Treinamento DICAS DE USO Micromedex Abril 2019 Jorge Siqueira · 4 IBM'sstatements regarding its...
Transcript of Treinamento DICAS DE USO Micromedex Abril 2019 Jorge Siqueira · 4 IBM'sstatements regarding its...
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Treinamento
Micromedex
Abril 2019
Jorge Siqueira
DICAS DE USO
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Agenda
▪O que é o Micromedex
▪Medicamentos
▪ Interações Medicamentosas
▪Compatibilidade IV
▪Neonatologia/Pediatria
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Legal Disclaimer
© IBM Corporation 2017. All Rights Reserved.
The information contained in this publication is provided for informational purposes only. While efforts were made to verify the completeness and accuracy of the information contained in this publication, it is provided AS IS without warranty of any kind, express or implied. In addition, this information is based on IBM’s current product plans and strategy, which are subject to change by IBM without notice. IBM shall not be responsible for any damages arising out of the use of, or otherwise related to, this publication or any other materials. Nothing contained in this publication is intended to, nor shall have the effect of, creating any warranties or representations from IBM or its suppliers or licensors,or altering the terms and conditions of the applicable license agreement governing the use of IBM software.
References in this presentation to IBM products, programs, or services do not imply that they will be available in all countries in which IBM operates. Product release dates and/or capabilities referenced in this presentation may change at any time at IBM’s sole discretion based on market opportunities or other factors, and are not intended to be a commitment to future product or feature availability in any way. Nothing contained in these materials is intended to, nor shall have the effect of, stating or implying that any activities undertaken by you will result in any specific sales, revenue growth or other results.
Performance is based on measurements and projections using standard IBM benchmarks in a controlled environment. The actual throughput or performance that any user will experience will vary depending upon many factors, including considerations such as the amount of multiprogramming in the user's job stream, the I/O configuration, the storage configuration, and the workload processed. Therefore, no assurance can be given that an individual user will achieve results similar to those stated here.
All customer examples described are presented as illustrations of how those customers have used IBM products and the results they may have achieved. Actual environmental costs and performance characteristics may vary by customer.
IBM, the IBM logo, ibm.com, and Watson Health are trademarks of International Business Machines Corp., registered in many jurisdictions worldwide. Other product and service names might be trademarks of IBM or other companies. A current list of IBM trademarks is available on the Web at “Copyright and trademark information” at ibm.com/legal/copytrade.
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IBM's statements regarding its plans,directions and intent are subject to change or withdrawal withoutnoticeatIBM'ssolediscretion.
Information regarding potential future products is intended to outline our general
product direction and it should not be relied on in making a purchasing decision.
The information mentioned regardingpotential future products is not a commitment,
promise, or legal obligation to deliver any material, code or functionality. Information
about potential future products may not be incorporated into any contract. The
development, release, and timing of any future features or functionality describedfor
our products remains at our sole discretion.
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Forward Looking Statements
Certain statements contained in this presentation may constitute forward-looking statements within the meaning of the
Private Securities Litigation Reform Act of 1995. Forward-looking statements are based on the company’s current
assumptions regarding future business and financial performance. These statements involve a number of risks,
uncertainties and other factors that could cause actual results to differ materially, including the following: a downturn in
the economic environment and client spending budgets; the company’s failure to meet growth and productivity
objectives; a failure of the company’s innovation initiatives; risks from investing in growth opportunities; failure of the
company’s intellectual property portfolio to prevent competitive offerings and the failure of the company to obtain
necessary licenses; cybersecurity and data privacy considerations; fluctuations in financial results; impact of local legal,
economic, political and health conditions; adverse effects from environmental matters, tax matters and the company’s
pension plans; ineffective internal controls; the company’s use of accounting estimates; the company’s ability to attract
and retain key personnel and its reliance on critical skills; impacts of relationships with critical suppliers; product quality
issues; impacts of business with government clients; currency fluctuations and customer financing risks; impact of
changes in market liquidity conditions and customer credit risk on receivables; reliance on third party distribution
channels and ecosystems; the company’s ability to successfully manage acquisitions, alliances and dispositions; risks from
legal proceedings; risk factors related to IBM securities; and other risks, uncertainties and factors discussed in the
company’s Form 10-Qs, Form 10-K and in the company’s other filings with the U.S. Securities and Exchange Commission
(SEC) or in materials incorporated therein by reference. The company assumes no obligation to update or revise any
forward-looking statements. These charts and the associated remarks and comments are integrally related, and are
intended to be presented and understood together.
