Information Retrieval CSB420 2019 Student Copy PDF

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STUDENT COPY TUTORIAL CSB420 2019 INFORMATION RETRIEVAL Objectives 1. To access internet sites of government bodies which contribute to ensuring that Australians have access to safe medicines and to ensuring that the quality of use of these medicines is of the highest standards 2. Be aware of the pharmacy-specific databases available on the computer network and to be able to access these databases proficiently 3. To be able to access both the hard copy resources available and the network available resources, and to be able to critically evaluate content, emphasis and the limitations of these resources. 4. Use the pharmacy computer network system in order to locate and access reference databases provided via internet systems and intranet systems. 5. To be able to draw on the variety of sites to be able to make critical decisions with regard to the appropriate dose regimen of a drug, the indications of use of that drug, the appropriate use of that drug in a particular patient, and to critically evaluate the seriousness of listed adverse effects 6. To be able to understand, differentiate and interpret technical language used in the description of drug and disease information. 7. To be aware of available publications and websites which can educate and inform on diseases and their drug therapies.

Essential reading: https://www.nps.org.au/australian-prescriber/articles/where-to-find-information-aboutdrugs

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Required reading: 1. APF current edition: Used to be a compendium of formulae. Now a book of standards and a major source of practical, clinical and pharmacokinetic information. Assists pharmacists in the provision of pharmaceutical services that are intended to promote optimal health outcomes through the Quality Use of Medicines. Hard copy plus CD updated every 2 years 2. Database –AusDi: Comprehensive information about medicines in Australia, including Product Information, Consumer Medicines Information (CMI) leaflets, drug information, indications, independent drug monographs and medicine images via Product Identifier. In addition, the Interactions and Safety feature offers a drug interaction checker to screen for clinically significant drug interactions, duplicate therapy warning and shared adverse effects between drugs. 3. Database-Natural medicines: Evidence based information about dietary supplements, natural medicines, and complementary alternative and integrative therapies. 4. Database- eMIMS: Medicines information including Full Product Information, Abbreviated Product Information, Consumer Medicine information (CMI) and Pill Identifier feature. Includes information for thousands of prescription and some non-prescription medicines in Australia. Potential drug interactions can be checked via the multi-drug interaction feature. 5. AMH current edition: Australian national formulary of independent information on medicines, therapeutic drug choices and treatment considerations relevant to Australia. Information is provided in therapeutic chapters and individual drug monographs, with Practice Points and comparisons between drug classes provided. An essential handbook for health professionals, with a key focus on safe and effective prescribing for Quality Use of Medicines. Hard copy and online version updated every 12 months 6. Database- Therapeutic guidelines: Provides independent and evidence-based recommendations about patient management that have been developed by specialist physicians, general practitioners, pharmacologists and pharmacists. It is an aid to general practitioners in the diagnosis of disease states and the accompanying therapeutic management of those disease states. It is dedicated to deriving guidelines for therapy from the latest world literature. 7. Internet resource - National Prescribing Service Ltd – is a member-based organization providing accurate, balanced, evidence-based information and services to health professionals and the community on Quality Use of Medicines (QUM). It works in partnership with GPs, pharmacists, specialists, other health professionals, Government, pharmaceutical industry, consumer organizations and the community. Independent, nonprofit and funded by the Australian Government Department of Health and Ageing.

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8. Database- LactMed: contains information on drugs and other chemicals to which breastfeeding mothers may be exposed. It includes information on the levels of such substances in breast milk and infant blood, and the possible adverse effects in the nursing infant. Suggested therapeutic alternatives to those drugs are provided, where appropriate. All data are derived from the scientific literature and fully referenced. A peer review panel reviews the data to assure scientific validity and currency. Updated monthly. 9. Database- TGA Prescribing Medicines in Pregnancy: has been developed by medical and scientific experts based on available evidence of risks associated with taking particular medicines while pregnant. This information is presented for the use of health professionals prescribing medicines to pregnant women, rather than for the general public to use. It is general in nature and is not presented as medical advice to health professionals or the public. It is not intended to be used as a substitute for a health professional's advice. 10. Medical dictionary https://medical-dictionary.thefreedictionary.com/

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Important information resource: TGA (Therapeutic Goods Administration) http://www.tga.gov.au/ Safety of Medicines Advisory Committee on the Safety of Medicines (ACM) What is the role of ACM?

What is an adverse event?

Why should we report adverse events to TGA?

How do we report an adverse effect of a medicine?

