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



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



Handouts

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

Top 200 Drugs Prescribed 2008 www.rxlist.com

http://www.rxlist.com/



Using the green Worksheetas we go thru the workshop,

identify drug questions you can use with students.



New Library Webpage (Fall 2010)

Summer 2010 7



Library Web Site



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)



PDA Drug Resources

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

Available free to all faculty



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



Who Has What?



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



Epocrates Essentials iPhone/iPod

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

Formulary

Get Back

Add to Favorites



Epocrates Essentials Rx

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

• Compare sub-categories of each type



Alt Meds OTCRx

Comparing Sub Categories

Add to Favorites



Dosage Calculator in Epocrates iPhone

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

http://www.medcalc.com/pedidose.html



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.



Epocrates PDA MultiCheck1. Type

2. Pick drug

3. Clic

k +

4. Repeat until all drugs in list

5. Click View Interactions

6. Tap Interaction




• Epocrates PDA: lisinopril, metformin, and hydrochlorothiazide

• Peds example: isoniazid, rifampin, ethambutol, acetaminophen



Epocrates Formularies

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



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?



Epocrates iPhone Pill Identifier




• What is this pill?



Epocrates PDA ID Tool



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)



Tables



EPOCRATES ONLINE

Rx, OTC and Alt Meds

P Rx Monographs

P OTC Monographs



P Drug Costs

P Dosage Calculator

P Formulary Tool

P Pill Identifier

P Antibiotics Guide

P Immunizations



Browsing Epocrates ONLINE

1. Pick a lette

r

2. Pick drug



2. Pick drug

Search for a Drug

1. Type



1. Pick category

2. Pick sub category

3. Pick drug

Using Classes



Prescription Drug Monographs

1. Pick category



Dosage Calculator



Alt Meds Monographs

1. Pick category



OTC Monographs




• 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)



Epocrates ONLINE Formulary

1. Pick formulary

2. Click to see meaning



Epocrates ONLINE Formulary

1. Click Code

2. Under View Alternatives, click class

Alternatives



Finding Substitutes

Codes



• 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


http://www.fingertipformulary.com/





Another Formulary Option



Epocrates ONLINE MultiCheck Tool

2. Click drug

Repeat until all drugs in list

Interactions appear as found

1. Type




• Check for Interactions: digoxin, furosemide, lisinopril

• Peds example: isoniazid, rifampin, ethambutol, acetaminophen



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.



Epocrates Online Tables



Epocrates Vaccinations




• 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?



PEPID

P Rx Monographs

P OTC Monographs



P Drug Costs

P Dosage Calculator

Formulary Tool

Pill Identifier

Antibiotics Guide

P Immunizations



PEPID Drug Information

1. Click on Dose



PEPID Drugs iPhone

1. Pick CRC




• 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?



PEPID Interaction Tool




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

hydrochlorothiazide • Peds example: isoniazid, rifampin,

ethambutol, acetaminophen



Immunizationss



FACTS ANDCOMPARISONS

P Rx Monographs

P OTC Monographs



P Drug Costs

Dosage Calculator

Formulary Tool

P Pill Identifier

Antibiotics Guide

P Immunizations



eFacts and Comparisons

• Detailed• For pharmacists• New interface

Browse Resources



Search eFacts & Comparisons

1. Type

2. Pick drug

3. Click Go



eFacts & Comparisons Online

• Monograph in Drug Facts and Comparisons will come up

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



Classifications



Tables in Facts and Comparisons




• 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?



eFacts Drug Interactions

Type in patient’s drugs, add

Check list, add more if needed

then click GO>>



eFacts Drug Interactions

Click on Interaction to see monograph




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

hydrochlorothiazide • Peds example: isoniazid, rifampin,

ethambutol, acetaminophen



eFacts Pill Identifier

1. Fill in and click Go

2. Click on underlined drug name



DYNAMED- EVIDENCE BASED

P Rx Monographs

P OTC Monographs


Drug Interaction Tool

P Drug Costs

Dosage Calculator

Formulary Tool

Pill Identifier

Antibiotics Guide

Immunizations



1. Type & choose

2. Choose



Choose category



Dynamed

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



MDCONSULT

P Rx Monographs

P OTC Monographs



Drug Costs

Dosage Calculator

Formulary Tool

Pill Identifier

Antibiotics Guide

Immunizations



MDConsult Drug Monographs

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

Adverse Reactions



ACCESS MEDICINEHARRISON’S PRACTICE

P Rx Monographs

P OTC Monographs

Alt Meds Monographs


Drug Costs

Dosage Calculator

Formulary Tool

Pill Identifier

Antibiotics Guide

Immunizations



LexiDrugs in Access Medicine

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



NATURAL MEDICINESDATABASE

Rx Monographs

OTC Monographs



Drug Costs

Dosage Calculator

Formulary Tool

Pill Identifier

Antibiotics Guide

Immunizations



Natural Medicines Database



Natural Medicines Effectiveness



Interaction Checker



PEDIATRIC CAREONLINE

Rx Monographs

OTC Monographs

Alt Meds Monographs


Drug Costs

Dosage Calculator

Formulary Tool

Pill Identifier

P Antibiotics Guide

Immunizations



Pediatric Care Online

• Antimicrobial Therapy Guide• Information by

• Diagnosis• Agent • Class



Pediatric Care Online

Interactive Periodicity Schedule includes Childhood Immunizations



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…)

drug resources

Documents

drug dosage

drug toxicology

drug questions

drug information resources

care drug references

drug interaction check

herbal drug information

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