Learning Outcomes
After completing this chapter, you will be able to
Classify a drug information request.
Explain how to obtain appropriate background information for a drug information request.
Distinguish between questions that may be answered by a technician and those that should be answered only by a pharmacist
Given a specific pharmacy-related question, identify the best resource to use to find the answer.
Describe how to find answers to drug information questions at the workplace.
Key Terms
| drug information request | A question regarding a medication. |
| drug monograph | Written information about a drug or class of drugs that contains product details, indications for use, safety information, dosing, administration, and other useful information about the drug(s). |
| material safety data sheets | Information sheets provided by manufacturers for chemicals or drugs that may be hazardous in the workplace. They provide information about the specific hazards of the chemicals or drugs used at the worksite, guidelines for their safe use, and recommendations to treat an exposure or clean up a spill. |
| Medline | A searchable database containing over 16 million references to journal articles and abstracts published in approximately 5,200 biomedical journals. |
Conducting the Search: Choosing the Right References
Drug Information and Poison Control Centers
Conducting a Search Using Medline Plus
Responding to the Drug Information Request |
|
The provision of drug therapy has become increasingly complex and the number of new drugs approved for use has significantly increased during the past decade. The result is that pharmacy technicians are frequently challenged with drug information questions throughout the workday and must become more knowledgeable about the handling, availability, and uses of medications. A basic knowledge of the drug information resources available will help prepare technicians and leave them better equipped to assist pharmacists with certain drug information requests.
Pharmacy reference books and electronic media, including the Internet, that are available in all practice settings often hold the answers to typical, day-to-day practice-related questions. These resources can also be used as study aids for the technician certification examination and to expand a technician’s general knowledge about medications. Therefore, it is essential that technicians understand the basics about frequently used, reputable pharmacy references.
The purpose of this chapter is to classify the various types of drug information requests, explain which types of questions are appropriate for pharmacy technicians to answer, and describe where technicians can find answers to drug information requests. With time and practice, technicians will be able to find the information that they need quickly and efficiently; in doing so, they will become even more valuable members of the health-care team.
The Drug Information Request
A drug information request is simply a question regarding a medication. The person requesting the information, the requestor, can be a nurse, doctor, other health-care professional, or patient. The request might be asked over the telephone, in person, or via fax or email. The request may be simple, requiring little time to research and answered quickly, such as “what is the generic name of Lipitor?” Other requests may be complicated, requiring a significant amount of research before they can be answered. An example of a complicated request is “what is the safety of fluoxetine (Prozac) in pregnancy?”
Before responding to a drug information request, technicians must clearly differentiate questions that fall within their scope of practice from those that may be answered only by a pharmacist.
In general, if a question requires specific knowledge about a medication and/or professional judgment, it should be answered by a pharmacist.
An example is a patient wanting to know whether he or she is experiencing a side effect from a medication. The pharmacist needs to research whether the medication could cause the side effect, obtain patient-specific information, and use his or her professional judgment to determine whether the side effect could be due to the medication or something else going on with the patient. In some cases, the distinction between the two types of questions may not be apparent. If there is any doubt about the nature of the question, the technician should defer the question to the pharmacist.
When approached with a drug information request over the telephone or in person, technicians should identify themselves as pharmacy technicians, so that the person asking the question will know the type of information that may be appropriately conveyed.
Keep in mind that consumers may not understand which questions a pharmacy technician can answer and which should be referred to the pharmacist. It is important to identify the person initiating the request and, when the request comes over the telephone, to obtain the necessary contact information (phone, pager, fax, etc.) in case the person needs to be called back. The search for and response to drug information requests will differ depending on who requests the information. Knowing information about the requestor, including his or her training and knowledge of the subject, will impact the final response and how it is given. For example, if a pharmacist is asked how the drug ondansetron (Zofran) works, he or she would respond differently if the request was from a patient compared to a physician. When answering questions from patients, medical terminology is avoided and the response is put into language that patients can understand. The answer would be more in-depth to a physician and written information might also be provided.
