drug resources

FLORIDA STATE UNIVERSITY

The College of Medicine

Drug Resources

Nancy Clark, MEd, Director Medical Informatics Education

Mark Strickland, MD, Informatics Curriculum Director, TLH Regional Campus

FLORIDA STATE UNIVERSITY

The College of Medicine

Objectives• Find the Drug Reference Library web page• Locate basic prescription, OTC and herbal

drug information (dosage, indication, etc.) online and on the PDA

• Calculate a drug dosage using an electronic resource

• Identify if a drug is on a particular formulary and locate alternatives

• Identify a pill from it’s imprint or description• Perform a drug interaction check • Use an infectious disease/antibiotics guide• Use an immunization schedule tool

FLORIDA STATE UNIVERSITY

The College of Medicine

Handouts

• Evaluations• Drug References Handout• Worksheet• Instructions for email alerts

Top 200 Drugs Prescribed 2008 www.rxlist.com

FLORIDA STATE UNIVERSITY

The College of Medicine

Using the green Worksheetas we go thru the workshop,

identify drug questions you can use with students.

FLORIDA STATE UNIVERSITY

The College of Medicine

New Library Webpage (Fall 2010)

Summer 2010 7

FLORIDA STATE UNIVERSITY

The College of Medicine

Library Web Site

FLORIDA STATE UNIVERSITY

The College of Medicine

Subscription Drug Resources• Epocrates Online or Essentials (web and PDA)• Facts and Comparisons (web)• PEPID (web and PDA)• Access Medicine’s Drugs (Lexi Drug) (web)• Harrison’s Practice (Lexi Drug) (web and PDA)• MDConsult (Clinical Pharmacology) (web)• Natural Medicines Database (web and in Epocrates

PDA)• Pediatric Care Online• Journals, News and periodical databases

– Prescriber’s Letter– Medical Letter (Handout on how to get alerts)

FLORIDA STATE UNIVERSITY

The College of Medicine

PDA Drug Resources

• Epocrates Essentials • PEPID• Harrison’s Practice• Pediatric Care Online• Dynamed

Available free to all faculty

FLORIDA STATE UNIVERSITY

The College of Medicine

Student Issues

• Taught generic names• Preceptors/clerkship faculty use brand

names• Don’t learn dosing in Pharmacology• Do not understand abbreviations (PO,

PRN, …)• When do they learn how to write a

prescription? 1st Clerkship

FLORIDA STATE UNIVERSITY

The College of Medicine

Who Has What?

FLORIDA STATE UNIVERSITY

The College of Medicine

EPOCRATES ESSENTIALS

P Rx Monographs

P OTC Monographs

P Alt Meds Monographs

P Drug Interaction Tool

P Drug Costs

P Dosage Calculator

P Formulary Tool

P Pill Identifier

P Antibiotics Guide

P Immunizations

FLORIDA STATE UNIVERSITY

The College of Medicine

Epocrates Essentials iPhone/iPod

Prescription, Alt Meds and OTC are combined in same list.

Formulary

Get Back

Add to Favorites

FLORIDA STATE UNIVERSITY

The College of Medicine

Epocrates Essentials Rx

• Search by drug or class– Rx – Alt – OTC

• Compare sub-categories of each type

FLORIDA STATE UNIVERSITY

The College of Medicine

Alt Meds OTCRx

Comparing Sub Categories

Add to Favorites

FLORIDA STATE UNIVERSITY

The College of Medicine

Dosage Calculator in Epocrates iPhone

• Online Dosage Calculator– http://www.medcalc.com/pedidose.html

FLORIDA STATE UNIVERSITY

The College of Medicine

Exercises for Practice

Using Epocrates PDA• A little boy who is eight years old just ate a bottle of Children’s

Tylenol tablets his mother had in the medicine cabinet. She thinks he ate forty or fifty of them. You search the Tables > Toxicology > Antidotes 1 and find that acetylcysteine is indicated for acetaminophen toxicity. Calculate the dosage of acetylcysteine for the child. He weighs 50 lbs.

FLORIDA STATE UNIVERSITY

The College of Medicine

Epocrates PDA MultiCheck1. Type

2. Pick drug

3. Clic

k +

4. Repeat until all drugs in list

5. Click View Interactions

6. Tap Interaction

FLORIDA STATE UNIVERSITY

The College of Medicine

Exercises for Practice

• Epocrates PDA: lisinopril, metformin, and hydrochlorothiazide

• Peds example: isoniazid, rifampin, ethambutol, acetaminophen

FLORIDA STATE UNIVERSITY

The College of Medicine

Epocrates Formularies

• Go to Epocrates.com• Manage My Account• Pick Formularies• Sync/update to add

FLORIDA STATE UNIVERSITY

The College of Medicine

Exercises for Practice• Using Formulary Tools on Epocrates online or PDA• I have a patient with H. Pylori who has BCBS of Florida 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?

FLORIDA STATE UNIVERSITY

The College of Medicine

Epocrates iPhone Pill Identifier

FLORIDA STATE UNIVERSITY

The College of Medicine

Exercises for Practice

• What is this pill?