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▪Sistema de Suporte à Decisão Clínica
▪Base de conhecimento com informações de
medicamentos, doenças, exames laboratoriais,
toxicologia e medicina alternativa.
▪Ferramenta da Saúde Baseada em Evidências e
Segurança do Paciente
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O que é o Micromedex
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Dicas básicas para usar o Micromedex
Online
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▪“Fuçem” a base
Lição número 1
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Abas, barra de busca e Recursos
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▪ É possível buscar informações especificamente em cada base
As 3 principais bases
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Atenção aos links laterais e abas de Respostas Rápidas e
Aprofundadas
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▪ Todos os
Resultados
traz uma
lista de
documentos
com o termo
buscado
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▪Tudo que está em azul é “clicável” e oferece um link
para outra base ou informação adicional
Lição número 2
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▪English!
▪Saibam os nomes dos medicamentos em inglês:▪Warfarin, dipyrone, simvastatin, panax ginseng,
chlorthalidone, hydrochlorothiazide
▪Saibam os nomes das doenças em inglês:▪Chronic renal failure, sepsis, hypertension, epilepsy,
Huntington’s disease
Lesson number 3
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Help: Tradutor do Google Chrome
▪ Tradução não é ideal, mas pode ajudar a dar um norte no entendimento
caso a língua inglesa seja uma dificuldade
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▪Quando buscando um termo específico dentro de um documento:
▪ Respostas Aprofundadas > Exibir Documento Completo
Lição número 4: buscando termos dentro da monografia
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▪Quando buscando um termo específico:
▪ Respostas Aprofundadas > Exibir Documento Completo > Barra de
busca interna
Lição número 4: buscando termos dentro da monografia
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Medicamentos
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▪ Busca por princípio
ativo em inglês ou
nome de marca
Busca por nomes de marca ou princípio ativo em inglês
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▪ Micromedex já oferece algumas opções de autocompletar
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▪ EUA e Global
Resultados de nome de marca
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▪ Abas de
▪ Respostas Rápidas: informações diretas, em bullet points, uso à
beira-leito
▪ Respostas Aprofundadas: informações mais detalhadas, descrições
de trabalhos científicos
Medicamentos
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Seções dos Medicamentos
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Dosagem/Administração
Segurança de Medicamentos
Mecanismo de Ação
Farmacocinética
Educação ao Paciente
Toxicologia
Sobre...
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Respostas Rápidas
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1.60mg/dia
2.80mg/dia
3.100mg/dia
4.120mg/dia
Qual a dose máxima da Fluoxetina
comprimido (liberação imediata) para
Distúrbio Depressivo Maior?
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Buscando Fluoxetina
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▪ Micromedex já oferece algumas opções de autocompletar
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Adult Dosing
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Adult Dosing
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▪ Traz as indicações clínicas do medicamento e sua dose;
dose máxima pode variar com base na indicação clínica
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▪Quais os usos aprovados e off-
label da Duloxetina?
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Indicações aprovadas pela FDA
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Indicações Off-label
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Qual o ajuste de dose da Olanzapina para função renal
alterada?
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Dose Adjustments – ajustes de dose
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▪Quais são as precauções de uso
da Rivaroxabana?
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Precautions – precauções gerais do uso do medicamento,
separado por categorias (Hematológico, Cardiovascular, etc)
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▪De maneira geral, o que orientar
para um paciente quanto ao uso
da duloxetina?
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Medication Counseling – Aconselhamento sobre
medicamentos
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Medication Counseling (Aconselhamento sobre
medicamentos)
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▪ Informações importantes para informar ao paciente sobre o uso
do medicamento
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Respostas Aprofundadas
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Qual a evidência para o uso da Duloxetina nas indicações
consideradas?
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▪ Lista das indicações
clínicas daquele
medicamento
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▪ Dentro da indicação
clínica, informações
sobre aprovação,
eficácia, estudos
clínicos, etc
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Bloco a: overview (geral)
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Força de recomendação
Força da evidência
Eficácia
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▪Resumo dos estudos que foram avaliados pelo comitê editorial do
Micromedex
Bloco b: sumário
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▪ Estudos e sua descrição: desenho, pacientes, desfechos, etc
Bloco c: estudos
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▪ Meu paciente está
em uso de
Sinvastatina. O que
preciso monitorar
do ponto de vista de
toxicidade?
