2–2: Appendix 2–2 Examples of Questions for Obtaining Background Information from Requestors

^∗Originally prepared by Craig Kirkwood

Regardless of the type or classification of the question, the following information should be obtained:

1. The requestor’s name

2. The requestor’s location and/or page number

3. The requestor’s affiliation (institution or practice), if a health care professional

4. The requestor’s frame of reference (e.g., title, profession/occupation, rank)

5. The resources the requestor has already consulted

6. If the request is patient-specific or academic

7. The patient’s diagnosis and other medications

8. The urgency of the request (negotiate time of response)

The following are examples of questions that can be asked to clarify the initial query and elicit pertinent background information. Please note that this Appendix addresses selected categories of queries and lists only a sampling of questions that can be posed to the requestor (i.e., it is not a comprehensive list).

Availability of Dosage Forms

1. What is the dosage form desired?

2. What administration routes are feasible with this patient?

3. Is this patient alert and oriented?

4. Does the patient have a water or sodium restriction?

5. What other special factors regarding drug administration should be considered?

Identification of Product

1. What is the generic or trade name of the product?

2. Who is the manufacturer? What is the country of origin?

3. What is the suspected use of this product?

4. Under what circumstances was this product found? Who found the product?

5. What is the dosage form, color markings, size, etc.?

6. What was your source of information? Was it reliable?

General Product Information

1. Why is there a particular concern for this product?

2. Is written patient information required?

3. What type of information do you need?

4. Is this for an inpatient, outpatient, or private patient?

Foreign Drug Identification

1. What is the drug’s generic name, trade, manufacturer, and/or country of origin?

2. What is the dosage form, markings, color, strength, or size?

3. What is the suspected use of the drug? How often is the patient taking it? What is the patient’s response to the drug? Is the patient male or female?

4. If the medication was found, what were the circumstances/conditions at the time of discovery?

5. Is the patient just visiting, or are they planning on staying?

Investigational Drug Information

1. Why do you need this information? Is the patient in need of the drug or currently enrolled in a protocol?

2. If a drug is to be identified, what is the dosage form, markings, color, strength, or size of the product?

3. Why was the patient receiving the drug? What is the response when the patient was on the drug? What are the patient’s pathological conditions?

4. If a drug is desired what approved or accepted therapies have been tried? Was therapy maximized before discontinued?

Method and Rate of Administration

1. What dosage form or preparation is being used (if multiple salts available)?

2. What is the dose ordered? Is the drug a one-time dose or standing orders?

3. What is the clinical status of the patient? For example, could the patient tolerate a fluid push of [ ] mL? Is the patient fluid or sodium restricted? Does the patient have CHF or edema?

4. What possible delivery routes are available?

5. What other medications is the patient receiving currently? Are any by the same route?

Incompatibility and Stability

1. What are the routes for the patient’s medications?

2. What are the doses, concentrations, and volumes for all pertinent medications?

3. What are the infusion times/rates expected or desired?

4. What is the base solution or diluent used?

5. Was the product stored and handled appropriately, based on requirements?

6. When was the product compounded/prepared?

Drug Interactions

1. What event(s) suggest that an interaction occurred? Describe.

2. For the drugs in question, what are the doses, volumes, concentrations, rate of administration, administration schedules, and length of therapies?

3. What is the temporal relationship between the drugs in question?

4. Has the patient received this combination or a similar combination in the past?

5. Other than the drugs in question, what other drugs is the patient receiving currently? When were these started?

Drug-Laboratory Test Interference

1. What event(s) suggest an interaction occurred? Describe.

2. For the drug in question, what is the dose, volume, concentration, rate of administration, administration schedule, and length of therapy?

3. What is the temporal relationship between drug administration and laboratory test sampling?

4. What other drugs is the patient receiving?

5. Has clinical chemistry (or the appropriate laboratory) been contacted? Are they aware of any known interference similar to this event?

6. Was this one isolated test or a trend in results?

Pharmacokinetics

1. Which product (e.g., drug, dose, brand) is being used?

2. What is the dose and route of the drug?

3. What is the patient’s age, sex, height, and weight?

4. What are the disease being treated and the severity of the illness?

5. What is the patient’s hepatic and renal function?

6. What other medications is the patient receiving?

7. What physiologic conditions exist (e.g., pneumonia, severe burns, or obesity)?

8. What are the patient’s dietary and ethanol habits?

Therapeutic Levels

1. Is the patient currently receiving the drug? Have samples already been drawn? At what time?

2. What is the disease or underlying pathology being treated? If infectious in nature, what is the organism suspected/cultured?

