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Amy Chatfield, MLS Norris Medical Library

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1 Amy Chatfield, MLS Norris Medical Library

2 Objectives  Identify preliminary and ultimate questions  Classify questions to aid retrieval in information resources  Differentiate between primary, secondary, and tertiary resources  Identify five major resources to answer questions on drugs  Identify major resources to locate guidelines and patient education materials

3 Pharmacy and Information  Information-heavy profession  Textbooks  Reference Books  Journal articles  Databases  Web pages  Clinical guidelines  Patient information  Government-produced web pages  Abstracting sources Information resources available to pharmacy students:

4 The Ultimate Question The actual question for which you are seeking an answer UQ

5 Scenario This patient is taking fosamax and Tums. Does that seem curious or unusual to you? Your preceptor

6 Questions!  What is fosamax used for?  How is fosamax administered?  Is fosamax a brand name or a generic?  How is fosamax absorbed by the body?  What is Tums?  What chemicals constitute Tums?  How does Tums work?

7 Ultimate question  Other questions: preliminary questions which permit us to create the ultimate question.  You may need to answer multiple preliminary questions before you can start answering the ultimate question- especially when new to a profession Are there known interactions between alendronate and calcium carbonate? UQ

8 Categorizing questions Adverse effects Availability Compatibility/stability Compounding Dosing/administration Drug interaction Herbal Identification Nomenclature Pharmacokinetics Pharmacology Poisoning/toxicology Pregnancy/lactation Therapeutic use

9 Categorizing questions  Therapeutic Use  Dosing/administration  Nomenclature  Pharmacokinetics  What is fosamax used for?  How is fosamax administered?  Is fosamax a brand name or a generic?  How is fosamax absorbed by the body? Categorizing your questions makes it easier to find information to answer each question

10 Three Types of Resources: Primary Secondary Tertiary

11 Primary Resources  Original research articles Many kinds of study designs Clinical trials Cohort studies  Conference Papers/Posters  Dissertations  Patents Advantages of primary sources: Current information May be only source of info on a new drug Narrow in scope Disadvantages of primary sources: Limited in scope Complex, hard to interpret

12 Secondary Resources  Review articles Literature reviews Meta-analyses  Guidelines  Indexing sources  Abstracting sources

13 Secondary Resources  Literature ReviewsAdvantages: Many primary resources consulted to write 1 article Disadvantages: Need to examine sources included closely Potential for bias in selection

14 Secondary Resources  Meta-AnalysesAdvantages: Many primary resources consulted to write 1 article All relevant studies must be included Disadvantages: Can only be created when a critical mass of primary studies are available

15 Secondary Resources  GuidelinesAdvantages: Many primary resources consulted to write 1 guideline Functionally oriented for clinical work (bullet points, not narrative) Disadvantages: Can only be created when a critical mass of primary studies are available

16 Secondary Resources  Indexing sources International Pharmaceutical Abstracts  Abstracting sources FDA’s MedWatch Advantages: Indexing sources create computerized records with additional information to make primary sources easier to find Abstracting services provide up- to-date information Disadvantages: Need to pay for access (for most) Don’t include full-text of the primary source

17 Tertiary Resources  Textbooks  Handbooks  Drug Compendia  Reference books Advantages of tertiary sources: Comprehensive information from a variety of sources Citations to primary and secondary sources Fast, easy to use Disadvantages of tertiary sources: Older, less current information Not sure if authors looked at the “right” sources Hint: Pro pharmacists consult two or more tertiary resources to check their answer!

18 Which ones do I use? Consult in backwards order! PrimarySecondaryTertiary Tertiary resources when: The answer to a question is basic factual knowledge in the field The question was studied extensively and a conclusion was made Many experts have addressed the question and agree on answer Secondary and primary resources when: A question is new and has never been studied There is no consensus among experts; various opinions abound There is conflicting evidence and the question needs further study

19 Resource Categories v Question Categories Many tertiary resources include these categories as chapter titles or section titles Secondary sources use these categories when they index primary sources Question categories Adverse effects Availability Compatibility/stability Compounding Dosing/administration Drug interaction Herbal Identification Nomenclature Pharmacokinetics Pharmacology Poisoning/toxicology Pregnancy/lactation Therapeutic use Lexi-Comp Table of Contents

20 Resource Categories v Question Categories Many tertiary resources include these categories as chapter titles or section titles Secondary sources use these categories when they index primary sources Question categories Adverse effects Availability Compatibility/stability Compounding Dosing/administration Drug interaction Herbal Identification Nomenclature Pharmacokinetics Pharmacology Poisoning/toxicology Pregnancy/lactation Therapeutic use Micromedex

21 Tertiary Resources  Epocrates  Drug Facts & Comparisons  Lexi-Comp  Micromedex  Clinical Pharmacology Things to think about when you use tertiary resources:  Availability of the resource  “Extra features” vary  How is it created, who creates it, and how frequently is it updated?