A customer comes in with a concern about her daughter’s antibiotic liquid. The pharmacist rang her and told her to bring it back to the pharmacy. Can you tell her what the problem is? Where would you look to find the appropriate advice for this customer?

Where would you look to see if there were any product recalls?

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Information Retrieval A vital accompaniment to having a thorough dispensing process is being able to find, understand and apply drug information. The following cases demonstrate these skills utilising commonly available resources. You will be expected to utilise these resources during your preparation and through-out the tutorials/practical exams.

Case ONE Generic drugs and available brands A patient, aged 35 years, presents with a prescription for diazepam, one tablet when required to be taken up to three times a day. Diazepam is a benzodiazepine which can be used to treat anxiety disorders. Diazepam is the generic name of the drug. 

Where would you look to discover what are the brand names of products containing diazepam?

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What does original brand/innovator or patent mean?

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What is a generic medicine?

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Where would you look to discover what forms are available (e.g. tablets, capsules, mixtures)?

Case TWO Dosing information 

Check the recommended dose for diazepam in the treatment of anxiety disorders in the following resources: o APF

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o AMH o AusDi

o Therapeutic Guidelines Psychotropics (Anxiety and associated disorders  Generalised anxiety disorder  Treatment) o eMIMS

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After consulting these resources, what does this tell you about the strengths and weaknesses of these resources with regard to dosing information?

Case THREE Indications of use of drugs 

From all the texts available, what else could this patient be taking diazepam for besides anxiety disorders?

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In the treatment of which conditions has diazepam been registered for use by the TGA for use?

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Case FOUR Adverse drug reactions The patient has heard that the medication may cause drowsiness? What other possible adverse effects may this medication cause? 

What is meant by ‘Common’ in the context of adverse reactions to drug therapies?

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Compare and contrast the amount of information from these texts regarding adverse drug reactions. Check the various texts for adverse drug reactions. o APF: o AMH: o AusDi: o eMIMS:

o Therapeutic Guidelines: Found under “Getting to know your drugs  Psychotropic drugs  Anxiolytics and hypnotics  Benzos”

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Case FIVE Therapeutics The patient is suffering from long term generalised anxiety disorder. What options are available for treatment of this patient? 

AMH:

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APF:

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eTG:

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eMIMS:

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AusDi:

Case SIX Onset of action The patient wants to know how long until the medication will start to work to relieve the anxiety.     

AMH: APF: eTG: eMIMS: AusDi:

Case SEVEN Medications in pregnancy & breastfeeding The patient wants to know if this medication is safe to take if she becomes pregnant. AMH:

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APF:

eTG:

eMIMS:

AusDi: TGA database: She wants to know if she can use this medication when she is breastfeeding.

AMH: APF: eTG: eMIMS: AusDi: LactMed:

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Case EIGHT Drug Interactions The patient suffers from allergies and has been recommended by a friend to take promethazine tablets. Are there any concerns with this combination?

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AMH:

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eMIMS:

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AusDi:

Case NINE The patient has found and taken a capsule she found in her bathroom draw. She has felt very sick since taking it and wants to know what it was.

Case TEN The patient has heard that Valerian is good for anxiety and wants to know if it would be suitable for her. APF: AusDi: Natural Medicines: 10

Case ELEVEN Checking doses and ingredients A mother comes to the pharmacy with her three year old (14kg) daughter requesting Panadol (paracetamol) in liquid form for the treatment of pain associated with earache. The child is also gluten intolerant.

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Utilise the information resources to recommend the most appropriate product and a dose. (e.g. how many mls and how often). Hint: see APF for recommendations re; paracetamol dosing in children

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How could you ascertain which products are gluten free and therefore appropriate for this child?

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Some useful publications and websites 1. NATIONAL PRESCRIBING SERVICE An independent, non-profit organization for Quality Use of Medicines, funded by the Australian Government Department of Health and Ageing

a. Australian Prescriber: Find this publication:- Aust Prescr 2015;38:152-55 https://www.nps.org.au/assets/f8fb3e6b3e9ec175-e71ef9258855benzodiazepine-misuse_138-5.pdf

Management of benzodiazepine misuse and dependence The patient has heard that people can get addicted to diazepam. She wants to know if this is true, how to prevent it and what symptoms of withdrawal to look out for.

b. NPS Health News and Evidence: Find this publication:- Managing benzodiazepine dependence in primary care https://www.nps.org.au/news/managing-benzodiazepine-dependence-inprimary-care

c. NPS MedicineWise website Look medication for consumer that empowers them to take control of their potential problem. Risks of sleeping pills and older people https://www.nps.org.au/news/sleeping-pills-and-older-people-the-risks

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