1.

INTRODUCTION TO
DRUG INFORMATICS

BY SHEWANEH AYELE

1
 OVERVIEW OF THE
ETHIOPIAN HOSPITAL
REFORM
IMPLEMENTATION
GUIDELINES (EHRIG)

2
EHRIG
2010

3
 OVER VIEW OF “EHRIG”

CH 1: Hospital leadership and CH 8: Facilities management

governance
CH 9: Medical equipment
CH 2: Patient flow
management
CH 3: Medical records
management CH 10: Financial asset management

CH 4: PHARMACY CH 11: Human resource

SERVICES management

CH 5: Laboratory services CH 12: Quality management

CH 6: Nursing care standards CH 13: Monitoring and reporting
CH 7: Infection prevention

4
4. PHARMACY SERVICES

5
4. 1: Introduction 4. 3.2.3 Dispensing and
4. 2: Operational standards medication use counseling
for pharmacy services 4. 3.2.4 Compounding of
4. 3: Implementation non-sterile extemporaneous
guidance preparations
4. 3.1. Drug and 4. 3.2.5 Patient medication
Therapeutic Committee profile card
4. 3.2: Hospital 4. 3.2.6 Pharmaceutical care
pharmaceutical plan
services
4. 3.2.8 Emergency
4. 3.2.1 Clinical pharmacy services
pharmaceutical
services 4. 3.3 DRUG
4. 3.2.2 Organization and
INFORMATION SERVICE
management of
pharmacy services
6
 4. 3.3. DRUG
INFORMATION SERVICE

7
⟡Upon completion of the lectures and
1.1. LEARNING OBJECTIVES

required readings, the trainee should be

able to explain or illustrate the following
subject areas regarding drug information
services (DIS):
− Define the term drug information services
− Review historical perspectives of drug
information services
− Describe the function of DIS and
responsibilities of the DIS specialist

8
 1.2. HISTORY OF DIS
(1960S & 1970s)
• University of Kentucky: The first formalized
drug information center
• Medlars: Medical literature analysis and retrieval
system (by US mail)
• Medline: Medical literature analysis and retrieval
system through a telephone line (for a fee).
• American society of health-system
pharmacists:
DI recognized as a specialty
• Pharmaceutical companies: Established in-
house DI services
9
 1.3. DRUG
O N S E R V I C E S
INFORMATI
D E F I N IT I O N
10
 Scenario I
• Patient: “Is hydrocortisone cream good for itching?

• Pharmacist: “Yes it is. However, you have to use it

twice a day. How often have you been using
it?”

• Patient: “I have only been using it once a day.”

• Pharmacist: “Well, to get the best result, twice a day is

recommended. By the way, use the one
with maximum concentration.”

11
 Scenario II
• Patient: “Is hydrocortisone cream good for
itching?
• Pharmacist: “Yes it is. Who is having the
itching?”
• Patient: “I am.”
• Pharmacist: “Why are you having the itching?
• Patient: “I do not know. It might be the new
medication that my Doctor started me
on last week.”
• Pharmacist: “Tell me about your new
medicine.”

12
 Scenario III
• Patient: “What is a good medicine for
stomach upset?”
• Pharmacist: “Are you on any
medications? is it food related?
Why are you having a
stomach upset?”
• Patient: “I am not on any medication
and I do not know why I am
having the stomach upset.”
• Pharmacist: “Try MOXAL. It is a good
antacid.”
13
 Scenario IV
• Patient: “What is a good medicine for stomach upset?”
• Pharmacist: “Are you on any medications? Is it food related?
Why are you having a stomach upset?”
• Patient: “I am not on any medication and I do not know why
I am having the stomach upset.”
• Pharmacist: “How about over the counter medications? or
herbal drugs?”
• Patient: “No. I am not taking any herbal products.”
• Pharmacist: “What do you take when you have a headache
or cough or Pain?”
• Patient: “Oh! I take one Aspirin a day. My Doctor told me it is
also good for my heart. That is not a medicine. Is
it?”

14
Q. Lesson learned from
these examples??

15
Drug Information (DI)
♦What do we learn from these cases?
−People do not know what the problem
is and they tend to generalize
−It is the pharmacist’s job to help find
the problem
♦Drug information:
−Identifying the ultimate
question!

16
 DI - What is it?
1. Identifying the ultimate question
2. Locating
• Resources, knowledge, techniques of
searching
3. Analyzing
• Statistics, literature evaluation
4. Applying information to the
question
• Pharmacotherapy/Pharmacology
5. Communicating information
17
DRUG INFORMATION;
− Is the provision of
unbiased, well
referenced, and critically
evaluated information on
drug related issues.

18
 N O F D R U G
1.4. FUNCTIO S
N C E N T E R
INFORMATIO
19
 FUNCTIONS OF DI SERVICES
1. Responding to DI questions
2. DTC and formulary support
3. Drug utilization review(DUR)
4. Adverse drug reaction (ADR) reporting
5. Patient counseling
6. Continuing education (CE) programs
7. Investigational drug studies
8. Research
9. Drug information education

20
OTHER FUNCTIONS OF DI
SERVICES
• RESEARCH

• Assess investigational drug therapy,

efficacy, and safety
• CONTINUING EDUCATION (CE)

• DRUG INFORMATION EDUCATION

• Training to pharmacy students

• Pharmacy has now DI course

21
 PUBLICATIONS
• Pharmacy newsletter: goal:
• Method of communication of the drugs &
therapeutics committee activities
• Inform practitioners of new and advances in
drug therapy
• Abstracting services
• Columns for journals
• Review articles for journals

22
PUBLICATIONS

23
24
WHO ARE THE MAJOR USERS OF
DIS?

