REFERENCE MEDIA FOR DRUG PRODUCTS

Vahn Lewis, UTDB, Copyright 2002

There are currently a number of useful reference sources, in addition to your pharmacology text books, that provide you with up-to-date information regarding the prescribing of drugs. Each of the sources has good features, some have deficits. In the practice of your profession you will need to have current reference sources available to you in order to competently prescribe for your patients. A brief synopsis of several of the references follows. You should also be aware that there are numerous sources which are misleading or just plain incorrect. Often sources which are pocket references and/or some memory guides (card decks) simplify the material to the point of error. There is a temptation to group dissimilar drug groups together and call them the same.

PHYSICIANS' DESK REFERENCE (PDR)

Certainly the most popular of the desk books, it has a good color photo section of some of the more common drug dosage forms. The indices are very useful; chemical, therapeutic, manufacturer and alphabetic. Its major problem lies in the fact that the information is the "package insert" from the companies who chose to pay for "advertisement" in the book. Not all products of the company may be listed and not all companies choose to advertise in this manner. Overall annual cost of the publication which has quarterly updates is quite reasonable. The PDR costs about $90(2002). Other references available from the Medical Economics Company are PDR's for nonprescription drugs, ophthalmology, drug interactions and side effects and all four volumes on a CD-ROM computer disk ($99). A digest version is available in an electronic pocket PDR ecard ($279+options). APDA version is available. www.pdrnet.com

DRUG FACTS AND COMPARISONS

This publication includes a listing of all drugs produced commercially in the USA (about 28,000 drugs) known to the publisher. The information is prepared by a panel of editors and provides summary charts comparing information for similar products. It includes both Rx, OTC, and dietray items. Drug are grouped according to their actions and various products are compared in tables with respect to quantity, strength, and a relative index of cost. It is updated monthly and includes information on new investigational drugs, deleted drugs and other items of interest. Since it is not supported by advertisement there is less bias, but it does cost more for annual renewal (bound version about $179/yr).  A constantly updated web-based eFacts and Comparisons can be licensed for $359.  Suplemental product concerning drug interactions are also available.  A CD ROM version and PDA versions are available. Facts and Comparisons, Inc., 111 West Port Plaza, Suite 300, S. Louis, MO 63146-3098. 1-800-223-0554. 

 UNITED STATES PHARMACOPEIA (USP) AND NATIONAL FORMULARY (NF)

These two compendia are quasi-legal documents that the Congress of the United States recognized in (1906) to establish the standards of purity and quality for drugs used in the USA.

The USP has been published since 1820 by a private non-profit corporation composed of educators, industry and governmental members, The United States Pharmacopeial Convention.  The USP primarily covers single drug entitities.  It has increased its scope recently to include approptiate herbal and health related entities.

The NF was started in the 1880's by The American Pharmaceutical Association and covers mixtures of drugs. Recently the rights to the NF were sold to the USP and the two official books are now combined.

USP DRUG INFORMATION (USP DI) - These references are authored annually by the United States Pharmacopeia, Inc. The material presented in the books is very critically reviewed by a panel of experts from industry, medicine, dentistry and pharmacy, schools and government
The first volume, "Drug Information for the Health Care Provider", includes monographs on all drugs recognized by the USP/NF. The American Medical Association Drug Evaluations was purchased by the USP in 1994. - Unlike the PDR, this book discussed 'off-lable' uses (i.e. uses not included on the package insert at the time that the FDA approved the drug) of drugs for particular disease states. These 'off lable' uses are now discussed in the USP monographs.

The second volume, "Advice for the Patient" includes pronunciation helps, side effects to be aware of, as well as information regarding how the patient should use their prescribed medications. This section is particularly useful in providing information for counseling patients on how to take their medications. In recent years effort and increasing the scope of medical information has led to the inclusion of informtion relavent for special classes of patients such as the eldery, childern's use, dental inpact, impact on pregnancy, etc. . USPDI is now marketed by micromedex http://www.micromedex.com/products/uspdi, and is available from the the PDR website as a "desktop series" CD for $199.

