❶ Tertiary sources provide information that has been summarized and distilled by the author or editor to provide a quick easy summary of a topic. Some examples of tertiary resources include textbooks, compendia, review articles in journals, and other general information, such as may be found on the Internet. These references may often serve as an initial place to identify information, due to the fact that they provide a fairly complete and concise overview of information available on a specific topic. These resources are also convenient, easy to use, and familiar to most practitioners. Most of the information needed by a practitioner can be found in these sources, making these excellent first-line resources when dealing with a drug information question.
The major drawback to print copy tertiary resources, however, is the lag time associated with publication, resulting in less current information. Medical information changes so rapidly that it is possible that information may be out of date before a text is even published. Electronically available tertiary resources have helped this situation; however, the requirement for information to be reviewed and summarized requires an inherent delay in communicating new information. It is also possible that information in a tertiary text may be incomplete, due to either space limitations of the resource or incomplete literature searches by the author. Other problems that can be seen with tertiary information include errors in transcription, human bias, incorrect interpretation of information, or a lack of expertise by authors. For these reasons readers must judge the quality of tertiary references and may need to verify the information in multiple sources. Some types of questions that should be considered when evaluating tertiary literature are listed in Table 3–1.
EVALUATION OF TERTIARY LITERATURE
||Download (.pdf) TABLE 3–1.
EVALUATION OF TERTIARY LITERATURE
|Does the author have appropriate experience/expertise to publish in this area? |
|Is the information likely to be timely based on publication date? |
|Is information supported by appropriate citations? |
|Does the resource contain relevant information? |
|Does the resource appear free from bias and blatant errors? |
It is impossible to compile a comprehensive list of tertiary resources that are useful in all areas of pharmacy practice. Differences in practice settings, available funding, patient populations seen, and types of information most commonly needed, all impact which tertiary resources should be available at a specific practice site. The legal requirements for information sources available at a practice setting vary from state to state, but rarely will the minimally required texts be sufficient to meet all information needs in a practice.
Another important factor in the selection of appropriate tertiary resources includes selecting a resource focused on the type of information needed for a specific request or situation. For example, a very well-written and comprehensive therapeutics text may have very limited use in providing information regarding pharmacokinetics of a specific drug. For this reason, it is important to consider the categories of requests received in a particular practice setting to ensure that appropriate tertiary texts are available. Table 3–2 lists resources that may be useful for specific categories of drug information requests.
USEFUL RESOURCES FOR COMMON CATEGORIES OF DRUG INFORMATION
||Download (.pdf) TABLE 3–2.
USEFUL RESOURCES FOR COMMON CATEGORIES OF DRUG INFORMATION
|Type of Request ||Useful Tertiary Sources ||Secondary Resources |
|General Product Information ||Major compendia,∗ Handbook of Nonprescription Drugs,3 product labeling ||MEDLINE®, EMBASE®, IPA, IDIS |
|Adverse Effects ||Meyler’s Side Effects of Drugs,4 Side Effects of Drugs Annual,5 product labeling, major compendia∗ ||Reactions Weekly, MEDLINE®, EMBASE®, IPA, IDIS |
|Availability of Dosage Forms ||Red Book,6 American Drug Index7 major compendia∗ ||_________ |
|Compounding/Formulations ||Remington: The Science and Practice of Pharmacy,8 Merck Index,9 A Practical Guide to Contemporary Pharmacy Practice,10 USP/NF,11 Trissel’s Stability of Compounded Formulations,12 Extemporaneous Formulations,13 Ansel’s Pharmaceutical Dosage Forms and Drug Delivery Systems,14 USP Pharmacists’ Pharmacopeia15 ||IPA, IDIS, EMBASE®, MEDLINE® |
|Dietary Supplements ||Natural Medicine Comprehensive Database,16 Review of Natural Products,17 Natural Standard,18 PDR for Herbal Medicine,19 Trease and Evans’ Pharmacognosy20 ||EMBASE®, MEDLINE®, IPA, IDIS |
|Dosage Recommendations (General and organ impairment) ||Major compendia,∗ Drug Prescribing in Renal Failure21 ||MEDLINE®, IPA, IDIS, EMBASE® |
|Drug Interactions ||Hansten and Horn’s Drug Interaction Analysis and Management,22 Drug Interaction Facts,23 Stockley’s Drug Interactions,24 Food-Medication Interactions,25 Drug Therapy Monitoring System,26 major compendia∗ ||Reactions Weekly, IPA |
|Drug-Laboratory Interference ||Basic Skills in Interpreting Laboratory Data,27 Laboratory Tests and Diagnostic Procedures28 || |
