08 29 23 Review of Drug Information Resources For Posting PDF

DRUG INFORMATION
RESOURCES AND
LITERATURE
SEARCH STRATEGIES
Anly Li, PharmD
Regulatory Pharmaceutical Fellow in Drug Information
Purdue University | Eli Lilly and Company | FDA
August 29, 2023
Identify and Identify and find available drug information
find resources
Differentiate between primary, secondary,

OBJECTIVES Differentiate
and tertiary literature
Select and Select and utilize appropriate drug

utilize information references based on DI request
DRUG INFORMATION SETTINGS
FORMAL INFORMAL
Hospital pharmacies Gym
Community pharmacies Dinner table
Ambulatory Clinics Places of worship
Managed Care Off-duty
Pharmaceutical Industry Anywhere friends/family/coworkers

can reach you
Public Health
Type of request
• Patient-specific
CONSIDERATIONS • Broad request
• Recent news
FOR DRUG
INFORMATION Identity of requestor
REQUESTS • Pharmacist
• Physician
• Nurse
• Patient
Lehmann MK, Trovato A. Drug Information Resources. In: Malone PM, Witt BA, Malone MJ, Peterson DM. eds. Drug Information: A Guide for Pharmacists, 7e. McGraw Hill; 2022.
Accessed September 07, 2022.
SELECTING REFERENCES
TERTIARY SECONDARY PRIMARY APPROPRIATE

LITERATURE LITERATURE LITERATURE REFERENCES
TERTIARY
RESOURCES
• Information that has been summarized
to provide an overview of a topic
• Examples
• Textbooks
• Compendia
• Guidelines
• Review articles
• Internet websites
TERTIARY RESOURCES
Benefits
• Comprehensive information
• Citations to primary and secondary
sources
• Fast, easy to use
Limitations
• Older, less current information

• Not sure if authors looked at the "right
sources"
• Bias/lack of expertise
SECONDARY
RESOURCES
• Databases that can be used to find primary or
tertiary resources via indexing or abstracting
• Indexing: Providing citation information
• Abstracting: Providing the citation and a
brief description (abstract)
• Examples
• PubMed
• Cochrane Library
• Google Scholar
• IPA
• EMBASE
SECONDARY RESOURCES
Benefits
• Easily accessible
• Directs to primary literature
Limitations
• Index terms
• Varying search terminology
• Cost
SECONDARY RESOURCES
• Search terminology
• Medical Subject Headings (MeSH)
• United States Adopted Name (USAN)
• International Classification of Disease (ICD)
• Additional search tools
• Limits
• Filters
• Boolean Operators
• Ex: deep vein thrombosis AND (rivaroxaban
OR apixaban) NOT pulmonary embolism
PRIMARY RESOURCES
• Clinical research studies and reports
(published or unpublished)
• Examples:
• Controlled trials
• Cohort studies
• Case series
• Case reports
PRIMARY RESOURCES
Benefits
• Detailed information regarding methods

• **Can personally assess quality of information**
• Contains most recent information
Limitations
• Potentially misleading conclusions

• Requires skilled expertise in literature evaluation
• Time intensive
DRUG INFORMATION
CATEGORIES
CATEGORIZING QUESTIONS
Adverse Effects Identification
Availability Nomenclature
Compatibility/Stability Pharmacokinetics
Compounding General Drug Information
Dosing/Administration Poisoning/Toxicology
Drug Interactions Pregnancy/Lactation
Herbal Therapeutic Use
FINDING RESOURCES
FINDING RESOURCES
FINDING RESOURCES
FINDING RESOURCES
REFERENCES
STUDY MATERIALS ACCESS
• E-text (Access Pharmacy, Lipincott Health Library)
• https://www.pharmacy.purdue.edu/current-students
• Current students → Health Library Access → Log In
• Textbook access through Access Pharmacy (DiPiro, Drug Information Textbook)
STUDY MATERIALS ACCESS
GENERAL DRUG INFORMATION
• American Hospital Formulary
Service (AHFS) Drug Information
• Epocrates
• Facts and Comparisons
• Lexicomp
• Micromedex
• Prescriber’s Digital Reference
• Pharmacist’s Letter
• National Library of Medicine (NLM)
Package inserts
(DailyMed)
• https://dailymed.nlm.nih.gov/daily
med/
• Monograph check #1!
Also found at:

• Drugs@FDA
• Drug Manufacturer’s Website
Boxed Warnings
Includes FDA approved

indications (no off-label Common side
uses) effects
6 Adverse Reactions
ADVERSE EVENTS
Drug-Induced Diseases:
General drug
Package inserts Prevention, Detection,
information references
and Management
FDAble
• Medications (MedWatch,
Meyler’s Side Effect of FAERS, AERS)
Drugs • Medical Devices (MAUDE)
• Vaccines (VAERS)
DISEASE INFORMATION
Harrison’s
Dipiro’s
Merck Manual Principles of
Pharmacotherapy
Internal Medicine
Goldman-Cecil CDC: diseases and

UpToDate
Medicine conditions
Dynamed Epocrates
COMPOUNDING
Remington’s The
Trissel’s Stability of
Science and
Compounded
Practice of
Formulations
Pharmacy
Allen’s
Compounded Merck Index
Formulations
United States International

Pharmacopeia Journal of
National Formulary Pharmaceutical
(USP-NF) Compounding
COMPATIBILITY/STABILITY
ASHP Injectable King's Guide to
Drug Information Parenteral
(Trissel's) Admixtures
Trissel’s Stability Trissel’s 2 Clinical

of Compounded Pharmaceutics
Formulations Database
DRUG INTERACTIONS
Drug interaction tool on Micromedex
and Lexicomp
Package Insert
Stockley’s Drug Interactions
Hansten and Horns Drug Interaction

Analysis and Management
PEDIATRICS
"Can IV levocarnitine be given orally to a pediatric patient?"
The Teddy Bear

Nelson’s Textbook The Harriet Lane
Book - Pediatric
of Pediatrics Handbook
Injectable Drugs
American
Pediatric and Academy of
Neonatal Lexi- Neofax
Pediatrics Red
Drugs Book
GERIATRICS
Merck
Geriatric
Manual of
Lexi-Drugs
Geriatrics
American
Geriatric
Society
PREGNANCY AND LACTATION
Briggs’ Drugs in Catalog of Drugs for
Pregnancy and Teratogenic REPROTOX Pregnant and
Lactation Agents - TERIS Lactating Women
Hale’s CDC:
Medications and NLM LactMed Medications and
Mothers’ Milk Pregnancy
DRUG IDENTIFICATION
Micromedex
Ident-A-Drug
(identidex)
Lexi-DrugID Drugs.com
Clinical
Epocrates
Pharmacology
OVER-THE-COUNTER
"Can I use clotrimazole for my foot fungus?"
Handbook of Nonprescription
Nonprescription Product
Drugs Therapeutics
DIETARY SUPPLEMENTS AND NATURAL PRODUCTS
Dietary Lexicomp
Natural Review of
Supplement Natural Products
Medicines Natural Products
Label Database Database
REGULATORY
• Red book (Micromedex)
• Drug pricing information
• Orange book (https://www.accessdata.fda.gov/scripts/cder/ob/index.cfm)
• Approved drug products and therapeutic equivalence
• Yellow book (https://wwwnc.cdc.gov/travel/page/yellowbook-home)
• Vaccines for international travel
• Purple book (https://purplebooksearch.fda.gov/)
• Approved biologic products and interchangeable biosimilars
• Green book (https://www.fda.gov/animal-veterinary/products/approved-animal-drug-products-green-
book)
• Approved animal drug product list
PHARMACOKINETICS/PHARMACODYNAMICS
Applied
Biopharmaceutics Applied Clinical
and Pharmacokinetics
Pharmacokinetics
Concepts in
Lexicomp and
Clinical
Micromedex
Pharmacokinetics
PHARMACOLOGY
Basic and
Goodman and
Clinical
Gillman’s
Pharmacology
Brody’s
Principles of
Human
Pharmacology
Pharmacology
TOXICOLOGY
Casaret and
Goldfrank’s
Doull’s: The Basic
Toxicologic
Science of
Emergencies
Poisons
Poison and
Lexi-Tox Toxicology
Handbook
Micromedex
National Poison
Toxicology
Control Center
Management
1-800-222-1222
PHARMACY LAW
Pharmacy
Practice and
Law
Individual
State Boards
of Pharmacies
INTERNATIONAL DRUGS
Index USP
Nominum Dictionary
Martindale
Summary of Commonly Used Resources
Reference Off-Label uses IV Drug Drug/Pill Natural Products International
Compatibility Identification Drug Names
Clinical ✓ ✓
✓ ✓ ✓
Pharmacology (via Trissel’s) (via Index Nominum)
Drugs.com ✓ ✓ ✓ ✓
✓
Epocrates ✓ ✓
(Epocrates +)
Facts and ✓ ✓
✓ ✓ ✓
Comparisons (via Trissel’s) (via Martindale)
✓
✓ ✓ ✓
Lexicomp ✓ (Lexi-Natural
(via Trissel’s) (Lexi-Drug ID) (via Martindale)
Products)
✓
✓ ✓ ✓
Micromedex ✓ (via Martindale,
(via Trissel’s) (INDENTIDEX) (AltMedDex)
Index Nominum)
Adapted from: RxPrep. RxPrep 2023 NAPLEX Course Book.; 2022.