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▪Monitoramento terapêutico e tóxico
▪ Parâmetros Laboratoriais
▪ Achados Físicos
Monitoramento - sinvastatina
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Mais informações sobre dose
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Ex: Doses do Alopurinol
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Ex: Doses do Alopurinol
Doses separadas por
▪ Tipo (Normal, Renal, etc)
▪ Sal
▪ Via
▪ Indicação clínica
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Uso label, off-label ▪ Doses detalhadas,
organizadas de forma
estruturada
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Referência a documentos adicionais (DrugConsults)
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▪ Algumas recomendações de dose estão em
documentos especiais – os Drug Consults
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▪Necessidade de administrar
medicamento como solução oral a
partir de um
comprimido/formulação IV. Tem
como?
53
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Formulações Extemporâneas (adaptações de forma
farmacêutica)
▪Eventualmente é necessário manipular algum medicamento para
adaptar uma forma farmacêutica em outra, por exemplo para
administração por sonda.
▪Quando houver um trabalho científico sobre tal processo, ele estará
em Respostas Aprofundadas > Administration
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Exemplo: metotrexato
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Exemplo: metotrexato
![Page 57: Treinamento DICAS DE USO Micromedex Abril 2019 Jorge Siqueira · 4 IBM'sstatements regarding its plans, directions and intent are subject to change or withdrawal withoutnoticeatIBM'ssole](https://reader030.fdocuments.in/reader030/viewer/2022041301/5e115781afc939639a070593/html5/thumbnails/57.jpg)
Exemplo: metotrexato
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Farmacocinética
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▪ Informações detalhadas sobre
início de ação, ADME, tempo de
meia-vida, etc
![Page 60: Treinamento DICAS DE USO Micromedex Abril 2019 Jorge Siqueira · 4 IBM'sstatements regarding its plans, directions and intent are subject to change or withdrawal withoutnoticeatIBM'ssole](https://reader030.fdocuments.in/reader030/viewer/2022041301/5e115781afc939639a070593/html5/thumbnails/60.jpg)
![Page 61: Treinamento DICAS DE USO Micromedex Abril 2019 Jorge Siqueira · 4 IBM'sstatements regarding its plans, directions and intent are subject to change or withdrawal withoutnoticeatIBM'ssole](https://reader030.fdocuments.in/reader030/viewer/2022041301/5e115781afc939639a070593/html5/thumbnails/61.jpg)
▪Reporte de farmacovigilância –
reação cutânea/dermatológica
grave após uso de
carbamazepina. Há relato
descrito?
61
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Reações adversas DETALHADAS da Carbamazepina
62
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63
▪ Reações Adversas separadas
por sistemas orgânicos
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64
▪ Dentro do sistema orgânico,
cada reação documentada
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Stevens-Johnson – General Information (informações
gerais)
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Stevens-Johnson – Prevention and Management
(prevenção e manejo)
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Stevens-Johnson – Case Reports (reportes de caso)
67
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▪Necessito informações clínicas
comparativas do Ácido Valpróico
com outros medicamentos
anticonvulsivantes.
68
X
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Comparative Efficacy – Eficácia Comparada
69
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70
▪ Seção traz os
medicamentos para os
quais existe um
artigo/evidência de
comparação de eficácia
com o medicamento em
questão
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71
▪ Descrição do trabalho científico de eficácia
comparada
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▪Além da Duloxetina, que outros
medicamentos são da classe dos
inibidores de recaptação de
serotonina/noradrenalina?
72
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Classes de medicamentos – acesso pelo medicamento
▪Acesso pelo medicamento
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Drug Classes - Classes de medicamentos
▪ Traz as classes de medicamentos às quais o medicamento pertence
e a lista de medicamentos dentro de uma classe
▪ Por exemplo, Sertralina:
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Duloxetina
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Se clicar na classe >>> lista dos medicamentos
daquela classe
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Classes de medicamentos – acesso índice completo
78
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Posso triturar o Tramadol para facilitar a administração
oral/sonda?
