Drug Information Resources for the Community Pharmacist

Release Date:  February 1, 2009

Expiration Date: February 28, 2011

FACULTY:

Emily M. Ambizas, PharmD
Assistant Clinical Professor St. John’s University, Queens, New York
Clinical Specialist, Rite Aid Pharmacy

Whitestone, New York

Danielle C. Ezzo, PharmD, BCPS
Assistant Clinical Professor St. John’s University, Queens, New York
Clinical Coordinator of Ambulatory Care
Long Island Jewish Medical Center

New Hyde Park, NY

Priti N. Patel, PharmD, BCPS
Assistant Clinical Professor
Director, Drug Information Center
St. John’s University

Queens, New York

FACULTY DISCLOSURE STATEMENTS:

Drs. Ambizas, Ezzo, and Patel have no actual or potential conflicts of interest in relation to this program.

U.S. Pharmacist does not view the existence of relationships as an implication of bias or that the value of the material is decreased. The content of the activity was planned to be balanced, objective, and scientifically rigorous. Occasionally, authors may express opinions that represent their own viewpoint. Conclusions drawn by participants should be derived from objective analysis of scientific data.

ACCREDITATION STATEMENT:

Pharmacists

acpePostgraduate Healthcare Education, LLC is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.
UAN: 430-000-09-002-H04-P; 430-000-09-002-H04-T
Credits: 2.0 hours (0.20 ceu)

Type of Activity: Knowledge

TARGET AUDIENCE:

This accredited activity is targeted to pharmacists and pharmacy technicians. Estimated time to complete this monograph and posttest is 120 minutes.

Exam processing and other inquiries and booklet orders to:
CE Customer Service (800) 825-4696

DISCLAIMER:

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patients’ conditions and possible contraindications or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

GOAL:

To briefly review various drug information resources available to the community pharmacist and to be able to identify appropriate resources when answering drug information queries.

OBJECTIVES: 

After completing this activity, participants should be able to:

  1. Discuss the differences between primary, secondary, and tertiary resources.*
  2. Compare and contrast various tertiary resources.*
  3. Identify appropriate resources when given a drug information question.*
  4. List ways that pharmacists and pharmacy technicians can keep up to date with health care changes.*
*Also applies to pharmacy technicians

With the expanding role of pharmacists, drug information evaluation and retrieval have become skills essential to the profession. One of the competencies that current doctor of pharmacy (PharmD) graduates must achieve includes the ability to “retrieve, analyze, and interpret the professional, lay, and scientific literature to provide drug information and counseling to patients, their families or care givers, and other involved health care providers.”1 In practicing patient care, all pharmacists have the responsibility to be effective drug information providers.

With the development of new drugs and the advancement of medication therapy, it has become very difficult for pharmacists and other health care professionals to keep abreast of all these changes. Furthermore, patients are continually becoming more involved with their health care by retrieving information independently. Many providers and patients prefer to direct their health/medication-related questions to their community pharmacists because these professionals are accessible to the public. Although pharmacists may not always have the answer to every question, they should know how to approach a question and where to locate this information.

The community pharmacist is asked an array of questions every day. The most common questions are related to dosage and administration, adverse effects, drug interactions, pharmacotherapy, and disease management, including the use of nonprescription medications and dietary supplements.2 In the research for appropriate recommendations, there is an assortment of drug information resources to choose from. Knowing the most appropriate resource to use in each situation and how to effectively use those tools will increase the likelihood of answering each particular question completely and efficiently.3

There are three categories of drug information resources based upon their proximity to the original source of information: primary, secondary, and tertiary. Primary resources are considered the raw material created and written by an individual, a team, or organization. Once published, this information serves as the basis for secondary sources, which professionally index such studies into a database. Tertiary sources are a compilation of the primary and secondary sources and tend to be factual in nature.4

PRIMARY RESOURCES

Primary drug information resources include randomized, controlled trials; cohort studies; case reports; and others. This type of resource is considered to be the most current source of information and forms the basis for the practice of evidence-based medicine, which is defined as the conscientious, explicit, and judicious use of current best evidence along with clinical expertise and patients’ values in making clinical decisions about the care of individual patients.5 Some examples of primary literature that may be of interest may be found in pharmacy-related journals such as Pharmacotherapy, The Annals of Pharmacotherapy, Journal of the American Pharmacists Association, and American Journal of Health-System Pharmacists and medical journals including the New England Journal of Medicine, Journal of the American Medical Association, Lancet, and British Medical Journal.

