Revision as of 00:48, 8 January 2014

Please be patient as this article is still being written

Various types of pharmacy publications and references have different characteristics. These can typically be broken into categories based on the following criteria:

• pharmacy literature which is based on how far removed it is from the original research (primary, secondary, and tertiary); and
• material based on format (books, articles, websites, etc.).

This article provides an overview of these types of resources along with some commonly used references. The mention of any particular reference is not intended as an official endorsement, but simply recognition of its common use.

Legal Aspects

Pharmacies should be aware of any requirements made of them with respect reference materials, both to avoid any citations for noncompliance and in order to provide an appropriate level of assurance that they are providing proper medication therapy.

On the federal level, there are currently no specified requirements for pharmaceutical references. The federal government has opted to leave these requirements up to each state.

States, as would be expected have a wide variety of requirements, depending on which state you are in, and what kind of practice setting you are in (community, institutional, mail order, etc.). To let's look at the reference requirements for Pennsylvania and California in order to get an idea of what states require.

Pennsylvania Chapter 27 State Board of Pharmacy:

An adequate reference library which meets the following standards:

(i) Enables a pharmacy to prepare and dispense prescriptions properly, consistent with its scope of practice.

(ii) Includes reference sources appropriate to the type of pharmacy practice at that particular location. A pharmacy shall include in the pharmacy’s library current material regarding the technical, clinical and professional aspects of practice with emphasis in the area in which the pharmacy specializes.

(iii) Enables the pharmacist to compound medications in a safe and effective manner consistent with accepted standards of pharmacy practice.

(iv) Lists the possible drug interactions and possible adverse effects of medications dispensed by the pharmacy.

(v) Lists the therapeutic equivalents for medications.

(vi) Lists the therapeutic usage and dosages of medications dispensed by the pharmacy.

(vii) Provides guidelines for the counseling of patients.

(viii) A pharmacy that specializes in nuclear or parenteral prescriptions may limit the library it maintains under subparagraph (ii) relating to the pharmacy’s own specialization.

(ix) Maintains the latest editions including current supplements of each of its reference sources.

California 2013 Lawbook for Pharmacy:

1751.8. Sterile Injectable Compounding Reference Materials.

In any pharmacy engaged in compounding sterile injectable drug products, there shall be current and appropriate reference materials regarding the compounding of sterile injectable products located in or immediately available to the pharmacy.

Whichever state(s) your pharmacy is practicing in, make sure your pharmacy is in compliance.

Pharmacy literature

Scholarly fields, such as pharmacy, requires much research, means for cataloging/indexing the research, and eventually compilations from the various research studies. All aspects should involve competent professionals capable of properly interpreting the information.

Primary

Primary literature provides direct access to the most current information resulting from contemporary research. It is the largest and most current source of information. This type of literature includes original reports of scientific, clinical, technological, and administrative research projects and studies.

Examples of primary pharmacy literature includes peer reviewed journals such as the New England Journal of Medicine (http://www.nejm.org), the American Journal of Health-System Pharmacy (http://www.ajhp.org), and the International Journal of Pharmaceutical Compounding (http://www.ijpc.com). For additional pharmacy journals, a list of popular pharmacy journals can be found at http://www.pharmacy.org/journal.html.

Secondary

Secondary literature involves the interpretation and evaluation of information derived from or in reference to the primary literature sources. This secondary literature takes the primary literature and synthesizes, generalizes, and integrates new research.

Examples of secondary literature includes review articles, systematic reviews, meta-analyses and reference works. Secondary literature also includes indexing and abstracting services. PubMed (http://www.ncbi.nlm.nih.gov/pubmed) and The Cochrane Library (http://www.thecochranelibrary.com) are common examples of secondary literature.

Tertiary

Tertiary literature references are condensed works based on primary and secondary literature, such as textbooks, encyclopedia articles, and guidebooks or handbooks. The purpose of tertiary literature is to provide an overview of key research findings and an introduction to principles and practices. These are the types of references most commonly used in both the classroom and pharmacy environment.