Obtaining information about the purpose of the request will help to determine the needs of the requestor and whether it involves clinical judgment, requiring the expertise of a pharmacist. It will also make the search for information more efficient. It is important to find out if the information is for general knowledge or if it pertains to a specific patient. If the question involves a specific patient, the pharmacist will need to obtain background information in order to respond to the question. For example, if a physician asks what the dose of gabapentin (Neurontin) is, the pharmacist would need to know if it was for a specific patient and, if so, what the indication is, the patient’s age, kidney function, other medications, allergies, etc.
The urgency of the request and the extent of the information needed should also be determined so that an appropriate amount of time is allotted to answer the request. Often, part of the question can be answered initially (if needed urgently), with the remainder of the answer provided later, allowing time for research in order to give a more thorough response. For example, a physician calls and wants to know if the pharmacy stocks a new drug that has recently been FDA approved. Upon further questioning, she has a patient in her office who might benefit from the drug and she needs to know if the drug is available. She would also like some written information about the drug. This is an urgent request, and the initial answer is no, the drug is not stocked in the pharmacy and does not appear to be available at the wholesaler yet. Because the drug is not even available yet, the request is no longer urgent. The technician can call the wholesaler and/or the manufacturer to find out when the drug will be available and the pharmacist can gather information about the new drug and follow up with the physician at a later time.
Classifying the Request
After information is gathered about the request and the requestor, it is helpful to identify the type of question that is being asked, that is, to classify the request. Classifying the type of request helps to narrow the search and make the search process more efficient. Many of the questions that technicians encounter fall into the categories outlined in table 7–1. The table also lists examples of questions within these categories.
Table 7–1. Classifications of Drug Information Questions
| Question Classification | Examples |
| General Drug Information | What is the brand name of warfarin? Do Naprosyn and Aleve contain the same active ingredient? Who manufactures Enbrel? Is Prilosec available as a generic? Is it a prescription or over-the-counter (OTC) product? |
| Availability and Cost | What dosage forms of Imitrex are available in your pharmacy? Is Zoloft available as a liquid? If so, what size and concentration is available? What are the prices of Adalat CC and Procardia XL? How long is the shortage of albumin expected to last? |
| Storage and Stability | Should Lovenox be stored in the refrigerator? How long is a flu shot stable after it is drawn up in a syringe? |
| Calculations | How many milliliters are in an ounce? |
| Preparation | How should ampicillin be reconstituted? |
| Pharmacy Law | In what controlled substance schedule is zolpidem (Ambien)? Can Tiazac be substituted for Cardizem CD (is it AB rated)? How many times can a prescription be transferred from one store to another? |
| Miscellaneous | Where can I find the phone number for SanofiAventis? When will the patent for Lipitor expire? Where can I get more Lovenox teaching kits? Where can I find the Vaccine Information Sheet for the influenza vaccine? |
As explained above, it is critical that technicians differentiate questions that fall within their scope of practice from those that may be answered only by a pharmacist.
Technicians should not interpret a patient-specific question or provide information that requires professional judgment.
Sometimes a simply stated question can actually represent a complex patient-specific situation. For example, the pharmacist may need to learn more about the patient’s specific problems and apply clinical judgment in order to answer the question appropriately and completely. Many times, the person requesting the information is indirectly asking for a pharmacist’s point of view or interpretation of a situation, which requires an in-depth analysis and recommendation from the pharmacist. For a technician, attempting to interpret or answer such a question could result in miscommunication and the delivery of inaccurate information, both of which could be potentially harmful to the patient. If there is any doubt about the nature of the question, the technician should defer the question to the pharmacist.