|Geriatric Dosage Recommendations ||Geriatric Dosage Handbook,29 major compendia∗ ||MEDLINE®, IPA, IDIS, EMBASE® |
|Identification of Product ||Identidex,30 Clinical Pharmacology,31 Drugs.com, IDENT-A-DRUG,32 Lexicomp,33 Facts & Comparisons® eAnswers34 || |
|Investigational Drug Information ||FDA Web site (http://www.fda.gov),35 Clinicaltrials.gov,36 MedlinePlus,37 manufacturer Web sites ||Current Contents, EMBASE®, MEDLINE®, LexisNexis®, IPA, IDIS |
|Incompatibility/Stability ||Handbook of Injectable Drugs,38 King Guide to Parenteral Admixtures,39 Trissel’s 2 Clinical Pharmaceutics Database,40 Extended Stability for Parenteral Drugs,41 Trissel’s Stability of Compounded Formulations,42 Remington: The Science and Practice of Pharmacy43 ||IPA, IDIS, EMBASE®, MEDLINE® |
|International Drug Equivalency ||Martindale: The Complete Drug Reference,44 Index Nominum,45 Internet Search Engines, Specific country resources || |
|Method/Rate of Administration ||Major compendia∗ || |
|Pediatric Dosage Recommendations ||The Harriet Lane Handbook,46 Pediatric and Neonatal Dosage Handbook,47 Neofax,48 major compendia∗ ||MEDLINE®, IPA, IDIS, EMBASE® |
|Pharmacokinetics ||Basic Clinical Pharmacokinetics,49 Applied Biopharmaceutics and Pharmacokinetics,50 major compendia∗ ||IPA, EMBASE®, MEDLINE®, IDIS |
|Pharmacology ||Goodman & Gilman’s: The Pharmacological Basis of Therapeutics,51 Basic & Clinical Pharmacology,52 Brody’s Human Pharmacology: Molecular to Clinical,53 Principles of Pharmacology54 ||IDIS, IPA, EMBASE®, MEDLINE® |
|Pharmacy Law ||Pharmacy Practice and the Law,55 Guide to Federal Pharmacy Law,56 State Board of Pharmacy Web sites ||LexisNexis® |
|Teratogenicity/Lactation ||Drugs in Pregnancy and Lactation,57 Medications and Mother’s Milk,58 Catalog of Teratogenic Agents,59 Drugs during Pregnancy and Lactation,60 REPRORISK,61 major compendia∗ ||Reactions Weekly, EMBASE®, MEDLINE®, IDIS, IPA |
|Therapy Evaluation/Drugs of Choice ||Pharmacotherapy: a Pathophysiologic Approach,62 Pharmacotherapy Principles and Practice, Applied Therapeutics: The Clinical Use of Drugs,63 The Merck Manual of diagnosis and therapy,64 Harrison’s Principles of Internal Medicine,65 Goldman’s Cecil Medicine,66 Textbook of Therapeutics,67 Conn’s Current Therapy,68 Medscape ||MEDLINE®, EMBASE®, IDIS, IPA |
|Toxicology Information ||POISINDEX®,69 Goldfrank’s Toxicologic Emergencies,70 Casarett & Doull’s Toxicology: The Basic Science of Poisons,71 Poisoning & Toxicology Handbook,72 Haddad and Winchester’s Clinical Management of Drug Overdose,73 TOXNET74 ||Reactions Weekly, EMBASE®, MEDLINE®, IPA, IDIS, BIOSIS |
|Veterinary Medicine ||Textbook of Veterinary Internal Medicine,75 The Merck Veterinary Manual (MVM),76 Pet Place,77 Pet education,78 Pets with Diabetes79 Plumb’s Veterinary Drug Handbook,80 Compendium of Veterinary Products (CVP),81 Exotic Animal Formulary,82 USP, Veterinary Medicine83 ||BIOSIS, EMBASE®, MEDLINE® |
A brief summary of selected tertiary resources is listed to provide examples of some resources that may be useful in the general pharmacy practice. Information is provided about the features of the resource as well as the publisher and publisher Web site. While specific electronic resources may be hosted at a different Web site, the publisher site will direct users toward the appropriate link.
This list is not comprehensive and reflects only a limited number of resources available. The Basic Resources for Pharmacy Education listing distributed by the American Association of Colleges of Pharmacy (AACP)1 was utilized in selecting the resources described in this chapter; additional commonly used resources in drug information2 were also included. These complete documents contain hundreds of other resources that may be useful depending on practice setting.
GENERAL PRODUCT INFORMATION
American Society of Health-System Pharmacists®, http://www.ahfsdruginformation.com This drug information resource is organized by monographs containing information on both Food and Drug Administration (FDA)-approved and off-label uses of medications. This resource is designated by the U.S. Congress as an appropriate source of information for determining reimbursement of unlabeled uses of medications. Information about dosing in specific populations is also included, as is a wide variety of general information about medications. Some information is also available about compatibility and stability of injectable formulations. AHFS Drug Information is available in paper format (updated annually), an excerpted paper format (AHFS DI®Essentials™), and a mobile drug reference version.
Gold Standard, http://www.clinicalpharmacology.com This electronic database contains monographs of prescription and nonprescription products as well as some dietary supplements. Tools within the database allow users to screen for drug interactions, create comparison tables for drug products, determine intravenous (IV) compatibility (based on Trissel’s 2™ Clinical Pharmaceutics Database) and search for tablets by description or imprint codes. Patient education information is available in English and Spanish. It is available online or as a smartphone application.
