tertiary resource

Tertiary Resource 1

Tertiary Resource 2

Introduction

Drug Information Resources

Objectives:1. Describe the attributes and the differences

between tertiary, secondary and primary resources

2. Identify the most appropriate resources for a given drug information inquiry and use them effectively.

3. Recognize that primary, secondary and tertiary resources may be available in hard copy, CD-ROM, ON-LINE and/or other Format.

4. Describe how to search computerized data bases.

Tertiary Resource 3

Introduction professional literatures

Tertiary Resource 4

Introduction Primary Resources

They are the research studies published in biomedical journals. It is the most current information about drugs. It is not easy job to use journals to answer a drug related question because of its huge growing number (>20000 biomedical journals available)

Tertiary Resource 5

Introduction Primary Resources

Primary recourse provides the broad base for development of the rest of the professional literature.

It contains original reports of scientific studies on which the knowledge of drugs and therapeutics is built.

Current of the information sources, and periodical journals are its most common format.

Providing access to the original data from a study as well, having the most current information

Tertiary Resource 6

Introduction Secondary Resources

They are indexes and abstracts for primary resources.

They are valuable tools for quick and selective screening for primary resources.

They provide the user with concise tools for gaining access to the primary literatures.

Any single indexing or abstracting service can not cover all published articles beside the lag time are the limitations to use secondary resources.

Tertiary Resource 7

Tertiary Resources “Literatures”

Tertiary Resource 8

Definition

Tertiary literature is core knowledge established via primary literature or accepted as standard of practice within the medical community.

Tertiary Resource 9

Introduction

tertiary resources include textbooks, monographs, compendia, handbooks, and published symposia.

They represent the condensation of basic facts originally published in the primary literature.

Tertiary Resource 10

Types Textbooks

Full-text databases

Compendia

Review articles

On various drug or disease topics

A vast array of information about manyDrugs such as the physician's desk reference

Including the internet, MICROMEDEX and LEXI

Summarize a particular topicContain more current information


Advantages Tertiary resources are the most commonly used

sources of information because they are easy to use, concise and compact.

Often they provide a review of the literature by an expert in the field.

Tertiary references (textbooks, CD-ROMs) are convenient and in general, fairly accessible.

Drug information references may be divided into specific subjects to make them easier to use..

Usually the information contained in tertiary literature is well accepted in medical practice.


Disadvantages

lag time ……. outdated even in "new" editions

Space limitations within a text may prevent extensive discussion of a drug or topic

Authors may emphasize limited information about a topic or drug

Authors may present information that is based on a less thorough review of the primary literature


Disadvantages (cont.)

It may not be referenced appropriately thus preventing a proper check of the primary literature

If the information presented in the tertiary literature is based on flawed primary literature (i.e. Poorly done studies are referenced) then the tertiary information may be suspicious.


Disadvantages (cont.)

Any updated or new information cannot be inserted into the printed (hard copy) tertiary literature in a timely fashion.

Human bias, error transcription, incorrect interpretation of data and lack of expertise by the author.


Evaluation of tertiary resources

Several points should be considered in evaluating tertiary resources as follows:

1. Does the author has sufficient experience and expertise to write on the topic?

2. What credentials do the authors/contributors have?3. Assess the text for timeliness (i.e. when was the last

edition published?)4. Is this the most recent edition of the tertiary

reference?5. Are statements of fact appropriately supported by

references?6. How many references does each section have and

how up-to-date are they?


Evaluation of tertiary

resources (cont.)

6. To assess consistency, compare information presented in one text to the same information presented in another text.

7. Is the reference likely to contain information relevant to the subject being researched?

8. Is the reference clear, concise and easy to use?


Availability of Tertiary Resources

Tertiary resources are available in many formats, including hard copy, microfiche, and computerized versions. Computerized resources may be available on floppy disks, or CD-ROMs for use in a single personal computer or computer network, a main frame system or via internet.


Classification of Tertiary Resources


Tertiary drug information resources

General references


A. General References


General features

1- They are referral books.2- Their formats are either monographs or

monographs plus chapters.3- Used through their indexes NOT through

their contents lists.


Textbooks.

Different from the general references in:1- Their formats are chapters.2- One can read them from cover to cover.3- One can use their contents list Not necessary to

go to index.


The most helpful of them to answer a drug related

questions are:

Martindale’s The complete drug reference



European and investigational drugs Published by the Royal Pharmaceutical

Society of Great Britain every 4 years Has a manufacturer directory and index

by clinical use (typical European style of indexing)

Lists other pharmacopeias the drug is found in.