Advantages to the use of primary drug information resources include the ability to read details about the individual studies, such as design, demographics, and statistical analysis, and assess the validity of the study results. In addition, primary literature is the most up-to-date information available; however, there are some disadvantages to the use of primary resources. First, the outcomes and conclusions made in these resources may be misleading as they are based upon a single clinical trial. Second, the reader must be familiar with the process of evaluating pharmacy and medical literature, and last, readers must dedicate much time to review the vast amount of available primary literature.3

SECONDARY RESOURCES

Secondary resources serve as gateways to primary drug information resources. These include indexing services, which provide bibliographic citation information, and abstracting services, which—along with the bibliographic citation information—provide a brief synopsis of each article. Most of these services are available in an electronic format. These databases will search literature from various journals, meetings, and publications.3 Some of the more commonly used secondary resources include MEDLINE/PubMed, the Cochrane Database of Systematic Reviews, the Iowa Drug Information Service (IDIS), and International Pharmaceutical Abstracts (IPA). When utilizing these resources, there are some challenges to keep in mind. Search techniques are not the same for all databases, requiring the user to be familiar with each of the various information sources.

TERTIARY RESOURCES

Tertiary drug information resources, which summarize and interpret the primary literature, are the most common types of references that the community pharmacist will utilize. They are a good starting point when researching a drug information question, as they are excellent sources for gaining an understanding of a new topic. Tertiary resources may include textbooks, review articles, and other general data, including information found on the Internet.

As with all types of information, tertiary resources have advantages and disadvantages. Some advantages include ease of use, convenience, and conciseness; however, disadvantages include the lag time associated with publication, which may be as long as one to two years. It is possible that some of the information may be outdated, particularly if new guidelines or new material has been released since the time of publication of the reference. Another consideration is that the information provided may be incomplete due to space limitations or because of incomplete literature searches performed by the author(s) of the material.

Important characteristics of tertiary sources that one should consider when utilizing these resources are the expertise of the author, purpose of the book, edition and year of publication, references cited, ease of use, and format in which the information is being obtained. Common tertiary resources that the community pharmacist will find useful will be reviewed in detail.

Drug Facts and Comparisons (F&C): This is one of the drug information resources best known by pharmacists.6 Although it is available in many different formats (i.e., bound books, CD-ROM, Web access), the most common source utilized is the loose-leaf binder that offers monthly updates to provide the most recent FDA-approved and off-label information regarding prescription and OTC medications. Information in F&C is organized by therapeutic topic, and use of the index is necessary in order to function within this reference. F&C utilizes helpful summary and comparison tables in order to facilitate easy comparison of products within the same class. For example, this reference would be useful when comparing oral contraceptives and their active ingredients.

American Hospital Formulary Service (AHFS) Drug Information: This resource is published by the American Society of Health-System Pharmacists, and it provides data on FDA-approved and off-label uses of prescription medications, similarly to F&C.7 The difference between the two references is that AHFS Drug Information provides more detailed information with evidence-based support, especially for a drug’s off-label use. This is one of AHFS’s biggest advantages over other tertiary references. AHFS is published annually, but it is also available as a Web-based reference and for personal digital assistants (PDAs). The text is organized by pharmacologic classes, requiring an index to search information efficiently.

USP Dispensing Information (USP DI): For years, the USP DI has been a common resource utilized by community pharmacists. This reference includes three volumes: I. For the Healthcare Professional; II. Advice for the Patient (in lay language); and III. Approved Drug Products and the Legal Requirements.8-12 Volume I provides the reader with drug monograph information. It is an unbiased source of drug information reviewed by a multidisciplinary team. Volume II offers information that may be useful during patient counseling; however, it is important to note that the information is written at a 12th-grade reading level, which may not be appropriate for all patients. Volume III contains therapeutic equivalency information (Orange Book), guidelines for the packaging, labeling, and storage of medications, and legal requirements for the dispensing of drugs. This three-volume set has been published annually, but beginning in 2008 this series will only be available online and as a PDA program. Volumes I and II have been renamed Drug-Points and Detailed Drug Information for the Consumer, respectively. New features in DrugPoints include evidence-based medicine ratings of indications, a new toxicology section, a feature on black box warnings, and images.

