for lecture (B.Pharm final semester,Nepal)

2. Introduction ;
 It is the current, relevant, critically examined data
about drug and drug use for given patient or
situation.
 Many institutes run DIC(Drug Information Center) for
the provision of drug information, to every
group/kind of people from any place

3.  First DIC was developed in University of
Kentucky in 1960. In United states 80% of the
Hospitals having DIC.
 Nepal, in infancy stage with a few centers.
 In Nepal DDA has started this type of services.

4. Need of drug information
 The no of drugs in the international market has increased very much
 The newer drugs are generally more potent & selective, and
formulations becoming increasingly complex
 The literature on drugs has also expanded and covers a wide range of
information
 To introduce a new drug into the practice, the professionals need to
evaluate the given information.
 A simple,quick reference to a pharmacopoeia or formulary is no
longer sufficient.

5. Aims and objectives of drug information services
 The provision of information to health professionals on
specific problems related to the use of drugs in particular
patients;
 The provision of information to officials in government
agencies to optimize the decision making process;
 The preparation and development of guidelines and
formularies;
 To improve patient compliance and to provide a guide to
responsible self medication;
 To develop and participate in continuing education
programs;

6.  To participate in undergraduate and graduate teaching
programs;
 To develop educational activities regarding the appropriate use
of drugs for patients in the community;
 To prepare and distribute material on drugs to health personnel
in the form of a drug Information bulletin and/or other media;
 To develop and participate in research programs;

7. The Sources of information/Resources available
Primary Source:
 Information is presented by authors without any evaluation by a second party.
 Provides must current information about drugs.
 Examples; articles published in journals(eg British Medical Journal), thesis etc.
Secondary source
 The original source has been evaluated by second party other than the publisher.
 Modified and rearranged form
 Examples; review articles like lexis-nexis, Medline etc
Tertiary source
 Information obtained from primary and secondary source and arranged in a
manner to represent a composite of the available information.
 Examples; Representative form Pharmacopeias - BP, USP, IP, BNF etc., Encyclopedia
Dictionaries Guides, text books

8. Other Sources:
The DIC also receives information from
The public and hospitals about the Adverse effects of any drug
 Local drug lists
National Formularies
Hospital Formularies
 Internet
Phone calls to Manufacturers
 Government and Non-government organizations
 and also to other DIC’s.

9.  Drug informer should understand the nature of the question and should ask
all the needed questions to get the ultimate question
 Most specialists today use the modified systematic approach designed by
‘Host and Kirkwood’, these are;
Step I ; Secure demographics of the requestors
 Who requests?
 Med/non med personnel
 Educated/un educated personnel
 Name/location/phone/email etc of requestor
This determines the type of response that will be given
Step II; Obtain background information
 Where the requestor heard/read about the drug?
 Is he/she taking medicine? Why?
 Is he/she a caregiver/wants to take medicine?
 This helps determining what additional information should be provided.

10. Step III; Determine and categorize the ultimate question
 Putting the pieces of information together to form ultimate question and
once it has been determined, the next step is to categorize the question.
Step IV;Develop strategy and conduct research
 Strategies should be developed with a typical algorithm with three essential
components; tertiary-secondary-primary literature
Step V;Perform evaluation, analysis & synthesis
 Provider should take time to evaluate the info, analyze and then synthesize
it into a good reply

11. Step VI;Formulate and provide response
 An outline should be established to help formulate a
response to the drug info request.
 Its important to have; introduction, body and conclusion
Step VII;Conduct follow-up and documentation
 Checking with the requestor to make sure his/her question
has been sufficiently and completely answered.
 Of vital importance is to document all the steps taken in this
process.

12.  Among the skills of drug information is a knowledge of drug literature
evaluation which allows one to provide a critical analysis of the literature
and have a better understanding of the studies done in health and medicine.
 It is a key component to provide a good quality answer to a requester
 Being able to separate good data from poor data is essential
 Knowing the limitations of any study can help in evaluating the usability of
its data
 Drug information specialists will often use some standard questions to help
in this process
 Several references provide guides to evaluate the medical and pharmacy
literature.

