Common Online Reference Sources & Medicinescomplete NMSF – CPD Centre – Sudan Nov 2017 Ammar Abbas Medicines Information / Medicines Management Pharmacist Pharmacy Department Countess of Chester Hospital (COCH) NHS Foundation Trust November 2017

Objectives To become familiar with: Common Online Reference Sources Demonstration of the Medicinescomplete package Common Search strategies based on UKMi Enquiry Answering Guidelines and the Medicines Learning Portal Limitations with common enquiry answering reference sources

Common online reference sources Applicable to most common MI enquiries: BNF / BNF for children (accessible via medicinescomplete) Martindale – The complete drug reference: (accessible via medicinescomplete) Electronic Medicines Compendium (EMC): freely accessible via https://www.medicines.org.uk/ Specialist Pharmacy Services https://www.sps.nhs.uk/ for UKMi specialist material: Drugs in Lactation; Medicines Q&A (mostly free access)

Electronic Medicines Compendium (EMC) First place to look if you need an up-to-date SPC or patient information leaflet (PIL) Access via electronic medicines compendium (emc): http://www.medicines.org.uk 170 Pharmaceutical companies subscribing – members of the Association of British Pharmaceutical Industry (ABPI) Advanced Search function enables more sophisticated searches (e.g. identifying products that do not contain lactose)

Electronic Medicines Compendium (EMC)

Specialist Pharmacy Services (SPS)

The Medicinescomplete Package Comprehensive online set of British, American and International pharmaceutical / clinical reference sources complied by the Pharmaceutical Press – RPSGB (UK) https://www.medicinescomplete.com/about/ https://www.medicinescomplete.com/about/pdfs/MC_UserGuide.pdf Available in Sudan on an unlimited user subscription access via The National Medical Supplies Fund Backbone of the UKMi Enquiry Answering Guidelines https://www.sps.nhs.uk/articles/ukmi-enquiry-answering/

The Medicinescomplete Package

The Medicinescomplete Package Comprehensive global list of reference sources but the main list of clinical resources includes: BNF & BNF for children Martindale AHFS Drug Administration via enteral feeding tubes Stockley’s Drug Interactions Stockley’s Herbal Medicines Interactions Herbal Medicines Handbook on Injectable Drugs Injectable Drugs Guide

The Medicinescomplete Package BNF / BNF c Concise, first-line reference source on the prescribing, dispensing and administration of medicines (UK) Updated monthly Limitations: The introductory paragraphs to sections often contain important information which can be missed if users consult individual monographs only. Listed side effects may not indicate frequency of occurrence. Indications/ uses/ unlicensed uses etc sometimes reflect the views/ practice of experts and so may not be evidence based or the same as in the SPC

The Medicinescomplete Package Martindale – The complete Drug Reference An evaluated source of drug information for practitioners working throughout the world. Includes drug monographs, brief drug treatment and disease reviews and a useful section to help you identify products from abroad. Good place to start if looking for information about unlicensed drugs, or drugs being used for ‘off-label’ indications.

The Medicinescomplete Package AHFS AHFS : The American Society of Health-System Pharmacists includes detailed monographs on most drugs available in the US, and is particularly helpful for drugs that are used more frequently in the US than the UK. has detailed descriptions of side effects and pharmacokinetics. does include information about unlicensed drug use, but it doesn’t include information about drugs not used in the US (e.g. diamorphine). Remember to look up drugs under their American names

The Medicinescomplete Package Drug Administration via Enteral Feeding Tubes Formulations guide on administration to patients with limited GI access covers legal (from a UK perspective), practical and technical aspects to consider before prescribing or administering drugs via an enteral feeding tube. Individual monographs contain guidance on safe administration of specific drugs and formulations.

The Medicinescomplete Package Stockley’s drug Interactions In order to search Stockley’s Drug Interactions comprehensively you need to search both interfaces i.e Stockley’s Drug Interactions and Stockley’s Interactions Checker Stockley’s Interactions Checker and Stockley’s Interactions Alerts are different terms for the same database. This is not and was never intended to be a definitive guide to every possible drug interaction – so should not be used as a sole source for “screening” patients’ medications for potential interactions

The Medicinescomplete Package Stockley’s Herbal Interactions Evidence based information on drug interactions between conventional medicines and herbals, complementary therapies & dietary supplements

The Medicinescomplete Package Herbal Medicines Evidence-based information on herbal medicines Better / more comprehensive reference sources ; not included in Medicinescomplete is Natural Medicines Comprehensive Database (www.naturaldatabase.com) – US reference source (subscription only)

The Medicinescomplete Package Handbook on Injectable Drugs Useful as an IV compatability guide in general but use with great care as information is product specific Gives information mainly on American preparations. Note that formulations may differ between the US and UK and thiscan affect compatibility.

The Medicinescomplete Package Injectable Drugs Guide Safe and effective administration of injectable drugs Can also access via www.injguide.nhs.uk (subscription only) Monographs describe the most appropriate method of preparation and administration of medicines administered by IV route with the exception of cytotoxics

Immunisation enquiries The Green Book : UK – Department of Health Publication Freely accessible National Protocols will be different from Sudan Clinical considerations should not be different Google : The Green Book – Immunisation against infectious disease and search for the most up to date edited chapters (careful) https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book

UKMi Risk Management Strategy Limitations of common reference sources No single source is totally comprehensive or completely up-to-date and all databases may have search function anomalies Think about synonyms when searching books, databases or websites since cross-referencing is not always reliable (e.g. “hypericum” vs. “St John’s Wort”; “alopecia” vs. “hair loss”). In US texts remember that some generic names differ from the UK. There is a UKMi Q&A that addresses this issue: https://www.sps.nhs.uk/articles/what-are-the-differences-between-us-and-uk-drug-names/ Expect most books to be at least 1-2 years out-of-date at the point of publication.

UKMi Risk Management Strategy Limitations of common reference sources A webpage retrieved from a search engine such as Google may be an old version (a ‘cache’ page). For more information see: www.googleguide.com/cached_pages.html so ‘refresh’ web pages to be sure you get the current version. Be aware that Google searches will return the entry with the most hits first which may not be the most recent. Some governmental websites can hold several versions of the same document (eg The Green Book). UKMi provides guidance to help you decide on the reliability of information on the web: www.ukmi.nhs.uk/filestore/misc/EffectiveuseoftheInternetforEnquiryAnswering_v1.1Dec.doc

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