Introduction ; It is the current, relevant, critically examined data

about drug and drug use for given patient or situation.

Many institutes run DIC(Drug Information Center) for the provision of drug information, to every group/kind of people from any place

First DIC was developed in University of Kentucky in 1960. In United states 80% of the Hospitals having DIC.

Nepal, in infancy stage with a few centers.

In Nepal DDA has started this type of services.

Need of drug information The no of drugs in the international market has increased very much

The newer drugs are generally more potent & selective, and formulations becoming increasingly complex

The literature on drugs has also expanded and covers a wide range of information

To introduce a new drug into the practice, the professionals need to evaluate the given information.

A simple,quick reference to a pharmacopoeia or formulary is no longer sufficient.

Aims and objectives of drug information services The provision of information to health professionals on

specific problems related to the use of drugs in particular patients;

The provision of information to officials in government agencies to optimize the decision making process;

The preparation and development of guidelines and formularies;

To improve patient compliance and to provide a guide to responsible self medication;

To develop and participate in continuing education programs;

To participate in undergraduate and graduate teaching programs;

To develop educational activities regarding the appropriate use of drugs for patients in the community;

To prepare and distribute material on drugs to health personnel in the form of a drug Information bulletin and/or other media;

To develop and participate in research programs;

The Sources of information/Resources available

Primary Source: Information is presented by authors without any evaluation by a second party. Provides must current information about drugs. Examples; articles published in journals(eg British Medical Journal), thesis etc.

Secondary source The original source has been evaluated by second party other than the publisher. Modified and rearranged form Examples; review articles like lexis-nexis, Medline etc

Tertiary source Information obtained from primary and secondary source and arranged in a

manner to represent a composite of the available information. Examples; Representative form Pharmacopeias - BP, USP, IP, BNF etc.,

Encyclopedia Dictionaries Guides, text books

Other Sources:

The DIC also receives information from The public and hospitals about the Adverse effects of any drug Local drug lists National Formularies Hospital Formularies Internet Phone calls to Manufacturers Government and Non-government organizations and also to other DIC’s.

Drug informer should understand the nature of the question and should ask all the needed questions to get the ultimate question

Most specialists today use the modified systematic approach designed by ‘Host and Kirkwood’, these are;

Step I ; Secure demographics of the requestorsStep I ; Secure demographics of the requestors Who requests? Med/non med personnel Educated/un educated personnel Name/location/phone/email etc of requestor This determines the type of response that will be given

Step II; Obtain background informationStep II; Obtain background information Where the requestor heard/read about the drug? Is he/she taking medicine? Why? Is he/she a caregiver/wants to take medicine? This helps determining what additional information should be

provided.

Step III; Determine and categorize the ultimate questionStep III; Determine and categorize the ultimate question Putting the pieces of information together to form ultimate

question and once it has been determined, the next step is to categorize the question.

Step IV;Develop strategy and conduct researchStep IV;Develop strategy and conduct research Strategies should be developed with a typical algorithm with three

essential components; tertiary-secondary-primary literature

Step V;Perform evaluation, analysis & synthesisStep V;Perform evaluation, analysis & synthesis Provider should take time to evaluate the info, analyze and then

synthesize it into a good reply

Step VI;Formulate and provide responseStep VI;Formulate and provide response An outline should be established to help formulate a

response to the drug info request.

Its important to have; introduction, body and conclusion

Step VII;Conduct follow-up and documentationStep VII;Conduct follow-up and documentation Checking with the requestor to make sure his/her

question has been sufficiently and completely answered.

Of vital importance is to document all the steps taken in this process.

Among the skills of drug information is a knowledge of drug literature evaluation which allows one to provide a critical analysis of the literature and have a better understanding of the studies done in health and medicine.

It is a key component to provide a good quality answer to a requester

Being able to separate good data from poor data is essential

Knowing the limitations of any study can help in evaluating the usability of its data

Drug information specialists will often use some standard questions to help in this process

Several references provide guides to evaluate the medical and pharmacy literature.