Truven Health Analytics, http://www.micromedexsolutions.com This electronic resource contains information about FDA-approved indications, off-label uses, pharmacokinetic data, safety information, and pharmacology. Multiple interactive tools are available to assess for drug–drug/food/supplement interactions, incompatibilities, and pharmacokinetic adjustments. There is an additional toxicology section which allows identification of drugs based on imprint codes and discussion of overdose management. Patient education materials are also included in this database. This resource is available online as well as for mobile devices. Please note that on mobile devices it is available as both a full version and an abridged application.
Wolters Kluwer Health, Inc., http://www.factsandcomparisons.com This reference contains information about prescription and nonprescription drugs organized by drug class. Information is provided about specific agents, including inactive ingredients in commercial preparations. There are comparative monographs of drug classes to help discern differences between agents of the same class. This resource is available via hardcopy, online (Facts & Comparisons® eAnswers), and for mobile devices. The electronic version of this resource allows for an integrated search across a variety of Facts & Comparisons publications (depending on subscription purchased).
Drug Information Handbook
Wolters Kluwer Health, Inc., http://www.lexi.com This handbook is organized in brief product monographs, where information is presented regarding clinical use, safety, and monitoring for a variety of drugs. Data are presented about FDA-approved and off-label use of medications. There is a tablet identification section as part of the electronic format. The resource also has several helpful appendices providing treatment options and comparing agents in the same class. This resource is available via hard copy, online, and for mobile devices. The electronic versions allow for integrated searches of various Lexicomp® products (depending on subscription purchased). The online resource also includes tablet identification features as well as medication pricing information. This resource has also partnered with AHFS (described above) to offer an electronic subscription combining their two databases in a seamless search.
Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care
American Pharmacists Association®, http://www.pharmacist.com This text is organized by body system, focusing on those disease states for which self-care may be appropriate. Information is provided about comparative efficacy of various over-the-counter (OTC) agents, as well as contraindications for self-treatment, drug interactions, and other safety information. The use of treatment algorithms and patient care cases make this resource especially helpful for students and new practitioners. The text is also available as an e-book.
Physicians’ Desk Reference®
PDR.net®, http://www.pdr.net This resource is a compilation of prescription product package inserts. Additional information includes contact information for manufacturers, a list of poison control centers, and very limited tablet identification. The company maintains a Web site, pdrhealth.com, which contains patient appropriate information. Information from the Physicians’ Desk Reference (PDR) is also available online at http://www.pdr.net or http://www.pdrhealth.com, or for mobile devices (PDRBooks®). In addition to the original PDR, there are a variety of focused editions, including the PDR®for Herbal Medicines, PDR®for Nutritional Supplements, PDR®for Ophthalmic Medicines, PDR®for Nonprescription Drugs.
U.S. Pharmacopeial Convention, http://www.usp.org This is the official resource for determining generic and chemical names of drugs, as well as the international nonproprietary name. Additionally, useful information such as chemical structure, molecular weight, Chemical Abstracts Services (CAS) registry number, and a pronunciation guide is provided. This resource is also available in an online format and in print.
Epocrates, http://www.epocrates.com This family of electronic resources includes both mobile and online products. These resources include information about drugs (monographs, interaction checker, safety data, tablet identification) and diseases (epidemiology, prognosis, treatment).
Meyler’s Side Effects of Drugs
Elsevier Publishing, http://www.elsevier.com This reference provides a critical review of international literature in the area of adverse events. Chapters are organized by drug classification; adverse events are organized by drug name and then by organ system within each drug. Information is provided about adverse events and management.
Side Effects of Drugs Annual: A Worldwide Yearly Survey of New Data and Trends in Adverse Drug Reactions
Elsevier Publishing, http://www.elsevier.com This reference which is updated annually serves as a companion to the text Meyler’s Side Effects of Drugs. A team evaluates international literature published each year identifying new information and summarizing that information in this resource.
Case Study 3–1
A 15-year-old patient has recently been started on atomoxetine for treatment of attention deficit/hyperactivity disorder. He is taking no other medications. He has noted recently that his hair is thinning and wants to know if this might be drug related.
• What are appropriate tertiary resources to consult for a response to this request?
AVAILABILITY OF DOSAGE FORMS
Lippincott Williams & Wilkins, http://www.lww.com This reference contains brief entries, indexed by product and generic name, with information about product use, available dosage forms and sizes, and manufacturer information. Several helpful charts are also available, including look-alike/sound-alike medications, pregnancy categories, normal lab values, as well as common pharmacy calculations.
Red Book® (Red Book Drug Topics)
Truven Health Analytics, http://www.redbook.com This resource primarily contains data regarding prescription and OTC product availability and pricing. There are also a number of tables listing information such as sugar-free, lactose-free, or alcohol-free preparations. Additionally, information such as National Drug Code (NDC) numbers, routes of administration, dosage form, size, and strength are included. This resource is available in paper copy and electronically within Micromedex® 2.0.
Some journals are especially useful for compounding formulations, for example, the International Journal of Pharmacy Compounding, U.S. Pharmacist, or American Druggist.
Extemporaneous Formulations for Pediatric, Geriatric, and Special Needs Patients (Children’s Hospital of Philadelphia)
American Society of Health-System Pharmacists®, http://www.ashp.org This resource is a compilation of published formulations with stability data. Most products are oral formulations to reflect the unique needs of some pediatric patients. Information is also provided about legal and technical issues in compounding practices.
