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Amy Chatfield, MLS Norris Medical Library [email protected] Objectives Identify preliminary and ultimate questions Classify questions to aid retrieval in information resources Differentiate between primary, secondary, and tertiary resources Identify five major resources to answer questions on drugs Identify major resources to locate guidelines and patient education materials Pharmacy and Information Information-heavy profession Information resources available to pharmacy students: Textbooks Reference Books Journal articles Databases Web pages Clinical guidelines Patient information Government-produced web pages Abstracting sources The Ultimate Question The actual question for which you are seeking an answer UQ Scenario This patient is taking fosamax and Tums. Does that seem curious or unusual to you? Your preceptor Questions! What is fosamax used for? How is fosamax administered? Is fosamax a brand name or a generic? How is fosamax absorbed by the body? What is Tums? What chemicals constitute Tums? How does Tums work? Ultimate question UQ Are there known interactions between alendronate and calcium carbonate? Other questions: preliminary questions which permit us to create the ultimate question. You may need to answer multiple preliminary questions before you can start answering the ultimate questionespecially when new to a profession Categorizing questions Adverse effects Availability Compatibility/stability Compounding Dosing/administration Drug interaction Herbal Identification Nomenclature Pharmacokinetics Pharmacology Poisoning/toxicology Pregnancy/lactation Therapeutic use Categorizing questions What is fosamax used for? How is fosamax administered? Is fosamax a brand name or a generic? How is fosamax absorbed by the body? Therapeutic Use Dosing/administration Nomenclature Pharmacokinetics Categorizing your questions makes it easier to find information to answer each question Three Types of Resources: Primary Secondary Tertiary Primary Resources Original research articles Many kinds of study designs Clinical trials Cohort studies Conference Papers/Posters Dissertations Patents Advantages of primary sources: Current information May be only source of info on a new drug Narrow in scope Disadvantages of primary sources: Limited in scope Complex, hard to interpret Secondary Resources Review articles Literature reviews Meta-analyses Guidelines Indexing sources Abstracting sources Secondary Resources Literature Reviews Advantages: Many primary resources consulted to write 1 article Disadvantages: Need to examine sources included closely Potential for bias in selection Secondary Resources Meta-Analyses Advantages: Many primary resources consulted to write 1 article All relevant studies must be included Disadvantages: Can only be created when a critical mass of primary studies are available Secondary Resources Guidelines Advantages: Many primary resources consulted to write 1 guideline Functionally oriented for clinical work (bullet points, not narrative) Disadvantages: Can only be created when a critical mass of primary studies are available Secondary Resources Indexing sources PubMed@USC International Pharmaceutical Abstracts Abstracting sources FDA’s MedWatch Advantages: Indexing sources create computerized records with additional information to make primary sources easier to find Abstracting services provide upto-date information Disadvantages: Need to pay for access (for most) Don’t include full-text of the primary source Tertiary Resources Textbooks Handbooks Drug Compendia Reference books Hint: Pro pharmacists consult two or more tertiary resources to check their answer! Advantages of tertiary sources: Comprehensive information from a variety of sources Citations to primary and secondary sources Fast, easy to use Disadvantages of tertiary sources: Older, less current information Not sure if authors looked at the “right” sources Which ones do I use? Consult in backwards order! Tertiary Secondary Primary Tertiary resources when: The answer to a question is basic factual knowledge in the field The question was studied extensively and a conclusion was made Many experts have addressed the question and agree on answer Secondary and primary resources when: A question is new and has never been studied There is no consensus among experts; various opinions abound There is conflicting evidence and the question needs further study Resource Categories v Question Categories Many tertiary resources include these categories as chapter titles or section titles Secondary sources use these categories when they index primary sources Lexi-Comp Question categories Adverse effects Availability Compatibility/stability Compounding Dosing/administration Drug interaction Herbal Identification Nomenclature Pharmacokinetics Pharmacology Poisoning/toxicology Pregnancy/lactation Therapeutic use Table of Contents Resource Categories v Question Categories Many tertiary resources include