Drug sources and information book

8/11/2019 Drug sources and information book

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Study Unit

Drug InformationSourcesReviewed By

Michelle Jones, Pharm.D.


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About the Reviewer

Michelle L. Jones, Pharm.D., received her Doctor of Pharmacy

degree from Philadelphia College of Pharmacy at the University of

the Sciences, Philadelphia, Pennsylvania. She has been an ambula-

tory staff pharmacist and pharmacy manager for many years.

Michelle also has experience in long-term care pharmacy. While atthe Philadelphia College of Pharmacy, Michelle tutored students

across a broad curriculum, including calculus, immunology, and

pharmacy calculations.


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This study unit describes the reference material most often

used by pharmacists and pharmacy technicians, who refer

to these sources of drug information to keep abreast of new

drugs, regulatory changes, professional news, and other

pertinent information.

Drug information sources and their delivery methods have

changed drastically in the past several years. Electronic

databases and technology such as handheld computers have

changed the way pharmacists, technicians, and other health-

care professionals access and review drug information. Most

drug information previously disseminated in book form is

now delivered electronically by means of CD-ROM or the

Internet. The sheer volume of information has increased

dramatically. Weve included many sources of information

most used by pharmacists and technicians, but this list is

far from exhaustive. Due to the rapid development in the

pharmaceutical industry and the new uses of drugs already

on the market, drug references are revised constantly. Web

addresses also change frequently. If you have difficulty

accessing a Web address, try looking for it by using an

Internet search engine such as Google, Dogpile, or Ask.

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When you complete this study unit, youll be

able to

Explain the main types of reference information and

their sources

Discuss various delivery methods of drug information

available to pharmacists and technicians

List various drug information sources that may be

required by law to be present in a pharmacy

Identify various journals and newsletters available to

pharmacists and technicians

Describe the most referenced sources of drug informa-

tion used in pharmacy practice

Remember to regularly check My Courses on your student homepage.

Your instructor may post additional resources that you can access to

enhance your learning experience.


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1

TYPES OF PROFESSIONALPHARMACY LITERATURE ANDDELIVERY METHODS

Professional Literature

Primary Sources

Primary resourcesare original sources of information. This

information is the most current data from recent research.

These sources often include raw statistics and unevaluated

information. A primary source typically includes information

written by researchers documenting their clinical trials and

scientific studies (Figure 1). For example, Medscapes journal

Pharmacotherapypublishes original research reports on drug

interaction studies, clinical trials, investigations of specific

pharmacological properties of drugs, and related topics.

In addition to print-based primary pharmaceutical literature,

MEDLINE (Medical Literature Analysis and Retrieval System

Online) is an international literature database of life sciences

and biomedical information. It covers the fields of medicine,

nursing, pharmacy, dentistry, veterinary medicine, andhealthcare. Youll learn more about how to access articles

contained in the MEDLINE database later in this study unit.

Drug Information Sources


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Drug Information Sources2

Secondary Sources

In general, secondary resourcesconsist of descriptions,

analyses, interpretations, and summaries of primary sources.

Secondary sources also include specialty textbooks written by

subject matter experts that are reviewed by peers. Secondary

sources are often indices and abstracts that glean and

summarize published information from technical sources. For

example, the American Pharmaceutical Review reviews busi-ness and technology for the pharmaceutical industry

throughout North America, covering topics such as drug

delivery, information technology, research and development,

equipment and facility manufacturing, and regulatory affairs.

FIGURE 1Documented

research statistics and results

are often presented in trade

journals.


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Drug Information Sources 3

Secondary sources often publish peer-reviewed articles in

journals such as The AAPS Journal, which is published by

the American Association of Pharmaceutical Scientists, or

The Journal of the American Pharmacists Association (JAPhA),

which is a peer-reviewed forum that includes original research

and experiences that link science to contemporary pharmacy

practice. Many secondary sources are available online and atuniversity and medical center libraries.

Tertiary Sources

Tertiary resources are references that are based on both

primary and secondary sources. Tertiary sources provide

summarized, condensed information for a quick reference

guide (Figure 2). MedlinePlus is an example of a tertiary

source of information that provides consumers with prescrip-

tion and over-the-counter (OTC) information in an easy-to-useonline format.

FIGURE 2MedlinePlus is a resource provided by the National Library of Medicine and the National

Institutes of Health.


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Delivery Methods

Journals and Newsletters

The world of pharmacy is changing constantly. New drugs are

being developed and marketed nearly every day. Community,

institutional, and mail-order/Internet pharmacies are using

computer software applications and automated technologies

that increase productivity and efficiency. Pharmacists and

pharmacy technicians can stay abreast of the latest develop-

ments in computer and automated technology as well as new

drugs and new uses for existing drugs by reading pharmacy

trade journals. Many journals related to pharmacy have free

versions available online.

