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

Published December 2015

Updated July 2019

 

You should complete the first, second, third, fourth, and fifth episodes of this tutorial miniseries before beginning this sixth episode.

 

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Sarah: case recap

Skip to the next screen if you don't need a recap.

It's now a half week after your appointment with Sarah and a week after her first appointment with her primary care practitioner. Sarah Pilger is now at 25 weeks gestation. Sarah's blood work shows a recent toxoplasmosis infection and the ultrasound shows evidence of fetal infection: placental thickening, ascites, and in the brain - mild ventriculmegaly and multiple small intraparenchymal calcifications.

Sarah: Update from Dr. Li

Dr. Li's office has called to let you know that Sarah's baby has been diagnosed with fetal toxoplasmosis. Sarah is now being treated with the standard therapy for fetal toxoplasmosis infection -- pyrimethamine, sulfadiazine and leucovorin. Dr. Li realizes that this therapy may have nutritional implications.

 

Learning Issue #8: Nutritional Implications of the antibiotic therapy

You decide to start  investigating the nutritional implications of the pyrimethamine, sulfadiazine and leucovorin therapy. Using Clinical Pharmacology, you can determine whether the nutrients in Sarah's prenatal vitamins will interact with the prescribed drugs.

Clinical Pharmacology -- Drug information, interaction reports

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To reach Clinical Pharmacology:

• Go to the McGoogan Library's website.

• Click on "Drug Resources"

• Click on the "Clinical Pharmacology" link.

• If asked to do so, login with your UNMC Net ID

Clinical Pharmacology -- Drug information, interaction reports

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After you reach the "Clinical Pharmacology" homepage:

• Click on the first option in the "Reports" menu -- the "Drug Interaction" report

• Begin by searching for --

pyrimethamine

• Click on the "Pyrimethamine Oral tablet" option

• "Pyrimethamine Oral tablet" will appear in the "Drug List"

Clinical Pharmacology -- Drug information, interaction reports

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• Next search for --

sulfadiazine

• Select the "Sulfadiazine Oral tablet" option

Clinical Pharmacology -- Drug information, interaction reports

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• The next drug to search for is --

leucovorin

• Select "Leucovorin Calcium Oral tablet"

Clinical Pharmacology -- Drug information, interaction reports

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• Finally, type --

prenatal

-- in the search box

• Choose the "TriCare Prenatal DHA ONE" option.

Clinical Pharmacology -- Drug information, interaction reports

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All Sarah's drugs and supplements should now appear in the "Drug list".

• Click on each of the relevant "Lifestyles" options under the "Drug list."

• Click the "Run Report" button.

• Scan the reported interactions.

Clinical Pharmacology -- Drug information, interaction reports

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All of the Drug-Food interactions listed are interactions between components of the prenatal supplement and food. However, this really just means that foods will not change the levels or action of pyrimethamine, sulfadiazine, or leucovorin.

You also need to know how the drugs will impact your patient's nutrient status.

Fortunately, you have listed a vitamin/mineral supplement among the "drugs."  The interactions between the drugs and the vitamins/minerals in the supplement will be listed as drug-drug interactions.

Clinical Pharmacology -- Drug information, interaction reports

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Take-away:

To get drug-nutrient interaction info,  list the nutrients of interest as nutrient supplements in the "drug interaction" report's drug list (even if your patient is taking no vitamin/mineral supplements).

Clinical Pharmacology -- Mobile App

If you'd like to install the mobile version of Clinical Pharmacology on your iPhone, iPad, or Android device:

• Click the "Register" link (you may have to click the "Menu" icon in the upper right corner to reach the "Register" link) and follow instructions to create your personal Clinical Pharmacology account through UNMC's license. Record the username and password that you select.
• Open the App store on your mobile device.
• Search for "Clinical Pharmacology"
• Install the Elsevier-produced "Clinical Pharmacology" app.
• Open the app when you will be within internet range for some time.  When you open the app, you will be asked to login with your personal, Clinical Pharmacology username and password, and the somewhat lengthy process of adding the apps information will begin.  Later, you can use the app offline.

LexiComp -- monographs focused on pregnancy and natural meds

1 of 6It might also be helpful to review the drug monographs for each of a patient's drugs. You could search Clinical Pharmacology for the monographs concerning pyrimethamine, sulfadiazine, and leucovorin.

However, a different drug resource licensed by the library, LexiComp, provides a simultaneous search of many different drug monograph sets.

The monograph sets searched by LexiComp include two monograph sets --

Briggs Drug Use in Pregnancy and Lactation

Pregnancy and Lactation, In-Depth

-- that focus solely on drug use during pregnancy and lactation.  

LexiComp -- monographs focused on pregnancy and natural meds

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To reach LexiComp:

• Go to the Library's homepage.

• Click on the "Drug Resources" button.

• Click on the "LexiComp/LexiDrugs" link.

• If asked to do so, log in with your UNMC Net ID

LexiComp -- monographs focused on pregnancy and natural meds

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Search for information about pyrimethamine in pregnancy:

• Type --

pyrimethamine

-- in the search box.

 

 

• Click the "Search" button or hit the "Enter" key on the keyboard.

 

LexiComp -- monographs focused on pregnancy and natural meds

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• Scroll to the bottom of the results list to find the "Briggs Drugs in Pregnancy and Lacation" heading.

• Click the "Pyrimethamine" link under the heading.

LexiComp -- monographs focused on pregnancy and natural meds

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LexiComp -- monographs focused on pregnancy and natural meds

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Other monograph sets included in the LexiComp search will also be useful to you during your career:

Some include information on nutrients:

LexiDrugs

AHFS DI

Some include information on natural medicines:

Martindale: The Complete Drug Reference

Natural Products Database

Briggs Drugs in Pregnancy and Lactation

 

Please note: UpToDate includes LexiDrugs and the LexiComp Drug Interactions tool but UpToDate includes none of the other monograph datasets included in our LexiComp license.

Want to check your resource knowledge?

Review

During this episode you used the two major drug information resources licensed by our library:

Clinical Pharmacology

• includes a drug interaction tool that lets you include vitamins in list of drugs
• is available as a mobile app
• is reached through the "Drug Resources" button

LexiComp/LexiDrugs via LexiComp

• includes access to many drug monograph sets including sets that focus on pregnancy and lactation and sets that include monographs on nutrients.
• is reached through the "Drug Resources" button

 

Link to next episode

http://list.unmc.edu/gots/tutorial/sb7n