Merck & Co., Inc., http://www.merck.com This resource provides descriptions of the chemical and pharmacological information about a variety of chemicals, drugs, and biologicals. Data include CAS number, chemical structure, molecular weight, and physical data, including solubility, which may be especially useful in compounding. This reference is available in print and online.
Remington: The Science and Practice of Pharmacy
Pharmaceutical Press, http://www.pharmpress.com This classic text contains information about all aspects of pharmacy practice. There is discussion of social issues impacting pharmacy as well as information about the basics of pharmaceutics, manufacturing, pharmacodynamics, nuclear pharmacy, and medicinal chemistry. Information is provided regarding common compounding techniques and ingredients. The paper text is divided into two volumes and also includes a companion CD-ROM.
A Practical Guide to Contemporary Pharmacy Practice
Lippincott, Williams & Wilkins, http://www.lww.com This text resource with CD-ROM is organized in an outline format to find information easily. Discussion of compounding techniques, pharmacy calculations, and explanations of additives used in compounding is very useful. Students and young practitioners may find the sample cases especially helpful.
Trissel’s™ Stability of Compounded Formulations
American Pharmacists Association®, http://www.pharmacist.com This text provides information about preparation of sterile and nonsterile dosage forms. The text is organized by drugs and provides a summary of the properties of a drug, general stability considerations, and stability reports of compounded preparations. There is also extensive information provided about beyond-use dating.
U.S. Pharmacopeial Convention, http://www.usp.org This resource, available in print, online, and flash drive formats, contains the official substance and product standards. Also, official preparation instructions are given for a limited number of commonly compounded products.
Natural Medicine Comprehensive Database
Therapeutic Research Faculty, http://www.naturaldatabase.com This resource is available in text, online, and mobile device formats. It provides a summary of the information available for various dietary supplements and rates the relative safety and efficacy of those products. Searches can be performed by brand names of supplements or by a variety of common names. The electronic version includes an interaction checker and disease state/condition search. The electronic resource has also partnered with the USP Verified program to indicate which supplements have been certified to contain a quality product by USP Verified.
Natural Standard, http://www.naturalstandard.com This resource is available in text and electronic forms. Extensive evidence-based information regarding efficacy is provided. The monographs utilize tables to quickly summarize published literature and to grade the quality of that evidence. The monographs also provide detailed dosing information reflecting the doses used in clinical studies as well as those recommended by expert opinion.
PDR® for Herbal Medicines
PDR.net®, http://www.pdr.net Products are indexed by common name and information is provided regarding action, usage, dosage, and other clinically useful information. Citations to the primary literature are also provided at the conclusion of each monograph. The focus on strictly herbal products, rather than nonbotanical dietary supplements, may limit utility in some settings.
Review of Natural Products
Wolters Kluwer Health, Inc., http://www.factsandcomparisons.com This resource provides information about the chemistry, pharmacology, and toxicology of a number of natural products, based on references to primary literature. A summary of relevant clinical trials is also available. There is also limited patient counseling information, but the strength of this resource is in the chemistry and pharmacology information. Recent revisions have dramatically increased the amount of information included in patient counseling sections. This is available in loose-leaf, bound, online, and mobile device formats.
Trease and Evans’ Pharmacognosy
Saunders Ltd., http://www.elsevier.com This text offers a mixture of more classic pharmacognosy, crude plant–based drug classification and examination, and some of the more clinical applications, pharmacology, and phytochemistry. This is not a resource focused on patient care issues.
Hansten and Horn’s Drug Interactions Analysis and Management
Wolters Kluwer Health, Inc., http://www.hanstenandhorn.com This resource provides summaries of, mechanism of, and management options for reported drug interactions. The authors also provide information regarding severity of interaction and any risk factors that might predispose patients to this event. The loose-leaf version of the reference is updated quarterly while the bound is updated annually. Both provide rapid information regarding severity and likelihood of an interaction and actions needed to minimize this risk based on the case studies and primary literature available. Some of this content is integrated into other electronic Facts & Comparisons products.
Wolters Kluwer Health, Inc., http://www.factsandcomparisons.com This resource provides information about drug–drug or drug–food interactions. Discussions of significance of the interaction as well as suggestions for management are included. This resource is available in both bound and loose-leaf texts. Electronically, it is available via CD-ROM and as integrated in other electronic Facts & Comparisons products.
Food-Medication Interactions™, http://www.foodmedinteractions.com This resource is available in print, online, and mobile device formats. This focuses on the impact food may have on mediations and also highlights what foods should be avoided with specific medications.
GERIATRIC DOSAGE RECOMMENDATIONS
Geriatric Dosage Handbook
Wolters Kluwer Health, Inc., http://www.lexi.com The monographs in this resource contain traditional sections of drug information, but focus on dosing recommendations for geriatric patients. There is a special section of each monograph addressing concerns specific to the geriatric population. Limited references to primary literature are provided. This reference is also available online and for mobile devices.
The Merck Manual of Geriatrics
Merck & Co., Inc., http://www.merck.com This resource available in print and online (http://www.merck.com/mkgr/mmg/home.jsp) focuses primarily on management of diseases and conditions common in geriatric patients. There is some discussion of appropriate dosing of medications in this population.