A. Health Care Providers

B. Patients and/or the general public
C. Students
D. News agency and lawyers
E. Others

25
1.5. SEARCH ENGINES AND
SEARCH STRATEGY

26
THE WEB IS GROWING
EXPONENTIALLY

27
28
 THREE METHODS OF SEARCHING
(1) SEARCH ENGINE
(2) DIRECTORIES
(3) PORTAL
(1) SEARCH ENGINE:
−Google; [Link]; [Link],
[Link]; etc..,
−Known as “robots” or “spiders” and are
“crawler-based”:
−“Spiders” or “crawlers” programs visit
websites and some of their pages
periodically, and add content to their
index.
−They also ranks in relevant order!
29
SEARCH ENGINE CONT.,
• Search various parts of the web
pages (title, URL, text):
−Comparing to directories, search
engines should be your first
choice when you know exactly
what you are looking for!
−They also cover a much larger
part of the web than the
directories.

30
Why to evaluate what we
find on the web?
• Anyone can put up a web page
− About anything, for pennies, in minutes
• Many pages are not kept up-to-date
• No quality control
− Most sites are not “peer-reviewed” and
hence, less trust worthy than scholarly
publications
− No selection guidelines for search
engines
31
The internet -
Reliability
• Accuracy:
−36% inaccurate; 19% are
harmful to the patient
• Bogus sites proliferate
−POP! the first human male pregnancy
−Http://www. [Link]

32
33
 Indicators
1. High Quality:
of quality
−Government (.gov), education
(.edu), professional association
(.org), military (.mil); news services
2. Medium Quality:
−Pharmaceutical manufacturers
(.com)
3. Low Quality:
−Individuals, Selling ideas or
products
34
 Search Engine Limitations
• Search “spiders” or “crawlers” do *not* crawl in
real time
• Lag times getting information to the index vary
by search engine
• If a website is not submitted to the search engine
it won’t be crawled
• Not all inclusive
• The best search engine only indexed 16-30%
• A webmaster can choose to not have a page
crawled
• Some formats like, zip files, executable programs,
and others cannot be searched
• Generate sites not relevant to your search
35
 Get a Second Opinion
• Statistics say no search engine has it all:
• Only about 60% of pages in google
are also in other search engines
• Only 50% of pages in any search
engine database are also found in all
others
• [Link]/
stats/
• Use another large search engine
36
Pick a few favorite search
engines and metasearch engines
and become well familiar with
them.

37
(2) DIRECTORIES
• Directories are where different resources are
gathered
− Are not a search engine and does not display lists
of web pages based on keywords; instead, it lists
web sites by category and subcategory.
• Difference from search engine
− Most of the edited by humans
−URLs are no gathered automatically by spiders but
submitted by site owners.

38
(3) PORTAL
• Bring information together from diverse sources in a uniform
way
• Represents a website that provides a single point of access to
applications and information.
• Service offered:
− e-mail
− news
− stock quotes
− information from databases
− entertainment content

39
EARLY PUBLIC WEB PORTALS

• AOL • Naver
• Exites • Lycos
• Netvibes • Rediff
• iGoogle • Sify
• MSN • Yahoo!
40
 TYPES

1. Personal portals 4. Corporate web portals

− Designed to distribute applications, − Include work flow management,

collaboration between work groups
different numbers and types of
middleware and haedware. 5. Stock portals
− Stock share portals or stock market
2. Government web portals
portals
− [Link]
6. Search portals
− [Link] − Aggregate results from several search
3. Cultural portals engine in to one page
7. Others: Domain specific, hosted
− Based around a specific nations or
web, portals
regional groupings of institutions

41
 1.6. RECEIVING AND
CLASSIFYING DRUG
INFORMATION QUESTIONS

42
STEP I: SECURING REQUESTER
INFORMATION
• Contact information
• Name and phone or fax number
• Professional background
• MD, RPH, RN, etc.
• Patients
• Others: Lawyers, Intermediaries, Journalists,
etc.

• Affiliation and address

43
DRUG INFORMATION WORKSHEET AND ITS
COMPONENTS
• Requester or source information
• Classification of request
• Patient data
• The request, actual drug information need
• Time frame for response
• Record of search/notes
• Clear statement of response
• Outcome
44
Step II: Obtain background
information

•Original Vs. ultimate question

•Time frame for response
•Determine the method of response

45
QUESTIONING STRATEGIES
• Open-ended versus closed-ended
questioning
• How is this information going to be used?
• Will the information be used in the care of a
specific patient?

• Direct versus indirect questioning

• What are this patient's age, weight, and
height?
• What other medications is this patient taking?

• Probing (examining)
• Reflective statement 46
 EXAMPLE
• Patient: Is dextromethorphan good for cough?"
• Pharmacist: "Yes, dextromethorphan is one of several effective
medications for cough. How much have you been taking?"

• Patient:"I've only been taking two tea spoonful in the morning. Should I
take more?"

• Pharmacist: “Do you have fever?”

• Patient: “No, not that I know of.”
• Pharmacist: “Do you have a productive cough or chest pain when you
breathe?”

• Patient: "No."
• Pharmacist: “Well, it's probably okay to take two teaspoonful every 6 hours
as needed for cough. If the cough doesn't go away in the next week or so,
you should con tact your doctor."

47
EXAMPLE
• Patient: "Can you check a drug interaction? I've been on so many medicines.
The Dr's don't know what to do with me anymore.”

• Pharmacist: "Your Dr. did not know what to do with you because you have
been on several medications and did not work?”

• Patient: “Yes, I think he does not want to see me any more.”

• Pharmacist: “Can you tell me what medicines you have tried in the past?“

• Patient: “I have high blood pressure. I've tried everything, and everything I
have ever taken has made me feel bad,“

• Pharmacist: "if I understand you, Mr. T, you are telling me that you believe
any new hypertension medicine is going to make you feel bad.”