22 Student Portal  Links to all resources on pharmacy student year 1 portal page   Drug Information tab

23 Drug Facts and Comparisons Pocket Version  Online is ABRIDGED version of print  Print copy available in Norris How is it created? -Team of Pharm Ds and MDs -Monitor primary literature and clinical guidelines -Updated annually/once a year -Most frequently used drugs in American hospitals are included in the online version Let’s search for Ambien

24 Drug Facts and Comparisons  Browse by category  Includes most popular drugs used in US  Functional, aimed at the practicing clinician

25 ePocrates Online Premium  Two versions available: ePocrates Online Premium- via computer ePocrates: FREE version to download onto your PDA Free version provides less detailed information How is it created? - Team of Pharm Ds and MDs - Monitor primary literature, clinical guidelines, manufacturer labels, and FDA drug safety alerts - Updated weekly (more frequently if safety problems are identified) Let’s search for Proventil

26 ePocrates Online Premium  Browse feature  Includes drugs and herbals  Patient education material, English and Spanish  Pictures  Downloadable version for PDA

27 Lexi-Comp  Includes several sources of drug monographs How is it created? -Lexi-Drugs: Two in-house teams: one monitors FDA drug safety alerts and manufacturer labels, the second monitors primary literature and guidelines -All material vetted by editorial team comprised of Pharm Ds, MDs, PhDs, and DDSs -Updated weekly (more frequently if safety problems are identified) Let’s search for Zoloft

28 Lexi-Comp  Audio Pronunciation  Patient education materials  Pearls and related info section cites guidelines

29 Micromedex  FREE version to download to your PDA or mobile device  Includes PoisonDEX and Clinical Points modules with additional information How is it created? -“Team of experts” who review primary literature - Update schedule - ?? Let’s search for Aricept

30 Micromedex  Patient education materials  Photos  Foreign brand names  Free download onto PDA

31 Clinical Pharmacology  ONLY for School of Pharmacy How is it created? - Team of editors, Pharm Ds, and MDs - Monitor primary literature, clinical guidelines, textbooks, other tertiary sources, trade magazines from the pharmacy industry, major abstracting sources. - Every monograph reviewed annually (at a minimum) - Includes dates of update in each section Let’s search for Zyrtec

32 Clinical Pharmacology  Global trade names  Chemical structure drawings  Interactions- sort by severity  How Supplied– photos, plus full formulation details (active and inactive ingredients)  Patient Education- English and Spanish Additional features! Reports- drug interactions, adverse reactions, more Find/List- by criteria; CAM, investigational monographs; access MedGuides Includes monographs on vaccines

33 Guidelines  Gather primary and secondary literature  Analyze, assess literature  Outline “best practices” for any aspect of clinical work (diagnosis, prevention, screening, treatment, etc.)  Write as steps or bullet points  Made for all health care professionals  May need to broaden search: beyond simply a drug name

34 Guidelines  Guidelines are produced by groups of health care professionals  Professional organizations, nonprofit organizations, government groups: coordinate the writing of guidelines

35 Guidelines  Guidelines can be referenced in drug monographs  Centers for Disease Control and Prevention (CDC) Centers for Disease Control and Prevention  American Pharmacists’ Association American Pharmacists’ Association  Pharmacists’ Letter Pharmacists’ Letter  National Guidelines Clearinghouse: Guideline.gov (part of AHRQ) National Guidelines Clearinghouse: Guideline.gov  EpSS- Electronic Preventive Services Selector (AHRQ- created) EpSS- Electronic Preventive Services Selector

36 Takeaways  The Big Picture: USC subscribes to a variety of information resources to help you answer questions about drugs and pharmacy practices Basics today: ○ Identify preliminary and ultimate questions ○ Classify questions to make retrieval easier ○ Using tertiary resources to answer questions

37 Takeaways  All the tertiary resources we used today are linked on your Blackboard site and on the Year 1 Pharmacy student portalYear 1 Pharmacy student portal  You will have assignments that require you to use and cite information resources Wikipedia Free websites found through Google

38 Questions? Contact us!  Contact Norris Library reference service (M-F, 9-5)  Contact Amy Chatfield, pharmacy liaison librarian


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