Drug lit midterm (exam 1) - EBM Flashcards

Question

Identifying search terms from a PICO question

Answer 1

Each component (P – I – C – O) can serve as a search term Generally start with P (diseasestate) and I Add C if specific to case at hand Add O if needed to narrow search

Answer 2

Is lisinopril better at protecting the kidneys than HCTZ in elderly people with DM2 What term(s) will we start with? - DM2, Lisinopril, HCTZ What term(s) can help narrow the search? - protecting the kidneys What term(s) can help us include or eliminate articles? - protecting kidneys, elderly

Answer 3

valid applicable can we apply it to the patient

Answer 4

The “So What?” test What outcomes were evaluated? What was the magnitude of the benefit? The number needed to treat (NNT) / Number needed to harm (NNH) Relative risk reduction vs. absolute risk reduction How will this change my practice?

Answer 5

Are the study participants similar to your patients? - Demographics - Level of risk What is the patient’s perspective and preference? - Values - Cultural norms - Costs

Answer 6

Disease-Oriented Evidence (DOE) - does the drug reduce BP or cholesterol, did the drug change a marker for disease Patient-Oriented Evidence (POE) - what patients care about

Answer 7

Evaluates the effectiveness of interventions that clinicians and patients care about DOE - Statins down cholesterol Statins down CV mortality/morbidity POEM - statins down overal mortality

Answer 8

DOE Vitamin E is a powerful antioxidant HRT (down) LDL and (up) HDL Erythropoietin increases Hgb in patients with cancer POE Vitamin E _does not prevent____________ CV disease or cancer HRT _raises risk of______ stroke and breast cancer Erythropoietin __increases mortality___________ in cancer patients

Answer 9

1- Does the primary outcome of the study address an outcome patients care about? 2- Is the intervention feasible? 3- Will the information require you to change practice? If yes to all 3 = POEM

Answer 10

A - talks about how the epithelial cells work which patients do not care about B - patients care about not having stroke

Answer 11

B is better because it focuses on what the patient cares about

Answer 12

can it be applied to the patient?

Answer 13

the doctor is right, I don't know your values but if they are abnormal then lisinopril will help you

Answer 14

Levels of interactions - Clinicians - Researchers - Professional organizations - Journals - Continuing education (CE) - Direct-to-consumer advertising

Answer 15

JNC V (1993) recommendations vs. actual practice Survey of 35,000 retail pharmacies (62% of US) for 1992 and 1995:

Answer 16

Most studies have shown that physicians do not believe that interactions with sales representatives impact prescribing Receipt of a higher number of gifts associated with the belief that there was no impact on prescribing Drug samples lead to higher brand-name prescriptions Sponsored lectures/symposia lead to prescribing without sufficient evidence

Answer 17

Purdue Pharma - Funded > 20,000 educational programs - Provided financial support for the American Pain Society - Salesforce provided doctors with merchandise they are addicted to drugs now :(

Answer 18

Code on Interactions with Healthcare - - Professionals (HCP) - Developed by PhRMA - Implemented in 2002, updated in 2009 - Limits on interactions with HCP Centers for Medicare & Medicaid Services (CMS) Open Payments Database - System to track physicians that receive payment from a pharmaceutical company

Answer 19

Comparison of prescribing in US academic medical centers with restrictions on sales representatives vs. those without Hospitals in 5 states evaluated (CA, IL, MA, PA, NY) Drugs in 8 classes were evaluated Analyzed > 1.6 million prescriptions written by > 2000 physicians Stricter policies led to modest by significant changes in prescribing

Answer 20

FDA Requirements - Accurate, truthful, and not misleading - Reflect balance between harms and benefits - Make claims only supported by appropriate evidence - Be consistent with FDA-approved labeling PhRMA Requirements - Educate patients about treatment options - Increase awareness about diseases - Motivate patients to consult their doctors - Increase the likelihood that patients will receive appropriate care - Encourage compliance with prescription drug treatment regimens

Answer 21

What do you notice in this advertisement? in the fine print: 1/2 of the patients lived 12 months compared to 9 months

Answer 22

the transfusion increased survival by 1 day

Answer 23

A sales representative tells you that Fosamax reduces the risk of hip fractures by 51% Is this true? - yes

Answer 24

Balancing your information PUSH - Receiving information from various sources on various topics - Extracting what we think we need for our practice PULL - Seeking informationto answer a specificquestion

Answer 25

Scour primary resources more completely than you could do on your own Utilize available data to answer questions Identify a variety of clinical information - Clinical practice guidelines - Patient education - Systematic reviews

Answer 26

MCPHS Library A-Z Databases - Change “All Subjects” to “Evidence-Based Practice” Partial list - DynaMed - Cochrane Library - TRIP Database - EBM Reviews - Pharmacist’s Letter

Answer 27

EBM is a life long learning process - Founded on problem-based learning - Converting information needs into focused questions - Utilizing web-based resources to generate evidence - Critical appraisal of the facts - Apply your conclusions to your patients