• Patient: “That's what I believe. The doctors told me that captopril ruined my
kidneys. The esidrix that I used before didn't make me feel bad, but it didn't do
any good. This nifedipine is really making me dizzy, and I can hardly stand up."

48
 PATIENT DATA
• Refers to patient’s name, age, account number,
room or bed number
• Diagnosis, acute and chronic medical problems
• Allergies/intolerance, pertinent medication
history
• Laboratory values, and other miscellaneous
information
• Patient data helps to individualize the response
49
Step III: Classification and
Categorizing
of Request
•Determine type of reference
sources
•Determine the types of
questions you need to ask

50
 EXAMPLE
• Can you tell me what “adistatin” is
indicated for?
[Link]
[Link]
[Link]
[Link] product
[Link] drug, etc.
51
Example - Determine and
Categorize Ultimate Question
• Physician: “What is the dose of ceftazidime?”
• Pharmacist: "Is this question about a patient?”
• Physician "Yes.”
• Pharmacist: "How old is this patient?”
• Physician: "He's a 59-year-old male.”
• Pharmacist: "How is his renal function?”
• Physician: "His renal function is fine; no problems.”
• Pharmacist: “1 to 2 gms every 8 hours.”
52
EXAMPLE
• Physician: “What is the dose of ceftazidime?”
• Pharmacist: "Is this question about a patient?”
• Physician "Yes.”
• Pharmacist: ”Why do you need to give
ceftazidime to this patient?”

• Physician: ”Well, the patient has most likely

developed a bad cellulitis. culture samples were
taken from the infection site. however, we would
like to initiate an antibiotic therapy empirically.”

53
Step IV: Develop Step V: Perform
strategy and evaluation, analysis,
conduct search and synthesis
Step VI: Formulate
• Searching strategy and provide response
personal • What you tell the
communications requester
with patients, care • The method you used to
provide a response
givers, etc.
• Verbally, in writing,
• Record the facsimile, or patient's
names/tel# of the medical chart.
individuals you
interacted with 54
Step VII: Outcome and
Follow-Up
•To determine the acceptance or
rejection of your recommendation
•To determine the impact on patient
care of those recommendations
accepted

55
 Re f e re n c e s
1.7. Types of

56
I. Primary

•Original research studies

•Details of research methodology
•Most current
•Over 20,000 biomedical journals
per year

57
 Primary
Literature
• History:
• The philosophical transactions of the royal society - the first periodical
• 1 edition in 1664 by henry oldenberg (london)
st

• Journals: the most common reference journals used by DICS:

• American journal of health-system pharmacists (AJHP)
• Annals of pharmacotherapy
• Hospital pharmacy
• Formulary
• New england journal of medicine (NEJM)
• Journal of the american medical association (JAMA)
• British medical journal
• Annals of internal medicine

58
II. SECONDARY
• Indexing (index) and abstracting
(abstracts)
• Searchable
• Mostly computerized
• User-friendly
• Covers thousands of articles (medline –
pubmed; micromedex*, biosis, etc.)

59
Secondary
References:
Computerized Drug
Information Systems
• Iowa drug information services (IDIS)
• Index medicus
• Micromedex (drugdex,identidex, poisondex)
• International pharmaceutical abstracts (IPA)
• Excerpta medica
• Embase
• National library of medicine (NLM) - includes medline,
toxline, toxlit

60
III. Tertiary

•General literature (books,

handbooks, manuals, etc.)
•Commonly used: easy, concise
•Summarizes findings
•Not up-to-date
•Authors view
•Incomplete information
61
TERTIARY REFERENCES
ARE
CORE REFERENCES

BOOKS!!!
62
BOOKS
MOST COMMON REFERENCES BOOKS USED BY DICS
• DRUG FACTS AND COMPARISONS
• MARTINDALE: THE EXTRA PHARMACOPOEIA
• HANDBOOK OF INJECTABLE DRUGS
• PHYSICIANS’ DESK REFERENCE (PDR)
• G & G’S THE PHARMACOLOGICAL BASIS OF THERAPEUTICS
• CLINICAL TOXICOLOGY OF COMMERCIAL PRODUCTS
• DRUG INTERACTIONS (HANSTEN)
• MERCK INDEX , AMERICAN DRUG INDEX
• HARRISON’S PRINCIPLES OF INTERNAL MEDICINE
• REMINGTON’S PHARMACEUTICAL SCIENCES
• AHFS DRUG INFORMATION (AHFS DI)
• PHARMACOTHERAPY: A PATHOPHYSIOLOGIC APPROACH
• APPLIED THERAPEUTICS
• MEYLER’S SIDE EFFECTS OF DRUGS
• UNITED STATES PHARMACOPOEIA/NATIONAL FORMULARY (USP DI -
VOLUME I-III)

63
PHYSICIAN
DESK
REFERENCE
(PDR)

64
 PHYSICIANS’ DESK REFERENCE
• “physicians’ bible” - 1st edition: 1940s
• It is a compilation of product package inserts
• Initially was biased and highly selective listing
• Free for consumers; for fee to manufacturers
• Product representation is limited due to fees
• The arrangement is not user friendly. the index is at the front; by
manufacturer, by drug name

• Contains:
• Visual product color photographs for identification
• DI and poison center and manufacturers address and listing
• FDA telephone numbers, medwatch report form.

65
DRUG FACTS
AND
COMPARISON
S

66
DRUG FACTS AND
COMPARISONS
• 1 edition - 1945
st

• One of the most commonly used references by

pharmacists
• > 16,000 Rx and 6,000 OTC products
• Categorized by: therapeutic class, brand and generic name
• Original name: facts and comparisons
• Facts to make it easy to compare drugs in the same
class/related products
• Once largely limited to community practice
• Diagnostic aids - office based or home test kits
• No references, loose-leaf binder.
67
AMERICAN
SOCIETY OF
HELATH SYSTEM
PHARMACISTS
(AHFS) DRUG
INFORMATION
(DI).