Martindale’s The complete drug reference

Drug Facts and Comparisons (F&C)



Drug Facts and Comparisons (F&C)

Updated monthly (loose-leaf version) Lag time 3 months Arranged by therapeutic class Prescription and OTC listings Helpful summary/comparison tables Contains information about

investigational, orphan, and discontinued products and off label uses

Not referenced, cumbersome

Mosby’s Drug Consult



Mosby’s Drug Consult

Frequently used brand and generic drugs

Available at www.merckmedicus.com

Annual update Additional information:

Drug identification, look-alike/sound-alike

Manufacturer information, discontinued Products

American Hospital Formulary Service (AHFS)

Drug Information



American Hospital Formulary Service (AHFS) Drug

Information Arranged by AHFS classification

number Monographs listed alphabetically Information in monograph:

Chemistry, pharmacology, mechanism

Dose, administration, pharmacokinetics

Drug interactions, preparations, toxicity


(AHFS) Drug Information

FDA-approved and off-label uses Published annually with quarterly

updates More clinically oriented References are not available in the

hard copy but may be available online or with software CD-ROMS

Not comprehensive, significant lag time

USP Dispensing Information (USP DI)




Three volumesI. DRUG Information for the Healthcare

ProfessionalII. Drug Information for the Patient (in lay

language)III. Legal Requirements

Monographs in alphabetical order in Volume I

Published annually Also contains some Canadian drug

names Most thorough information on:

• Monitoring• Adverse drug events



Useful Appendices: (typical American style of indexing)

• Selected List of Drug-Induced Effects• Therapeutic Guidelines• Poison Control Center Listing• Veterinary Medication Classification• Excluded Monograph Listing



Off-label uses indexed by drug and by indication

Not referenced, lag time, only FDA-approved uses, inconvenient to compare agents in the same therapeutic class

Drug Information Handbook (Lexi-Comp)



Drug Information Handbook (Lexi-Comp)

Pocket-sized; PDA & online versions are also available

Published annually Drugs listed alphabetically by generic name Useful charts and tables. Specialty versions are available:

Pediatric, psychiatric, geriatric Not referenced Lists all reported adverse events but does not

always provide the incidence


MICROMEDEX®

CD-ROM Access information by brand or generic

name of drug Referenced, quick and easy to use Expensive, uses other tertiary

references Databases available:

• DRUGDEX® - main drug information database• DISEASEDEX® - disease states• IDENTIDEX® - drug identification by imprint code• POISINDEX® - poisoning and toxicology• Martindale’s – foreign drugs

Physicians’ Desk Reference (PDR)



Physicians’ Desk Reference (PDR)

Updated annually Color pictures and markings for drug

identification Has FDA-approved product information

only Manufacturers pay to have product

information Included Contains section on diagnostics May not contain the complete package

insert Not referenced

Drug Topics Red Book



Drug Topics Red Book

Cost data: average wholesale prices (AWP) and NDC numbers. (The National Drug Code)

Alphabetical listing of manufacturers with contact information

Prescription and OTC products List of drugs that should not be crushed

or chewed Published annually with monthly

updates

http://www.fda.gov/cder/ndc/


B. Specialized References


Pharmacotherapy

Pharmacotherapy: A Pathophysiologic Approach

(Dipiro)



Pharmacotherapy: A Pathophysiologic Approach

(Dipiro) Well-written and referenced with helpful

tables. Pocket version is available. Focuses on drug therapy, good

background information. Also covers non-drug treatment options. Updated edition about every 4 years.

Applied Therapeutics: The Clinical Use of Drugs

(Koda-Kimble)



Applied Therapeutics: The Clinical Use of Drugs (Koda-

Kimble) Well-written with focus on drug therapy. Updated every 4 years. Useful summary tables. Case presentation format, may be more

difficult to use as a quick reference.


The Washington Manual of Medical Therapeutics

Quick reference with many charts and tables.

Updated about every 2 to 3 years.


Internal Medicine


Harrison’s Principles of Internal Medicine

Gold standard for internal medicine Published every 5 years, referenced Pathophysiology, clinical presentation,

diagnosis and treatment guidelines Little drug information & dosing

recommendations


The Merck Manual Used by many healthcare professionals Also includes pediatrics, gynecology,

psychiatry, ophthalmology, otolaryngology, dental disorders

Clinical Medicine (Kumar &Clark )



comprehensive and authoritative single-volume textbook of internal medicine.

