1 / 47

Drug Information Resources: An Overview

Drug Information Resources: An Overview. Rob Barcelona, PharmD, BCPS Clinical Pharmacy Specialist, CICU. Objectives. Utilize drug information sources available at University Hospitals Case Medical Center Describe UHCare functionality as it relates to Pharmacy Services

hung
Download Presentation

Drug Information Resources: An Overview

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Drug Information Resources:An Overview Rob Barcelona, PharmD, BCPS Clinical Pharmacy Specialist, CICU

  2. Objectives • Utilize drug information sources available at University Hospitals Case Medical Center • Describe UHCare functionality as it relates to Pharmacy Services • List dosing and monitoring of specific patient populations and medications

  3. Pharmacy Clinical Resources • Clinical on Call Pager 30558 • Rotates among all clinical specialists • CICU: Rob Barcelona 30274 • SICU: Wes Bush 30393 • Infectious Diseases: Ron Cowan 31960 • NSU: Jason Makii 37884 • MICU: Andreea Popa 31503 • Transplant: Raelene Trudeau 38643

  4. Tertiary Resources • Condense, digest, and summarize information from primary and other resources • Provide rapid access to information • Limitations: • Currency of the resource (i.e., how long ago was that information published?) • Accuracy of information • Incompleteness (e.g., over the counter medications not contained) • Examples include MICROMEDEX®, textbooks, UpToDate®, review articles, and encyclopedias

  5. UH Case Medical Center Specific Resources • Anticoagulation Therapy and Anticoagulation Reversal • Adult IV Medication Guidelines • Antimicrobial Usage • Restricted Medications • Drug Specific Guidelines (e.g., antibiotic locks, IVIG, etc.)

  6. Where can resources be found?

  7. Lexi - Comp® Online™ • > 4,000 monographs of medications and nearly 30 fields with each drug monograph • Both text and on-line in UpToDate® • Information includes: • Dosing • Pharmacology • Pharmacokinetics • Pregnancy/lactation considerations • Adverse reactions • Drug interactions • Nutrition/herb interactions

  8. MICROMEDEX® • Available from UH Pharmacy website: http://intranet.uhhs.com/pharmnet/ • Facts on drugs, teratogenicity, toxicology, and alternative medicine • On-line version of the Physicians’ Desk Reference • Very comprehensive and contains the following: • Dosing • Pharmacology • Pharmacokinetics • Drug interactions, cautions • Clinical applications • References • Limitations: difficulty in finding information and frequency of updates

  9. UHCMC Adult IV Guidelines

  10. The Internet • Many resources available using the Internet • Should be utilized only if other databases or references fail to provide any valid information • Limitations include lack of quality control and imprecise searching that may lead to many undesired “hits” • Information found may not come from a verifiable source and potentially could be inaccurate, possibly leading to patient harm • If UHCMC has guidelines, protocols, or ordersets, use those developed by UHCMC staff

  11. Conclusion • Variety of resources are available • Familiarize yourself with the on-line resources, databases, and textbook references in finding drug information • If all else fails, ask your pharmacist

  12. More on Resources … and EMR stuff Andreea Popa PharmD, BCPS MICU Clinical Pharmacy Specialist

  13. MICU and other resources

  14. Invalid order/need further clarification Renal Dosing Drug interactions Restricted drug Bad Orders Non-formulary drug Drug on short supply Duplicate orders Why does the pharmacist call you???

  15. What happens after you place an order? • Pharmacist actively looks for the orders on the different units (2-3 units per pharmacist; 60 -100 pts) • Looks at all medication orders for that patient, diagnosis and pertinent labs

  16. User Schedule Ordering

  17. Verification Screen

  18. Order verification • If no questions order is verified and a label prints  technician prepares drug  pharmacist checks drug again  drug leaves for delivery to respective nursing units • Controlled substances, emergency meds  OMNICELL • If need something urgent: call area pharmacist

  19. EMR issues….. • Standard administration times • QD: 9:00 • BID: 09:00; 21:00  12 hours off drug • TID: 09:00; 14:00; 21:00  12 hours off drug • QID: 09:00; 13:00; 17:00; 21:00  12 hours off drug • Q 24, Q 12, Q 8, Q 6: Timing of these is dependent on ordering/nursing administration; subsequent doses are automatically scheduled based on the first dose

  20. Routine, now, stat and time critical….

  21. Routine, now, stat and time critical…. • Amlodipine 5 mg daily • Routine: if passed 9 am, first dose schedule for RN to givenext dayat 9 am • (99% of ALL medication orders defaulted to routine) • Now: one dose will be sent now and than next day at 9 am • STAT: generates a red flag for the pharmacist  urgent order  first dose now then next day at 9 am (regardless what time now, could be 9 PM) • TIME CRITICAL: you select the time for the 1st dose and the subsequent doses will be automatically scheduled q 24 hours from the time of first dose (if ordered Q24H)

  22. Routine, now, stat and time critical…. • Cipro 400 mg IVPB q 24 hours • Routine: scheduling of first dose related to ordering time • Now and Stat: create a yellow/red flag for verification • TIME CRITICAL: you select the time for the 1st dose and the subsequent doses will be automatically scheduled q 24 hours from the time of first dose!

  23. Ordering IV Heparin: Loading dose, infusion, repeat bolus • Pearls: • Most of lab work is pre-checked • If running continuous infusion, ALWAYSorder the repeat boluses • Open Dosing: Never order the open dosing unless Heme/Onc or • Vascular Medicine involved

  24. Electrolyte Ordering

  25. Units, units……. • MMF grams vs. milligrams

  26. Premixed antibiotics, customizing the dose • So, how do I order: • 1,000 mg • 500 mg or • 2,000 mg of vancomycin ????

  27. Pulmonary Hypertension Hemodialysis/CVVH Chemotherapy Dofetilide (Tikosyn) Non-formulary drugs REMS (Risk Evaluation and Mitigation Strategy) > 200 REMS Drugs > 30 Drugs have Elements to Assure Safe Use > 20 REMS Drugs require informed consent Restricted Ordersets and REMS

  28. Other Ordersets… • Admission Ordersets • Most patients do not need an IV PPI… • Pneumonia Orderset • Antibiotics default to routine • Antibiotic selections in alphabetical order vs. preferred • Tylenol OD

  29. Generic Questions • When calling pharmacy for drug info questions: • Ask to talk to a pharmacist • Tell them who you are/contact info • Give them patient name and location • Give them synopsis of case and relevant clinical information to get most appropriate answer (what you are treating,other drugs, renal function, etc.)

  30. Drug Dosing in Special Populations • Renal Failure • Intermittent vs Continuous Hemodialysis vs Ultrafiltration • Obese/Low weight • Geriatrics

  31. Estimating Renal Function • Cockcroft and Gault equation: CrCl = (140 - age) x IBW / (Scr x 72)      (x 0.85 for females) • IDMS-traceable MDRD Study EquationConventional unitsGFR (mL/min/1.73 m2) = 175 x (Scr)-1.154 x (Age)-0.203 x (0.742 if female) x (1.212 if African American)

  32. Drug Levels

  33. Questions?????

More Related