Systematic Approach to Answering Drug Information Questions

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1 Systematic Approach to Answering Drug Information Questions Sherief I Khalifa, Ph.D. Professor, College of Pharmacy, Qatar University Based on lecture/slides by Dr. J. Russell May, University of Georgia

2 The Systematic Approach (7 steps) Secure demographics of requestor Obtain background information Determine and categorize the ultimate question Develop a search strategy and conduct a search Perform evaluation, analysis and synthesis Formulate and provide response Conduct follow-up and documentation

3 Secure Demographics of Requestor Name Profession / Position Telephone or

4 Obtaining Background Information Must be sufficiently comprehensive yet not overly time-consuming for requestor General information: Where has the requestor looked so far? Is this a patient-specific question or academic?

5 Obtaining Background Information If patient-specific question: Patient s medical/medication history Age, sex, weight, allergies Organ function Prescription and OTC medications

6 Obtaining Background Information Availability/ Identification / Investigational What is the country of origin? Where did patient obtain product? What is the trade, generic or chemical name? What is the therapeutic use?

7 Obtaining Background Information Availability/ Identification / Investigational Is this the correct spelling? What is dosage form? Are there any markings on the dosage form? Reason for inquiry?

8 Obtaining Background Information Drug Dosing / Pharmacokinetics Patient specific questions listed previously Nutritional status Previous drug concentrations and timing of the concentrations Other pertinent labs Route of administration, dose of drug and administration schedule Patient compliance

9 2. Obtaining Background Information Drug-Drug Interaction What are the drugs in question? What are the respective doses, duration and time course? What are the details of event? What is the medical/medication history? What has been done so far?

10 Obtaining Background Information Drug Therapy (drug of choice) Patient specific questions: Medical/medication history Age, sex, weight Organ function Allergies Diagnosis / indication

11 Obtaining Background Information Adverse Drug Reactions What are the signs and symptoms? What was the onset/duration/severity of reaction? What is the temporal relationship between drug administration and reaction?

12 Obtaining Background Information Adverse Drug Reactions What is medical/medication history? What is route of administration, dose of drug, diluent, duration of therapy? What has been done so far?

13 Obtaining Background Information Stability / Compatibility What kinds of lines are available? Will drug be administered via y-site or other method? What diluents were used for each drug? What is the rate of infusion? What are the concentrations of drugs in solution?

14 Obtaining Background Information Pregnancy and Lactation Did patient take drug? In what trimester is the patient? What is time course? Are alternatives available? Has baby been exposed via breastfeeding? Is baby experiencing any clinical manifestations?

15 Systematic Approach to Drug Information Secure demographics of requestor Obtain background information Determine and categorize the ultimate question Develop a search strategy and conduct a search Perform evaluation, analysis and synthesis Formulate and provide response Conduct follow-up and documentation

16 Determine and Categorize the Ultimate Question Need adequate background information The information a person requests, is not always what the person really wants to know or needs to know!

17 Determine and Categorize the Ultimate Question What is the dose of oral cefpodoxime in patient with a urinary tract infection? I will look in lexicomp for you doctor. Hold on one minute. 2 minutes later. Doctor I found that dose for you it is 100 mg PO Q12HR x 3 days.

18 Determine and Categorize the Ultimate Question What is the dose of oral cefpodoxime in patient with a urinary tract infection? 2 minutes later. 1. Age? Doctor Weight? I found 2. Renal that Function? dose for you 3. What type it is 400 of UTI mg? PO once daily.

19 Determine and Categorize the Ultimate Question Doctor let me ask you a couple of questions First, how old is your patient? How much does she weigh? Do you know if she has normal renal function? Finally, what type of UTI do you suspect? Is it uncomplicated cystitis or more complicated such as pyelonephritis?

20 Determine and Categorize the Ultimate Question Well for one thing - SHE S a HE and HE is about 65 years old and weighs about 90 lbs. I think his SCr is about 1.8 mg/dl so what ever that comes out to be I am admitting him to the hospital today because he s complaining of this flank pain, has a fever and he looks really sick. I think he has pyelonephritis.

21 Determine and Categorize the Ultimate Question Let me look into it and I will get back to you within 15 minutes. Ok that will be good!

22 Determine and Categorize the Ultimate Question Initial Question: What is the dose of oral cefpodoxime in patient with a urinary tract infection? Ultimate Question: What is the best drug for an 65 yo male admitted to the hospital with a complicated pyelonephritis who has renal dysfunction.