A third volume is aimed at generic drug selection issues and is called Volume III: Approved Drug Products and Legal Requirements. The USP reprints the Approved Drug Products with Therapeutic Equivalence Evaluations (Orange book) where the generics accepted as equivalent to a particular proprietary drug are listed. In addition, the USP publishes the principle federal laws and regulations pertaining to prescribing, licensing and dispensing drugs. Supplements to the USP covering each states laws are also available.

Besides USP/NF, USP-DI (already discussed), the USPC also publishes the "USAN and the USP Dictionary of Drug Names". The role of the USAN Committee (United States Adopted Names) is to provide common generic nomenclature for all new drugs entering the U.S. market. An example of their efforts is illustrated by the fact that all beta blockers now have the same suffix, "olol". There are many other examples of their efforts to standardize drug names.

 HANDBOOK OF NONPRESCRIPTION DRUGS - This book, published by the American Pharmaceutical Association, provides information about the OTC preparations available to you or your patients. This book is in its 13th edition, 2002 ($135). The new edition also provides practitioners with quick access to OTC drug information, assessment techniques, treatment algorithms, and patient counseling information.
Key Features:
1. Forty-eight chapters by 61academics and practitioners from multiple health care fields, who have expertise in self-care options and nonprescription medical devices/supplies
2. Using an interactive approach, features all self-care options-nonprescription medications, complementary therapies, nondrug measures, and preventive measures-for self-treatable disorders
3. Contains treatment algorithms, assessment Q&A, case studies, and patient counseling tips
4. Index that lists major topics of each disorder, as well as generic and trade names of nonprescription products and dietary supplements
http://www.aphanet.org   Several copycat publications available from PDR and others.

In addition to the above references it is often useful to obtain specialty publications such as

Risk by Gerald G. Briggs, Sumner J. Yaffe, Roger K. Freeman (2002 Amazon.com: Price $110.00, 5th edition CD $74.50, used $55 -five stars!) if you need to determine if a drug could be prescribed to a pregnant woman. Other publications are available with recommendations for treating older patients or particular drugs such as drugs used for psychiatric disorders.

Other books available to you through your local pharmacy include the RED BOOK which lists manufacturers and the drugs and dose form plus the wholesale costs of their products.

DRUG INFORMATION NEWSLETTERS

Besides books, today we have many newsletters being published which provide current information about drugs and drug therapy. Examples of these are:

Medical Letter - A monthly newsletter presenting a current update on a new drug, new therapy, etc. They publish lists of drugs of choice for various conditions. It is a high quality publication and can be bound for reference use (Student rate $27.50 (2002)).

Druglink-Drug Newsletter- Published by the Facts and Comparisons group it is similar to the medical letter and updates practitioner on current events in drug therapy.

Physician Drug Alert - Similar to Medical Letter. The monographs are shorter, but cover more items per issue. 

All totaled, the above books and newsletters would represent an annual expense of about $500.00, but would provide you with an excellent reference library regarding drugs. In these days where negligence lawsuits are common, one of the first questions asked by the plaintiff's attorneys is about current library holdings. The attorneys have all the current editions of these books.

INTERNET DRUG RESOURCES

There are a number of drug resources available on the Internet Web. These resources can be accessed with a computer and a net browser such as Microsoft's Internet Explorer or Netscape. Since the net resources are still being developed, we can expects more entries in the future. This list is not exhaustive.

There are no nationally accepted standards for drug information on the WEB. You must always be cautious about the authority and validity of information you may find on the WEB. Reviewing standards will need to be developed. An example of a peer reviewed monographs can be seen at the University of Iowa’s Virtual Hospital (see web site at the end of this list). A review of reviewers of Web based medical information has appeared in JAMA. 1998;279:611-614.

