Lexicomp Online Help

Welcome to Lexicomp Online. Lexicomp Online is a collection of clinical databases and clinical decision support tools that provides users with an extensive medical library. This guide is designed to help users understand and navigate all of the features of the Lexicomp Online application. The initial home screen of the application provides users access to Lexicomp content via global searching or by browsing the available content. In addition to browsing/searching our clinical databases, the blue tool bar across the top of the application allows the user to access all clinical decision support tools.

Searching from the Home Page

From the opening screen, enter any keyword (i.e., drug, lab, disease) in the search box and click the "Search" button. To assist with searching, a possible keyword list will appear after you enter at least four (4) characters. To select a suggested term, simply click on the desired search term and the system will automatically perform a search and display the results. Additionally, if you misspell a search term, you will be presented with a "Did you mean" list of possible search terms. To perform a new search using the correct term, simply click on the desired search term and you will then see a results list for the correctly spelled keyword.

Once you have entered your search term, clicking the "Search" button or hitting the enter key on the keyboard will initiate a global search across all available databases. Any database that has information on the keyword searched will be displayed on the results screen.

In addition to basic global searching, Lexicomp Online allows users to perform a more refined search of the clinical content. To perform a more targeted search within a specific section of the monograph, click the "Limit Search to" drop-down arrow to view a list of possible sections that can be searched. To limit your search to a particular field, simply click on the desired listing from the drop-down menu. Below is a comprehensive listing of the sections that can be searched specifically:

Explore by general category

The "Explore by general category" function allows the user to browse the available databases using different indexes. The databases are classified into four main categories: Drugs, Diseases, Toxicology, Patient Education, and International Drugs. To browse the available drug databases, click the Drugs button; to browse the available disease databases, click the Diseases button; to access toxicology information, click the Toxicology button; to browse available laboratory databases, click the Laboratory button; to browse the patient education databases, click the Patient Education button; and to browse international drug information, click the International Drugs button.

New Drug Approvals & Special Alerts

These sections will dynamically display new U.S. drug approvals and the most recent Special Alerts added to the Lexi-Drugs database. Clicking on any topic will direct the user to the indicated Lexi-Drugs monograph.

Mobile Device Software

For clients that have access to our mobile device software, this button will direct users to information on how to download Lexicomp software to a mobile device.

Training Videos & Quick Reference Guide

These two buttons provide access to additional training materials. The first will link the user to a series of short training videos ranging from a quick overview of how to use Lexicomp Online to how to use individual databases. The second button will open the the Quick Reference Guide that can be reviewed or printed.

Clinical Decision Tool Bar

The blue Clinical Decision Tool Bar provides access to all clinical tools that are included in the user's account. This bar is always available from any screen in the application and provides access to the following tools:

Recent Documents

This button allows the user to review the last ten (10) documents accessed. This functionality is local to the computer and therefore may reflect the searching activity of multiple users on computers that are located in common areas of the facility.

Additional Links
Drug Databases

The Explore by general category links allow the user to browse the databases included in Lexicomp Online. Clicking on the "Drugs" button from the home page will take the user to a listing of available drug databases. This screen provides brief overviews of each drug database that is available with Lexicomp Online. The left side of the screen provides links to the available indexes for each database.

Click on the database name to display a more detailed overview of the content available in that database, as well as a list of the editorial panel. The "Available Drug Indexes" links on the left side of the screen can be used to browse each database via a number of useful indexes.

Generic Names

This link will display an alphabetical index of generic drug names. Click on a letter to display a list of generic drugs that begin with that letter. From the list of drugs, you can view the drug monograph by clicking on the name of the medication.

U.S. Brand Names

This link will display an alphabetical index of brand name products marketed in the United States. Click on a letter to display a list of brand name products that begin with that letter. From the list of brand name products, you can view a drug monograph by clicking on a product from the list.

Canadian Brand Names

This link will display an alphabetical index of brand name products marketed in Canada. Click on a letter to display a list of brand name products that begin with that letter. From the list of brand name products, you can view a drug monograph by clicking on a product from the list.

Charts/Special Topics

This link will provide an alphabetical listing of all Charts/Special Topic documents available within this database. The Charts/Special Topics section consists of supplemental information such as drug comparison charts, treatment overviews and other therapeutically relevant topics.