Some common examples of these are the Drug Information Handbook (http://webstore.lexi.com/Drug-Information-Handbook), Micromedex (http://www.micromedex.com), and Drug Facts and Comparisons (http://www.factsandcomparisons.com).

Common references

Depending on the types of information specifically needed, along with accessibility and individual preference, a particular format or specific resource may be better suited. With that in mind there are numerous books, websites, and dedicated applications to help ensure that professional have access to the necessary information. The listing below are not intended to be exhaustive, but simply to detail some of the more commonly used references.

Printed references

Print references usually offer some reasonable advantages over other types of media in that they are available off-line, relatively easy to navigate, and a format that most people are comfortable using. Conversely, a disadvantage is that most of them are limited to annual updates (although some publish monthly updates that would need to be inserted). In a dynamic field like pharmacy this can be a concern. As you read through the list, you will find it very common that many of the books listed offer varios electronic tools/versions (eBooks, web sites, mobile apps, and database integration).

Some of the books listed below are very broad in subject matter (Drug Facts and Comparisons) while others are more specialized in their content (Drugs in Pregnancy and Lactation). As previously mentioned, any references listed are not intended as recommendations, but are simply being highlighted because they are commonly used.

Drug Facts and Comparisons

The Drug Facts and Comparisons provides the following drug information:

• medication availability,
• drug formulations,
• general dosing guidelines,
• adverse drug reactions,
• phamacokinetics,
• drug interactions,
• general pharmacology,
• indications,
• over the counter drugs,
• the alcohol content of drugs, and
• sugar-free liquid preparations.

The Drug Facts and Comparisons also provides information on manufacturers' phone numbers and diagnostic aids. The print version can receive monthly updates to ensure current content. There is also an online version of this available as a subscription service. The online version is discussed further in the online drug information resource section.

AHFS Drug Information

The AHFS Drug information (AHFS DI) provides the following drug information:

• medication availability,
• drug formulations,
• general dosing guidelines,
• adverse drug reactions,
• drug interactions,
• general pharmacology,
• indications,
• over the counter drugs,
• unlabelled (off-label) uses, and
• immunizations.

The AHFS Drug information is broken into sections divided by drug classifications. The print version is updated annually with a new edition. It is also available through online subscription and through specific apps for Android and iOS.

Physician's Desk Reference

The Physician's Desk Reference (PDR) provides the following drug information:

• approved FDA product information equivalent to package insert,
  • general pharmacology,
  • indications and usage,
  • adverse drug reactions,
  • drug interactions, and
  • dosage and administration
• tablet and capsule identification, and
• the manufacturer's telephone numbers.

The Physician's Desk Reference effectively prints the information approved by the FDA for the package insert. The PDR is also available online at http://www.pdr.net, and for various smart phones and tablets (Android, BlackBerry, and iOS).

Martindale: The Complete Drug Reference

The Martindale: The Complete Drug Reference provides drug information on:

• drug availability,
• formulations,
• general dosing,
• investigational drugs,
• manufacturer information,
• foreign drugs,
• compatibility,
• adverse drug reactions, and
• efficacy of drug therapy.

Besides pharmaceuticals, the Martindale also covers herbals, diagnostic agents, radiopharmaceuticals, pharmaceutical excipients, toxins, and poisons.

Drug Information Handbook

The Drug Information Handbook provides drug information on:

• drug availability,
• formulations,
• general dosing,
• adverse drug reactions,
• pharmacokinetics,
• drug interactions,
• general pharmacology,
• and indications.

The Drug Information Handbook is updated annually and is conveniently organized alphabetically by generic drug names with cross-references from common brand names. It is also available as an app for Android, BlackBerry, and iOS. The publisher of the Drug Information Handbook, Lexicomp, also provides an online version at http://online.lexi.com.

