Drug Information Resources "Tertiary literature“ Tertiary Resource

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. Tertiary Resource

professional literatures Introduction professional literatures Tertiary Resource

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 (>20000 biomedical journals available) Tertiary Resource

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 Tertiary Resource

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. Tertiary Resource

Tertiary Resources “Literatures”

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

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

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 Tertiary Resource

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. Tertiary Resource

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 Tertiary Resource

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. Tertiary Resource

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. Tertiary Resource

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? Tertiary Resource

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? Tertiary Resource

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. Tertiary Resource

Classification of Tertiary Resources

Tertiary drug information resources Specialized references General references Specialized references Tertiary Resource

General References Tertiary Resource

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. Tertiary Resource

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. Tertiary Resource

The most helpful of them to answer a drug related questions are: Tertiary Resource

Martindale’s The complete drug reference Tertiary Resource

Martindale’s 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. Tertiary Resource

Drug Facts and Comparisons (F&C) Tertiary Resource

Drug Facts and Comparisons (F&C) 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 Tertiary Resource

Mosby’s Drug Consult Tertiary Resource

Mosby’s 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 Tertiary Resource

American Hospital Formulary Service (AHFS) Drug Information Tertiary Resource

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 Tertiary Resource

(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 Tertiary Resource

USP Dispensing Information (USP DI) Tertiary Resource

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 Tertiary Resource

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 Tertiary Resource

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 Tertiary Resource

Drug Information Handbook (Lexi-Comp) Tertiary Resource

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 Tertiary Resource

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 Martindale’s – foreign drugs Tertiary Resource

Physicians’ Desk Reference (PDR) Tertiary Resource

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 Tertiary Resource

Drug Topics Red Book Tertiary Resource

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 Tertiary Resource

Specialized References Tertiary Resource

Pharmacotherapy Tertiary Resource

Pharmacotherapy: A Pathophysiologic Approach (Dipiro) Tertiary Resource

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. Tertiary Resource

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

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. Tertiary Resource

The Washington Manual of Medical Therapeutics Quick reference with many charts and tables. Updated about every 2 to 3 years. Tertiary Resource

Internal Medicine Tertiary Resource

Harrison’s 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 Tertiary Resource

The Merck Manual Used by many healthcare professionals Also includes pediatrics, gynecology, psychiatry, ophthalmology, otolaryngology, dental disorders Tertiary Resource

Clinical Medicine (Kumar &Clark ) Tertiary Resource

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. Tertiary Resource

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…… Tertiary Resource

Cardiology Tertiary Resource

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. Tertiary Resource

Hurst’s The Heart Organized by condition Comprehensive information on drug therapies and regimens Rapid Interpretation of EKG’s (Electrocardiogram (EKG or ECG)) Best guide to learning EKG’s User-friendly format. Tertiary Resource

Pediatrics Tertiary Resource

Harriet Lane Handbook Tertiary Resource

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 Tertiary Resource

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 Tertiary Resource

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 Tertiary Resource

Pregnancy Tertiary Resource

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 Tertiary Resource

Infectious Diseases Tertiary Resource

Mandell’s Principles and Practice of Infectious Disease Gold standard reference Infection, diagnosis, treatment and useful background information Tertiary Resource

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 Tertiary Resource

Oncology Tertiary Resource

Cancer: Principles and Practice of Oncology (devita) Gold standard, published every 3 to 4 years Pathology, treatment options, & adverse effects Referenced Tertiary Resource

Cancer Chemotherapy Handbook Useful index, introduction on malignancies Pharmacology and use of chemotherapeutic agents Lists investigational drugs and combinations Well-referenced Tertiary Resource

Pharmacology Tertiary Resource

Goodman & Gilman’s 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) Tertiary Resource

Drug Interactions Tertiary Resource

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 Tertiary Resource

Drug Interaction Facts Published by F&C Alphabetical by drug name Referenced Provides information regarding: Significance and severity Onset of interaction Documentation Not complete, subjective rating scale Tertiary Resource

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 Tertiary Resource

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 Tertiary Resource

Adverse Drug Reactions Tertiary Resource

Meyler’s Side Effects of Drugs Tertiary Resource

Meyler’s 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 Tertiary Resource

Compatibility and Stability Tertiary Resource

Handbook on Injectable Drugs (Trissel’s) Tertiary Resource

Handbook on Injectable Drugs (Trissel’s) 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 Tertiary Resource

King Guide to Parenteral Admixtures Chart format, loose-leaf Alphabetical listing by generic name May have information not available in Trissel’s Pages are not numbered Tertiary Resource

IV INDEX® Component of MICROMEDEX® Easy to use Information taken mostly from Trissel’s Tertiary Resource

Compounding and Pharmaceutics Tertiary Resource

Remington’s The Science and Practice of Pharmacy Helpful for extemporaneous compounding Pharmaceutical calculations, chemistry, radioisotopes New edition every 5 years Tertiary Resource

Merck Index Chemical name, formula, & structure Physical data, therapeutic category Published every 6 to 10 years Tertiary Resource

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 Tertiary Resource

Pharmacokinetics Tertiary Resource

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 Tertiary Resource

Applied Pharmacokinetics: Principles of Therapeutic Drug Monitoring Published by Applied Therapeutics Most advanced reference More specific drug information than Winter’s Includes analytical methods and clinical applications Tertiary Resource

Toxicology Tertiary Resource

Toxicologic Emergencies (Goldfrank’s) Poison management guidelines Useful tables and case studies Practice multiple-choice questions Tertiary Resource

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. Tertiary Resource

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

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 Tertiary Resource

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) Tertiary Resource

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

Drug Identification Tertiary Resource

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

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. Tertiary Resource

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. Tertiary Resource

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 Tertiary Resource

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 Tertiary Resource

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 Tertiary Resource

Non-Prescription Products Tertiary Resource

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 Tertiary Resource

Handbook of Nonprescription Drugs Useful tables and comparisons Includes: Patient assessment and counseling guidelines Pathophysiology and treatment options Dosing, adverse events, & interactions Tertiary Resource

Natural Products Tertiary Resource

Lawrence Review of Natural Products Comprehensive and up-to-date information Published by F&C Monthly updates Provides uses, toxicity, & patient info Scientific approach to herbal products Tertiary Resource

Electronic Tertiary Resources

Multipurpose Resources (disease and drug information) Tertiary Resource

Access Medicine (http://www.accessmedicine.com/) Collection of textbooks, clinical practice guidelines, news Includes: Goodman & Gilman, Harrison’s, 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 Tertiary Resource

ClinicalResource@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 Tertiary Resource

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 Mosby’s drug Consult, package insert information, FDA information Customizable patient handouts – diseases and drugs Tertiary Resource

MedlinePlus (http://medlineplus.gov) NLM’s 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 Tertiary Resource

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 Tertiary Resource

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 Tertiary Resource

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 Tertiary Resource

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 Tertiary Resource

Drug and Natural Products Information Resources Tertiary Resource

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 Tertiary Resource

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 Tertiary Resource

Natural Medicines Comprehensive Database (http://www.therapeuticresearch.net/nd/Search.aspx?s=ND) 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 Tertiary Resource

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 Tertiary Resource