Laura Enderle Associate Editor

Tired of scouring the iTunes app store or Android market for apps you can actually use? Here are 7 recommendations from the editors of 

If you unwrapped a shiny new smartphone or iPad this week, chances are you’re on the lookout for apps you can use behind the counter. Although the market for healthcare apps is decidedly physician-driven, the choices for pharmacists are steadily growing. New apps are added every day, and reliable standbys—such as Lexicomp and Epocrates&mdash;continue to be upgraded on a regular basis.

For new smartphone owners, these 7 apps are a good place to start:

The OTC Guide App is the newest addition to the growing 

family of mobile offerings, and the first on our list of must-try apps for pharmacists. It brings the results of our 2011 survey of pharmacist’s OTC recommendations directly to your iPad or iPhone. Products are categorized and color-coded for quick and easy searching, and condition guides for each category give the pharmacist a top-level view of key counseling points for patients.

The gold standard for mobile drug references, Epocrates is available at multiple price points to fit every budget. It’s also easier than ever to navigate, thanks to a user-friendly upgrade to its interface that includes customizable features and faster access to information. The free version, Epocrates Rx, provides access health plan formularies, a drug interaction checker, medical calculators, clinical updates and medical news, in addition to its flagship product: a database of brand, generic, and OTC medicines that is illustrated with images and searchable by shape, color, or imprint code.

iPhone/iPod touch, Android, BlackBerry, Palm, Windows Mobile

Lexicomp partners with the American Pharmacists Association and the American Society of Health-System Pharmacists (ASHP), and members of both organizations get a special discounted price.  Users can choose Lexi-COMPLETE, which includes all 20 of Lexicomp’s drug and disease databases, or mix and match references to meet their needs. Some options include a patient education module with leaflets covering pediatric and adult medications; references for looking up pediatric and neonatal dosing guidelines and pregnancy and lactation labeling; and AHFS Essentials, a database of detailed information about prescription and OTC drugs that is published independently by ASHP. 

iPhone/iPod touch, iPad, Android, BlackBerry, Palm Windows Mobile

 wants to know how you use mobile apps—both at home and on the job. Do you use your iPad or Droid behind the counter? Have a favorite pharmacy app we missed? Share it in the comments!

Since it made our March 2011 list ranking 

, Thomson Reuters’ Micromedex has garnered high praise from 

magazine for its usability. According to the publication’s first-ever App Guide, “its user interface is the best of all the prescription drug apps. Many of the others have login menus or a bunch of clutter. But Micromedex is so fast and easy.” The app—which includes generic and trade names, adult and pediatric dosages, warnings, adverse effects, toxicology, and other information&mdash;was also recently added to Apple’s curated “Apps for Healthcare Professionals” category in iTunes. The current version is rated 4.5 stars out of 5 in iTunes, and is available for both iPhone and iPad.

 by iMedicalApps, Sigler Drug Cards is an ideal study resource “if you’re the type of person who is more likely to have a smartphone with you than a pile of flash cards.” For each of the top 300 most commonly prescribed drugs, the Sigler app provides a full-color picture, FDA dosages and indications, pharmacology, drug interactions and precautions, adverse effects, illustrated chemical structure, and patient counseling tips. Fans of 

?” and “Case Studies” columns will appreciate a forthcoming “Quiz” section, which the app’s developers say is currently under construction.

$29.99 (a free “lite” version is planned)

As our legal expert Joseph Fink, BSPharm, JD, noted in his October 2011 article about the 

implications of clinical practice guidelines

 (CPGs), “being familiar with the origins and uses of CPGs and their potential contributions to clinical decision making is essential.” Redi-Reader is a free app that makes it easier for pharmacists to access these evidence-based recommendations from a mobile device. It includes official guidelines set by the Infectious Disease Society of America, the American Diabetes Association, the Centers for Disease Control and Prevention, and the American Thoracic Society, among other organizations.

The latest version of this mobile tool from Monthly Prescribing Reference (MPR) includes a drug interactions checker and improved news and alerts. Users can search within the app for information on more than 4000 prescription and OTC drug monographs listed by brand or generic name, disease, pharmacological class, or manufacturer. Edited by pharmacists, MPR also provides up-to-date drug news, safety alerts, and recall information and features more than 30 medical calculators.

Handy for pharmacists who work with non-English speaking patients, Google translate allows you to translate words and phrases in more than 60 languages, including English, Arabic, Catalan, Chinese, Croatian, Czech, Danish, Dutch, Finnish, French, German, Greek, Hebrew, Hungarian, Indonesian, Italian, Japanese, Korean, Malay, Norwegian, Polish, Portuguese, Romanian, Russian, Slovak, Spanish, Swedish, Thai, Turkish, Ukrainian, and Vietnamese.

Articles

8 Must-Try Apps for Pharmacists

A new study reports that patients are more likely to seek information about a drug online after seeing a spam ad. 

	With subject lines like “Paradise of Viagra Price” and “Cheap Cialis Now,” spam emails pushing prescription drugs are easy for most patients to spot—and ignore.