Drug Information Handbook: Lexi-Comp’s Drug Information Handbook is one of the most compact text references available for pharmacists.13 This resource contains abbreviated monographs on prescription medications and is well known for its useful charts and comparison tables. It is easy to use and is organized in alphabetical order according to a drug’s generic name. The handbook provides useful information when looking for a quick response to a simple drug information request, such as indications, dosages, general adverse effects, and drug interactions. The main disadvantage to this reference is its conciseness, which results in the elimination of some details from the monographs. The Drug Information Handbook provides an updated edition annually to include new drugs and updates to current medications. Lexi-Comp has also published many supplementary additions to the original Drug Information Handbook for specific specialties, such as pediatrics, geriatrics, and oncology.

Physicians’ Desk Reference (PDR): The PDR is a compilation of drug package inserts.14 It does not include all prescription medications because of space limitations. A new PDR is published every year; however, it is important to note that the information may not be updated with each annual publication. It is also important to note that only FDA-approved indications and dosages can be found within the PDR.

Red Book: The Red Book is an extremely useful tool when inquiring about dosage forms, package sizes, average wholesale price (AWP), and manufacturers’ contact information.15 It also contains poison control center numbers and a list of sugar-free and alcohol-free medications. The reference is published annually and contains useful tables to assist in finding information.

Educational Textbooks: Textbooks of therapeutics are a staple of pharmacy education. Two popular examples are Pharmacotherapy: A Pathophysiologic Approach and Applied Therapeutics: The Clinical Use of Drugs.16,17 Pharmcotherapeutic textbooks provide a general overview of disease state topics and include patho-physiology, epidemiology, and treatment approaches. These textbooks are most useful when an overview of a disease state is necessary.

Nonprescription Medications and Self-Care

On a daily basis, community pharmacists will encounter questions regarding self-care using nonprescription drugs. Pharmacists should be prepared to handle these questions.

Handbook of Nonprescription Drugs: The Handbook of Nonprescription Drugs has a similar design to Pharmacotherapy: A Pathophysiologic Approach and Applied Therapeutics: The Clinical Use of Drugs with regard to topic review.18 This resource covers an overview of therapeutic topics specifically designed for self-treatable conditions. Therapeutic topics are reviewed for self-treatable conditions and treatment options are discussed. Community pharmacists will find this reference particularly useful, especially since they are the health care professionals who a patient may approach first.

PDR for Nonprescription Drugs, Dietary Supplements and Herbs: In this resource, products are arranged by therapeutic category and indication.19 It provides a brief description about each therapeutic condition as well as basic information regarding nonprescription products for treatment. The information is organized into charts, allowing for easy comparison of name, strength, and dosage of various products.

Herbal Medicines and Dietary Supplements

Herbal products are being used increasingly in the United States. In 1997, 12.1% of U.S. adults reported using herbal products.20 As of 2002, this number had increased to 18.6%.20 Because of this increased use and awareness, more patients are asking pharmacists about these products. Up to 50% of questions posed to pharmacists are related to herbal products and dietary supplements.21,22

Natural Medicines Comprehensive Database: This is one of the most comprehensive and useful resources available for herbal and natural medicines.23 Available online, in print, and as a PDA program, it contains evidence-based referenced ratings on the efficacy and safety of both botanical and nonbotanical products. Users can search by the ingredient name or the brand name of the product in question. Combination products, which can be linked to monographs for each individual ingredient using the online version, are also included. Each supplement monograph also provides a list of USP-verified products.

The patient handouts provided are unique in that they are in question-and-answer format. The online version also allows for searches using disease states and includes a place to perform potential drug-supplement interaction reviews. The online version is especially useful because it is frequently updated, while the print version is published once annually.

PDR for Nonprescription Drugs, Dietary Supplements and Herbs: This resource contains information on select herbal and natural medicines; however, the data may be limited as this publication focuses largely on nonprescription drugs rather than the herbal products.19 The information provided can be used for a quick, at-a-glance view, but may not be enough to use to make a clinical decision about therapy.

Natural Standard: This is a peer-reviewed online resource that offers an evidence-based rating system of efficacy for various uses of each product.24 Each monograph provides brief details about each study in user-friendly charts. The user is given in-depth information that is useful in clinical decision making. The book, abridged desktop, and PDA versions are available for individual purchase; however, the online version is only available for institutional subscription.