23 Categorizing (Classifying) Questions Availability/Identification/Investigational Drugs Drug dosing / Pharmacokinetics Drug-drug / Drug-lab / Drug-food interactions

24 Categorizing (Classifying) Questions Drug therapy (drug of choice) / Therapeutics Adverse drug reactions Poisonings Stability / Compatibility

25 Categorizing (Classifying) Questions Pharmacognosy / Natural products Pharmacology Pharmaceutics / Compounding Pregnancy and lactation Immunizations Cost Patient Counseling

26 Systematic Approach to Drug Information Secure demographics of requestor Obtain background information Determine and categorize the ultimate question Develop a search strategy and conduct a search Perform evaluation, analysis and synthesis Formulate and provide response Conduct follow-up and documentation

27 Developing a Search Strategy and Conducting a Search Categorize ultimate question Determine effort level needed Use tertiary, secondary and primary resources General to specific Prioritize resources

28 Developing a Search Strategy and Conducting a Search Recognize limitations of resources Use at least two resources to validate and verify information Document all references used

29 Search Strategy: General to Specific Flow of information into the literature Order of use when answering questions Primary Literature (original research reports) Secondary Literature (indexing and abstracting services) Tertiary Literature (textbooks and compendias)

30 Search Strategy Search Strategy: Start with general (tertiary) references, and proceed through secondary references to the primary literature Evaluation/Analysis: Based on analysis, formulate your response

31 Systematic Approach to Drug Information Secure demographics of requestor Obtain background information Determine and categorize the ultimate question Develop a search strategy and conduct a search Perform evaluation, analysis and synthesis Formulate and provide response Conduct follow-up and documentation

32 Perform Evaluation, Analysis and Synthesis Evaluate and document all references searched Write down pertinent statements from the references Prepare summary

33 Perform Evaluation, Analysis and Synthesis Determine the need for peripheral information Think about logical follow-up questions Synthesize a patient-specific or situation specific response Document activities

34 Perform evaluation, analysis and synthesis

35 Perform evaluation, analysis and synthesis

36 Systematic Approach to Drug Information Secure demographics of requestor Obtain background information Determine and categorize the ultimate question Develop a search strategy and conduct a search Perform evaluation, analysis and synthesis Formulate and provide response Conduct follow-up and documentation

37 Formulate and Provide Response Be confident with your answer Don t use I think or I don t think Can you say, There are no reports in the literature Prepare answers in a logical sequence

38 Formulate and Provide Response Using logical argument may be necessary if literature includes conflicting data (see next for format for logical argument in response formulation)

39 Formulate and Provide a Response Format for Logical Argument in Response Formulation Present the presenting viewpoints State the assessment of the literature and claim the superior viewpoint Succinctly refute the major strengths and present the weaknesses of the inferior viewpoint

40 Formulate and Provide Response Format for Logical Argument in Response Formulation Defend the major weaknesses and promote the strengths of the superior viewpoint Reiterate the final assessment in support of the superior viewpoint

41 Formulate and Provide Response Do not use abstracts alone when communicating response Anticipate other questions and be prepared with answers Present verbal or written reply within time frame specified

42 Formulate and Provide a Response Ask if information provided is what is needed or required Ask if additional information is needed or if they need it in writing If quick answer needed, offer to follow-up with additional information if found You and the requestor should be happy

43 Formulate and Provide Response Based on what you told me cefpodoxime may not be the best drug for your patient. Well, why not!

44 Formulate and Provide Response For a couple of reasons. Let me explain. First you are admitting him with what sounds more like a severe, complicated UTI. Cefipodoxime is more for outpatient therapy in uncomplicated cystitis. Something more broad spectrum like piperacillin-tazobactam may be more appropriate. And with her renal dysfunction, you may want to decrease the dose to 2.25 gm IV q6hr

45 Ok you sound like you know what you are talking about. That is what I will write for piperacillin/tazobactam 2.25 gm IV q6hr.

46 Follow-up Is there anything else I can do for you? No - that s it for now! Thanks for your help!

47 Follow-Up Follow-up Follow-through Documentation

48 The Systematic Approach (7 steps) Secure demographics of requestor Obtain background information Determine and categorize the ultimate question Develop a search strategy and conduct a search Perform evaluation, analysis and synthesis Formulate and provide response Conduct follow-up and documentation

49

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