Explains the management of disease, based on an understanding of scientific principles and including the latest developments in treatment.

Colour-coded chapters are attractive and make the book easy to navigate.

Comprehensive index, clearly displayed, pinpoints information rapidly.



Boxes and tables pull out and display important information.

Drawings and photographs. Carefully structured headings provide a

useful outline for study and quick reference.

Gastrointestinal, Rheumatology, Renal, Cardiovascular, Respiratory ,Intensive care medicine, Drug Therapy and poisoning……



Cardiology


Textbook of Cardiovascular Medicine

Published every 5 years. Good illustrations. Addresses modern-day issues such as medical

economics and assessing quality of care. Well-referenced.


Hurst’s The Heart Organized by condition Comprehensive information on drug therapies

and regimens Rapid Interpretation of EKG’s (

Electrocardiogram (EKG or ECG)) Best guide to learning EKG’s User-friendly format.

http://www.americanheart.org/presenter.jhtml?identifier=3005172




Pediatrics

Harriet Lane Handbook



Harriet Lane Handbook

Useful pocket guide published every 3 years

Has dosing information Electronic version updated annually Four sections: emergency management,

diagnostic, formulary, and therapeutic data

Some information on pregnancy and lactation

Not referenced, not frequently updated, confusing organization, not complete


Pediatric Injectable Drugs (“Teddybear Book”)

Alphabetical order by generic name Formerly known as Guidelines for

Administration of Intravenous Medications to Pediatric Patients

Dose, concentration, rate, cautions


Pediatric Dosage Handbook (Lexi-Comp)

Pediatric version of the Drug Information Handbook

Dose, administration, how supplied, contraindications, adverse effects, drug interactions, antidotes

Also contains adult doses May sometimes have information on

extemporaneous formulations


Pregnancy


Drugs in Pregnancy and Lactation (Briggs)

Excellent reference, gold standard Updated every 4 years Alphabetical by generic name Generic name, class, & pregnancy risk

factor Summaries of risk to fetus and risk during

breastfeeding Editors assign categories for drugs not

classified by the manufacturer Referenced


Infectious Diseases


Mandell’s Principles and Practice of Infectious Disease

Gold standard reference Infection, diagnosis, treatment and

useful background information


Sanford Guide to Antimicrobial Therapy

Published annually Pocket-sized and easy to use Includes: dosing in renal impairment,

brand & generic names, empiric therapy guidelines, antimicrobial spectra of the agents

Not well-referenced


Oncology


Cancer: Principles and Practice of Oncology (devita)

Gold standard, published every 3 to 4 years

Pathology, treatment options, & adverse effects

Referenced


Cancer Chemotherapy Handbook

Useful index, introduction on malignancies

Pharmacology and use of chemotherapeutic agents

Lists investigational drugs and combinations

Well-referenced


Pharmacology


Goodman & Gilman’s Pharmacological Basis of

Therapeutics Gold standard pharmacology text Grouped by therapeutic class Mechanism, absorption, distribution, and

metabolism Contains review of pharmacokinetics,

therapeutics, and toxicology Well-referenced, very thorough Updated every 5 years (infrequent)


Drug Interactions


Hansten and Horn's Drug Interactions Analysis and

Management Loose-leaf format, updated Introductory chapter discusses

mechanisms of interactions Rates significance of interaction and

recommends management Referenced Not complete, subjective rating system


Drug Interaction Facts

Published by F&C Alphabetical by drug name Referenced Provides information regarding:

• Significance and severity• Onset of interaction• Documentation

Not complete, subjective rating scale


A typical monograph contains a summary, clinical evidence for the interactions under discussion, the probable mechanism, clinical importance and management

Covers interactions between therapeutic drugs, proprietary medicines, herbal medicines, foods, drinks, pesticides and some drugs of abuse

Stockley's Drug Interactions


• Based on published sources and fully referenced

• Covers over 14,000 drug interactions• Contains over 2,800 monographs

• Includes 17,600 references

• Book & CD-ROM

Stockley's Drug Interactions


Adverse Drug Reactions

Meyler’s Side Effects of Drugs



Meyler’s Side Effects of Drugs

Indexed by drug and by adverse event Most comprehensive Published every 4 years with annual

updates Contains tables and lists References for some side effects not

included Information provided:

Effects on organs and systems, lab/diagnostic interference, withdrawal and overdose

May not be complete, references for widely known effects are not included


Compatibility and Stability

Handbook on Injectable Drugs (Trissel’s)



Handbook on Injectable Drugs (Trissel’s)

Gold standard reference Updated every 2 years with annual

supplements Drugs organized alphabetically by

generic name Information on compatibility and stability

with diluents and drugs Solution, Y-site, syringe, and additive

compatibility Table format, very useful Not complete, lag time


King Guide to Parenteral Admixtures

Chart format, loose-leaf Alphabetical listing by generic name May have information not available in

Trissel’s Pages are not numbered


IV INDEX®

Component of MICROMEDEX®

Easy to use Information taken mostly from Trissel’s


Compounding and Pharmaceutics


Remington’s The Science and Practice of Pharmacy

Helpful for extemporaneous compounding

Pharmaceutical calculations, chemistry, radioisotopes

New edition every 5 years


Merck Index

Chemical name, formula, & structure Physical data, therapeutic category Published every 6 to 10 years


United States Pharmacopeia – National Formulary (USP-NF)

Official monographs for preparation and assay of pharmaceutical products

Published every 5 years with periodic supplements

Information on storage, packaging, labeling, reference standards, & assays

USP: drug substances & dosage forms NF: pharmaceutical ingredients Not a very useful reference since most

pharmaceuticals are mass-produced


Pharmacokinetics


Basic Clinical Pharmacokinetics (Winters)

Case-study format Includes principles of monitoring

therapy, basic pharmacokinetics, & clinical applications

Appendix of commonly used equations Mostly theory, little patient integration


Applied Pharmacokinetics: Principles of Therapeutic Drug

Monitoring Published by Applied Therapeutics Most advanced reference More specific drug information than

Winter’s Includes analytical methods and

clinical applications


Toxicology


Toxicologic Emergencies (Goldfrank’s)

Poison management guidelines Useful tables and case studies Practice multiple-choice questions


Casarett & Doull's Toxicology: The Basic Science of Poisons

gold standard in toxicology field basic concepts and fundamental

principles needed to grasp current issues in modern toxicology

The text is organized and presented in a logical progression of general principles to specific topics such as organ system toxicology, specific agent toxicology, and environmental toxicology.


POISINDEX®

Toxicology component of MICROMEDEX®

Search by brand or generic name Describes what substance looks like, any

imprint codes, management of toxicity


Toxic Emergencies: Clinics in Emergency Medicine (Clinics in emergency medicine) by William Hanson

Current Approaches in Toxicology by Bryan Ballantyne

Handbook on the Toxicology of Metals (Hardcover) by Lars Friberg Lars

Other Toxicology Books


Toxicology of the Eye: by W.Morton Grant. Joel S. Schuman

Effects on the Eyes and Visual System from Chemicals, Drugs, Metals and Minerals, Plants, Toxins, and Venoms; Also, Systemic Side Effects from Eye med (Hardcover)



Clinical Toxicology of Commercial Products (Hardcover) by Robert E. Gosselin, Roger P. Smith, Harold C Hodge, Jeannet Braddock



Drug Identification


1.American Drug Index Cross-referenced by brand, generic,

and chemical names

2.The Pill Book3.IDENTIDEX®

Component of MICROMEDEX® Identify drug by imprint code


4.British National Formulary BMJ Publishing, London, United Kingdom. The standard reference for prescribing and

dispensing drugs in Britain. Included are notes on the different drug

groups to help in the choice of appropriate treatment.

The BNF is updated in March and September of each year

available on disk and CD-ROM as the Electronic British National Formulary and An electronic web-based format is also available.


5.Saudi National Formulary It is a joint publication of the Saudi

pharmaceutical society & Ministry of Health, Riyadh, KSA

The standard reference for prescribing and dispensing drugs in Saudi Arabia.

Included are notes on the different drug groups to help in the choice of appropriate treatment.

The SNF is only one edition published in 1424 H (previous two editions were directory formats).

Available as hardcopy only.


