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Tertiary Resource

Introduction

Drug Information
Resources
Objectives: 1. Describe the attributes and the differences between tertiary, secondary and primary resources 2. Identify the most appropriate resources for a given drug information inquiry and use them effectively. 3. Recognize that primary, secondary and tertiary resources may be available in hard copy, CD-ROM, ON-LINE and/or other Format. 4. Describe how to search computerized data bases.
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Introduction
professional literatures

Tertiary
Secondary Primary Sources

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Introduction Primary Resources


They are the research studies published in biomedical journals. It is the most current information about drugs. It is not easy job to use journals to answer a drug related question because of its huge growing number (>20000 biomedical journals available)

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Introduction Primary Resources


Primary recourse provides the broad base for development of the rest of the professional literature. It contains original reports of scientific studies on which the knowledge of drugs and therapeutics is built. Current of the information sources, and periodical journals are its most common format. Providing access to the original data from a study as well, having the most current information

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Introduction Secondary Resources

They are indexes and abstracts for primary resources. They are valuable tools for quick and selective screening for primary resources. They provide the user with concise tools for gaining access to the primary literatures. Any single indexing or abstracting service can not cover all published articles beside the lag time are the limitations to use secondary resources.

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Tertiary Resources Literatures

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Definition

Tertiary literature is core knowledge established via primary literature or accepted as standard of practice within the medical community.

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Introduction

tertiary resources include textbooks, monographs, compendia, handbooks, and published symposia. They represent the condensation of basic facts originally published in the primary literature.

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Types
Textbooks On various drug or disease topics

Compendia

A vast array of information about many Drugs such as the physician's desk reference

Full-text databases

Including the internet, MICROMEDEX and LEXI

Review articles

Summarize a particular topic Contain more current information


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Advantages

Tertiary resources are the most commonly used sources of information because they are easy to use, concise and compact. Often they provide a review of the literature by an expert in the field. Tertiary references (textbooks, CD-ROMs) are convenient and in general, fairly accessible. Drug information references may be divided into specific subjects to make them easier to use.. Usually the information contained in tertiary literature is well accepted in medical practice.
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Disadvantages

lag time . outdated even in "new" editions Space limitations within a text may prevent extensive discussion of a drug or topic Authors may emphasize limited information about a topic or drug Authors may present information that is based on a less thorough review of the primary literature

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Disadvantages (cont.)

It may not be referenced appropriately thus preventing a proper check of the primary literature If the information presented in the tertiary literature is based on flawed primary literature (i.e. Poorly done studies are referenced) then the tertiary information may be suspicious.

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Disadvantages (cont.)

Any updated or new information cannot be inserted into the printed (hard copy) tertiary literature in a timely fashion. Human bias, error transcription, incorrect interpretation of data and lack of expertise by the author.

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Evaluation of tertiary resources


Several points should be considered in evaluating tertiary resources as follows: 1. Does the author has sufficient experience and expertise to write on the topic? 2. What credentials do the authors/contributors have? 3. Assess the text for timeliness (i.e. when was the last edition published?) 4. Is this the most recent edition of the tertiary reference? 5. Are statements of fact appropriately supported by references? 6. How many references does each section have and how up-to-date are they?
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Evaluation of tertiary resources (cont.)


6.
7. 8.

To assess consistency, compare information presented in one text to the same information presented in another text. Is the reference likely to contain information relevant to the subject being researched? Is the reference clear, concise and easy to use?

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Availability of Tertiary Resources


Tertiary resources are available in many formats, including hard copy, microfiche, and computerized versions. Computerized resources may be available on floppy disks, or CD-ROMs for use in a single personal computer or computer network, a main frame system or via internet.

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Classification of Tertiary Resources

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Tertiary drug information resources

General references

Specialized references

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A. General References

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General features
1- They are referral books. 2- Their formats are either monographs or monographs plus chapters. 3- Used through their indexes NOT through their contents lists.

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Textbooks.
Different from the general references in: 1- Their formats are chapters. 2- One can read them from cover to cover. 3- One can use their contents list Not necessary to go to index.

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The most helpful of them to answer a drug related questions are:

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Martindales The complete drug reference

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Martindales The complete drug reference

European and investigational drugs Published by the Royal Pharmaceutical Society of Great Britain every 4 years Has a manufacturer directory and index by clinical use (typical European style of indexing) Lists other pharmacopeias the drug is found in.

