1. Drug Information Resources
Joe Pozdol, MLIS
Norris Medical Library

2. Learning Goals
To understand the magnitude of health information available today
To be able to classify questions as background or foreground
To understand the differences between primary, secondary, and tertiary resources
To be able to determine ultimate questions and classify them by drug information type
To be able to use Drug Facts and Comparisons, Epocrates, Lexi-Comp, Micromedex, and Clinical Pharmacology

3. The Growth of Medical Information
Indexed Citations Added to MEDLINE (i.e. PubMed) by Fiscal Year ??
U.S. National Library of Medicine. National Institutes of Health. Reviewed 25 March

4. How does one navigate the information overload without getting overwhelmed and confused?

5. Partner Introductions

6. Pair Activity: Assessing What You Already Know
For a drug information question, which would you consult?
List a pro and a con for each resource.
Journal
Textbook

7. Background v. Foreground Questions

8. Background Questions Question is broad in scope
Answer is general knowledge in field
Can best be addressed with tertiary resources
E.g. Is a drug available in the U.S.?
What is a drug’s mechanism of action?
When is a drug contraindicated?

9. Foreground Questions Question is narrow in scope
Answer may require examining new or conflicting evidence
Can best be addressed with secondary and primary resources
E.g. How effective is a new drug when compared to
drugs that are already on the market?
Are there clinical trials supporting an off-label use of a
drug in a specific population?

10. Resource Types:
Primary
Secondary
Tertiary

11. Primary Resources Scientific journals
Provide original studies or reports
E.g. Clinical trial, case series, case report
Good for foreground questions
Scope is narrow
Good when topic is new or new data has been published

12. Primary Resources Pros: Cons: Most current evidence
Provide data on new drugs
Can personally assess validity of studies
Cons:
May not lead one to best decision because of limited scope
Data can be poor or controversial
Every study has limitations
Too complex for patients

13. Secondary Resources
Bibliographic databases that provide abstracts or full-text of studies
Good for foreground questions

14. Secondary Resources Pros:
Can construct searches to find specific information
at high granularity
Cons:
Often require more expertise to use than primary or tertiary
resources
Retrieved references must be filtered for quality
Must track down resources before looking for answers
Too complex for patients

15. Tertiary Resources Compilations of knowledge in the field
E.g. Textbooks, handbooks, online drug compendia
Good for background questions
Scope is broad

16. Tertiary Resources Pros: Provide comprehensive information
Information reflects views of multiple experts in field
Fast, easy to use, and may be good for patients
Cons:
Usually at least 2 years out of date by publication
High dependency on interpretation of authors**
**Pharmacists can address this by consulting at least
2 tertiary resources to find corroborating information

17. Tertiary, Secondary, Primary
When trying to answer a clinical question, the best strategy is often to consult resources in the following order:
Tertiary, Secondary, Primary
Tertiary resources are good 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 are good 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

18. Resource Table Primary Resources Secondary Tertiary
JAPhA JAMA Pharmacotherapy
New England Journal of Medicine
Annals of Internal Medicine AJHP
Secondary
PubMed/Ovid MEDLINE
Cochrane Database of Systematic Reviews
DARE TRIP
National Guideline Clearinghouse
Tertiary
Access Pharmacy UpToDate
Drug Facts and Comparisons
Epocrates Lexi-Comp Micromedex
Clinical Pharmacology

19. Determining the Ultimate Question
Real Estate Agent Last Dec.
44 y.o. male
High blood pressure
Rx ACE inhibitor
Develops dry cough
Ultimate Question:
Is cough a side effect of ACE inhibitors?
Question Type:
Background
Resource Type:
Tertiary
Major Concepts
(i.e. search terms):
ACE inhibitors, side effects, cough

20. Categorizing the Ultimate Question
**Adverse effects
Availability
Compatibility/stability
Compounding
**Dosing/administration
**Drug interaction
Herbal
Identification
Pharmacokinetics
Pharmacology
Poisoning/toxicology
Pregnancy/lactation
**Therapeutic use
**Especially relevant for Medication Therapy Review assignment

21. Pair Activity
List 3 facts about Ambien (Zolpidem Tartrate) OR Insomnia

22. Drug Facts and Comparisons
Search for information about Ambien (Zolpidem Tartrate)

23. Pair Activity
List 3 facts about Proventil (Albuterol Sulfate) OR Asthma

24. Epocrates Search for information about Proventil (Albuterol Sulfate)

25. Pair Activity
List 3 facts about Zoloft (Sertraline Hydrochloride) OR Depression

26. Lexi-Comp
Search for information about Zoloft (Sertraline Hydrochloride)

27. Pair Activity
List 3 facts about Aricept (Donepezil Hydrochloride) OR Dementia

28. Micromedex
Search for information about Aricept (Donepezil Hydrochloride)

29. Pair Activity
List 3 facts about Zyrtec (Cetirizine Hydrochloride) OR Allergies

30. Clinical Pharmacology
Search for information about Zyrtec (Cetirizine Hydrochloride)

31. Topic Recap Excess of Medical Info Background v. Foreground
Tertiary, Secondary, Primary
Ultimate Questions
Drug Facts and Comparisons
Epocrates
Lexi-Comp
Micromedex
Clinical Pharmacology

32. The Big Picture Addressing a Drug Info Need
Obtain background info/understand context
Determine ultimate question
Select and search appropriate resources
Evaluate and analyze information found
Draw conclusion and formulate response

33. Medication Therapy Review Assignment
Due Dec. 4
References used to support recommendation:
WRONG
Student Google
Wikipedia
RIGHT
Student Drug Facts and Comparisons
Lexi-Comp

34. Please fill out an evaluation:
Class: Drug Info Resources
Date: 9/11/09
Instructor: Joe Pozdol