5. Saudi National Formulary (cont.)

Having guidelines appendix. Drug interactions appendix. Drug information links appendix. List of community pharmacies all over

the kingdom Containing different indexes like:- Vendors index.- Manufacturers index.- Alphabetical drug index- Therapeutic index


Edited by the Swiss Pharmaceutical Society

Alphabetical by generic and brand name Drug name, structure, therapeutic class,

synonyms, and manufacturer Cross-referenced by all trade names and

substances Not much information is provided

5. Index Nominum: International Drug

Directory


Drugs Available Abroad Alphabetical by generic name Drug manufacturer, when it became

available, dosage forms, where it is approved

Indexed by disease, country of use, drug category

Appendices with information on manufacturers and drug regulatory authorities in other countries

5. Index Nominum: International Drug

Directory


Non-Prescription Products


PDR for Nonprescription Drugs and Dietary

Supplements Format similar to PDR, updated every

year Indexed by product name, category,

manufacturer, & active ingredient Includes color pictures of products Information: indications, cautions, dose,

administration, patient instructions, precautions, how supplied


Handbook of Nonprescription Drugs

Useful tables and comparisons Includes:

Patient assessment and counseling guidelines

Pathophysiology and treatment options

Dosing, adverse events, & interactions


Natural Products


Lawrence Review of Natural Products

Comprehensive and up-to-date information

Published by F&C Monthly updates Provides uses, toxicity, & patient info Scientific approach to herbal products


Electronic Tertiary Resources


A. Multipurpose Resources (disease and drug

information)


Access Medicine

(http://www.accessmedicine.com/) Collection of textbooks, clinical practice

guidelines, news Includes: Goodman & Gilman,

Harrison’s, Current Medical Diagnosis & Treatment, and the Lange series.

Drug monographs (include images, chemical structures, patient education materials) provided by Gold Standard™

Patient education handouts on common medical problems provided by Postgraduate medicine


ClinicalResource@Ovid

(http://clinicalresource.ovid.com/autologin.html)

Collection of books, clinical practice guidelines, patient education materials and links to databases

Includes: Clin-eguide, Facts and Comparisons and 5-Minute Consult series


MD Consult

http://home.mdconsult.com/groups/uwash8783.html)

Collection of textbooks, journals, drug information, guidelines, patient education handouts, news and updates

Drug information and updates from Mosby’s drug Consult, package insert information, FDA information

Customizable patient handouts – diseases and drugs


MedlinePlus

(http://medlineplus.gov) NLM’s database aimed at consumers for

health and wellness information English and Spanish versions as well as

“large print” and audio Includes health topics, drug information,

dictionaries, interactive tutorials, directories and links to other resources


MedlinePlus

Especially good for quick overview, including statistics, of topics and illustrations

Drug information includes MedMaster from ASHP, USP DI Advice for Patients, Natural Standard Online (for natural products) and links to FDA and ClinicalTrials.gov


Micromedex Healthcare series

(http://www.thomsonhc.com/hcs/librarian/) Collection of databases that can be

searched individually or all together contents of collection depends on your subscription

Includes DrugDex and Drug Consults, IV Compatibility, PoisIndex, AltMedDex, Martindale, Reproprisk, TOMES and CareNotes


Micromedex Healthcare series

Use for detailed information about medications (US and foreign) and natural products as well as exposures to chemicals, toxins and poisonous animals and plants

Lengthy bibliographies Instructions for citing under Warranties

a& Disclaimers link


UpToDate

(http://www.uptodateonline.com/) Evidence-based electronic textbook of

medicine Lexi-Interact Drug Interactions program

from Lexi-Comp for drug interactions Links from drug names to Lexi-Comp

drug information within monographs Provides recommendations for good

practice Graphs and tables that may be exported

to personal documents


B. Drug and Natural Products

Information Resources


Facts & Comparisons

(http://online.factsandcomparisons.com/) Collection of resources that can be

searched individually or all together – drugs and natural products

Includes Drug Facts & Comparisons, Nonprescription Drug therapy, Drug Interaction Facts, Review of Natural Products, MedFacts Patient information


Facts & Comparisons

Print version has been gold standard for drug information for years

Includes comparison tables for drugs by class or pharmacological action

In general, references are included in the Drug Interactions section and in drug class monographs but not in individual drug monographs


Natural Medicines Comprehensive Database

(http://www.therapeuticresearch.net/nd/Search.aspx?s=ND)

Comprehensive, evidence-based information about herbal and dietary supplements used in the US and Canada

Produced by publishers of Prescribers' Letter and Physicians' Letter

Many products have patient handouts


Natural Medicines Comprehensive Database

Updated daily Several entry points, e.g. product or

common name, scientific name, people use

this for, interactions with foods, herbs, dietary supplements, lab tests, diseases or conditions

tertiary resource

Documents