13.  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.

14.  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.

15.  Research the Facts, gather information(from the resources available i.e.
tertiary- secondary- primary resources)about the question of oral report.
 List the facts and interesting information accurately.
 Remember that relevant details and vivid descriptions will make oral report
more interesting
 Organize the Information/oral report in three parts.
◦ Introduction
◦ Body (main part)
◦ Conclusion
 Practice Giving the Oral Report
 Speak clearly and deliberately
 Make A Final Copy of Report Notes.

16. Drug information centers
 Drug information centers (DICs) in general, are service
providers, which provide drug information relating to
therapies, pharmacoeconomics, education, and research
programs.
 It provides unbiased information to health care
professionals and/or patients and consumers.
 Many centers also provide workshops or other forms of
training to enhance the skills of healthcare professionals.
 A drug information center is usually a unit located within
and/or affiliated with a larger organization (i.e., a
pharmaceutical association, a hospital etc).

17.  Pharmacist; specialists with proper knowledge of drug and
actions associated with it with academic degree. ƒ
(they provide drug information)
 Pharmacy Technicians & Students
(they assist pharmacists in providing drug information like literature
searching,retrieval of data,resources updating etc)
 People trained in library science with computer
knowledge
(they are supporting staffs in DIC for their own expertise)
ƒ

18.  The center should have specific hours of operation(24hrs
preferably) and adequate technological resources (i.e.,
computers, phone lines, faxes, etc.)
 The drug information center should have the latest
publications and ideally publish a newsletter or other
informational updates.
Role of Pharmacist:
 Must be a part of DIC,should be “ready to go” for information
all the time.
 ‘The Drug-Information Pharmacist’ is at interface of vast
amount knowledge on onside and the persons needing the
knowledge on other.
 Should provide proper information irrespective of the

19. Drug Information Centers in Nepal
Four organizations in Kathmandu were initially identified as potential sites for
drug information centers:
 Department of Drug Administration (DDA), Ministry of Health
 Drug Information Unit(DIU), Tribhuvan University Teaching Hospital
 Resource Centre for Primary Health Care (RECPHEC), a local non-
governmental organization
 Nepal Chemists and Druggists Association (NCDA), a professional
association for retailers and wholesalers
 A fifth organization, the Nepal Health Research Council(NHRC), also
expressed an interest in establishing a drug information center. NHRC is a
relatively new, quasi-governmental body whose mission is to review and
approve all proposals for medical and health research to be conducted in
Nepal.

20. Drug Information Network of Nepal (DINoN)
 The Drug Information Network of Nepal (DINoN) was established on
23rd September, 1996 with multi-sectoral participation including
government, academic and non-government institutions to provide
unbiased information on drugs to various constituency groups.
 A single organization may not have enough expertise, resources and
capacity to satisfactorily meet the drug information needs of a wide
range of target groups
 DINoN is an initiative to develop and disseminate information about
the proper use of drugs, possible adverse reactions,
contraindications, toxicity, drug standards and efficacy, precautions,
and proper storage and handling to health care professionals in the
public and private sector, and to consumers.

21. Founder members of DINoN
 DDA, Ministry of health and population
 Tribhuvan University Teaching Hospital, Drug Information Center
 Nepal Chemists and Druggists Association (NCDA)
 Resource Center for Primary Health Care (RECPHEC)
 Nepal Health Research Council (NHRC)
Ordinary members of DINoN
 United Hands to Nepal Poison Information Center (UHN)
 Britain Nepal Medical Trust (BNMT)
 B.P. Koirala Institute of health Sciences (BPKIHS)
 Manipal College of Medical Sciences (MCOMS)

22. Note;
 The primary role of a DIC in a developing country is to give clear and
definitive information on well-established essential drugs and
promote their rational use.
 A secondary role would be to keep up-to-date with pharmacological
and therapeutic literature and to disseminate relevant
information, as it becomes available.

