3. application of pharmacoinformatics

APPLICATION OF PHARMACOINFORMATICS

Compiled by:FACULTY School of Pharmacy

DRUG INFORMATION SERVICE

•DRUG INFORMATION CENTER (DIC)

•DRUG INFORMATION SPECIALIST

HISTORY• Develop in the early sixties when

used in conjunction with the words center and specialist.

• Area was separated from the pharmacy and was dedicated to providing drug information

• The center was established to be a source of selected comprehensive drug information for health care professionals to evaluate and compare drugs.

HISTORY

• The purpose is to influence pharmacy students in developing their role as drug consultants.

• Different approaches to providing drug information services were developed.

• The individual responsible for operating the center is the drug information specialist.

Drug Information Service (DIS)

• It refers to the access, evaluation, selection and organization of drug literature for the use of health professionals, patients and the public.

• It also involves the interpretation and application of drug information to patient care problems.

DRUG LITERATURE

Is comprised of primary, secondary and tertiary literature that can be used as basis for optimizing the use of drugs in patients.

Why the need for it?• Vast drug literature• Increasing drug therapy problems• Growth of clinical pharmacy

practice

TERTIARY LITERATURE

• Sometimes referred to as general literature

• Consists of textbooks, compedias, full text computer databases and review articles.

TERTIARY LITERATURE

Advantages:Generally simple to use and more accessibleMost commonly used sources of information because they are easy to use, convenient, concise and compact.

TERTIARY LITERATUREDisadvantages:

Information may not be completeTopics may be presented into insufficient detailAuthors may conduct incomplete literature searchesInformation may not be timelyOthers may exist like human bias, incorrect interpretation of research and lack of expertise by the author

Considerations in evaluating tertiary literature:

• 1. Does the author have sufficient experience and expertise to be writing the topic?

• 2. Is this the most recent edition of the textbook?

• 3. Are the statement of facts appropriately supported with citations?

Considerations in evaluating tertiary literature:

• 4. Is the reference likely to contain information relevant to the subject being researched?

• 5. Is the reference clear, concise and easy to use?

Examples of Tertiary Literatures and their Descriptions

• 1. Physician Desk Reference (PDR)Medical Economics Data, Montvale NJ. A compilation of package inserts for prescription drug products from pharmaceutical manufacturers. Both active and inactive ingredients are listed for most drug products. It contains approximately 1,000 pictures of drug products useful for identification. Also available in CD ROM. Updated annually. CD ROM version updated quarterly.


• 2. Drug Facts and ComparisonsFacts and Comparison, St. Louis. A comprehensive reference containing comparative information of individual drugs in specific drug classes. Hard bound edition updated annually. Available in CD ROM.


• 3. USP DI (United States Pharmacopoeia- Drug Information)

USP Convention Inc. Rockville MD.Three (3) volume set:

Volume 1- Drug Information for the Health Care Provider It contains information on drug products in monograph format including both FDA approved and unlabeled indications.


Includes information on veterinary drugs and OTC diagnostic agents.

Volume 2- Advice for the PatientIt contains drug information for the patient in lay language grouped by drug class.


Volume 3- Approved Drug Products and Legal RequirementsIt includes information found in FDA Orange book that indicates products that are A/B rated and considered bioequivalent. It provides a list of discontinued drug products and other documents from the USP Convention. Published annually.


• 4. The Merck ManualMerck and Co. Rathway NJ. A handbook on disease states and their management in easy to read format.


• 5. Stedman’s Medical DictionaryWilliam and Wilkins, Baltimore. A resource for definition of medical terms. Available in CD ROM format.


• 6. Goodman and Gilman’s Pharmacological Basis of Therapeutics

McGraw-Hill, New York. It is considered the premier textbook on Pharmacology.


• 7. Remington Pharmaceutical Science (RPS)

Mack Publishing Co. A dissertation on the practice of pharmacy. It contains useful information for prescription compounding. Some older edition particularly 1960s are especially good sources of compounding information.


• 8. Harrison's’ Principles of Internal Medicine

McGraw-Hill N.Y. One of the most comprehensive medical textbooks useful for researching, diagnosis, symptomatology and treatment of disease states. Available in CD ROM format.


• 9. Geriatric Dosage HandbookLexi-Comp., Inc. Hudson OH. A guide to drug dosage in geriatric patients including dosage recommendations for patients with renal and hepatic failure. Published annually.


• 10. Pharmacotherapy: A Pathophysiologic Approach

DiPiro JT et al. NY Elsevier Science Publishing Company. Reviews the pathophysiology of a disease state before explaining its drug therapy. A good study guide for students.


• 11. Pharmaceutical CalculationsStoklosa MJ, Ansel HC. Philadelphia: Lea and Febiger. This reference discusses the basics of pharmacy math, statistics, units and compounding calculations.

SEATWORK NO.3

Instruction: Identify the latest edition of the following tertiary literatures.

• 1. RPS• 2. USP/NF• 3. Goodman and Gilman’s Pharmacological

Basis of Therapeutics• 4. PDR• 5. Stedman’s Medical Dictionary• 6. Pediatric Dosage Handbook Lexi Com• 7. Drug Facts and Comparison• 8. Martindale: The Extra Pharmacopoeia• 9. Pharmaceutical Calculations by Ansel• 10. USP DI

SECONDARY LITERATURE

• It consists of indexing and abstracting services of the journal articles.