Pharmacotherapy A Pathophysiologic Approach

Pharmacotherapy A Pathophysiologic Approach provides information on:

• disease state and appropriate drug therapy including:
  • diagnostic flow diagrams,
  • treatment algorithms,
  • dosing guideline recommendations,
  • monitoring approaches, and
  • evaluation of therapeutic outcomes
• details disease signs and symptoms
• covers clinical controversies
• includes pharmacoeconomic issues/concerns
• discusses challenges with patient compliance

This is highly detailed therapeutic text is available in both a traditional printed format and as an ebook.

Applied Therapeutics: The Clinical Use of Drugs

Applied Therapeutics: The Clinical Use of Drugs provides information on:

• drug therapeutics including:
  • comparative drug information,
  • pharmacokinetic properties,
  • dosing guidelines, and
  • risk factors
• disease information including:
  • common disease and disorder diagnosis information,
  • treatment options (including drug regimens),
  • risk factors, and
  • Q & A sections for major disease states

The information in this textbook is often provided through the use of case studies in the attempt to provide demonstrative examples of patient care and the challenges associated therein.

Goodman and Gilman's Pharmacological Basis of Therapeutics

The Goodman and Gilman's Pharmacological Basis of Therapeutics covers the following nine categories:

• general principles
• neuropharmacology
• modulation of cardiovascular function
• inflammation, immunomodulation, and hematopoiesis
• endocrine pharmacology
• gastrointestinal pharmacology
• chemotherapy of infectious disease
• chemotherapy of neoplastic diseases
• special systems pharmacology

Goodman and Gilman's Pharmacological Basis of Therapeutics is the "Gold Standard" for pharmacology textbooks; although, it is deficient on information for clinical application. This is available as both a printed book and as an ebook. Some concern has been expressed over the legibility of the charts and tables contained within the ebook version.

Red Book: Pharmacy's Fundamental Reference

Red Book: Pharmacy's Fundamental Reference provides information on:

• avereage wholesale drug prices for over 100,000 prescription drugs, OTC drugs, and medical supply items,
• direct purchasing prices on many pharmaceuticals,
• general availability of drugs,
• availability of sugar-free liquid preparations,
• tablet and capsule identification, and
• manufacturers telephone numbers and addresses.

This product is also available on CDROM for MS Windows and an online version is available as well. The Red Book can be integrated into the Micromedex online subscription service as both products are available through Truven Health Analytics. While the various electronic versions have continued to receive updates, the print edition has not been updated since 2010.

Handbook on Injectable Drugs

Handbook on Injectable Drugs (often referred to as Trissel's Handbook on Injectable Drugs or simply the Trissel due to the books primary author, Lawrence Trissel) provides information on:

• multisource/ingredient compatibility and stability of parenteral admixtures when mixed directly and when mixing only in an infusion set,
• information for safe/appropriate rates of administration,
• monographs on
  • storage,
  • preparation,
  • concentration,
  • pH,
  • dosing, and
  • administration.

The information from this product is available in multiple formats including print, online via a subscription, and for mobile devices including Android and iOS. This product can also be integrated intp the online version of Facts and Comparisons.

King Guide to Parenteral Admixtures

King Guide to Parenteral Admixtures (a.k.a., Cutter Guide) provides information on:

• contains information on over 500 drugs in 12 different diluents,
• compatibility and stability of drugs and solutions by route of administration, and
• charts for every medication that provide easy view of the information.

This product is available in an array of formats including a loose leaf print edition that receives quarterly updates, various mobile devices including Android and iOS, online, and it can be integrated into other pharmacy databases. Wall charts of information from this publication are also available to help with many common stability and compatibility questions.

Drugs in Pregnancy and Lactation

Drugs in Pregnancy and Lactation (also sometimes simply referred to as Briggs, due to the last name of the book's lead author) provides information on:

• drug monographs containing:
  • generic name,
  • pharmacologic class,
  • risk factor(s),
  • fetal risk summary, and
  • breast feeding summary,
• cross referenced combination drugs,
• lists of drugs contraindicated in breastfeeding, and
• lists of drugs contraindicated in pregnancy.

