Medicines Information Skills for NHS Direct NAs & HIAs

Where to find information about medicines?

This learning resource looks at some of the electronic medicines information sources available at your NHSD site. It is not exhaustive, but designed to give you an introduction to handle calls about medicines. For each information source, it explains what it covers, strengths, limitations and search tips for using the source.

Key information sources for calls about medicinesInformation source What it is Web address PageeBNF British National

Formularynww.intranet.nhsdirect.nhs.uk(go to Medicines Complete)

3

eBNFC British National Formulary for Children

nww.intranet.nhsdirect.nhs.uk (go to Medicines Complete)

6

eMC SPCs (datasheets) & PILs (patient information leaflets)

www.emc.medicines.org.uk 6

Medicine Chest Online Directory of over-the-counter medicines

www.medicinechestonline.com 9

Netdoctor Patient information about medicines

www.netdoctor.co.uk 10

NHS Direct Medicines Q&As

Q&As about medicines nww.intranet.nhsdirect.nhs.uk (go to Medicines Q&As)

10

Additional sources of information for calls about medicinesInformation source What it is Web address PageDietary Supplements Monographs of dietary

supplementsnww.intranet.nhsdirect.nhs.uk(go to Medicines Complete)

12

FPA website Family planning information and advice

www.fpa.org.uk 13

Herbal Medicines Monographs of herbal medicines

nww.intranet.nhsdirect.nhs.uk (via link to Medicines Complete)

14

Immunisation NHS website for the public

Immunisations & vaccines www.immunisation.nhs.uk 15

Immunisation against infectious disease “Greenbook”

Immunisations & vaccines www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/Greenbook

16

Martindale Specialist medicines monographs

nww.intranet.nhsdirect.nhs.uk (go to Medicines Complete)

17

MHRA website Licensing & safety of medicines

www.mhra.gov.uk 18

Prescription Pricing Authority website

Prescription fee exemptions, Drug Tariff

www.ppa.org.uk 19

Stockley’s Drug Interactions

Specialist drug interaction resource

nww.intranet.nhsdirect.nhs.uk (go to Medicines Complete)

20

Toxbase (Exposures in pregnancy)

Medicines in pregnancy www.spib.axl.co.uk(NHSD log-in required)

21

Travax Travel medicines www.travax.nhs.uk 23

UKMI Central (Lactation) Medicines in breast milk www.ukmicentral.nhs.uk 24

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An explanation of each of the medicines information sources follows. The list is arranged to first cover the key information sources (in alphabetical order) and then the additional information sources (in alphabetical order).

Key information sources for calls about medicines

Medicines Complete nww.intranet.nhsdirect.nhs.uk (go to Medicines Complete)

Medicines Complete is a website that hosts the following medicines information sources

eBNF BNF for Children Stockley’s Drug Interactions

Martindale: the Complete Drug Reference Dietary Supplements Herbal Medicines

The information in all these sources is written for healthcare professionals to help them answer questions about medicines. Please consider this when giving information and advice to members of the public.

Tips for searching It is accessed via the NHS Direct Intranet using the Medicines Complete link (there is now no

need for an individual Log-in).

Click on link on the left hand side of NHSD Intranet Home Page. (NB: to add to Favorites right mouse click on the link here and ‘add to favourites’. This should save the link correctly so that you have full access to Medicines Complete without the need to log in.)

System states ‘You are logged in as a member of NHS Direct SSO’.

A technical Helpdesk is available 9am to 6pm if any technical support is required: Telephone: 01988 600 789 Email: support@medicinescomplete.com

It is important to search each database separately to ensure you are using the system effectively. When you have logged in, click on the icon for a specific source and then search. DO NOT use the search button at the top of the main screen.

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DO NOT search here. Instead click on the icon for a specific source then Search

eBNF nww.intranet.nhsdirect.nhs.uk (go to Medicines Complete)

The eBNF should be your first port of call for every medicines call. There are 15 chapters that cover the main areas of therapeutics. This is where the monographs for each medicine can be found e.g. uses, side effects, doses and cautions. The 9 appendices cover more specialist areas e.g. drug interactions, medicines in pregnancy, medicines whilst breast-feeding.

Strengths Limitations

Comprehensive and reliable source of information on medicines.

Updated every 6 months.

Specialist appendices.

Some information on unlicensed uses of medicines.

Difficult to navigate - need to practice.

Need to scan down the whole page as content may sometimes be hidden from view.

Fair amount of jargon/technical wording.

No information on complementary medicines, apart from St. John’s Wort.

Limited information on adverse effects, pregnancy, breast feeding

Tips for searching Type the name of the medicine in the white box at the top right hand of the screen, then click

Search Try to use generic names, not brand names and spell correctly.