79
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80▪ Acessar o medicamento, verificar Resultados Relacionados
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Drug Consults
81
▪ Drug Consults é uma base com vários documentos
relacionados ao medicamento em questão, como tabelas
comparativas, protocolos de tratamento, avaliações de
reações adversas, etc
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Drug Consults – DO NOT CRUSH
82
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83
▪ DO NOT CRUSH LIST – lista dos
medicamentos que não devem ser
triturados
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Como acessar: Drug Consults índice completo
84
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Drug Consults importantes
▪Não Triturar (Do Not Crush):
http://www.micromedexsolutions.com/micromedex2/librarian/deeplink
access?source=deepLink&SearchTerm=do%20not%20crush
▪ Administração de medicamentos por sonda (Enteral Feeding):
http://www.micromedexsolutions.com/micromedex2/librarian/deeplink
access?source=deepLink&SearchTerm=enteral%20feeding
▪ Listas de inibidores, substratos e indutores das CYPs (CYP):
http://www.micromedexsolutions.com/micromedex2/librarian/deeplink
access?source=deepLink&SearchTerm=CYP
▪Critério de Beers (uso de medicamentos em idosos) (Beers Criteria):
http://www.micromedexsolutions.com/micromedex2/librarian/deeplink
access?source=deepLink&SearchTerm=beers%20criteria
85
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Drug Consults importantes 2
▪Protocolos de Quimioterapia (chemo acronyms):
http://www.micromedexsolutions.com/micromedex2/librarian/deeplink
access?source=deepLink&SearchTerm=chemo%20acronyms
▪ Tosse induzida por iECA:
http://www.micromedexsolutions.com/micromedex2/librarian/deeplink
access?source=deepLink&SearchTerm=ACE%20cough
▪ Terapia da Sepse:
http://www.micromedexsolutions.com/micromedex2/librarian/deeplink
access?source=deepLink&SearchTerm=sepsis%20and%20septic%2
0shock%20in%20adults
86
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Exemplo de DrugConsults – Desprescrevendo IBPs
87
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Informações sobre doenças e exames
88
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Doenças
89
▪ Lista quais
documentos de
doença tem o
medicamento em
questão como
tratamento
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Doenças
90
▪ Documentos de
doenças trazem a
terapia
medicamentosa de
modo estruturado e
rápido
![Page 91: Treinamento DICAS DE USO Micromedex Abril 2019 Jorge Siqueira · 4 IBM'sstatements regarding its plans, directions and intent are subject to change or withdrawal withoutnoticeatIBM'ssole](https://reader030.fdocuments.in/reader030/viewer/2022041301/5e115781afc939639a070593/html5/thumbnails/91.jpg)
Exames
91
▪ Lista quais
documentos de
exames laboratoriais
para o
monitoramento do
medicamento
![Page 92: Treinamento DICAS DE USO Micromedex Abril 2019 Jorge Siqueira · 4 IBM'sstatements regarding its plans, directions and intent are subject to change or withdrawal withoutnoticeatIBM'ssole](https://reader030.fdocuments.in/reader030/viewer/2022041301/5e115781afc939639a070593/html5/thumbnails/92.jpg)
Documento de Exames Laboratoriais
92
▪ Traz indicações do
exame
(recomendação,
evidência),
resultados
anormais,
interações com
medicamentos,
metodologia, etc
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Drugs That Treat/Cause
93
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Drugs That Treat/Cause
▪Essa busca permite trazer quais os medicamentos podem ser usados
para tratar uma doença específica ou quais medicamentos podem
causar uma reação adversa específica
▪ Essas funcionalidades ajudam nas escolhas terapêuticas (por
exemplo, nas decisões da Comissão de Farmácia e Terapêutica) e
também na farmacovigilância/avaliação de reações adversas
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▪Digite o nome da indicação clínica e observe
o autocompletar
▪Lista de medicamentos que TRATAM
constipação (treat)
95
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Lista de medicamentos separados por Eficácia
96
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Lista de medicamentos separados por Eficácia
97
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▪ Paciente apresenta síncope, sem causa clara aparente
▪ Em uso de
▪ Metformina
▪ Carbamazepina
▪ Rosuvastatina
▪ Atenolol
▪ Podem ser os responsáveis?