these categories as chapter titles or section titles Secondary sources use these categories when they index primary sources Question categories Adverse effects Availability Compatibility/stability Compounding Dosing/administration Drug interaction Herbal Identification Nomenclature Pharmacokinetics Pharmacology Poisoning/toxicology Pregnancy/lactation Therapeutic use Micromedex PubMed@USC Tertiary Resources Epocrates Drug Facts & Comparisons Lexi-Comp Micromedex Clinical Pharmacology Things to think about when you use tertiary resources: Availability of the resource “Extra features” vary How is it created, who creates it, and how frequently is it updated? Student Portal Links to all resources on pharmacy student year 1 portal page http://norris.usc.libguides.com/pharmyr1 Drug Information tab Drug Facts and Comparisons Pocket Version Online is ABRIDGED version of print Print copy available in Norris How is it created? -Team of Pharm Ds and MDs -Monitor primary literature and clinical guidelines -Updated annually/once a year -Most frequently used drugs in American hospitals are included in the online version Let’s search for Ambien Drug Facts and Comparisons Browse by category Includes most popular drugs used in US Functional, aimed at the practicing clinician ePocrates Online Premium Two versions available: ePocrates Online Premium- via computer ePocrates: FREE version to download onto your PDA Free version provides less detailed information How is it created? - Team of Pharm Ds and MDs - Monitor primary literature, clinical guidelines, manufacturer labels, and FDA drug safety alerts - Updated weekly (more frequently if safety problems are identified) Let’s search for Proventil ePocrates Online Premium Browse feature Includes drugs and herbals Patient education material, English and Spanish Pictures Downloadable version for PDA Lexi-Comp Includes several sources of drug monographs How is it created? -Lexi-Drugs: Two in-house teams: one monitors FDA drug safety alerts and manufacturer labels, the second monitors primary literature and guidelines -All material vetted by editorial team comprised of Pharm Ds, MDs, PhDs, and DDSs -Updated weekly (more frequently if safety problems are identified) Let’s search for Zoloft Lexi-Comp Audio Pronunciation Patient education materials Pearls and related info section cites guidelines Micromedex FREE version to download to your PDA or mobile device Includes PoisonDEX and Clinical Points modules with additional information How is it created? -“Team of experts” who review primary literature - Update schedule - ?? Let’s search for Aricept Micromedex Patient education materials Photos Foreign brand names Free download onto PDA Clinical Pharmacology ONLY for School of Pharmacy How is it created? - Team of editors, Pharm Ds, and MDs - Monitor primary literature, clinical guidelines, textbooks, other tertiary sources, trade magazines from the pharmacy industry, major abstracting sources. - Every monograph reviewed annually (at a minimum) - Includes dates of update in each section Let’s search for Zyrtec Clinical Pharmacology Global trade names Chemical structure drawings Interactions- sort by severity How Supplied– photos, plus full formulation details (active and inactive ingredients) Patient Education- English and Spanish Additional features! Reports- drug interactions, adverse reactions, more Find/List- by criteria; CAM, investigational monographs; access MedGuides Includes monographs on vaccines Guidelines Gather primary and secondary literature Analyze, assess literature Outline “best practices” for any aspect of clinical work (diagnosis, prevention, screening, treatment, etc.) Write as steps or bullet points Made for all health care professionals May need to broaden search: beyond simply a drug name Guidelines Guidelines are produced by groups of health care professionals Professional organizations, nonprofit organizations, government groups: coordinate the writing of guidelines Guidelines Guidelines can be referenced in drug monographs Centers for Disease Control and Prevention (CDC) American Pharmacists’ Association Pharmacists’ Letter National Guidelines Clearinghouse: Guideline.gov (part of AHRQ) EpSS- Electronic Preventive Services Selector (AHRQcreated) Takeaways The Big Picture: USC subscribes to a variety of information resources to help you answer questions about drugs and pharmacy practices Basics today: ○ Identify preliminary and ultimate questions ○ Classify questions to make retrieval easier ○ Using tertiary resources to answer questions Takeaways All the tertiary resources we used today are linked on your Blackboard site and on the Year 1 Pharmacy student portal You will have assignments that require you to use and cite information resources Wikipedia Free websites found through Google Questions? Contact us! Contact Norris Library reference service [email protected] 323- 442-1111 (M-F, 9-5) Contact Amy Chatfield, pharmacy liaison librarian [email protected] 323-442-1128