Changed Last 7 Days

This index displays all drugs that have been updated or modified in the last seven (7) days. From this list, the user can click on any drug and view the monograph.

Pharmacologic/Therapeutic Category

This index will display an alphabetical listing of all pharmacologic categories. Clicking on a pharmacologic category will display all drugs in that category. From this list, the user can click on any drug displayed and access the full monograph for that drug.

REMS

This index provides a list of all drugs that have a Risk Evaluation and Mitigation Strategy (REMS) as required by the FDA. From the list displayed, the user can click on any drug and access the full monograph.

Monographs with Prescribing and Access Restrictions

This index provides a list of all drugs that have restricted access or prescribing restrictions that fall outside of the FDA's REMS program. From this list, the user can click on any drug and access the full monograph.

Monographs with Black Box Warnings

This index provides a list of all drugs that have a black box warning issued by the FDA. From this list, the user can click on any drug displayed and access the full monograph for that drug.

Monographs with Special Alerts

This index displays a list of all drugs that have a "Special Alert." The Special Alert field displays important information, such as new warnings, adverse reactions, recalls, etc., that is of a time-sensitive nature. From this list, the user can click on any drug and view the entire drug monograph.

Disease Databases

The "Explore by General Category" links allow the user to browse the available databases that are part of Lexicomp Online. Clicking on the "Diseases" button from the home page will take the user to a listing of the available disease databases. This screen provides brief overviews of each disease database that is available within Lexicomp Online. The left side of the screen provides links to the available indexes for each database.

Click on the database name to display a more detailed overview of the content available in that database as well as a list of the editorial panel. The "Available Disease Indexes" links on the left side of the screen can be used to browse each database via a number of useful indexes which were reviewed above.

Toxicology Databases

The "Explore by General Category" links allow the user to browse the available databases that are part of Lexicomp Online. Clicking on the "Toxicology" button from the home page will take the user to a listing of the available toxicology databases. This screen provides brief overviews of each toxicology database that is available within Lexicomp Online. The left side of the screen provides links to the available indexes for each database.

Click on the database name to display a more detailed overview of the content available in that database, as well as a list of the editorial panel. The "Available Toxicology Indexes" links on the left side of the screen can be used to browse each database via a number of useful indexes which were reviewed above.

Patient Education Databases

The "Explore by General Category" links allow the user to browse the available databases that are part of Lexicomp Online. Clicking on the "Patient Education" button from the home page will take the user to a listing of the available patient education databases. This screen provides brief overviews of each patient education database that is available within Lexicomp Online. The left side of the screen provides links to the available indexes for each database.

Click on the database name to display a more detailed overview of the content available in that database, as well as a list of the editorial panel. The "Available Patient Education Indexes" links on the left side of the screen may be used to browse each database via a number of useful indexes which were reviewed above.

Laboratory Databases

The "Explore by General Category" links allow the user to browse the available databases that are part of Lexicomp Online. Clicking on the "Laboratory" button from the home page will take the user to a listing of the available laboratory databases. This screen provides a brief overview of the laboratory and diagnostic procedures database that is available within Lexicomp Online. The left side of the screen provides links to the available indexes for this database.

Click on the database name to display a more detailed overview of the content available in that database, as well as a list of the editorial panel.

International Drug Databases

The "Explore by General Category" links allow the user to browse the available databases that are part of Lexicomp Online. Clicking on the "International Drugs" button from the home page will take the user to a listing of the available international drug databases. This screen provides a brief overview of the international drug databases that are available within Lexicomp Online. The left side of the screen provides links to the available indexes for these databases.

Click on the database name to display a more detailed overview of the content available in that database, as well as a list of the editorial panel.

Search Results Window

After performing a search, the user will be presented with results from all databases that have a match to the search performed. Only databases that are available to the user and have a result will be displayed in the search results. To view the monograph within any database, click on the hyperlinked drug name displayed under the desired database.

Filter Results

The "Filter Results" drop-down menu can be used to sort your search results to display only specific databases. The menu can be used to filter by the following topic areas:

Field Selection

To activate the "Jump to field" menu, hover the cursor over the hyperlinked drug name in the results list and a list of the available fields within that monograph will display. From this list, the user can select a field of interest and immediately open the drug monograph to that section.

Monograph Display

Once a user selects a database by clicking on a drug name or using the field selection function on the search results page, the drug monograph will be displayed. In the top left corner of the screen, the monograph title and database name will be displayed as a point of reference.