Formularyis a peer-reviewed journal for P & T committee

members and those with drug management responsibilitiesat hospitals, HMOs and other managed care settings, PBM

companies, and within the VA (Veterans Affairs) system.

It covers formulary trends and practical information related

to evaluating drugs for the formulary and developing policies

and procedures for effective drug use.

Hospital Pharmacyis a peer-reviewed journal dedicated to the

promotion of safe medication practice and the prevention of

medication errors to optimize patient care provided by the

health-system pharmacist. It features drug and disease state

management, recent FDA approvals, medication error and

adverse-reaction reporting, automation, medical-usage

evaluation and governmental regulation related to practice in

hospitals, organized health systems, and nursing homes.

The American Journal of Health-System Pharmacy (AJHP) is a

semimonthly publication of the American Society of Health-

System Pharmacists. The AJHP provides reports on practice,

career development, and studies on drug therapy. A sub-

scription to the print version of AJHP and additional online

features are included as part of ASHP membership.

Pharmacy Timesprovides pharmacists and technicians with

practical everyday information related to patient education

and counseling, new products, pharmacy law, drug inter-

actions and safety, continuing education, and pharmacy news.


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Pharmacy Today is a monthly medication therapy manage-

ment (MTM) magazine of the American Pharmacists Association.

Regular features include new approvals of selected Rx and

OTC items, in-depth coverage of newly approved chemical

entities, and practical OTC information.

Drug Topicsis a bimonthly online news magazine covering

managed care trends, professional issues, national and state

governmental activities, new prescription drugs, and OTC

products, as well as retail management and store operations.

Drug Topicsalso includes health-system topics in the second

issue of each month. Drug Topicsalso has a helpful list of

online resources for pharmacists and technicians that

includes links to state, national, and international pharmacy

associations, pharmaceutical magazines, and government

and health agencies.

U.S. Pharmacist is a monthly journal offering peer-reviewedclinical articles concerning pharmacy practice in community,

hospital, managed-care, home-care, and long-term care

settings, as well as pharmacy industry and academia.

U.S. Pharmacistprovides information relevant to pharmacy

technicians, students, other health professionals interested

in health management.

Drug News Weeklydelivers information on new-drug

approvals, indications, warnings, doseforms, and Rx-to-OTC

status switches via e-mail. It also includes summaries of per-

tinent journal articles and reviews pharmacy news in the

popular press to help keep pharmacists and technicians

abreast of patient concerns and questions.

Pharmacy Choice Newsletteris delivered online and covers

industry headlines, disease-focused articles, and continuing

education opportunities.

Pharmacists Letteris a monthly newsletter that pharmacists

and other healthcare professionals can subscribe to. Its

available in print, via the Internet, and for use on PDAs. The

Pharmacists Letter began in 1985, and is characterized by

very short, concise updates and advice. This is an independent

publication, and therefore provides objective unbiased data

and advice related to drug therapy. Within each letter, topics

are usually separated by either disease state or therapeutic

class. Each topic provides concise information, usually in the


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form of a few short paragraphs. If you need more in-depth

information, each section gives reference to a Detail-Document,

that can be accessed online or mailed to the subscriber on

demand.

The Pharmacists Letteralso puts out the Pharmacy

Technicians Letter.This publication is in the same format as

the Pharmacists Letter, but provides reliable recommendations

and practical help for pharmacy technicians. Each month,

the newsletter contains the CE-in-the-Letter, which allows

the practitioner to earn continuing education credit based on

that months articles.

Subscribers of both newsletters also have access to other

articles that provide additional CE credits. Both the

Pharmacists Letterand the Pharmacy Technicians Letter

Web sites allow access to many useful tables and charts,

along with a section titled Rumor vs. Truth, which coversmany common rumors and myths surrounding drug therapy.

Subscribers to either publication may also have access to

the Ident-a-Drug Reference and the Natural Medicines

Comprehensive Database. The Natural Medicines

Comprehensive Database provides objective information

on effectiveness, uses, and potential drug interactions of

natural medicines, such as herbal supplements.

The Medical Letteris another newsletter-type resource for phar-

macists and other healthcare professionals. The Medical Letter

was founded in 1959, and is divided into two separate publica-

tions: The Medical Letter on Drugs and Therapeutics (known as

The Medical Letter) and Treatment Guidelines from the Medical

Letter (known as Treatment Guidelines).