QUESTIONS?
APPROPRIATE USE
OF THE INTERNET
Anly Li, PharmD
Regulatory Pharmaceutical Fellow in Drug Information
Purdue University | Eli Lilly and Company | FDA
August 29, 2023
Examine Examine use of online health information by the public
Explain proper and improper use of online health

Explain information to patients
OBJECTIVES
Identify reliable sites containing useful health
Identify information for patient referral
Cite Cite online health information appropriately

INTERNET USE IN THE USA
• US population as of August 4th, 2023
• 335,183,881
• 93% use the internet
• Of those 80% look up health information online
• 15% use smart phones as primary means of internet access
Discuss: What are some resources that non-

HCPs might use for medical/drug
information?
US and World Population Clock. United States Census Bureau. Accessed August 4, 2023. https://www.census.gov/popclock.
Internet/Broadband Fact Sheet. Pew Research Internet and Technology. Accessed September 5, 2022. http://www.pewinternet.org/fact-sheet/internet-broadband.
WHO IS MORE HELPFUL WHEN YOU NEED...
Fox S, Rainie L. Vital Decisions: A Pew Internet Health Report. Vital decisions: How internet users decide what information to trust when they or their loved ones are
sick 2002. Accessed September 5, 2022. http://www.pewinternet.org/2002/05/22/vital-decisions-a-pew-internet-health-report/
HEALTH LITERACY
2003 National Assessment of Adult Literacy (NAAL) Survey
Health Literacy Level Task Example Percentage
Using a table, calculate an employee’s share

Proficient 12%
of health insurance costs for a year
Read instructions on a prescription label,

Intermediate and determine what time a person can take 53%
the medication
Read a pamphlet, and give 2 reasons a

Basic person with no symptoms should be tested 21%
for a disease
Read a set of short instructions, and identify

Below Basic what is permissible to drink before a medical 14%
test
America’s Health Literacy: Why We Need Accessible Health Information. An Issue Brief From the U.S. Department of Health and Human Services. 2008.
WHY IS THIS IMPORTANT
FOR PHARMACISTS?
HEALTH INFORMATION "IN THE NEWS"
WEBSITE #1
WEBSITE #2
WEBSITE #3 http://www.nlm.nih.gov/medlineplus/
WIKIPEDIA
• NEVER REFERENCE
• Wikipedia compared to Medscape
• Scope, accuracy, and completeness
• Less information, no dosing, less complete
answers on Wikipedia
• Drug Safety
• New FDA safety communications were not
updated in a timely manner (i.e., black-box
warning)
• After communication, 82% increase in
Google searches and 175% increase in
Wikipedia page views
Clauson K et al. Ann of Pharmacother 2008; 42: 1814-21 Hwang TJ, et al. N Engl J Med 2014; 370: 2460-2.
AI TECHNOLOGY
• ChatGPT, BARD, Dougall GPT
• Large language models (LLM)
• Introduced late 2022
• Potential Uses
• Healthcare education
• Research
• Healthcare practice
• But… many concerns
Sallam M. ChatGPT Utility in Healthcare Education, Research, and Practice: Systematic Review on the Promising Perspectives and Valid Concerns. Healthcare (Basel).
2023;11(6):887. Published 2023 Mar 19. doi:10.3390/healthcare11060887
EVALUATING
WEBSITES
• Who runs the website?
• What is the purpose of the website?
• What is the original source of
information on the website?
• How is the information reviewed before
it is put on the website?
• How current is the information on the
website?
FINDING CREDIBLE HONCODE Certification
SOURCES 1. Authority: Authors’ qualifications
Complements the patient-provider

