Drug information It is the current, relevant, critically examined data about drug and drug use for given

patient or situation.

Many institutes run DIC(Drug Information Center) for the provision of drug information, to every group/kind of people from any place

HISTORY

First DIC was developed in University of Kentucky in 1960. In United states 80% of the Hospitals having DIC.

INDIA, in infancy stage with a few centers.

In India beginning has been made by the professor of pharmacology Mumbai at a govt medical college

CMC and Hospital vellore has been trying in this direction earlier

Need of drug information

The no of drugs in the international market has increased very much

The newer drugs are generally more potent & selective, and formulations becoming increasingly complex

The literature on drugs has also expanded and covers a wide range of information

To introduce a new drug into the practice, the professionals need to evaluate the given information.

A simple,quick reference to a pharmacopoeia or formulary is no longer sufficient.

Aims and objectives of drug information services

The provision of information to health professionals on specific problems related to the use of drugs in particular patients;

The provision of information to officials in government agencies to optimize the decision making process;

The preparation and development of guidelines and formularies;

To improve patient compliance and to provide a guide to responsible self medication;

To develop and participate in continuing education programs;

1

To participate in undergraduate and graduate teaching programs;

To develop educational activities regarding the appropriate use of drugs for patients in the community;

To prepare and distribute material on drugs to health personnel in the form of a drug Information bulletin and/or other media;

To develop and participate in research programs;

The Sources of information/Resources available

Primary Source:

Information is presented by authors without any evaluation by a second party.

Provides must current information about drugs.

Examples; articles published in journals(eg British Medical Journal), thesis etc.

Secondary source

The original source has been evaluated by second party other than the publisher.

Modified and rearranged form

Examples; review articles like lexis-nexis, Medline etc

Tertiary source

Information obtained from primary and secondary source and arranged in a manner to represent a composite of the available information.

Examples; Representative form Pharmacopeias - BP, USP, IP, BNF etc., Encyclopedia Dictionaries Guides, text books

Other Sources:

The DIC also receives information from

The public and hospitals about the Adverse effects of any drug

Local drug lists

National Formularies

Hospital Formularies

Internet

2

Phone calls to Manufacturers

Government and Non-government organizations

and also to other DIC’s.

DRUG INFORMATION SKILLS

Drug informer should understand the nature of the question and should ask all the needed questions to get the ultimate question

Most specialists today use the modified systematic approach designed by ‘Host and Kirkwood’, these are;

Step I ; Secure demographics of the requestors

Who requests?

Med/non med personnel

Educated/un educated personnel

Name/location/phone/email etc of requestor

This determines the type of response that will be given

Step II; Obtain background information

Where the requestor heard/read about the drug?

Is he/she taking medicine? Why?

Is he/she a caregiver/wants to take medicine?

This helps determining what additional information should be provided.

Step III; Determine and categorize the ultimate question

Putting the pieces of information together to form ultimate question and once it has been determined, the next step is to categorize the question.

Step IV; Develop strategy and conduct research

Strategies should be developed with a typical algorithm with three essential components; tertiary-secondary-primary literature

Step V;Perform evaluation, analysis & synthesis

Provider should take time to evaluate the info, analyze and then synthesize it into a good reply

3

Step VI;Formulate and provide response

An outline should be established to help formulate a response to the drug info request.

Its important to have; introduction, body and conclusion

Step VII;Conduct follow-up and documentation

Checking with the requestor to make sure his/her question has been sufficiently and completely answered.

Of vital importance is to document all the steps taken in this process.

DRUG LITERATURE EVALUATION

Among the skills of drug information is a knowledge of drug literature evaluation which allows one to provide a critical analysis of the literature and have a better understanding of the studies done in health and medicine.

It is a key component to provide a good quality answer to a requester

Being able to separate good data from poor data is essential

Knowing the limitations of any study can help in evaluating the usability of its data

Drug information specialists will often use some standard questions to help in this process

Several references provide guides to evaluate the medical and pharmacy literature.

