TONY WAKA.
Lecture Note: Practical Drug Information
1. Introduction to Drug Information (DI) Drug Information (DI) is impartial, well-
referenced, and critically evaluated information pertaining to any aspect of pharmaceutical
practice. It is a fundamental professional responsibility of all pharmacists to provide drug
information.
Why is Drug Information Important?
• It is essential for ensuring rational drug usage, where patients receive medications
appropriate to their clinical needs, in correct doses, for an adequate period, and at the
lowest cost.
• It helps in aligning the vast amount of existing scientific information with clinical
practice.
• It promotes secure and efficient therapeutic practices, ultimately benefiting patient
care.
• Pharmacists must demonstrate proficiency in accessing, retrieving, evaluating, and
exchanging relevant information to ensure safe and effective patient care.
2. Types of Drug Information Resources Drug information resources are generally
categorized into three main types based on their content and how the information is
presented:
• Tertiary Sources
o Description: These sources provide information that has been summarized,
evaluated, and distilled by an author or editor to offer a quick, easy
overview of a topic. They compile primary literature.
o Advantages:
▪ Convenient and quick access to information.
▪ Easy to handle, promptness of use, objectivity, and variety of
information.
▪ Often serve as a quick reference at the point of care.
o Limitations: May contain outdated information if not regularly updated.
o Examples:
▪ Textbooks and Reference Books: Such as Drug Information
Handbook, Pharmacotherapy: A Pathophysiologic Approach (Dipiro),
E-therapeutics (RxTx), Compendium of Pharmaceuticals and
Specialties, and Maudsley Prescribing Guidelines in Psychiatry.
▪ Monograph Books and Review Articles.
▪ Systematic Reviews/Meta-analyses.
▪ Product Labeling.
▪ Major Compendia.
▪ The Drug Information Handbook, 15th edition, is described as a well-
written reference for concise drug information for clinicians and
students, most useful for quick reference at the point of care.
• Secondary Sources
o Description: These resources are indexing and abstracting services that
provide quick access or a path to primary literature. They do not provide
full text but direct users to original articles.
o Advantages:
▪ Offer refined search results and useful filtering systems.
▪ Crucial for conducting systematic searches.
o Examples:
▪ PubMed/MEDLINE.
▪ EMBASE.
▪ Cochrane Database of Systematic Reviews.
▪ Reactions Weekly, IPA, IDIS.
• Primary Sources
o Description: These are original manuscripts, documents, or records that
report results from original studies.
o Advantages: Provide the most up-to-date information and direct insight into
original research.
o Limitations: Consulting primary sources for every information request is not
always feasible due to time constraints or the nature of the question.
o Examples: Randomized clinical trials, cohort studies, case-control studies,
and other scientific articles reporting original data.
3. Systematic Approach to Drug Information Queries Effectively searching healthcare
literature requires a systematic approach. The following 7-step process is recommended for
addressing drug information queries:
• Step 1: Secure Demographics of Requestor
o Identify the requester's professional and educational background to tailor the
response appropriately.
o Gather contact information (e.g., address, phone, pager, fax) for follow-up.
• Step 2: Obtain Background Information
o Act as a "detective" to understand the true underlying question.
o Determine if the question is general or patient-specific (e.g., patient's
diagnosis, medications, pregnancy, weight, renal function).
o Identify resources the requestor has already consulted.
o Clarify the urgency of the request.
• Step 3: Determine and Categorize the Ultimate Question
o Classify the request as patient-specific or academic.
o Categorize by type of question to guide the search strategy and resource
selection. Common categories include: Administration of Medicines, Adverse
Drug Reactions, Drug Interactions, Drugs in Pregnancy, Compatibility of
Parenteral Drugs, Drugs in Renal Disease, Drugs in Liver Disease, Drugs in
Breast-feeding, Children and Medicines, Alternative Medicines, and Product
Availability.
• Step 4: Develop Strategy and Conduct Search
o Select and prioritize resources based on the likelihood of finding the desired
information. Start with tertiary literature, then proceed to secondary
resources to locate primary literature.
o Use reputable online resources, typically those ending in .gov or .org.
o Employ Boolean Operators and Search Syntax:
▪ Boolean Operators:
▪ OR: Used to expand a search by combining synonymous
terms (e.g., "heart attack OR cardiac arrest OR myocardial
infarction"). This creates large pools of articles for each topic.
