Responding to 


Drug Information Inquiry

Charliemaign Stanley S. Cruz, R.Ph., MSc.
 The Inquiry

Is any question/query made by a certain

requester in search for any information regarding
a medication.

Can be via different means of communication

Steps in Providing 

Drug Information
 Analyze Data
Receive the Search for Data
and Formulate
Question
Response

Follow-up Communicate
Response
 Step 1:

Receive and Understand the Question

Receive, Expand and Classify

Identify the Requester

Obtain Necessary Background Information

Identify the Type of Question

Reformulating the Request

 Step 1:

Receive and Understand the Question

Identify the Requester

The depth of response is DEPENDENT on the REQUESTER
Level of complexity
Under-answering vs. Over-answering
Level of urgency
Mode of response
 Step 1:

Receive and Understand the Question

Obtain Necessary Background Information

General Research Questions
Patient-specific Questions

“Obtaining appropriate and necessary background

information is the KEY to understanding and
reformulating the QUESTION”
 Step 1:

Receive and Understand the Question

Common Types of Drug Information Requests

ADRs Drug Identification
Compatibility/Stability Drug recalls
Compounding/Formulation Drug usage in Pregnancy
Identify the Type of Question
Contraindication/warning/ Efficacy in specific disease states
precaution
Cost/Pharmacoeconomics Formulary status of Drugs
Dosing/Dosing Schedule General prescribing/monograph
Drug availability Pharmacology/Pharmacokinetics
Drug Interactions Toxicology/Poisonings
 Step 1:

Receive and Understand the Question

Reformulating the Request

Was the appropriate question asked?
What does the requester really want to know?
What does the requester really need to know?
How will the information be used?
 Step 2:

Search for Data

Primary

Secondary

Tertiary
 Step 2:

Search for Data
Tertiary Resources
General literature, made from summarized, integrated and
evaluated original reports
textbooks and reference books
Advantage:
provides literature review
accessible and simple to use
Disadvantage:
bias from authors
lack of depth and detail
out-dated information
 Step 2:

Search for Data
Secondary Resources
indexing and abstracting services
published texts, newsletter, microfilm, CD-ROM, online
services
Advantage:
Rapid access to specific topics in the primary literature
Disadvantage:
lag time on when the information was made public and indexed
requires training/expertise to use
 Step 2:

Search for Data

Primary Resources
-un/published study, original papers, reports in journals
Advantage:
current, detailed and allows personal assessment of information
Disadvantage:
may miss conflicting evidences
time-consuming
 Step 3:

Analyze Data & Formulate Response
“Critical information that defines the problem
and elucidates the context of the question is not
readily volunteered.”

“Providing information without knowledge of

pertinent patient information, context of request,
or how the information will be applied can be
detrimental.”
 Step 3:

Analyze Data & Formulate Response

Patient Factor Hx of present illness

demographics PMH
primary diagnosis FH/Genetics/SH
allergies/intolerances review of systems
end-organ function/ medication
immune function/
nutritional status PE/Lab tests

chief complaint diagnostic studies

 Step 3:

Analyze Data & Formulate Response

Disease Factor

definition
Tx
epidemiology
prevention & control
etiology
risk factors
pathophysiology
complications
clinical findings
prognosis
diagnosis
 Step 3:

Analyze Data & Formulate Response

Medication Factor
indication
name of medications
use
status & availability
adverse effects
physicochemical properties
allergy
pharmacology
cross-allergenicity/cross-
PD/PK
reactivity
pharmacogenetics
contraindication/precaution
 Step 3:

Analyze Data & Formulate Response

Medication Factor

effects of patient
demographics/ DI/Lab test interference
environment administration
mutagenicity/ dosage form/regimen
carcinogenecity
monitoring parameters
effect of fertility
product preparation
acute/chronic toxicity
compatibility/stability
 Step 3:

Analyze Data & Formulate Response

Pertinent background
Information unusual circumstances

setting acuity/time constraints

context scope of question

sequence/time frame of depth of response

events
resource limitation
rationale for the question
sufficient quality info
events prior to question
applicability of response
 Step 3:

Analyze Data & Formulate Response

Analysis and Synthesis

the most critical steps in formulating a responses

and recommendation

Analysis - separating information into isolated

parts for critical evaluation

Synthesis - careful, systematic, & orderly

process of combining varied resource into a
coherent response
 Step 4:

Communicate the Response
Verbal, written, or combination of both
engage in a DIALOG
address 3 basic factors:
confirmation that the information was RELAYED effectively
confirmation that the recipient UNDERSTOOD the information
provided
opportunity to give final “RECOMMENDATION”
response should always be in ORGANIZED LOGICAL
FASHION
 Step 4:

Communicate the Response

Characteristic of a Response:

timely clear and logical

accurate objective and balanced

complete free of bias

consice applicable and appropriate

supported by best evidence answer the related questions

available
address specific
well-referenced management of patients
 Step 5:

Follow-up
Purpose:
How was the information used
Did the information made a positive impact on patient care
Was is it adequate
Was is it provided in a clear, logical manner
Were there additional information needs

DIRECT CONTACT
is the most accurate method of receiving feedback
 Sample Case
INITIAL QUESTION:

“Are there any drug interactions between

labetalol, clonidiine, amlodipine,
lorazepam and minoxidil?”
 Sample Case

PERTINENT BACKGROUND INFORMATION:

The requestor is Dr. Augustus Potter who is

caring for a patient with sever hypertension. He
plans to add minoxidil to the hypertensive
regimen because the patient’s morning blood
pressure is not optimally controlled. He would
like to make sure that there are no drug
interactions between minoxidil and the other
medication.
 Sample Case

PERTINENT PATIENT FACTORS:

Joaquin Valdez is a 40-year old man with severe hypertension

and renal insufficiency

PMH

HIV infection x 5 years

Hepatitis x 8 years

HT x 4 years

Renal dysfunction
 Sample Case

PERTINENT PATIENT FACTORS:

SH

1-2 pints vodka daily x 12 years

1 PPD of cigarettes x 25 years

Hx of IV drug abuse
 Sample Case

P E RT I N E N T PAT I E N T lorazepam 1 mg PO
FACTORS: PRN for anxiety

Current medication multiple vitamin PO

OD
labetalol 400 mg PO
OD @ 9 AM no complimentary/
non-Rx meds
clonidine trasdermal
patch 0.3 mg/day Allergy

amlodipine 10 mg PO lisinopril (angioedema)

OD @ 9 AM
 Sample Case

PERTINENT PATIENT FACTORS:

Lab Results

Na (136 mmol/L), K (4.7 mmol/L), Cl (102 mmol/

L), CO2 (136 mmol/L), Crea (2.9 mg/dL), glucose
(98 mg/dL), BUN 14 mg/dL

Viral DNA <100 copies/mL

Cluster designation 4 (CD4) count 900 cells/mm3

 Sample Case

PERTINENT PATIENT FACTORS:

Lab Results (Blood pressure)

4/15 4/16 4/17

@6AM 172 / 116 168 / 100 178 / 114
@NOON 121 / 81 116 / 86 119 / 84
@8PM 158 / 100 150 / 104 166 / 100
 Sample Case

PERTINENT DISEASE FACTORS

it is not known whether patients with HIV

infection respond differently to anti-
hypertensive medications
 Sample Case

PERTINENT MEDICATION FACTORS

there are no primary/tertiary literature reports

describing DI between minoxidil and any of the
other meds of Joaquin Valdez.

The prescribed meds are appropriate for

achieving adequate blood pressure control even
wit significant renal compromise.
 Sample Case

1. Give an analysis and synthesise the information

about the case.

2. Provide a response for the need of the requester.