68
 AHFS DRUG INFORMATION
- Published by ASHP for hospital pharmacists
• American hospital formulary service (AHFS); 1st
Edition - 1959
-A highly respected authoritative drug
information resource and the most useful
reference to Hospital Pharmacists to this day.
- Primary focus is prescription, parenterals and
some OTC products are included
- Radiopharmaceuticals, Biologics/Vaccines
- Off Label Versus approved uses
69
UNITED STATES
PHARMACOPOEI
A DISPENSING
INFORMATION
(USP DI)

70
UNITED STATES PHARMACOPOEIA DISPENSING
INFORMATION (USP DI)

- > 11,000 generic and brand name products

- Is narrower in scope compared to ASHP DI
- Volume I: drug information for health care
professionals; Volume II: for patients
- Extensive review
process - over 700 expert advisory
panel members involved
- In 1998: USP formed an alliance with micromedex.
- The on-line version is available at :
[Link] or [Link]

71
PUBME D / M E D L I N E
72
73
INTRODUCTION
• Created by public law 100-607 in 1988 as part of national library of
medicine at NIH
• Maintained by national library of medicine
• Free of charge, since 1997
>10 million references since 1966
> 4000 biomedical journals
> 80% in english
> 80% have abstracts
• Content of medline database
• Records received from publisher, assigned a PMID (record as supplied
by publisher), then assigned uid (premedline, medline record in
process), then indexed with mesh terms (medline)
• Indexer assign the most specific mesh headings to describe each
major concept discussed in the article

74
PUBMED

75
PUBMED: SEARCHING

76
PUBMED: MESH BROWSER

77
PUBMED: LIMITS

78
PUBMED: ADVANCED SEARCH

79
PUBMED: DIRECT LINK TO
PUBLISHER

80
OVERVIEW OF NLM DATABASES
• Medlineplus
• [Link]
• Dirline
• Medline
• Locatorplus
• NLM gateway
• Toxnet
81
 S Y S T E M AT I C
1.8. THE
SEARCH

82
SEARCHING TECHNIQUE
• Point of entry for searching
• Starting point for searching
• General-to-specific searching
• Core general references
• Drug facts and comparison
• Physician drug reference (PDR)
• AHFS drug information
• USP-drug information Vol I-III
• Internet
• General search engines: google, yahoo; look
smart; lyocs; excite
• Specific search engines: webmd; mayohealth;
healthfinder

83
ADVERSE DRUG REACTIONS (ADR)
• General references
• PDR, drug facts and comparison, AHFS DI
• Meyler’s side effects of drugs
• Clin-alert*/reactions
• Textbook of ADR
• Secondary references
• Medline, IPA, excerpta medica, drugdex
• Pharmaceutical manufacturers
84
AD
R

85
COMPATIBILITY/
STABILITY
•Core general references
•Handbook on injectable drugs
(trissel)*
•Handbook of injectable drugs (kings)
•Pharmaceutical industry
86
COMPATIBILI
TY

87
 COMPOUNDING
•Apediatrician called to see if you
can find him the formula to prepare
captopril for a 4-year old child with
heart failure.

88
 COMPOUNDING CONT..,
• Remington’s pharmaceutical sciences*
• Handbook of extemporaneous formulations (ASHP)
• Pediatric drug formulations (nahata and hipple)
• Manufacturers - paddock lab
[Link]

• Professional compounding centers of America (PCCA)

- Compounding formulas from recent journal literature:
[Link]

- Pharminfo net ([Link]/drugdb/), pharmweb ([Link])

- contemporary compounding:
[Link]

89
90
 DISEASE STATE
MANAGEMENT
•A mother called about her child’s
asthma drug.
•She wanted to get the latest guideline
in management of asthma.

91
DISEASE MANAGEMENT
REFERENCES
• Principles of internal medicine (Harrison)
• Merck manual
• Clinical pharmacology
• Applied therapeutics (Koda-Kimble)
• Pharmacotherapy (Dipiro)
• Cecil’s medicine
• Current medical diagnosis and treatment (CMDT)
92
93
Case: Drug Interaction

A patient wants to know if there is

an interaction between ginseng and
diazepam?

94
DRUG INTERACTIONS
• Core general references
• Stockley’s drug interaction
• Drug interaction facts
• Hansten and horn’s drug interactions analysis
and management
• Clinical pharmacology online
• Drug-reax (micromedex)
• Several websites (medscape, drugs, Rx list,
drugdigest, etc.)

95
DIR

96
DRUG HANDBOOKS ON THE
INTERNET

•Medlineplus
•Rx list:
•Medscape drug search:
[Link]
•Merck manuals

97
FOREIGN DRUGS
YOU RECEIVED A CALL FROM
THE AMERICAN EMBASSY TO
FIND THE U.S. EQUIVALENT OF
“DAONIL”.

98
FOREIGN DRUG RESOURCES
• Martindale: the extra pharmacopoeia
• European drug index
• Index nominum: international drug
directory
• Drugdex (micromedex)
• International pharmaceutical abstract
• Canadian compendium of pharmaceuticals
• Medline, excerpta medica
99
FOREIGN DRUG RESOURCES

100
HERBAL PRODUCT
A herbalist wanted a literature
review on the effect of “garlic”
on the liver.

101
HERBAL MEDICINE
• German commission e monograph*
• Review of natural products* (drug facts &
comparison)
• PDR for herbal medicine
• NIH national center for complementary and
alternative medicine (cam): [Link]
• The international bibliographic information on
dietary supplements database (IBIDS):
[Link]
• Local health food store
102
cavorite-lis
n
-fGET
tg/stores/d
communit
rate-item
cust-rec
just-say-no
true
m/justsay

10
3
 IDENTIFICATION
• A patient was found unconscious
with a prescription bottle and
tablets over his body.
• The tablets have an imprint code of
“433”, and is a diabetic drug

104
IDENTIFICATION FOR
•TABLETS/CAPSULES
Rx [Link]
•Clinical CODE
IMPRINT
pharmacology
online
•Identidex
(micromedex)
•Clinical reference
library
•Ident-a-drug 105
reference
WHAT IS THE BEST OTC
PRODUCT TO TREAT
HAIR LOSS??