The Medical Letteris published every other week as a four-page

newsletter. It offers unbiased critical evaluations of drugs

(especially new drugs), in terms of effectiveness, toxicity, cost,

and possible alternatives. The Medical Letteralso reviews older

drugs when theres important new information available. It

differs from the Pharmacists Letter in that it provides a bitmore detail with respect to clinical studies and their outcomes,

where the Pharmacists Lettermainly offers summaries.


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Treatment Guidelinesis published once a month in a newsletter

format. This publication offers review articles of drug classes

for treatment of common disorders. Issues contain recom-

mendations on first choice and alternative therapies for a

given condition, along with considerations for effectiveness,

cost, and safety.

Books

Several major drug information (DI)references have been in

print for many years. Although many are now available in

various electronic formats, most are still printed as either

hardbound books or loose-leaf pages to be kept in a binder.

The loose-leaf editions are often updated several times each

year. Textbooks are also a good source of reference material

and often have ancillary material available online from the

publisher. In addition, medical dictionaries, drug guides, andlanguage translations are useful additions to your bookshelf.

Many books related to drug information, pharmacy operations,

and legal issues are available at university and medical center

libraries (Figure 3).

FIGURE 3Most states require pharmacies to have certain professional

literature available, including applicable legal references.


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Desktop Computers

At one time, information was passed among pharmacists by

word of mouth or handwritten notes. For years, pharmacies

relied on volumes of books containing drug-related informa-

tion. Today, with so many drugs on the market and so much

material available about each drug, information is produced,

stored, and delivered by computer.

Pharmacies rely on software applications to view formularies,

drug monographs, and legal issues related to pharmacy. Staff

members can access this information on CD-ROMs or online

using desktop computers. Later in this study unit, youll

learn about many drug references that are delivered in print,

online, and by CD-ROM.

Personal Digital Assistants (PDAs)

Handheld and palm-sized computers, known as personal

digital assistants, or PDAsfor short, have become a main-

stay for the medical community. Theyre small, easy-to-use

computers that can store information and access the

Internet. Using PDAs, physicians and pharmacists can access

drug databases to instantly get current drug information,

such as warnings, drug/food interactions, side effects, and

dosing (Figure 4). Most drug information available in print is

also available electronically for PDAs.

Many software applications for drug formularies and drug

information are available from sources such as Epocrates,

Skyscape, Micromedex, and Lexi-Comp.


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FIGURE 4Many medical professionals rely on PDAs to access the most

current drug information available.

Health on the NetHONcode Accreditation

Whenever youre looking for drug information on the Internet, its important to make sure

youre getting accurate information. Many Web sites that at first appear to be giving good infor-

mation turn out to be nothing more than advertisements. One thing you can look for is the logo

from Health on the Net Foundation, or HON. HON was created for improving the quality of med-

ical and health information available to both patients and healthcare professionals. In order for

Web sites to be HONcode accredited, there are specific criteria that the Web site must meet and

maintain, including whether medical advice is being given by a medical professional. Becoming

HONcode accredited is a voluntary process, so not all Web sites will display the logo. However,

if you do see the logo, you can be sure that you are getting accurate, trustworthy information.


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Self-Check 1

At the end of each section of Drug Information Sources, youll be asked to pause and check

your understanding of what youve just read by completing a Self-Check exercise.

Answering these questions will help you review what youve studied so far. Please

complete Self-Check 1 now.

15: Indicate whether the following statements are True or False.

______ 1. Due to time constraints, desktop computers are rarely used by community pharmacists

and technicians to access drug information such as formularies.

______ 2. Epocrates provides drug-related software for PDAs.

______ 3. Pharmacy technicians can stay abreast of the latest computer applications and auto-

mated technology by reading journals and newsletters.

______ 4. Primary sources are often analyses of secondary sources.

______ 5. Drug Topics is a helpful weekly online magazine for pharmacists and technicians.

Check your answers with those on page 35.


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OFFICIAL COMPENDIAREQUIRED BY LAW INPHARMACIES

Introduction

There are several legal reference books commonly found in

any pharmacy in the United States. Which legal references

are required in pharmacies varies from state to state.

Pharmacists should check their states statutes and rules

and regulations for the specific compendia they need to

have on shelf to comply with the law. A compendium is a

condensed summary or list compiling information about a

particular field of knowledge.

There are no federal laws governing what professional

literature needs to be maintained in a pharmacy. However, as

you learned previously, OSHA requires that MSDS (Material

Safety Data Sheets) be kept on hand for chemicals used and

stored in the pharmacy.

In addition, you should always remember that the federal

government requires all pharmacies to adhere to HIPAA pri-

vacy standards as found in the HIPAA Privacy Standards: A

Compliance Manual for Pharmacies.

Lets look at the legal references available to pharmacies

concerning issues related to the manufacturing, handling,

and distribution of all drugs found in the pharmacy.

