Drug Information Resources Review

1. Drug Information Resources Review Jennifer L. Rodis, PharmD, BCPS The Ohio State University College of Pharmacy October 25, 2011

2. Objectives • Review the differences between primary, secondary, and tertiary resources • Discuss the value of each resources type • Provide a refresher on searching Pubmed

3. Types of Literature

4. Types of literature • 3 main types of drug information literature • Tertiary • Interpretation of primary data • Secondary • No interpretation, just helps you find sources • Primary • Original research & analysis

5. Real-life Research

6. Tertiary Literature Summarizes and interprets the primary literature Information generally well accepted Place to start for basic information and guidance Can inform your subsequent research

7. Tertiary Literature • Advantages • Convenient, accessible • Often available online • Review process of information is already done • Disadvantages • Lag time • Not as complete • Author’s interpretation

8. Tertiary Literature Textbooks Electronic also Compendia Electronic also Full-text computer databases (Internet) Review articles

9. Tertiary Resources – Drug Databases • Online • Lexi Comp CRL • MICROMEDEX • Drug Facts and Comparisons • MD Consult • AHFS Drug Information • Epocrates • Print • PDR (Physician’s Desk Reference)

10. Tertiary Resources - Books • Print Books • Remington’s • Trissel’s (2 titles) • Handbook of Nonprescription Drugs • Redbook • Drugs in Pregnancy & Lactation (aka: Brigg’s) • Martindale: The Complete Drug Reference

11. Tertiary Resources - Other • UpToDate • Pharmacist’s Letter • Natural Medicines Comprehensive Database • Ohio Administrative Code (pharmacy.ohio.gov) • FDA.gov (Orange Book, Drugs@FDA) • CDC.gov • Professional Organizations • APhA’s MTM Central • Package Insert • Manufacturer web sites

12. Using Tertiary Literature • Does author have expertise? • Is the information current? • Is the information supported with citations? • Does the resource contain relevant information? • Is the resource free of bias or errors? • Is it clear/concise/easy-to-use?

13. Secondary Literature Guides you to the primary and tertiary literature Indexing Bibliographic info only Abstracting Bibliographic citation plus brief summary of article or resource Almost all are electronic format

14. Secondary Literature • Advantages • Simple search strategies • Very current citation information • Access point for tremendous amount of primary sources • Disadvantages • Understanding coverage of the database • Tweaking search strategies unique to each database

15. Secondary Resources • ClinAlert • EMBASE (Elsevier) • International Pharmaceutical Abstracts (IPA) • Iowa Drug Information System (IDIS) • Journal Watch • Lexis-Nexis • MEDLINE / PubMed

16. Primary Literature Primary research Journal articles that are: Case reports Drug studies Original reports of data Meta-analysis? Unpublished studies

17. Primary Literature Considerations • Evaluating the basics • Peer-reviewed • Journal reputation • Source of funding • Digging deeper • Study methodology • Clinical relevance • Patient populations

18. Primary Literature • Advantages • Most current published source • Tremendous range of information • Personally assess utility/validity • Disadvantages • Overwhelming volume • Interpretation of results • Not yet vetted by experts

19. Primary Literature Peer-reviewed journals JAMA New England Journal of Medicine American Journal of Health-system Pharmacy Annals of Internal Medicine Non-peer reviewed journals Supplements Pharmacy Today

20. What’s the difference? Ease of Use Tertiary Secondary Primary

21. What’s the difference? Most Current Primary Secondary Tertiary

22. Alternate Sources of DI Internet, Listservs, and medical news briefs Local and national professional organizations and meetings Pharmaceutical manufacturers Drug information and poison control centers

23. Searching Strategies • Begin broad, then narrow your search • Start with tertiary sources • Use “related articles” • Bibliographies • Secondary resource guides • Always be sure to assess most up to date information available • Primary sources

24. Searching Pubmed

25. Searching Strategies Develop focused question and break into parts What is the question asking? “Is peptic ulcer prevention with proton pump inhibitors and NSAIDs dose-related?” proton pump inhibitors, dose, non-steroidal anti-inflammatory agents, prevention of peptic ulcer disease Other forms of the above words and phrases

26. Searching Strategies • Putting together an answerable question is key to successful evidence-based medicine practice • Use PICO method • Patient or problem • Intervention • Comparative intervention • Outcome Be Specific!

27. What is the minimum or maximum dose of NSAIDs at which proton-pump inhibitors are effective for peptic ulcer disease prophylaxis? Patient or problem Intervention Comparison Outcome Example: PICO

28. Searching Strategies Read up on the basics of the question Start with tertiary resources for foundation Build on information gathered from texts, review articles, and drug databases with a primary literature search

29. Searching Strategies • Gather as many articles as possible for all of the parts of the search • Use MeSH headings to help narrow or broaden your search • MeSH = Medical Subject Headings • Official indexing terms for MEDLINE

30. Searching Databases: Basic Boolean “AND” Combines 2 terms (shrinks search) “OR” Gives database more choices (broadens search) “NOT” Limits search (removes undesired terms)

31. Basic Boolean Both words must be present in results paroxetine AND suicide

32. Basic Boolean Either word can be present in results paroxetine OR suicide

33. Basic Boolean The first but not the second term will be present in the results paroxetine NOT suicide

34. Pubmed Search Example What is the minimum or maximum dose of NSAIDs at which proton-pump inhibitors are effective for peptic ulcer disease prophylaxis?

35. Search keywords • Proton pump inhibitors and dose and non-steroidal anti-inflammatory agents • proton pump inhibitors and dose and non-steroidal anti-inflammatory agents and prevention of peptic ulcer disease • MeSH term search: PPIs, NSAIDs, PUD http://www.ncbi.nlm.nih.gov/pubmed/19240698

36. Adapted from lectures by Bridget Protus, PharmD, CGP, MLS delivered 1/2010. Thrower MR. Literature retrieval and Finding Resources Electronically. In: Felkey BG, Fox BI, Thrower MR. Health care informatics: a skills-based resource. Washington DC: American Pharmacists Association; 2005. p. 191-228. West, PM. Literature evaluation. In: Pharmacotherapy self-assessment program: science and practice of pharmacotherapy, 5th ed. (PSAP V). Kansas City: American College of Clinical Pharmacy; 2005. p. 93-110. Shields, KM. Drug information resources. In: Malone PM, Kier KL, Stanovich JE. Drug information: a guide for pharmacists, 3rd ed. New York: McGraw Hill; 2006. p.61-101. Resources

37. Resources Thrower MR. Literature retrieval and Finding Resources Electronically. In: Felkey BG, Fox BI, Thrower MR. Health care informatics: a skills-based resource. Washington DC: American Pharmacists Association; 2005. p. 191-228. West, PM. Literature evaluation. In: Pharmacotherapy self-assessment program: science and practice of pharmacotherapy I, II, III. Kansas City: American College of Clinical Pharmacy; 2005. p. 93-5.