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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Drug Resources Nancy Clark, MEd, Director Medical Informatics Education Mark Strickland, MD, Informatics Curriculum Director, TLH Regional Campus

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY 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 its imprint or description Perform a drug interaction check Use an infectious disease/antibiotics guide Use an immunization schedule tool

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Not Covering Patient Education Handouts on drugs Drug News: recalls, dosing and delivery changes, safety issues, FDA approvals, etc. Research articles on clinical trials, drug toxicology, etc.

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Handouts Evaluations Drug References Handout Worksheet Instructions for email alerts Top 200 Drugs Prescribed 2008 www.rxlist.comwww.rxlist.com

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Medication Errors Adverse Drug Events (ADEs) rash drop dead ADEs due to inappropriate prescribing & pt noncompliance = 3-28% hospitalizations 30% of pts who suffer ADEs die or are disabled for > 6 months IOM: 98,000 deaths per year from medication errors in hospitals Cost of drug related morbidity and mortality in US estimated $1.56-$5.6 billion/yr

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Using the green Worksheet as we go thru the workshop, identify drug questions you can use with students.

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine New Library Webpage (Fall 2010) Summer 20107

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Library Web Site

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Subscription Drug Resources Epocrates Online or Essentials (web and PDA) Facts and Comparisons (web) PEPID (web and PDA) Access Medicines Drugs (Lexi Drug) (web) Harrisons 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 Prescribers Letter Medical Letter (Handout on how to get alerts)

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine PDA Drug Resources Epocrates Essentials PEPID Harrisons Practice Pediatric Care Online Dynamed Available free to all faculty

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Free Drug Resources Johns Hopkins Antibiotic Guide (Web) http://hopkins-abxguide.org http://hopkins-abxguide.org Shots (immunization schedules) (Web and PDA) http://www.immunizationed.org http://www.immunizationed.org CDC Travelers' Health http://wwwn.cdc.gov/travel/ http://wwwn.cdc.gov/travel/ Medscape (iPhone) Merck Medicus (PDR Library) (web and PDA) http://www.merckmedicus.com http://www.merckmedicus.com Drugs.com http://www.drugs.com/ http://www.drugs.com/ Toxnet (poisons and toxic agents) http://toxnet.nlm.nih.gov/ http://toxnet.nlm.nih.gov/

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Student Issues Taught generic names Preceptors/clerkship faculty use brand names Dont learn dosing in Pharmacology Do not understand abbreviations (PO, PRN, ) When do they learn how to write a prescription? 1 st Clerkship

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Who Has What?

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine EPOCRATES ESSENTIALS Rx Monographs OTC Monographs Alt Meds Monographs Drug Interaction Tool Drug Costs Dosage Calculator Formulary Tool Pill Identifier Antibiotics Guide Immunizations

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Epocrates Essentials iPhone/iPod Prescription, Alt Meds and OTC are combined in same list. Formulary Get Back Add to Favorites

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Epocrates Essentials Rx Search by drug or class Rx Alt OTC Compare sub- categories of each type

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Alt Meds OTC Rx Comparing Sub Categories Add to Favorites

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Dosage Calculator in Epocrates iPhone Online Dosage Calculator http://www.medcalc.com/pedidose.htmlhttp://www.medcalc.com/pedidose.html

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Exercises for Practice Using Epocrates PDA A little boy who is eight years old just ate a bottle of Childrens 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.

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Epocrates PDA MultiCheck 1. Type 2. Pick drug 3. Click + 4. Repeat until all drugs in list 5. Click View Interactions 6. Tap Interaction

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Exercises for Practice Epocrates PDA: lisinopril, metformin, and hydrochlorothiazide Peds example: isoniazid, rifampin, ethambutol, acetaminophen

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Epocrates Formularies Go to Epocrates.com Manage My Account Pick Formularies Sync/update to add

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY 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?

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Epocrates iPhone Pill Identifier

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Exercises for Practice What is this pill?