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Drug Facts and Comparisons (F&C)

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Drug Facts and Comparisons (F&C)

Updated monthly (loose-leaf version) Lag time 3 months Arranged by therapeutic class Prescription and OTC listings Helpful summary/comparison tables Contains information about investigational, orphan, and discontinued products and off label uses Not referenced, cumbersome
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Mosbys Drug Consult

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Mosbys Drug Consult

Frequently used brand and generic drugs Available at www.merckmedicus.com Annual update Additional information:

Drug identification, look-alike/sound-alike Manufacturer information, discontinued Products

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American Hospital Formulary Service (AHFS) Drug Information

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American Hospital Formulary Service (AHFS) Drug Information

Arranged by AHFS classification number Monographs listed alphabetically Information in monograph: Chemistry, pharmacology, mechanism Dose, administration, pharmacokinetics Drug interactions, preparations, toxicity

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(AHFS) Drug Information


FDA-approved and off-label uses Published annually with quarterly updates More clinically oriented References are not available in the hard copy but may be available online or with software CD-ROMS Not comprehensive, significant lag time

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USP Dispensing Information (USP DI)

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USP Dispensing Information (USP DI)

Three volumes
I. DRUG Information for the Healthcare Professional II. Drug Information for the Patient (in lay language) III. Legal Requirements

Monographs in alphabetical order in Volume I Published annually Also contains some Canadian drug names Most thorough information on:
Monitoring Adverse drug events
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USP Dispensing Information (USP DI)

Useful Appendices: (typical American style of indexing) Selected List of Drug-Induced Effects Therapeutic Guidelines Poison Control Center Listing Veterinary Medication Classification Excluded Monograph Listing

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USP Dispensing Information (USP DI)

Off-label uses indexed by drug and by indication Not referenced, lag time, only FDA-approved uses, inconvenient to compare agents in the same therapeutic class

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Drug Information Handbook (Lexi-Comp)

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Drug Information Handbook (Lexi-Comp)

Pocket-sized; PDA & online versions are also available Published annually Drugs listed alphabetically by generic name Useful charts and tables. Specialty versions are available: Pediatric, psychiatric, geriatric Not referenced Lists all reported adverse events but does not always provide the incidence

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MICROMEDEX

CD-ROM Access information by brand or generic name of drug Referenced, quick and easy to use Expensive, uses other tertiary references Databases available:
DRUGDEX - main drug information database DISEASEDEX - disease states IDENTIDEX - drug identification by imprint code POISINDEX - poisoning and toxicology Martindales foreign drugs
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Physicians Desk Reference (PDR)

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Physicians Desk Reference (PDR)

Updated annually Color pictures and markings for drug identification Has FDA-approved product information only Manufacturers pay to have product information Included Contains section on diagnostics May not contain the complete package insert Not referenced
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Drug Topics Red Book

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Drug Topics Red Book

Cost data: average wholesale prices (AWP) and NDC numbers. (The National Drug Code) Alphabetical listing of manufacturers with contact information Prescription and OTC products List of drugs that should not be crushed or chewed Published annually with monthly updates

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B. Specialized References

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Pharmacotherapy

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Pharmacotherapy: A Pathophysiologic Approach (Dipiro)

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Pharmacotherapy: A Pathophysiologic Approach (Dipiro)

Well-written and referenced with helpful tables. Pocket version is available. Focuses on drug therapy, good background information. Also covers non-drug treatment options. Updated edition about every 4 years.

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Applied Therapeutics: The Clinical Use of Drugs (Koda-Kimble)

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Applied Therapeutics: The Clinical Use of Drugs (Koda-Kimble)

Well-written with focus on drug therapy. Updated every 4 years. Useful summary tables. Case presentation format, may be more difficult to use as a quick reference.

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The Washington Manual of Medical Therapeutics

Quick reference with many charts and tables. Updated about every 2 to 3 years.