Do not guess

Take several ethical issues into account◦ Patient privacy must be maintained

◦ Patient-physician relation cannot be breached

◦ Response is not necessary if the inquirer intends to misuse or abuse the information that is provided.

Organize information before attempting to communicate the response to the inquirer.

Tailor the response to the inquirer’s background.

Tell the inquirer where the information was found.

Alert the inquirer of a possible delay when it takes longer than anticipated to answer the question.

Ask if the inquirer’s question is answered by the information.

Research the Facts, gather information(from the resources available i.e. tertiary- secondary- primary resources)about the question of oral report.

List the facts and interesting information accurately. Remember that relevant details and vivid descriptions will make

oral report more interesting

Organize the Information/oral report in three parts. ◦ Introduction ◦ Body (main part)◦ Conclusion

Practice Giving the Oral Report Speak clearly and deliberately Make A Final Copy of Report Notes.

  Drug information centersDrug information centers Drug information centers (DICs) in general, are service

providers, which provide drug information relating to therapies, pharmacoeconomics, education, and research programs.

It provides unbiased information to health care professionals and/or patients and consumers.

Many centers also provide workshops or other forms of training to enhance the skills of healthcare professionals.

A drug information center is usually a unit located within and/or affiliated with a larger organization (i.e., a pharmaceutical association, a hospital etc).

Pharmacist; specialists with proper knowledge of drug and actions associated with it with academic degree. ƒ

(they provide drug information)

Pharmacy Technicians & Students(they assist pharmacists in providing drug information like

literature searching,retrieval of data,resources updating etc)

People trained in library science with computer knowledge

(they are supporting staffs in DIC for their own expertise)

ƒ

The center should have specific hours of operation(24hrs preferably) and adequate technological resources (i.e., computers, phone lines, faxes, etc.)

The drug information center should have the latest publications and ideally publish a newsletter or other informational updates.

Role of Pharmacist: Must be a part of DIC,should be “ready to go” for

information all the time. ‘The Drug-Information Pharmacist’ is at interface of vast

amount knowledge on onside and the persons needing the knowledge on other.

Should provide proper information irrespective of the informer’s status,but accordingly with informer’s status.

Drug Information Centers in Nepal Four organizations in Kathmandu were initially identified as potential

sites for drug information centers:

Department of Drug Administration (DDA), Ministry of Health Drug Information Unit(DIU), Tribhuvan University Teaching

Hospital Resource Centre for Primary Health Care (RECPHEC), a local non-

governmental organization Nepal Chemists and Druggists Association (NCDA), a professional

association for retailers and wholesalers A fifth organization, the Nepal Health Research Council(NHRC),

also expressed an interest in establishing a drug information center. NHRC is a relatively new, quasi-governmental body whose mission is to review and approve all proposals for medical and health research to be conducted in Nepal.

Drug Information Network of Nepal (DINoN)Drug Information Network of Nepal (DINoN) The Drug Information Network of Nepal (DINoN) was established on

23rd September, 1996 with multi-sectoral participation including government, academic and non-government institutions to provide unbiased information on drugs to various constituency groups.

A single organization may not have enough expertise, resources and capacity to satisfactorily meet the drug information needs of a wide range of target groups

DINoN is an initiative to develop and disseminate information about the proper use of drugs, possible adverse reactions, contraindications, toxicity, drug standards and efficacy, precautions, and proper storage and handling to health care professionals in the public and private sector, and to consumers.

Founder members of DINoN DDA, Ministry of health and population Tribhuvan University Teaching Hospital, Drug Information Center Nepal Chemists and Druggists Association (NCDA) Resource Center for Primary Health Care (RECPHEC) Nepal Health Research Council (NHRC)

Ordinary members of DINoN United Hands to Nepal Poison Information Center (UHN) Britain Nepal Medical Trust (BNMT) B.P. Koirala Institute of health Sciences (BPKIHS) Manipal College of Medical Sciences (MCOMS)

Note; The primary role of a DIC in a developing country is to give clear anddefinitive information on well-established essential drugs andpromote their rational use.