WEB-BASED RESOURCES

Tertiary references also include Internet-based resources. Some useful tertiary references that are Web-based include Micromedex, Clinical Pharmacology, and Lexi-Comp Online.

Micromedex: Micromedex is a popular Web-based resource.25 Using one search box, a clinician is able to search many different databases that include detailed and summarized drug information, toxicology, alternative medicine, and reproductive risk evaluation. Micromedex’s detailed information highlights Drugdex, PDR, and Martindale’s (for use in searching foreign medications). The toxicology information that is included with these resources is trademarked as Poisindex and Identidex. Poisindex identifies ingredients for commercial, biological, and pharmaceutical products and delivers summarized toxicology data. Identidex allows the pharmacist to identify a medication using its embossed lettering or numbering and other descriptive characteristics, such as color and shape. Other useful tools in this resource include a drug interaction reviewing tool, patient education leaflets for both prescription drugs and dietary supplements, and clinical calculators to help determine body mass index, ideal body weight, metric conversions, and others.

Clinical Pharmacology: Clinical Pharmacology is a Web-based application providing a vast array of information that is both thorough and practical.26 It has multiple functions, allowing users to obtain product information, view monographs, identify medications, and print patient education materials. The site also contains drug class overviews, various interactions (including drug–drug, drug–herbal, drug–nutritional, and drug–food interactions), and full-color product images.

Lexi-Comp Online: In addition to the compact handbook discussed above, Lexi-Comp also provides Web-based and PDA resources with annual subscriptions.27 Lexi-Comp Online offers a convenient way to search medications quickly and easily. Once a medication is searched, the user can scroll through various parts of the drug monograph using the simple drop-down menu. This allows the user to move from section to section with ease and speed. Other features included are a drug-interaction reviewing tool, patient education leaflets, a drug-identification database, lists of drug recalls and shortages, and recent drug news.

WEB SITES

The Internet is being increasingly used as a resource when answering drug information questions, and it is especially useful when timely information is required. While many reputable Web sites are useful for obtaining information, one should be aware that not all Web sites are reputable. Some things to assess when determining whether the information contained on a site is trustworthy include the authors of the information, financial support of the site, presence of misleading advertisements, and the frequency of updates. Due to the variable nature of information on the Internet, the Health on the Net Foundation has developed a list of principles that improve quality and reliability of health information. Submission of a Web site’s information to the foundation is voluntary, but if submitted and approved, the site may display its symbol, known as the HON code. A pharmacist can be more confident that the information on the site is reliable if this symbol is displayed. Detailed information regarding these principles can be found at http://www.hon.ch.

Food and Drug Administration: The FDA’s Web site is an important source of information regarding the most recent drug-related news, including drug approvals, recalls, and safety warnings.28 It is the home of MedWatch, the national adverse event reporting system (AERS). Users will also find the Orange Book with therapeutic equivalency codes at this site.

Centers for Disease Control and Prevention (CDC): The CDC Web site is an essential resource when looking for information regarding prevention and treatment of infectious diseases.29 There is an abundance of information to be found on topics regarding infectious disease, including annually updated immunization recommendations and scheduling, travelers’ health, and treatment guidelines for infectious diseases.

American Society of Health-System Pharmacists: One of the most useful aspects of this Web site is that it provides information about drug shortages, including recommendations for alternative treatments.30

Medscape: Medscape is a free Internet resource that provides health care professional–specific information. It is organized into sections by medical specialty, including one for pharmacists.31 The Web site provides numerous items of evidence-based information, including free access to some journals and many useful review articles.

SPECIAL POPULATIONS

There are several patient populations that require special attention when it comes to providing drug information. These populations include pediatric patients, geriatric patients, and pregnant and lactating women. The section below details some resources that may be useful when researching information on patients who fall into these categories.

Pediatrics

Medication use in children requires special attention. It is important to remember that children are not small adults, and that adult drug information may not necessarily apply to children. Bioavailability, pharmacokinetics, and pharmacodynamics may all differ in children as compared to the adult patient. Following the thalidomide tragedy of the 1960s, the FDA mandated that a specific section of every drug’s monograph address indications for children.32 As of 1994, 67% to 75% of all drugs approved by the FDA for adults were not approved for use in children.33 Since then, several FDA acts have been introduced to bridge this gap. This lack of information presents a dilemma for the pharmacist when dispensing medications that lack FDA approval for use in children. References that include off-label uses are very useful and essential to ensure proper dosage and use of medications in this patient population.