Navigating a Monograph

Once in the monograph, the user has three ways to navigate the information presented. The first method is to use the "Navigation Tree" displayed on the left side of the screen. This box provides a table of contents view of the available sections of the drug monograph. To jump to a particular section, click on the desired section. Sections that have a "+" sign next to them have sub-sections that allow the user to jump to more specific areas of content. To expose all of the sub-sections at once, click the "Expand All" link at the top right of the Navigation Tree box. To hide the Navigation Tree box and expand the screen space for monograph viewing, click the "Hide" link in the top right corner of the box. To open the Navigation Tree once it has been hidden, click the "Show Tree" link in the top left corner of the monograph window.

The second navigation method is located in the top left area of the monograph display in a box titled "Jump to Section." Click on this box and an alphabetical list of all sections and sub-sections is displayed in a drop-down menu. To jump to a particular section, click on the desired field from the drop-down list.

Lastly, the drug monograph can be viewed by scrolling through the entire document using the standard browser scroll bars located on the left side of the monograph window.

Linking to Other Content from a Drug Monograph

Throughout the drug monograph, hyperlinks are presented that allow the user to link to additional content. In some instances, these links provide access to related content within Lexicomp Online such as: calculators, disease/organism content (infectious disease drugs only), pharmacogenomics information, charts/special topics, allergy/idiosyncratic reaction information, pregnancy/lactation detail, and AHFS content, to name a few.

Along with the additional Lexicomp content, other hyperlinks provide access to content found on the Internet such as: FDA medication guides; Clinical Practice Guidelines; FDA warnings/alerts and PubMed links for references.

Accessing Images, Patient Education Leaflets

In addition to the monograph information, additional content is available via the tabs across the top of the monograph window. Clicking on these tabs will give users access to images of solid oral dosage forms, adult patient education material, and pediatric patient education material.

Images

From a monograph, clicking on the "Images" tab displays a list of the available products with images (oral solid dosage forms). To view a larger image and additional detail about a particular product, click on the image.

Note: To access the drug identification tool for identifying unknown medications, click on the "Drug I.D." button in the Blue Tool bar.

To return to the monograph information, simply click on the "Monograph" tab at the top of the content panel.

Adult & Pediatric Patient Education

From the monograph, clicking on the patient education tabs will display the patient education document (adult or pediatric) for that drug. This document can be navigated using the same three methods used to navigate a drug monograph: (1) the left panel Navigation Tree; (2) the "Jump to Section" drop-down menu in the upper right corner of the content panel; or (3) scrolling the document using the right side scroll bars.

The patient education handouts are written at a consumer level and can be viewed in multiple languages. To view the document in a different language, click on the "Switch Language" drop-down menu in the upper right corner of the content panel. Available languages will be displayed using this menu.

To print the document, click on the "Print" link in the upper right corner of the content window and a list of the available printers to which your computer is connected will be displayed.

Interactions

The interactions tool is accessed via the blue tool bar at the top of the screen. Lexi-Interact is a complete drug and herbal interaction analysis program capable of assessing potential drug-drug interactions, drug-allergy interactions, and duplicate therapy interactions. Begin by entering the list of medications and known drug allergies to be analyzed. The interactions tool allows users to enter medications (both prescription and over-the-counter), natural products, foods and/or alcohol. Allergies may be entered by medication name (e.g., aspirin) or by the pharmacologic class (e.g., salicylates).

To enter an item, begin typing a keyword into the "Search Drugs" and/or the "Search Allergies" box. After you enter at least four (4) characters, suggested terms will populate, and you can select the desired term from the list. If multiple products match your search term, a list of products will appear. To add that medication to the medication list, simply click the "Add" button. Continue this process until all items are added. To remove an item from the list, uncheck the selected box next to the product you wish to remove.

Once the list is complete, click the "Analyze" button to perform an analysis. The "Duplicate Drug Therapy" feature is automatically checked to provide an analysis of the selected medications that are considered duplications because they belong to the same pharmacologic class. If you do not want the duplicate therapy screening to performed, the box can be unchecked prior to clicking the "Analyze" button.

The "Interaction Analysis" screen provides a summary of interactions organized by drug-drug, drug-allergy and duplicate therapy sections. An assigned risk rating (A, B, C, D or X) appears on the Interaction Analysis screen. Each letter represents a different level of urgency in responding to the identified interactions. The risk rating scale is defined in more detail below.