This book is available in traditional print and in various eBook formats. A companion website aids in keeping information current and adds another level of search capabilities. The book also comes with a free mobile app that has limited functionality, but can be upgraded from within the app.

Medications and Mothers' Milk

Medications and Mothers' Milk(also sometimes simply referred to as Hale, due to the last name of the book's lead author) provides information on:

• the effects of numerous drugs expressed in breast milk including:
  • legend drugs,
  • chemotherapeutic agents,
  • radiopharmaceuticals,
  • vaccines,
  • over the counter drugs, and
  • herbals,
• various syndromes that effect lactation,
• radiocontrast agents, and
• various quick reference tables/charts.

This publication is typically updated every two years. Hale Publishing also maintains an online database with this information as a subscription service available for both individual and institutional subscriptions.

Online references

There is a vast amount data related to health care available through the internet. With that in mind, there are several things that should be looked at in this section:

• the pros & cons of health care information available on the internet
• how to properly evaluate the claims and statements made by various websites
• good online resources for students and professionals
• easy to understand and reliable online resources for patients
• contending with the potential bias of a particular search engine
• dispelling online rumors/hoaxes concerning health care

The pros & cons of online health care information

Of the approximately 313,000,000 people living in the United States, over 245,000,000 use the internet. Many of these Americans regularly use the internet to research health related information with an over abundance of sites offering medical information. If someone does a general search for the word “cancer” online a voluminous number of results will appear in the results (about 181,000,000).

With this high degree of information accessibility, brief lists of the 'Pros & Cons' can be made for looking up health care information via the internet.

As we move forward in this article, we will look for ways to manage some of these 'cons'.

Evaluating information from online resources

When evaluating online resources it is useful for sites to follow best practices as described by Healthcare On the Net (HON), but if all these policies are not necessarily in place there are also 'red flags' to warn you of inappropriate information.

Best practices

Health On the Net (HON) provides 8 principles for its code of conduct for medical and health related web sites. These principles are commonly identified as best practices. Listed below are their 8 principles.

1. Authoritative - Indicate the qualifications of the authors
2. Complementarity - Information should support, not replace, the doctor-patient relationship
3. Privacy - Respect the privacy and confidentiality of personal data submitted to the site by the visitor
4. Attribution - Cite the source(s) of published information, date and medical and health pages
5. Justifiability - Site must back up claims relating to benefits and performance
6. Transparency - Accessible presentation, accurate email contact
7. Financial disclosure - Identify funding sources
8. Advertising policy - Clearly distinguish advertising from editorial content

Red Flags to spot noncredible web sites

While the best practices mentioned above is a good way to identify a quality information resource, it is also important to be able to identify the traits of noncredible resources. The following is a short list:

• Lacking contact information or an "About Us" section
• No reference to updates
• No disclaimer (eg, "This is not meant to be medical advice...")
• Claiming a scientific breakthrough or ancient or miraculous cures
• Claiming that a product is effective for a wide range of ailments
• Undocumented case histories
• Missing references or citing only unpublished or obscure studies
• Product available from only one source, with a money-back guarantee
• Lacking links to endorsed and generally accepted sites

Online resources for professionals

There are a number of free and subscription based web sites available for health care professionals, particularly for pharmacists and pharmacy technicians. In this article we will once again focus on resources commonly used by pharmacy students and professionals. A particular site being listed in this article is not necessarily a particular endorsement for a web site, but is instead a recognition of its frequent use.

Free websites

By free, this only implies that it requires no monetary remuneration by individual users. Some of these sites require free registration, and most also include advertising to cover their costs.

