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Answering Drug Information Questions

Answering Drug Information Questions

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Answering Drug Information Questions

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  1. Answering Drug Information Questions Presented by: Andrew Hamilton Date: November 7, 2008

  2. Answering Drug Information Questions Subtitle • Drug Information questions can be broken down into the following elements: • Nomenclature & Identification • Therapeutic Usage • Adverse Effects • Business & Economics • Governmental Regulation

  3. Answering Drug Information Questions • Nomenclature & Identification • Identifying the name of a drug • Finding synonymous names & codes for a drug • Determining the chemical composition and physical properties of a drug • Identifying other drugs that possess a similar chemical structure or mode of action

  4. Answering Drug Information Questions • Therapeutic usage • Determining which diseases are approved to be treated by a drug • Discovering how a drug works to achieve its therapeutic activity • Finding the recommended dosage and route administration of a drug • Learning how a drug is absorbed, distributed, metabolized, and excreted

  5. Answering Drug Information Questions • Adverse Effects • Side effects • Interactions • Drug/Drug • Drug/Food • Drug/Herb • Toxic potential • Contraindications • Teratogenicity

  6. Answering Drug Information Questions • Business & Economics • Drug prices • Drug sales • Drug companies • Drug Manufacturers • Drug Stores • Most commonly prescribed drugs

  7. Answering Drug Information Questions • Government regulation • Drug approval process • Identifying which countries have approved the usage of a specific drug • The restriction or prohibition of the usage of specific drugs (controlled substances) • Policies and codes regulating the manufacture, distribution, and sales of pharmaceutical agents

  8. Answering Drug Information Questions • Names & Classifications of Drugs • Drugs can be referred to by a number of synonymous names and codes. • These terms fall into three basic categories • Names • Codes • Classifications • Using Nitroglycerin as an example, we’ll examine the different terms that refer to it

  9. Answering Drug Information Questions • Names • Chemical • 1,2,3-Propanetriol trinitrate • Glycerol trinitrate • Nitroglycerin • Approved Name (USAN,INN,BAN,JAN) • Nitroglycerin • CAS# • 55-63-0

  10. Answering Drug Information Questions • Names • Trade Names • +200 proprietary names for Nitroglycerin are listed in ChemIDplus • NDC • 177 different NDC codes exist for Nitroglycerin formaulations • Molecular formula • C3H5N3O9

  11. Answering Drug Information Questions • Names • Structural formula • Where are the five hydrogen atoms? • H atoms are often not shown in structural formulas

  12. Answering Drug Information Questions • Classifications • Classifications serve to organize drugs into groups. In pharmacology, they fall into three categories based on the following criteria: • Chemical structure • Pharmacologic action • Therapeutic use

  13. Answering Drug Information Questions • Classifications • Nitroglycerin is classified in the following ways • Chemical • Nitrate • Pharmacologic action • Vasodiltor • Therapeutic use • Anti-anginal agent • Nitroglycerin is also industrially classified as an explosive agent

  14. Answering Drug Information Questions • What is the difference between pharmacologic action & therapeutic use? • Pharmacologic action refers to what the drug does • Beta adrenergic blocker, Serotonin uptake inhibitor • Therapeutic use refers to the condition that the drug is treating • Antihypertensive, Anti-depressive agent

  15. Answering Drug Information Questions • Adverse Drug Reactions (ADR) • ADRs are the greatest cause of patient non-compliance with therapeutic interventions • At least 1.5 million Americans are sickened, injured or killed each year by ADRs • ADRs are 4th leading cause of death in the United States • Estimated annual cost of ADRs is $136 billion

  16. Answering Drug Information Questions • Adverse Drug Reaction • Refers to any harmful/undesired/irrelevant effect of a drug • Categories of ADR include • Side effect • Interaction • Toxicity • Teratogenicity • Contraindication • Precautions