GENERAL GUIDELINES FOR RESPONSES TO DRUG INFORMATION

Do not guess

Take several ethical issues into account

◦ Patient privacy must be maintained

◦ Patient-physician relation cannot be breached

◦ Response is not necessary if the inquirer intends to misuse or abuse the information that is provided.

Organize information before attempting to communicate the response to the inquirer.

Tailor the response to the inquirer’s background.

Tell the inquirer where the information was found.

Alert the inquirer of a possible delay when it takes longer than anticipated to answer the question.

4

Ask if the inquirer’s question is answered by the information.

Drug information centers

Drug information centers (DICs) in general, are service providers, which provide drug information relating to therapies, pharmacoeconomics, education, and research programs.

It provides unbiased information to health care professionals and/or patients and consumers.

Many centers also provide workshops or other forms of training to enhance the skills of healthcare professionals.

A drug information center is usually a unit located within and/or affiliated with a larger organization (i.e., a pharmaceutical association, a hospital etc).

STAFFING

Pharmacist; specialists with proper knowledge of drug and actions associated with it with academic degree. �

(they provide drug information)

Pharmacy Technicians & Students

(they assist pharmacists in providing drug information like literature searching,retrieval of data,resources updating etc)

People trained in library science with computer knowledge

(they are supporting staffs in DIC for their own expertise)

The center should have specific hours of operation(24hrs preferably) and adequate� technological resources (i.e., computers, phone lines, faxes, etc.)

The drug information center should have the latest publications and ideally publish a newsletter or other informational updates.

Role of Pharmacist:

Must be a part of DIC,should be “ready to go” for information all the time.

‘The Drug-Information Pharmacist’ is at interface of vast amount knowledge on onside and the persons needing the knowledge on other.

Should provide proper information irrespective of the informer’s status,but accordingly with informer’s status.

5

Drug information bulletin

It publishes the latest developments in medical sciences, the newly introduced drugs, new indication and other information regarding drugs.

One of the PTCs duties is to assist the pharmacist in conducting a teaching program within the hospital through a pharmacy publication.

The methods employed to disseminate interdepartmental information are usually bulletins, bulletin board notices and committee meetings.

The bulletin normally publishes the latest development in the medical sciences, the newly introduced drugs, new indications for certain drugs, newer drug delivery systems, updates on drug interactions and ADRs.

Pharmacist is normally held responsible for its publication however; contributions are obtained from pharmacists, physicians and nursing and other interested groups like therapeutic dietician for food drug interactions for publishing the bulletin.

The contents should however be educative and informative.

POISON INFORMATION

HISTORY

The first centers were instituted in North America and Europe during the 1950’s.

The International Programme on Chemical Safety (IPCS) was established in 1980 as a collaborative programme of the International Labor Organization (ILO), the United Nations Environment Programme (UNEP), and the World Health Organization (WHO) in order to provide assessments of the risks to human health and the environment posed by chemicals.

The IPCS provides guidance on the use of such assessments and seeks to strengthen the capacity of each country to prevent and treat the harmful effects of chemicals and to manage emergencies involving chemicals.

Its work on prevention and treatment of poisoning is undertaken in collaboration with the World Federation of Associations of Clinical Toxicology Centers and Poison Control Centers and its member associations.

The aims of the European Commission (EC) in the field of poison control are similar to those of the IPCS and many activities are undertaken jointly by the two bodies.

POISON INFORMATION SERVICES

PCC(Poison control center);

6

For the provision of service regarding poison and related danger, and to manage with the poisoning Cases

Concept initiated in chicago in 1953

PCC were established for two reasons:

To provide rapid access to information valuable in assessing and treating poisonings.

To assist with poisoning prevention

STAFFING

Pharmacy team�

pharmacist; specialists trained in poison information and in the management of poisoning emergencies. �

Pharmacy Technicians & Students �

Medical team

Toxicologists specializing in medical toxicology are also available for consultation.