The main information about a medicine can be found by clicking on the name of that medicine when it is written in CAPITAL letters e.g. FUROSEMIDE / FRUSEMIDE

Other useful information about that medicine can be found by clicking on the words underlined in blue. The information in black tells you what kind of information you will find.

If the medicine name has two parts e.g. St. John’s Wort then it is more effective to type as a phrase in speech marks e.g. “St. John’s Wort”. This instructs the search engine to look for matches only where the words appear together in the text.

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Type the generic drug name here e.g. cefaclor

Tips for searching for drug interactions Enter the drugs you wish to search for in the white search box at the top right of the page.

To search for the interactions of a single drug, enter either a single word e.g. aspirin or a phrase enclosed in double quotes e.g. "ace inhibitors". To search for interactions between pairs of drugs, enter the drugs separated by a space e.g. cefaclor warfarin

Click on the Interactions button.

If an interaction is listed, you will be able to click on the name of these medicines highlighted in blue & underlined. Note down the classes of drugs that this interaction refers to, so you can find these on the next page. You MUST look for both the name of the other medicine in this list AND the class of drugs it belongs to e.g. cefaclor and cephalosporins.

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Click here to search for interactions with cefaclor

scroll down to look for information about cefaclor eg dose

Click on the link in CAPITALS for the main entry for that drug

The background colour behind the text tells you the importance of the interaction. Interactions with a Yellow background do not usually have serious consequences but Red are potentially hazardous.

For ‘Co-‘drugs e.g. co-codamol you must check what it contains first. It is then safer to search for interactions with ‘Co-‘ drugs separately e.g. for Co-dydramol and ciprofloxacin search for interactions with paracetamol and ciprofloxacin, THEN dihydrocodeine and ciprofloxacin.

If no interaction is listed, do not assume that none exists. Check other medicines information sources e.g. eMC and Stockley’s Drug Interactions.

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Click on the + sign to check what drug class cefaclor belongs to

Information about the interaction between cefaclor and warfarin. The red box denotes it is a very clinically important interaction

BNF for Children nww.intranet.nhsdirect.nhs.uk (go to Medicines Complete)

The BNF for Children should be consulted for all calls about medicines in children. It covers information and advice (including unlicensed uses and doses) from birth to 18 years.

Tips for searching It is searched in the same way as the eBNF.

eMC www.emc.medicines.org.uk

The Electronic Medicines Compendium (eMC) contains the Summaries of Product Characteristics (SPCs/datasheets) and Patient Information Leaflets (PILs) produced by drug companies. A drug company must produce an SPC and PIL for all their medicines as part of the product licence, although not all of them can be found on the eMC.

Strengths Limitations

Comprehensive source of information on medicines. Good for branded medicines

Very easy to search.

Updated when changes made to the SPC.

Can view the Patient Information Leaflet (PIL) that is given to the patient.

Good for adverse effects

Not all generic brands are listed.

Information on licensed uses only.

Uses technical medical & pharmaceutical terms.

Written by the manufacturer so the information can be cautious because of medico-legal concerns.

Limited information about use in pregnancy /breastfeeding

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Click here to look at the table of contents

Type the generic drug name here e.g. ribavirin

Tips for searching Use the search bar on the top right hand side of the screen. You can use the generic or brand

name but make sure the name is spelt correctly.

The results page is the same layout in each case; a list of the preparations will be seen, specifying in each case whether it is the SPC or PIL.

The SPC is the technical guide written for healthcare professionals on the use of the medicine.

The PIL is the leaflet written for patients and is supplied with the medicine.

Click on the blue text next to the SPC or PIL box depending on what you want to look at.

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Click on Visit the eMC

Type the generic/brand name here e.g. atenolol or Tenormin

Each SPC is set out in exactly the same way, making navigation straightforward once you are familiar with the format.

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Select the correct brand, strength and type of information (SPC or PIL)

Click on the blue arrow to go back to the table of contents

Medicine Chest Online www.medicinechestonline.com

Medicine Chest is a directory of medicines and food supplements that are available 'over the counter' (OTC) from a pharmacy.

Strengths Limitations

Lists OTC medicines giving trade name, manufacturer and active ingredient(s).

No clinical information.

Symptoms:  Ignore symptom(s) aboveBase results on the symptom(s) selected above

Manufacturer:   Product name:  

Brand name:   Legal status:  

Active ingredient:   :

Tips for searching Enter trade name (exact spelling) e.g. Benylin in the Product name field. Click display

products.

A list of products will appear. Click on the relevant picture for more information.