  17. Answering Drug Information Questions • Side Effect • Secondary effect of a drug that sometimes accompany the desired therapeutic effect • Side effects are seen when the drug is being given at the normal therapeutic dose • Side effects are not necessarily harmful • Both Rogaine & Viagra started off being used as Anti-hypertensives

  18. Answering Drug Information Questions • Drug interaction • An alteration in the properties of a drug that manifests itself only in the presence of a another drug (or class of drugs) • Interactions involve a precipitant drug affecting the effects of the object drug • Effects can range from being life-threatening to clinically insignificant

  19. Answering Drug Information Questions • Interactions – Nitroglycerin • Aspirin increases serum levels of NG which results in the increase of its effect relative to the administered dosage • NG causes a decrease in the activity of a common anti-coagulant, Heparin • Interactions are common when two drugs compete to be metabolized via the same enzymatic pathway

  20. Answering Drug Information Questions • Other interactions • Drug/Test • NG interferes with the reaction used in the lab test that measures serum cholesterol resulting in the underestimation of a patients cholesterol level • Drug/Food & drink • Alcohol potentiates the effect of NG, possibly triggering a hypotensive crisis and cardiovascular collapse

  21. Answering Drug Information Questions • Other interactions • Drug/Equipment • NG is actively absorbed by PVC tubing with the degree of absorption determined by: • The rate of flow • The concentration of NG • The length of the tube • Only glass bottles & non-PVC tubing can be used to deliver NG intravenously

  22. Answering Drug Information Questions • Toxicity • Describes effects seen when a drug is administered at a dosage greater than that normally used for therapy or has been used for an extended period of time • Acetaminophen – unintentional ingestion of more than recommended maximum daily dose may result in liver injury & abdominal pain.

  23. Answering Drug Information Questions • Poisoning • Refers to the administration or ingestion of a life-threatening dose of drug • Acetaminophen – normal dose is 650-1000mg, but permanent liver failure can occur at 10x the normal dose

  24. Answering Drug Information Questions • Contraindication • A circumstance or condition that causes the administration of the drug to become inadvisable or inappropriate • Xanax is contraindicated in patients with narrow angle glaucoma • Morphine is contraindicated in patients with severe asthma

  25. Answering Drug Information Questions • Precaution • Indicates situation where greater caution must be exercised with the use of the drug • Propranolol must be used with caution in diabetics due to its ability to mask hypoglycemia and in patients w/ impaired liver function due to their reduction of the ability to metabolize it • A precaution does not preclude the use of the drug in indicated cases but does require greater vigilance to monitor the patient

  26. Answering Drug Information Questions • Teratogen • A drug capable of producing developmental abnormalities in an embryo, fetus, or postnatal individual • Thalidomide – When introduced as a sleep aid in the early 1960’s it caused a number of limb deformities due to its teratogenic properties • Accutain – Used to treat acne, it carries a high risk of causing deformities if a developing embryo/fetus is exposed to it

  27. Answering Drug Information Questions • Printed Drug Reference Sources • IDENTIFICATION – US DRUG NAMES • USP Dictionary of USAN and International Drug Names. • American Drug Index. • Merck Index.

  28. Answering Drug Information Questions • Printed Drug Reference Sources • IDENTIFICATION – FOREIGN DRUG NAMES • Index Nominum • International Nonproprietary Names (INN) for pharmaceutical substances • Martindale: the complete drug reference (Warning: – Does not provide an A-Z name index)

  29. Answering Drug Information Questions • Printed Drug Reference Sources • THERAPEUTIC USAGE – ARRANGED BY DRUG CLASS • AHFS Drug Information • Drug Facts and Comparisons • Martindale: the complete drug reference • THERAPEUTIC USAGE – ARRANGED BY NAME • USP DI Volumes I-II

  30. Answering Drug Information Questions • Printed Drug Reference Sources • THERAPEUTIC USAGE – ARRANGED BY DISEASE • Harrison’s Principles of Internal Medicine • Applied Therapeutics: The Clinical use of Drugs. Author: Mary Anne Koda-Kimble • THERAPEUTIC USAGE – ARRANGED BY MANUFACTURER • Physicians‘ Desk Reference : PDR.