Some important definitions to know when researching pediatric information include premature (born before 37 weeks’ gestational age), neonate (between 1 day and 1 month of life), infant (1 month to 1 year of life), child (1 year to 11 years), and adolescent (12 to 16 years).34 For neonates born prematurely, there is more terminology to further categorize this population. These terms may be used to predict maturation of the gastrointestinal tract, the kidneys, and the liver in order to guide proper medication dosing. The gestational age indicates time from conception to the date of birth, the postnatal age signifies the number of days or weeks since birth, and the post-conceptional/postmenstrual age means the time from conception to the current date.

An additional difficulty encountered with pediatric patients is the frequent lack of suitable dosage forms. Some medications must be compounded into a formulation that can be administered to an infant or child. This may lead to questions regarding stability and bioavailability. Dosage guidelines for pediatric patients vary according to each drug. Some dosages are calculated by weight, while some are determined by body surface area.

When considering an inquiry about a pediatric patient, some important questions to ask may include the patient’s weight, height, and age (in weeks, months, or years, as appropriate). For neonates, it may be important to know the gestational age at which the patient was born, especially in the case of premature infants.

Many general tertiary references contain pediatric drug information, including F&C, AHFS, and Micromedex; however, the references listed below are specifically designed for pediatric patients.

NeoFax: This is the standard neonatal reference.35 Every drug is listed on one to two pages according to the class of medication to which it belongs. Most medication dosages include a chart of dosing according to the postmenstrual and postnatal age to indicate dosing interval. While NeoFax is used widely for neonates, the pharmacist must remember that as the neonate reaches a postconceptional age of 41 weeks, infant dosing now should be applied because of organ maturity.

The Harriet Lane Handbook: A Manual for Pediatric House Officers: This reference has been used for many years by the medical and pharmacy staff.36 It is a guide for pediatric therapy management that can be carried in a lab coat and includes useful tables and concise information, including dosage and administration of medications.

Pediatric Dosage Handbook: This is the most useful reference for dosing medications in children.37 Off-label uses are presented along with references supporting the recommended doses. Information on compounding extemporaneous preparations is provided. The information is concise and is based on the literature. It is also updated annually and has appendices for useful information about normal vital signs in children, medications that can be crushed, and the sugar content of medications that has to be accounted for in a child who is placed on a ketogenic diet.

Geriatrics

In terms of pharmacotherapy, the geriatric population is defined as persons aged 65 years and older. This population requires that special care be given to their medications for several reasons. First, most organ systems experience a decline in function as a person ages, often leading to reduced renal and hepatic function. This means that lower dosages or longer intervals are often recommended in older patients, and toxicity may occur more frequently. Second, since the older patient frequently has multiple disease states, polypharmacy is often encountered. This leads to the potential for numerous drug interactions, as well as problems with medication adherence.

When answering a drug information request involving a geriatric patient, some questions to ask may include the patient’s age, height, weight, concomitant medications, concomitant disease states, and renal and hepatic function.

Geriatric Dosage Handbook: The Geriatric Dosage Handbook is the geriatric version of the Drug Information Handbook.38 It is organized alphabetically by generic and brand names. Each drug monograph contains useful information on medication safety issues, availability of generic products, geriatric dosage, dosage in renal and hepatic impairment, and special geriatric considerations. Also useful is the large appendix at the end of the book, which contains drug comparison tables, methods for assessing renal function, management of diseases commonly seen in the geriatric population, and other helpful information.

Pregnancy

Drug use in pregnancy is one of the most difficult types of questions for a pharmacist to answer. One reason for this is the lack of adequate data. Research conducted in animals can give us information about the teratogenic effects of drugs; however, it is often difficult to apply these data to humans. Most human data come from case reports and epidemiologic studies and not from clinical trials due to the ethical dilemma that type of study would pose.39

Another reason these questions are difficult to answer is that not all adverse effects to the fetus are easy to identify. Some effects are physical and easily seen, such as anatomic malformations. Behavioral and functional problems are much more difficult to see and quantify, especially those that do not manifest until a child is older.