State Board of Pharmacy Law Book

Every state in the United States has a board of pharmacy to

oversee pharmacy practice and create laws to ensure public

safety. Every pharmacy is required to have a copy of the statelaw book, which usually contains the federal laws as well.

This reference lists all requirements for pharmacy technicians

practicing in that state.


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United States Pharmacopeia-National

Formulary (USP-NF)

In the past, the United States Pharmacopeia (USP)and the

National Formulary (NF)were separate books. However,

they were combined in 1980 to become The United States

Pharmacopeia-National Formulary (USP-NF).Today, the

USP-NF is available in print, on CD, and online at

www.usp.org.The U.S. Federal Food, Drug, and Cosmetic

Act designates the USP-NF as the official compendia for

drugs manufactured and marketed in the United States.

The USP-NF includes monographs for drug substances and

preparations, as well as monographs for dietary supplements

and ingredients (Figure 5).

Traditionally, the USP-NF was a required reference in every

pharmacy. Today, however, some states are allowing flexibilityin the selection of titles and available references to meet the

needs of individual practices.

FIGURE 5The USP-NF is available in an easy-to-navigate online presentation.


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United States Pharmacopeia

Dispensing Information (USP DI)

Some states allow The United States Pharmacopeia Dispensing

Information (USP DI)to be used in place of the USP-NF. The

USP DI is produced by Thomson Healthcare as three separate

bodies of work. Many states have adopted it as a required

reference in pharmacies.

The USP DI contains

DrugPoints, formerly the USP DI, Volume I, Drug

Information for the Health Care Professional

USP DI, Volume II, Advice for the Patient

USP DI, Volume III, Approved Drug Products and Legal

Requirements

DrugPoints provides comparable drug information to Drug

Information for the Health Care Professional, plus black box

warnings, images, and a new toxicology section. Primarily

used by healthcare professionals, DrugPoints includes

summary information on dosing, drug interactions, adverse

effects, pregnancy warnings, indications, cautions, therapeutic

classes, and brand information.

Advice for the Patient, the second USP DI volume, is intended

for patient education. The monographs are written in laylanguage to make them easy to understand. The material in

this section is available through MicroMedex Healthcare

Series or in print.

The United States Pharmacopeia Drug Information (USP DI)

Volume III: Approved Drug Products and Legal Requirements

contains the national standard for products made in the

United States as well as state and federal laws related to the

manufacturing and dispensing of medicines. Excerpts on

quality, packaging, storage, and labeling requirements are

included from the USP-NF. The USP DI Volume III contains the

complete FDA Orange Book. Pharmacists and technicians can

review a drugs chemical properties, find out if a drug has been

discontinued, and choose a generic substitute for a brand name

drug. The USP DI Volume III is a comprehensive source for

guidelines and laws governing the safe handling and distribu-

tion of drugs and is available only in print.

A black box warning

indicates that medical

studies have deter-

mined that the drug

carries a significant

risk of serious or even

life-threatening

adverse effects.


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Drug Formulary

As you learned previously, a drug formulary is a source of drug

information for ambulatory, institutional, and managed-care

organizations. It includes policies and procedures concerning

drugs, a list of drug products, and special information. Some

drug formularies are more comprehensive and include infor-mation on dosing, precautions, special drug substitutions,

dosage forms in stock, and side effects.

Formularies today are stored and viewed electronically via

desktop computers and handheld devices using formulary

software applications.


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Self-Check 2


______ 1. The USP-NF contains information on U.S. standards for drugs.

______ 2. A drug formulary is a list of drugs that have been deemed unacceptable for use by an

authoritative group.

______ 3. The second volume of the USP DI contains drug information as a patient reference.

______ 4. DrugPoints was formerly Volume III of the USP DI.



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COMMON DRUG INFORMATIONSOURCES

Introduction

A quick look on the Internet using a search engine will reveal

hundreds of sources of drug information. Here weve included

those sources most useful to the pharmacist and technician,

as well as a sample of sources meant to aid the consumer.

American Hospital Formulary Service

Drug Information (AHFS DI)

American Hospital Formulary Service Drug Information

(AHFS DI), produced by the American Society of Health

System Pharmacists, is an authoritative source of drug infor-

mation. It was first published in 1959 as the Big Red Book

and is still known by that name. Its monographs are grouped

by therapeutic category using the AHFS classification system.

They contain information on use, drug interactions, toxicity,

cautions, dosing, stability, pharmacology, andpharmaco-

kinetics, which is the study of the rate of movement of a drug

in a body system. Theres also a section on investigational

drugs that are not FDA-approved for use in the United States.