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Internal Medicine

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Harrisons Principles of Internal Medicine

Gold standard for internal medicine Published every 5 years, referenced Pathophysiology, clinical presentation, diagnosis and treatment guidelines Little drug information & dosing recommendations

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The Merck Manual

Used by many healthcare professionals Also includes pediatrics, gynecology, psychiatry, ophthalmology, otolaryngology, dental disorders

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Clinical Medicine (Kumar &Clark )

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Clinical Medicine (Kumar &Clark )

comprehensive and authoritative single-volume textbook of internal medicine. Explains the management of disease, based on an understanding of scientific principles and including the latest developments in treatment. Colour-coded chapters are attractive and make the book easy to navigate. Comprehensive index, clearly displayed, pinpoints information rapidly.
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Clinical Medicine (Kumar &Clark )

Boxes and tables pull out and display important information. Drawings and photographs. Carefully structured headings provide a useful outline for study and quick reference. Gastrointestinal, Rheumatology, Renal, Cardiovascular, Respiratory ,Intensive care medicine, Drug Therapy and poisoning

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Cardiology

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Textbook of Cardiovascular Medicine

Published every 5 years. Good illustrations. Addresses modern-day issues such as medical economics and assessing quality of care. Well-referenced.

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Hursts The Heart

Organized by condition Comprehensive information on drug therapies and regimens Rapid Interpretation of EKGs (Electrocardiogram (EKG or ECG)) Best guide to learning EKGs User-friendly format.

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Pediatrics

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Harriet Lane Handbook

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Harriet Lane Handbook

Useful pocket guide published every 3 years Has dosing information Electronic version updated annually Four sections: emergency management, diagnostic, formulary, and therapeutic data Some information on pregnancy and lactation Not referenced, not frequently updated, confusing organization, not complete
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Pediatric Injectable Drugs (Teddybear Book)

Alphabetical order by generic name Formerly known as Guidelines for Administration of Intravenous Medications to Pediatric Patients Dose, concentration, rate, cautions

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Pediatric Dosage Handbook (Lexi-Comp)

Pediatric version of the Drug Information Handbook Dose, administration, how supplied, contraindications, adverse effects, drug interactions, antidotes Also contains adult doses May sometimes have information on extemporaneous formulations

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Pregnancy

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Drugs in Pregnancy and Lactation (Briggs)

Excellent reference, gold standard Updated every 4 years Alphabetical by generic name Generic name, class, & pregnancy risk factor Summaries of risk to fetus and risk during breastfeeding Editors assign categories for drugs not classified by the manufacturer Referenced
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Infectious Diseases

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Mandells Principles and Practice of Infectious Disease

Gold standard reference Infection, diagnosis, treatment and useful background information

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Sanford Guide to Antimicrobial Therapy

Published annually Pocket-sized and easy to use Includes: dosing in renal impairment, brand & generic names, empiric therapy guidelines, antimicrobial spectra of the agents Not well-referenced

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Oncology

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Cancer: Principles and Practice of Oncology (devita)

Gold standard, published every 3 to 4 years Pathology, treatment options, & adverse effects Referenced

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Cancer Chemotherapy Handbook

Useful index, introduction on malignancies Pharmacology and use of chemotherapeutic agents Lists investigational drugs and combinations Well-referenced

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Pharmacology

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Goodman & Gilmans Pharmacological Basis of Therapeutics

Gold standard pharmacology text Grouped by therapeutic class Mechanism, absorption, distribution, and metabolism Contains review of pharmacokinetics, therapeutics, and toxicology Well-referenced, very thorough Updated every 5 years (infrequent)

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Drug Interactions

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Hansten and Horn's Drug Interactions Analysis and Management

Loose-leaf format, updated Introductory chapter discusses mechanisms of interactions Rates significance of interaction and recommends management Referenced Not complete, subjective rating system

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Drug Interaction Facts

Published by F&C Alphabetical by drug name Referenced Provides information regarding:


Significance and severity Onset of interaction Documentation

Not complete, subjective rating scale


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Stockley's Drug Interactions

A typical monograph contains a summary, clinical evidence for the interactions under discussion, the probable mechanism, clinical importance and management Covers interactions between therapeutic drugs, proprietary medicines, herbal medicines, foods, drinks, pesticides and some drugs of abuse

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Stockley's Drug Interactions


Based on published sources and fully referenced Covers over 14,000 drug interactions Contains over 2,800 monographs Includes 17,600 references Book & CD-ROM

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Adverse Drug Reactions

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Meylers Side Effects of Drugs

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Meylers Side Effects of Drugs

Indexed by drug and by adverse event Most comprehensive Published every 4 years with annual updates Contains tables and lists References for some side effects not included Information provided:

Effects on organs and systems, lab/diagnostic interference, withdrawal and overdose

