Drug Information Services

Sub: BP703T Pharmacy Practice

Unit III

Dr. Biswatrish Sarkar

Assistant Professor

Department of Pharmaceutical Sciences & Technology

1
 Drug Information: It’s Need
❑ The ability to provide up-to-date drug information is an important skills for all pharmacists
❑ The information services include and not limited to:
❑ Provide drug information to medical staff aimed at improving prescribing
❑ Information to patient relating to the medicines which they have been prescribed or purchased
❑ Updating of knowledge of Pharmacists themselves
❑ Royal Society of Great Britain have 30 hrs of continuing education per year
❑ Recently IPA, West Bengal has initiated Refresher Courses for Registered Pharmacists in West Bengal

❑ Drug information may be described as being:

❑ Reactive: provided in response to a specific enquiry
❑ Proactive: provided other than responses to a specific enquiry. Examples are:
▪ Information and advice provided as part of patient counselling
▪ Feedback to doctors on trends in prescribing
▪ Production of information bulletins concerning recently marketed drugs
 Enquiries Commonly Encountered
1. From Health care professionals 2. From Patients
❑ Drug Choice, e.g. in pregnancy or breast feeding ❑ What is the drug is for and how it works
❑ Dose ❑ How much to take
❑ Dose Interval ❑ When o take
❑ Route of administration ❑ Length of time until treatment gegins to work
❑ Adverse drug reaction ❑ Expected duration of therapy
❑ Drug-drug interactions ❑ Side effects
❑ Drug-disease state interactions ❑ OTC drugs to avoid during the treatment
❑ Duration of therapy ❑ Storage
❑ Formulations
❑ Storage
❑ Costs
❑Ideal approach to deal with these enquiries:

❑Identify the enquirer, his or her status

❑Establishing the degree of urgency of the enquiry

❑Obtaining the full background of the information

❑Using the most appropriate source of information

❑Delivering the responses

 Obtaining Background Information
❑ Important to obtain full information before attempting to answer any enquiry
❑ The level of background information required will depend on the type of enquiry
❑ For example:
❑ Doctors mostly enquire about the dose of a drug for individual patients
❑ Although a straightforward question, but it is complex with full background information which
includes:
▪ Age of patient
▪ Sex of patient
▪ Other disease state
▪ Levels of renal and hepatic function
▪ Other drug therapy
 Sources of Information
❑ Before starting to search the mass of literature, it is important to know which sources have been checked
by the enquirer
❑ This will save valuable time and not repeating of the work
❑ Next stage is to determine most appropriate sources of information (classified as Primary, Secondary and
Tertiary)
Secondary Sources
❑ Sources which provide reviews of research articles
Primary Sources
❑ Abstracting systems:
❑ Research articles published in reputed journals:
❑ regularly review selected journals and
▪ American Journal of Health- Systems
provide summaries of all research articles
Pharmacy
❑ Example: Medline (https://medlineplus.gov/)
▪ British Journal of Clinical Pharmacy
which reviews articles in journals relevant to
▪ British Medical Journal
medicine
▪ Journal of the American Medical Association
❑ Limitation: summaries are short and do not
(JAMA)
reflect the content of original articles
▪ Indian Journal of Medical Research
 Tertiary Sources Limitations of Literatures
❑ Standard reference books ranging from medical ❑ With research there is a delay
dictionaries to specialized texts in between writing and
❑ Examples: publication
▪ British National Formulary ❑ Many journals are not of
▪ Martindale: The Extra Pharmacopeia suitable standards and do not
▪ USP undergo strong peer review
▪ IP
▪ Davidson’s Principles and Practice of Medicine
 Delivering the Response

Finally the enquiry should

Once the appropriate The form of response
be fully documented This may save a great deal
sources of information have whether the verbal or
including background of time if the same
been checked and response written, should be agreed
information, sources of question is asked at a later
formulated, the next stage at the very beginning of the
information used and date
is to deliver enquiry
response given
 Evaluation of Clinical Trial Papers
❑ The efficacy and toxicity of drugs are assessed by carrying out clinical trials
❑ Test drugs are compared to standard treatment and/ or placebo
❑ Such studies may appear as clinical trial papers in primary reference sources, or form the basis of review articles in
secondary reference sources
❑ These studies are often used as soruces of drug information and pharmacist must be able to critically analyze the
data presented
❑ Research papers generally have following format:
1. Title
2. Summary
3. Introduction
4. Methods
5. Results
6. Discussion and Conclusion
7. References
 Qualification of the Pharmacists to
run DIC
❑ To critically evaluate the drug literature

❑ To edit the information to facilitate decision making Types of

DICs
❑ He should have good communication skills

❑ He should be computer literate

Hospital Industry Community
Based Based Based
❑ He should be member of PTC

❑ He should be redefine his role into an expert drug counselor from a mere dispenser

❑ He should have knowledge in research methodology

❑ He should be aware of different sources of information and collect secondary data

 Functions of DIC
❑Primary Functions: Respond to enquiries on therapeutic drug use
1. Drug Evaluation:
▪ Assessment of therapeutic drugs
▪ Centre must have access to the principal medical and pharmaceutical journals
▪ The staff should be capable of critically assessing medical literature and information from industry and media
sources

2. Therapeutic Advice:
▪ Patient related activity is the primary functions of many centres
▪ This requires adequate understanding of disease states and therapy
▪ Therapeutic advice includes factors such as efficacy, optimum dosage, interactions, adverse effects, mode of
administration, effects of other disease states and strategies to promote adherence to chronic conditions