The AHSP also produces the AHFS Handbook, a concise guide

for pharmacists and pharmacy technicians.

AHSP is partnered with several formulary hosting services

that provide hospital pharmacists and technicians access to

the hospitals formulary as well as AHFS DI drug references

via a handheld device or desktop computer. Skyscapes

SmARTlink technology is one of several providers of electronic

access to AHFS DI. Refer to Figures 68 to view typical drug

information as you would while working in a pharmacy.Figure 6 shows the Skyscape trial versions table of contents

for AHFS DI material.


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Drug Facts & Comparisons

Drug Facts & Comparisonsis available in two print versions:one is bound and doesnt provide updates until the next edi-

tion; the other is a loose-leaf edition with monthly updates.

The book is organized by drug class, and it compares drugs

within the groups using text, charts, and tables. This source is

available in most pharmacies and is often consulted for brand

and generic name, dose, and use information. Facts and

comparisons are also provided for such items as IV solutions,

investigational chemotherapeutic drugs, and combination

cancer chemotherapy regimens. Most of the information is

the same as that found in package inserts, but its rearrangedin an easier-to-read format.

FIGURE 7Heres a

portion of the Uses for

Lovastatin in the AHFS DI

displayed via Skyscape.


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Drug Facts and Comparisons is available online and on CD.It contains a list of manufacturers, plus comprehensive infor-

mation on both Rx and OTC items grouped by therapeutic

category for ease of comparison. Drug Facts and Comparisons

also produces A2zDrugs(a drug guide with the latest FDA

approvals, indications, dosages, side effects, and patient care

considerations) and iFacts (information on drug interactions).

Also included with Drug Facts and Comparisonsis MedFacts

Patient Information, Review of Natural Products, Herbal

Interaction Facts, and Off-Label Drug Facts. You can see from

these various available sections that much information can be

gained from Drug Facts and Comparisons.The Web site also

includes a section on drug identification. Often, patients will

call the pharmacy asking to identify an unknown pill based on

shape, color, and markings. This program helps to identify pills

based on the information entered.

FIGURE 8Heres a

portion of the Lovastatin

Preparation section in

the AHFS DI displayed via

Skyscape.


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Handbook on Injectable Drugs

The Handbook on Injectable Drugs, produced by ASHP, provides

information on injectable medications in a collection of mono-

graphs. Each monograph contains information on

concentration, dosage, administration rates, stability, and

compatibility in various solutions or when combined withother drugs.

This reference is available on CD and for download to a PDA.

Its commonly found in hospital pharmacies, as well as other

settings where injectable drugs are prepared (such as home

IV services or community pharmacies). You may also hear

this reference referred to as Trissels, after the author

Lawrence A. Trissel.

King Guide to Parenteral AdmixturesThe King Guide to Parenteral Admixtures is available in hard

cover, loose-leaf editions updated quarterly and via the

Internet and CD, which can be used on an individual com-

puter or on a hospital-wide network (Figure 9). The King

FIGURE 9The King Guide to Parenteral Admixtures is available online.


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Guidefeatures more than 450 injectable drug monographs,

with information on the routes, dosages, temperatures, and

containers used to determine compatibility and stability.

Hansten and Horns Drug Interactions

Analysis and Management

Hansten and Horns Drug Interactions Analysis and

Management explains the possible drug interactions and

choices to consider for patients receiving a combination of

drugs. Each monograph contains a summary, risk factors,

related drugs, management options, and references. It pro-

vides information to reduce the risk to a patient by switching

medicines or watching the patient carefully. This work is

published in loose-leaf format thats updated quarterly and

also in a bound edition. Hansten and Horns Top 100 DrugInteractionscontains nearly 3400 interactions in 137 mono-

graphs and continues to list potentially important herb-drug

interactions.

Martindale: The Complete Drug

Reference

Travelers around the world bring unfamiliar medications and

remedies with them. Pharmacists in tourist and high-travel

areas often use Martindale: The Complete Drug Reference

published by the Pharmaceutical Press in London. This

comprehensive reference provides encyclopedic information

on 6300 drug monographs, 150,000 products, 14,700 manu-

facturers, 660 disease reviews, and 40,700 references. It

provides the best worldwide drug coverage including prepara-

tions used in 37 nations around the world. Providing extensive

information on drugs in clinical use worldwide, it provides

therapeutic data, synonyms, and manufacturer brand names.

The electronic version of Martindale: The Complete Drug

Referenceis available in English and Spanish by Thomson

Micromedex.


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Drug Information Handbook (DIH)

The Drug Information Handbook (DIH) by Lexi-Comp, Inc., is

published in cooperation with the American Pharmacists

Association (APhA). It contains over 1400 monographs,

including 30 new drugs and U.S. black box warnings.