You can filter the interactions that are displayed on the Interaction Analysis screen using the available drop-down menus. You may filter by drugs or allergies entered and/or by various risk ratings. To remove the filters selected, simply click the "Reset Filters" button to return to the full, unfiltered interaction analysis results. In addition to the risk rating scale, any dependencies associated with a particular drug interaction will also be listed.

Dependencies & Risk Rating Scale

Dependencies (if applicable): Identifies various factors that may influence the occurrence or severity of the interaction. The factors may involve patient-specific variables, such as organ dysfunction (e.g., renal/hepatic), smoking status, genotype (e.g. VKORC1 haplotype), or phenotype (e.g., CYP2D6 poor metabolizer). Additional factors may relate to specific pharmaceutical dosage forms, routes of administration, and/or specific dosing regimens. The presence of one or more factors may result in an increased risk and/or severity of interaction, or conversely, disqualify an interaction. Highlighting this information at the top of the monograph enables the clinician to more thoroughly evaluate the interaction relevance for a specific patient.

Risk Rating: Rapid indicator regarding how to respond to the interaction data. Each drug-drug interaction is assigned a risk rating of A, B, C, D, or X. The progression from A to X is accompanied by increased urgency for responding to the data. In general, A and B monographs are of academic, but not clinical concern. Monographs rated C, D, or X always require the user's attention. The text of the "Patient Management" section of the monographs will provide assistance regarding the types of actions that could be taken. Each drug-allergy interaction is assigned a risk rating of X. The definition of each risk rating is as follows:

Risk Rating Action Description

A No Known Interaction Data have not demonstrated either pharmacodynamic or pharmacokinetic interactions between the specified agents

B No Action Needed Data demonstrate that the specified agents may interact with each other, but there is little to no evidence of clinical concern resulting from their concomitant use.

C Monitor Therapy Data demonstrate that the specified agents may interact with each other in a clinically significant manner. The benefits of concomitant use of these two medications usually outweigh the risks. An appropriate monitoring plan should be implemented to identify potential negative effects. Dosage adjustments of one or both agents may be needed in a minority of patients.

D Consider Therapy Modification Data demonstrate that the two medications may interact with each other in a clinically significant manner. A patient-specific assessment must be conducted to determine whether the benefits of concomitant therapy outweigh the risks. Specific actions must be taken in order to realize the benefits and/or minimize the toxicity resulting from concomitant use of the agents. These actions may include aggressive monitoring, empiric dosage changes, choosing alternative agents.

X Avoid Combination Data demonstrate that the specified agents may interact with each other in a clinically significant manner. The risks associated with concomitant use of these agents usually outweigh the benefits. These agents are generally considered contraindicated.

To view more detail about a particular drug-drug interaction, click on a hyperlinked term to review information on:

To view more detail about a particular drug-allergy interaction, click on a hyperlinked term to review information on:

To return to the Interaction Analysis summary page, click on the "Interaction Analysis" tab at the top of the content panel. To return to the initial search screen to enter in additional item, click on the "Drugs" tab at the top of the content panel.

The "Clear" button will clear all items from the list and allow the user to start a new regimen.

Drug I.D.

The drug identification tool, powered by Medi-Span® data, is accessed via the blue tool bar at the top of the screen. Lexi-Drug I.D. is an application that allows identification of tablets, capsules, aerosals, lotions, creams, and a variety of other oral and topical dosage forms. To begin, enter known product characteristics, such as: imprint, dosage form, shape and color.

When entering an imprint code, enter each discrete marking from the tablet as a separate imprint. For example, to identify a tablet with "M" on one side and "100" on the other side, enter "M" into the "Imprint Side 1" box, then enter "100" into the "Imprint Side 2" box. When entering the dosage form, shape, and color, select from the drop-down menu of choices in each of the respective boxes.

It is not necessary to populate all of the product characteristics into each of the boxes to be able to execute the search; however, the more information that is inputted, the greater the accuracy of the search results with drugs meeting that criteria.

Note: Multiple colors can be entered by returning to the drop-down menu and selecting additional colors.

Once the search criteria have been inputted, click the "Search" button to execute the search. The results will be displayed according to "Exact Match Results" (if any are found), followed by "Partial Match Results."

