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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
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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
Full-text databases
Compendia
Review articles
On various drug or disease topics
A vast array of information about manyDrugs such as the physician's desk reference
Including the internet, MICROMEDEX and LEXI
Summarize a particular topicContain 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. To assess consistency, compare information presented in one text to the same information presented in another text.
7. Is the reference likely to contain information relevant to the subject being researched?
8. 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
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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:
Martindale’s The complete drug reference
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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.
Martindale’s The complete drug reference
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
Mosby’s Drug Consult
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Mosby’s 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
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
USP Dispensing Information (USP DI)
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USP Dispensing Information (USP DI)
Three volumesI. DRUG Information for the Healthcare
ProfessionalII. 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
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• Martindale’s – foreign drugs
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
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
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.
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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Harrison’s 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
Clinical Medicine (Kumar &Clark )
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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.
Clinical Medicine (Kumar &Clark )
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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……
Clinical Medicine (Kumar &Clark )
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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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Hurst’s The Heart Organized by condition Comprehensive information on drug therapies
and regimens Rapid Interpretation of EKG’s (
Electrocardiogram (EKG or ECG)) Best guide to learning EKG’s User-friendly format.
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Pediatrics
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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Mandell’s 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 & Gilman’s 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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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
Stockley's Drug Interactions
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• 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
Stockley's Drug Interactions
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Adverse Drug Reactions
Meyler’s Side Effects of Drugs
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Meyler’s 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
Handbook on Injectable Drugs (Trissel’s)
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Handbook on Injectable Drugs (Trissel’s)
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
Trissel’s Pages are not numbered
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IV INDEX®
Component of MICROMEDEX®
Easy to use Information taken mostly from Trissel’s
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Compounding and Pharmaceutics
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Remington’s 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
Winter’s Includes analytical methods and
clinical applications
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Toxicology
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Toxicologic Emergencies (Goldfrank’s)
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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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
Other Toxicology Books
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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)
Other Toxicology Books
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Clinical Toxicology of Commercial Products (Hardcover) by Robert E. Gosselin, Roger P. Smith, Harold C Hodge, Jeannet Braddock
Other Toxicology Books
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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 Book3.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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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
5. Index Nominum: International Drug
Directory
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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
5. Index Nominum: International Drug
Directory
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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,
Harrison’s, 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 5-Minute 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 Mosby’s drug Consult, package insert information, FDA information
Customizable patient handouts – diseases and drugs
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MedlinePlus
(http://medlineplus.gov) NLM’s 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 Lexi-Comp 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