 Drug Reference
We have two primary recommendations in this area, the first (DrDrugs) a lower-priced
option suitable for undergraduate medical students or those limited to 8MB
or 16MB of memory, and the second (LexiDrugs) a higher-priced but also more
powerful option for residents and physicians, especially those with 16MB or
32MB units and memory expansion cards. Both titles contain a wealth of accurate
information (even in often-neglected areas like mechanism of action and pharmacokinetics),
include Canadian brand names, and provide updates without sending personal
data to the publisher.
A popular option, ePocrates Rx, is not recommended as a primary reference
for Canadian medical education use, although we recognize that it may have
a useful role in combination with another reference.
The PEPID Portable Drug Companion is a usable reference that may
appeal to users of one of the PEPID clinical products, and the Tarascon Pharmacopoeia
also has many fans. Finally, if your institution has a site licence to another
drug reference, such as MicroMedex, you should definitely take advantage of
that.
Reviews
We have found three useful published reviews of the available PDA drug database software titles:
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Clauson, KA, Seamon MJ, Clauson AS, Van TB. Evaluation of drug information dtabases for personal digital assistants. Am J Health Syst Pharm. 2004 May 15 61(10):1015-24.
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Galt, KA, Rule, AM, Houghton, B, Young, DO, Remington, G. Personal digital assistant-based drug information sources: potential to improve medication safety. J Med Libr Assoc, April 2005, 93(2):229-236.
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Barrons R. Evaluation of personal digital assistant software for drug ineractions. Am J Health Syst Pharm. 2004 Feb 15 61(4):380-5.
Note that these are US publications, and do not include in their criteria
the requirement for Canadian trade names & availability, which is clearly
one of our major interests.
We also recommend that you visit the RxFiles website,
an academic detailing program providing drug information and education to
Saskatchewan Physicians & other Health Care Professionals.
www.rxfiles.ca
Make sure to download the "Drug Resources for Hand-held PDA"
document, in Adobe Acrobat format.
Titles
DrDrugs from Skyscape (www.skyscape.com) is very good, relatively inexpensive, only about 2.4MB in size, does not return usage information to the publisher, and does include Canadian product names (the present version, unlike earlier ones, doesn't include Canadian availability, but has several improvements in indexing and background information). The content publisher is F.A. Davis Company, and the full name is Drug Guide for Physicians. It is user-friendly, accurate, and has sufficient information on drug action, interactions and natural products to provide a good knowledge base for students. It remains our top recommendation for undergraduate medical students or others without a prior wide knowledge base in drug information.
The drugs can be displayed in 7 different lists: An overall index; selectively under generic names, brand names or combination drugs; or under natural product, therapeutic or pharmacologic indexes. Each drug file is divided into 15 different sections of information, easily called up from a menu. These include the usual categories of indication, dosage, adverse effects etc; but the information under [mechanism of] action, pharmacokinetics, time/action profile, patient/family teaching - and even pronunciation - makes this software very useful for those learning about drugs for the first time. The content is accurate and has useful links to explanations of terms or to other related drugs. Each drug listing includes extensive basic information on potential drug interactions. DrDrugs lists a large number of natural product preparations and covers many new drugs (although not as well as LexiDrugs). A well-integrated drug interaction package named iFacts is also available, but is 3 MB in size. Also available for the PocketPC.
LexiDrugs from Lexi-Comp ( www.lexi.com ) is probably the most thorough electronic drug reference available. Lexi-Drugs Platinum is the core drug reference. LexiInteract is an add-on program that allows you to review a comprehensive list of interactions associated with any individual drug. LexiDrugs is without doubt the most up-to-date in terms of current drugs available, and has a link to Special Alerts from the main menu. These features make LexiDrugs the most attractive for those who need a reference for daily clinical use; however, it is less ideal for students, who are in the process of acquiring knowledge on drug use and action.
There are only two ways of displaying the drug lists: as an overall index or as 'pharmacological categories'. The latter is so extensive as to be of limited help in navigating (there are for example 7 groups for adrenergic antagonists/blocking agents). The information content however is excellent. The information is organized under 24 categories, each which can be selected using a 'jump' function which is essentially a menu tag. The information is less friendly to the student than DrDrugs, with no handy explanations of the basics, but there are links to other drug groups where relevant, and other Lexi-Comp products. There are no herbal/alternative products listed. Canadian trade names are included (in the "Comprehensive" view), as is a subscription allowing unlimited updates (to update, a complete re-installation is necessary). Overall, this is the software of choice for the professional, but less user friendly and comprehensive for the student.