3. If not stated in the question, what was the source of the sample (blood, urine, saliva; venous or arterial blood)?

4. What was the timing of the samples relative to drug administration? Over what period of time was the drug administered and by what route?

5. What were the previous concentrations for this patient? Was the patient receiving the same dose then?

6. How long has the patient received the drug? Is the patient at steady state?

Therapy Evaluation/Drug of Choice

1. What medications, including doses and routes of administration, is the patient receiving?

2. What are the patient’s pathology(ies) and disease(s) severity?

3. What are the patient’s specifics: age, weight, height, gender, organ function/dysfunction?

4. Has the patient received the drug previously? Was the response similar?

5. Has the patient been adherent?

6. What alternative therapies has the patient received? Was therapy maximized for each of these before discontinuation? What other therapies are being considered?

7. What monitoring parameters have been followed (serum concentrations/levels, clinical status, other clinical lab results, objective measurements, and subjective assessment)?

Dosage Recommendations

1. What disease is being treated? What is the extent/severity of the illness?

2. What are the medications (all) being prescribed? Has the patient been adherent?

3. Does the patient have any insufficiency of the renal, hepatic, or cardiac system?

4. For drugs with renal elimination, what are the serum creatinine/creatinine clearance, blood urea nitrogen (BUN), and/or urine output? Is the patient receiving peritoneal dialysis or hemodialysis?

5. For drugs with hepatic elimination, what are the liver function tests (LFTs), bilirubin (direct and indirect), and/or albumin?

6. For drugs with serum level monitoring utility, characterize the most recent levels per timing relative to dose and results.

7. Are these lab values recent? Is the patient’s condition stable?

8. Does this patient have a known factor that could affect drug metabolism (ethnic background or acetylator status)?

Adverse Events

1. What are the name, dosage, and route for all drugs currently and recently prescribed?

2. What are the patient specifics (age, sex, height, weight, organ dysfunction, and indication for drug use)?

3. What is the temporal relationship with the drug?

4. Has the patient experienced this adverse relationship (or a similar event) with this drug (or similar agent) previously?

5. Was the suspected drug ever administered before? Why was it discontinued then?

6. What were the events/findings that characterize this adverse drug reaction (include onset and duration)?

7. Has any intervention been initiated at this time?

8. Does the patient have any food intolerance?

9. Is there a family history for this ADR and/or drug allergy?

Toxicology Information

1. What is your name, relationship to the patient, and telephone number?

2. What are the patient specifics (age, sex, height, weight, organ dysfunction, and indication for drug use)?

3. Is this a suspected ingestion or exposure?

4. What is the product suspected to have been ingested? What is the strength of the product and the possible quantity ingested (e.g., how much was in the bottle)?

5. How long ago did the ingestion occur?

6. How much is on the patient or surrounding area?

7. How much was removed from the patient’s hands and mouth? Was the ingestion in the same room where the product was stored?

8. What has been done for the patient already? Has the poison control center or emergency department been called?

9. Do you have syrup of ipecac available (only if recommended by a poison control center)? Do you know how to give it properly?

10. What is the patient’s condition (sensorium, heart rate, respiratory rate, temperature, skin color/turgor, pupils, sweating/salvation, etc.)?

11. Does the patient have any known illnesses?

Teratogenicity/Drugs in Pregnancy

1. What is the drug the patient received and what was the dose? What was the duration of therapy?

2. Is the patient pregnant or planning to become pregnant?

3. When during pregnancy was the exposure (trimester or weeks)?

4. What are the patient specifics (age, height, weight, sex)?

5. Was the patient adherent?

6. For what indication was the drug being prescribed?

Drugs in Breast Milk/Lactation

1. What is the drug the patient received and what was the dose? What was the duration of therapy?

2. How long has the infant been breast-feeding?

3. Has the infant ever received nonmaternal nutrition? Is bottle feeding a plausible alternative?

4. What is the frequency of the breast feeds? What is the milk volume?

5. How old is the infant?

6. Does the mother have hepatic or renal insufficiency?

7. What was the indication for prescribing the drug? Was this initial or alternate therapy?

8. Has the mother breast-fed previously while on the drug?