PHA 458 Exam I and Final Exam 2022 with complete
solution
Evidence based approach to answering clinical questions steps
4 A's
Ask (the question)
Acquire (the evidence)
Appraise (the evidence)
Apply (the evidence to the patient case or question)
PICO
Patient or problem
Intervention
Comparison
Outcome
What to do "Ask" or define the question
PICO
What to do to "Acquire" the evidence
Determine the type of information or evidence needed
Package inset
Practice guidelines
Clinical research
Conduct a systematic search for this information
What to do the "Appraise" the evidence
Is it relevant?
Is it valid?
Are the results statistically significant?
Are the results clinically significant?
What to do the "Apply" the evidence
Clinical judgement/reasoning calls for you to determine how the evidence can be best
applied to your patient
Drug Interaction Facts
Includes documentation level and onset
Includes interactions with food/alcohol
Includes precautions for special populations
Includes diseases/conditions and allergies
Levels of severity assigned to drug interactions in Drug Interaction Facts
Major- interaction is life threatening or may cause permanent damage
Moderate- the interaction may cause the patient's clinical status to deteriorate and
additional treatment, hospitalization, or an extended hospital stay may be necessary
Minor- the interaction usually have mild effects that may be bothersome or unnoticeable
but should not affect the therapeutic outcome and more treatment is usually not
necessary
Lexi-Interact
Allergies
Clinical pharmacology interactions
,Alcohol, caffeine, enteral feedings, food, grapefruit juice, tobacco
Can run professional or consumer report
Clinical pharmacology interactions ratings
Severe- avoid using these drugs together (CI)
Major- using the medications together may be CI in certain patients, the patient should
be monitored and further therapy and/or a change in therapy may be necessary
Moderate- using the medications together may have unintended clinical effects, the
patient should be monitored or changes in therapy may be necessary
Minor- using the medications together does not usually result in clinically significant
interactions and monitoring or changes in therapy are not usually required
Lexi-interact ratings
A- no known interaction
B- no action needed
C- monitor therapy
D- consider therapy modification
X- avoid combination
Includes severity and reliability rating
Name a resource that focuses specifically on side effects of drugs
Meyler's Side Effects of Drugs
Resources that report adverse reactions
Facts and comparisons- drug search by adverse reaction
Lexi-comp- drug search by adverse reaction
Clinical pharmacology- adverse reaction report, find/list by adverse reaction report, drug
allergy and idiosyncratic reactions database
Meyler's Side Effects of Drugs
Individual drug monographs in alphabetical order
Important monograph features:
Organs and systems
Long-term effects
Second-generation effects
Susceptibility factors
Drug administration
Drug interactions
Interference with diagnostic tests
Diagnosis of adverse drug reactions
Management of adverse drug reactions
Monitoring thearpy
Side Effects of Drugs Annual
Published as a compliment to Meyler's
Chapters arranged as drug classes
Reviews publications over the past year
How does the FDA define a serious adverse event
One in which the patient outcome is death, a life-threatening condition, initial or
prolonged hospitalization, disability or permanent damage, or congenital anomaly/birth
defect; intervention is required to prevent permanent impairment or damage
FDA Adverse Events Reporting System (FAERS)
, Reporting and searching for adverse events
Search by product or reaction
Pregnancy and Lactation sources
Facts & Comparisons- information in monograph, link to Briggs
Lexi-Comp- information in monograph, link to Briggs
Clinical Pharm- information in monograph
Explain how Drugs in Pregnancy and Lactation differs from the Drugs and
Lactation Database (LactMed)
Briggs has a drug use in pregnancy section while LactMed just has drug use in lactation
LactMed has more information about drugs used in lactation in their monographs
including maternal and infant drug levels, effects in breastfed infants, possible effects on
lactation, and alternate drugs to consider
A widely used pediatric resource written by medical residents at The Johns
Hopkins Hospital is called
The Harriet Lane Handbook
Pediatrics resources
Facts & Comparisons- information in monograph
Lexi-Comp- pediatric and neonatal lexi-drugs
Clinical pharm- Separate pediatric monograph
The Harriet Lane Handbook
Nelson Textbook of Pediatrics
Current Diagnosis and Treatment: Pediatrics
Compatability and stability resources
Trissel's Handbook on Injectable Drugs
Lexi-comp and Facts both link to Trissel's
Clinical Pharm has compatibility checker
Compounding resources
International Journal of Pharmaceutical Compounding (IJPC)
Lexi-Comp
Natural Products resources
Facts & Comparisons and Lexi-Comp- natural products database
Clinical pharmacology- Has around 100 natural product monographs
Natural medicines
NIH database
Herbal Medicine: Expanded Commission E Monographs- not updated since 2000
What are the ratings for Natural Medicines based off of
Safety: likely safe, possibly safe, possibly unsafe, likely unsafe, and unsafe
Effectiveness: Effective, likely effective, possibly effective, possibly ineffective, likely
ineffective, and ineffective
Foreign Drugs resources
Lexi-Comp- Martindale, Lexi-Drugs international
Clinical Pharmacology- searches global drugs
Toxicology resources
Goldfrank's Toxicology Emergencies
Poisoning and Drug Overdose
Lexi-Tox
solution
Evidence based approach to answering clinical questions steps
4 A's
Ask (the question)
Acquire (the evidence)
Appraise (the evidence)
Apply (the evidence to the patient case or question)
PICO
Patient or problem
Intervention
Comparison
Outcome
What to do "Ask" or define the question
PICO
What to do to "Acquire" the evidence
Determine the type of information or evidence needed
Package inset
Practice guidelines
Clinical research
Conduct a systematic search for this information
What to do the "Appraise" the evidence
Is it relevant?
