Epocrates and Other PDA Reference Tools 1 NANCY

Epocrates and Other PDA Reference Tools 1 NANCY CLARK, M. ED. DIRECTOR OF MEDICAL INFORMATICS EDUCATION FSU COLLEGE OF MEDICINE

Objectives for Workshop 2 Download and Install on the PDA Use Epocrates Rx find dosage, calculate dosages Identify if drug on formulary Use Multi. Check to find interactions Use Sx to get a Differential Use Dx to find Disease information Use Lab to find Laboratory information Use ID to find recommended Antibiotics Use Med. Math Medical calculators Use Tables for guidelines and algorithms

Handouts 3 Power. Point Downloading instructions for Epocrates Essentials (yellow) Using Epocrates Essentials User. ID and Password sheet (blue) List of PDA software available and description of uses Consent form and evaluations

Installing Software 4 SEE HANDOUT

Links to Download Sites 5

PDA Websites Page 6

FSU Licensed PDA Software 7 Epocrates Essentials ($149/yr) Rx, Sx-Differential diagnosis, Dx-5 MCC, ID, LAB, M -interactions, tables, CME, tools and calculators Info. Retriever ($249/yr) 5 MCC, Cochrane, Info. POEMs, calculators, guidelines, ICD-9 and E&M coder POCKETConsult (FIRSTConsult) ($149/yr) Differential diagnosis, medical conditions Clinical Evidence ($99/yr) - EBM treatment recommendations Dyna. Med ($200/yr) Disease and conditions reference Harrison’s Practice ($325/yr) Disease and conditions reference

Free PDA Software Used in Curriculum 8 Geriatrics at Your Fingertips (GAYF)* From AGS, tools and guidelines for care of older patient *free to students, $30 for faculty e. PSS Tool From US Preventive Services Task Force (USPSTF) tool, enter patient’s age, gender and get latest preventive services recommendations Archimedes Numerous handy medical calculators free from Skyscape

Full Installation Instructions 9 Handout for Epocrates Essentials Other program instructions on Intranet – will require you to sign in if off campus Login: medfirstname. lastname College of Medicine User. ID and Password Updated weekly

General Steps for All Installations 10 1. Go to the Library web page, 2. Log onto EZProxy 3. PDA Websites page: Follow link to product web site 4. Register and get an account 5. Pick platform (Palm, Windows Mobile 5 or Pocket. PC) 6. Download software to desktop 7. Run the software with the PDA connected (Serial #) 8. Tell it where to put the software (device or SD) 9. When it finishes, test the software 10. Register Product

Adding Applications 11 PDA App 3. Download software 1. Go to Product Web site 2. Register* PDA App 4. Run Software on Computer 5. Install to PDA Device Memory or SD card

Drug Information 12 EPOCRATES ESSENTIALS RX (ALSO ONLINE) Prescription Drug Information Alt Med Information

Epocrates Rx 13 Prescription drugs and alternative medicines combined in same list Lookup by Drug or by Class Search tool lets you look up drugs by indication, adverse reactions, etc. Dosage Calculator pops up for all drugs reported in mg/kg Formularies available with status of each drug

Navigation 14 App: Hide Alt Meds, Auto Update, Memory Mgmt Edit: find Tools: Abbreviations, Formulary Info, Preferences, Update Email, Disclaimer and About Multi. Check Drug Interactions Search Tool Home

Epocrates Essentials Rx 15 2. ick P u dr g y 1. te r go e yp T c ca k 3 i. P

Exercises for Practice 16 How should you prescribe acyclovir for the initial episode of genital herpes? (dose) Is acyclovir indicated for children with Chicken Pox under the age of 2? How much does one month supply of Glucophage 850 mg bid cost? What is the off label indication for Neurontin (gabapentin) (* indicates off label)

Searching for a Drug 17

Dosage Calculator in Epocrates Rx 18 q t 3. ick Cl l 2. C A 4. e dos ick e Typ W mt, re &F e Online Dosage Calculator http: //www. medcalc. com/pedidose. html lat ed 1. P lcu Ca g osin s. D

Exercises for Practice 19 A little boy who is eight years old just ate a bottle of Fe. So 4 tablets his mother had in the kitchen. She thinks he ate forty or fifty of them. You search indications and find that desferol is indicated for iron intoxication. Calculate the dosage of desferol for the child. He weighs 50 lbs. You have a patient that is on amitriptyline, Flonase, Synthroid, Reglan, and Zyrtec. She comes in with tardive dyskinesia. Which of these drugs might be causing this? (Use Search tool for Adverse Reactions. )

Add Drug Formularies 20 Go to Epocrates. com Manage My Account Add Formularies y lar u Pick Formularies Sync to add Tap for Alternatives Pic. m for k 1 2. C lick Cod e

Exercises for Practice 21 I have a depressed patient with BCBS of Georgia who needs a low copay. Which of the SSRI are covered by BCBS low copay? Look up drugs By Class> psychiatric> SSRIs. I have a depressed patient with no health insurance who is indigent. Which SSRI can they get assistance to pay for (Needy Meds)? A 58 yr old female with osteoporosis is on Boniva. CHP Basic has stopped covering it. Which of the calcium metabolism class drugs do they cover?

