Major Online Drug Information Resources

by Cindy Schmidt, M.D., M.L.S.

Created July 2014

Revised June 2019

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Instructions:

• Do not use Internet Explorer to work on this tutorial.  Instead, open Firefox or another browser and go to

http://list.unmc.edu/gots/tutorial/onlinedruginfo

• Clicking the "Single page view" link at the top of the instruction screen (blue arrow in the screenshot below) will produce a transcript of the entire tutorial.

• If you want to skip between distant parts of the tutorial, you can use the "Menu/Contents" button next to the tutorial title (red arrow in the screenshot above) to show the tutorial's "Table of Contents."

• If you find that the menu/contents panel is jittering or frozen, right click on the instruction panel header and select the "reload" or "refresh" option. The menu should begin to work.

Assignment Instructions

• Please record your answers to the tutorial questions in a Word document or on a sheet of paper (after considering and making any changes based on the tutorial feedback).

• After completing the tutorial, you will submit the answers to the tutorial questions through a Canvas quiz.

Objectives

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All of the online, drug information resources licensed by the McGoogan library provide drug monographs.  Each monograph summarizes the most important information concerning a drug. 

While providing much of the same information, each of the resources has specific strengths and/or provides tools that make it valuable.

Objectives

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When you have completed this tutorial, you will have used some of these unique tools.  Specifically, you will:

• know how to create a custom IV compatibility report
• know how to create a custom drug interaction report in consumer-oriented language
• know how to create a custom adverse effect report
• know how to find drug price information

Introducing Mrs. Dilworth

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For the purposes of this tutorial, pretend that you are a fourth year pharmacy student completing a critical care rotation.  

Your clinical team is caring for Mrs. Jill Dilworth, a 60 year-old female.  Mrs. Dilworth has just been admitted with peritonitis (inflammation of the lining of the abdominal cavity) and septic shock (low blood pressure and high pulse related to severe infection).  The team is worried that circulatory collapse is imminent.

Introducing Mrs. Dilworth

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The third-year medical resident wants to treat Mrs. Dilworth

a.  with two antibiotics--

clindamycin phosphate

--and--

aztreonam

b.  as an admixture

c.  diluted in either --

dextran 40/10% normal saline solution

--OR in--

normal Saline.

Will this admixture be compatible?

Which resource will you use to address this question?

Introducing Mrs. Dilworth

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A table summarizing the features of the major, online drug information resources available through the McGoogan Library is shown in the window to the right.

IV Compatibility Reports

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Click here to open McGoogan Library's homepage in the window to the right.  You may have to scroll to the right to see the buttons on the right-hand side of the Library's homepage.

• Click on the "Drug Resources" button.

• Click on the "LexiComp/LexiDrugs via LexiComp" link.

IV Compatibility Reports

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• You may be asked to login with your UNMC netID (your UNMC e-mail username and password)

• The web browser may tell you the website isn't trusted.  Go ahead and click buttons/links as necessary to tell the browser that you understand the risks and want to continue or confirm a security exception.

IV Compatibility Reports

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After you reach the LexiComp homepage,

• click "Continue" to allow use of cookies during your LexiComp session (if asked)

• click on the "Trissel's IV Compatibility" button. 

 

IV Compatibility Reports

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You want information on the compatibility of the drugs --

aztreonam

clindamycin phosphate

• Enter the first drug name in the "Search IV Drugs" box.
• Hit the "enter" button on your keyboard or click on the "Add" button. 
• Enter and add the second drug. 

Although you are interested in diluting the drugs in specific solutions, you do not need to enter the solution names here.  Entering solutions names here is really only useful if you want information about the solubility of a single drug in a particular solution.

• When you have added both drug names to the box on the left, click the "Analyze" button at the lower-left.

IV Compatibility Reports

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A "Compatibility Chart" will appear.  Note the definitions of the icons that appear at the upper left of this chart.

• Click on the link to the "Admixture" information to get further details on the different admixture concentrations and diluents that have been tested.

IV Compatibility Reports

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The third-year resident wants to use 10 mg/ml aztreonam and 3 mg/ml Clindamycin Phosphate. Find the entries for these concentrations.