On the Search Results screen, additional information can be viewed for each of the products displayed by clicking anywhere on that product's description. The additional information retrieved includes a larger image (when available), NDC, manufacturer, a written description of the imprint code, Rx/OTC classification, and a bioequivalency rating. To return to Search Results screen, click the "Search Results" tab.

Calculations

The calculations tool is accessed via the blue tool bar at the top of the screen. Lexi-CALC is an extensive medical calculations application covering infusions, adult and pediatric organ function assessment, and other conversion calculations.

Upon opening the tool, the user is presented with an alphabetical list of the available calculators in the left panel. Select the desired calculation by searching for keywords in the "Calculator Lookup" box or by scrolling through the list of calculations displayed. The "Browse Category" drop-down menu can be used to browse a specific subset of calculators. The available categories include: Adult, Conversions, Dental, Emergency Drugs, General, Infusions, Pediatric, Pharmacokinetics, and Toxicology. Click on the desired calculator, and it will appear in the right content panel.

To perform a calculation, enter in the required variables. Note: You must change the units before entering a value if you are changing from the default settings. (i.e., when entering weight, change the unit to "lbs" before entering a patient weight of 180 pounds). When a value is entered and the unit input is changed, the value will be converted to the new unit. Once all the inputs are entered, click the "Calculate" button to perform the calculation.

To help ensure patient safety, input data is checked against accepted values/ranges throughout the calculation process. When an input is restricted, click on the "Input" button to display the accepted range. If a value is entered that falls outside of the accepted range, a warning will be displayed after the "Calculate" button is clicked. This warning will be displayed in red text and will instruct the user to correct the value that is out of range before the calculation can be performed.

To start over, click the "Reset" button to clear all values and begin the calculation again.

To print a calculation, click the "Print" button in the upper right corner of the content panel and the printer options will be displayed.

I.V. Compatibility

The I.V. compatibility tool can be accessed via the blue tool bar at the top of the screen. This tool provides access to information on stability and compatibility for through either the King Guide® or Trissel's IV-Chek™.

King Guide:

Clicking on "I.V. Compatibility" and then "King Guide" in the blue tool bar opens the King Guide® to Parenteral Admixtures™ home page in its own window.

Begin by entering a drug name in the search box or by selecting a drug from the alphabetical list displayed below the search box. Once you have found a medication of interest, click on the drug to to view stability information for this medication. Click on the buttons for "Y-Site," "Syringe," or "Admixture to see the results for the single drug.

References can also be displayed by clicking the blue reference links within the monograph text.

In addition to single drug compatibility, the King Guide also allows the user to enter up to 10 different medications to check for admixture, Y-site, or syringe compatibility. To begin, enter a drug name in the search box and click on the drug name. As each drug is added, the table results will build and be displayed per the Y-site, admixture or syringe compatibility results.

To view compatibility information for a specific pair, click the compatibility symbol to display detailed information

Trissel's IV-Chek:

Clicking on "I.V. Compatibility" and then "Trissel's IV-Chek™" in the blue tool bar opens Trissel's™ 2 Clinical Pharmaceutics Database home page in its own window.

Depending on the information you wish to retrieve, there are 3 (three) available tabs to select: "Compatibility Chart," "Check Compatibility," and "Drug Properties."

Compatibility Chart tab: This allows you to enter a drug and solution, or multiple drugs and solutions, to create a compatibility chart. The compatibility information presented is based on one of four (4) ratings: C (indicates compatibility for this method), U (uncertain or variable for this method), I (indicates incompatibility for this method), or X (no data for any method). Begin by entering a drug name in the "Drug" search box. Once you have found a medication of interest, click on that medication within the possible list of medications provided or click the "Add" button if it has been auto-populated in the search box. Either method will move it into the "Drugs" box. Enter an I.V. solution using the same method described above in the "Solution" search box. This will move it into the "Solutions" box. You may add additional drugs and solutions using these same methods. To view the compatibility chart for the drugs and solutions entered, click the "Go" button. Clicking on any underlined text within the compatibility chart will provide you with additional information and references related to the drug or the compatibility information, depending on which one is selected.

