Lecture 2 Flashcards
Systematic Approach
7steps
Step 1: Identify the requestor and establish timeframe
Step 2: Obtain background information and define informational need
Step 3: categorize the ultimate question
step 4: develop and conduct an efficient search strategy
step 5: evaluate, analyze and synthesize relevant literature into a response
step 6: communcation response
step 7: conduct follow up
Step 1: Identify the requestor and establish timeframe
a. Requestor
i. Healthcare professional vs. Consumer
ii. Information should be appropriate for requestor’s level of understanding
b. Timeframe for response
i. Urgency of request
ii. Determine how to deliver response
Step 2: Obtain background information and define informational need
a. Establish context of the question
i. General information vs. patient specific
ii. If patient specific, consider the following:
• patient demographics ex) age, gender, weight, height, race, ethnicity, etc
• health problems or conditions; primary diagnosis
• end organ function
• allergy history
• prescription and OTC medications
b. Determine why the question is being asked
i. Gather as much information as possible
ii. Sufficient backgrounds is definted by the situation
c. Important to have a clear understanding of situation
d. “Real” question being asked may be buried in original question- determine the “ultimate” question
e. Type of questions ask depend on the request - Sample Background Questions/Considerations by Classification Type
• Drug Identification
Where the patient is from?
Has there been an ingestion?
Who wants this information and why do they want the information?
Where did they get the product?
What does the patient believe they are taking it for?
What is the dosage form, color markings, size, etc?
• Pharmacokinetics or Dosing
Patient compliance
Patient’s age and gender
Patient’s weight (fluid overload vs obesity)
Patient’s end-organ function
Concomitant medications/disease states
Nutritional status – What are the patient’s dietary (and alcohol) habits?
Patient’s condition
Previous drug concentrations and timing of the concentrations
Route of administration, dose of the drug, and administration schedule
• Adverse Drug Reaction
Route of administration, dose of drug, diluent, duration of therapy, and administration schedule
A list of all other medications which the patient has taken during the previous 2 weeks
Onset, duration, severity of reaction
Changes in soaps, lotions, perfumes
Changes in diet
Concomitant diseases and other health conditions
Known allergies and their manifestations
• Stability or Compatibility Number of peripheral lines, central lines, etc. Y-sites, IV piggyback, in-line filters Diluents of each medication Type of tubing Suspected contact time of the agents
• Drug-drug Interactions
Description of the interaction – What event(s) suggest that an interaction occurred?
All current medications including dose, route, duration, and sequence of administration
Has the patient received this combination or similar combination in the past?
OTC medications
Patient’s condition and other health problems
Step 3: Categorize the ultimate question
a. Serves to refine and understand the request
b. Also serves to define the scope of the search needed
c. Example classifications below (this is NOT a comprehensive list)
- Adverse Drug Reaction
- Availability/Cost- do you have it in the pharamcy
- Compounding/Stability/ Formulation
- Dosing and Administration
- Drug-drug, Drug-food, Drug-lab Interactions
- Drug Identification
- IV Compatibility/Stability
- Method of Administration- how should i give this
- Natural Products
- Patient Education
- Pediatrics
- Pharmacoeconomics
- Pharmacokinetics
- Pharmacology
- Pregnancy/Lactation
- Special Populations
- Therapeutic Consult
- Toxicology
Practice Question – Select the BEST category for the question below
Q: What dose of oral clonidine is equivalent to the patch form?
dosing and administration
Practice Questions
Which category?
1. What is the dose for Zosyn® (piperacillin/tazobactam)?
dosing and adminstration
Which category?
2. What is this white, oval tablet used for?
drug identification
Select the BEST category for the questions below
- Is Lamictal® (lamotrigine) available as a suspension?
compounding/ stability/ formulation
Select the BEST category for the questions below
- Which antibiotic can be used to treat a sinus infection if the patient is allergic to penicillin?
therapeutic consult
Select the BEST category for the questions below
- Can warfarin and metronidazole be taken together?
drug drug interaction
Step 4: Develop and conduct an efficient search strategy
a. General specific
i. Tertiary Secondary Primary
• Tertiary – provide information that is collected and evaluated from multiple types of references and are organized in a useful way
Examples: texbooks, lexicomp, micromedex, clinical practice guidelines, revew articles
• Secondary – abstracting and indexing services; allow for efficient access to primary literature. Do NOT interpret the primary literature
Examples: pubmed, OVID, cochrane library, IPA
• Primary – introduces new knowledge or enhances existing knowledge on a subject; data are original
Examples: clinical trials, case reports, conference proceedings
ii. Use general knowledge from tertiary references to narrow scope
Step 5: Evaluate, analyze and synthesize relevant literature into a response
a. Apply information to the given situation and synthesize a specific response
b. Questions to consider before formulating a response (Table 2-1)
i. Do you know the requestor’s name, profession, and contact information?
ii. Is the request in reference to a specific patient?
iii. Do you have a clear understanding of the question being asked?
iv. Do you know why the requestor is asking the question?
v. Do you understand the requestor’s expectations?
vi. Do you have enough background?
vii. Do you know the unique circumstances that generated the question?
viii. Do you know when the information is really needed?
ix. Do you know how the problem or situation has been managed to date?
x. Do you have an idea how the information supplied will be used?
xi. Do you know about alternative explanations or management options that have been considered or should be evaluated further?
step 5: c. Critical factors to consider
i. Patient factors • Patient demographics • History of present illness • Past medical and surgical history • Social history • Family history • Allergy history • Prescription and OTC medications • End-organ functions, physical examination, lab test, diagonostic tests ii. Disease factors • Definition • Epidemiology • Etiology • Pathophysiology • Risk factors • clinical findings, diagonosis, treatment and prevention iii. Medication factors • Names • Pharmacology • Pharmacokinetics • Indications • Dosing and administration • adverse effects, toxicity, drug interactions and monitoring parameters iv. Pertinent background information • Setting • Context • Rationale for the question • Unusual or special circumstances • scope of question, limitations of available information, applicability and generalization
Step 5: d analysis
critical assessment of the nature, ment and significance of individual elements, ideas and factors.
Review and evaluation of pertinent information and evidence.
Need to look negative and positive effects
Step 5: e Synthesis
careful, systematic and orderly process of combining or blending vares and diverse elements, ideals or factors into coherent response.
Integrate data from diverse sources