23. Drug information bulletin
 It publishes the latest developments in medical sciences, the newly introduced
drugs, new indication and other information regarding drugs.
 One of the PTCs duties is to assist the pharmacist in conducting a teaching
program within the hospital through a pharmacy publication.
 The methods employed to disseminate interdepartmental information are usually
bulletins, bulletin board notices and committee meetings.
 The bulletin normally publishes the latest development in the medical sciences,
the newly introduced drugs, new indications for certain drugs, newer drug delivery
systems, updates on drug interactions and ADRs.
 Pharmacist is normally held responsible for its publication however; contributions
are obtained from pharmacists, physicians and nursing and other interested
groups like therapeutic dietician for food drug interactions for publishing the
bulletin.
 The contents should however be educative and informative.

24. PCC(Poison control center);
 For the provision of service regarding poison and
related danger, and to manage with the poisoning
Cases
 Concept initiated in chicago in 1953
PCC were established for two reasons:
 To provide rapid access to information valuable in
assessing and treating poisonings.
 To assist with poisoning prevention

25. ƒPharmacy team
 pharmacist; specialists trained in poison information
and in the management of poisoning emergencies. ƒ
 Pharmacy Technicians & Students ƒ
Medical team
 Toxicologists specializing in medical toxicology are
also available for consultation.
Supporting team
 People trained in library science with computer
knowledge

26. ◦ Assess and treatment recommendations during
poisoning via 24-hour emergency telephone services
◦ Provide public and professional educational programs
◦ To collect data on poisonings
◦ To perform research
◦ Assist the public and health care providers during
hazardous material spills

27.  My daughter is 2 years old and just swallowed ½
a bottle of PCM… ƒ
 I just turned my heater on for the winter season
and I am feeling light headed…
 ƒ I’m 72 years old and think I took a double dose
of my medicine… ƒ
 I have a patient who swallowed …? ƒ

28.  Exact name of the product involved (have the container
close at hand) ƒ
 Amount of poison the person was exposed to ƒ
 Any symptoms ƒ
 Time of exposure
 Age and weight of the victim ƒ
 Any health problems the person has ƒ
 Any treatment that has been given ƒ
 Where the person is ƒ
 How the person was poisoned

29.  Obtain History
 Consult References
 Assess Risk & Formulate Treatment Plan
 Communicate Assessment and
Recommendations to Client
 Complete Coding & Documentation

31.  Poison; Any substance that can harm the body by altering
cell structure or functions
 Toxin; A poisonous substance secreted by bacteria, plants,
or animals
◦ Examples: Mushrooms,Variety of plants, Bacterial contaminants in
food
Common Ingested Poisons
Acetaminophen
Acids and alkalis
Antihistamines
Food poisoning
Insecticides
Petroleum products
Plants (cont.)

32. Inhalation
Absorption
Injections
Ingestion

33. Acids and Alkalis
Burns on or around the lips
Burning in mouth, throat, and abdomen
Vomiting
Food Poisoning
Various types of signs and symptoms
Abdominal pain
Nausea and vomiting
Diarrhea
Fever

34. Insecticides
Slow pulse
Excessive salivation and sweating
Nausea, vomiting, and diarrhea
Breathing difficulties
Constricted pupils
Petroleum Products
Characteristic odor of breath, clothing, and vomitus
Coughing and difficulty breathing

35. Range of signs and symptoms

36. Important questions to consider asking
patient
What substance?
When did you ingest/become exposed?
If an ingestion, how much did you ingest?
Over what time period?
What Interventions?
How much do you weigh?
[What effects are you experiencing from the
ingestion?]

37. Poisons that are swallowed:
◦ Household and industrial chemicals
◦ Medications
◦ Improperly prepared food
◦ Plant materials
◦ Petroleum products
◦ Agricultural products

38. Ingested Poisons
Signs and Symptoms
Nausea,Vomiting,Diarrhea,Altered mental status,
Abdominal pain,Chemical burns around the mouth,
Different breath odors
Emergency medical care
•Remove from unsafe environment
•Maintain airway and provide oxygen
•Remove pills, tablets or fragments with gloves from
patient’s mouth, as needed, without injuring oneself.
•Consult medical direction
•activated charcoal.
•Bring all containers, bottles, labels, etc.
of poison agents to receiving facility.

