For Use with the Franklin Electronic Publishers IC-104 Digital Book System DIGITAL BOOK The Medical Letter Rx F HANDBOOK OF ADVERSE DRUG INTERACTIONS User's Manual Contents Introduction .......................................................2 Getting Started ..................................................6 Seeing a Demonstration ...................................8 Entering Drug Names .......................................9 Correcting Misspellings ..................................11 Brands, Generics, and Groups ...................... 13 Finding Interactions ........................................ 15 Between Many Drugs ..................................15 For a Single Drug ........................................ 17 Viewing References ........................................ 19 Sending Words to Other Books ..................... 21 Digital Book System ........................................22 Warranty ...........................................................27 Product Specifications ................................... 28 Key Guide .........................................................29 Index ..................................................................32 1 Introduction This handbook offers a quick guide to possible adverse effects of drug interactions, with brief recommendations for precautionary measures. References are given to original reports that provide more complete discussions of each interaction. This book-- lists adverse drug interactions, their mechanisms, and recommendations for clinical management. These listings are usually based on clinical reports in humans. Reports of interactions between more than two drugs are appearing in the medical literature with increasing frequency. Where these have been documented, they are noted as comments under interacting pairs of drugs. Interactions listed for groups of drugs (such as "cephalosporins" or "antidepressants, tricyclic") may not have been reported for every drug in the group; known exceptions to the interaction are noted. It is not possible to determine the frequency of most interactions. When an interaction is documented by one or two case reports rather than by clinical studies or reports in many patients, the year of each report is given as some indication of frequency. Omissions--Drugs for which we have no documented interaction are not included. New adverse interactions are continually being reported; the absence of an interaction does not necessarily mean that drugs will not interact when given concurrently. Interactions between general anesthetics and drugs likely to be administered during surgery, such as autonomic drugs and local anesthetics, are not included here. Interactions useful in therapy, such as increased plasma concentration of penicillin with concurrent use of probenecid, are also not included. Common additive effects, such as occur with the use of two 2 Introduction antihypertensive agents or two central-nervous-system depressants, are generally not included. Effects expected from the mechanism of a drug's action, such as that of potassium on digitalis glycosides or calcium on calcium-entry blockers, and useful antagonist effects, such as that between a poison and an antidote, are not listed. Most interactions of drugs with foods, beverages, or other nutrients are not included, but foods interacting with monoamine oxidase inhibitors are included. Mechanisms of Interaction--Genetic differences can affect drug metabolism and interactions. Drugs can interact by changing the metabolism of other drugs, either through inhibition or induction of any of several hepatic enzyme activities or through alterations in hepatic blood flow; by altering the binding of other drugs to plasma proteins or tissue receptors; by altering the distribution of drugs to active receptor sites; by delaying or enhancing excretion; or by causing additive or synergistic effects. Recommendations--Monitoring is most important when one of the interacting drugs is stopped or started. Some experienced clinicians may prefer to monitor the patient's clinical status rather than follow serum concentration of drugs. Important Notice: The Medical Letter Drug Interactions Program reports interactions occurring in people, which can be documented primarily by published reports. These may not include interactions mentioned in other sources, such as the manufacturer's package insert, which are extrapolated from animal studies or interactions reported for related drugs. 3 Introduction What the Handbook Can Do The Medical Letter® Handbook of Adverse Drug Interactions digital book is a powerful reference. Using the Handbook, you can. . . · find brand name drugs, generic drugs, drug groups, and food groups, · correct and find drug name spellings, · find foods that interact with MAO inhibitors, · enter up to 20 drugs and see a list of the interactions between them, · enter a single drug and see a list of the drugs with which it interacts, · read descriptions and references about interactions, and · look up drugs and words in related digital books. Read this User's Manual to learn how. You can follow its numbered steps using the examples shown or drugs that interest you. 4 Introduction How the Handbook Works The Handbook is easy to use. Here are the basics: Highlight the HADI symbol. Then press At the main drug list, type a drug name. Then press ENTER . Type another drug name. Press ENTER Press Press Press ENTER ENTER . As you type, the drug name is highlighted. You see a prompt to "show interactions." You see the interactions, if any, between the drugs. You see a description of the interaction. You're ready to find other interactions. . . . . ENTER CLEAR About Illustrations The illustrations in this User's Manual are from the 1992 edition of the Handbook. The information that you see on screen may be different. 5 Getting Started If you're using the Handbook for the first time, read this section. WARNING: If you install the Handbook with the Digital Book System on, information that you entered in the other installed book may be erased. 1. Turn the Digital Book System off. 2. Put the Handbook in either slot on the back of the Digital Book System. Align the book's tabs with the notches in the slot. Make sure its metal contacts face down. 3. Press ON/OFF . 4. To adjust the screen contrast, turn the wheel on the side of the Digital Book System. 