Drug resources - Florida State University College of Medicine

Drug resources - Florida State University College of Medicine

1 2016 USING DRUG RESOURCES Nancy Clark, M.Ed, Director Medical Informatics Education , M.D. Informatics Curriculum Director Regional Campus

2016 2 Objectives Find the Drug Reference Library web page Identify teaching opportunities for medical students around drug questions Locate basic prescription, OTC and herbal drug information (dosage, indication, etc.) online and on the PDA Identify the types of information and tools in the resources

Utilize drug tools (interactions, calculators, pill ID, ) 4 2016 Handouts Evaluations please complete pre- workshop evaluation Drug References Handout Worksheet Top 200 Drugs Prescribed www.rxlist.com

6 New Library Webpage 2016 2016 Library Web Site 7 2016 Subscription Drug Resources Access Medicines Drugs (Lexi Drug)

Dynamed Plus Epocrates Online or App Facts and Comparisons (web) Harriet Lane Johns Hopkins ABX guide PEPID Clinical Key (Clinical Pharmacology) Natural Medicines Pediatric Care Online Journals, News and periodical databases Prescribers Letter Medical Letter 8 9

2016 Mobile Drug Resources Apps Epocrates Essentials Dynamed Plus Johns Hopkins ABX Guide (uCentral) Harriet Lane (uCentral) Medical Letter Natural Medicines Comprehensive Database Pediatric Care Online PEPID Available free to all faculty 2016

Free Drug Resources Medscape (App) CDC Vaccinations (App) CDC Travelers' Health http://wwwn.cdc.gov/travel/ Toxnet (poisons and toxic agents) http://toxnet.nlm.nih.gov/ 10 2016 11

Student Issues Taught generic names Preceptors/clerkship faculty use brand names Dont learn dosing in Pharmacology. Get a little in D2. When do they learn how to write a prescription? D3 Do not understand abbreviations (PO, PRN, etc.) Renal and hepatic dosing introduced 2nd yr What weakness do you see with students? What kinds of questions do you ask students to look up regarding drugs? 12

2016 EPOCRATES P P P P P P P P P P Rx Monographs

OTC Monographs Alt Meds Monographs Drug Interaction Tool Drug Costs Dosage Calculator Formulary Tool Pill Identifier Antibiotics Guide Immunizations 13 2016 Content Differences Epocrates Online

Epocrates App Drugs DDX Diseases Drugs Interaction Checker EBMcalc Diseases Interaction Checker

EBMcalc Pill ID Pill ID Tables Tables Selected Patient Education Resources Lab Manual Infectious Disease

ICD-9 and CPT codes Guidelines 14 2016 Epocrates Drug Monographs Rx OTC Alt Costs provided Patient Ed Handouts online only Dosage Calculator linked to dose/kg in app

Pill pictures require internet connection on app Teaching opportunities: Prescription writing Pill pictures => patients ability to swallow Abbreviations in Help menu Review pharmacology Evaluating patients adverse reactions 15

2016 Comparing Sub Categories Rx Alt Meds Add to Favorites OTC Add to interaction 2016 16

Exercises for Practice Using Epocrates What is the starting dose of lisinopril to treat HTN if the patient is not on a diuretic? (dose) How much does one month supply of Cymbalta 60 mg (30-ea) cost? What are the off label indications for Ativan (adult)? ( indicates off label) How do you write a prescription for 750 mg PO q12 of ciprofloxacin for a patient that cant swallow large pills? 2016 Dosage Calculators in Epocrates Mobile and online

Dosage Calculator http://www.medcalc.co m/pedidose.html Teaching opportunity Considerations Liquid vs tablet Forms available 17 18

2016 Epocrates Interaction Check OTC, Alt meds, Rx and limited foods Teaching opportunity Classifications Caution Monitor Avoid/Use Alternative Contraindicated Include patients OTC, alt meds, & foods in

check 2016 Exercises for Practice Epocrates PDA: lisinopril, metformin, Tylenol Cold and Flu Severe, and hydrochlorothiazide Add lithium Peds example: isoniazid, rifampin, ethambutol, acetaminophen 19

20 2016 Epocrates Formularies All available online Must select payers to put on mobile devices Go to Epocrates.com Manage My Account Pick Formularies Sync/update to add Teaching Opportunity Find alternatives