Drug Interactions 22 EPOCRATES MULTICHECK

Multi. Check 23 Find all drugs patient is on Select one at a time Run the Drug Interaction Contraindicated Avoid/Use Alternatives Monitor Caution Also checks IV solubility Use Back to add more drugs

Multi. Check Drug Interactions 24 g 2. ick P u dr p Ty. e 1 3. Repeat until all drugs in list k 4. lic C gs u Dr

Epocrates Multi. Check 25 n tio c k lic C ra te in se U to a dd m e or

Exercises for Practice 26 What interactions exist for the following combinations of drugs? Lexapro, Lortab, Xanax and Zocor Nitrobid and Viagra Glucophage, Lopressor, itraconazole (Sporonox), and simvastatin (Zocor)

Epocrates Essentials Sx 27 DIFFERENTIAL DIAGNOSIS ENGINE

Dx. Plain 28 Included in e. Pocrates Essentials (Sx) From Harvard Age, gender and duration Allows for multiple symptoms and lab results Results: in decreasing order of likelihood Online on library web page

Exercises for Practice 29 A 22 year old girl has a dry cough, chest pain, weight loss, and erythema nodosum. She has been feeling “poorly” for over a month. What might she have?

Epocrates Essentials Dx 30 DISEASE QUICK REFERENCE

5 Minute Clinical Consult 31 In Epocrates Essentials PDA under Dx tab Not in Epocrates online – in Info. Retriever online Author: Mark R Dambro, MD, updated annually 600 common problems, bottom line, quick info, shallow content, ICD-9 s Treatment section linked to Rx,

Exercises for Practice 32 What is the incidence and prevalence of and the latest treatment recommendations for acute otitis media? What imaging test is becoming procedure of choice for kidney stones? What is the ICD-9 code for psoriatic arthritis? What OTC is drug of choice for sphincter incompetence in urinary incontinence? (not approved by FDA)

Epocrates Lab 33 DIAGNOSTIC LABORATORY INFORMATION

Original Lab Content 34 View by Name, Specimen Type or Panels only. Interpretation: diseases linked to Dx section, drugs linked to Rx section Cost/Billing tells ICD-9 codes to justify test

Exercises for Practice 35 A basic metabolic panel reveals that a 30 year old man suffering from bipolar disorder has a serum calcium level of 10. 9 mg/d. L. He is taking lithium and valproate. Could his medications be a factor? Which ICD-9 codes would decrease your chances of being denied payment for a Growth Hormone test?

Epocrates ID Tool 36 ANTIBIOTICS GUIDE

ABX Guide 37 Look up by Bug, Drug or System Antibiotics linked to Rx section Age and Gender specific Emperic treatment before culture Specific treatment for known pathogen

Exercises for Practice 38 Which antibiotics should be used for a neonate with empyema, etiology unknown? The culture comes back with Haemophylius influenzae in the same neonate. What antibiotic should I use? Using the PDA, find the antibiotic, calculate the dose for a 2. 84 kg baby.

Epocrates Med. Math 39 MEDICAL CALCULATORS

Med. Math 40 Small number of handy calculators Many more in Epocrates online Most in Info. Retriever Info gives you parameters

Exercises for Practice 41 Calculate your own Body Mass Index, Ideal Body Weight, Basal Energy Expenditure, and Body Surface Area. What is the predicted peak flow for a 60 year old woman with asthma? She is 5’ 2”.

Epocrates Tables 42 ODDS AND ENDS

Tables 43 Text based content of value to clinicians Online and PDA Guidelines (HIV, HTN, Vaccinations…) Dosing equivalents (ACE, insulins, steroids…) Algorithms (PALS, ACLS…)

Exercises for Practice 44 Patient has planned a trip touring Mayan ruins in the jungles of Belize. What immunizations does she need? Patient walks in with an inhaler with no labels attached. It is gray with a green cap. Which inhaled steroid is this?

Epocrates Free Add-Ons 45 MEDTOOLS

Manage Your Account 46 www. epocrates. com My Account Log in Free Add-ons Pick your tools, formularies Takes memory; puts in main memory Includes free CME, international drug name directory, clinical decision calculators

Please Complete your Evaluations 47 CONTACT INFORMATION FOR HELP NANCY CLARK NANCY. CLARK@MED. FSU. EDU (850)644 -9706 KENNETH HIGGINS KENNETH. HIGGINS@MED. FSU. EDU (850)644 -7473 COM IT HELP DESK HELP. DESK@MED. FSU. EDU (850) 644 -3664

FYI – What to Buy 48 Cell Phone/PDAs AT&T – Tilt (WM 6, 128/256 memory, 802. 11, BT) Sprint - Mogul Verizon – XV 6800 Pocket PC/Windows Mobile PDA HP i. PAQ hx 2795 Pocket. PC Palm PDA Palm T|X Most Important Features: Large screen, memory, speed AT&T Tilt