Section V. Review for Mid-Term

Topics/objectives most likely to be covered by the exam

1. Distinctive characteristics of major tertiary resources and the fact that the following are tertiary resources.

Major tertiary resources (major drug information compendia):

• • Each of the  “general, tertiary resources”   include  one or more sets of drug monographs that cover the basics (indications, dosage, pharmacokinetics, precautions/contraindications, adverse reactions, interactions).  Some go beyond the basics.
  • The content of the specialty resources varies.

General, tertiary resources  that only contain FDA-approved info:

DailyMed –Government database of PPIs, includes generic and brand name drugs, free to manufacturer and end user

• • • • PPIs are FDA-approved
      • cannot discuss off-label uses (uses not approved by the FDA)
      • Package inserts are manufacturer and drug/drug form-specific as are inactive ingredients. Thus, Package inserts (PPIs) are a good source for inactive ingredient info.
      • Any change must be approved by the FDA — revisions are slow.
      • If you need mnemonic, try thinking of package inserts/PPIs as things that pharmacists see in abundance, daily, as they open packages of meds received from the manufacturer.

General tertiary resources that are not dependent on FDA approval and not controlled by the FDA:

• • • The resources  that don’t dpend on FDA approval can discuss off-label uses and can react quickly to new research findings.

Clinical Pharmacology (custom reports and monographs)

• • • • cli – custom  consumer-level/language interaction reports
      • ar – custom adverse reaction reports
      • can also produce custom profedssional-level interaction reports and custom IV compatibility (based on Trissel’s) reports

Drug Facts and Comparisons (only available at UNMC in print)

• • • • Organized by drug class and include sections introducing each class that include tables that compare all class members.  Tables sometimes compare dosage, administration route, adverse effects, interactions, pharmacokinetic properties, etc.

UpToDate LexiDrugs 

• • • • Unites different monograph sets under one searchable interface.
        
      • can also produce custom profedssional-level interaction reports and custom IV compatibility reports

General, Monograph sets available through our LexiComp license:

LexiDrugs

• • • • Think of LexiDrug$ – general LexiDrugs monographs provide price information.

AHFS DI (AHFS Drug Information)

• • • • Pearls of information not found elsewhere (think of pearl “AHFS DI” ID bracelet).  These pearls are often based on personal communications from manufacturers or from posters  or papers presented at conferences (conference abstracts)

Martindale:  The Complete Drug Reference

• • • • Complete list of English and foreign generic and brand names. Also lists scientific and investigational names.

Specialty, Tertiary Resources

Briggs Drugs in Pregnancy and Lactation (available in print and through UpToDate LexiDrug)

• • • • Gold standard for pregnancy and lactation questions

ASHP Injectable Drug Information  (Trissel’s )–

• • • •   Information on IV/injectabledrug compatibility/incompatibility.
      •  Trissel’s data is available in a printed book (title above), through Clinical Pharmacology ‘s IV compatibility reports and through UpToDate LexiDrug’s IV compatibility reports

Neofax –(online only)

• • • • Gold standard for dosing and administration questions for neonatal patients, especially important resource for premature neonates.

 Natural Medicines Comprehensive Database – (Available at Nebraska Medicine.  Not available at UNMC.)

• • • • Gold standard for natural medicine/herbal medicine/supplement questions

2. Distinctives of the following U.S. Government-maintained databases:

Orange Book — published by the FDA

• • •  therapeutic equivalence
    • If you think of a good mnemonic for this one, let Cindy know

Drugs@FDA

• • • Documents  submitted in support of the FDA-approval application (approved drugs only)
    • Think of the application documents  (including extensive review of studies) being received at the FDA

Yellow Book CDC

• • • • think of yellow fever and other diseases that can be acquired during travel.
        
      • CDC guide to immunizations/prophylaxis, etc. needed for travel

HSDB (Hazardous substances databank) – drug and other potentially hazardous substance toxicity in animals  (LD 50/lethal dose 50%) and humans, antidotes used in humans

LactMed – information useful to lactating women and their healthcare providers.  information on half-life of drugs in breast milk, etc. (not FDA-controlled or approved)

ClinicalTrials.gov – information on trials registered with Clinical Trials. gov

DailyMed — Package insert database (remember PPI’s are FDA-approved/controlled) Good source of inactive ingredients.

PubChem — Includes structural diagrams of chemicals (including drugs), often including 3-d rotating diagrams.

Drugs@FDA — Documents  submitted in support of the FDA-approval application (approved drugs on

3.   Distinction between the following National Library of Medicine (NLM)-produced resources that have MEDLINE or PubMed in their names:
   

PubMed (MEDLINE, PREMEDLINE)  —

• • • MEDLINE indexes the professional journal literature.
    •  PREMEDLINE is like a waiting room for MEDLINE (records for journal articles before they are completely indexed)
    • non-MEDLINE PubMed Central (PubMed contains a record for each PubMed Central item.  Some are in PREMEDLINE or MEDLINE, some are not destined for inclusion in MEDLINE.  These are called non-MEDLINE PubMed Central.)