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▪Digite o nome da doença, sinal, sintoma ou reação adversa
▪ Comece digitando o nome, e o auto-complete pode ajudar a
preencher o resto
▪Observe na lista drop-down as opções Drugs that treat e Drugs
that cause
Drugs that Treat/Cause
99
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▪Drugs That Cause traz os medicamentos que tem documentada a
reação adversa selecionada
Drugs That Cause
100
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▪ Após clicar em Carbamazepina:
Drugs That Cause – Syncope >>> Carbamazepina
101
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Interações Medicamentosas
10
2
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Interações Medicamentosas - acesso
10
3
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Interações Medicamentosas
10
4
▪ Digite o nome dos
medicamentos (princípios
ativos), em inglês, e passe-os
para a caixa ao lado direito
![Page 105: Treinamento DICAS DE USO Micromedex Abril 2019 Jorge Siqueira · 4 IBM'sstatements regarding its plans, directions and intent are subject to change or withdrawal withoutnoticeatIBM'ssole](https://reader030.fdocuments.in/reader030/viewer/2022041301/5e115781afc939639a070593/html5/thumbnails/105.jpg)
DrugREAX - gravidade
▪ Perfil de interações
medicamentosas do paciente
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DrugREAX - gravidade
10
6
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DrugREAX - documentação
10
7
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▪Detalhe da interação:
▪Warning
▪Clinical Management
▪Onset
▪Severity
DRUG-REAX - detalhe
10
8
▪Documentation
▪Probable Mechanism
▪Summary
▪Literature
▪References
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Clinical Management
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Literature
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Compatibilidade IV
111
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Compatibilidade IV - acesso
11
2
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Compatibilidade IV – inserindo medicamentos
11
3
▪ Digite o nome dos
medicamentos IV (princípios
ativos), em inglês, e passe-os
para a caixa ao lado direito
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Resultados
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▪Diluentes utilizados, Compatibilidade física, período do estudo,
método, etc
Detalhes da incompatibilidade
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Monografia do produto IV – acesso
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Monografia do produto IV
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▪Documento do produto com informações sobre:❑pH range
❑Formulation
❑Reconstitution
❑Osmolality
❑Storage
❑Maximum Stability
❑pH effects
❑Interaction with plastics
❑etc
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▪ Interaction with Plastics (0031; 1443; 2660; 2792; 8999; 9739; 9740)Sorption:Amiodarone hydrochloride 1 to 6 mg/mL in dextrose 5% has demonstrated loss due to sorption to flexible polyvinyl chloride (PVC) plastic containers. The loss exceeded 10% after 2 hours of contact; another study found 25% loss in 24 hours at room temperature.
No loss due to sorption occurred with glass, polyolefin, and rigid PVC (PVC Container Corporation) containers. The manufacturer recommends the use of glass or polyolefin containers for infusions that are in contact for more than 2 hours.
The drug is also lost to PVC infusion sets, but the manufacturer indicates that the loss is accounted for in their dosage recommendations. Consequently, the use of PVC administration sets is permitted but the recommended dosage must be followed.
Monografia do produto IV - Amiodarone
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NeoFax/Pediatrics
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Monografias
▪ Selecione a aba Drug Monographs
▪ Selecione o tipo de paciente (Neonatal ou
Pediatric)
▪ Digite o nome do medicamento em Alpha Filter
ou busque na tabela Drug
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Monografias
▪ Clique nos tópicos para acessar as
informações
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Calculadoras de Dose
▪ Selecione a aba Dosing Calculators
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Calculadoras de Dose
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▪ Data de
nascimento
▪ Tipo de população
(recomendações
▪ Tempo gestacional
▪ Peso
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Calculadoras de Dose
124
▪ Digite o nome do medicamento em Alpha Filter
ou busque na tabela Drug
▪ Dados demográficos do paciente ficam salvos
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Calculadoras de Dose
125
▪ Escolha o uso, a rota, e informe dose, tempo de administração e
concentração do medicamento e clique em Calculate
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Calculadoras de Dose
126
▪ Se a dose for maior do que a recomendada, o sistema dá um
alerta
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Calculadoras de Dose
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▪Clique em Print para imprimir o cálculo e ver informações
adicionais
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Busca por inteligência artificial – IBM Watson
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129
▪ Faça a pergunta
sobre medicamentos
de forma natural, em
inglês
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130
▪ Watson compreende
a pergunta e busca a
resposta direta,
dentro do
Micromedex
▪ É possível dar
feedback ao Watson
caso ele erre a
resposta
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▪Feedback do uso
▪Sugestões de melhorias
▪Procuram alguma informação
e não encontram?
Usuários – o que queremos deles?
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