Chapter 3: Drug and Health Information Resources

A. B. C. D. E. Tertiary Literature Secondary Literature Primary Literature Alternative Sources of Drug Information Introduction to Biomedical Literature and Evaluation

To be an efficient drug information provider, an understanding of the different kinds of resources available is necessary. When information is needed, resources need to be prioritized on the basis of their likelihood for containing the requested information. This process will then require knowledge of the content of the resources, as well as proficiency in searching the resource. A. Tertiary Literature aka general literature consulted first most commonly used sources of information because they are easy to use, convenient, concise, and compact majority of the information needed by practitioners can be found in these sources Types: Textbooks eg. The Pharmacological Basis of Therapeutics Compendia eg. Drug Facts and Comparisons, USP Fulltext computer databases eg. Drug Interaction Facts on Disk Review articlesa review of the literature is provided by an expert in the field 1. Contents and Quality answers to simple questions such as those pertaining to availability of dosage strengths and forms, active ingredients, FDA-approved indications may provide drug information in lay language

2. Availability and Limitations Availability: readily available; provides rapid access to information; are available in many formats such as hard copy, microfiche and computerized/electronic versions. Electronic forms are preferable because they are easy to use, allow easy access and provide the capability to search multiple resources at the same time. Disadvantages/Limitations: a. may not be complete topics may be presented in insufficient detail because of textbook space limitations or the degree of importance placed on the topic by the author; authors may conduct incomplete literature searches before writing a textbook, thus failing to include all pertinent information on a topic b. information may not be timely new textbooks may be several years out of date because of the lag time that occurs from the time the book is written until publication/release date; because standards of medical practice may change during this lag time, a new textbook may not contain all of the relevant information in a field=may not reflect current standards of practice c. various other problems may exist in literature such as human bias, incorrect interpretation of research (leading to inaccuracy), and lack of expertise by the author

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Examples a. Physicians Desk Reference (PDR) a compilation of package inserts for prescription drug products from pharmaceutical manufacturers. Contains lists of both active and inactive ingredients for some products. Available in hard copy and CD-ROM.Updated annually. b. DRUGDEX system (under Micromedex) a well-referenced drug resource in monograph format. It also contains a drug consult section that provides responses to drug information questions written by drug information specialists. Available on microfiche, CD-Rom and Network systems. Updated quarterly. c. Handbook of extemporaneous Compounding a manual of formulas commonly used for prescription compounding. d. Meylers Side Effects of Drugs the most comprehensive resource for information on adverse reactions associated with drug therapy. Extremely well-referenced and published every four years. e. Drug Interaction Facts a resource for drug-drug and drug-food interactions. Well-referenced, providing details on mechanisms, clinical significance and management of drug interactions. One of the clearest and easiest publications to use. Updated quarterly; also available as a computer program.

**Review articles analyze, assess and evaluate primary literature (eg. 2 or more studies about a certain topic) provide a summary of many primary research studies allowing rapid access to large quantities of information; may pertain to clinical information or topics related to pharmacy administration purpose is to determine the truth among conflicting and variable primary literature are generally considered tertiary/general literature because they provide much the same information as found in textbooks but are sometimes used like secondary references because they contain extensive bibliographies. have to be unbiased and objective because poorly written articles may be misleading and may result in inappropriate responses to drug inquiries Two types: f. General overviews may contain subjective opinions g. Meta-analyses apply statistical techniques to combine the results of a collection of studies often considered superior for reviewing a topic because a systematic, quantitative approach is used to analyze the primary literature B. Secondary Literature 1. Contents and quality

provide access to primary literature; contain information about primary resources consists of indexing and abstract services of primary literature sources *Indexing services provide only bibliographic information (eg. author, title, issue of publication for journals, publisher, date of publication) indexed by topic *Abstracting services provide a brief description (abstract) of information contained in a specific citation 2. Availability and Limitations Availability: hard copies electronic format: may be provided in CD formats or online access (for a fee); more preferable because it is easier to use Disadvantages/Limitations: may be expensive, thus difficult to access 3. Examples a. Clinical Abstracts/Current Therapeutic Findings (CA/CTF) a newsletter that abstracts international literature pertaining to pharmacotherapy, drug comparisons, drug interactions, factors influencing drug action and adverse effects. Published monthly. b. MEDLINE one of the most expansive databases of biomedical information containing approximately 370,000 references. Citations from 1966 to the present can be searched for approximately 3,500 journals. Available in CDROM or via online services and various other formats. c. Reactions an indexing and abstracting service that summarizes current literature on adverse drug reactions, drug dependence and toxicology. Available in newsletter, CD-ROM and online formats. Published weekly. d. InPharma an indexing and abstracting service that summarizes current literature related to pharmacotherapy. Available in newsletter, CD-ROM and online systems. Published Weekly. e. International Pharmaceutical Abstracts The most complete abstracting service for international information relevant to pharmacy and pharmaceutical sciences. Most other systems cover only a limited amount of the pharmacy literature, whereas the philosophy of this system is to cover all pharmacy periodicals, domestic and international. Provides access to both journal articles and abstracts. Available in index and CD-ROM formats and via online services. Published semi-monthly. C. Primary Literature consists of research studies published in biomedical journals and is usually the most current resource for information 1. Contents and quality provides details of research methodology and scientific results that lead to therapeutic conclusions (unlike tertiary or secondary resources) allows users to determine whether the study conclusions are reliable based on the strength of the research techniques and the scientific results of the study. 2. Availability and Limitations

