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CHAPTER 3

Case Study 3–1

Common side effects would be included in all major compendia (e.g., IBM® Micromedex®, Clinical Pharmacology, or Lexicomp®) which would be a good initial search. In addition, some of the adverse effect specific resources (e.g., Meyler’s Side Effects of Drugs) would be appropriate to consult for less common side effects. The package insert will also contain detail on common side effects based on results of clinical trial(s) leading to FDA approval.

Case Study 3–2

  • There are a variety of resources that could be consulted for this information including LactMed, Drugs in Pregnancy and Lactation, or the major compendia (possibly, IBM® Micromedex® or Clinical Pharmacology).

  • Practitioners should review multiple resources to determine if there are additional pertinent data. If there are concerns with fluconazole, the practitioner can review the disease state to determine other possible treatment options.

Case Study 3–3

  • The student might start a search for general information in a toxicology text such as Goldfrank’s Toxicologic Emergencies. She could then search in Lexicomp® or IBM® Micromedex® to find some general toxicology information, and within the POISINDEX® component of IBM® Micromedex® for comprehensive information on this topic.

  • The student would do best to identify relevant MeSH terms prior to searching (e.g., gabapentin, opioid-related disorders, substance-related disorders). Identifying appropriate search terms can help the student find results involving the correct drug and patient population.

Case Study 3–4

  • Since this would be an off-label use, there may be fewer data in the tertiary resources. However, AHFS® DI, DRUGDEX® (part of IBM® Micromedex®), and Lexicomp® may contain information on off-label uses. In this case, related treatment guidelines may also contain information on the use of this combination prior to hematopoietic stem cell transplant. A literature search may be appropriate if the tertiary resources do not contain adequate data. MEDLINE® and Embase, using MeSH and Emtree terms, respectively, are good places to start.

  • Initially conducting a search with no restrictions/limits ensures that valuable information is not missed.

  • If the initial search yields a significant number of results, then a restriction to human clinical trials may be beneficial. It is important to realize that the term “Hematopoietic Stem Cell Transplantation” has changed over time in the MeSH database, so a more general search for stem cell transplant will give more results. In addition, searching for the specific drugs fludarabine and busulfan will yield useful data, but expanding the search using the class of drugs will provide more data.

Case Study 3–5

  • Tertiary resources could provide a good overview on how a treatment might work in a large patient population, appropriate dosing, as well as provide a quick summary of safety data. The disadvantage is the lag time from when the information is updated until it is published, ...

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