MedlinePlus

• • • authoritative, consumer-oriented disease, drug and supplement info

PubMed Central

• • • PubMed Central is a full-text repository.
    • Contains the full-text of articles that report the results of NIH-supported research published after late 2007.
    • Also contains the full-text of articles from some “open access” (free to the reader) journals

4. Be able to match drug information questions with the standard, tertiary references that would best answer those questions
5. Know the differences between PREMEDLINE and MEDLINE records and how these differences affect the search techniques and limits/filters that can be used.
6. Know how to use Boolean operators, parentheses, quotes, truncation, and limits/filters correctly in both keyword and subject heading searches.
7. Know how to troubleshoot errors in the use of Boolean operators, parentheses, quotes, truncation, and limits/filters
8. Know when keywords must be used to search to search MEDLINE (the indexed portion of PubMed).
9. Be able to use search templates to model subject heading searches in PubMed
10. Know how the default explosion of subject headings affects retrieval of results in PubMed MeSH searches.
11. Understand how the use of subheadings affects result retrieval.
12. Know which types of terms must be included in a comprehensive keyword search for a specific drug and which types of terms should be included in a comprehensive keyword search for a class of drugs.
13. Know the tips for finding alternate terms for a non-drug concept and steps that can be used to find alternate terms needed for a single drug or drug class search.
14. Know the steps that may be taken to refine a search strategy.  Specifically:

• • Know how to deal with  ‘problems’ listed above the search results
  • Know how to deal with ‘problems’ identified in the “translations” section of the  “Details” in the “History and Search Details” table that is on the “Advanced” page.
  • Be familiar with the process of reviewing the keyword search results not retrieved by the MeSH search to look for additional headings that should be added to the MeSH search and/or to identify concepts that should be represented by keywords as well as headings in the MeSH search.
  • Be familiar with the process of reviewing MeSH search results not retrieved by the keyword search to look for additional keywords.

15. Know how to use “GetIt!@UNMC” buttons and the Online Journal Finder to determine whether a journal article is available online
    • Know that all journals available through UNMC licenses/subscriptions are available on- and off-campus.
    • Know that interlibrary loan is free to students and that >90% of requests are filled in less than 2 days.
    • Know that searching “Google Scholar” for an article’s title may be helpful when you have problems reaching full-text through UNMC subscriptions or when full-text isn’t available through UNMC’s licenses/subscriptions.
16. Know that HonCode certification indicates ethical provision of information.  It does not guarantee accuracy of the provided information.
17. Know that UNMC provides a free, Consumer Health Information Resources Service (CHIRS)
    • The service available to residents of the state of Nebraska and patients of Nebraska Medicine.
    • Patients can request information directly, but that healthcare professionals can also request information for  patients.
    • Consumer-oriented and/or professional-level resources may be delivered (depending on patient/requester preference)
    • Materials will be delivered either by e-mail or US mail.
18. Know which resources covered in this class are primary, secondary, or tertiary resources.
19. Know the steps in clarifying and responding to a drug information request including
    • the questions you should ask to clarify a question
    • the fact that you should usually begin your information search with a tertiary reference
    • the fact that more than one resource should be consulted
    • the types of information that should be included in a written (e.g. e-mail) response to a drug information request.
20. Know the differences between an adverse reaction, drug interaction, and IV drug incompatibility
21. Know when you might want to search Google Scholar (when terms of interest are not always mentioned in the title or abstract, but rather buried in full-text)
22. Know what the following will do in Google or Google Scholar:
    • double dot (as in 10..100 )
    • site: (as in site:.gov)
    • minus sign (as in -cart(
    • intitle: (as in intitle:pharmacist)
    • quotation marks as in  “pharmacy management”
    • OR (as in intitle:pharmacist OR intite:pharmacists
    • a space between search terms as in

(pharmacist OR pharmacists management)

• • Know that asterisks (*) do not work as wildcards(truncating symbols) in Google or Google Scholar

Some Exam Facts

You will have 1 hour and 50 minutes for the proctored exam.

You will be allowed to keep your tablet computer, the exam handout and a writing implement on the desk/table.

You will be asked to place all other electronics, book contents, notes, etc. out of sight lines.   You will NOT be allowed to consult any notes or course materials during the exam.

You will be given a handout.  You may write on the handout.  You will turn the handout in before you leave the exam room. The handout will  contain:

• the MeSH templates and the PubMed tag table.
• definitions for  most of the medical terminology used in the exam.  You do not need to know these definitions to finish the exam, but they may be helpful to some students.
• copies of the screenshots included in the exam (as it’s not always easy to see these in ExamSoft).

Exam settings:

• You may have to scroll left and right or up and down to see the whole question and all available answers.
• The exam will be set to allow you to go back and revise previously answered questions.

Exam content:

• There are 20 questions which ask you to identify the best resources for a stated information need.  These multiple choice questions are similar to the questions on the quiz.
• The remaining 30 questions include multiple choice questions, and a few True/false questions that are focused on the other objectives.
• The exam is worth 185 points.  Each question is worth 3.7 points.

A word about past students’ performance on the exam:

• In the past, about half of the  students have finished the exam in less than an hour.  However, there have always been some students who use all, or nearly all, of the 1 hour and 50 minutes available for the exam.
• There is  usually at least one student who answers all questions correctly and at least one student who fails the exam.   It’s not an easy exam.

Questions, Problems, Text Errors?

Before you leave, …

• Do you have any questions or do you feel that clarification of some aspect of the materials would be helpful?
• Have you noticed any errors or problems with course materials that you’d like to report?
• Do you have any other comments?

If so, you can submit questions, comments, corrections, and concerns anonymously — or with your e-mail (your choice) — through this online form . Alternatively, you’re always welcome to contact Cindy Schmidt directly 402-650-5056, cmschmidt@unmc.edu, or by making an appointment to meet with Cindy via Zoom.

Answers to questions or requests for clarification that are submitted anonymously will be answered in Canvas on the “Discussions” page for this course.