The main drawbacks of LexiDrugs are size and cost. Together, the Lexi titles can take up to 6.5 megabytes, making use of a memory expansion card essential on 8MB units (it fully supports the use of Handspring flash memory expansion, SD or CF cards, and the Sony MemoryStick). A discount is available if the two titles are purchased at the same time on their website. A 20-use demo version is available. Also available for the PocketPC.
ePocrates Rx (www.epocrates.com) is one of the best-known Palm drug references--largely because it is, and has always been, free. However, there is now a commercial (not free) version, Rx Pro. Unlike the free version, Rx Pro includes an alternative medicine reference, an infectious disease guide, clinical tables, and the MedMath medical calculator, and does get high marks in the reviews shown above; we have, however, not tested the Pro version, and evaluated it for Canadian content. The free version does include a suite of free MedTools, which includes calculators such as STATCholesterol, Physician Psychiatry Compendica, and an IV Drip Calculator (among others). Both come with a PocketPC version (a relatively new development).
It has been widely reported, and discussed within this committee, that by default ePocrates includes a component (AutoUpdate) that, at every HotSync, returns to the publisher a list of the drugs that have been looked up. In addition, ePocrates requests information about the users occupation and specialty, which is ostensibly used to provide appropriate DocAlert messages. The return of usage information to the company, and the storage of demographic information, bothers some people more than others, and we believe these factors should be taken into consideration when making your decision about whether or not to use the title. The company's explanation about what is done with this information, and how your personal information is kept private, can be found at:
http://www2.epocrates.com/company/privacy.html
ePocrates is simple to navigate, with a general listing as well as a grouping by drug class. The classification is sometimes hard to follow, but is at least of a manageable size (19 classes). The content is basic, with less than the information most students would hope for (much of the material is in the form of lists, with limited explanations). Information on drug pharmacokinetics and mechanism of action is limited. The main concern for those who are unfamiliar with drug information (such as beginning medical students) is that there is some outdated data, especially concerning generic drugs and mechanisms of action. The free ePocrates contains no Canadian trade names, and no information on alternative medicines. Nevertheless, it remains a widely used, user-friendly and well-regarded reference, and its drug interactions feature (MultiCheck) is very popular. Many people, if they have enough free memory, run this as well as another drug reference, and will cross-check between them.
Three Alternatives
Users of PEPID products may wish to consider using the PEPID Portable Drug
Companion ( www.pepid.com ),
a drug reference product that is included with any of their clinical products
(for emergency physicians, family physicians, medical students, nurses, and
EMS and EMT professionals). The Portable Drug Companion is independent of
pharmaceutical company financing (unlike ePocrates) and does include Canadian
trade names, though they are not linked to the main database, and are thus
somewhat less useful than the integrated ones include in Lexidrugs. It also
includes a wide variety of medical calculators. Our reviewers tended to prefer
the LexiDrugs or Skyskape interfaces, but the Portable Drug Companion is a
usable and reasonably comprehensive listing, and PEPID users may find it more
convenient and cost-effective to use it than adding a separate drug reference.
A Pocket PC version is also available.
The Tarascon Pocket Pharmacopoeia ( www.tarascon.com )
is another title that some physicians prefer, for a number of reasons:
- Most of it resides on the memory card
- It has most Canadian tradenames
- Interactions are based on medical letter
- It doesn't report your usage back to the vendor
- It has alternative medicine tables (+ID & a/b)
Tarascon also gets good reviews in the published articles listed above, and also is known for having excellent pediatric content. However, Tarascon has insufficient detail for some people. A 30-day trial is available for you to test it out, and we recommend doing this if you are interested.
Some hospitals have site licences to MICROMEDEX (from
Thomson Healthcare), which has a downloadable PDA version that focusses on
drug and toxicology data, with concise information on alternative medicines
and acute care included, and even a Diagnosis tool. This is an excellent title,
if a little large and unwieldy to install (it appears to take up 21.5 MB on
a Tungsten T5) and for most uses can replace any of the titles above, if you
have access to it.
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