He wants to deliver these drug concentrations either in-- 

Dextran 40 /10% normal saline

(note:dextran and dextrose are not the same thing)

-- or in --

normal saline.

Have the desired drug concentrations been tested for compatibility in either of these solutions?

 

IV Compatibility Reports

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The resident wants you to show him the journal article that reported the results of the compatibility testing.

When you find the line for 10 mg/ml aztreonam and 3 mg/ml Clindamycin Phosphate in one of the desired solutions, click on either the "Study" link or the "Compatible" link for that combination.  You will be taken to more details about the compatibility test.

IV Compatibility Reports

8 of 15Look at the citation information. Find the name of the journal that published the study.

IV Compatibility Reports

9 of 15If you're not used to reading journal article citations, the information below will help. Read it and then answer the question on the next page. 

If you're used to reading journal article citations, you can skip to the next page.

Here's another citation in the same style as the citation you're viewing.

Marble DA, Bosso JA, Townsend RJ, "Stability of clindamycin phosphate with aztreonam, ceftazidime sodium, ceftriaxone sodium, or piperacillin sodium in two intravenous solutions", Am J Hosp Pharm, 1986; Volume 43:pp. 1732-6.

• The authors names are listed first (Marble DA, Bosso JA, Townsend RJ).

• In this citation style, the article title is listed next ("Stability of clindamycin phosphate with aztreonam, ceftazidime sodium, ceftriaxone sodium, or piperacillin sodium in two intravenous solutions"). Some, but not all, citation styles enclose article titles in quotes.

• The journal title or an abbreviation for the journal title is listed next (Am J Hosp Pharm). Some, but not all, citation styles italicize journal titles.

• The journal title is followed, in this style, by the publication year (1986).

• This citation style indicates which numbers are volume and page numbers. This is unusual. A more usual format is --

43(7):1732-6.

-- where the volume number is 43, the issue number is 7 (often the July issue), and the page numbers are 1732 - 1736.

IV Compatibility Reports

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IV Compatibility Reports

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It's always best to check at least two sources when answering a clinical question.  What if a typing error appears in one of the resources?

Clinical Pharmacology is the other UNMC-licensed resource that provides a custom, IV compatibility report tool.

To access Clinical Pharmacology:

• Click here to return to the Library's homepage

• Scroll to the right if needed to reach and click the "Drug Resources" button.

• Click on the "Clinical Pharmacology" link.

IV Compatibility Reports

12 of 15To double-check the IV compatibility of aztreonam and clindamycin in admixture:

• Click on the "IV Compatibility" link

• Search for the two antibiotics, aztreonam and clindamycin, one at a time.
• Click the relevant option after each search.

IV Compatibility Reports

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• When both drugs are present in the "Drug List" on the left, click the "Run Report" button.

 

IV Compatibility Reports

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• Since, Mrs. Dilworth's physicians want to infuse the drugs in an admixture, look at the icons in the "Admixture" table        

Check the "Legend" at the lower left for icon definitions.   

IV Compatibility Reports

15 of 15If you want to determine which diluents have been tested :

• Click on a "C" icon in the "Admixture" table.
• A pop-up box will appear.
• Clinical Pharmacology will show one tested dose/diluent combination at a time.  If there are 10 tested combinations, you will have to click on the arrow at the upper right of the pop-up to move from "1 of 10" to "2 of 10", etc.

Update on Mrs. Dilworth

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Mrs. Dilworth is given aztreonam and clindamycin within 30 minutes of her admission to the ER.

Just two hours after admission, she is recovering from successful surgery to remove an abscessed appendix.

Mrs. Dilworth tells you that she has bipolar disorder (manic-depressive disorder). She says that she was a bit manic during the week prior to admission.  The mild mania may have made it easier to ignore some mild symptoms of appendicitis. She had stopped taking risperidone because of the high cost. Her health insurance only covers a small part of the cost of risperidone. 

Mrs. Dilworth's nurses are concerned about her current mental state.  Mrs. Dilworth seems quite manic to them, and they're worried that she may decide that she doesn't need her IV's or may decide to leave the hospital before she has adequately recovered.