Medscape

Medscape - http://medscape.com/ - is a free web resource (registration required) for health professionals. It includes:

• peer-reviewed original medical journal articles,
• Continuing Medical Education (CME),
• a customized version of the National Library of Medicine's MEDLINE database,
• daily medical news,
• major conference coverage, and
• drug information including:
  • drug monographs,
  • patient handouts,
  • drug prices,
  • medication images, and
  • a drug interaction checker.

Medscape also provides a mobile app both Android and iOS.

DailyMed

DailyMed - http://dailymed.nlm.nih.gov/ - is a website operated by the U.S. National Library of Medicine (NLM) to publish up-to-date and accurate labels (package insert) for health care providers and the general public. The contents of DailyMed is provided and updated daily by the U.S. Food and Drug Administration (FDA). The FDA in turn collects this information from the pharmaceutical industry. As of January 3rd, 2014 it contains 58,383 package inserts (23,490 prescription labels, 26,780 OTC labels, 4,932 homeopathic labels, 1,646 animal labels, and 1,535 labels for bulk ingredients, vaccines, and some medical devices). DailyMed also provides an RSS for updated drug information.

PDR.net

PDR.net - http://www.pdr.net/ - provides the same information as the printed version of the PDR, with the significant improvement that it is updated regularly. The site also provides:

• downloadable PDF of the PDR,
• drug alerts,
• drug recalls,
• drug approvals, and
• access to articles on various clinical trials.

There are also PDR apps available for Android and iOS.

Drugs.com

Drugs.com - http://www.drugs.com/ - provides the following:

• drug monographs,
• a pill identifier,
• interactions checker,
• the ability to look up medications phonetically, and
• drug news such as:
  • recalls,
  • alerts,
  • labeling changes, and
  • new drug approvals.

Drugs.com has both paid for and free apps available for Android and iOS.

RxList

RxList - http://www.rxlist.com/ - provides the following information:

• drug monographs,
• pronunciation keys and audio files providing proper pronunciation,
• a pill identifier,
• a dictionary with both medical terminology and medical abbreviations,
• various health related slide shows,
• a symptom checker, and
• various quizzes.

Epocrates

Epocrates - http://www.epocrates.com/ - is a free web resource (registration required) for health professionals. It provides the following information:

• drug monographs,
• disease look-up,
• drug interaction checker,
• pill identifier,
• various drug dosage calculators, and
• various comparison tables.

Epocrates has also had apps available for most mobile platforms.

Websites requiring paid subscriptions

Subscription sites do offer some advantages when compared to free websites. There is a general perception that these subscription websites offer more information. There is a commonly held belief that they are less likely to inappropriately bias individuals through advertising since ads are not included in search results. Also, there is generally the ability to subscribe to additional databases that may be useful to your facility based on the kinds of patients that are being served.

These subscription sites usually require contracts which are based on various items including corporate vs individual user licenses, the number of people that will be provided direct access to the program, educational rates compared to rates for healthcare facilities. As these rates can be complex to determine, specific costs will not be discussed in this article.

The four subscription websites (Micromedex, Facts and Comparisons eAnswers, Lexicomp Online, and Clinical Pharmacology) mentioned in this article are among the most commonly used drug information subscription services.

Micromedex

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Facts and Comparisons eAnswers

Facts and Comparisons eAnswers - http://online.factsandcomparisons.com - is the web based alternative to maintaining the paper based Drug Facts and Comparisons, and it also provides additional features not available in the print edition. Facts and Comparisons eAnswers provides access to the following information:

• medication availability,
• drug formulations,
• general dosing guidelines,
• adverse drug reactions,
• phamacokinetics,
• drug interactions,
• allergy screening,
• general pharmacology,
• indications,
• over the counter drugs,
• the alcohol content of drugs,
• sugar-free liquid preparations,
• comparative drug tables,
• pill identification
• patient counseling/education notes,
• Risk Evaluation and Mitigation Strategy (REMS) summaries, and
• Patient Assistance Program information.

