Drug Information Resources Review Jennifer L. Rodis, PharmD, BCPS The Ohio State University College of Pharmacy October 25, 2011

Objectives Review the differences between primary, secondary, and tertiary resources Discuss the value of each resources type Provide a refresher on searching Pubmed

Types of Literature

Types of literature 3 main types of drug information literature Tertiary Interpretation of primary data Secondary No interpretation, just helps you find sources Primary Original research & analysis

Real-life Research

Tertiary Literature Summarizes and interprets the primary literature Information generally well accepted Place to start for basic information and guidance Can inform your subsequent research

Tertiary Literature Advantages Disadvantages Convenient, accessible Often available online Review process of information is already done Disadvantages Lag time Not as complete Author’s interpretation

Tertiary Literature Textbooks Compendia Electronic also Compendia Full-text computer databases (Internet) Review articles

Tertiary Resources – Drug Databases Online Lexi Comp CRL MICROMEDEX Drug Facts and Comparisons MD Consult AHFS Drug Information Epocrates Print PDR (Physician’s Desk Reference)

Tertiary Resources - Books Print Books Remington’s Trissel’s (2 titles) Handbook of Nonprescription Drugs Redbook Drugs in Pregnancy & Lactation (aka: Brigg’s) Martindale: The Complete Drug Reference

Tertiary Resources - Other UpToDate Pharmacist’s Letter Natural Medicines Comprehensive Database Ohio Administrative Code (pharmacy.ohio.gov) FDA.gov (Orange Book, Drugs@FDA) CDC.gov Professional Organizations APhA’s MTM Central Package Insert Manufacturer web sites Orange book: approved drugs, patent expiration, and therapeutic equivalents / Drugs@FDA: package inserts, Dear Doctor letters, review info, therapeutic equvalents CDC.gov: vaccines, international travel prophylaxis, infections/bioterrorism

Using Tertiary Literature Does author have expertise? Is the information current? Is the information supported with citations? Does the resource contain relevant information? Is the resource free of bias or errors? Is it clear/concise/easy-to-use?

Secondary Literature Guides you to the primary and tertiary literature Indexing Bibliographic info only Abstracting Bibliographic citation plus brief summary of article or resource Almost all are electronic format

Secondary Literature Advantages Disadvantages Simple search strategies Very current citation information Access point for tremendous amount of primary sources Disadvantages Understanding coverage of the database Tweaking search strategies unique to each database

Secondary Resources ClinAlert EMBASE (Elsevier) International Pharmaceutical Abstracts (IPA) Iowa Drug Information System (IDIS) Journal Watch Lexis-Nexis MEDLINE / PubMed Shouldn’t cite a secondary resource

Primary Literature Primary research Journal articles that are: Case reports Drug studies Original reports of data Meta-analysis? Unpublished studies

Primary Literature Considerations Evaluating the basics Peer-reviewed Journal reputation Source of funding Digging deeper Study methodology Clinical relevance Patient populations

Primary Literature Advantages Disadvantages Most current published source Tremendous range of information Personally assess utility/validity Disadvantages Overwhelming volume Interpretation of results Not yet vetted by experts

Primary Literature Peer-reviewed journals Non-peer reviewed journals JAMA New England Journal of Medicine American Journal of Health-system Pharmacy Annals of Internal Medicine Non-peer reviewed journals Supplements Pharmacy Today

What’s the difference? Ease of Use Tertiary Secondary Primary

What’s the difference? Most Current Primary Secondary Tertiary

Alternate Sources of DI Internet, Listservs, and medical news briefs Local and national professional organizations and meetings Pharmaceutical manufacturers Drug information and poison control centers

Searching Strategies Begin broad, then narrow your search Start with tertiary sources Use “related articles” Bibliographies Secondary resource guides Always be sure to assess most up to date information available Primary sources

Searching Pubmed

Searching Strategies Develop focused question and break into parts What is the question asking? “Is peptic ulcer prevention with proton pump inhibitors and NSAIDs dose-related?” proton pump inhibitors, dose, non-steroidal anti-inflammatory agents, prevention of peptic ulcer disease Other forms of the above words and phrases

Searching Strategies Putting together an answerable question is key to successful evidence-based medicine practice Use PICO method Patient or problem Intervention Comparative intervention Outcome Be Specific!

Example: PICO What is the minimum or maximum dose of NSAIDs at which proton-pump inhibitors are effective for peptic ulcer disease prophylaxis? Patient or problem Intervention Comparison Outcome

Searching Strategies Read up on the basics of the question Start with tertiary resources for foundation Build on information gathered from texts, review articles, and drug databases with a primary literature search

Searching Strategies Gather as many articles as possible for all of the parts of the search Use MeSH headings to help narrow or broaden your search MeSH = Medical Subject Headings Official indexing terms for MEDLINE

Searching Databases: Basic Boolean “AND” Combines 2 terms (shrinks search) “OR” Gives database more choices (broadens search) “NOT” Limits search (removes undesired terms)

Basic Boolean Both words must be present in results paroxetine AND suicide

Basic Boolean Either word can be present in results paroxetine OR suicide

Basic Boolean The first but not the second term will be present in the results paroxetine NOT suicide

effective for peptic ulcer disease prophylaxis? Pubmed Search Example What is the minimum or maximum dose of NSAIDs at which proton-pump inhibitors are effective for peptic ulcer disease prophylaxis?

Search keywords Proton pump inhibitors and dose and non-steroidal anti-inflammatory agents proton pump inhibitors and dose and non-steroidal anti-inflammatory agents and prevention of peptic ulcer disease MeSH term search: PPIs, NSAIDs, PUD 1=226 2=96 3=45 http://www.ncbi.nlm.nih.gov/pubmed/19240698

Resources Adapted from lectures by Bridget Protus, PharmD, CGP, MLS delivered 1/2010. Thrower MR. Literature retrieval and Finding Resources Electronically. In: Felkey BG, Fox BI, Thrower MR. Health care informatics: a skills-based resource. Washington DC: American Pharmacists Association; 2005. p. 191-228. West, PM. Literature evaluation. In: Pharmacotherapy self-assessment program: science and practice of pharmacotherapy, 5th ed. (PSAP V). Kansas City: American College of Clinical Pharmacy; 2005. p. 93-110. Shields, KM. Drug information resources. In: Malone PM, Kier KL, Stanovich JE. Drug information: a guide for pharmacists, 3rd ed. New York: McGraw Hill; 2006. p.61-101.

Resources Thrower MR. Literature retrieval and Finding Resources Electronically. In: Felkey BG, Fox BI, Thrower MR. Health care informatics: a skills-based resource. Washington DC: American Pharmacists Association; 2005. p. 191-228. West, PM. Literature evaluation. In: Pharmacotherapy self-assessment program: science and practice of pharmacotherapy I, II, III. Kansas City: American College of Clinical Pharmacy; 2005. p. 93-5.