Midterm Content Flashcards
What are the 7 steps in handling Drug Information Requests?
- Secure requester demographics
- Obtain necessary background information
- Determine and categorize the ultimate question
- Develop a strategy and conduct systematic search
- Perform evaluation, analysis and synthesis of information
- Formulate and provide a response
- Conduct follow-up and documentation
If a DI request is about a specific patient, what information should you obtain?
- patient name, weight, age, sex
- medical history
- major organ functions
- drug history
- history of allergy or adverse reactions
Where should the search of external information start for a DI request?
Tertiary sources first, then secondary, then primary
What should be included in a written response to a patient concerning a DI request?
- Summary of request and background information
- Response; clarify any terminology and include any inadequacies in findings in the literature
- Conclusion; summarize information and answer the request
- REFERENCES
What are the four steps in investigating drug information requests?
- Understand the diagnosis
- Understand the medication
- Understand patient specifics
- Tackle DI request
What are the desired characteristics of a response to a DI request?
- Timely
- Current
- Complete
- Concise
- Supported by the best available evidence
- Well-referenced
Should you report small effect sizes to patients when giving them a response to a DI question?
Yes, even small effect sizes are necessary information to give to a patient. If there was a surgery with a 97% rate but a 3% rate of major complications, depending on the patient they may make a different decision based on these results
Why is it important to document any DI request, no matter the severity?
- Allows coworkers to facilitate care if you are away
- Allows you to remember other options when “plan A” doesn’t work
- Allows you to remember the case if there is a follow-up later on
- Legal liability
What are the four aspects of a research study that define what method was used and their associated pros and cons?
- Nature of Research - Descriptive vs Explanatory
- Time frame of research - Retrospective/cross-sectional/prospective
- Investigator approach - Observational/experimental
- Type of Data - Quantitative/Qualitative
Define Administration
The giving of a therapeutic agent to a patient
Define Adverse Reaction
Any undesirable or unwanted consequence of a preventative, diagnostic, or therapeutic procedure or regimen
Define Compatibility
Able to be safely mixed, as in the case of blood for transfusion or drugs for simultaneous administration
Define Cross-sectional reserach
- captures data at a single point in time
- useful for determining the prevalence of current rug exposure or health behaviour in a population
Define Drug Information
Integration of locating, analyzing, applying and communicating information concerning drugs, usually for use by the person in a decision making role in patient management
Define Experimental Research
Investigator controls exposures that may influence an outcome of interest. Has 4 components:
- Manipulation by investigator
- Control
- Random assignment
- Random selection
Define Explanatory research
Research meant to explain rather than describe a phenomena
Define Observational research
Investigator does not influence the exposures but tracks their natural course/progression
Define Pharmacodynamics
The study of how a drug acts on a living organism, including the pharmacological response and duration and magnitude of response observed relative to the concentration of the drug at an active site in the organism
Define Pharmacokinetics
The study of action of drugs within the body which can be envisioned more accurately as the actions of the body on an administered drug; includes mechanisms of drug absorption, distribution, metabolism, excretion, onset of action and duration of effect
Define pharmacology
Field studying the characteristics, effects and uses of drugs and their interactions with living organisms
Define Pilot
Small-scale preliminary studies to see if an intervention is feasible or worthwhile to do a full study on; not designed to draw conclusions from
What are some pros and cons of a prospective time frame in a study?
Pro: investigator controls quantity/quality of data
Con: more expensive and more time consuming
Define quasi-Experimental research
Looks like experimental research but it does not randomly assign subjects to a group
What are some pros and cons to a retrospective time frame in a study?
Pros: quick and inexpensive
Cons: cannot control the quality of data collected
What is the difference between internal and external evience?
Internal - knowledge acquired from formal education and training
External - accessible information from research
What are the 6 steps in the evidence based decision making approach?
- Transformation of a clinical problem into smaller part questions to investigate
- Answer the questions based only on internal evidence
- Find external evidence to answer the question
- Critically appraise the external evidence
- Integrate internal and external evidence
- Evaluate decision making process by considering the process and outcome as opportunities for improvement
What is GeriMedRisk?
Consultation and education service that connects HCPs to an interdisciplinary team of geriatric specialists; focuses on medication, physical, and mental health optimization for older adults
Who might be involved in an eConsult from GeriMedRisk/what is the interdisciplinary team made up of?
- geriatric pharmacy
- geriatric psychiatry
- geriatric medicine
- clinical pharmacology
What is the role of the pharmacist at GeriMedRisk?
- triage consults, coordinate and contribute to recommendations from the team
- provide recommendations on pharmacotherapy
- answer DI requests
- making DI documents to support education
- contribute to research projects
Define Primary literature
Original source of information; authors design their own research study and report on the results collected from their experiment or discovery
What are some strengths and limitations of primary literature?
