies
• Pharmacology and use of chemotherapeutic agents
• Lists investigational drugs and combinations
• Well-referenced

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Pharmacology
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Goodman Gilmans Pharmacological Basis of
Therapeutics

• Gold standard pharmacology text
• Grouped by therapeutic class
• Mechanism, absorption, distribution, and
  metabolism
• Contains review of pharmacokinetics,
  therapeutics, and toxicology
• Well-referenced, very thorough
• Updated every 5 years (infrequent)

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Drug Interactions
76
Hansten and Horn's Drug Interactions Analysis and
Management

• Loose-leaf format, updated
• Introductory chapter discusses mechanisms of
  interactions
• Rates significance of interaction and recommends
  management
• Referenced
• Not complete, subjective rating system

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Drug Interaction Facts

• Published by FC
• Alphabetical by drug name
• Referenced
• Provides information regarding
• Significance and severity
• Onset of interaction
• Documentation
• Not complete, subjective rating scale

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Stockley's Drug Interactions

• A typical monograph contains a summary, clinical
  evidence for the interactions under discussion,
  the probable mechanism, clinical importance and
  management
• Covers interactions between therapeutic drugs,
  proprietary medicines, herbal medicines, foods,
  drinks, pesticides and some drugs of abuse

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Stockley's Drug Interactions

• Based on published sources and fully referenced
• Covers over 14,000 drug interactions
• Contains over 2,800 monographs
• Includes 17,600 references
• Book CD-ROM

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Adverse Drug Reactions
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Meylers Side Effects of Drugs
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Meylers Side Effects of Drugs

• Indexed by drug and by adverse event
• Most comprehensive
• Published every 4 years with annual updates
• Contains tables and lists
• References for some side effects not included
• Information provided
• Effects on organs and systems, lab/diagnostic
  interference, withdrawal and overdose
• May not be complete, references for widely known
  effects are not included

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Compatibility and Stability
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Handbook on Injectable Drugs (Trissels)
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Handbook on Injectable Drugs (Trissels)

• Gold standard reference
• Updated every 2 years with annual supplements
• Drugs organized alphabetically by generic name
• Information on compatibility and stability with
  diluents and drugs
• Solution, Y-site, syringe, and additive
  compatibility
• Table format, very useful
• Not complete, lag time

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King Guide to Parenteral Admixtures

• Chart format, loose-leaf
• Alphabetical listing by generic name
• May have information not available in Trissels
• Pages are not numbered

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IV INDEX

• Component of MICROMEDEX
• Easy to use
• Information taken mostly from Trissels

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Compounding and Pharmaceutics
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Remingtons The Science and Practice of Pharmacy

• Helpful for extemporaneous compounding
• Pharmaceutical calculations, chemistry,
  radioisotopes
• New edition every 5 years

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Merck Index

• Chemical name, formula, structure
• Physical data, therapeutic category
• Published every 6 to 10 years

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United States Pharmacopeia National Formulary
(USP-NF)

• Official monographs for preparation and assay of
  pharmaceutical products
• Published every 5 years with periodic supplements
• Information on storage, packaging, labeling,
  reference standards, assays
• USP drug substances dosage forms
• NF pharmaceutical ingredients
• Not a very useful reference since most
  pharmaceuticals are mass-produced

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Pharmacokinetics
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Basic Clinical Pharmacokinetics (Winters)

• Case-study format
• Includes principles of monitoring therapy, basic
  pharmacokinetics, clinical applications
• Appendix of commonly used equations
• Mostly theory, little patient integration

94
Applied Pharmacokinetics Principles of
Therapeutic Drug Monitoring

• Published by Applied Therapeutics
• Most advanced reference
• More specific drug information than Winters
• Includes analytical methods and clinical
  applications

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Toxicology
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Toxicologic Emergencies (Goldfranks)

• Poison management guidelines
• Useful tables and case studies
• Practice multiple-choice questions

97
Casarett Doull's Toxicology The Basic Science
of Poisons

• gold standard in toxicology field
• basic concepts and fundamental principles needed
  to grasp current issues in modern toxicology
• The text is organized and presented in a logical
  progression of general principles to specific
  topics such as organ system toxicology, specific
  agent toxicology, and environmental toxicology.

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POISINDEX

• Toxicology component of MICROMEDEX
• Search by brand or generic name
• Describes what substance looks like, any imprint
  codes, management of toxicity

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Other Toxicology Books

• Toxic Emergencies Clinics in Emergency Medicine
  (Clinics in emergency medicine) by William Hanson
• Current Approaches in Toxicology by Bryan
  Ballantyne
• Handbook on the Toxicology of Metals (Hardcover)
  by Lars Friberg Lars

100
Other Toxicology Books

• Toxicology of the Eye by W.Morton Grant. Joel S.
  Schuman
• Effects on the Eyes and Visual System from
  Chemicals, Drugs, Metals and Minerals, Plants,
  Toxins, and Venoms Also, Systemic Side Effects
  from Eye med (Hardcover)

101
Other Toxicology Books

• Clinical Toxicology of Commercial Products
  (Hardcover) by Robert E. Gosselin, Roger P.
  Smith, Harold C Hodge, Jeannet Braddock

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Drug Identification
103

• American Drug Index
• Cross-referenced by brand, generic, and chemical
  names
• The Pill Book
• IDENTIDEX
• Component of MICROMEDEX
• Identify drug by imprint code

104

• British National Formulary
• BMJ Publishing, London, United Kingdom.
• The standard reference for prescribing and
  dispensing drugs in Britain.
• Included are notes on the different drug groups
  to help in the choice of appropriate treatment.
• The BNF is updated in March and September of each
  year
• available on disk and CD-ROM as the Electronic
  British National Formulary and An electronic
  web-based format is also available.

