Philip O Anderson and Susan M McGuinness
11.3 DRuG InFORMATIOn DATABASES FOR PROFESSIOnALS
Four popular stand-alone drug information databases are comprehensive in scope. The main features of these databases are reviewed next. Each database also contains a variety of ancillary databases, such as FDA warnings, manufacturer contact information, normal laboratory values, and dosage calculators; however, these will not be reviewed.
11.3.1 Clinical Pharmacology
Founded in 1993 by Gold Standard (http://www.goldstandard.com), Clinical Pharmacology is one of the newer comprehensive drug information databases. The database has a clear, simple user interface. Records are divided into 11–12 subsections so that the user can reach information quickly. Drug records contain standard package insert recommendations supplemented by literature sources that can be found by clicking on the reference numbers; many of the references have hot links to PubMed.
Because of excellent consistency and deployment of controlled vocabulary throughout the database, it can be searched by several different factors, such as indication, adverse reactions, contraindications, etc. The consistent terminology also allows for a unique customizable report feature. For example, a question such as, “Which of the patient’s five drugs could be causing thrombocytopenia?” can be searched simply from one screen. Drug interaction and intravenous (IV) compatibility checkers, a tablet identification feature, and patient informa- tion leaflets are included in the package as well as several preprogrammed comparison charts. The Natural Medicines Comprehensive Database is also linked to Clinical Pharmacology, providing the user with an extensive database on natural products and nutraceuticals. 11.3.2 Facts and Comparisons
Facts and Comparisons (http://factsandcomparisons.com/) is one of the oldest print drug information sources. It was originally developed as an alternative to the manufacturer- focused Physician’s Desk Reference. Information in the main drug information database is primarily reformatted information from the package insert with some literature referenc- ing. Other databases (e.g., Drug Interactions Facts) are more literature based and more completely referenced. The online version is called Facts and Comparisons 4.0. It has a fairly simple user interface with two search sections: one for drug information and one for disease and symptom searching. Several different databases can be searched for informa- tion, including the main database, an abbreviated database (A to Z drug facts), the drug– drug and drug–herbal interactions databases, patient information, the Review of Natural Products, nonprescription products, tablet identification, and off-label indications.
Although exclusive to Facts and Comparisons, some of these databases, such as Drug Interactions Facts and the Review of Natural Products, are produced by outside consultants.
This occasionally leads to contradictions between databases—for example, different ratings of herbal drug interactions between the two interactions databases. A strong point of the print version of Facts and Comparisons has always been its comparison charts, which are helpful in comparing drug products with similar uses and ingredients. The online version continues this tradition. Facts and Comparisons 4.0 does not contain an IV compatibility checking program, but does have a number of useful tables, such as look-alike/sound-alike drugs and don’t crush/chew lists.
11.3.3 Lexi-Comp
LexiComp (http://www.lexi.com/) is one of the newer drug information databases and is available as online, desktop, and PDA (personal digital assistant) versions. Numerous databases—some produced by outside sources and some aimed at other professions such as dentists and nurses—are available in various combination packages. Information in the databases tends to be concise and sparsely referenced; this serves it well in independent tests of the PDA versions, but not in comparative studies of the more complete databases. A strong point is its pediatric database, which is expertly written and well referenced. 11.3.4 Micromedex
Micromedex (http://www.micromedex.com) was one of the first electronic database provid- ers. Micromedex provides a number of separate databases produced by different providers that can be purchased in many combinations. Available databases are searched via a single search box and then the user selects which database to examine to find the desired infor- mation. DRUGDEX is the comprehensive general drug information database produced by Micromedex. The user can reach DRUGDEX monographs and then can either scroll through the record or jump to one of the subsections. Information is laid out in an outline format rather than in continuous paragraphs. The outline elements include information from the package insert and primary literature abstracts.
The details from the literature can be useful, but the lack of flow and integration of the outline format can be confusing. The records are thoroughly referenced, and references are provided alphabetically at the end of each drug record. However, the user must jump to the end of the record and search to locate the reference by author name and publica- tion year. Other database features include drug interaction and IV compatibility checkers and the ability to compare two drugs at a time in an abbreviated (DrugPoints) format. Micromedex also has some databases from other producers such as Martindale from Great Britain, which offers foreign drug information, and four databases on the reproductive effects of drugs and chemicals.
11.3.5 Embedded Databases
In addition to these stand-alone references, most pharmacy computer systems have embed- ded databases that automatically perform functions such as drug interactions and allergy checking. Such programs are available from providers such as First Data Bank (the most widely used) and Medi-Span. The programs may also have drug information that can be accessed by clicking on links in the program. These sources have not been compared as
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rigorously as have the stand-alone programs, except for their drug–drug interaction check- ing modules (discussed later).