There are numerous aspects of drug use to consider during pregnancy.40 Physiologic changes in the mother, including gastric pH, increases in plasma volume, changes in hormone levels, and increased glomerular blood flow, can greatly influence drug pharmacokinetics. Other things to consider include the potential transfer of the drug through the placenta to the fetus, which may be affected by the drug’s molecular weight, maternal dose, protein binding, lipid solubility, and ionization at physiologic pH. Some information to obtain when answering a question about drug use in pregnancy includes which trimester the mother is in and the intended maternal dose.

Most general tertiary resources include information about drug use in pregnancy. The package insert will include the risk rating as assigned by the manufacturer. While the risk rating can offer some guidance, it is often too simplistic when evaluating an issue as complex as drug use during pregnancy.

Briggs’ Drugs in Pregnancy and Lactation: The most commonly used reference for pregnant and nursing women is Briggs’ Drugs in Pregnancy and Lactation.41 It is organized in alphabetical order by generic name and also includes information on illicit drugs. Each drug monograph includes the pregnancy risk rating established by the drug’s manufacturer and information for use during breast-feeding, and offers a summary of clinical information currently available. For those drugs that do not have an assigned rating, the authors have assigned a pregnancy risk.

Breast-feeding

Breast-feeding is widely known to be beneficial for the nursing infant owing to transfer of nutrients, immune factors, growth factors, and hormones from the mother to the child. Benefits to the mother include weight loss after birth and decreased risk of ovarian cancer, premenopausal breast cancer, and osteoporosis.40

Factors that influence the passage of a drug into breast milk include molecular weight, protein binding, lipid solubility, and maternal dose. Important information to obtain when answering a drug-use question during breast-feeding includes the age and weight of the child and the intended maternal dose. Often, specific information about passage into breast milk is not available, and the clinician must use drug-related factors such as molecular weight and protein binding to make a recommendation.

Briggs’ Drugs in Pregnancy and Lactation: Each drug monograph within Briggs’ Drugs in Pregnancy and Lactation contains a section on breast-feeding issues.41 The authors assign a breast-feeding compatibility rating and include the American Academy of Pediatrics (AAP) rating where possible.

American Academy of Pediatrics: Transfer of Drugs and Other Chemicals Into Human Milk: First published in 1983, this AAP policy statement was updated most recently in 2001.42 This policy statement includes lists of drugs and chemicals transferred into human milk and describes their possible effects on the infant or on lactation. Some drugs and chemicals are not included within the tables, which indicates that information for these agents was not available. Also included are illicit drugs and drugs of abuse, psychotropic drugs, effects of smoking, and breast implants and lactation issues.

The World Health Organization: Breastfeeding and Maternal Medication: This document, published by the World Health Organization in 2002, offers ratings for drugs for compatibility during breast-feeding and recommendations for monitoring infants for adverse effects.43

Medications and Mother’s Milk: This useful resource offers the author’s safety rating for use during breast-feeding.44 Another useful aspect of this reference is the inclusion of documented and theoretical adverse events in the breast feeding infant that a clinician and mother should be aware of. The AAP rating is also included when available.

ASSESSING QUALITY OF DRUG INFORMATION RESOURCES

Resources, whether in print or online, should be assessed for quality and reliability. First, the source of information in terms of authors and editors should be questioned. Are the authors well qualified to write on the topic? Second, the information should be appropriately referenced and evidence based. Third, financial disclosures should be made. Fourth, the information should be as current as possible. Other aspects that may be assessed include ease of use, portability (if necessary), and cost. As noted above, Web sites should be assessed for quality as well.

APPROACH TO ANSWERING A DRUG INFORMATION QUESTION

A systematic approach to answering a drug information question has been developed and widely accepted.45 The process starts by receiving the question and obtaining the demographics of the requestor. Requestor-specific information will help the pharmacist appropriately answer the question posed. The second step is to obtain necessary background information. Here is where the pharmacist would determine if the question is patient specific and, if so, would ask about patient age and weight, allergies, concomitant medications, etc. Once this information is obtained, the pharmacist can determine and categorize the question, and this will help guide an appropriate search strategy. After synthesizing and analyzing the search results, the pharmacist can then formulate and deliver a clear recommendation. Finally, the pharmacist should document the question and conduct follow-up with the requestor as necessary.

STAYING UP TO DATE

With the ever-changing field of medicine, pharmacists are faced with new information on a daily basis. To provide optimum patient care, pharmacists must stay abreast of current events in health care, updated clinical guidelines, and new drugs and indications. There are many options to help individual pharmacists stay current, including participating in professional organizations and publications. Many of the resources discussed above may also serve as a way for pharmacists to stay current.