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Type the product name here

Netdoctor www.netdoctor.co.uk

This website is specifically aimed at members of the public. It can be a very useful source of information but does not have the depth found in the eBNF or eMC.

Strengths LimitationsGood source of general information on medicines especially as a starting point before looking at a more complicated text.

Very easy to search.

Written for the lay public with limited amount of jargon. Worded such that it can be read to the caller with little adaptation.

Medicines content has much input from pharmacists – it has good focus on the key facts to be aware of.

Not very helpful for information about medicines during pregnancy or whilst breastfeeding.

Very little information about complementary medicines.

Does not have the depth of information found in other sources such as the BNF or eMC.

Tips for searching Click on the Medicines button in centre of the homepage.

Search for the trade name or generic name by clicking onto the relevant letter of the alphabet.

NHS Direct Medicines Q&As nww.intranet.nhsdirect.nhs.uk (go to Medicines Q&As)

There is a set of standard answers to some of the more common medicines calls produced by UKMI pharmacists. They may be used as a single information source.

Strengths Limitations

Topics identified by NHSD Nurse Advisors and Health Information Advisors.

Content is well researched, peer reviewed and referenced.

Updated every 15 months but immediately if necessary.

Can be used as single information source.

Limited number of Q&As currently but more planned.

The Q&A can only answer a question that matches the title and must not be used to answer questions that are related.

Tips for searching The Medicines Q&As are accessed via the NHS Direct Intranet

nww.intranet.nhsdirect.nhs.uk. Go to the National home page and click on the “Medicines Q&As” link.

Many of the NHSD Q&As are also available on the NHS Direct online website in a patient-friendly format at www.nhsdirect,nhs.uk Go to Common Health Questions - Medicines.

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Click on link for full Medicines Q&A

e.g. Click on the link eg A-C for Q&As about Antibiotics or Medicines in Breastfeeding

Additional information sources for calls about medicines

Dietary Supplements nww.intranet.nhsdirect.nhs.uk (go to Medicines Complete)

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Click here to find out more

Type the name of the supplement here e.g. glucosamine

Scroll down to find out more information about the supplement

FPA website www.fpa.org.uk

The Family Planning Association (FPA) website is written for members of the public. It gives information and advice about the use of all forms of contraception including a series of leaflets on each form of hormonal contraception.

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Appendix 2 in the Contents list gives some information about interactions with supplements.Scroll down to find glucosamine

Click on Information to find patient information leaflets and factsheets regarding methods of contraception

Herbal Medicines nww.intranet.nhsdirect.nhs.uk (go to Medicines Complete)

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Appendix 2 in the Contents list gives some information about interactions with supplements.Scroll down to find glucosamine.

Type herbal medicine here e.g. evening primrose and click Search

Alternatively you can select the herbal medicine from the list of monographs. Click on Contents

You can then scroll down to look for information e.g. herbal use

Searching the Appendices in Herbal Medicines

Click on Appendix 1 to search for possible interactions.

Immunisation NHS Website www.immunisation.nhs.uk

This is a NHS website about immunisations, including travel, aimed at members of the public.

Strengths Limitations

Comprehensive and reliable NHS source of information on immunisations.

Useful summary of childhood immunisations.

Website quick to load and search.

May not give the level of clinical detail available in the ‘Greenbook’.

Aimed at members of the public, information required not always available or in sufficient detail to answer call.

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Go to relevant Appendix to see list of herbal medicines which may affect the drug e.g. Appendix 2 lists herbal medicines with a laxative effect that could counteract the effect of an anti-diarrhoeal drug eg White Horehound & loperamide

Scroll down to find the appropriate drug category

Tips for searching Type the specific immunisation in the search box or click on the relevant immunisation from the

contents list.

Immunisation Against Infectious Disease (‘Greenbook’)

www.dh.gov.uk/en/Policyandguidance Healthandsocialcaretopics/Greenbook

The Green Book is a document, which charts the history of immunisation and immunisation advice over the years. It was published in 1996 as a book, which has now been superseded with the on-line version housed on the Department of Health website: www.dh.gov.uk.

Strengths Limitations

Comprehensive and reliable source of information on immunisations.

Website is often slow to load and search.

Take care when using as the updated sections are listed above the original sections.

Tips for searching To find the green Book on the Department of health website, search using the exact term

‘Green Book’, remember to include the inverted commas. N.B. Make sure you chose the most up to date version.

The first 12 chapters provide general information regarding immunisation including general indications/contraindications, adverse effects, storage conditions and immunisation schedules.

The following chapters are each dedicated to an individual infection, covering background to each infection, how vaccines are used to treat it, dosage instructions, adverse effects and more specific contraindications for that vaccine.