106
1.9. OTC DRUG
RESOURCES:
•Handbook of nonprescription
drugs
•Drug facts and comparison
•PDR for nonprescription
drugs
•Several websites
107
108
PAEDIATRIC DOSING
A pharmacist from a local pharmacy
called the DIC to get assistance in
preparing a captopril 2.5 mg dose for
a child.

109
PD Cont.,
• Core general references
• Nelson textbook of pediatrics
• Current pediatric diagnosis and treatment
• Lexi-comp’s pediatric dosage handbook
• BNF for children
• The harriet lane handbook

110
PAEDIATR
IC
DOSING

111
 2. CONSUMER
DRUG INFORMATION

112
CDI CONT..,

•Yourpatient asked you for a

recommended website that is
dependable, to get answers for
questions related to her illness.

113
 CDI CONT..,
• FDA consumer information – drug database:
[Link]
• Medline plus
• USP-DI Volume II: advise for the patient: on health
resources [Link]
• Intelihealth – USP-DI Volume I&II
[Link]
• Medscape patient information:
[Link]
[Link]
• Mayoclinic
114
2.1. PREGNANCY AND LACTATION
• You are consulted by an obstetrician who is
examining a patient in a clinic and has just
confirmed that the patient is pregnant.
• The patient has a long history of depression
that has responded positively to an
antidepressant called amitriptyline.
• The doctor wants to know if it is safe to use
it in pregnancy.

115
P&L Cont.,
• Core general references
• Drugs in pregnancy and lactation (briggs)
• Drugs and human lactation (bennett)
• Medications and mother’s milk (hale)
• Teris, reprorisk
• Principles and practices of medical therapy in
pregnancy
• Drugdex, medline, etc.
116
DRUGS IN PREGNANCY AND
LACTATION

117
2.2. TRAVEL MEDICINE

• A pharmacist called to ask for the

recommended chemoprophylaxis
for one of his clients , who is
traveling to shashemene next
week.
118
2.2. TM CONT..,
• CDC international travel directory [Link]
• Who international health and travel
• US department of health and human services
health information for international travel
• The american college of physicians guide to adult
immunization
• Morbidity and mortality weekly reports (MMWR)

119
[Link]
content/yellowbook/[Link]

[Link]
ith/chapters/en/
[Link]

IAMAT International Association for

Medical Assistance to Travellers

12
0
2.3. OTH ER U SEF U L
RESOURCES
121
DRUG ADMINISTRATION AND CONTROL
AUTHORITY

122
FEDERAL MINISTRY OF
HEALTH

123
AIDS RESOURCE CENTER

124
CENTERS FOR DISEASE CONTROL AND
PREVENTION

125
US FOOD AND DRUG ADMINISTRATION

126
WORLD HEALTH ORGANIZATION

127
HTTP://[Link]/EDRUG/

128
MEDLINE PLUS

129
INFECTIOUS DISEASES SOCIETY OF
AMERICA

130
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL
EXCELLENCE (NICE)

131
[Link]

132
EPOCRATES ONLINE

133
134
135
CENTER FOR EVIDENCE BASED
MEDICINE

136
JOURNAL WATCH

137
 3.
PROFESSIONAL
WRITING
138
MEMO
•TO: PHARMACY STUDENTS
•FROM: EPHREM ABEBE
•DATE: JANAURY 31, 2011
•RE: WHAT IS A MEMO?
Cited
Literature
A memo is a brief document
that members within an
ychiatric
organization use to exchange
information. when writing a
American Ps
(2000).
memo, consider the following:
• needs of your colleagues,
• bullets to summarize main Association
nd
Diagnostic a
points,
• order of
anual of
statistical m
information/priorities, and
• clear deadlines/timelines,
meeting
ders
locations, responses needed,
etc. mental disor
t
writing good memos can help (4th ed., tex
revision).
you practice summarizing and
prioritizing information. in a
DC:
Washington,
situation in which your
intended reader may be
flooded daily with memos,
spice it up with color or clip
art to get the reader’s Author. ACKNOWLEDGMENTS……………
LIST OF TABLES…………………….
4
6
attention.
LIST OF FIGURES…………………… 7
ABSTRACT…………………………… 8
CHAPTER
1 INTRODUCTION…………………… 9
2 MATERIALS AND METHODS…… 13
Subjects………………………………. 15
Age Range……………………………. 19
Inclusion Criteria……………………… 21
Method used to correlate age
range and inclusion criteria 23
Overview of the correlation between
age range and inclusion criteria…. … 24
Overall Methodology……………….. 25

139
3.1. PREPARING TO
WRITE

• Firststep: know the purpose — why something

needs to be written in the first place.

• Have a good idea of the expected endpoint.

• Topic should be of interest and/or importance to the
prospective readers.

• Decide whether there needs to be a coauthor

140
CRITERIA FOR AN INDIVIDUAL TO BE
GIVEN CREDIT AS AN AUTHOR

• Conception and design of the study, or analysis

and interpretation of the data in the study.

• Writing or revising the article.