3. Pharmaceutical Advice:
▪ Issue related to availability, formulation, cost, storage and stability
4. Education and Training:
▪ Provide information to health professional and public
▪ Support national and regional authorities responsible for drug use program
▪ Training UG/ PG students in overall clinical training

5. Dissemination of Information:
▪ Preparation of drug monographs, bulletins and websites
▪ Editorial skills are important for these functions
▪ International Society of Drug Bulletins (ISDB) runs training courses for editors
▪ WHO is responsible for preparing independent drug bulletin

6. Research:
▪ Could be centre of research on Pharmacoepidemiology e.g. drug utilization studies and PV
▪ Nature of enquiries received can be used to plan educational programs within the centre
❑ Secondary Functions:
1. Pharmacovigilance:
▪ Monitoring adverse drug reactions (ADR)
▪ Enquiries about potential ADR can lead to reports of suspected reactions: research may be required to assess the likelihood that a
drug has contributed to a reaction or subsequent patient management

2. Toxicology:
▪ Through dedicated Poison Information centres
▪ It provides information and advice on the diagnosis and treatment of poisoning
▪ Suitable information regarding poison should be available with health professionals and public
▪ Personnel need to suitably train in toxicology and would be able to respond to request for information on acute management of
poisoning
▪ Should organize educational programs for public to reduce incidence of poisoning
▪ Should collect data systematically on the circumstances leading to poisonings and the outcome od specific cases
▪ This could form basis for research in epidemiology of human toxicology

3. Resources:
▪ DICs should organized on a cooperative model involving a multidisciplinary team, where possible existing resources such as
libraries, computers and databases should be used
4. Personnel:
▪ The number of personnel required will be depended on range of activities offered and hours of service (e.g.
24X7)
▪ A centre should aim to provide a direct service during periods of major demands by clients
▪ Patient-related enquiries is likely to be when clinic consultations occur and during peak periods for hospital
functions
▪ Professional staff should include a full-time clinical pharmacist or a clinical pharmacologist
▪ Clinical training and experience is essential for effective communication with clinicians
▪ Other attributes are computer skills, literature analysis and editing and library management
 Guidelines for Setting up a DIC
❑ Professional and technical competence in the evaluation of critical selection and utilization of the drug

literature: Information with a minimum volume of pertinent supporting documentation to permit an

independent, informed conclusions and decisions should be made available.

❑ The knowledge of institutional and library facilities, literature utilization and library services will help in

taking full advantage of all the resources available for this purpose

❑ Written and verbal communication skills: enable to contribute effectively to intra- and inter-institutional

dialogue regarding pharmacotherapeutic information

❑ Capacity to contribute in education: for health professionals

❑ DIC is involved directly and indirectly in patient care and acts as a monitor

❑ DIC should provide professional services to support the PTC

 General Guidelines For Responses To Drug Information
❑ Do not guess
❑ Take several ethical issues into account:
▪ Patient privacy must be maintained
▪ Patient- physician relation cannot be breached
▪ Response is not necessary if the inquirer intends to misuse or abuse the information that is provided

❑ Organize information before attempting to communicate the response to the inquirer

❑ Tailor the response to the inquirer’s background
❑ Tell the inquirer where the information was found
❑ Alert the inquirer of a possible delay when it takes longer than anticipated to answer
the question
❑ Ask if the inquirer’s question is answered by the information
 Poison Information Centre
❑ It is a specialized unit that advises on, and assists with, the prevention, diagnosis and management of
poisoning
❑ PIC answers enquiries about exposure to chemical agents, including products, pharmaceuticals, natural
toxins, pesticides and industrial chemicals
❑ It provides an assessment of whether a particular exposure is hazardous, and information on the need for
treatment and the kind of treatment that should be given
❑ Poisons centres aim to promote the evidence-based, cost-effective management of poisoning and to
ensure that unnecessary or ineffective treatment is avoided
❑ Poisons centres offer a service to health professionals and also, in many countries, to the general public
❑ Poisons centres also maintain databases, including toxicological databases, databases of product
formulations and databases of poisoning enquiries to the centre
 The main functions of PIC
❑ Provision of toxicological information.
❑ Advice on the management of poisoning cases
❑ Training to the professional and paraprofessionals on first-aid, management and
prevention of poisoning.
❑ It also provides toxicological laboratory services
❑ Helps in developing contingency plans for chemical disaster with other responsible
bodies.
❑ The centre responds to chemical disasters.
❑ The center carries out epidemiological and experimental studies to
❑ find out the toxic risks and mechanisms.
❑ National Poisons Information Centre
(NPIC) in India started at Department of
Pharmacology in AIIMS in 1995
❑ NPIC provides information and advice
on management of poisoning 24 x 7
❑ On receiving an enquiry on telephone/fax or in
person, details about the patient and poisoning
are noted on a proforma
❑Poisindex Database is consulted for all the
relevant details by a trained poisons information
specialist
❑The advice to the inquirer is given by a follow-up
call
❑ This advice is provided to the hospital
emergencies and private practitioners
❑ In case the caller is from a community, general
advice on first-aid management is given or if the
incident does not warrant any treatment,
reassurance is given with follow-up
❑ Similarly, enquiries from various government agencies and parliament regarding the acute or long-term
effects of chemicals on population are answered accordingly
❑ The individual enquiries in the form(s) of letter from public/professionals about dyes, colours, food
adulterants and additives etc. are also answered accordingly
❑ Various Roles of NPIC:
▪ Provision of Information and Advice
▪ Patient Management
▪ Laboratory Services
▪ Teaching and Training
▪ Toxicovigilance
▪ Prevention
▪ Drug Information and Pharmacovigilance
▪ Environmental Toxicology
▪ Research