5. Press 6. Press CARD . to highlight HADI. or 6 Getting Started 7. Press ENTER . This is the Handbook's initial screen, the top of the main drug list. Here you enter drug names to find interactions. Clearing the Screen and Backing Up You can always return to the initial screen by pressing CLEAR . When you do, the drug names in your query list are also cleared. You can always return to the previous display by pressing BACK . Help is Always at Hand If you're ever unsure about which key to use, press HELP to see an appropriate help message. To scroll down help messages, press To exit them, press BACK . . 7 Seeing a Demonstration Before you start using the Handbook, you may want to see a brief demonstration. 1. At the initial screen, press 2. Press MENU . to highlight D e m o o. 3. Press ENTER to start the demonstration. CLEAR 4. To stop the demonstration, press . Resuming Where You Left Off If you turn off the Digital Book System while using the Handbook, you'll return to the previous screen when you turn the Digital Book System on. All the drugs that you entered in your query list are saved, too. 8 Entering Drug Names You enter drug names by typing them at the main drug list. The main drug list contains brand and generic names, foods, and drug and food groups. In this User's Manual, "drug name" refers to any name on the main drug list. Try this example. 1. At the initial screen, type M E T A A. 2. Press ENTER query list . 3. Press CLEAR to enter the drug in the your to clear the entry. Tips for Entering Drug Names · Usually you need type only the first few letters to highlight a drug name. · You don't need to type capitals or punctuation. · To type numbers, hold and press the numbered keys. · To erase letters, press BACK . 9 Entering Drug Names Moving Up and Down Lists You can use these keys to move up and down the main drug list, the query list, and other lists: To. . . Scroll up and down Page up and down Go to the start or end of the list Press. . . Hold UP or or + DN or * * Hold while pressing the other key, or press and then the other key. The second way displays a G at the bottom of the screen. Follow the Arrows Blinking arrows at the top right of the screen indicate which direction keys you can press to move around the screen. Look for them. 10 Correcting Misspellings When you type letters that don't match any drug name on the main drug list, you activate the spell-correction mode. Try this example. D. 1. At the initial screen, type P S E U D O F E D To exit the spell-correction mode, press repeatedly. BACK 2. Press ENTER . 3. Press to highlight a drug name. 4. Press ENTER to enter the drug in your query list. Then press Y to add the related drug. 5. Press ENTER to clear your entry. 11 Correcting Misspellings Finding Spellings with ? and You can find spellings even when you don't know all the letters in the names. Simply type a question mark for each letter that you don't know in a name. Or type an asterisk for a series of unknown letters. For example. . . · Type CIM?T?DINE and press ENTER . You'll see the correct spelling, CIMETIDINE . · Type CORTI* . To type the asterisk, hold SHIFT and press ? * . Then press ENTER . You'll see a list of drugs and groups starting with CORTI. You can type more than one question mark or asterisk in a drug name. And you can type both in one name. 12 Brands, Generics, and Groups By highlighting a drug name on the main drug list and pressing SPEC , you can see its generic or brand names and any drug or food groups to which it belongs. In this example, we'll find the brand names and drug group of penicillin G. 1. At the initial screen, type P E N I C I L L I N G G. 2. Press SPEC . 3. To see the brands, press Or press plus DN . repeatedly. At the bottom of the list, notice that penicillin G belongs to the drug group, penicillins. 13 Brands, Generics, and Groups 4. Press ENTER to see the drugs in the group. 5. Press to scroll down. BACK 6. To return to the main drug list, press twice. Finding MAO Inhibitor Interactions When you highlight a food on the main drug list, pressing SPEC shows if it interacts with MAO inhibitors. For example. . . 1. Type AVOCADOS . Then press SPEC . is highlighted. MAO Inhibitor info 2. Press ENTER . You see a description of avocados and MAO inhibitors. 14 Finding Interactions You can see adverse interactions by entering drug names at the main drug list and pressing ENTER at *SHOW INTERACTIONS* . Then you can read a description of each interaction. Between Many Drugs You can enter up to 20 drugs at time to find interactions between them. In this example, we'll find the interactions between alcohol and acetaminophen. 1. At the initial screen, enter A L C O H O L L. 2. Enter A C E T A M I N O P H E N N. 3. Press ENTER . Or press MENU and select s. Query interactions 15 Finding Interactions 4. If there is more than one interaction, press to highlight an interaction. To return to the main drug list (for example, if there are no interactions), press BACK . 5. At a highlighted interaction, press ENTER . This is an interaction description. The pointing hand indicates a comment or recommendation. 6. Press To. . . or DN to move down. Press. . . SPEC View the drug names of the interaction description View the next or previous description, if any Return to the interactions then or BACK + DN UP BACK 7. Press CLEAR to clear your entries. 16 Finding Interactions For a Single Drug You can enter a single drug and quickly see the drugs with which it interacts. In this example, we'll find the interactions for heparin. N. 1. At the initial screen, type H E P A R I N 2. Press 3. Press ENTER LIST . to see your query list. 4. Press O . Or press MENU and select s. Other interacting items These are the interactions for heparin. 17 Finding Interactions 5. Press 6. Press to highlight an interaction. ENTER to see its description. Using Your Query List Whenever you enter a drug name, it's saved in your query list. To see your query list, press LIST . At the query list, use these keys: To. . . Delete a highlighted drug See the interactions between all the drugs See all the interactions for a highlighted drug Go to the initial screen and save the query list Go to the initial screen and clear the query list Press. . . D Q O A CLEAR NOTE: Your query list is saved between sessions unless you reset the Digital Book System or remove its batteries. 18 Viewing References Whenever ...