• Health on the Net (HON) Foundation 2. Complementarity: relationship
• Laid criteria for certification 3. Privacy policy: Respect privacy and confidentiality
• No longer updated as of Dec, 2022
4. Attribution and date: Citations and dates
Backs up claims of benefits and

5. Justifiability: performance
Accessible presentation and valid

6. Transparency: contact information
7. Financial disclosure: Details of funding
Distinguishes advertising from

8. Advertising policy: editorial content
DISEASE STATE SPECIFIC SITES
• HIV http://www.hiv.gov/ - U.S. Department of
Health & Human Services
• Juvenile Diabetes Research Foundation
http://www.jdrf.org/
• American Academy of Allergy Asthma &
Immunology http://aaaai.org/
• American Lung Association http://www.lung.org/
• Bone Health and Osteoporosis Foundation Good resources for
https://www.bonehealthandosteoporosis.org/ patients or
professionals
GOVERNMENT WEBSITES
Lehmann MK, Trovato A. Drug Information Resources. In: Malone PM, Witt BA, Malone MJ, Peterson DM. eds. Drug Information: A Guiark SK, eds. New York:
McGraw Hill; 2018.
PHARMACY PROFESSION
American Society of Health-System Pharmacists (ASHP)
American Pharmacists Association (APhA)
American Association of Colleges of Pharmacy (AACP)
National Pharmaceutical Association (NPhA)
National Community Pharmacists Association (NCPA)
National Association of Boards of Pharmacy (NABP)
Great resources
for professionals
MOBILE
APPS
• Millions of people use health applications
every day
• Applications for drug databases and other
websites for health care professionals
• Considerations
• Who administers the app?
• What is the purpose of the app?
• What is the original source of
information?
• How current is the information?
REFERENCING INTERNET SOURCES
• AMA Manual of Style 11th edition citation format
• Website:
• Authors (if indicated) If none provided use the name of the group/organization. Title of the page
being cite (use the organization responsible for the site if no title). Name of the website. Date
published (month day, year). Date site was updated (month day, year). Date accessed (month
day, year). URL.
• Database
• Authors (if applicable). Name of monograph or document. Database name. Company (or vendor)
maintaining the database. City, State Abbreviation. Accessed Month day, year. URL.
• AI Tools
• Software Name. Version Number (for ChatGPT, this should include the year). Publisher.
Question Prompt. Accessed Date. URL
QUESTIONS?
Anly Li, PharmD
li4970@purdue.edu

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DRUG INFORMATION

Differentiate between primary, secondary,

Select and Select and utilize appropriate drug

Hospital pharmacies Gym

Community pharmacies Dinner table

Ambulatory Clinics Places of worship

Managed Care Off-duty

Pharmaceutical Industry Anywhere friends/family/coworkers

TERTIARY SECONDARY PRIMARY APPROPRIATE

• Older, less current information

• Detailed information regarding methods

• Potentially misleading conclusions

Compounding General Drug Information

Drug Interactions Pregnancy/Lactation

Herbal Therapeutic Use

Also found at:

Includes FDA approved

Goldman-Cecil CDC: diseases and

United States International

Trissel’s Stability Trissel’s 2 Clinical

Stockley’s Drug Interactions

Hansten and Horns Drug Interaction

The Teddy Bear

Adapted from: RxPrep. RxPrep 2023 NAPLEX Course Book.; 2022.

Explain proper and improper use of online health

Cite Cite online health information appropriately

Discuss: What are some resources that non-

Using a table, calculate an employee’s share

Read instructions on a prescription label,

Read a pamphlet, and give 2 reasons a

Read a set of short instructions, and identify

Complements the patient-provider

Backs up claims of benefits and

Accessible presentation and valid

7. Financial disclosure: Details of funding

Distinguishes advertising from

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