Discuss considerations 2016 Medscape Mobile Version Now contains formularies 21 2016 22 Exercises for Practice Using Formulary Tools on Epocrates online or

app I have a patient with H. Pylori who has BCBS of GA 3 Tier who needs a low copay. Which of the treatments are covered by BCBS low copay? Look up drugs by class > gastrointestinal> H. Pylori. I have a depressed patient with no health insurance who is indigent. Which SSRI can they get for $4 at Target? 2016 23 Exercises for Practice A 65 year-old female with osteoporosis is

on Boniva. She has recently changed to AARP Medicare Complete MA. Can she continue taking Boniva? Are there lower cost choices? 2016 Epocrates Pill Identifier Brand names easy Generics iffy Teaching opportunity Sack of pills Use different resources Imprints work best If Epocrates doesnt

have it, try Pepid or Facts and Comparisons 24 2016 Exercises for Practice What is this pill? 25 26 2016

Epocrates Tables Lots of teaching opportunities Vaccinations Drug/dose comparisons: topical steroids, opiates, ACE Give students time to look up 2016 27

Exercises for Practice Using any of the Immunizations tools: Patient has planned a mission trip to Central America. What immunizations does she need? Patient has a rash on hands, likely contact derm, but 1% OTC hydrocortisone not working. What topical steroid should we try next? 2016 28 Epocrates Infectious Disease (ID)

Tool Look up Dx only Treatment choices: Empiric Specific to bug Other Info Linked to drug monographs (blue) Teaching opportunities: Depends on level of student (Yr1 vs Yr2/3) Emphasize allergies, side effects, Pregnancy class

29 2016 P P P P PEPID Drug Information and tools Rx Monographs OTC Monographs Alt Meds Monographs

Drug Interaction Tool Drug Costs/Formulary P P P P P P Dosage Calculator Drug Allergy Checker Pill Identifier IV Compatibility Immunizations Beers List

2016 PEPID Drug Monographs OTC, Alt and Rx Adverse reactions include %ages Interactions not listed, must use interaction tool. Kinetics/Dynamics included Include evidence-based inquiries Tap dose to get dosage calculator Overdose mgmt included

30 31 2016 PEPID Drugs Teaching Opportunities Generic/Brand namesTrade names listed for all generics. Getting a side effects historyFrequency of side effects Overdose management issues Contraindication considerations (much more detail) Kinetics/Dynamics

Geriatric considerations (send to Beers List) 2016 32 Exercises for Practice Using PEPID online or PDA What percentage of people will have dizziness while taking Topamax? What are the symptoms of a Prozac OD? You have a child with otitis media for whom you need to give PO amoxicillin. The child weighs 62 Lbs. How many ml of 250 mg/5 ml should you prescribe per

dose? 2016 PEPID Interaction Tool 1 5 point system for severity 1-Minor or non-significant interaction 2-Significant interaction possible, monitor closely 3-Possible serious or life-threatening interaction. Monitor closely. Use alternatives if available. 4-High likelihood serious or lifethreatening interaction. Contraindicated unless benefits outweigh risks and no alternatives available.

5-Never use combination. 33 2016 Exercises for Practice digoxin, furosemide, lisinopril, grapefruit lisinopril, metformin, hydrochlorothiazide, alcohol Peds example: isoniazid, rifampin, ethambutol, acetaminophen 34

2016 Immunizations 35 36 2016 P P P P

Rx Monographs OTC Monographs Alt Meds Monographs Drug Interaction Tool Drug Costs FACTS and COMPARISONS Dosage Calculator Formulary Tool P Pill Identifier Antibiotics Guide

P Immunizations 37 2016 Facts and Comparisons Online only Detailed For pharmacists Research presented Comparison tables Nice tools

38 2016 Facts and Comparisons eAnswers Browse Resources 2016 39 Drug Facts and Comparisons Monographs Linked to Class Monograph and Tables and

breadcrumbs Patient Handouts Contain aftermarket adverse reactions Evidence of efficacy Patient Information includes advice to patient about this drug. 2016 Navigation Drug Monograph 40 2016

41 Tables in Facts and Comparisons Teaching opportunities Renal dosing Compare drugs in class: Adverse Effects Indications Drug-Pregnancy Drug-Lactation Contraindications/Precautions Drug-Drug Interactions Drug-Food Interactions Drug-Alcohol Interactions 2016