IDENTIFICATION OF PRODUCT
Therapeutic Research Faculty, http://www.indentadrug.com This resource is organized by imprint codes and provides identification of drugs based on those codes. Descriptions of medications as well as NDC and Canadian DIN numbers are provided. Electronic and text versions of this reference are available.
Drugsite Trust, http://www.drugs.com This electronic resource has an easy-to-use imprint search. This is especially useful as it is available to patients and has no charge for use.
Other resources, discussed elsewhere, also have some tablet identification features including Clinical Pharmacology, Lexicomp Online, Micromedex 2.0®, and Facts & Comparisons eAnswers®.
INCOMPATIBILITY AND STABILITY
Handbook on Injectable Drugs
American Society of Health-System Pharmacists®, http://www.ashp.org This resource, commonly called Trissel’s, includes information regarding the compatibility and stability of various parenteral medications. Information is primarily provided in the form of charts and tables, making finding information relatively quick. This resource also provides information about routes of administration and commercially available strengths. A pocket-sized handbook and online subscription are also available.
King® Guide to Parenteral Admixtures®
King Guide Publications, http://www.kingguide.com Over 450 IV drug monographs are provided. This resource focuses on compatibility information. Also, limited information about stability is available. This is available in loose-leaf, bound copy, online, and mobile device formats.
Trissel’s™ 2 Clinical Pharmaceutics Database
TriPharma, http://trissels2.rcl.com/tsweb/. This electronic resource compiles data from other Trissel publications. Information about parenteral admixtures, compounded formulations, physical compatibility, and chemotherapy formulations is included. Extensive information describing published information is provided which can be applied to specific clinical situations. This resource is available for the intranet, as well as via CD-ROM and the Internet.
INTERNATIONAL DRUG EQUIVALENCY
Index Nominum: International Drug Directory
Medpharm Publishers, http://www.medpharm.de This drug information source contains information on drugs available in over 130 countries. Information is included regarding structure, therapeutic class, and proprietary names for single entity medications. A CD-ROM is included containing contact information for pharmaceutical manufacturers worldwide.
Martindale: The Complete Drug Reference
Pharmaceutical Press, http://www.pharmpress.com This resource includes information on a variety of domestic and international drugs. Proprietary names and manufacturer contact information are available for a variety of countries. Some information is provided about common herbal products as well as diagnostic agents, radioactive pharmaceuticals, and some veterinary products. This information is available in hardcopy, CD-ROM, via online MedicinesComplete subscription, and is also included in some Micromedex® Healthcare Series packages.
Additional resources are available that are specific to individual countries including Diccionario de Especialidases Farmaceuticas (Mexico), British Pharmacopoeia (United Kingdom), Rote Liste® (Germany), Dictionary Vidal (France), Compendium of Pharmaceuticals and Specialties (Canada), and Repertorio Farmaceutico Italiano (Italy).
PEDIATRIC DOSAGE RECOMMENDATIONS
The Harriet Lane Handbook
Mosby, http://www.us.elsevierhealth.com This resource, assembled by medical residents, contains a succinct discussion of common diseases and conditions of newborn to adolescent patients. A significant portion of the book is dedicated to medication dosing, specifically pediatrics. This section also contains information about common side effects and dosage forms available. The resource includes a variety of topic areas including palliative care and toxicology information. There is a separate publication which focuses on antimicrobial therapy. This resource is also available for mobile devices.
Pediatric Dosage Handbook
Wolters Kluwer Health, Inc., http://www.lexi.com The monographs in this resource contain traditional sections of drug information, but focus on detailed dosing recommendations for pediatrics. There is also information about common extemporaneous preparations. Limited references to primary literature are provided. This reference is also available online, on CD-ROM, and for mobile devices.
Basic Clinical Pharmacokinetics
Lippincott Williams & Wilkins, http://www.lww.com This text discusses the basic principles of pharmacokinetics especially interpretation and implications of plasma concentrations. The second section of the book provides monographs and discussions focused on drugs most commonly assessed by blood concentration levels.
Applied Biopharmaceutics and Pharmacokinetics
McGraw-Hill Professional, http://www.mcgraw-hill.com This text describes the role of pharmacokinetics as it relates to drug development and to patient care. This covers the clinical application of pharmacokinetics and also addresses the impact of pharmacogenetics on drug metabolism. This text is also included in the Access Pharmacy™ electronic subscription.
Goodman & Gilman’s: The Pharmacological Basis of Therapeutics
McGraw-Hill Professional, http://www.mcgraw-hill.com This classic pharmacology text also provides information about pharmacokinetics and pharmacodynamics of a number of drugs. The focus of the resource is to provide a correlation between principles of pharmacology and contemporary clinical practice. The text makes extensive use of charts and tables to convey information. This text is also included in the Access Pharmacy™ electronic subscription.
Basic & Clinical Pharmacology
McGraw-Hill Professional, http://www.mcgraw-hill.com This text, organized by therapeutic class of agents, provides general discussion of pharmacology principles as well as more detailed discussion of specific agents. Figures and tables are frequently used to illustrate difficult material. This text is also included in the Access Pharmacy™ electronic subscription.
