Epocrates and Other PDA Reference Tools

1. Epocrates and Other PDA Reference Tools Nancy Clark, M.Ed. Director of Medical Informatics Education FSU College of Medicine

2. Objectives for Workshop • Download and Install on the PDA • Use Epocrates Rx • find dosage, calculate dosages • Identify if drug on formulary • Use MultiCheck to find interactions • Use Sx to get a Differential • Use Dx to find Disease information • Use Lab to find Laboratory information • Use ID to find recommended Antibiotics • Use MedMath Medical calculators • Use Tables for guidelines and algorithms

3. Handouts • PowerPoint • Downloading instructions for Epocrates Essentials (yellow) • Using Epocrates Essentials • UserID and Password sheet (blue) • List of PDA software available and description of uses • Consent form and evaluations

4. Installing Software See Handout

5. Links to Download Sites

6. PDA Websites Page

7. FSU Licensed PDA Software • Epocrates Essentials ($149/yr) • Rx, Sx-Differential diagnosis, Dx-5MCC, ID, LAB, M-interactions, tables, CME, tools and calculators • InfoRetriever ($249/yr) • 5MCC, Cochrane, InfoPOEMs, calculators, guidelines, ICD-9 and E&M coder • POCKETConsult (FIRSTConsult) ($149/yr) • Differential diagnosis, medical conditions • Clinical Evidence ($99/yr) • EBM treatment recommendations • DynaMed ($200/yr) • Disease and conditions reference • Harrison’s Practice ($325/yr) • Disease and conditions reference

8. Free PDA Software Used in Curriculum • Geriatrics at Your Fingertips (GAYF)* • From AGS, tools and guidelines for care of older patient • *free to students, $30 for faculty • ePSS Tool • From US Preventive Services Task Force (USPSTF) tool, enter patient’s age, gender and get latest preventive services recommendations • Archimedes • Numerous handy medical calculators free from Skyscape

9. Full Installation Instructions • Handout for Epocrates Essentials • Other program instructions on Intranet – will require you to sign in if off campus • Login: med\firstname.lastname • College of Medicine UserID and Password • Updated weekly

10. General Steps for All Installations • Go to the Library web page, • Log onto EZProxy • PDA Websites page: Follow link to product web site • Register and get an account • Pick platform (Palm, Windows Mobile 5 or PocketPC) • Download software to desktop • Run the software with the PDA connected (Serial #) • Tell it where to put the software (device or SD) • When it finishes, test the software • Register Product

11. Adding Applications PDA App 3. Download software • Go to Product Web site • Register* 4. Run Software on Computer PDAApp 5. Install to PDA Device Memory or SD card

12. Drug Information Epocrates Essentials Rx (Also online) Prescription Drug Information Alt Med Information

13. Epocrates Rx • Prescription drugs and alternative medicines combined in same list • Lookup by Drug or by Class • Search tool lets you look up drugs by indication, adverse reactions, etc. • Dosage Calculator pops up for all drugs reported in mg/kg • Formularies available with status of each drug

14. Navigation • App: Hide Alt Meds, Auto Update, Memory Mgmt • Edit: find • Tools: Abbreviations, Formulary Info, Preferences, Update Email, Disclaimer and About MultiCheck Drug Interactions Home Search Tool

15. Epocrates Essentials Rx 2. Pick drug 3. Pick category 1. Type

16. Exercises for Practice • How should you prescribe acyclovir for the initial episode of genital herpes? (dose) • Is acyclovir indicated for children with Chicken Pox under the age of 2? • How much does one month supply of Glucophage 850 mg bid cost? • What is the off label indication for Neurontin (gabapentin) (* indicates off label)

17. Searching for a Drug

18. Dosage Calculator in Epocrates Rx • Online Dosage Calculator • http://www.medcalc.com/pedidose.html 3. Type Amt, Wt & Freq 2. Click dose 4. Click Calculate 1. Peds Dosing

19. Exercises for Practice • A little boy who is eight years old just ate a bottle of FeSo4 tablets his mother had in the kitchen. She thinks he ate forty or fifty of them. You search indications and find that desferol is indicated for iron intoxication. Calculate the dosage of desferol for the child. He weighs 50 lbs. • You have a patient that is on amitriptyline, Flonase, Synthroid, Reglan, and Zyrtec. She comes in with tardive dyskinesia. Which of these drugs might be causing this? (Use Search tool for Adverse Reactions.) 

20. Add Drug Formularies • Go to Epocrates.com • Manage My Account • Add Formularies • Pick Formularies • Sync to add • Tap for Alternatives 1. Pick formulary 2. Click Code

21. Exercises for Practice • I have a depressed patient with BCBS of Georgia who needs a low copay. Which of the SSRI are covered by BCBS low copay? Look up drugs By Class> psychiatric> SSRIs. • I have a depressed patient with no health insurance who is indigent. Which SSRI can they get assistance to pay for (Needy Meds)? • A 58 yr old female with osteoporosis is on Boniva. CHP Basic has stopped covering it. Which of the calcium metabolism class drugs do they cover?  