• An indexing system provides only bibliographic information that is index by topic.


• An abstract service provides a brief description of information contained in a specific citation.

• This resources generally are used to refer the researcher to more detailed information found in the journal articles.


• Available in different formats including published texts and newsletters, microfilm, microfiche, CD ROM and various online services.

SECONDARY LITERATUREAdvantage:

It provides rapid access to specific topics found in the primary literature (journal article) and an abstract or description of the article.

SECONDARY LITERATUREDisadvantages:

Lag time between the time of information is made public or published in the primary literature and the time the information is indexed by the secondary literature.


Disadvantages:The number and source of journals index vary among these indexing and abstracting sources.Many secondary resources require a certain amount of training or expertise to use.

Examples of Secondary Literatures

• 1. IOWA Drug Information System (IDIS)

The University of Iowa, Iowa City. An indexing service that allows retrieval of complete articles from more than 180 biomedical journals. Information can be searched by generic drug name or disease classification. Available in microfiche, CD ROM or on line service. Updated monthly.


• 2. Index MedicusNational Library of Medicine. Indexing service covering the entire spectrum of medical and pharmaceutical literature. Approximately 25% of articles indexed are drug-related. Abstracts are not provided. Can be searched through MEDLINE computerized services.


• 3. International Pharmaceutical Abstracts (IPA)

Bethesda: American Society of Health-System Pharmacists. A semi-monthly publication especially useful for administrative aspects of pharmacy practice. Coverage includes manufacturing, clinical practice, pharmacoeconomics and all aspects of pharmacy practice.

PRIMARY LITERATURE

• It includes unpublished studies, original papers and published studies or reports appearing in journals.

• Consists of research studies published in biomedical journals

PRIMARY LITERATUREAdvantages:

Access to detailed information regarding a particular issueThe entire article including study methods are typically available for personal assessment

PRIMARY LITERATUREAdvantages:

Information can be considered currentJournals provide the most current information about drugs and ideally should be the source for answering therapeutic questions

PRIMARY LITERATURE

Disadvantages:One may be misled to an incorrect conclusion by missing conflicting evidence also available in the literatureSkills in evaluating clinical trials and study methodology are necessary to accurately assess the journal article.

PRIMARY LITERATUREDisadvantages:

Time consuming to read and analyze all the details often found in original studies and reports.Many article possess inadequacies that become apparent as the ability to evaluate drug information improves.

Examples of Primary Literatures• 1. American Journal of Health

System PharmacyAmerican Society of Health-System Pharmacists, Bethesda M.D. A journal focused on clinical and managerial aspects of Pharmacy practice in health systems. This journal previously was known as the American Journal of Hospital Pharmacy and incorporates the contents of previously published journal known as Clinical Pharmacy. Published semi-monthly.

Examples of Primary Literature• 2. JAMA- The Journal of the

American Medical AssociationAmerican Medical Association, Chicago. One of the premier medical journals that publishes investigation and review information of key importance to health care. Published weekly.

Examples of Primary Literature• 3. Journal of the American

Pharmaceutical Association J.B. Lippincott, Philadelphia. The official journal of the American Pharmaceutical Association that publishes news, information and research in the areas of pharmacotherapeutic management of diseases. Trends in pharmacy practice and the provision of pharmaceutical care. Formerly known as American Pharmacy. Published monthly.

Examples of Primary Literature• 4. Journal of Pharmacy Teaching

Pharmaceutical Products Press, Binghamton N.Y. A journal dedicated to issues relevant to pharmaceutical education. Published quarterly.

Examples of Primary Literature• 5. Lippincott’s Hospital Pharmacy

Lippincott Raven Publishers, Hagerstown M.D. A journal divided to the practice of pharmacy in institutional settings. Published monthly.

APPROACH IN RESEARCHING LITERATURES

OTHER REFERENCES:

The Internet and Other Sources of Information (Computer Aided Instructions, Application software)

CD-ROM and Other Computer Databases

• DRUGDEX System. Micromedex Inc.It contains drug evaluation monographs. Monographs includes dosing, pharmacokinetics, cautions, interactions, comparative drug efficacy, and clinical applications. A Drug Consult section provides answers to common questions received by drug information centers. References provided at the end of each monograph.

CD-ROM and Other Computer Databases

• POISONDEX. Micromedex Inc. A quick, comprehensive information

identification of commercial chemicals and pharmaceuticals and the management of poisonings which result from them. The Product and Substance Identification section provides information on common household products, industrial chemicals and products, biological entities, as well as pharmaceuticals. Management Treatment Protocols provide details of treatment.

Textbooks

• Should be revised frequently• Should be heavily referenced, at

least for declarations about diagnosis and management

• Evidence in support of a statement should be selected according to explicit principles of evidence

HOW TO FIND THE CURRENT BEST EVIDENCE

Journal Articles• Refereed (Peer-reviewed) Journals

(http://www.nejm.org)• Journal databases (

http://www.ovid.com, http://www.epnet.com)

• Free access internet journals (http://www.freemedicaljournals.com)

Evidence databases

• Evidence-based Medicine Reviews (EBMR) from Ovid Technologies (http://www.ovid.com)

• Medline/Pubmed (http://www.pubmed.gov)

• Cochrane Library (CL) (http://update.cochrane.co.uk)

• BestEvidence (BE) (http://www.acponline.org)

3. application of pharmacoinformatics

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