Strengths:
- cutting edge research
- could be the only source of information on a new drug/rare diseases
Limitations:
- possible flaws in study methodology
- critical appraisal is necessary
- new information means it may take time before wide acceptance occurs in the medical community
Define secondary literature
Describes and interprets, evaluates or analyzes information reported by researchers in the primary literature
Examples: review articles, systematic reviews
What are some of the strengths and limitations of secondary literature?
Strengths:
- many primary resources consulted to write one article on a topic
- aims to collect many/all primary research studies on a given topic
- saves time
Limitations:
- need to examine sources included
- search strategy description and process may be weak
Define tertiary literature
Summarize information from the primary literature and secondary literature
Examples: textbooks, encyclopedias, compendiums, handbooks
What are some strengths and limitations of tertiary literature?
Strengths:
- quick access to primary and secondary literature
- good for getting background info
- easy to use
Limitations:
- chapter length may limit in-depth discussion
- may not be most current (excluding drug databases)
- hard to see if authors used the ‘right’ sources and whether or not they appraised their literature
When would be an appropriate time to consult secondary and primary literature?
New and emerging topics; no consensus among experts; conflicting evidence; question requires further study
What is a systematic review and what is the quality level of this evidence?
A thorough search of the literature, screening of studies to see if they are similar enough to compare and then vigorous analysis and appraisal of individual studies
–> highest level of evidence
What is a randomized control trial?
Experimental study design introducing an intervention to modify course of disease
–> patients are randomly assigned to an intervention or control group and then followed forwards
What is a cohort study?
Patients with a specific exposure are followed forward in time and compared to a similar group which has not been effected by the exposure
What is a case control study?
Patients with and without a specific condition are compared by the researchers to identify which exposures have contributed to the condition
“Looking back”
What is a case series/report?
Collections or reports/report on the diagnosis, treatment and follow up on a small group of patients or single patient
–> useful for calling attention to an unusual association, adverse event or a rare disease
What falls on the bottom of the evidence pyramid?
Editorials/opinion pieces and animal research
What is Dr. David Sackett known for?
Being a pioneer of evidence based practice; he wrote articles on the critical appraisal of research for the Canadian Medical Association Journal (CMAJ)
Define Evidence based practice according to Sackett
Conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients while integrating individual clinical expertise with the best available external clinical evidence from a systematic source
Define evidence based practice according to Carnwell
Systematic search for and appraisal of the best evidence in order to make a clinical decision that might require changes in current practice while taking into account the individual needs of the patient
What is the significance of Johns Hopkins and Ellen Roche
Ellen Roche was a test subject who was killed because of a lethal dose of hexamethonium. Johns Hopkins missed some of the literature that indicated this amount of the chemical would injure the lungs during his research.
What does PICO stand for?
P = population/patient/problem I = intervention C = comparison/control O = outcome
What does the AND function do as an operator?
AND = search results must contain all of the terms
What does the OR function do as an operator?
OR = search results must contain at least one of the terms
**terms connected with OR must always be in paretheses
What might happen in a PubMed search if OR is not capatalized?
May be changed to ANDs
What is the core, international database for health research?
PubMed
What is IPA?
IPA = International Pharmaceutical Abstracts
- -> only research database specializing in pharmacy related literature
- -> international
What types of literature can you find in IPA?
- drug therapy
- toxicity
- Pharmacokinetics
- pharmacy practice
- pharmaceutics
- legislation
- ethics
In IPA, should you use the basic or advanced search function?
ALWAYS use advanced search
How does the adjacency operator work and what is it used for?
Type: first word adj_ (synonym OR synonym)
In the _, you put the number of words that can be between the first word and the following synonyms
Works from 1 to 99
Takes into account different phrasings of the words
What does Embase contain and why would you search this database?
Covers biomedicine and pharmacology in European literature
Search here if PubMed and IPA don’t yield results
What can you find on the Cochrane Library?
Collection of systematic reviews and randomized control trials
There is a separate tab for trials although it’s not super helpful and the entries don’t give a lot of information and are sometimes incomplete
Define Scholarly information; include author, writing style and intended audience.
Scholarly information:
- IS PEER REVIEWED
- includes details of the author; scholar with a high level of education in their area of specialization (bibliography, credentials and institutional affiliation)
- written with discipline-specific terminology and is 10-35 pages in length
- Intended audience includes students, researchers, professionals and academics
- bibliography or reference list showing details of works the author referred to in the article
How does peer review work?
- Researcher submits article to journal for publication
- Journal editor screens the paper; acceptable papers are passed to a committee of experts in the field who review it
- Committee looks for originality, added value, quality, reproducibility, study design, biases
- Decide whether to accept, reject or revise
What 5 things can you find in google scholar?
- Book chapters
- Theses
- Journal articles
- Conference presentations
- Reports
What are the pros and cons of Google Scholar?
Pros:
- good starting point for research
- good for finding grey literature
Cons:
- MASSIVE amounts of results
- unclear definition of scholarly research
- searches limited to 32 words or less
- search results not reproducible
- updating schedule is unknown
When should you use Google Scholar?