Update on Mrs. Dilworth

2 of 2Please, click this link to open the table summarizing the features of the major, online drug information resources available through the McGoogan Library. Adjust the position of the new window so that you can still see the tutorial instruction screen.

Drug Prices

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The third-year resident orders risperidone for Mrs. Dilworth. You wonder how much risperidone actually costs.

Drug price information is available from Lexi-Drugs.

(To remember this think of Lexi-Drug$.)

• Click here to return to Lexi-Comp.  

Drug Prices

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• Enter --

risperidone

-- in the Lexi-Comp search box.

• To find price information, click the link to the Lexi-Drugs' "RisperiDONE" monograph (red arrow in figure below).

Drug Prices

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• Look at the navigation panel on the left.  Initially, the entry for "pricing US" is hidden. 

• Click the arrow next-to "Preparations."

• Click the "Pricing US" link that appears.

 

Another Update on Mrs. Dilworth

After Mrs. Dilworth regained consciousness, she began to complain of nausea.  Ondansetron administered by IV push through a separate IV line was prescribed for the nausea. Ondansetron is an anti-emetic/anti-nausea drug.

A day after odansetron administration was initiated Mrs. Dilworth begins to complain of severe itching (pruritus).  The clinical team asks you whether the pruritus could be an adverse effect of one or more of Mrs. Dilworth's medications.

Which resource provides a custom adverse effects report tool?

Custom Adverse Reaction Reports

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Please, click this link  to open the table summarizing the features of the major, online drug information resources available through the McGoogan Library. Adjust the position of the new window so that you can still see the tutorial instruction screen.

Custom Adverse Reaction Reports

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To remember that Clinical Pharmacology provides custom, adverse reaction reports, think of this:

Custom Adverse Reaction Reports

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To access Clinical Pharmacology:

• Click here to return to the Library's homepage

• Scroll to the right if needed to reach and click the "Drug Resources" button.

• Click on the "Clinical Pharmacology"  link.

Custom Adverse Reaction Reports

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To create the "Adverse Reaction" report that you need:

• Use Clinical Pharmacology's "Reports" menu to select the "Adverse Reaction" report tool

Custom Adverse Reaction Reports

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• Enter Mrs. Dilworth's medications (one-by-one) into the "Search for drug..." box.   Mrs. Dilworth's medications include:

aztreonam

clindamycin

risperidone

ondansetron

• After entering a drug's name, hit the keyboard "enter" key or click the name of the appropriate drug in the list that appears below the search box (see red arrow in figure below).

Custom Adverse Reaction Reports

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• After you have added all the drug names to the "Drug list", click on the circle in front of "By frequency"

• Click the "Run report" button.

 

Custom Adverse Reaction Reports

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• When the report appears, find the entry for -- 

pruritus

Custom Adverse Reaction Reports

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While three of the drugs the patient is receiving might cause the itching,  the fact that the itching started soon after initiation of the ondansetron makes you suspect that the ondansetron is responsible in this patient.   Also, the fact that Mrs. Dilworth has been taking risperidone for a long time makes this medication a less likely culprit.

One of the team members asks whether systemic clindamycin causes itching or whether this adverse effect is only seen after topical administration.

• Click on the "clindamycin" link next to "pruritus."

A Third Update on Mrs. Dilworth

By the third hospital day, Mrs. Dilworth is receiving --

aztreonam (an antibiotic)
clindamycin phosphate (an antibiotic)
ondansetron (an anti-emetic/anti-nausea drug),
risperidone (an anti-psychotic drug given to this patient because of her history of bipolar disease ),
and
loratadine (for itching).

The patient has a fainting episode and an EKG is ordered. Heart beat irregularities are noted on the EKG.  The patient team wonders whether a drug interaction might be causing the heart beat irregularity.

Drug Interaction Reports

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Please, click this link to open the table summarizing the features of the major, online drug information resources available through the McGoogan Library. Adjust the position of the new window so that you can still see the tutorial instruction screen.

Drug Interaction Reports

2 of 6Lexi-Comp and Clinical Pharmacology contain custom "drug interaction report" tools.  However, only Clinical Pharmacology can produce these reports in either consumer-oriented or professional-level language. The LexiComp "drug interaction report" tool only produces professional-level reports.