Table 7–2. Drug Information Questions Appropriate for Pharmacists
| Question Classification | Examples | Rationale |
| Identification and Availability | What is paracetamol and what is its U.S. equivalent? | Although it is appropriate for a technician to obtain technical information about availability (e.g., anticipated length/reasons for a shortage), questions that require clinical knowledge, such as therapeutic alternatives, must be answered by a pharmacist |
| Allergies | Which narcotic is safe to use in a patient with a codeine allergy? | For allergy questions, the pharmacist must obtain more patientspecific information, such as a description of the allergy and the condition being treated. Clinical judgment is required. |
| Dosing and Administration | What is the usual dose of propranolol? How long should ciprofloxacin be given for a urinary tract infection? What is the best way to give gentamicin IV? | Answers to dosing and administration questions depend on many factors, especially the indication for use and patient-specific information (e.g., age, weight, and kidney and liver function). |
| Compatibility | Is Primaxin compatible with dopamine? | More information is needed (e.g., doses, concentrations, fluids, and type of IV lines), and a pharmacist must interpret information found in a reference and apply it to the situation. |
| Drug Interactions | Is it OK to take aspirin with warfarin? | Drug interaction questions are complex and require patient-specific information and interpretation by a pharmacist in order to apply the significance of a potential interaction to a specific patient. |
| Side Effects | Can Celebrex cause renal failure? | Package inserts and textbooks provide lists of side effects that are often difficult to interpret and convey. Also, a pharmacist must interpret whether the request is being made because an adverse event is suspected with one or more medications. |
| Pregnancy and Lactation | Is albuterol safe to use in pregnancy? Can I get a flu shot if I am breastfeeding? | Pregnancy and lactation questions are complicated because more information is needed about the patient, the stage of pregnancy, and/or age of the infant. A pharmacist must interpret the findings and apply them to the specific situation. |
| Therapeutic Use | Has clonidine been used to treat opiate withdrawal? | The use of drugs for non-FDA-approved uses often requires evaluation and interpretation of the literature and clinical judgment. |
Don’t attempt to answer a question when there is any doubt about its nature.
Table 7–2 provides examples of questions that require a pharmacist’s interpretation and should not be answered by pharmacy technicians, as well as the rationale for why it is necessary for a pharmacist to answer the question.
Conducting the Search: Choosing the Right References
There are a number of drug information resources available. The key to answering questions quickly and accurately is to know where the necessary information is likely to be found. Not all references contain every possible answer to every drug information question. At times, it may be difficult to find a reference that contains the information that you are seeking. Pharmacists usually search for information until they exhaust all possible resources. Often, they use multiple resources to verify the information that is found, such as in determining the dose of a medication in a pediatric patient. As part of a systematic search strategy, a pharmacist is taught to first consult tertiary references, then secondary references, and, finally, primary references.1
Tertiary references are general references that present documented information in a condensed and compact format. They may include textbooks; compendia (e.g., American Hospital Formulary Service Drug Information (AHFS DI), and Drug Facts & Comparisons); computerized systems, such as Micromedex® Clinical Information System; review articles; or information found on the Internet. Tertiary references are the most common references used because they are easy to use, convenient, readily accessible, concise, and compact. Disadvantages of tertiary references are that information may not be up to date, they may contain errors, and the level of detail on a specific topic may not be deep enough due to space restrictions.
Secondary references include indexing systems such as Medline (further explained later in the chapter), which provide a list of journal articles on the topic that is being searched. Secondary references are used when new or very up-to-date information is required, or when no information can be located in tertiary references.
Primary references are original research articles published in scientific journals, such as the American Journal of Health-System Pharmacists (AJHP) or the Journal of the American Pharmacists Association (JAPhA).
Other resources that can be used include pharmaceutical manufacturers and specialized drug and poison information centers.
If the information cannot be found in a tertiary reference, then the technician should consult a pharmacist, who may advise an alternative search strategy or consult a secondary reference. If time permits, the technician should consult as many resources as possible and compare information from several different sources.
Common References
There are numerous resources that are extremely useful for pharmacy professionals. This section highlights common, reputable drug information resources. A brief discussion of the resource, its features, and questions that the reference will help answer are provided. The following discussion may not apply equally to the various practice settings and does not include all the information resources that are available. Technicians should familiarize themselves with the references in their practice settings to determine which resources best fit their needs.
General Drug Information
General drug information references are found in virtually every type of pharmacy setting and are used frequently by pharmacists and technicians. There are many general information references available in a variety of formats, including textbooks, PDAs, CD-ROMs, and online versions. Following are descriptions of the most common general references that are used by pharmacy professionals.
Drug information databases are now integrated with many computer systems and automated dispensing cabinets, offering drug information directly at the point of care