Supporting team

People trained in library science with computer knowledge.

The poison information centre is a specialized unit providing information on poisoning, in principle to the whole community.

Its main functions are provision of toxicological information and advice, management of poisoning cases, provision of laboratory analytical services, toxicovigilance activities, research, and education and training in the prevention and treatment of poisoning.

As part of its role in toxicovigilance, the centre advises on and is actively involved in the development, implementation, and evaluation of measures for the prevention of poisoning.

It also plays an important role in developing contingency plans for, and responding to, chemical disasters, in monitoring the adverse effects of drugs, and in handling problems of substance abuseAssess and treatment recommendations during poisoning via 24-hour emergency telephone services

Provide public and professional educational programs

To collect data on poisonings

7

To perform research

Assist the public and health care providers during hazardous material spills

Drug information and Pharmacovigilance

Substances of abuse

Environmental toxicology

Contingency planning for chemical incidents and disasters

Cooperation and interrelationships

TEACHING AND TRAINING

The experience gained in a poison information centre can be an important source of human and animal toxicological data.

The application and communication of this knowledge are vital for improving the prevention and management of poisoning. Centers thus have educational responsibilities that extend to the training of medical practitioners and other professional health workers likely to encounter cases of poisoning, and to communication with the local population and the mass media.

Later sections of these guidelines include advice on the training needs of centers as well as on their teaching and training functions.

TOXICOVIGILANCE

Toxicovigilance is an essential function of poison information centers. It is the active process of identifying and evaluating the toxic risks existing in a community, and evaluating the measures taken to reduce or eliminate them.

Analysis of enquiries received by centers permits the identification of those circumstances, populations, and possible toxic agents most likely to be involved, as well as the detection of hidden dangers.

The role of a centre in toxicovigilance is to alert the appropriate health and other authorities so that the necessary preventive and regulatory measures may be taken.

This role enables them to make a major contribution to the prevention of poisoning through their collaboration with the health and other appropriate authorities.

ENVIRONMENTAL TOXICITY

Poison information centres, particularly in countries where there is no other readily accessible source of information on toxic chemicals, are being asked to provide information on the effects of environmental contaminants, on the risks associated with

8

toxic wastes, and on safe levels of chemicals in the environment and in food and other consumer goods.

Medical practitioners must also be provided with data on the possible effects of exposure to environmental contaminants, and information on the types of biological and other samples that should be collected and analyzed.

Mechanisms for the systematic collection, validation, and follow-up of data should be established; it is also essential that the data are comparable, both nationally and internationally, so that they may be used for the benefit of all.

CONTINGENCY PLANNING FOR CHEMICAL INCIDENTS AND DISASTER

Poison information centers can contribute to the handling of major chemical incidents and disasters by providing appropriate information in the event of an emergency and by taking an active part in contingency planning and in education and training.

They should also take part in epidemiological follow-up studies and other research initiatives, where appropriate, collaborating and acting in concert with other bodies involved in accident prevention and control.

A national or regional poison information centre can serve to centralize and coordinate such activities.

BENEFITS

Service provided by poison information centers offers considerable direct health benefits by reducing morbidity and mortality from poisoning and enabling the community to make significant savings in health care costs.

Mild poisoning cases that can be treated by first-aid measures alone or by non-hospital medical personnel are quickly recognized. Specific antidotes, therapeutic agents, and medical equipment can be made more easily available through coordination of stocks, so reducing costs and saving lives.

Centers can also help to prevent the unnecessary use of special antidotes and of sophisticated and expensive treatments.

The case data collected by centers provide an epidemiological basis for local toxicovigilance and contribute to the international fund of knowledge about human toxicology and management of poisoned patients.

The education and training provided by poison information centers enable professional health workers and the general public to recognize and avoid the dangers of poisoning and to take effective action when poisoning incidents occur.

9

10