42 Exercises for Practice Using Facts and Comparisons Online Is it possible that Wellbutrin causes tinnitus? (hint: CTRL-F) Which of the proton pump inhibitors are used off label for GERD in children? 2016 43

Facts Drug Interactions Can enter patient age, gender, drugs, allergies, and condition Information very detailed Each interaction linked to a monograph Each monograph included Significance, Onset, Severity (3 levels) and the level of documentation of this interaction. 2016 44 Exercises for Practice

digoxin, furosemide, lisinopril lisinopril, metformin, and hydrochlorothiazide Peds example: isoniazid, rifampin, ethambutol, acetaminophen 2016 JOHNS HOPKINS ABX uCentral Web and Mobile 45

2016 Johns Hopkins ABX Guide Look up by bug, drug or disease Section on Vaccines includes vaccine/drug interactions, contraindications 46 2016 47

Pathogen vs Condition vs Antibiotic 48 2016 P P P Rx Monographs OTC Monographs Alt Meds Monographs Drug Interaction Tool Drug Costs

DYNAMED PLUSEVIDENCE BASED Dosage Calculator Formulary Tool Patient Ed Handouts Antibiotics Guide Immunizations 2016 Dynamed Plus Drug Topics Now contains Micromedex Drug monographs 49

2016 50 Dynamed Plus Teaching Opportunities Renal impairment dosing (Dosing Adjustments) Geriatric dosing What is the evidence for using that drug? 51 2016 P

P Rx Monographs OTC Monographs Alt Meds Monographs Drug Interaction Tool P ACCESS MEDICINE Drug Costs Dosage Calculator Formulary Tool Pill Identifier Antibiotics Guide Immunizations

2016 52 LexiDrugs in Access Medicine Access Medicine Lexi Drug Content (Rx and OTC) 53 2016 P P P

Rx Monographs OTC Monographs Alt Meds Monographs Drug Interaction Tool Drug Costs ClinicalKey Dosage Calculator Formulary Tool Pill Identifier Antibiotics Guide Immunizations 2016

ClinicalKey Drug Monographs From Gold Standard 54 55 2016 Rx Monographs OTC Monographs P P

Alt Meds Monographs Drug Interaction Tool Drug Costs NATURAL MEDICINES Dosage Calculator Formulary Tool Pill Identifier Antibiotics Guide Immunizations 2016 56

Natural Medicines Online and mobile Effectiveness Checker Drug Interaction Checker Nutrient Depletion Checker includes prescription drugs Clinical management series offers CME 2016 57 Natural Medicines Effectiveness Select condition

Provides clinical evidence for natural therapies broken down by: Likely effective Possibly effective Possibly ineffective Likely ineffective Insufficient evidence 2016 58 Interaction Checker Enter prescription meds, foods, OTC multi-

ingredient products, and alt meds Breaks down all ingredients Lists all interactions 2016 59 Exercises for Practice Drug interactions: lisinopril, metformin, hydrochlorothiazide and Airborn What is the evidence of effectiveness for St. Johns Wort for depression? What other alternative therapies are

effective for depression? 60 2016 Rx Monographs OTC Monographs Alt Meds Monographs Drug Interaction Tool Drug Costs PEDIATRIC CARE ONLINE Dosage Calculator

Formulary Tool Pill Identifier P Antibiotics Guide Immunizations 2016 Pediatric Care Online Antimicrobial Therapy Guide Information by Diagnosis, Agent, Class Limited number of conditions 61

2016 Harriet Lane In uCentral 62 2016 63 Harriet Lane Best resource for pediatric dosing drugs approved for children

Formulary includes dosing by indication for each age group including infants adults 2016 64 Renal, Hepatic, Geriatric Dosing Epocrates limited Some in Pepid Best resources: Dynamed Plus (Dosing: Special Populations) Facts and Comparisons Harriet Lane (Chapter 31 Drugs in Renal Failure) Tables

2016 65 Summary PEPID competes well with Epocrates as a one- stop quick shop Facts and Comparisons and Dynamed Plus for detail Infectious disease: Johns Hopkins over all others Peds dosing: Harriet Lane Look for opportunities to increase students clinical reasoning and patient centered implications in regards to the drug information they find

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