Doctor’s Guide.  A listing of recently marketed or new indication products. Need to keep up with the dizzying array of new agents?….http://www.pslgroup.com/NEWDRUGS.HTM

www.rxlist.com is a developing drug information source. It is copyrighted by the publisher Mosby. It concentrates on the top 200 prescribed drugs in the most recently reported year. The list of drugs can be sorted in various ways. Information on chemistry, pharmacology, side effects, warnings contraindications, etc. and dosing. The hot links do not work in some of the monographs, although the information is adequate (in some cases extensive). It provides information on yearly drug costs, national sales figures, brand and generic equivalents, and insurance formularies which include the drugs. It has an improved search engine and allows the search of the entire data base for items. A search on the drug side effect Stevens-Johnson Syndrome resulted in 52 hits.

http://dir.yahoo.com/Health/Pharmacy/Drugs_and_Medications/ is a search engine for pharmacology information on the WEB. Lycos www.lycos.com can also be used for pharmacology searches.

Patient Drug Information Sites-The Mayo Clinic, John Hopkins University   Healthtouch and www.drkoop.com (former Surgeon General)  provide patient drug information at their sites.  Each of these has multiple features.    The Mayo and John Hopkins sites features USP Drug Infomation (USPDI).   The John Hopkins site often includes pictures of the medications for medication identification.  One nice teaching feature for Healthtouch  is that it has a pronunciation guide that help the patient (or student!) pronounce the drug names correctly.   Not all drugs are necessarily listed Dolobid (diflunisal a NSAID useful in dentistry is not always mentioned.

A relatively new approach for the delivery of drug information is thorough specific drug webpages.  Manufacturers are providing drug use instructions on web pages devoted to single agents.  In general, these are aimed at patient level drug information but can be very helpful if it is a drug you are prescribing.

General Dug Information Sources

http://www.aspet.org/ is the home page for the American Pharmacology and Experimental Therapeutics Society. This page as a number of educational resources on it.

http://www.bumc.bu.edu/www/busm/pharmacology/links.html has an excellent link page to many pharmacology departments, databases, societies and journals, educational materials and other sites. This has a cool listing of world wide poison information centers. This would be a worthwhile page to visit.

www.fda.gov This is the home page for the Food and Drug Agency. It has information on new drugs being released, drugs that are under review or recall, information on human and animal drugs, biologics, toxicology, cosmetics, and foods. An interesting exercise is to look over the import seizures of tainted foods and drugs being sent into this country. The Center for Drug Evaluation and Research (CDER) describes how new drugs are developed and the FDA evaluation procedures. There are sites for Orphan Drug procedures and Development of Generic Drugs.  If you would like a history of the laws defining the actions of the FDA try http://www.fda.gov/opacom/backgrounders/miles.html

The Drug Enforcement Agency (DEA) http://www.usdoj.gov/dea/ is responsible for the Diversion Control Program. You will need to register with them to get your "DEA number" for prescribing controlled substances Look under "Programs" and then "Diversion" http://www.deadiversion.usdoj.gov/. and then under Drug Registration (which is a strange way of saying practitioner registration or manufacture registration). This program monitors the use of controlled substances under the authorization of several U.S. Laws and International Treaties. You can read about the history of the laws at the DEA webpage: http://www.usdoj.gov/dea/deamuseum/home.htm  

The Virtual Hospital project at indy.radiology.uiowa.edu is a source of information for both patients and professionals. It supplies some drug information within the structure of their Virtual Hospital. Reading some of these pages is a real treat. They currently include peer reviewed monographs on the 50 most common medical disorders. Note in 1998: This site is only getting better and contains screens and screens of valuable information.

There are many other sites that may be of interest. If you find one that you really like and would like to see them listed here (and soon on an RX Writing Web Page) please send the URL to Vahn.A.Lewis@uth.tmc.edu.

Link to Web Pharmacology References

Copyright 2002: Vahn a. Lewis, UTDB, Houston, TX