May not be complete, references for widely known effects are not included
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Compatibility and Stability

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Handbook on Injectable Drugs


(Trissels)

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Handbook on Injectable Drugs (Trissels)

Gold standard reference Updated every 2 years with annual supplements Drugs organized alphabetically by generic name Information on compatibility and stability with diluents and drugs Solution, Y-site, syringe, and additive compatibility Table format, very useful Not complete, lag time
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King Guide to Parenteral Admixtures

Chart format, loose-leaf Alphabetical listing by generic name May have information not available in Trissels Pages are not numbered

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IV INDEX

Component of MICROMEDEX Easy to use Information taken mostly from Trissels

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Compounding and Pharmaceutics

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Remingtons The Science and Practice of Pharmacy

Helpful for extemporaneous compounding Pharmaceutical calculations, chemistry, radioisotopes New edition every 5 years

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Merck Index

Chemical name, formula, & structure Physical data, therapeutic category Published every 6 to 10 years

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United States Pharmacopeia National Formulary (USP-NF)


Official monographs for preparation and assay of pharmaceutical products Published every 5 years with periodic supplements Information on storage, packaging, labeling, reference standards, & assays USP: drug substances & dosage forms NF: pharmaceutical ingredients Not a very useful reference since most pharmaceuticals are mass-produced
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Pharmacokinetics

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Basic Clinical Pharmacokinetics (Winters)

Case-study format Includes principles of monitoring therapy, basic pharmacokinetics, & clinical applications Appendix of commonly used equations Mostly theory, little patient integration

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Applied Pharmacokinetics: Principles of Therapeutic Drug Monitoring

Published by Applied Therapeutics Most advanced reference More specific drug information than Winters Includes analytical methods and clinical applications

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Toxicology

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Toxicologic Emergencies (Goldfranks)

Poison management guidelines Useful tables and case studies Practice multiple-choice questions

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Casarett & Doull's Toxicology: The Basic Science of Poisons

gold standard in toxicology field basic concepts and fundamental principles needed to grasp current issues in modern toxicology The text is organized and presented in a logical progression of general principles to specific topics such as organ system toxicology, specific agent toxicology, and environmental toxicology.

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POISINDEX

Toxicology component of MICROMEDEX Search by brand or generic name Describes what substance looks like, any imprint codes, management of toxicity

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Other Toxicology Books

Toxic Emergencies: Clinics in Emergency Medicine (Clinics in emergency medicine) by William Hanson Current Approaches in Toxicology by Bryan Ballantyne Handbook on the Toxicology of Metals (Hardcover) by Lars Friberg Lars

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Other Toxicology Books

Toxicology of the Eye: by W.Morton Grant. Joel S. Schuman Effects on the Eyes and Visual System from Chemicals, Drugs, Metals and Minerals, Plants, Toxins, and Venoms; Also, Systemic Side Effects from Eye med (Hardcover)

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Other Toxicology Books

Clinical Toxicology of Commercial Products (Hardcover) by Robert E. Gosselin, Roger P. Smith, Harold C Hodge, Jeannet Braddock

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Drug Identification

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1. American Drug Index


Cross-referenced by brand, generic, and chemical names

2. The Pill Book 3. IDENTIDEX


Component of MICROMEDEX Identify drug by imprint code

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4. British National Formulary


BMJ Publishing, London, United Kingdom. The standard reference for prescribing and dispensing drugs in Britain. Included are notes on the different drug groups to help in the choice of appropriate treatment. The BNF is updated in March and September of each year available on disk and CD-ROM as the Electronic British National Formulary and An electronic web-based format is also available.

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5. Saudi National Formulary

It is a joint publication of the Saudi pharmaceutical society & Ministry of Health, Riyadh, KSA The standard reference for prescribing and dispensing drugs in Saudi Arabia. Included are notes on the different drug groups to help in the choice of appropriate treatment. The SNF is only one edition published in 1424 H (previous two editions were directory formats). Available as hardcopy only.

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5. Saudi National Formulary (cont.)