- quick background search on a specific topic
- when you now the title of the paper needed
- quick overview of works by a particular author
What is grey literature and who produces it?
Literature that is not published in a book or journal
Produced by government, academics, business and industry
**CPA is grey literature, conference posters are grey literature
What is a pre-print and what databases can you find it?
Early version of a research article published before peer review
- published electronically in pre-print database (MedRxiv)
- institutional databases (UWspace)
- Clinical trial websites (clinicaltrials.gov)
- search engines (Google Scholar; no way to limit to only grey)
What are some strengths and limitations of grey literature?
Strengths:
- unique info not found elsewhere
- compliments published literature; fills in gaps and reports on negative results
- freely available and timely
- good source for data/statistics
Limitations:
- disorganized
- time consuming search
- publications might be biased
- lack of peer review
What is predatory research?
Prioritizes self-interest at the expense of scholarship and characterized by:
- false/misleading information,
- deviation from best editorial/publication practices
- lack of transparency
- use of aggressive and indiscriminate solicitation practices
How can you spot a predatory conference?
- not organized by scholarly societies
- fast acceptance of submissions ~1 week
- higher registration fee than usual
- lack of program diversity
- connections to predatory publishers
- usually marketed as a holiday rather than academic opportunity
What is the usual amount of time that takes for an article to be peer reviewed?
Usually 7 weeks, if there is a publisher that is advertising 1 day- 1 week peer review time this is a red flag
What does RADAR stand for?
RADAR is a tool to appraise literature
R - Relevance A - Authority D - Date A - Accuracy R - Reason
Where can you find the most reliable, comprehensive and evidence based resource about natural medicines?
Natural Medicines
What information is included on a drug monograph from Natural Medicines?
- safety
- effectiveness
- interactions with drugs
- adverse effects
What is found in “Databases” on Natural Medicines?
- Food/herbs/supplements monographs
- Health and wellness
- Sports medicine
- Comparative effectiveness
- Manufacturer/commercial product information
- Fixed Herbal combinations (Chinese herbal combinations)
What two types of evidence are considered level A on Natural medicines?
RCT and meta-analyses/quantitative systematic review (high quality)
What level of evidence is an expert opinion considered on Natural medicines?
C
What can you find on the Licensed Natural Health Products Database?
Licensed products:
- medicinal and non-medicinal ingredients
- dosage form
- recommended use or purpose
- risks/known adverse reactions
What books can you find on the CPS online?
- CTC (compendium of therapeutic choices)
- CTMA (Compendium of therapeutics for minor ailments)
- CPMA (Compendium of products for minor ailments)
What does the CPS contain?
- pill identification
- interaction checker
- drug administration and food
- calculators/dosing tools
- updates and advisories
- public drug programs
- medical abbreviations
- patient handouts
What is Lexicomp?
Collection of databases, clinical decision support tools & electronic books
–> includes American and Canadian brand names
What can you find on Lexicomp?
- drug interactions
- patient handouts
- calculators
- IV compatibility
- pill identification
What is AHFS essentials?
patient counselling information and talking points
Why would you use Lexicomp?
- detailed drug information for specific populations
- off-label uses
- checking interactions
- pharmacogenomics
- international drugs
- pronunciation feature
- drugs associated with allergic reactions
What is MicroMedex?
Unbiased, referenced information about drugs, diseases, toxicology, alternative medicines —> compiled by editorial board of healthcare practitioners
- -> American and Canadian brand names included
- -> able to search more than one search term
What is one of the drawbacks of LexiComp?
unable to type more than one word into the search bar
Why would you use MicroMedex?
- Drug comparison tool; side by side comparison of efficacy, dosing, contraindications, and adverse effects
- detailed pharmacokinetics info
- interactions are more extensive than Lexicomp
- “do not confuse” drug list
- reproductive risk information
- CareNotes patient handouts
- 5 mobile apps
What is RxFiles?
Evidence based treatment overviews and comparative drug information on the optimal selection and use of medications
–> Canadian
What is contained in RxFiles?
- trial summaries
- GeriRxFiles for long term care and older adults
- Q&A summaries
What is the DPD and what does it contain?
Health Canadas DPD = Drug product database
Contains drugs approved for use in Canada; human, veterinary, radiopharmaceuticals, disinfectant products
- -> also all discontinued products
- -> monographs not found in the CPS
***updated nightly
What is UpToDate?
Provides comprehensive overviews of diseases and conditions; broad coverage of adult primary care, internal medicine, ob/gyn, general surgery and pediatrics
***Drug information is integrated from Lexicomp, if you’re looking for DI just go there
What is Pharmacist’s Letter Canada?
Unbiased evidence and recommendations on new developments in drug therapy conveyed in a monthly newsletter; concise updates and advice
*promotes continuing education for pharmacists
What can you find in veterinary medicine resources?
- calculating drug doses
- instructions for use
- mechanism of action
- compounding formulations
- precautionary information
- monitoring
- drugs for common infections
