drug information and poison information

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Drug information
 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
HISTORY
 First DIC was developed in University of Kentucky in 1960. In United states 80% of
the Hospitals having DIC.
 INDIA, in infancy stage with a few centers.
 In India beginning has been made by the professor of pharmacology Mumbai at a govt
medical college
 CMC and Hospital vellore has been trying in this direction earlier
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.
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;

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 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;
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
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

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 Internet
 Phone calls to Manufacturers
 Government and Non-government organizations
 and also to other DIC’s.
DRUG INFORMATION SKILLS
 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.
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

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 Provider should take time to evaluate the info, analyze and then synthesize it into a
good reply
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.
DRUG LITERATURE EVALUATION
 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.
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.

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 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.
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).
STAFFING
 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 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.

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 Should provide proper information irrespective of the informer’s status,but
accordingly with informer’s status.
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.
POISON INFORMATION
HISTORY
 The first centers were instituted in North America and Europe during the 1950’s.
 The International Programme on Chemical Safety (IPCS) was established in 1980
as a collaborative programme of the International Labor Organization (ILO), the
United Nations Environment Programme (UNEP), and the World Health
Organization (WHO) in order to provide assessments of the risks to human health
and the environment posed by chemicals.
 The IPCS provides guidance on the use of such assessments and seeks to strengthen
the capacity of each country to prevent and treat the harmful effects of chemicals and
to manage emergencies involving chemicals.
 Its work on prevention and treatment of poisoning is undertaken in collaboration with
the World Federation of Associations of Clinical Toxicology Centers and Poison
Control Centers and its member associations.
 The aims of the European Commission (EC) in the field of poison control are similar
to those of the IPCS and many activities are undertaken jointly by the two bodies.
POISON INFORMATION SERVICES

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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
STAFFING
ƒ Pharmacy 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.
The poison information centre is a specialized unit providing information on
poisoning, in principle to the whole community.
 Its main functions are provision of toxicological information and advice,
management of poisoning cases, provision of laboratory analytical services,
toxicovigilance activities, research, and education and training in the prevention and
treatment of poisoning.
 As part of its role in toxicovigilance, the centre advises on and is actively involved in
the development, implementation, and evaluation of measures for the prevention of
poisoning.
 It also plays an important role in developing contingency plans for, and responding
to, chemical disasters, in monitoring the adverse effects of drugs, and in handling
problems of substance abuseAssess and treatment recommendations during poisoning
via 24-hour emergency telephone services
 Provide public and professional educational programs

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 To collect data on poisonings
 To perform research
 Assist the public and health care providers during hazardous material spills
 Drug information and Pharmacovigilance
 Substances of abuse
 Environmental toxicology
 Contingency planning for chemical incidents and disasters
 Cooperation and interrelationships
TEACHING AND TRAINING
 The experience gained in a poison information centre can be an important source of
human and animal toxicological data.
 The application and communication of this knowledge are vital for improving the
prevention and management of poisoning. Centers thus have educational
responsibilities that extend to the training of medical practitioners and other
professional health workers likely to encounter cases of poisoning, and to
communication with the local population and the mass media.
 Later sections of these guidelines include advice on the training needs of centers as
well as on their teaching and training functions.
TOXICOVIGILANCE
 Toxicovigilance is an essential function of poison information centers. It is the active
process of identifying and evaluating the toxic risks existing in a community, and
evaluating the measures taken to reduce or eliminate them.
 Analysis of enquiries received by centers permits the identification of those
circumstances, populations, and possible toxic agents most likely to be involved, as
well as the detection of hidden dangers.
 The role of a centre in toxicovigilance is to alert the appropriate health and other
authorities so that the necessary preventive and regulatory measures may be taken.
 This role enables them to make a major contribution to the prevention of poisoning
through their collaboration with the health and other appropriate authorities.
ENVIRONMENTAL TOXICITY
 Poison information centres, particularly in countries where there is no other readily
accessible source of information on toxic chemicals, are being asked to provide

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information on the effects of environmental contaminants, on the risks associated with
toxic wastes, and on safe levels of chemicals in the environment and in food and other
consumer goods.
 Medical practitioners must also be provided with data on the possible effects of
exposure to environmental contaminants, and information on the types of biological
and other samples that should be collected and analyzed.
 Mechanisms for the systematic collection, validation, and follow-up of data should be
established; it is also essential that the data are comparable, both nationally and
internationally, so that they may be used for the benefit of all.
CONTINGENCY PLANNING FOR CHEMICAL INCIDENTS AND
DISASTER
 Poison information centers can contribute to the handling of major chemical incidents
and disasters by providing appropriate information in the event of an emergency and
by taking an active part in contingency planning and in education and training.
 They should also take part in epidemiological follow-up studies and other research
initiatives, where appropriate, collaborating and acting in concert with other bodies
involved in accident prevention and control.
 A national or regional poison information centre can serve to centralize and
coordinate such activities.
BENEFITS
 Service provided by poison information centers offers considerable direct health
benefits by reducing morbidity and mortality from poisoning and enabling the
community to make significant savings in health care costs.
 Mild poisoning cases that can be treated by first-aid measures alone or by non-
hospital medical personnel are quickly recognized. Specific antidotes, therapeutic
agents, and medical equipment can be made more easily available through
coordination of stocks, so reducing costs and saving lives.
 Centers can also help to prevent the unnecessary use of special antidotes and of
sophisticated and expensive treatments.
 The case data collected by centers provide an epidemiological basis for local
toxicovigilance and contribute to the international fund of knowledge about human
toxicology and management of poisoned patients.
 The education and training provided by poison information centers enable
professional health workers and the general public to recognize and avoid the dangers
of poisoning and to take effective action when poisoning incidents occur.

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