• Final approval of the version that is published.
• things that do not qualify a person to be listed
as an author include: ,
• Acquisition of funding
• General supervision of the research group
141
KNOW THE AUDIENCE: Aim both the
writing style and depth of information
toward the audience.
Types of technical writing:
• Pure technical style—used by professionals
addressing other professionals in the same field
• Middletechnical style—used by professionals
addressing professionals in other fields
• Populartechnical style—used by professionals
addressing laypeople

142
KNOW THE REQUIREMENTS OF THE
PUBLISHER

•Specific guidelines are followed

by a number of professional
journals

143
3.2. GENERAL RULES OF WRITING

• Once the preparation is completed, it is time

to start writing.
• No easy way to learn how to write
professionally; it just requires a lot of practice.
• Organize the information before starting to
write

144
 CHECKLIST IN PREPARATION OF WRITTEN
MATERIALS
• Do research first.
• Put yourself in the reader's position.
• Use proper grammar and spelling.
• Make the document look "professional."
• Keep things simple and direct: kiss (keep it
simple) principle
• Keep the document short.
• Avoid abbreviations and acronyms.
• Avoid the first person (e.g., I, We, and Us).
145
CHECKLIST IN PREPARATION OF WRITTEN
MATERIALS
• Use active sentences.
• Avoid slash construction (e.g., he/she use he or she).
• Avoid contractions.
• Avoid sexism
• Cite other references wherever appropriate (and get
permission to do so where appropriate).
• Cover things in whatever order is easiest.
• Get everything down on paper before revising.
• Edit, edit, edit!
146
SPECIFIC DOCUMENT SECTIONS

•A typical document consists of three main

parts—the introduction, body, and
conclusion.

• In the case of a clinical study, follow the

"IMRAD" structure:
• Introduction, methods, results, and discussion.
147
3.3. INTRODUCTION
• Startout strong, to encourage the reader to
continue reading.
• First paragraph should also inform the reader of
what they can expect in the rest of the
document.
• Introduction should have a clear objective for the
existence of the document.
• The introduction should generally not be a
conclusion.

148
• BodyBODY
3.4. of the document contains all of the
details.
• Ina research article, the body may be
divided into the methods, results,
discussion, and conclusion.
• Be concise, yet present all necessary
information (do not stray from the
subject unless it is absolutely
necessary).
• Provide a balanced coverage of the
149
material and avoid unsupported bias.
 3.4. BODY CONT..,
• Cover the information in a logical order, so that it
flows easily from one point to another.

• Copied wording (directly from another's work)

should
be in quotations (or otherwise shown to be a quote)
and a citation should appear to give credit to the
original author(s).

• Avoid extensive quotations.

• Paraphrased information should have the original
publication(s) cited, if it comes from one or a limited
number of sources.

150
3.5. CONCLUSION
•A conclusion should be placed at the end of
the body of the document, except for certain
documents (e.g., policy and procedures).
•Conclusion should follow logically from the
information presented and should serve to
summarize that information.
•Conclusion should also correspond with the
objective stated in the introduction.

151
3.6. OTHER ITEMS
•Other items such as tables, graphs,
figures, and so forth should
supplement or clarify (not distort or
misrepresent) and not duplicate
material in the text portion of a
piece of written work.

15
2
 C DOC U MENTS
4. SPECIFI

153
4.1. NEWSLETTERS AND
•Define the audience
WEBSITES
•Define the goals of the newsletter or
website
•Identify constraints
•Newsletter/website design
• “appearance is more important than
substance”
• [Link]
[Link] 154
NEWSLETTER OR WEBSITE TOPICS
• Adverse drug reactions
• Calendar of events
• Clinical "pearls"
• Effects of external events on jobs
• Job-related information
• New information sources
• New legal or regulatory requirements
• New services
155
NWT CONT..,
• News from other departments
• Organization's stand on issues
• Personnel policies
• Pharmacoeconomics
• Pharmacy and therapeutics committee actions and news
(major area to be covered)
• Productivity improvement
• Professional announcements
• Review of drugs/drug classes
• Quality assurance
156
4.2. NEWSLETTER
DISTRIBUTION
•A good distribution system must be
developed.
• It
is important to make sure the readers
get the newsletter.
• Ensure readers get the newsletters on a
regular "cycle," so that they know when
to anticipate the arrival of the publication.

157
4.3. WEB POSTING
• Consider making the material available
on the internet.
• Text documents, such as posters, are
easily placed on a website.
• Full slide presentations can be placed on
a website, using streaming audiovisual.

158
 ASSIGNMENT (10%)

• DEVELOP AND SUBMIT ONE NEWSLETTER

ON A TOPIC OF YOUR INTEREST.

• Topic should be related to medication or

disease state management and should
be relevant to pharmacy practice

159
 I N F O R M A T I O N
5. DRUG
CON S U L T W R I T I N G
GU ID E
160
ASSIGNMENT(10%)
•Youwill need to prepare a written
drug information consult for a
question given to you.
•You will need to write this at a level
appropriate to give to a health care
professional requesting the
information.
161
5.1. CHOOSING A TOPIC
• Your topic will be written in the
• Form of a question;
• One sentence long;
• Appear at the top of your paper;
• Must be related to a medication (prescription, over-
the-counter or herbal products);
• Must include the disease state for which the drug is
being used;

• Example:
• Is metformin used for the treatment of infertility?
162
5.2. REFERENCE SOURCES
• You will need to use at a minimum
• Four sources from the primary literature and
• The tertiary literature.
• It is traditional and logical to use:
• Tertiary literature when preparing your
introduction, and
• Primary literature when writing the body of
your reply.

163
5.3. LENGTH AND STYLE
• The finished consult should be
• 2 pages in length and
• Typed double-spaced in 12-point fonts
• In a word document.
• It should contain an
• Introduction that is at least a paragraph in
length;
• The body of the paper (including one
paragraph for each study you consulted), and
• A summary or conclusion paragraph
164
5.3. LENGTH AND STYLE
CONT..,
•
Your paper should be
•Written in third person
language only.
•Your conclusion should be
evidence-based and should
clearly answer the question.