Each monograph includes nearly 33 fields of information,with detailed content on dosage, drug interactions, and

adverse reactions. The appendix includes hundreds of charts

and reviews of therapy recommendations and treament guide-

lines. Lexi-Comp also publishes the Drug Information Handbook

with International Trade Names Index that includes Canadian

and international entries.

The Lexi-Comp line of databases is also available to sub-

scribers online (which well discuss later), on CD, and for

handheld PDAs. Many practitioners use the Lexi-Comp

software on their PDAs because its easy to navigate.

In addition to the geriatric and pediatric handbooks described

next, Lexi-Comp also produces handbooks on topics including

Oncology

Anesthesiology and critical care

Psychiatry

Allied health

Geriatric Dosage Handbook (GDH)

The Geriatric Dosage Handbook (GDH)by Lexi-Comp, contains

information for medications used for elderly patients. The

monographs give geriatric dosing information and monitoring.

It also cover side effects and provides specific considerations

when using drug therapy in older adults, which have been

compiled from current literature and clinical experience.

Pediatric Dosage Handbook (PDH)

The Pediatric Dosage Handbook (PDH) also by Lexi-Comp,

contains medications used in pediatric patients. Dosing infor-

mation is provided for ages from neonate to adult. The drug


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monographs are cross-indexed and arranged alphabetically

by brand and generic names. Tables, charts, graphs, and

recommendations are found at the back of the book. The

PDH is also updated annually.

The Merck ManualThe Merck Manual gives brief descriptions of disease conditions

and treatments and includes topics such as critical care

medicine, biological warfare and terrorism, SARS, and small-

pox. The primary users of this reference are physicians.

However, its also a very useful source for pharmacists who

want to better understand diseases and treatment. The Merck

Manuals are a series of healthcare books with content avail-

able online as part of the Merck Manuals Online Medical

Library, which is updated periodically with new information,

and contains photographs, and audio and video material not

present in the print versions. In addition, the Merck Index,

which contains more than 10,000 monographs, 32 supple-

mental tables, and a companion CD, is available online by

subscription.

American Drug Index

The American Drug Indexis an exhaustive alphabetical list

of generic, brand, and chemical names. Brand name listings

include the manufacturer, dosage form, package size, and

use. It includes common abbreviations used in medical

orders or prescriptions, conversion equivalents for dose cal-

culations, normal laboratory values, a glossary, a list of oral

dosage forms that shouldnt be crushed, and a list of pharma-

ceutical companies with NDC numbers and addresses. As you

learned previously, NDC numbers are unique 11-character

codes that numerically identify all prescription medicines. The

first five digits identify the manufacturer, the next four digits

identify the product (dosage form and strength), and the last


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two digits identify the package type or size (for example, 10 or

30 tablets). Updated annually, the latest American Drug Index

includes appendices on cancer chemotherapy regimens, as

well as new and discounted drugs.

Handbook of Nonprescription DrugsThe Handbook of Nonprescription Drugs: An Interactive Approach

to Self-Care, organized by body systems, provides information

on nonprescription drug pharmacotherapy, nutritional supple-

ments, medical foods, nondrug and preventive measures, and

complementary and alternative therapies. The handbook also

contains FDA pregnancy and lactation risk categories for

selected nonprescription products and herbs. The index lists

generic and trade names of nonprescription products and

dietary supplements. With purchase of the printed version,

buyers can download a fully seachable electronic version.

Physicians Desk Reference (PDR)

The Physicians Desk Reference (PDR)contains only informa-

tion that has been approved by the FDA, as found in the

product package inserts. This book is widely accepted in

healthcare fields, though it promotes only those products

selected for inclusion by the manufacturer. For this reason, its

important to note that the PDR isnt an exhaustive resource,

though many practitioners are under the misconception that it

is. Running more than 3,000 pages, it contains brand and

generic names, manufacturers, and product categories of

more than 4,000 drugs. In addition, it provides usage infor-

mation, warnings, and drug interactions. Thomson, the

publisher of the PDR line of products also offers a Concise

Guide for Pharmacists.There are several additional PDR prod-

ucts

covering topics such as

Herbal medicines

Terrorism response

Dietary supplements

Pediatrics


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Mental health

Opthalmic medicines

Drug interactions, side effects, and indications

Modells Drugs in Current Use and NewDrugs

Published for more than 50 years, Modells Drugs in Current

Use and New Drugs is an annually updated drug reference

that provides brief information on the years new drugs and

on medications in current use. The compact format makes it

an alternative to the large drug reference volumes. It includes

a glossary listing the common side effects of the drugs.

Modells gives special attention to new drugs with expanded

patient care implications for nurses and other allied health

professionals.