22. Drug Interactions Epocrates Multicheck

23. MultiCheck • Find all drugs patient is on • Select one at a time • Run the Drug Interaction • Contraindicated • Avoid/Use Alternatives • Monitor • Caution • Also checks IV solubility • Use Back to add more drugs

24. MultiCheck Drug Interactions 2. Pick drug 1. Type 3. Repeat until all drugs in list 4. Click Drugs

25. Epocrates MultiCheck Click interaction Use to add more

26. Exercises for Practice What interactions exist for the following combinations of drugs? • Lexapro, Lortab, Xanax and Zocor • Nitrobid and Viagra • Glucophage, Lopressor, itraconazole (Sporonox), and simvastatin (Zocor) 

27. Epocrates Essentials Sx Differential Diagnosis Engine

28. DxPlain • Included in ePocrates Essentials (Sx) • From Harvard • Age, gender and duration • Allows for multiple symptoms and lab results • Results: in decreasing order of likelihood • Online on library web page

29. Exercises for Practice • A 22 year old girl has a dry cough, chest pain, weight loss, and erythema nodosum. • She has been feeling “poorly” for over a month. • What might she have?

30. Epocrates Essentials Dx Disease Quick Reference

31. 5 Minute Clinical Consult • In Epocrates Essentials PDA under Dx tab • Not in Epocrates online – in InfoRetriever online • Author: Mark R Dambro, MD, updated annually • 600 common problems, bottom line, quick info, shallow content, ICD-9s • Treatment section linked to Rx,

32. Exercises for Practice • What is the incidence and prevalence of and the latest treatment recommendations for acute otitis media? •  What imaging test is becoming procedure of choice for kidney stones? • What is the ICD-9 code for psoriatic arthritis? • What OTC is drug of choice for sphincter incompetence in urinary incontinence? (not approved by FDA)

33. Epocrates Lab Diagnostic Laboratory information

34. Original Lab Content • View by Name, Specimen Type or Panels only. • Interpretation: diseases linked to Dx section, drugs linked to Rx section • Cost/Billing tells ICD-9 codes to justify test

35. Exercises for Practice • A basic metabolic panel reveals that a 30 year old man suffering from bipolar disorder has a serum calcium level of 10.9 mg/dL. He is taking lithium and valproate. Could his medications be a factor? •  Which ICD-9 codes would decrease your chances of being denied payment for a Growth Hormone test?

36. Epocrates ID Tool Antibiotics Guide

37. ABX Guide • Look up by Bug, Drug or System • Antibiotics linked to Rx section • Age and Gender specific • Emperic treatment before culture • Specific treatment for known pathogen

38. Exercises for Practice • Which antibiotics should be used for a neonate with empyema, etiology unknown? • The culture comes back with Haemophylius influenzae in the same neonate. What antibiotic should I use? Using the PDA, find the antibiotic, calculate the dose for a 2.84 kg baby. 

39. Epocrates MedMath Medical Calculators

40. MedMath • Small number of handy calculators • Many more in Epocrates online • Most in InfoRetriever • Info gives you parameters

41. Exercises for Practice • Calculate your own Body Mass Index, Ideal Body Weight, Basal Energy Expenditure, and Body Surface Area. • What is the predicted peak flow for a 60 year old woman with asthma? She is 5’2”.

42. Epocrates Tables Odds and Ends

43. Tables • Text based content of value to clinicians • Online and PDA • Guidelines (HIV, HTN, Vaccinations…) • Dosing equivalents (ACE, insulins, steroids…) • Algorithms (PALS, ACLS…)

44. Exercises for Practice •  Patient has planned a trip touring Mayan ruins in the jungles of Belize. What immunizations does she need? • Patient walks in with an inhaler with no labels attached. It is gray with a green cap. Which inhaled steroid is this?

45. Epocrates Free Add-Ons Medtools

46. Manage Your Account • www.epocrates.com • My Account • Log in • Free Add-ons • Pick your tools, formularies • Takes memory; puts in main memory • Includes free CME, international drug name directory, clinical decision calculators

47. Please Complete your Evaluations Contact Information for help Nancy Clark nancy.clark@med.fsu.edu (850)644-9706 Kenneth Higgins kenneth.higgins@med.fsu.edu (850)644-7473 CoM IT Help Deskhelp.desk@med.fsu.edu (850) 644-3664

48. FYI – What to Buy • Cell Phone/PDAs • AT&T – Tilt (WM6, 128/256 memory, 802.11, BT) • Sprint - Mogul • Verizon – XV6800 • Pocket PC/Windows Mobile PDA • HP iPAQ hx2795 PocketPC • Palm PDA • Palm T|X • Most Important Features: • Large screen, memory, speed AT&T Tilt