105

• Saudi National Formulary
• It is a joint publication of the Saudi
  pharmaceutical society Ministry of Health,
  Riyadh, KSA
• The standard reference for prescribing and
  dispensing drugs in Saudi Arabia.
• Included are notes on the different drug groups
  to help in the choice of appropriate treatment.
• The SNF is only one edition published in 1424 H
  (previous two editions were directory formats).
• Available as hardcopy only.

106
Saudi National Formulary (cont.)

• Having guidelines appendix.
• Drug interactions appendix.
• Drug information links appendix.
• List of community pharmacies all over the kingdom
• Containing different indexes like
• Vendors index.
• Manufacturers index.
• Alphabetical drug index
• Therapeutic index

107
Index Nominum International Drug Directory

• Edited by the Swiss Pharmaceutical Society
• Alphabetical by generic and brand name
• Drug name, structure, therapeutic class,
  synonyms, and manufacturer
• Cross-referenced by all trade names and
  substances
• Not much information is provided

108
Index Nominum International Drug Directory

• Drugs Available Abroad
• Alphabetical by generic name
• Drug manufacturer, when it became available,
  dosage forms, where it is approved
• Indexed by disease, country of use, drug category
• Appendices with information on manufacturers and
  drug regulatory authorities in other countries

109
Non-Prescription Products
110
PDR for Nonprescription Drugs and Dietary
Supplements

• Format similar to PDR, updated every year
• Indexed by product name, category, manufacturer,
  active ingredient
• Includes color pictures of products
• Information indications, cautions, dose,
  administration, patient instructions,
  precautions, how supplied

111
Handbook of Nonprescription Drugs

• Useful tables and comparisons
• Includes
• Patient assessment and counseling guidelines
• Pathophysiology and treatment options
• Dosing, adverse events, interactions

112
Natural Products
113
Lawrence Review of Natural Products

• Comprehensive and up-to-date information
• Published by FC
• Monthly updates
• Provides uses, toxicity, patient info
• Scientific approach to herbal products

114
Electronic Tertiary Resources
115
Multipurpose Resources (disease and drug
information)
116
Access Medicine

• (http//www.accessmedicine.com/)
• Collection of textbooks, clinical practice
  guidelines, news
• Includes Goodman Gilman, Harrisons, Current
  Medical Diagnosis Treatment, and the Lange
  series.
• Drug monographs (include images, chemical
  structures, patient education materials) provided
  by Gold Standard
• Patient education handouts on common medical
  problems provided by Postgraduate medicine

117
ClinicalResource_at_Ovid

• (http//clinicalresource.ovid.com/autologin.html)
• Collection of books, clinical practice
  guidelines, patient education materials and links
  to databases
• Includes Clin-eguide, Facts and Comparisons and
  5-Minute Consult series

118
MD Consult

• http//home.mdconsult.com/groups/uwash8783.html)
• Collection of textbooks, journals, drug
  information, guidelines, patient education
  handouts, news and updates
• Drug information and updates from Mosbys drug
  Consult, package insert information, FDA
  information
• Customizable patient handouts diseases and drugs

119
MedlinePlus

• (http//medlineplus.gov)
• NLMs database aimed at consumers for health and
  wellness information
• English and Spanish versions as well as large
  print and audio
• Includes health topics, drug information,
  dictionaries, interactive tutorials, directories
  and links to other resources

120
MedlinePlus

• Especially good for quick overview, including
  statistics, of topics and illustrations
• Drug information includes MedMaster from ASHP,
  USP DI Advice for Patients, Natural Standard
  Online (for natural products) and links to FDA
  and ClinicalTrials.gov

121
Micromedex Healthcare series

• (http//www.thomsonhc.com/hcs/librarian/)
• Collection of databases that can be searched
  individually or all together contents of
  collection depends on your subscription
• Includes DrugDex and Drug Consults, IV
  Compatibility, PoisIndex, AltMedDex, Martindale,
  Reproprisk, TOMES and CareNotes

122
Micromedex Healthcare series

• Use for detailed information about medications
  (US and foreign) and natural products as well as
  exposures to chemicals, toxins and poisonous
  animals and plants
• Lengthy bibliographies
• Instructions for citing under Warranties a
  Disclaimers link

123
UpToDate

• (http//www.uptodateonline.com/)
• Evidence-based electronic textbook of medicine
• Lexi-Interact Drug Interactions program from
  Lexi-Comp for drug interactions
• Links from drug names to Lexi-Comp drug
  information within monographs
• Provides recommendations for good practice
• Graphs and tables that may be exported to
  personal documents

124
Drug and Natural ProductsInformation Resources
125
Facts Comparisons

• (http//online.factsandcomparisons.com/)
• Collection of resources that can be searched
  individually or all together drugs and natural
  products
• Includes Drug Facts Comparisons,
  Nonprescription Drug therapy, Drug Interaction
  Facts, Review of Natural Products, MedFacts
  Patient information

126
Facts Comparisons

• Print version has been gold standard for drug
  information for years
• Includes comparison tables for drugs by class or
  pharmacological action
• In general, references are included in the Drug
  Interactions section and in drug class monographs
  but not in individual drug monographs

127
Natural Medicines Comprehensive Database

• (http//www.therapeuticresearch.net/nd/Search.aspx
  ?sND)
• Comprehensive, evidence-based information about
  herbal and dietary supplements used in the US and
  Canada
• Produced by publishers of Prescribers' Letter and
  Physicians' Letter
• Many products have patient handouts

128
Natural Medicines Comprehensive Database

• Updated daily
• Several entry points, e.g. product or common
  name, scientific name, people use
• this for, interactions with foods, herbs, dietary
  supplements, lab tests, diseases or conditions

Thank You