165
5.4. THE INTRODUCTION
• Purpose:
• Is to explain to your reader why the
question you have asked is important;
• Why the answer is not universally already
known.
• Your introduction will generally be 1-2
paragraphs in length.
• It should provide information about:
• The disease state or condition for which the
drug is used
• A description of the pharmacology of a
drug, where appropriate.
166
• Start with introducing
5.4. INTRO CONT..,
the disease or
condition first
• Make good use of statistics or numbers
to explain to your reader how prevalent
the condition is
• Remember that you can get information
about disease epidemiology from
good review articles
• Then, discuss the treatments for the
condition, focusing your reader on the
specific treatment about which you will be
167
providing evidence.
5.4. INTRO CONT..,
•The last sentence in the introduction
will be a transition sentence.
• It should make your reader want to read
on to examine the evidence regarding
the question.
•Plan to reference at least one
common medicine resource
• (1) diseases-specific reference for the
first step (harrison's, pharmacotherapy,
or the merck manual) and
• (2) tertiary drug resource in your
introduction.
168
 NID IN E U S E D F OR
5.5. IS CLO AIN E
T O F M IG R
THE TREATMEN
HEADACHE?

169
PLEASE FOLLOW THE FOLLOWING FORMAT:
• Paragraph 1: introduction to the diseases
(including the definition of the disease,
epidemiology or prevalence). use 1-2 tertiary
references here
• Paragraph 2: introduction to the drug (what it
is? what is its most common indications)
• Paragraph 3: current therapy of the disease
and the problem with current therapy
• Paragraph 4: clinical studies (at least two) of
the drug and the disease state. use 2 or more
primary references here
• Paragraph 5: summary
170
6. F O R M U L A RY
M A NA G E M E N T
171
6.1.
• DRUG
Contains a FORMULARY
list of drugs that are available under
that formulary system, which reflects the
clinical judgment of the medical staff.

• List usually contains information on the dosage

forms, strengths, names (e.g., generic, trade,
and chemical), and ingredients of combination
products.

• Many drug formulary publications contain a

great deal more material related to the drugs,
including a summary of indications, side
effects, dosing, use restrictions, and other
clinical information.
172
6.1. DF CONT..,
• Goal of the formulary system is to provide a decision-
making process leading to the selection of
medications.
• Formulary medications should be the most efficacious
and cost-effective agents with the fewest side effects.
• other factors should also be taken into consideration,
such as the variety of dosage forms available for the
medication, estimated use, convenience, dosing
schedule, compliance, abuse potential, physician
demand, ease of preparation, and storage
requirements.

173
 6.2. EVALUATING DRUGS FOR
FORMULARY INCLUSION
• Criteriadeveloped for approving addition of a
drug to a formulary need to minimally include
the following:
• Indications for use
• Effectiveness
• Risks (e.g., adverse effects, drug interactions, and
potential for medication errors )
• Cost
• Validformulary decisions should be based on
objective evidence

174
6.3. THERAPEUTIC
INTERCHANGE
• Authorized exchange of therapeutic
alternatives in accordance with
previously established and approved
written guidelines or protocols within a
formulary system."
• Several medication classes may be the
target of therapeutic interchange and an
aggressive IV to PO conversion may be
part of this process.
175
6.4. POLICIES AND PROCEDURES
• As needed (PRN) • Compounded or admixed
medications drugs

• Medication-related devices
• Standing order
medications • Investigational medications
• Herbal/natural medications
• Hold medications • Discharge medications
• Automatic stop • Self-administered
• Resume medications medications

• Dosage adjustment
• Dosage taper
176
ASSIGNMENT (10%)

•WRITEAND SUBMIT A DRUG

MONOGRAPH BASED ON THE
FORMAT PROVIDED FOR THE
DRUGS YOU ARE GIVEN.

177
 LI S H I N G A N D
7. ESTAB
RUN N I N G A D R U G
T I O N C E N T E R
IN F O R M A
178
7.1. REQUIREMENTS

• Resources:
• DI resources: books, journals, databases
• Office furniture: shelves for books and journals
• Computer station with printer
• Direct telephone line
• Fax
• Internet access
179
7.1. REQUIREMENTS CONT..,
• Written guidelines and policies for the DIC
• Good documentation systems: di forms,
databases

• Quality assurance mechanisms

• DI personnel: trained pharmacists
180
181
182
183
184
7.2. PROMOTION OF DIC

• Newsletter
• Alerts
• Meetings
• Participation in DTC/morning/rounds
• CE programs
• Website
185
 L P H A R M A C Y
8. CLINICA
A N D R O LE O F
PRACTICE T
TH E D I P H A R M A C I S
186
 8.1. ROLE CHANGE
• Sweeping changes continue to reshape the
practice of pharmacy.

• The pharmacy professional needed today is a

knowledgeable drug expert and skilled,
persuasive communicator and not a pill
counter.

• This pharmacist embraces a new practice

model - pharmacy care.
187
 8.2. ACTIVITIES
1. Perform and record patient medication histories.
2. Initiate and update patient medication profiles.
3. Perform therapeutic drug monitoring through patient
interview and medication profile review and drug serum
concentrations and other laboratory tests as needed.
[Link] and teach patients regarding the appropriate
use of prescription medication, OTC medications, and
medical supplies.
5. Participatein drug and therapeutics committee by
preparing drug monographs, formulary reviews and
conducting drug utilization reviews

188
 8.2. ACTIVITIES CONT..,

7. Interact with health care providers verbally

and in writing as necessary.
8. Give in service on medication related
issues to the nursing staff.
9. Answer with proper documentation at all
drug information questions arise during
rounds and discussion form patients or other
health related professionals.

189
8.3. PHARMACEUTICAL CARE
• Is the new term introduced in recent years
• Adapted by who and in 2000 taken up by
international pharmacy federation
• Accordingly, the policy sees the pharmacist as
a member of the healthcare team;
• From medicine supply to patient care.
−From a compounder of pharmaceutical
products to a provider of services and
information and
−Ultimately that of a provider of patient
care.