Check Compatibility tab: This allows you to retrieve compatibility information based on administration method(s) selected. Available administration methods include: Y-site, Admixture, Solution, Syringe, TPN, or All. Depending on the administration method selected, you may select up to two drugs and two vehicles, as well as a solution. To begin, type the medication name, vehicle, and solution into the appropriate boxes and hit "Go." This will display the compatibility information specific to the parameters entered. You may click on the hyperlinks to retrieve additional information on the compatibility study and the reference citation.

Drug Properties tab: This allows you to select a drug or solution to display its properties. Properties may include: formulation or reconstitution information, stability and storage information, light effects, pH, and various other information. To begin, type the medication name in the "Drug" search box. You may click on the medication to place it in the search box, or if it has already been auto-populated into the search box, you may click "Show Properties" to retrieve the properties information. A solution is added to the "Solution" search box in the same manner, and you may click "Show Properties" to retrieve the information for the solution.

Once you have retrieved information from any of the tabs described, you may return back to the page where you first entered the drug(s) and/or solution(s) by clicking "Modify Criteria" or "New Criteria," depending on whether you want to adjust your selections or clear the selections.

Patient Education

The Patient Education tool can be accessed via the blue tool bar at the top of the screen. This tool provides an opportunity to access and print patient-focused materials addressing medications, conditions, procedures, discharge instructions, natural products and healthy living.

Searching for Leaflets

The right content panel includes several tabs across the top to allow the user to find desired leaflets using searching or browsing alphabetically or by topic. To search for a topic, enter a keyword into the search box and click the "Search" button. A list of matching topics will be displayed.

To preview a leaflet, click on "Leaflet Preview" and the leaflet will be displayed in a preview window. To print from this preview screen, click "Print." To exit the preview mode, click "Close." To print a leaflet in English directly from the search results screen, click the blue "Print" button.

To add a leaflet to the printable packet from the preview mode, click the "Add To Packet" button. To add the leaflet to the printable packet from the search results screen, click the "Add" button next to the desired leaflet. Continue this process until all desired leaflets are added to your printable packet. Once all the desired leaflets have been added to the packet, you may print them. You have the option to print in English or a variety of other languages.

To find leaflets by browsing the available documents via an alphabetical or topical index, click the "Browse" tab at the top of the content panel. From this screen, the user can choose to browse conditions, procedures, discharge instructions, healthy living topics, natural products, and medication leaflets (both adult and pediatric). To view available topics, click on the desired hyperlink under the type of leaflet you wish to view ("Alphabetically" or "By Body System"). When browsing by alphabetical index, select a letter of the alphabet to view the topics that begin with that letter. When browsing by body system, click on the desired body system to see a list of topics available. In either case, the "Preview" and "Add" options will function in the same manner as outlined above.

Stored Packets

To access Lexicomp pre-defined patient education packets or any custom stored packets, click the "Stored Packets" tab at the top of the content window. A list of available packets will be displayed. To use a pre-defined packet, click the "Load" button to the left of the desired packet. This will add all of the patient education materials that are part of this packet. If desired, you can return to the "Search" or "Browse" tabs at the top of the application to add more documents to your packet before printing.

Lexicomp also allows the user to store a custom packet that is created by the user. To create a custom packet, use the "Search" or "Browse" functionality to add all of the desired leaflets to your packet. Once you have added all desired leaflets, click the "Stored Packet" tab and then choose the "Store Current Packet" button. This will allow you to enter a name for your packet. Please keep in mind that the naming convention used should not contain any patient identifiers to avoid any HIPAA conflicts. Once you have entered your name, click the "Store" button to save the packet contents. The next time you access the Patient Education tool, your packet will be available under the "Stored Packet" tab.

Preview Current Packet

To preview the current contents of your packet, click the "Preview Current Packet" tab at the top of the content window. This will display all of the documents that you have currently added to your packet as well the Patient Summary and Signature Page (if selected). From this preview screen, you can choose to add the patient's name and any notes to be printed on the Patient Summary and Signature Page (Note: this information is not stored in the system and will be lost if you exit this tool or print the packet and start over).

Packet Contents

The left side of the screen displays the "Packet Contents" panel. This panel allows the user to select several options for the packet being created and will also display a list of the current leaflets that are included in the packet. The packet options that can be added include:

In addition to the above options, the "Packet Content" panel also allows the user to modify the font size for the entire packet using the "Font Size for Printout" drop-down menu. In addition to font size, the leaflets are available in multiple languages. Under each leaflet type subsection (Medications, Conditions, Procedures, etc.) is a drop-down menu with the available languages. To select a different language, click on the drop-down menu and highlight the desired language (only available languages will be displayed in the drop-down menu).

