The first installment of the BaseCamp Rx column, The Right Stuff, asked readers to “Know Your Drugs: Make sure you are fully informed about the drugs you are carrying and administering (if allowed).” It reviewed the Rights of Medication Administration—the tenets that should be followed not only in a professional setting, but I will add, for personal use as well. If you’ve been trained in medicine, nursing, pharmacy, EMS, etc., then you have taken pharmacology courses and have formally learned the proper uses of medication administration. But if you aren’t formally trained, do you know enough about the medications that you are putting into your own body?
The following Rights are applicable whether you are a practitioner recommending or providing a medication for a patient, or it’s for you:
- Right Patient: The medication belongs to the correct person
- Right Time: The medication is dosed correctly according to the appropriate schedule
- Right Medication: The medication is for the correct person and correct for the condition
- Right Dosage: The medication is the correct dosage for the person and for the condition
- Right Route: The medication is being administered via the correct route: oral, sublingual, topical, parenteral, etc.
- Right Expiration Date: This appears on the original manufacturer's package or the pharmacy bottle label (as discussed in the May 2021 and November 2015 installments of this column)
- Right Response: Make sure the drug you gave resulted in the desired pharmacologic effect, especially if given for an acute situation
Drug Information Sources
In addition to textbooks and professional online resources, there is an overwhelming tsunami of print magazines, websites, apps, social media sites (think movie stars), etc. providing information about health, herbs, supplements, magic potions, illicit and licit drugs. But like a tsunami, some of this information rushes onto the scene, then recedes just as quickly. Healthcare professionals are trained on those drug information resources that are the best for their particular field of practice, which can be very expensive and/or accessible only through a university/college or practice setting. For those that don’t have access to costly subscriptions or don’t want to pay for them, there are some terrific free websites and apps that provide accurate and useful drug information.
I will be the first to admit, although I haven’t practiced in a pharmacy for quite some time, that these days, many prescribing healthcare practitioners (physicians, PAs, NPs) and even pharmacists may not take enough time counseling their patients on prescription drugs, nor inquiring about whether they are taking any over-the-counter medications, herbs, supplements, and recreational drugs, including alcohol (and think THC with more and more states legalizing it.) So, if you are a wilderness medicine practitioner prescribing or administering a medication or you’re packing a personal medical kit for a wilderness trip, you need to be familiar with not only the drugs being administered for an allergic reaction or traveler’s diarrhea, for example, but you should also consider other substances being taken and what they are being taken for.
Nothing replaces the drug prescribing information or package insert (PI), available for both prescription and many OTC drugs, for the most complete information on indications (disease/condition being treated), dosage and administration, adverse reactions, contraindications/warnings/precautions, drug interactions, dosage forms and strengths, storage and handling, and use in special populations like the elderly, pediatrics, and pregnancy/breast feeding. But no one really wants to plow through the entire PI, not even physicians—the FDA adopted the Physician Labeling Rule in 2001 to make the prescribing information more readable and well, understandable for busy practitioners. And sometimes a full PI is not available for products that have been generic for years, or the PI is outdated.
Remember that the information about a drug in the prescribing information is considered on- label, but drugs can be used off-label as well, that is, for an indication, dose, or population that is not in the PI. Generally, this is done under the direction of a prescriber.
The Physician’s Desk Reference (PDR) is sort of the bible of PIs, as it used to be a hardcopy compilation of PIs and pharmaceutical manufacturer contact information. The burly tome, weighing almost 5 pounds, was finally discontinued in 2017 after a 74 year run, but is now renamed the Prescribers’ Digital Reference and is available online (pdr.net), and as the app mobilePDR®. The site also contains information about nonprescription drugs, but not herbs or supplements; the latter used to be available in previous hardcopy versions. In the “Using Drug Information Resources to Search” below, you’ll see that pdr.net may contain off-label information as well.
Another extremely comprehensive source for product labels is Drugs@FDA, but for the average user, there is much more wheat than chaff here. For those that want whole grain, though, this site from the FDA seems to have it all. Although not nearly as comprehensive, DailyMed, from the National Library of Medicine (NLM), is much more user-friendly, and includes photos as well.
Calling a poison center or drug information center (in a hospital, for example) that used Identidex®, or buying a PDR and plowing through all of the photos in the front of the book used to be the only way to identify that pill that rolled under the bed or what that blue one is in the bottle of pills you threw together the last time you traveled. Like identifying potential edible mushrooms or plants, it’s a good idea to use more than one pill identifier, unless with the first identification, it jars your memory.
Believe it or not (of course you can believe it), you can type in the color, shape, imprint – or any combination of these – into google.com and it will quickly come up with sites that have pill identifiers.
Drug Interaction (DI) Checker
It’s important to ascertain whether clinically relevant drug interactions are going to occur with currently taken medications, including OTC drugs, as well as herbs, supplements, alcohol, and recreational drugs, although there usually is not information regarding the latter. So something that was once relegated to a prescriber or pharmacy is now in the hands of anyone with a smartphone or computer. If an important drug interaction has been identified, it would be prudent to discuss this with the prescribing physician or pharmacist.
Reliable and Free Drug Information Websites and Apps
As noted above, there is A LOT of drug information out there available to graze on. But what is safe to consume? Be very wary of personal testimonials—an N of 1 or even 5 doesn’t mean that peculiar adverse reaction will happen if you or your mother take the same drug. Use reliable and trusted sources of information.
Below are listed what I think are websites and apps that provide reliable and free sources of drug (and disease) information. There are many sites and apps that provide drug pricing information; a good example is GoodRx.