Brody’s Human Pharmacology: Molecular to Clinical
Elsevier, http://www.elsevier.com This text is designed with a student focus and emphasizes therapeutic impact of pharmacology. The text is organized by organ system impacted. The text also has accompanying mobile device downloads and Internet updates.
Modern Pharmacology with Clinical Applications
Lippincott Williams & Wilkins, http://www.lww.com This textbook is focused on the clinical application of drugs. The text has moved away from an emphasis on chemical structures to an emphasis on structure-activity relationships. This text also includes information on some common dietary supplements.
Information about individual state pharmacy law is best obtained through the individual state boards of pharmacy. A listing of state board Web site URLs is available at http://www.nabp.net/boards-of-pharmacy/. Often the Board will have this information available in PDF format on the Web site. The Code of Federal Regulations containing aspects of federal laws is available at http://www.gpoaccess.gov/cfr/index.html. One general text about federal law is listed below.
Pharmacy Practice and the Law
Jones and Bartlett Publishers, http://www.jblearning.com This resource contains information about federal laws and regulations impacting pharmacy practice. Additional implications for pharmacy practice are provided for some legislation. Information is provided about federal and state regulation of product development, dispensing, and development. Various summaries of case law are provided. Additionally information regarding Internet pharmacies and electronic transmission of prescriptions has been added.
Drugs in Pregnancy and Lactation
Lippincott Williams & Wilkins, http://www.lww.com As the title implies, this text (often referred to as Brigg’s) focuses exclusively on information available about the use of medications in pregnant or lactating women. Summaries of the literature available regarding fetal exposure in utero or exposure through breast milk are provided. Animal literature is provided in cases where human literature is lacking. Additional information about recommendations by organizations such as the American Academy of Pediatrics is provided.
Catalog of Teratogenic Agents
Johns Hopkins University Press, http://www.press.jhu.edu This resource covers pharmaceuticals, chemicals, environmental pollutants, food additives, household products, and viruses and their possible teratogenicity. Special attention has been paid to including the international as well as domestic information.
Case Study 3–2
A new mother has been breast-feeding her child for 3 months. The mother has recently been prescribed levofloxacin for treatment of an infection.
• What sources should be consulted to determine the appropriateness of this choice?
• Is it safe for her to continue breast-feeding during this therapy?
• What additional information is needed to answer this patient’s question?
THERAPY EVALUATION/DRUG OF CHOICE
Applied Therapeutics: The Clinical Use of Drugs
Lippincott Williams & Wilkins, http://www.lww.com This text includes information about disease states and treatment options. Information is presented in the form of cases with follow-up discussion. Its focus is on clinical case–based presentation of information. There is also a pocket-sized handbook designed to accompany the text. This print resource is updated every few years and comes with a CD-ROM. A version is also available for use on a mobile device.
Saunders, http://www.us.elsevierhealth.com This text is available in print, CD-ROM, mobile device, and Internet (http://www.cecilmedicine.com) formats. Information is organized by disease state and color-coded to speed usage. Information about etiology, manifestations, diagnosis, treatment, and prognosis is provided.
Harrison’s Principles of Internal Medicine
McGraw-Hill Professional, http://www.mcgraw-hill.com This text serves as a fairly comprehensive introduction to clinical medicine. It is available in text and electronic formats. Comprehensive information is presented including pathophysiology, differential diagnosis, and disease management. This text is also included in the Access Pharmacy™ electronic subscription.
The Merck Manual of Diagnosis and Therapy
Merck & Co., Inc., http://www.merck.com This source provides a quick summary of disease state information, including pathology, symptoms, diagnosis, and treatment. This resource is also available online as a free resource at http://www.merckmanuals.com/, and mobile device version.
Medscape, http://www.medscape.com This electronic resource provides extensive information about disease states and conditions. It includes news and updates on treatment. In addition, it includes basic monographs about prescription and OTC medications.
Pharmacotherapy: A Pathophysiological Approach
McGraw-Hill Professional, http://www.mcgraw-hill.com This text focuses on the management of a variety of disease states. Information provided about disorders include epidemiology, etiology, presentation of disease, treatment, and treatment outcomes. This is available in text and electronic formats. This resource also has accompanying texts: Pharmacotherapy Casebook: A Patient-Focused Approach and Pharmacotherapy Handbook. These texts are also included in the Access Pharmacy™ electronic subscription.
Pharmacotherapy Principles and Practice
McGraw-Hill Professional, http://www.mcgraw-hill.com This text focuses on the management of a variety of disease states, centering on the diseases most likely to be seen by pharmacists, nurse practitioners, and physician assistants. It is more concise than Pharmacotherapy: A Pathophysiological Approach and is focused on diseases most likely to be seen in practice, including community pharmacy; it also contains various features to help student learning. Information provided about disorders include epidemiology, etiology, presentation of disease, treatment, and treatment outcomes. This is available in text and electronic formats. This resource also has accompanying text: Pharmacotherapy Principles and Practice Study Guide.