190
8.3. PHARMACEUTICAL CARE
CONT..,
“Pharmaceutical care is the responsible
provision of drug therapy for the purpose
of achieving definite outcomes that
improve or maintain a patient’s quality of
life”.
−(Charles Hepler and Linda Strand, 1990)

191
8.3. PHARMACEUTICAL CARE
CONT..,
ADOPTING A NEW PHILOSOPHY
• Providing PC means adopting a philosophy of
practice where pharmacists work with and
for the patient to optimize the outcomes of
medication therapy.
• “Drugs don’t have doses - people have doses
!” Robert Cipole

192
8.3. PHARMACEUTICAL CARE
CONT..,
CASE STUDY

−Almaz has diabetes and a history of arthritis.

−Today, she brought a prescription from her
physician to her local pharmacy for:
• NPH insulin injection (35 units QAM) and
• Timolol 1 drops in each eye QD for glaucoma.

193
8.3. PHARMACEUTICAL CARE
CONT..,
•INGlaucoma - insulin dosing
THE PHARMACIST’S EYE errors
• Hypoglycemia – may be life threatening –
cause poor compliance or failed to take it
altogether
• Hyperglycemia – complications, diabetic
coma risk
• Abnormal HGBA1C results – dose adjustment
issues

• Arthritis - incorrect eye drop

• Asymptomatic – risk of blindness
194 syringe
• Difficult of using an insulin
8.3. PHARMACEUTICAL CARE
CONT..,
• Expert knowledge of therapeutics
• A good understanding of disease process
• Knowledge of pharmaceutical products
• Drug monitoring skills
• Provision of drug information
• Communication skills
195
 8.4. COMPARING PROBLEMS AND
TREATMENTS

• AFTER DETERMINING A PATIENT’S

MEDICAL CONDITIONS, SYMPTOMS, AND
DRUG THERAPIES, THE PHARMACIST
MUST COMPARE THE PATIENT’S MEDICAL
PROBLEMS AND MEDICATION LIST

196
8.4. COMPARING PROBLEMS AND
TREATMENTS CONT..,

• The pharmacist needs to answer the

following questions:
−Are all conditions being
managed?
−Are all drug therapies
managing a condition?

197
8.5. DRUG THERAPY PROBLEM:
DEFINITION
•A drug therapy problem is any
undesirable event experienced by a
patient which involves, or is
suspected to involve, drug therapy,
and that interferes with achieving
the desired goals of therapy. ,

198
8.6. THE SEVEN DRUG THERAPY
PROBLEMS
1. Unnecessary drug therapy
2. Ineffective drug
3. Dosage too low
4. Adverse drug reaction
5. Dosage too high
6. Inappropriate compliance (sometimes
called adherence)
7. Needs additional drug therapy
199
Drug-related needs Categories of drug
therapy problems

Indication 1. unnecessary drug

therapy
2. needs additional
drug therapy
Effectiveness 3. ineffective drug
4. dosage too low

Safety 5. adverse drug

reaction
6. dosage too high
Compliance 7. noncompliance
200
8.7. DISCOVERING DRUG THERAPY PROBLEMS
REQUIRES MORE THAN CHART REVIEW

• KT, a 67-year-old man admitted with a probable thrombotic

stroke. the patient was on warfarin 5 mg tablet for atrial
fibrillation, esomeprazole 20 mg for gastric reflux, and an
salbutamol inhaler for occasional mild asthma.
• In talking with the patient, the pharmacist found that kt was
not taking his warfarin because he runs out. his stroke and
hospitalization are a direct result of the drug therapy problem
of noncompliance.
• The pharmacist uncover the drug therapy problem by
discussing with the patient
• The pharmacist would not be able to get this if he only relays
on the patient chart.

201
 Five steps in the pharmaceutical
care process
[Link] a profession relationship with the patient
[Link] patient-specific medical information
3. Evaluate patient-specific medical information and
develop a drug therapy plan mutually with the patient.
4. Ensure the patient has all supplies, information, and
knowledge necessary to carry out the drug therapy plan.
5. Review, monitor, and modify the therapeutic plan as
necessary and appropriate, in concert with the patient
and health care team.

202
8.8. BEYOND COUNSELING

• The traditional dispensing practices

• Pharmacists were simply responsible for dispensing
prescriptions accurately, as prescribed.
• Pharmacists assumed responsibility for ensuring that
the right patient got the right quantity of the right
medication of the right strength at the right time.

• The pharmaceutical care model of practice

• Pharmacist goes far beyond counseling to assume
responsibility for all the patient’s drug-related needs.
• Pharmacists take responsibility for ensuring the
desired outcome of the drug therapy is met.

203
 8.9. ACTUAL AND POTENTIAL DRUG
THERAPY PROBLEM
An actual problem
• Is one that has already occurred. action should
be taken to resolve it.
Potential problem
• Isone that is likely to occur. the necessary
steps should be taken prevent it. before
deciding to contact the prescribing physician,
they should consider how severe the
consequences of the potential problem could
be.
Exercises
204
8.10. SUBJECTIVE AND OBJECTIVE
DATA
• Pharmaceutical care practitioners collect two type of
data to help them evaluate and mange patients’ drug
therapy: subjective and objective.

• Subjective data
• Is data that cannot be measured directly and may not always be
accurate or reproducible.
• Most of the data that the pharmacist collects directly from patients,
such as medical history, are subjective.

• Objective data
• Are measurable and observable, and are not influenced by emotion
or prejudice. much objective information is numerical.

• Exercises
205
THE PHARMACEUTICAL CARE
CYCLE

206
Drugs and Therapeutics
Committee

20
7
Drug Evaluation
Monographs

20
8
ADR and Medication
Errors

20
9
THANK YOU!

210