Availability: May be accessed via purchasing or subscription to journals, and also via the internet. Disadvantages/Limitations: may be expensive; usually published in technical language which includes medical terms that may not be understood by nonspecialists 3. Examples a. American Journal of Health System Pharmacy A journal focused on clinical and managerial aspects of pharmacy practice in health systems. Previously known as the American Journal of Hospital Pharmacy and incorporates the contents of a previously published journal known as Clinical Pharmacy. Published semi-monthly. b. Clinical Drug Investigation A journal that publishes primary literature related to pharmacoeconomic and outcomes research. Published monthly. c. Therapeutic Drug Monitoring A journal devoted to therapeutic drug monitoring and clinical drug toxicology. d. Drug Investigation A journal focused on drug research in animals and humans conducted during all phases of drug development including pharmacological, toxicological, and clinical studies. e. The Journal of the National Cancer Institute A journal that publishes news, information, and research pertaining to cancer treatment, prevention and control.

D. Alternative Sources of Drug Information In situations wherein drug information inquiries cannot be answered using tertiary, secondary or primary resources, the pharmacist has to turn to alternative sources of information. 1. Electronic Bulletin Boards several pharmacy organizations have developed electronic bulletin boards through online computers. These bulletin boards allow practitioners to communicate with and ask questions from each other. Disadvantage: success with these systems tends to be hit or miss depending on the practitioners online or participation around the time the question is asked. *Examples of Pharmacy-oriented bulletin boards: a. ClinNet Source: American College of Clinical Pharmacy (access is for ACCP members only) b. FDA Source: Food and Drug Administration (anyone can access; annual subscription fee) c. Helix Source: St. Louis College of Pharmacy (Anyone can access, supported by Glaxo) d. Pharmnet American Society of Health-System Pharmacists (For ASHP members only) 2. Internet sources: a. World Wide Web servers computers connected to the internet that provide a graphical interface to a variety of information available as text, pictures, databases and other electronic files, which users access via web browsers.

one of the major sources of information; is now becoming a valuable source of information as technology for accessing the internet improves and more users become proficient in its use contains information from several government agencies as well as other resources form various consumer and professional organizations may allow access to the most up-to date information available *Examples of Websites that may be valuable resources for pharmaceutical information: i-National Library of Medicine Website (www.nlm.nih.gov) ii-Food and Drug Administrations Website (www.fda.gov) iii-World Health Organizations Website (www.who.ch) iv-Centers for Disease Control and Prevention (www.cdc.gov) b. List servers computers/servers which automatically send information to a users e-mail account. The information can either be specifically requested (eg. data files) or can be information from a discussion group (wherein individuals send messages to the list server and that server relays the messages to all subscribers). This allows people to simply read or even participate in a discussion that will occur over a matter of hours or days with individuals scattered all over the world. c. USENet News similar to bulletin boards and list servers; contains thousands of discussion groups on a variety of topics (from the most serious to the absurd) Information is relayed over the Internet to various computers where users can read and contribute to the discussions. The newsgroup of most interest to pharmacists is sci.med.pharmacy. 3. Telnet and FTP programs a. Telnet application/protocol used to connect to remote computers. An application which turns a computer into a terminal that can access and use information on remote computers. Related to drug information, this function can be useful to access the electronic card catalogs of various libraries. For example, from home, you can use your telnet application to connect from your computer to one of your school's servers. Once you established your connection, you would then log in with your account information and execute commands remotely on that computer. b. FTP (File Transfer Protocol) the protocol for exchanging files over the Internet; programs which allow transfer of files from remote computer systems to the users computer system. Commonly, a web-browser is used to access an FTP site. FTP works in the same way as HTTP for transferring Web pages from a server to a user's browser. 4. Local and National Professional Organizations are also useful sources of information, especially for identifying individuals who can assist in answering an inquiry. National organizations are helpful in answering questions relevant to the organizations focus. They are often good resources for information on investigational drugs and alternative medications. (eg. Philippine Tuberculosis Society, Philippine Cancer Society, BFAD, etc.)

 may also be able to provide referrals and provide names of individuals practicing in specific areas 5. Pharmaceutical manufacturers may be a valuable source of information since many pharmaceutical manufacturers have drug information departments or individuals dedicated to answering drug information questions and toll-free numbers. Often have access to unpublished information such as clinical and stability data and awareness of ongoing research related to their drug products. May also have information on investigational drugs 6. Drug Information and Poison Control Centers useful in community settings where time for answering inquiries is minimal or in institutional settings where a drug information center may not exist. Some of these centers may charge a minimal fee for provision of their services Poison control centers are focused on responding to toxicity questions in emergency situations, however, these centers also respond to nonemergency inquiries. These centers may have knowledge of treatment of toxicities, trends in drug abuse, etc., and are also an excellent source for drug identification. E. Introduction to Biomedical Literature and Evaluation