FLORIDA STATE UNIVERSITY

The College of Medicine

Epocrates PDA ID Tool

FLORIDA STATE UNIVERSITY

The College of Medicine

Exercises for Practice• Using Epocrates ID• Which antibiotics should be used for a 17 year

old outpatient female with PID, etiology unknown?

• The DNA probe comes back with Chlamydia in the same patient. What antibiotic should I use? Using the PDA, find the antibiotic.

• What other treatment recommendations for this patient are found in ID? (choose the “Info” tab across the top)

FLORIDA STATE UNIVERSITY

The College of Medicine

Tables

FLORIDA STATE UNIVERSITY

The College of Medicine

EPOCRATES ONLINE

Rx, OTC and Alt Meds

P Rx Monographs

P OTC Monographs

P Alt Meds Monographs

P Drug Interaction Tool

P Drug Costs

P Dosage Calculator

P Formulary Tool

P Pill Identifier

P Antibiotics Guide

P Immunizations

FLORIDA STATE UNIVERSITY

The College of Medicine

Browsing Epocrates ONLINE

1. Pick a lette

r

2. Pick drug

FLORIDA STATE UNIVERSITY

The College of Medicine

2. Pick drug

Search for a Drug

1. Type

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The College of Medicine

1. Pick category

2. Pick sub category

3. Pick drug

Using Classes

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The College of Medicine

Prescription Drug Monographs

1. Pick category

FLORIDA STATE UNIVERSITY

The College of Medicine

Dosage Calculator

FLORIDA STATE UNIVERSITY

The College of Medicine

Alt Meds Monographs

1. Pick category

FLORIDA STATE UNIVERSITY

The College of Medicine

OTC Monographs

FLORIDA STATE UNIVERSITY

The College of Medicine

Exercises for Practice

• Using Epocrates Online• 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 30 mg cost?

• What is the off label indication for Ativan?( indicates off label)

FLORIDA STATE UNIVERSITY

The College of Medicine

Epocrates ONLINE Formulary

1. Pick formulary

2. Click to see meaning

FLORIDA STATE UNIVERSITY

The College of Medicine

Epocrates ONLINE Formulary

1. Click Code

2. Under View Alternatives, click class

Alternatives

FLORIDA STATE UNIVERSITY

The College of Medicine

Finding Substitutes

Codes

FLORIDA STATE UNIVERSITY

The College of Medicine

• A 65 yr 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? 

• Another formulary resource:– http://www.fingertipformulary.com/ – Can’t vouch for accuracy

Exercises for Practice

FLORIDA STATE UNIVERSITY

The College of Medicine

Another Formulary Option

FLORIDA STATE UNIVERSITY

The College of Medicine

Epocrates ONLINE MultiCheck Tool

2. Click drug

Repeat until all drugs in list

Interactions appear as found

1. Type

FLORIDA STATE UNIVERSITY

The College of Medicine

Exercises for Practice

• Check for Interactions: digoxin, furosemide, lisinopril

• Peds example: isoniazid, rifampin, ethambutol, acetaminophen

FLORIDA STATE UNIVERSITY

The College of Medicine

Epocrates ONLINE Pill Identifier

Pick shape, color, etc. If imprint readable, type it in

and click Identify Pills

Scroll through results until you find your pill.

Click name to go to monograph.

FLORIDA STATE UNIVERSITY

The College of Medicine

Epocrates Online Tables

FLORIDA STATE UNIVERSITY

The College of Medicine

Epocrates Vaccinations

FLORIDA STATE UNIVERSITY

The College of Medicine

Exercises for Practice

• Using any of the Immunizations tools:• Patient has planned a mission trip to Central

America. What immunizations does she need? • The news of a meningitis outbreak brings in a 53

yr old man with a history of TB but otherwise healthy who is worried that he might be exposed. Should we give him Menactra?

FLORIDA STATE UNIVERSITY

The College of Medicine

PEPID

P Rx Monographs

P OTC Monographs

P Alt Meds Monographs

P Drug Interaction Tool

P Drug Costs

P Dosage Calculator

Formulary Tool

Pill Identifier

Antibiotics Guide

P Immunizations

FLORIDA STATE UNIVERSITY

The College of Medicine

PEPID Drug Information

1. Click on Dose

FLORIDA STATE UNIVERSITY

The College of Medicine

PEPID Drugs iPhone

1. Pick CRC

FLORIDA STATE UNIVERSITY

The College of Medicine

Exercises for Practice

• Using PEPID online or PDA• 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?