 

To remember that Clinical Pharmacology provides custom consumer-level interaction and adverse reaction reports, think of

Drug Interaction Reports

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• If you've left Clinical Pharmacology, click here.
• Use Clinical Pharmacology's "Reports" menu to select the "drug interaction Report" option.

Drug Interaction Reports

4 of 6Enter Mrs. Dilworth's medications (one-by-one) into the "search for drug..." box. Mrs. Dilworth's medications include:

aztreonam (solution for injection)

clindamycin phosphate (solution for injection)

risperidone (oral tablet)

ondansetron hydrochoride (solution for injection)

loratadine (oral tablet)

• After entering a drug's name, click the relevant option or hit the keyboard's "enter" key

 

Drug Interaction Reports

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• When the drug list is complete, select the "consumer" option.

• Hit the "run report" button.

You can change the options (e.g. consumer vs. professional)  later by clicking the desired option and hitting the "Run Report" button again.

 

Drug Interaction Reports

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Pearls of Information

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A member of Mrs. Dilworth's physician team visits her to let her know that they are going to discontinue the ondansetron.  At the time of this visit he notices that she seems a bit jaundiced (the whites of her eyes are slightly yellow).  He begins investigating what might be causing the mild jaundice. 

An adverse reaction report in Clinical Pharmacology shows that all of Mrs. Dilworth's meds except ondansetron can be associated with jaundice.  However, Mrs. Dilworth's liver tests and jaundice have actually decreased by the next day.  Mrs. Dilworth's resident asks if its possible that the discontinued ondansetron might have been causing the slight jaundice. 

Please, click this link to open the table summarizing the features of the major, online drug information resources available through the McGoogan Library.

 

Pearls of Information

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It my help you remember that AHFS DI can provide pearls of information if you remember the graphic shown below.

Pearls of Information

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To reach the electronic version of the  AHFS DI:

• Click here to open McGoogan Library's homepage in the window to the right. 

You may have to scroll to the right to see the buttons on the right-hand side of the Library's homepage.

• Click on the "Drug Resources" button.

• Click on the "AHFS Drug Information via LexiComp" link.

Pearls of Information

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To find the AHFS DI "Ondansetron" monograph:

• Search LexiComp for -

Ondansetron

• Find the "AHFS DI (Adult and Pediatric)" heading

• Click on the subjacent "Ondansetron Hydrochloride" link

 

Pearls of Information

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To look for any mention of jaundice:

• Click the AHFS DI window.

• Click Ctl-f (Windows) or Command-f (Mac) to open a "Find" box. 

• Type in --

Jaundice

• Click the "Ref" link next to the word "jaundice"

• Note that the reference shown in the "Reference" pop-up box is a conference abstract, a source type rarely cited in the other drug information resources.

AHFS DI frequently cites conference abstracts and personal communications and, thus, provides information that is not available through other sources.

Conclusion

Points to remember:

1.  Clinical Pharmacology and LexiComp (via LexiComp or via UpToDate) are the only two resources UNMC provides that include custom report tools.

2. Both Clinical Pharmacology and LexiComp via LexiComp include I.V. Compatibility report tools

3.  Both Clinical Pharmacology and LexiComp include Drug Interaction report tools, but only Clinical Pharmacology can provide interaction reports in consumer language.

4.  Only Clinical Pharmacology includes a custom adverse reactions report tool.

5. LexiDrugs provides price information

Think: LexiDrug$

6. AHFS Drug Information provides very thorough monographs that often reference conference abstracts and personal communications. -- these may provide pearls of info not available elsewhere.

Assignment

If you completed this tutorial as part of PHPR 562 (Introduction to Drug Information), please,

• enter the answers to this tutorial's questions in the Canvas-based quiz available through the "Major Online Drug Information Resources Tutorial Assignment" in "week 1"
• complete the last two assignments for week 1 (don't worry most students complete these two relatively quickly) . 

 

Certificate

Please enter your name and email address to retrieve a copy of your completed quiz.

You can enter multiple email addresses separated by commas. If you are doing this for a class, you may need to enter your instructor's email address also.

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