41. Be prepared for vomiting.
Repeat vital signs.
Dilution:
Based on medical direction

42. Antidote—few and limited
Prevent absorption (charcoal).
Supportive care (airway management, oxygenation,
treatment of shock)
Kidney dialysis

43. Poisons that are breathed in:
◦ Gases: ammonia, chlorine
◦ Vapors: carbon monoxide
◦ Sprays: insecticides
◦ Volatile liquid chemicals: change easily from liquid to
gas
G G
A A
S S

44. Fire suppression and
motor vehicle exhaust
indoor cooking in areas
without adequate
ventilatio
Colorless, odorless, and
tasteless gas
Prevents oxygen
binding with red
blood cells

45. Inhaled Poison
Signs and Symptoms
Difficulty breathing ,Chest
pain,Cough,Hoarseness,Dizziness,
Headache,Confusion,Seizures,Altered mental status
Emergency medical care
Follow the chart

47. Poisons taken in through unbroken skin:
◦ Corrosives or irritants
◦ Through bloodstream
◦ Insecticides and chemicals

48. Absorbed Poisons
Signs and Symptoms
Liquid or powder on the patient’s
skin,Burns,Itching,Irritation,Redness
Emergency medical care
Skin--remove contaminated clothing while protecting
oneself from contamination
Powder--brush powder off patient, then continue as
for other absorbed poisons.
Liquid--irrigate with clean water for at least 20
minutes
Eye--irrigate with clean water away from affected eye for
at least 20 minutes

49. Powders—brush powder off. Liquids—irrigate with water for at least
20 min.

50. Toxic injection
Signs and Symptoms
Weakness,Dizziness,Chills,Fever,Nausea,Vomiting
Emergency medical care
Airway and oxygen
Be alert for vomiting.
Bring all containers, bottles labels, etc. of poison agents
to receiving facility.

51. Alcohol and Substance Abuse
Emergency medical care
Establish and maintain a patent airway;
Administer oxygen, as needed.
If the patient is responsive, try to get him to sit or lie on a stretcher.
Monitor the patient’s, mental status and vital signs frequently.
Try to maintain proper body temperature
Take measures to correct or prevent shock
Protect from self-injury,Stay alert for seizures
Transport

52. Perform an initial assessment.
Provide oxygen and assist ventilations, if needed.
Treat for shock.
Perform rapid trauma assessment.
Identify and treat life-threatening problems.
Do focused history and physical exam.
Assess baseline vital signs.
Consult Medical Direction.
Transport with all containers, bottles, and labels.
Perform ongoing assessment. (cont.)

53. Indications:
◦ Poisoning by mouth
Contraindications:
◦ Altered mental status
◦ Ingestion of acids or alkalis
◦ Inability to swallow
Medication form
◦ Pre-mixed in plastic bottle (12.5 grams)
◦ Powdered form
Dosage
◦ Adults and children: 1 gram/kg
Adult dose: 25–50 grams
Pediatric dose: 12.5–25 grams
Actions:
◦ Binds to certain poisons
◦ Reduces absorption
Side effects:
◦ Black stools
◦ Vomiting (cont.)

54.  Syrup of Ipecac
◦ Not so used
◦ Reason for removal;
 It is said that it takes too long to cause vomiting and it does
not remove enough of the poison from the stomach.
◦ Indications - poisoning by mouth

55. Antidotes
Drugs Antidotes
Morphine Naloxone
Benzodiazepines Flumazenil
Barbiturates Tacrine
Acetlycholine Atropine
Warfarin Vitamin K
Isoniazid Vitamin B6
Insulin Dextrose or Glucagon
Paracetamol Acetylcysteine
Heparin Protamine Sulphate