Clinical Pharmacology

Clinical Pharmacology, produced by Gold Standard, provides

current, peer-reviewed information on all U.S. prescription

drugs, as well as off-label uses and dosage, herbal supple-

ments, nutritional and over-the-counter products, and new

and investigational drugs. It includes monographs, overviewsof many therapeutic drug classes, customizable tables to

compare drugs by indications, contraindications, interactions,

and adverse reactions. It also provides patient medication

safety education with OBRA-compliant drug information

handouts in English or Spanish. Written specifically for the

electronic environment, Clinical Pharmacologyis available

online for desktop computers and PDAs. It can also be set up

to use via an intranet and is available on CD.


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Medical Drug Reference

The Medical Drug Referenceby Mosby includes pertinent drug

information for the most commonly dispensed drugsmore

than 850 generic and 2800 trade drugsincluding nonFDA-

approved uses. Comparative drug tables aid in the selection

of the best medicinal therapy for patients. A therapeutic indexhelps to quickly locate all potential therapies for a specific

condition. Software is included to provide access to the entire

reference on a PDA.

Red Book

Redbook: Pharmacys Fundamental Reference(referred to as

the Drug Topics Red Book) is produced by Medical Economics,

a division of Thomson Healthcare. The Red Book provides

nationally recognized average wholesale prices (AWPs), direct

prices, and federal upper limit prices for prescription drugs,

as well as suggested retail prices for OTC products. In addi-

tion, the Red Book lists NDC numbers for all FDA-approved

drugs and complete package information including dosage

form, route of administration, strength, and size.

Pharmacists and technicians can refer to the Red Book for

summaries of drug/food, drug/alcohol, and drug/tobacco

interactions, as well as sugar-free, alcohol-free, lactose- and

galactose-free, and sulfite-containing product listings.

The Red Book contains comprehensive manufacturer, pharma-

ceutical wholesaler, and third-party administrator directories.

Its vitamin comparison table shows the amounts of vitamins and

minerals in more than 50 popular multivitamin products.

The Red Book also contains a guide to leading alternative

medicines and a controlled substance inventory sheet.

The Red Book is available in a single annual print version, a

print version with monthly or quarterly updates, as well as

on CD. A subscription to the Redbook Update keeps youabreast of pricing changes on top-volume prescription and

OTC products.


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Micromedex Computerized Clinical

Information System (CCIS)

In addition to the products mentioned previously, Micromedex

has several electronic systems for the pharmacy, including

DRUGDEX, which covers FDA-approved and investiga-

tional prescription and nonprescription drugs, as well

as non-U.S. preparations. It includes dosage, cautions,

interactions, clinical applications, adverse effects, com-

parative efficacy, and orphan drug status.

Index Nominum, Micromedexs international guide to

drugs from 133 countries

Thomson Clinical Xpert, formerly mobileMICROMEDEX,

a PDA DI software

DRUG-REAX, an aid to identifying drug interactions and

minimizing adverse events

IV INDEX, which includes more than 50,000 compatibility

results and 600 drugs and solutions for IV infusions

Formulary Advisor, used to help manage a hospitals for-

mulary and provide access to formulary information

throughout a facility. Formulary Advisor is accessible via

desktop PCs and handheld computers.

IDENTIDEX, which helps with identifying unknown tablets

and capsules based on description.

Lexi-Comp ONLINE

In addition to the many print-based items weve discussed,

Lexi-Comp provides Lexi-Comp ONLINE, which provides real-

time drug information (including AHFS DI in hospital settings)

via a network system in both hospital and retail settings.

Lexi-Comp ONLINE includes

Lexi-Interact, which is a complete drug and herbal inter-

action analysis program


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Lexi-Drug ID, which allows for the identification of

unknown tablets or capsules

Web Search, which is a tool that allows Lexi-Comp

online users to search other medically based web sites

Patient Care Module, which allows the user to access

and print patient-focused information leaflets on condi-tions, procedures, and medications

I.V. Compatibility, which allows access to the King Guide

to Parenteral Admixtures homepage

Lexi-CALC, which is a comprehensive medical calculations

application

Package Inserts

The United States Package Insert, usually referred to as simply

thepackage insert, or PI, is a summary of a product and

contains the information needed to safely prescribe the med-

ication. The information found in the PI has been reviewed by

the FDA. A copy of the PI comes with every package of the

product. It provides general information on dosing, use, side

effects, precautions, pharmacology, mechanism of action (how

it works), contraindications, and warnings.

One drawback of the PI is that although products can be pre-

scribed for other uses, the PI reflects only uses and doses

approved by the FDA. However, information to support these

uses is often available in other sources. Many pharmacists

would like to see a real-time electronic package insert (ePI)

orprescribing information (PI) that would reflect the most

current information available from the manufacturer.