A secondary role would be to keep up-to-date with pharmacological and therapeutic literature and to disseminate relevant

information, as it becomes available.

Drug information bulletin It publishes the latest developments in medical sciences, the newly introduced

drugs, new indication and other information regarding drugs.

One of the PTCs duties is to assist the pharmacist in conducting a teaching program within the hospital through a pharmacy publication.

The methods employed to disseminate interdepartmental information are usually bulletins, bulletin board notices and committee meetings.

The bulletin normally publishes the latest development in the medical sciences, the newly introduced drugs, new indications for certain drugs, newer drug delivery systems, updates on drug interactions and ADRs.

Pharmacist is normally held responsible for its publication however; contributions are obtained from pharmacists, physicians and nursing and other interested groups like therapeutic dietician for food drug interactions for publishing the bulletin.

The contents should however be educative and informative.

PCC(Poison control center); For the provision of service regarding poison and related danger, and to manage with the poisoningCases

Concept initiated in chicago in 1953

PCC were established for two reasons: To provide rapid access to information valuable in

assessing and treating poisonings.

To assist with poisoning prevention

ƒPharmacy team pharmacist; specialists trained in poison

information and in the management of poisoning emergencies. ƒ

Pharmacy Technicians & Students ƒ

Medical team Toxicologists specializing in medical toxicology

are also available for consultation.

Supporting team People trained in library science with computer knowledge

◦ Assess and treatment recommendations during poisoning via 24-hour emergency telephone services

◦ Provide public and professional educational programs

◦ To collect data on poisonings

◦ To perform research

◦ Assist the public and health care providers during hazardous material spills

My daughter is 2 years old and just swallowed ½ a bottle of PCM… �

I just turned my heater on for the winter season and I am feeling light headed…

I’m 72 years old and think I took a double �dose of my medicine… �

I have a patient who swallowed …? �

Exact name of the product involved (have the container close at hand) ƒ

Amount of poison the person was exposed to ƒ Any symptoms ƒ Time of exposure Age and weight of the victim ƒ Any health problems the person has ƒ Any treatment that has been given ƒ Where the person is ƒ How the person was poisoned

Obtain History Consult References Assess Risk & Formulate Treatment Plan Communicate Assessment and

Recommendations to Client Complete Coding & Documentation

Poison; Any substance that can harm the body by altering cell structure or functions

Toxin; A poisonous substance secreted by bacteria, plants, or animals◦ Examples: Mushrooms,Variety of plants, Bacterial contaminants in food

Common Ingested PoisonsCommon Ingested PoisonsAcetaminophenAcids and alkalisAntihistaminesFood poisoningInsecticidesPetroleum productsPlants

(cont.)

Inhalation

Absorption

Injections

Ingestion

Acids and AlkalisAcids and AlkalisBurns on or around the lips

Burning in mouth, throat, and abdomen

Vomiting

Food PoisoningFood PoisoningVarious types of signs and symptoms

Abdominal pain

Nausea and vomiting

Diarrhea

Fever

InsecticidesInsecticidesSlow pulse

Excessive salivation and sweating

Nausea, vomiting, and diarrhea

Breathing difficulties

Constricted pupils

Petroleum ProductsPetroleum ProductsCharacteristic odor of breath, clothing, and vomitus

Coughing and difficulty breathing

Range of signs and symptoms

Important questions to consider asking patient

What substance?When did you ingest/become exposed?If an ingestion, how much did you ingest?Over what time period? What Interventions?How much do you weigh?[What effects are you experiencing from the ingestion?]

Poisons that are swallowed:◦ Household and industrial chemicals

◦ Medications

◦ Improperly prepared food

◦ Plant materials

◦ Petroleum products

◦ Agricultural products

Ingested PoisonsSigns and SymptomsSigns and Symptoms

Nausea,Vomiting,Diarrhea,Altered mental status,Abdominal pain,Chemical burns around the mouth,Different breath odors

Emergency medical careEmergency medical care•Remove from unsafe environment•Maintain airway and provide oxygen•Remove pills, tablets or fragments with gloves from patient’s mouth, as needed, without injuring oneself.