Each chapter is a separate PDF file that can be downloaded. This means that by using the binoculars function, you can search the document for a particular word/phrase. It will scan the document and highlight the relevant part of text, a useful way of quickly finding information in the document.

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or click on the relevant immunisation

Type the specific immunisation in the search box

Martindale: the Complete Drug Referencenww.intranet.nhsdirect.nhs.uk

nww.intranet.nhsdirect.nhs.uk(go to Medicines Complete)

Martindale is a specialist information source that gives highly detailed drug monographs primarily aimed at pharmacists. It is particularly useful for identifying the active ingredient within foreign medicines.

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Use the binoculars function or ‘Ctrl F ’to search for a word or phrase

Type foreign medicine here e.g. Presoquim

Click here to find out more about the foreign medicine

ie Presoquim contains diltiazem.

MHRA www.mhra.gov.uk

The Medicines & Healthcare Products Regulatory Authority (MHRA) website contains information about the licensing and safety of medicines. It is useful for finding out about recent drug safety issues/scares and also contains a link for patient reporting of side effects.

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Click for safety information.

Click to report a side effect

Prescription Pricing Authority www.ppa.org.uk

The Prescription Pricing Authority (PPA) website contains information about prescription charges and exemptions from prescription charges. There is an on-line facility to order and pay for pre-payment certificates as well as details of the telephone order/advice line.

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Click for safety warnings

Use the search box to search for information in this section

Click here to access online purchasing of Pre-Payment Certificates

The Drug Tariff link can be used to find information about prescription charges and drugs allowed on the NHS

Stockley’s Drug Interactions nww.intranet.nhsdirect.nhs.uk (go to medicines complete)

Stockley’s Drug Interactions is a specialist information source about drug interactions. It gives very detailed technical information. Take care to use Stockley’s Drug Interactions denoted by the icon

on the Medicines Complete Homepage) and not Stockley's Interaction Alerts denoted by the icon and which is an abbreviated reference source that does not cover all interactions.

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Select the link you need. This will take you to more detailed information about the interaction

Click here to find out what class of drug ciprofloxacin belongs toN.B. you should check what the drugs are in the eBNF first

Toxbase – Exposures in pregnancy www.spib.axl.co.uk

Toxbase contains the specialist database from the National Teratology Information Service (NTIS). It holds information about the risks associated with exposure to certain medicines during pregnancy. There is also a section that looks at how to manage common medical conditions in pregnancy.

Strengths Limitations

Very useful monographs on the use of individual medicines e.g. amoxicillin but also groups of medicines e.g. antibiotics.

Well researched, peer reviewed and referenced.

Some information on illicit drugs.

Not all medicines covered/medical conditions covered.

Technical language used.

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Toxbase has an e-learning website at www.toxbase.co.uk. This can also be accessed under Specialist Areas: NHS Direct / NHS 24.

Tips for searching Click on the text that says “Specialist areas” and then select “Exposures in pregnancy” in

the drop down list.

A list of drug names appears. Remember to look for both the drug name and the class of drug.

If no information listed – do not assume that it is safe. Check other resources and/or refer to UKMI.

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Click here to find out more about drugs in pregnancy

Scoll down to find the drug or class of drugs you are looking for

Travax www.ukmicentral.nhs.uk

Travax is a specialist database aimed at healthcare professionals that gives detailed information about travel vaccines and immunisations. Access to the database requires a NHS Direct username and password.

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Use the drop down menu to select the destination of travel

UKMI Central www.ukmicentral.nhs.uk

This guide is written by the UK Drugs in Lactation Advisory Service - a joint service provided by the West Midlands and Trent Medicines Information Services. It is intended to help assess risk where the infant is normal, healthy, and born full-term. Calls about infants born prematurely, or with serious illnesses or more complex problems should be referred to the Medicines Information Service.

Strengths Limitations

Useful traffic light coding for safety medicines use whilst breastfeeding.

Difficult to find this information elsewhere.

Well researched, peer reviewed and referenced.

Written by specialists in breastfeeding, and can sometimes contradict manufacturers advice. If in doubt obtain further advice.

Not for use if infant is born prematurely, or with a serious illnesses / complex problem.

Doesn’t include all medicines.

Tips for searching Click on the “quick reference guide” under the heading Drugs in Lactation on the home page.

Scroll down the list to find drugs grouped together in their therapeutic class e.g. antihistamines, antidepressants.

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Click on “Quick ref guide”

Click Enter to access the full list

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Check the traffic light symbols to see if the drug is suitable for use in breast feeding.

click here for safety information