Having guidelines appendix. Drug interactions appendix. Drug information links appendix. List of community pharmacies all over the kingdom Containing different indexes like: Vendors index. Manufacturers index. Alphabetical drug index Therapeutic index
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5. Index Nominum: International Drug Directory


Edited by the Swiss Pharmaceutical Society Alphabetical by generic and brand name Drug name, structure, therapeutic class, synonyms, and manufacturer Cross-referenced by all trade names and substances Not much information is provided

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5. Index Nominum: International Drug Directory


Drugs Available Abroad Alphabetical by generic name Drug manufacturer, when it became available, dosage forms, where it is approved Indexed by disease, country of use, drug category Appendices with information on manufacturers and drug regulatory authorities in other countries

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Non-Prescription Products

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PDR for Nonprescription Drugs and Dietary Supplements

Format similar to PDR, updated every year Indexed by product name, category, manufacturer, & active ingredient Includes color pictures of products Information: indications, cautions, dose, administration, patient instructions, precautions, how supplied

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Handbook of Nonprescription Drugs

Useful tables and comparisons Includes: Patient assessment and counseling guidelines Pathophysiology and treatment options Dosing, adverse events, & interactions

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Natural Products

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Lawrence Review of Natural Products

Comprehensive and up-to-date information Published by F&C Monthly updates Provides uses, toxicity, & patient info Scientific approach to herbal products

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Electronic Tertiary Resources

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A. Multipurpose Resources (disease and drug information)

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Access Medicine
(http://www.accessmedicine.com/) Collection of textbooks, clinical practice guidelines, news Includes: Goodman & Gilman, Harrisons, Current Medical Diagnosis & Treatment, and the Lange series. Drug monographs (include images, chemical structures, patient education materials) provided by Gold Standard Patient education handouts on common medical problems provided by Postgraduate medicine
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ClinicalResource@Ovid
(http://clinicalresource.ovid.com/autologin.html) Collection of books, clinical practice guidelines, patient education materials and links to databases Includes: Clin-eguide, Facts and Comparisons and 5Minute Consult series

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MD Consult
http://home.mdconsult.com/groups/uwash8783.html) Collection of textbooks, journals, drug information, guidelines, patient education handouts, news and updates Drug information and updates from Mosbys drug Consult, package insert information, FDA information Customizable patient handouts diseases and drugs

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MedlinePlus
(http://medlineplus.gov) NLMs database aimed at consumers for health and wellness information English and Spanish versions as well as large print and audio Includes health topics, drug information, dictionaries, interactive tutorials, directories and links to other resources

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MedlinePlus

Especially good for quick overview, including statistics, of topics and illustrations Drug information includes MedMaster from ASHP, USP DI Advice for Patients, Natural Standard Online (for natural products) and links to FDA and ClinicalTrials.gov

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Micromedex Healthcare series


(http://www.thomsonhc.com/hcs/librarian/) Collection of databases that can be searched individually or all together contents of collection depends on your subscription Includes DrugDex and Drug Consults, IV Compatibility, PoisIndex, AltMedDex, Martindale, Reproprisk, TOMES and CareNotes

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Micromedex Healthcare series

Use for detailed information about medications (US and foreign) and natural products as well as exposures to chemicals, toxins and poisonous animals and plants Lengthy bibliographies Instructions for citing under Warranties a& Disclaimers link

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UpToDate
(http://www.uptodateonline.com/) Evidence-based electronic textbook of medicine Lexi-Interact Drug Interactions program from LexiComp for drug interactions Links from drug names to Lexi-Comp drug information within monographs Provides recommendations for good practice Graphs and tables that may be exported to personal documents
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B. Drug and Natural Products Information Resources

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Facts & Comparisons


(http://online.factsandcomparisons.com/) Collection of resources that can be searched individually or all together drugs and natural products Includes Drug Facts & Comparisons, Nonprescription Drug therapy, Drug Interaction Facts, Review of Natural Products, MedFacts Patient information

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Facts & Comparisons

Print version has been gold standard for drug information for years Includes comparison tables for drugs by class or pharmacological action In general, references are included in the Drug Interactions section and in drug class monographs but not in individual drug monographs

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Natural Medicines Comprehensive Database


(http://www.therapeuticresearch.net/nd/Search.aspx?s=ND) Comprehensive, evidence-based information about herbal and dietary supplements used in the US and Canada Produced by publishers of Prescribers' Letter and Physicians' Letter Many products have patient handouts

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Natural Medicines Comprehensive Database

Updated daily Several entry points, e.g. product or common name, scientific name, people use this for, interactions with foods, herbs, dietary supplements, lab tests, diseases or conditions

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