Is it valid?
Are the results statistically significant?
Are the results clinically significant?
What to do the "Apply" the evidence
Clinical judgement/reasoning calls for you to determine how the evidence can be best
applied to your patient
Drug Interaction Facts
Includes documentation level and onset
Includes interactions with food/alcohol
Includes precautions for special populations
Includes diseases/conditions and allergies
Levels of severity assigned to drug interactions in Drug Interaction Facts
Major- interaction is life threatening or may cause permanent damage
Moderate- the interaction may cause the patient's clinical status to deteriorate and
additional treatment, hospitalization, or an extended hospital stay may be necessary
Minor- the interaction usually have mild effects that may be bothersome or unnoticeable
but should not affect the therapeutic outcome and more treatment is usually not
necessary
Lexi-Interact
Allergies
Clinical pharmacology interactions
,Alcohol, caffeine, enteral feedings, food, grapefruit juice, tobacco
Can run professional or consumer report
Clinical pharmacology interactions ratings
Severe- avoid using these drugs together (CI)
Major- using the medications together may be CI in certain patients, the patient should
be monitored and further therapy and/or a change in therapy may be necessary
Moderate- using the medications together may have unintended clinical effects, the
patient should be monitored or changes in therapy may be necessary
Minor- using the medications together does not usually result in clinically significant
interactions and monitoring or changes in therapy are not usually required
Lexi-interact ratings
A- no known interaction
B- no action needed
C- monitor therapy
D- consider therapy modification
X- avoid combination
Includes severity and reliability rating
Name a resource that focuses specifically on side effects of drugs
Meyler's Side Effects of Drugs
Resources that report adverse reactions
Facts and comparisons- drug search by adverse reaction
Lexi-comp- drug search by adverse reaction
Clinical pharmacology- adverse reaction report, find/list by adverse reaction report, drug
allergy and idiosyncratic reactions database
Meyler's Side Effects of Drugs
Individual drug monographs in alphabetical order
Important monograph features:
Organs and systems
Long-term effects
Second-generation effects
Susceptibility factors
Drug administration
Drug interactions
Interference with diagnostic tests
Diagnosis of adverse drug reactions
Management of adverse drug reactions
Monitoring thearpy
Side Effects of Drugs Annual
Published as a compliment to Meyler's
Chapters arranged as drug classes
Reviews publications over the past year
How does the FDA define a serious adverse event
One in which the patient outcome is death, a life-threatening condition, initial or
prolonged hospitalization, disability or permanent damage, or congenital anomaly/birth
defect; intervention is required to prevent permanent impairment or damage
FDA Adverse Events Reporting System (FAERS)
, Reporting and searching for adverse events
Search by product or reaction
Pregnancy and Lactation sources
Facts & Comparisons- information in monograph, link to Briggs
Lexi-Comp- information in monograph, link to Briggs
Clinical Pharm- information in monograph
Explain how Drugs in Pregnancy and Lactation differs from the Drugs and
Lactation Database (LactMed)
Briggs has a drug use in pregnancy section while LactMed just has drug use in lactation
LactMed has more information about drugs used in lactation in their monographs
including maternal and infant drug levels, effects in breastfed infants, possible effects on
lactation, and alternate drugs to consider
A widely used pediatric resource written by medical residents at The Johns
Hopkins Hospital is called
The Harriet Lane Handbook
Pediatrics resources
Facts & Comparisons- information in monograph
Lexi-Comp- pediatric and neonatal lexi-drugs
Clinical pharm- Separate pediatric monograph
The Harriet Lane Handbook
Nelson Textbook of Pediatrics
Current Diagnosis and Treatment: Pediatrics
Compatability and stability resources
Trissel's Handbook on Injectable Drugs
Lexi-comp and Facts both link to Trissel's
Clinical Pharm has compatibility checker
Compounding resources
International Journal of Pharmaceutical Compounding (IJPC)
Lexi-Comp
Natural Products resources
Facts & Comparisons and Lexi-Comp- natural products database
Clinical pharmacology- Has around 100 natural product monographs
Natural medicines
NIH database
Herbal Medicine: Expanded Commission E Monographs- not updated since 2000
What are the ratings for Natural Medicines based off of
Safety: likely safe, possibly safe, possibly unsafe, likely unsafe, and unsafe
Effectiveness: Effective, likely effective, possibly effective, possibly ineffective, likely
ineffective, and ineffective
Foreign Drugs resources
Lexi-Comp- Martindale, Lexi-Drugs international
Clinical Pharmacology- searches global drugs
Toxicology resources
Goldfrank's Toxicology Emergencies
Poisoning and Drug Overdose
Lexi-Tox