Toxicology

The toxicology tool is accessed via the blue tool bar at the top of the screen. The Lexi-Tox tool combines information on agents of toxicity, antidotes and decontaminants, household products, toxicology-specific calculators, and drug identification in one point-of-care application.

Searching in Lexi-Tox

From the opening screen, enter any keyword (i.e., drug, household product) into the search box and click the "Search" button. To assist with searching, a possible keyword list will appear after you enter at least four (4) characters. To select a suggested term, simply click on the desired search term, and the system will automatically perform a search and display the results. Additionally, if you misspell a search term, you will be presented with a "Did you mean" list of possible search terms. To perform a new search using the correct term, simply click on the desired search term, and you will see a results list for the correctly spelled keyword.

Once you have entered your search term, clicking the "Search" button or hitting the enter key on the keyboard will initiate a global search across both the Household Products and Lexi-Tox databases. Any database that has information on the keyword searched will be displayed on the results screen. When searching for a particular brand-name product, such as Lysol or Drano, results will likely display in the Household Products database, and when searching for a topic that has an actual treatment monograph (i.e., a drug or chemical), results will likely appear in the Lexi-Tox database.

Explore by General Category

The "Explore by General Category" box allows a user to browse either the Lexi-Tox database or the Household Products database using an alphabetical index. To browse the Lexi-Tox database, click on the "Toxicology" button to display an alphabetical listing. Choose a letter to display the topics that begin with that letter of the alphabet. A similar process can be used to browse the Household Products database.

Accessing Content in Lexi-Tox

To review information about a specific household product, click on the hyperlinked term displayed under the Household Products database. This database will provide information on the product selected, including manufacturer, ingredients and MSDS-derived safety information. From the Household Products database, you can click on any hyperlinked ingredient from the ingredient table to be taken to the Lexi-Tox monograph for that chemical.

The Lexi-Tox database is designed to provide information on the signs/symptoms, diagnosis and treatment of acute poisonings and emergent overdose situations. To review information within this database, use the same navigation techniques available throughout Lexicomp Online, including the left panel "Table of Contents" links or the alphabetical "Jump to Section" drop-down menu at the top of the content panel.

Throughout the Lexi-Tox database there are hyperlinks that allow the user to access additional details on antidotes or link to dosing calculators when available.

Clinical Tools in Lexi-Tox

Similar to the blue tool bar in the main Lexicomp Online application, Lexi-Tox also provides access to clinical tools that are relevant to the management and treatment of acute toxicology and emergent overdose situations. These clinical tools include Drug I.D., Calculators and I.V. Compatibility.

Facts & Comparisons®

The Facts & Comparisons® module can be accessed from the blue tool bar at the top of the screen. This tool provides access to Drug Comparison Reviews and Comparative Data Tables.

Drug Comparison Reviews: The Drug Comparison Reviews tool is powered by The Formulary Monograph Service™ (Online) to deliver detailed information about recently released and investigational drugs. It provides one-page summary reviews of drugs published each month that are useful for P&T Committee presentations and in-services. In addition, the tool also offers a certain number of Class Review summaries as well as Drug Utilization Evaluations forms for Medication Use Evaluations (MUE). Begin by clicking on the letter of the alphabet that corresponds to the first letter in the generic name of the medication of interest. Once selected, you will see all monthly reviews for that letter.

You may click on the "Next" button to advance to the next page or the "Prev" button to return to the previous page. Clicking on the hyperlinked medication that you are interested in allows you access to all available information. Alternatively, you may click "View All" at the end of the A-Z choices to view all available medications sorted alphabetically.

Comparative Data Tables: The Comparative Tables tool from Drug Facts and Comparisons® allows you to quickly access over 3,000 comparative tables.

Using the "Monograph Summary" option, you may choose up to four (4) drugs you want to compare side-by-side. You may compare them by viewing "All Sections" or select only the sections you want to compare (such as Adverse Drug Reactions, Indications, and many more options). Using the "Comparative Data Tables" option, you may choose up to four (4) drugs you want to compare by creating a dynamic data table. You may compare these drugs by selecting "All Sections" or by limiting the comparisons to only the topic sections you want to review (such as Drug-Drug Interactions, Contraindications, and many more options).