Pharmacy Publications

There are many pharmacy magazines, such as U.S. Pharmacist, Pharmacy Times, and Drug Topics, that offer information on a variety of topics, including clinical reviews, pharmacy law, patient education, nonprescription products, and product news, as well as continuing education (CE) courses.

Pharmacist’s Letter (PL)

PL is a Web-based service offered to pharmacists through a yearly subscription.46 PL’s services include brief, well-summarized discussions of topics currently in health care news. Useful comparison charts with links to their detailed documents are available. Detailed documents that accompany most of the PL’s summaries direct the clinician to primary resources for further information. Pharmacists may also obtain CE credits through programs offered through PL’s services.

American Pharmacists Association

The Web site www.pharmacist.com provides updates in drug news in a concise, easy-to-read format.47 It provides information from the FDA Web site as well as updates in clinical pharmacy practice and new drug products.

CONCLUSION

Community pharmacists frequently encounter questions from other health care professionals, patients, and their families. With the rapid advancement of medicine today, it is important to know where to find information when faced with an inquiry, to provide the most current and relevant response. Familiarity with the various resources will help the pharmacist provide drug information more efficiently in the fast-paced environment of community pharmacy.

REFERENCES

  1. Accreditation Council for Pharmacy Education. Accreditation standards and guidelines for the professional program in pharmacy leading to the doctor of pharmacy degree. www.acpe-accredit.org/pdf/ACPE_Revised_PharmD_Standards_Adopted_Jan152006.pdf. Accessed October 1, 2007.
  2. Iwanowicz SL, Marciniak MW, Zeolla MM. Obtaining and providing health information in the community pharmacy setting. Am J Pharm Educ. 2006;70:57.
  3. Shields KM, Lust E. Drug information resources. In: Malone PM, ed. Drug Information: A Guide for Pharmacists. 3rd ed. New York, NY: McGraw Hill Inc; 2006:61.
  4. University of Minnesota Libraries. Primary, secondary and tertiary sources in the health sciences. www.biomed.lib.umn.edu/ inst/sourcesinhs.pdf. Accessed October 1, 2007.
  5. Gaebelein CL, Gleason BL. Contemporary Drug Information: An Evidence-Based Approach. Philadelphia, PA: Lippincott Williams & Wilkins; 2008.
  6. Drugs Facts and Comparisons. St. Louis, MO: Facts and Comparisons; 2007.
  7. AHFS Drug Information 2007. Bethesda, MD: American Society of Health-System Pharmacists; 2007.
  8. USP DI Volume I: Drug Information for the Healthcare Professional. 27th ed. Greenwood Village, CO: Thomson Micromedex; 2007.
  9. USP DI Volume II: Advice for the Patient. 27th ed. Greenwood Village, CO: Thomson Micromedex; 2007.
  10. USP DI Volume III: Approved Drug Products and Label Requirements. 27th Ed. Greenwood Village, CO: Thomson Micromedex; 2007.
  11. USP DI Volume I: Drug Information for the Healthcare Professional. www.micromedex.com/products/uspdi/v1/. Thomson. Accessed December 17, 2007.
  12. Thomson. Detailed information for the consumer. www.micromedex.com/products/uspdi/v2/. Accessed December 17, 2007.
  13. Lacy C. Drug Information Handbook. 15th ed. Hudson, OH: Lexi-Comp; 2007.
  14. Physicians’ Desk Reference 2007. 61st ed. Montvale, NJ: Thomson; 2007.
  15. Red Book 2007. Montvale, NJ: Thomson; 2007.
  16. DiPiro JT, Talbert RL, Yee GC, et al, eds. Pharmacotherapy: A Pathophysiologic Approach. 6th ed. New York, NY: McGraw-Hill Inc; 2005.
  17. Koda-Kimble MA, Young LY, Kradjian WA, et al, eds. Applied Therapeutics: The Clinical Use of Drugs. 8th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005.
  18. Berardi RR, Kroon LA, McDermott JH, et al, eds. Handbook of Nonprescription Drugs. 15th ed. Washington, DC. American Pharmacists Association; 2006.