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Epocrates PDA ID Tool

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY 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)

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Tables

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine EPOCRATES ONLINE Rx, OTC and Alt Meds Rx Monographs OTC Monographs Alt Meds Monographs Drug Interaction Tool Drug Costs Dosage Calculator Formulary Tool Pill Identifier Antibiotics Guide Immunizations

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Browsing Epocrates ONLINE 1. Pick a letter 2. Pick drug

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine 2. Pick drug Search for a Drug 1. Type

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine 1. Pick category 2. Pick sub category 3. Pick drug Using Classes

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Prescription Drug Monographs 1. Pick category

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Dosage Calculator

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Alt Meds Monographs 1. Pick category

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine OTC Monographs

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY 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)

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Epocrates ONLINE Formulary 1. Pick formulary 2. Click to see meaning

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Epocrates ONLINE Formulary 1. Click Code 2. Under View Alternatives, click class Alternatives

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Finding Substitutes Codes

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY 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/http://www.fingertipformulary.com/ Cant vouch for accuracy Exercises for Practice

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Another Formulary Option

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Epocrates ONLINE MultiCheck Tool 2. Click drug Repeat until all drugs in list Interactions appear as found 1. Type

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Exercises for Practice Check for Interactions: digoxin, furosemide, lisinopril Peds example: isoniazid, rifampin, ethambutol, acetaminophen

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY 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.

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Epocrates Online Tables

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Epocrates Vaccinations

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY 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?

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine PEPID Rx Monographs OTC Monographs Alt Meds Monographs Drug Interaction Tool Drug Costs Dosage Calculator Formulary Tool Pill Identifier Antibiotics Guide Immunizations

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine PEPID Drug Information 1. Click on Dose

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine PEPID Drugs iPhone 1. Pick CRC

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY 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?

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine PEPID Interaction Tool

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Exercises for Practice digoxin, furosemide, lisinopril lisinopril, metformin, and hydrochlorothiazide Peds example: isoniazid, rifampin, ethambutol, acetaminophen

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Immunizationss

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine FACTS AND COMPARISONS Rx Monographs OTC Monographs Alt Meds Monographs Drug Interaction Tool Drug Costs Dosage Calculator Formulary Tool Pill Identifier Antibiotics Guide Immunizations

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine eFacts and Comparisons Detailed For pharmacists New interface Browse Resources

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Search eFacts & Comparisons 1. Type 2. Pick drug 3. Click Go

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY 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

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Classifications

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Tables in Facts and Comparisons

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY 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?

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine eFacts Drug Interactions Type in patients drugs, add Check list, add more if needed then click GO>>

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine eFacts Drug Interactions Click on Interaction to see monograph

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Exercises for Practice digoxin, furosemide, lisinopril lisinopril, metformin, and hydrochlorothiazide Peds example: isoniazid, rifampin, ethambutol, acetaminophen

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine eFacts Pill Identifier 1. Fill in and click Go 2. Click on underlined drug name

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine DYNAMED- EVIDENCE BASED Rx Monographs OTC Monographs Alt Meds Monographs Drug Interaction Tool Drug Costs Dosage Calculator Formulary Tool Pill Identifier Antibiotics Guide Immunizations

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine 1. Type & choose 2. Choose

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Choose category

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Dynamed New 1000 drug monographs Evidence-based Linked to disease content

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine MDCONSULT Rx Monographs OTC Monographs Alt Meds Monographs Drug Interaction Tool Drug Costs Dosage Calculator Formulary Tool Pill Identifier Antibiotics Guide Immunizations

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine MDConsult Drug Monographs Gold Standards Clinical Pharmacology Thorough By Indication, Contraindication and Adverse Reactions

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine ACCESS MEDICINE HARRISONS PRACTICE Rx Monographs OTC Monographs Alt Meds Monographs Drug Interaction Tool Drug Costs Dosage Calculator Formulary Tool Pill Identifier Antibiotics Guide Immunizations

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine LexiDrugs in Access Medicine Access Medicine Lexi Drug Content (Rx and OTC) Also in Harrisons Practice online and PDA

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine NATURAL MEDICINES DATABASE Rx Monographs OTC Monographs Alt Meds Monographs Drug Interaction Tool Drug Costs Dosage Calculator Formulary Tool Pill Identifier Antibiotics Guide Immunizations

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Natural Medicines Database

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Natural Medicines Effectiveness

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Interaction Checker

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine PEDIATRIC CARE ONLINE Rx Monographs OTC Monographs Alt Meds Monographs Drug Interaction Tool Drug Costs Dosage Calculator Formulary Tool Pill Identifier Antibiotics Guide Immunizations

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Pediatric Care Online Antimicrobial Therapy Guide Information by Diagnosis Agent Class

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY The College of Medicine Pediatric Care Online Interactive Periodicity Schedule includes Childhood Immunizations

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F LORIDA S TATE U NIVERSITY The College of Medicine F LORIDA S TATE U NIVERSITY 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)