To begin to use either of the above-mentioned tools, start typing the drug name into the search box. Once you have found the medication of interest and it appears in the search box, click "Add" to move the drug into the "Search Criteria" box.

Continue this method to add at least two (2) drugs and up to four (4) drugs into the "Search Criteria" box. If you have added a drug and then wish to remove it from the list, click the red X button to the left of the drug name. You may also enter in drugs by NDC rather than by drug name. If you wish to use this method, change the choice above the search box from the default of "Drugs" to "NDC." You may adjust your choices to launch either the Monograph Summary or the Comparative Data Tables option. This is also where you may leave the default to compare "All Sections" or uncheck the "All Sections" choice and begin checking which sections you wish to view. Once the selections are entered, click "Go" to view the information.

Drug Plans

The drug plans tool is accessed via the blue tool bar at the top of the screen under the "More Clinical Tools" heading. The Lexi-Drug Plans tool provides the formulary status of medications, and other plan-specific information, for over 5,500 prescription drug plans. This application may be customized to limit the plans searched to only those applicable to a given facility or healthcare system. This module is an optional resource within Lexicomp Online.

To begin, select a plan from the "Select Plan" window. If desired, you can filter the plans that are shown in this window by selecting a state from the drop-down box located directly above the "Select Plan" window. Once a plan has been selected, a search box will display in the right content panel along with several additional tabs across the top. To find a drug, enter a drug name into the search box (brand or generic), or click on the "Browse" tab at the top of the monograph to view an alphabetical listing of choices by generic name, brand name or therapeutic category.

When using the search method, enter the drug name (brand or generic) into the search box and click the search button. The results will then display below the search box. To view the drug monograph containing information on the formulary status of the drug, click on the hyperlinked term.

To browse and select the drug from one of the available alphabetical indexes, first click the "Browse" tab at the top of the content panel. This tab will present the user with three (3) index options: "Generic Drug Name," "Brand Drug Name," and "Therapeutic Category." Select the desired index, and an alphabetical listing will be presented. Click on a desired letter and further click on the drug/therapeutic category of choice to display the formulary status of the drug.

Once in the formulary monograph, the Strength, Status, Cost and Notes will be displayed for any available dosage forms. Also, a therapeutic category listing will be displayed as a hyperlink. These links can be used to display other drugs in the given category.

Web Search

The Web Search tool can be accessed via the blue tool bar at the top of the screen under "More Clinical Tools." Web Search is a tool that allows the Lexicomp Online user to expand a search to other medically based websites.

To begin, enter a desired search term in the Lexicomp Online search box (search terms can be any medically related keyword). Once the desired term is entered into the search box, click on the "Web Search" button from the blue tool bar under "More Clinical Tools." Results are displayed in a separate window, with access to content from various resources, plus additional links to abstracts and primary literature.

After the results are displayed, click on any of the links to access more detail. Access to full text articles from the results will depend on your institution's subscriptions to those sites.

Other Clinical Links

Other clinical links can be accessed from the blue tool bar at the top of the screen. To begin, click on "More Clinical Tools" and then "Other Clinical Links."

This will open a page of weblinks that allows you to access a variety of useful information for clinicians. When these hyperlinks are clicked, the page will be opened in a new browser tab to allow you to easily return to Lexicomp Online by clicking back on that tab and resume work from your original location.

Available hyperlinks include:

New Drugs – This opens a Lexicomp page with a listing of recent new drug approvals.

ASHP Drug Shortages – This opens the American Society of Health-System Pharmacists® (ASHP) webpage to search current drug shortages.

National Library of Medicine – This opens the U.S. National Library of Medicine's webpage which allows you access to a multitude of databases including, but not limited to, PubMed/MEDLINE, ClinicalTrials.gov, and TOXNET.

Orange Book – This opens the U.S. Food and Drug Administration (FDA) Orange Book which provides information on approved drug products with therapeutic Equivalence Evaluations.

FDA Recall – This opens the U.S. Food and Drug Administration (FDA) webpage with Recalls, Market Withdrawals, & Safety Alerts.

Dangerous Abbreviations – This opens a list from the National Coordinating Council for Medication Error Reporting and Prevention of dangerous abbreviations that should not be used in clinical practice.

Canadian Drug Shortages – This opens the Canadian Drug Shortage Database which provides information on Canadian products affected by drug shortages.