•Consult medical direction•activated charcoal.

•Bring all containers, bottles, labels, etc. of poison agents to receiving facility.

Be prepared for vomiting.Repeat vital signs.Dilution:Based on medical direction

Antidote—few and limitedPrevent absorption (charcoal).Supportive care (airway management, oxygenation, treatment of shock)Kidney dialysis

Poisons that are breathed in:◦ Gases: ammonia, chlorine◦ Vapors: carbon monoxide◦ Sprays: insecticides◦ Volatile liquid chemicals: change easily from liquid to

gas

GAS

GAS

Fire suppression and motor vehicle exhaust

indoor cooking in areas without adequate ventilatio

Colorless, odorless, and tasteless gas

Prevents oxygen binding with red blood cells

Inhaled Poison

Signs and SymptomsSigns and SymptomsDifficulty breathing ,Chest pain,Cough,Hoarseness,Dizziness,Headache,Confusion,Seizures,Altered mental status

Emergency medical careEmergency medical care

Follow the chart

Poisons taken in through unbroken skin:◦ Corrosives or irritants◦ Through bloodstream◦ Insecticides and chemicals

Absorbed Poisons

Signs and SymptomsSigns and SymptomsLiquid or powder on the patient’s skin,Burns,Itching,Irritation,Redness

Emergency medical careEmergency medical careSkin--remove contaminated clothing while protecting oneself from contamination

Powder--brush powder off patient, then continue as for other absorbed poisons.

Liquid--irrigate with clean water for at least 20 minutes

Eye--irrigate with clean water away from affected eye for at least 20 minutes

Powders—brush powder off. Liquids—irrigate with water for at least 20 min.

Toxic injection

Signs and SymptomsSigns and SymptomsWeakness,Dizziness,Chills,Fever,Nausea,Vomiting

Emergency medical careEmergency medical careAirway and oxygen

Be alert for vomiting.

Bring all containers, bottles labels, etc. of poison agents to receiving facility.

Alcohol and Substance Abuse

Emergency medical careEmergency medical care

Establish and maintain a patent airway;

Administer oxygen, as needed.

If the patient is responsive, try to get him to sit or lie on a stretcher.

Monitor the patient’s, mental status and vital signs frequently.

Try to maintain proper body temperature

Take measures to correct or prevent shock

Protect from self-injury,Stay alert for seizures

Transport

(cont.)

Perform an initial assessment.

Provide oxygen and assist ventilations, if needed.

Treat for shock.

Perform rapid trauma assessment.

Identify and treat life-threatening problems.

Do focused history and physical exam.

Assess baseline vital signs.

Consult Medical Direction.

Transport with all containers, bottles, and labels.

Perform ongoing assessment.

Indications:◦ Poisoning by mouth

Contraindications:◦ Altered mental status◦ Ingestion of acids or alkalis◦ Inability to swallow

Medication form◦ Pre-mixed in plastic bottle (12.5 grams)◦ Powdered form

Dosage◦ Adults and children: 1 gram/kg

Adult dose: 25–50 grams Pediatric dose: 12.5–25 grams

Actions:◦ Binds to certain poisons◦ Reduces absorption

Side effects:◦ Black stools◦ Vomiting (cont.)

Syrup of IpecacSyrup of Ipecac◦ Not so used◦ Reason for removal;

It is said that it takes too long to cause vomiting and it does not remove enough of the poison from the stomach.

◦ Indications - poisoning by mouth

Antidotes Antidotes

DrugsDrugs AntidotesAntidotes

Morphine NaloxoneBenzodiazepines FlumazenilBarbiturates TacrineAcetlycholine AtropineWarfarin Vitamin KIsoniazid Vitamin B6Insulin Dextrose or GlucagonParacetamol AcetylcysteineHeparin Protamine Sulphate