Epocrates and Other PDA Reference Tools

NANCY CLARK, M.ED.DIRECTOR OF MEDICAL INFORMATICS EDUCATION

FSU COLLEGE OF MEDICINE

Epocrates and Other PDA Reference Tools

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Objectives for Workshop

Download and Install on the PDAUse Epocrates Rx

find dosage, calculate dosages Identify if drug on formulary

Use MultiCheck to find interactionsUse Sx to get a DifferentialUse Dx to find Disease informationUse Lab to find Laboratory informationUse ID to find recommended AntibioticsUse MedMath Medical calculatorsUse Tables for guidelines and algorithms

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Handouts

PowerPointDownloading instructions for Epocrates

Essentials (yellow)Using Epocrates EssentialsUserID and Password sheet (blue)List of PDA software available and

description of uses

Consent form and evaluations

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SEE HANDOUT

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Installing Software

Links to Download Sites5

PDA Websites Page6

FSU Licensed PDA Software

Epocrates Essentials ($149/yr)Epocrates Essentials ($149/yr) Rx, Sx-Differential diagnosis, Dx-5MCC, ID, LAB, M-

interactions, tables, CME, tools and calculators InfoRetriever ($249/yr)InfoRetriever ($249/yr)

5MCC, Cochrane, InfoPOEMs, calculators, guidelines, ICD-9 and E&M coder

POCKETConsult (FIRSTConsult) ($149/yr)POCKETConsult (FIRSTConsult) ($149/yr) Differential diagnosis, medical conditions

Clinical Evidence ($99/yr)Clinical Evidence ($99/yr)- EBM treatment recommendations

DynaMed ($200/yr)DynaMed ($200/yr) Disease and conditions reference

Harrison’s Practice ($325/yr)Harrison’s Practice ($325/yr) Disease and conditions reference

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Free PDA Software Used in Curriculum

Geriatrics at Your Fingertips (GAYF)* From AGS, tools and guidelines for care of older

patient *free to students, $30 for faculty

ePSS 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

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Full Installation Instructions9

Handout for Epocrates EssentialsOther program instructions on Intranet – will

require you to sign in if off campus Login: med\firstname.lastname College of Medicine UserID and Password

Updated weekly

General Steps for All Installations10

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 PocketPC)

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 Applications11

1. Go to Product Web site

2. Register*

PDAApp

4. Run Software on Computer

PDAApp 5. Install to PDA

Device Memory or SD card

3. Download software

EPOCRATES ESSENTIALS RX(ALSO ONLINE)

Drug Information

Prescription Drug Information Alt Med Information

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Epocrates Rx

Prescription drugs and alternative medicines combined in same list

Lookup by Drug or by ClassSearch 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

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Navigation

App: Hide Alt Meds, Auto Update, Memory Mgmt

Edit: findTools: Abbreviations, Formulary Info,

Preferences, Update Email, Disclaimer and About

MultiCheck Drug Interactions Search Tool Home

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Epocrates Essentials Rx

1. Typ

e

2. Pick

drug

3. Pick

category

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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)

Exercises for PracticeExercises for Practice16

Searching for a Drug17

Dosage Calculator in Epocrates Rx

Online Dosage Calculator http://www.medcalc.com/pedidose.html

1. Peds Dosing

2. Click dose

3. Type Amt, Wt & Freq

4. Click C

alculate

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Exercises for PracticeExercises for Practice

A little boy who is eight years old just ate a bottle of FeSo4 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.) 

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Add Drug Formularies

Go to Epocrates.comManage My AccountAdd FormulariesPick FormulariesSync to addTap for Alternatives

1. Pick

form

ulary

2. Click Code

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Exercises for PracticeExercises for Practice

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?  

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EPOCRATES MULTICHECK

Drug Interactions22

MultiCheck

Find all drugs patient is onSelect one at a timeRun the Drug Interaction

Contraindicated Avoid/Use Alternatives Monitor Caution

Also checks IV solubilityUse Back to add more drugs

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MultiCheck Drug Interactions

1. Typ

e

2. Pick

drug

3. Repeat until all drugs in list

4. Clic

k Dru

gs

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Epocrates MultiCheck

Click i

nteraction

Use to

add more

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Exercises for PracticeExercises for Practice

What interactions exist for the following combinations of drugs?

Lexapro, Lortab, Xanax and ZocorNitrobid and ViagraGlucophage, Lopressor, itraconazole

(Sporonox), and simvastatin (Zocor) 

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DIFFERENTIAL DIAGNOSIS ENGINE

Epocrates Essentials Sx27

DxPlain

Included in ePocrates Essentials (Sx)

From HarvardAge, gender and durationAllows for multiple

symptoms and lab resultsResults: in decreasing

order of likelihood Online on library web

page

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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?

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Exercises for PracticeExercises for Practice

DISEASE QUICK REFERENCE

Epocrates Essentials Dx30

5 Minute Clinical Consult

In Epocrates Essentials PDA under Dx tab

Not in Epocrates online – in InfoRetriever online

Author: Mark R Dambro, MD, updated annually

600 common problems, bottom line, quick info, shallow content, ICD-9s

Treatment section linked to Rx,

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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)

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Exercises for PracticeExercises for Practice

DIAGNOSTIC LABORATORY INFORMATION

Epocrates Lab33

Original Lab Content34

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

A basic metabolic panel reveals that a 30 year old man suffering from bipolar disorder has a serum calcium level of 10.9 mg/dL. 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?

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Exercises for PracticeExercises for Practice

ANTIBIOTICS GUIDE

Epocrates ID Tool36

ABX Guide

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

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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. 

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Exercises for PracticeExercises for Practice

MEDICAL CALCULATORS

Epocrates MedMath39

MedMath

Small number of handy calculators

Many more in Epocrates online

Most in InfoRetrieverInfo gives you

parameters

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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”.

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Exercises for PracticeExercises for Practice

ODDS AND ENDS

Epocrates Tables42

Tables

Text based content of value to clinicians

Online and PDAGuidelines (HIV,

HTN, Vaccinations…)Dosing equivalents

(ACE, insulins, steroids…)

Algorithms (PALS, ACLS…)

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 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?

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Exercises for PracticeExercises for Practice

MEDTOOLS

Epocrates Free Add-Ons45

Manage Your Account

www.epocrates.comMy AccountLog inFree Add-onsPick your tools, formulariesTakes memory; puts in main

memoryIncludes free CME,

international drug name directory, clinical decision calculators

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CONTACT INFORMATION FOR HELP

Nancy Clark nancy.clark@med.fsu.edu (850)644-9706

Kenneth Higginskenneth.higgins@med.fsu.edu (850)644-7473

CoM IT Help Deskhelp.desk@med.fsu.edu

(850) 644-3664

Please Complete your Evaluations

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FYI – What to Buy

Cell Phone/PDAs AT&T – Tilt (WM6, 128/256 memory, 802.11, BT) Sprint - Mogul Verizon – XV6800

Pocket PC/Windows Mobile PDA HP iPAQ hx2795 PocketPC

Palm PDA Palm T|X

Most Important Features: Large screen, memory, speed

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AT&T Tilt