Lippincott, Williams and Wilkins, http://www.lww.com PDA, CD-ROM, and print versions of this resource are available. While the resource focuses on treatment of disease states and development of a therapeutic plan, sections regarding pathophysiology and clinical presentation are also provided.
Casarett & Doull’s Toxicology: The Basic Science of Poisons
McGraw-Hill Professional Medical Publishing, http://www.mcgraw-hill.com This resource is designed to serve as a textbook rather than a quick resource for toxicology information. Extensive information is provided regarding organ- and nonorgan-directed toxicity. This text is also included in the Access Pharmacy™ electronic subscription.
Goldfrank’s Toxicologic Emergencies
McGraw-Hill Professional Medical Publishing, http://www.mcgraw-hill.com This text is designed to offer a case study approach to toxicology. Initial basic toxicology data are provided, but the majority of this text focuses on management of toxicologic emergencies with a variety of common drugs, botanicals, pesticides, and other occupational or environmental hazards.
Case Study 3–3
A pharmacy student is working on a presentation involving illicit drugs. She knows that there have been recent news stories about adolescents using Coricidin™ products for recreational use, and she is curious at what doses these products are toxic.
• Which resources would be useful for her project?
• What search terms might she utilize?
Veterinary pharmacy as a specialty practice is a growing area in the United States, and pharmacists are interested in obtaining veterinary specific knowledge and skills. The growth in veterinary pharmacy has allowed pharmacists to apply their drug knowledge resources to veterinary situations.
Supporting the growth of veterinary pharmacy is the concept of “One Medicine,” a blending of veterinary medicine and human medicine for the benefit of public health, and to better serve human and animal patients alike. From a clinical pharmacy perspective, veterinary medicine and human medicine complement each other, with the human-trained pharmacist being uniquely positioned to educate and serve veterinarians and animal owners.
Opportunities for the practical application of One Medicine can occur in community pharmacy settings as most pharmacists practicing in a community setting have been presented with prescriptions for animal patients at some time during the course of their career. Veterinarians outsource prescriptions to community pharmacists to help control inventory, high drug costs, and the need for compounded drug therapies. The use of human-labeled pharmaceuticals prescribed in an off-label manner to treat companion animal disease states is a viable option for veterinary medicine. These factors contribute to a situation where pharmacists who receive veterinary prescriptions can be challenged in their knowledge of veterinary drugs, indications, dosages, disease states, and therapeutic monitoring parameters.
Plumb’s Veterinary Drug Handbook
Wiley-Blackwell Publishing, http://www.wiley.com/wiley-blackwell This resource is considered one of the most useful references for extra-label drug dosages, indications, and specific drug information on human and veterinary labeled pharmaceuticals. Monographs are listed in alphabetical order, and categorize the drugs’ chemistry, pharmacology, indications, species dosing, contraindications, and interactions into an easily identifiable format. It is often referred to as “The Virus” in veterinary medicine because it is everywhere. A client information booklet is also available.
Textbook of Veterinary Internal Medicine
Saunders, http://www.us.elsevierhealth.com This is a practical, valuable, and informative two-volume resource, focusing on internal medicine topics in canines and felines. The text provides extensive coverage of pathophysiology, diagnosis, and treatment of diseases affecting dogs and cats.
Compendium of Veterinary Products (CVP)
North American Compendiums, http://naccvp.com This online reference is similar to the human PDR in terms of information provided and format. The resource contains the product monographs for over 5000 FDA-approved pharmaceuticals, USDA-approved biologicals, diagnostic, feed additive, and Environmental Protection Agency (EPA)-approved pesticide products that are currently available. The reference contains indexes of manufacturers and distributors, brand name/ingredient indexes, and product category indexes.
http://www.fda.gov/AboutFDA/CentersOffices/OfficeofFoods/CVM/default.htm This Web site provides information for pharmacists about the legal or regulatory issues that affect the practice of veterinary pharmacy or veterinary medicine. It is useful for regulatory issues pertaining to animal health. The compliance policy guide (CPG 608.400) “Compounding of Drugs for Use in Animals” and the Animal Medicinal Drug Use Clarification Act (AMDUCA) can be found at this site; these documents are considered essential reading for any pharmacist who practices veterinary pharmacy. Center for Veterinary Medicine (CVM) updates are available that detail the prohibited use of drugs in certain animal populations. Updates on the judicious use of antibiotics in food producing animals are posted at this site. A listing of all FDA-approved animal drug products, also known as the “Green Book,” is available and searchable at this site. Patent information, manufacturer lists, indications, approval numbers, general drug information, code of regulations, and trade/generic names are just a few pieces of information that can be gathered from this Web site. Practitioners can also access the FDA Veterinarian Newsletter from this site.
American Veterinary Medical Association, Scientific Reference Material on Veterinary Compounding
The American Veterinary Medical Association (AVMA) has a wealth of information for pharmacists and veterinarians alike (http://www.avma.org). There is a collection of valuable veterinary compounding guidelines, brochures, federal regulations, frequently asked questions, definitions of compounding, and the AVMA compounding position statements at https://www.avma.org/KB/Resources/Reference/Pages/Compounding.aspx. This information is an excellent starting point for any health care professional wishing to prescribe, provide, or utilize compounded drug products for animal patients.