Facts and Comparisons eAnswers also provides (for additional cost) access to the following list of add-on modules:

• Trissel's IV-Chek,
• Toxicology Treatment Guidelines,
• The Formulary Monograph Service,
• Martindale: The Complete Drug Reference,
• Drug Plans, and
• HL7 InfoButton.

Lexicomp Online

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Clinical Pharmacology

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Online resources for patients

The Medical Library Association finds the following web sites particularly useful for people outside of the medical community (sites are listed in alphabetical, NOT ranked, order):

• Cancer.gov
• Centers for Disease Control and Prevention (CDC)
• familydoctor.org
• healthfinder®
• HIV InSite
• Kidshealth®
• Mayo Clinic
• MedlinePlus (English | Spanish)
• NetWellness
• NIH SeniorHealth

The Consumer and Patient Health Information Section (CAPHIS) of MLA evaluates websites based on the following criteria: credibility, sponsorship/authorship, content, audience, currency, disclosure, purpose, links, design, interactivity, and disclaimers.

Mollifying biased search engine results

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Dispelling online rumors and hoaxes

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Smart phone and tablet applications

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Additional external resources

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See also

Pharmacology
Patient package insert

References

1. Types of Medical Literature, Mercer University Atlanta Swilley LibGuides: Updates to Colleges of Pharmacy and Health Professions Resources, http://mercer.libguides.com/content.php?pid=81289&sid=802112
2. CHAPTER 27. STATE BOARD OF PHARMACY, The Pennsylvania Code, http://www.pacode.com/secure/data/049/chapter27/chap27toc.html
3. 2013 Lawbook for Pharmacy, California Board of Pharmacy, http://www.pharmacy.ca.gov/laws_regs/lawbook.pdf
4. Journals, Virtual Library Pharmacy, http://www.pharmacy.org/journal.html
5. Drug Facts and Comparisons, http://www.factsandcomparisons.com/drug-facts-and-comparisons-loose-leaf/
6. AHFS Drug Information, http://www.ahfsdruginformation.com/
7. Physician's Desk Reference, http://www.pdr.net/
8. Martindale: The Complete Drug Reference, http://www.pharmpress.com/product/9780853699330/martindale
9. Drug Information Handbook, http://webstore.lexi.com/Drug-Information-Handbook
10. Pharmacotherapy A Pathophysiologic Approach, http://accesspharmacy.com/resourceToc.aspx?resourceID=669
11. Applied Therapeutics: The Clinical Use of Drugs, http://www.accp.com/bookstore/th_09at.aspx
12. Goodman and Gilman's Pharmacological Basis of Therapeutics, http://accessmedicine.com/resourceTOC.aspx?resourceID=651
13. Red Book: Pharmacy's Fundamental Reference, http://www.redbook.com/redbook/
14. Handbook on Injectable Drugs, http://www.ahfsdruginformation.com/product-hid.aspx
15. King Guide to Parenteral Admixtures, https://www.kingguide.com/
16. Drugs in Pregnancy and Lactation, http://www.accp.com/bookstore/th_09dpl.aspx
17. Medications and Mothers' Milk, http://www.ibreastfeeding.com/catalog/p301/2012-Medications-and-Mothers&%2339-Milk/product_info.html
18. Internet Usage and Population in North America, Internet World Stats, http://www.internetworldstats.com/stats14.htm
19. Search results for the word "cancer", Google, https://www.google.com/search?q=cancer
20. The HON Code of Conduct for medical and health Web sites, Health On the Net, http://www.hon.ch/HONcode/Conduct.html
21. Medscape, Wikipedia, http://en.wikipedia.org/wiki/Medscape
22. DailyMed, Wikipedia, http://en.wikipedia.org/wiki/DailyMed
23. Download, DailyMed, http://dailymed.nlm.nih.gov/dailymed/downloadLabels.cfm
24. For Health Consumers: "Top Ten" Most Useful Websites, Medical Library Association, http://www.mlanet.org/resources/medspeak/topten.html