FLORIDA STATE UNIVERSITY

The College of Medicine

PEPID Interaction Tool

FLORIDA STATE UNIVERSITY

The College of Medicine

Exercises for Practice

• digoxin, furosemide, lisinopril• lisinopril, metformin, and

hydrochlorothiazide • Peds example: isoniazid, rifampin,

ethambutol, acetaminophen

FLORIDA STATE UNIVERSITY

The College of Medicine

Immunizationss

FLORIDA STATE UNIVERSITY

The College of Medicine

FACTS ANDCOMPARISONS

P Rx Monographs

P OTC Monographs

P Alt Meds Monographs

P Drug Interaction Tool

P Drug Costs

Dosage Calculator

Formulary Tool

P Pill Identifier

Antibiotics Guide

P Immunizations

FLORIDA STATE UNIVERSITY

The College of Medicine

eFacts and Comparisons

• Detailed• For pharmacists• New interface

Browse Resources

FLORIDA STATE UNIVERSITY

The College of Medicine

Search eFacts & Comparisons

1. Type

2. Pick drug

3. Click Go

FLORIDA STATE UNIVERSITY

The College of Medicine

eFacts & Comparisons Online

• Monograph in Drug Facts and Comparisons will come up

• Expand sections• Or Show All• See link to Class• Breadcrumbs

FLORIDA STATE UNIVERSITY

The College of Medicine

Classifications

FLORIDA STATE UNIVERSITY

The College of Medicine

Tables in Facts and Comparisons

FLORIDA STATE UNIVERSITY

The College of Medicine

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?

FLORIDA STATE UNIVERSITY

The College of Medicine

eFacts Drug Interactions

Type in patient’s drugs, add

Check list, add more if needed

then click GO>>

FLORIDA STATE UNIVERSITY

The College of Medicine

eFacts Drug Interactions

Click on Interaction to see monograph

FLORIDA STATE UNIVERSITY

The College of Medicine

Exercises for Practice

• digoxin, furosemide, lisinopril• lisinopril, metformin, and

hydrochlorothiazide • Peds example: isoniazid, rifampin,

ethambutol, acetaminophen

FLORIDA STATE UNIVERSITY

The College of Medicine

eFacts Pill Identifier

1. Fill in and click Go

2. Click on underlined drug name

FLORIDA STATE UNIVERSITY

The College of Medicine

DYNAMED- EVIDENCE BASED

P Rx Monographs

P OTC Monographs

P Alt Meds Monographs

Drug Interaction Tool

P Drug Costs

Dosage Calculator

Formulary Tool

Pill Identifier

Antibiotics Guide

Immunizations

FLORIDA STATE UNIVERSITY

The College of Medicine

1. Type & choose

2. Choose

FLORIDA STATE UNIVERSITY

The College of Medicine

Choose category

FLORIDA STATE UNIVERSITY

The College of Medicine

Dynamed

• New• 1000 drug monographs• Evidence-based• Linked to disease content

FLORIDA STATE UNIVERSITY

The College of Medicine

MDCONSULT

P Rx Monographs

P OTC Monographs

P Alt Meds Monographs

Drug Interaction Tool

Drug Costs

Dosage Calculator

Formulary Tool

Pill Identifier

Antibiotics Guide

Immunizations

FLORIDA STATE UNIVERSITY

The College of Medicine

MDConsult Drug Monographs

• Gold Standard’s Clinical Pharmacology• Thorough• By Indication, Contraindication and

Adverse Reactions

FLORIDA STATE UNIVERSITY

The College of Medicine

ACCESS MEDICINEHARRISON’S PRACTICE

P Rx Monographs

P OTC Monographs

Alt Meds Monographs

Drug Interaction Tool

Drug Costs

Dosage Calculator

Formulary Tool

Pill Identifier

Antibiotics Guide

Immunizations

FLORIDA STATE UNIVERSITY

The College of Medicine

LexiDrugs in Access Medicine

• Access Medicine Lexi Drug Content (Rx and OTC)• Also in Harrison’s Practice online and PDA

FLORIDA STATE UNIVERSITY

The College of Medicine

NATURAL MEDICINESDATABASE

Rx Monographs

OTC Monographs

P Alt Meds Monographs

P Drug Interaction Tool

Drug Costs

Dosage Calculator

Formulary Tool

Pill Identifier

Antibiotics Guide

Immunizations

FLORIDA STATE UNIVERSITY

The College of Medicine

Natural Medicines Database

FLORIDA STATE UNIVERSITY

The College of Medicine

Natural Medicines Effectiveness

FLORIDA STATE UNIVERSITY

The College of Medicine

Interaction Checker

FLORIDA STATE UNIVERSITY

The College of Medicine

PEDIATRIC CAREONLINE

Rx Monographs

OTC Monographs

Alt Meds Monographs

Drug Interaction Tool

Drug Costs

Dosage Calculator

Formulary Tool

Pill Identifier

P Antibiotics Guide

Immunizations

FLORIDA STATE UNIVERSITY

The College of Medicine

Pediatric Care Online

• Antimicrobial Therapy Guide• Information by

• Diagnosis• Agent • Class

FLORIDA STATE UNIVERSITY

The College of Medicine

Pediatric Care Online

Interactive Periodicity Schedule includes Childhood Immunizations

FLORIDA STATE UNIVERSITY

The College of Medicine

Summary

• Epocrates on PDA different than online. • PEPID competes well with Epocrates as a one-

stop shop • Facts and Comparisons more detailed

monographs and interactions but only online• Many other resources have good drug

information but without tools (formularies, interaction tools, dosage calculators…)