Animal Poison Control Center
The Web site, http://www.aspca.org/pet-care/poison-control/, focuses on animal toxicology and safety and is the premier resource for pharmacists in a community setting who may receive poisoning questions about animals. A toll-free number is available for immediate assistance when faced with a toxicology problem (888-426-4435), and a fee is required. The center has extensive experience in assisting veterinarians in poison management by providing immediate and specific treatment recommendations. The site also provides useful information on poison prevention, human medications that are poisonous to pets, and guidance on what to do if a pet is poisoned. References to toxicology publications and general consultation are listed in this Web site.
Veterinary Pharmacology and Therapeutics
Wiley-Blackwell, http://www.wiley.com This textbook provides comprehensive information on the basic and applied principles of veterinary pharmacology and therapeutics. Information on mechanisms of action, pharmacodynamics, and pharmacokinetics is detailed.
Small Animal Clinical Pharmacology and Therapeutics
Saunders Ltd., http://www.elseiver.com A useful pharmacology reference textbook focusing on pharmaceuticals for the prevention and treatment of small animal diseases. The book is divided into three sections detailing principles of drug therapy with special attention to clinical relevancy, the use of drugs from a categorical basis, and pharmaceutical use from a body systems approach.
The Merck Veterinary Manual (MVM)
Merck & Co., Inc., http://www.merck.com The manual has served veterinarians and other health care professionals as a concise and reliable animal health reference for over 45 years. The full-text electronic version is available for free online at http://www.merckvetmanual.com. A guide to abbreviations used in veterinary medicine is also included.
The Web site, http://www.petplace.com, has pet centers focusing on different species (dog, cat, bird, horses, fish, reptiles, and small mammals) and is written for laypersons. The database includes articles on veterinary disease states and preventative medicine. The drug library search tool allows the user to find drug information on a specific pharmaceutical. There are also text and graphics describing medication administration techniques for dogs and cats.
The Web site, http://www.petdiabetes.com, contains information on diabetes in small animals particularly dogs and cats. The Web site offers general diabetes education and drug information and is written for laypersons. The site also offers insight into and information on home testing and complications. There are also resources to support owners of diabetic animals.
American Veterinary Medical Association (AVMA)
From this site, http://www.avma.org/, pharmacists can read about the latest developments in One Medicine, public health issues affecting human and veterinary patients, peer-reviewed journal articles, and legal/regulatory issues and recent developments in veterinary medicine. The site provides numerous links organized by discipline for locating information. Under the scientific resources tab, there is a resource titled Veterinary Therapeutics that is valuable for educating veterinary pharmacists about current therapeutics issues in veterinary medicine.
Case Study 3–4
You have an appointment to discuss compounding services with a local veterinarian. Your pharmacy has just begun offering these services and in the dialog the veterinarian references AMDUCA. You have not heard of this.
• What is your strategy to find the meaning and relevance of this term?
SELECTING A FORMAT FOR TERTIARY RESOURCES
Pharmacists should also be aware that more resources are becoming available in a variety of formats. Many resources that have been traditionally available only in a paper text are now accessible via a variety of electronic formats. Electronic resources are often preferred because they may be easier to use, allow quicker access to information, allow multiple searches to be performed simultaneously, and often contain the most recent information available regarding a topic. Additionally, many electronic networked resources allow use of the same resource at more than one location. This lets many practitioners access information from a variety of physical locations rather than being restricted to only medical libraries or drug information centers.
Many texts are now being combined into electronic packages, for example, the McGraw-Hill Professional product AccessPharmacy® (http://www.accesspharmacy.com/index.aspx). The combination of multiple resources in one package may make selection of resources for a practice site much easier, but also more costly. As these combination packages increase in popularity with students and universities the expectations practitioners have for access to resources in work settings will also likely continue to increase.
REFERENCES FOR MOBILE DEVICES
The increasing incorporation of mobile devices into clinical practice settings has prompted an expanding choice of drug information databases for that medium. As described earlier in the chapter, many of the major compendia available electronically also offer a product for a mobile device. It is important to recognize that the information available in an app version of a database may differ from that available in the online or hardcopy forms.86 One study looking specifically at dietary supplements databases highlighted some of the variations which may exist between different forms of the same resource.87 While the specific functionality of an app and the way that one accesses information for most apps may change, the information is generally similar. Due to factors such as cost and memory requirements practitioners must be judicious in their selection of databases to purchase for a mobile device.
A limited number of critical evaluations of these databases have been performed to aid in the selection of the highest quality databases.43,88-89 Based on the limited data available Lexicomp, ePocrates, and Clinical Pharmacology OnHand appear to be among the best quality PDA drug information databases available at the time of these studies. One additional study90 evaluating the efficacy of PDA databases specifically for addressing drug interaction information found slightly different results from previous studies but did find Lexi-Interact to be one of the top performers, in addition to iFacts™ (http://www.skyscape.com).
Lexicomp provides access to excerpts from AHFS, the Lexicomp products, and Stedman’s medical dictionary (http://www.ahfsdruginformation.com/products.aspx).
In general, it should be noted that some of the utility of mobile device apps is the ability to embed links to additional content and resources. This can be a very useful feature especially for students.