  31. Answering Drug Information Questions • Printed Drug Reference Sources • THERAPEUTICS – NONAPPROVED INDICATIONS • Drug Facts & Comparisons • Martindale: The complete drug reference • THERAPEUTIC USAGE – PEDIATRICS • The Harriet Lane Handbook : a manual for pediatric house officers.

  32. Answering Drug Information Questions • Printed Drug Reference Sources • ADVERSE EFFECTS • Meyler's Side Effects of Drugs/Dukes Annual. • AHFS Drug Information • Facts & Comparisons • ADVERSE EFFECTS – INTERACTIONS • Drug Interactions : Analysis and Management. Authors: Philip D. Hansten & John R. Horn.

  33. Answering Drug Information Questions • Printed Drug Reference Sources • ADVERSE EFFECTS – DERMATOLOGIC • Litt’s Drug Eruption Reference Manual. Author: Jerome Z. Litt • ADVERSE EFFECTS – TERATOLOGY • Drugs in Pregnancy and Lactation. Author: Gerald Briggs.

  34. Answering Drug Information Questions • Printed Drug Reference Sources • ADVERSE EFFECTS – IN VITRO COMPATIBILITY • Handbook on Injectable Drugs. Author: Lawrence A. Trissel. • OTC DRUG INFORMATION • Handbook of Non-prescription Drugs. • PHARMACOLOGY (HOW DRUGS WORK) • Goodman & Gilman's the Pharmacological Basis of Therapeutics.

  35. Answering Drug Information Questions • Printed Drug Reference Sources • BUSINESS & ECONOMICS • Red book : Pharmacy's Fundamental Reference. • Remington : the Science and Practice of Pharmacy. • REGULATORY INFORMATION • USP DI Vol III. • Remington : the Science and Practice of Pharmacy.

  36. Answering Drug Information Questions • Printed Drug Reference Sources • INFORMATION FOR THE PATIENT • USP DI Vol II. • Essential Guide to Prescription Drugs. Author: James Rybacki • Complete Guide to Prescription & Nonprescription drugs. Author: H. Winter Griffith, Updated by Stephen Moore.

  37. Answering Drug Information Questions • Printed Drug Reference Sources • TOXICOLOGY • Patty’s Toxicology • Sax's Dangerous Properties of Industrial Materials • Disposition of Toxic Drugs and Chemicals in Man. Author: Randall C. Baselt

  38. Answering Drug Information Questions • Printed Drug Reference Sources • SUBJECT GUIDES • Drug Information. Author: Bonnie Snow • Using the Pharmaceutical Literature. Author: Sharon Srodin • Information Resources in Toxicology. Editor: Philip Wexler

  39. Answering Drug Information Questions • Online Drug Reference Sources • Comprehensive resources • AHFS Drug Information • Facts & Comparison • Micromedex • Gold Standard Clinical Pharmacology

  40. Answering Drug Information Questions • Online Drug Reference Sources • Name Identification • Rxlist.com (fuzzy logic spellchecker) • ChemIDPlus.gov • Drugs@fda.gov • Drugs.com (phonetic search)

  41. Answering Drug Information Questions • Online Drug Reference Sources • Pill Identification • Drugs.com • Rxlist.com • Drugdigest.com • WebMD.com

  42. Answering Drug Information Questions • Online Drug Reference Sources • New Drugs • Drugs@fda.gov • Centerwatch.com • Drugs.com

  43. Answering Drug Information Questions • Online Drug Reference Resources • Manufacturers • Druginfonet.com • Medilexicon.com

  44. Answering Drug Information Questions • Online Drug Reference Sources • Toxicology • TOXNET.gov • Includes HSDB, LactMed, Household products databank • Consumer Health • MedlinePlus • NOAH