▪ AND: Used to narrow a search by combining different
concepts or "pools" of articles. This ensures that results include
all specified topics (e.g., "heart attack pool AND adult women
pool AND statin pool").
▪ NOT: Excludes terms from the search results (e.g., "Vegan
NOT Vegetarian").
▪ Search Syntax (not applicable to MeSH terms):
▪ Truncation (*): Finds alternate endings of a word (e.g.,
depress* finds depress, depressed, depressing).
▪ Mandated Wildcard (#): Replaces exactly one letter (e.g.,
wom#n finds woman, women).
▪ Optional Wildcard (?): Replaces zero or one letter (e.g.,
p?ediatric finds pediatric, paediatric).
▪ Nesting (...): Groups similar terms to perform a combined
search (e.g., (behavio?r AND (depression OR anxiety)) ).
▪ Proximity (adjn): Finds words within a specified number of
words of each other in any order (e.g., disturb* adj3 sleep ).
o MeSH (Medical Subject Headings) Terms:
▪ Medline and PubMed use MeSH terms (controlled vocabulary) to
index articles by concept, and keywords for exact phrases.
▪ MeSH terms are arranged hierarchically and automatically include
variations of terms, making searches more comprehensive.
▪ When searching in Medline, select the 'Map Term to Subject Heading'
option. Review the "Scope" to ensure relevance and "Explode" to
include all subheadings.
▪ Use both keywords and MeSH terms for a comprehensive search.
• Step 5: Perform Evaluation, Analysis, and Synthesis
o Objectively critique all information retrieved from the search.
o Consider the background information of the question and consult with experts
if necessary.
o Confirm information with other references to ensure consistency and
reliability across various sources.
• Step 6: Formulate and Provide Response
o Restate the question and any pertinent background information.
o Provide the information and any applicable recommendations.
o Compose the response at the requestor's comprehension level.
o Responses should be: Timely, Current, Accurate, Complete, Concise,
Supported by the best available evidence, Well-referenced, Clear and
logical, Objective and balanced, Free of bias or flaws, Applicable and
appropriate for specific circumstances, and address any important related
questions.
• Step 7: Conduct Follow-Up and Documentation
o Document the request, information resources consulted, the response
provided, and any follow-up actions. This can be done via log books,
computer databases, or paper forms.
o Reasons for documentation: Justifies the pharmacist's professional value,
serves as a future reference for repetitive queries, and acts as a protective
measure against legal liability.
o Follow-up assessment determines the utility of the information provided and
its impact on patient outcomes or medication-use practices.
4. Practical Hands-on: Searching Databases (Focus on PubMed)
PubMed Overview
• PubMed is a free database containing over 37 million citations for published articles
in biomedicine and health.
• It incorporates the MEDLINE® database, citations from the PubMed Central
(PMC) free full-text archive, and books from the NCBI Bookshelf.
• It is used by millions daily, including health professionals, researchers, and those
involved in public health and clinical care.
• Full text is not always free, but links are provided to publisher sites, PMC, or
institutional subscriptions.
How to Search in PubMed ([Link])
• Searching by Author:
o Best practice: Search by last name and initials (e.g., collins f).
o No need to use special tags, capitalization, or punctuation.
o For common names, PubMed's Computed Author Sort algorithm identifies
and prioritizes articles most likely by your author of interest based on co-
authors, affiliations, and topic terms.
• Researching a Topic:
o Enter your search terms directly into the search box.
o Be specific and avoid quotation marks or truncation (*) initially, as PubMed
automatically adds relevant MeSH terms and synonyms to improve your
search.
o You can view your search details to understand how PubMed processed your
query.
• Finding a Known Article:
o Copy the full article title into the search box.
o Alternatively, enter citation elements (author, title words, journal, volume,
year) and let the citation sensor find the article (e.g., nolte blood 2019).
MeSH (Medical Subject Headings) in PubMed/Medline
• MeSH is a controlled vocabulary used for indexing articles by concept.
• MeSH terms are arranged in a hierarchy, from broad to specific, and articles are
assigned the most relevant headings.
• The "Map Term to Subject Heading" feature helps find matching MeSH terms
automatically.
• The "Scope" icon (i) provides a definition of the term, and "Explode" allows you to
include all narrower terms within a subject heading's hierarchy, making your search
more comprehensive.
Accessing Full Article Text
• Free Full Text Filter: Use this filter on the left sidebar to narrow results to freely
available articles, including those from PubMed Central, Bookshelf, and publishers'
websites.