Manufacturers Advertising

The pharmaceutical industry advertises to increase awarenessof its products. Advertising can take many forms, from a

national television commercial to print ads in weekly consumer

magazines, daily newspapers, and professional journals.


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In addition, drug companies often devote entire Web sites

to marketing the individual drugs they produce. All claims

made in advertisements must be supported with data. Many

U.S. drug companies also have sister Web sites for drugs

they produce that are sold outside the United States.

Drug sites are often designed with a dual format: one for the

health professional and one for the patient or caregiver.

Pharmacists and technicians can get detailedprescribing

information (PI) as provided in the package insert. Lets look

again at Lescol XL, the cholesterol-lowering drug whose pack-

age insert is shown in Figure 10. Norvartis, the manufacturer of

Lescol XL, has developed a Web site that provides information

for both the patient and the healthcare professional (Figure 10).

FIGURE 10Pharmacists and technicians can access prescribing information on the Lescol XL Web site.


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NOTES


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PubMed

Earlier, we discussed primary sources of information. One

such primary source that includes pharmacy information is

MEDLINE. Compiled by the U.S. National Library of Medicine

(NLM), MEDLINE is available on the Internet and searchable

via PubMed. Its offered by the NLM at the National Institutesof Health as part of the Entrez information retrieval system.

It gives access to more than 5,000 journals published in the

United States and more than 80 other countries primarily

from 1950 to the present. NLM provides and maintains this

Web site for public use and regularly processes data files

uploaded from the FDAs system. Additional information

about medicines is available on NLMs MedlinePlus Web site.

You can also try PubMed Reader/MEDLINE Reader, which

is a free Web-based research program thats used to display

PubMed/MEDLINE search results on an individual basis.

AHFS Consumer Medication

Information

AHFS Consumer Medication Information is a software pack-

age for patient drug information education produced by the

ASHP. It helps pharmacists give accurate information and

advice to patients by allowing pharmacists to customize

more than 800 monographs in English and Spanish in

easy-to-understand language. The software is available in

single-user and network versions.

Patient Drug Facts

Patient Drug Factsis a professionals guide to face-to-face

patient counseling. It covers the most commonly prescribed

drugs listed by generic and brand name, organized by thera-

peutic category. It includes easy-to-understand discussionson drug usage, precautions, side effects, and food and drug

interactions. Its purpose is to aid the pharmacist or health-

care professional in communicating important drug

information to patients.



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DrugDigest

DrugDigest is a drug information site for consumers. It reviews

drugs, vitamins, herbs, and supplements. It also provides

drug images and instructions on using medications correctly.

DrugDigest is offered by Express Scripts, a pharmacy benefit

manager for employers, managed-care plans, unions, andgovernment entities.

RxList

RxList.com is owned and operated by WebMD and is part of

the WebMD network. RxList is an online medical resource

that offers detailed and current pharmaceutical information

on brand and generic drugs. RxList information on medica-

tions can be found using the Drugs AZ list (an alphabetical

listing of both brand and generic drug names) or by entering

the generic or brand drug name in the sites search box.

RxList also lists the top 200 dispensed drugs, new drugs, and

recent drug updates, as well as relevant articles written by

pharmacists and physicians. It also has a pill identifier sec-

tion and a section on diseases and conditions provided by

eMedicineHealth.

Drugs.com

Drugs.com is the a popular Web site for both consumers and

professionals. It provides information on more than 24,000

prescription drugs and over-the-counter medicines. Users

can search for drugs and medications, as well as diseases or

conditions and the drugs used to treat them. Drug.com also

presents pharmaceutical news, FDA updates, and new drug

applications and approvals. Other features include a drug

interactions checker, medical encylopedia, medical dictionary,

and community forums.


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Self-Check 3


______ 1. The PDR provides complete drug information for all products available in the United

States.

______ 2. The Handbook on Injectable Drugs is used to find information on drug stability and

administration rates for products given intravenously.

______ 3. The Merck Manual gives information concerning diseases and treatments.

______ 4. MEDLINE is a database produced by the National Library of Medicine.

______ 5. DRUGDEX is a module developed by Micromedex thats used to look up information to

treat poisonings.

______ 6. Pharmaceutical companies generally dont need to advertise their products.



40/40

Answ

e

rs

An

sw

e

rs

Self-Check 1

1. False

2. True3. True

4. False

5. False

Self-Check 2

1. True

2. False

3. True

4. False

Self-Check 3

1. False

2. True

3. True

4. True

5. False

6. False

Documents

Drug sources and information book