  19. Tindle HA, Davis RB, Phillips RS, Eisenberg DM. Trends in use of complementary and alternative medicines by US adults: 1997-2002. Altern Ther Health Med. 2005;11:42-49.
  20. Cerulli J, Zeolla MM, Cottrell J. Drug information questions posed to a community pharmacy advanced practice experience students. Am J Pharm Educ. 2004;68:article 68.
  21. Lauderdale SA, Kendrach MG, Freeman MK. Preparing students for community pharmacy practice during a drug information advanced practice experience. Am J Pharm Educ. 2007;71: article 25.
  22. Therapeutic Research Center. Natural Medicines Comprehensive Database. www.naturaldatabase.com. Accessed December 17, 2007.
  23. Physicians’ Desk Reference for Nonprescription Drugs, Dietary Supplements, and Herbs. 27th ed. Montvale, NJ: Thomson; 2006.
  24. Natural Standard. http://naturalstandard.com. Accessed December 17, 2007.
  25. MICROMEDEX Healthcare Series [database online], Green-wood Village, CO: Thomson MICROMEDEX; 2007. www.thomsonhc.com. Accessed December 17, 2007.
  26. Clinical Pharmacology [database online], Tampa, FL: Gold Standard; 2007.
  27. Lexi-Comp Online [database online], Hudson, OH: LexiComp; 2007.
  28. Food and Drug Administration. www.fda.gov. Accessed December 17, 2007.
  29. Centers for Disease Control and Prevention. www.cdc.gov. Accessed December 17, 2007.
  30. American Society of Health-System Pharmacists. www.ashp.org. Accessed December 17, 2007.
  31. Medscape. www.medscape.com. Accessed December 17, 2007.
  32. Chesney RW, Christensen ML. Changing requirements for evaluation of pharmacologic agents. Pediatrics. 2004;113:1128-1132.
  33. Cote CJ, Kauffman RE, Troendle GJ, Lambert GH. Is the “therapeutic orphan” about to be adopted? Pediatrics. 1996;98:118-23.
  34. Nahata MC, Taketomo C. Pediatrics. In: DiPiro JT, Talbert RL, Yee GC, et al, eds. Pharmacotherapy: A Pathophysiologic Approach. New York, NY: McGraw-Hill Inc; 2005:91-102.
  35. Young TE, Mangum B, eds. NeoFax. 20th ed. Raleigh, NC: Acorn Publishing; 2007.
  36. Robertson J, Shilkofski N, eds. The Harriet Lane Handbook: A Manual for Pediatric House Officers. 17th ed. St. Louis, MO: Mosby; 2005.
  37. Takemoto CK, Hodding JH, Kraus DM. Pediatric Dosage Handbook. 14th ed. Hudson, OH: Lexi-Comp; 2007.
  38. Semla TP, Beizer JL, Higbee MD. Geriatric Dosage Handbook. 13th ed. Hudson, OH: Lexi-Comp; 2007.
  39. Schaefer C, ed. Drugs During Pregnancy and Lactation. Amsterdam, The Netherlands: Elsevier; 2001.
  40. Walbrandt Pigarelli DL, Kraus CK, Potter BE. Pregnancy and lactation: therapeutic considerations. In: DiPiro JT, Talbert RL, Yee GC, et al, eds. Pharmacotherapy: A Pathophysiologic Approach. New York, NY: McGraw-Hill Inc; 2005:1425-1442.
  41. Briggs GG, Freeman RK, Yaffe SJ, eds. Drugs in Pregnancy and Lactation. 7th ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2005.
  42. American Academy of Pediatrics. Transfer of drugs and other chemicals into human milk. http://aappolicy.aappublications.org/cgi/content/full/pediatrics%3b108/3/776. Accessed December 17, 2007.
  43. The World Health Organization. Breast feeding and maternal medication. http://www.who.int/child-adolescenthealth/ New_Publications/NUTRITION/BF_Maternal_Medication.pdf. Accessed December 17, 2007.
  44. Hale TW. Medications in Mother’s Milk. 12th ed. Amarillo, TX: Pharmasoft Medical Publishing; 2006.
  45. Kirkwood CF, Kier KL. Modified systematic approach to answering questions. In: Malone PM, ed. Drug Information: A Guide for Pharmacists. 3rd ed. New York, NY: McGraw-Hill Inc; 2006:61.
  46. Therapeutic Research Center. Pharmacist’s Letter. www.pharmacistsletter.com. Accessed December 17, 2007.
  47. American Pharmacist Association. www.pharmacist.com. Accessed December 17, 2007.
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