• PubMed Central (PMC): NIH's free digital archive. Look for the "Free in PMC"
icon on the abstract display.
• From the Publisher: Icons linking to articles on journal publisher websites may
indicate free access, or access after registration/payment.
• Hospital, University, or Other Major Institution: If affiliated, your library may
provide access through specific icons or offer interlibrary loan services for articles not
directly accessible.
• Local Public Library: Some public libraries have medical journals or can facilitate
interlibrary loans.
Additional PubMed Features
• Cite Button: Generates citations for articles.
• Save Button: Saves selected results.
• Email Button: Emails selected results.
• "Send To" Button: Allows sending results to various destinations.
• Create Alert: Set up alerts for new articles matching your search criteria.
• Results By Year: Displays a graph showing the number of articles published each
year.
• Text Availability Filter: Filters by "Free full text" or "Full text".
• Article Type Filter: Filters by specific article types (e.g., clinical trial, review).
• Publication Date Filter: Limits results to a specific publication timeframe.
• Advanced Search Builder and History: Allows for building complex searches and
reviewing past queries.
• Search Details: Shows how PubMed translated your search query.
• Best Match: A feature that prioritizes search results based on an algorithm that
identifies the most relevant articles.
5. Evaluating Online Drug Information Resources While online resources offer convenient
and quick access to information, it is crucial to critically evaluate their reliability.
• Advantages of Online Resources:
o Convenient and quick access to updated medical information.
o Many resources are freely accessible.
o Provide more detailed information on rare or tropical diseases and
alternative medicine that might not be available in printed formats.
• Disadvantages of Online Resources:
o Accessing and navigating the Internet can be time-consuming and
restrictive.
o Not all content is useful or reliable.
o Many useful sites may require a fee or subscription.
o Presence of unreliable sources with unreferenced citations.
o Many patients utilize online resources as their primary information source,
which can be problematic if the information is inaccurate.
• Key Questions to Ask When Evaluating a Website:
o Who runs the Website? Be wary of sites funded by entities that profit from
the message. Look for suffixes like .gov (governmental), .edu (academic), or
.org (not-for-profit) as clues to reliability.
o What is the purpose of the Website? It should be educational, not primarily
for financial gain.
o What is the original source of the information on the Website? References
should be readily available.
o What are the credentials of the contributors or reviewers? They should
ideally be healthcare professionals.
o Is the information current? Locate the date of the last update.
o What is the Website's linking policy? (Linking should not be allowed without
approval).
o What is the Website's privacy policy? (Information obtained from users may
be sold).
o Is contact information readily available?.
o Who monitors the chat room, if available? (Preferably a healthcare provider).
6. Addressing Challenges in Drug Information
• Requests Without Information (RWI): Studies show that about a quarter of
responses provided by Drug Information Centers (DICs) may not have
conclusive information in the consulted sources.
o The majority of RWI (51%) come from hospital professionals, often due to
complex cases involving critical, paediatric, or pregnant patients for whom
specific studies are not always available.
• Difficult Topics for Information Retrieval:
o The greatest difficulties in finding information are related to off-label drug
administration and indication issues, accounting for 52% of RWI from
hospitals.
▪ Common types of off-label use include changing the original
pharmaceutical form (45%), route of administration (32%), use in
specific age groups (13%) such as paediatrics, neonatology, and
geriatrics, and dosage (6%).
▪ Reasons for this scarcity of information include manufacturers not
specifying off-label routes and a lack of approved therapeutic options
or studies for specific populations.
o Questions related to Adverse Drug Reactions (ADRs) are also frequently
challenging to answer due to the complexities of establishing causal
relationships.
▪ The FDA provides resources like Drugs@FDA database and
FDALabel database for side effect information, and the MedWatch
program for reporting serious problems.
7. Conclusion In an era of exponentially expanding medical knowledge, health professionals
and students must develop robust strategies for efficiently and effectively accessing drug
information. Understanding the types of drug information resources, employing a systematic
approach to inquiries, and mastering advanced search techniques (including Boolean
operators and MeSH terms) in databases like PubMed are invaluable skills. Furthermore, the
ability to critically evaluate online resources for accuracy and bias is paramount. By
consistently applying these principles, pharmacists can ensure the provision of high-quality,
evidence-based drug information, which is crucial for supporting clinical practice,
education, and ultimately, improving patient outcomes.