	However, new research shows that drug spammers’ marketing tactics—as transparent as they are&mdash;do influence behavior in subtle but significant ways. Patients who view spam ads are more likely to use the Internet to research prescription drugs, according to a report on the study published in the January 2012 issue of the 

International Journal of Business and Systems Research.

	That means exposure to drug spam could put patients at risk for misinformation, depending on which sites they visit. It’s also likely to lead them to rogue online pharmacies. A recent study conducted by computer scientists at Carnegie Mellon University found that 1 in 3 Google searches for drug names are rerouted, 

diverting users to illicit online pharmacies.

 are known, the new study, “Online information seeking for prescription drugs,” is one of the first to look at why patients do so in the first place, according to the authors. Its findings have implications for pharmacists, who, as medication experts, are often left to deal with the public’s misconceptions about prescription drugs.

	Protecting patients from false marketing messages is the goal behind laws that limit claims pharmaceutical companies can make in ads targeting consumers. But unlike traditional direct-to-consumer advertising (DTCA), spam ads are largely unregulated, says senior author and consumer behavior researcher Sanjoy Ghose, PhD, who is also a professor of marketing at the University of Wisconsin-Milwaukee.

	In their report, Dr. Ghose and colleagues explained that although drug spam is rampant and the Web has become “a powerful media tool” for sharing information about medication, regulators have been slow to respond to the changing landscape of online communication. Results of experiments like theirs should drive policy going forward; however, for the time being, “national DTCA regulations have little control over communication through the Internet,” they wrote.

How Drug Spam Hooks Patients

With medication poisonings on the rise in children, parents need to develop a routine for putting medicine away every time it’s used. 

Thanks to years of campaigning by poison prevention experts, most parents of young children know to childproof their kitchen cabinets. But when it comes to what’s in the medicine cabinet, parents and caregivers aren’t nearly as vigilant as they should be, according to the Centers for Disease Control and Prevention (CDC).

Accidental overdoses in children are up by 20%, and more than 60,000 children are sent to emergency departments each year after being exposed to medicine. CDC research shows a large majority of cases are the result of medications left unsecured—stacked on countertops, tucked into purses and coat pockets, or stored bathroom cabinets.

Whether it’s a toxic dose of cough medicine or a handful of antidepressants, accidental poisonings can be prevented. Being mindful of habits is an important part of the equation, and a simple reminder may be all it takes to get parents on the right track, says Emily Skor, vice president of Communications & Alliance Development at the Consumer Healthcare Product Alliance (CHPA).

Her organization, which represents the nation’s OTC drug makers, recently partnered with the 

,” an educational campaign that offers resources pharmacists can use to promote 

. “Parents work hard to protect their children,” said Skor. “This program reminds them to keep medicines and vitamins up and away and out of sight.”

The campaign focuses not just on prescription drugs, but OTC medicines as well—including children’s cough and cold medicines and supplements, which parents may not think of as dangerous. “Up and Away” offers a Web site and other educational materials parents can use to develop a “safe storage routine” to follow every time they open up a medicine bottle.

	Pharmacists do their part to protect children from accidental medicine poisonings by sharing these 5 tips with parents:

Walk through the house with your child’s field of vision in mind. The best place to store medicines is a high, hidden spot, such as on top of the refrigerator, in an upper kitchen cabinet, or on the highest shelf of the linen closet. Although it’s common to store medications in the bathroom, the damp, warm conditions aren’t ideal for medicines. The storage spot should have a steady temperature and low humidity. 

  Seeing prescriptions or vitamins lined up on the counter can be a useful reminder to stick to your daily regimen. But with young children in the house, it’s an accident waiting to happen. Set cell phone reminders, use a medicine log, or write notes to yourself, but don’t leave your medications out in plain view. The same goes for children’s medicines—even if your child is sick and you expect she’ll need another dose in a few hours.

 Get into the habit of listening for the “click”—the sound a child safety cap makes when it’s locked in place. Remember that although locking caps are child-resistant, they aren’t childproof. A study conducted at the Long Island Poison Center found the locking caps no better than ordinary caps at preventing 

child poisonings involving a grandparent's medication

In addition to taking steps to safeguard medicines, take time to explain to children what medicine is and why only an adult should handle it. CDC adds this warning for parents: “Never tell children medicine is candy to get them to take it, even if your child does not like to take his or her medicine.”

 Caring for children requires a strong support network, and medicine safety is no different. Grandparents and other guests who come to visit may not be accustomed to keeping tabs on their medications. Ask them to help you safeguard your home by stowing purses, bags, or coats that might have medicine in them out of your child’s reach.

Precautionary measures are the best way to reduce medication poisonings, but knowing how to respond to a suspected poisoning is also important. “Up and Away” urges parents to prepare by programming the poison control center number, 1-800-222-1222, into the address books of their home and cell phones. The help line connects callers to a specially trained pharmacist, nurse, or doctor who can provide guidance during a poison emergency.

"We know that, unfortunately, many children have to visit the emergency room because of accidental medication exposures," said Dan Budnitz, MD, director of the CDC's Medication Safety Program. "To help combat these preventable harms, the Up and Away and Out of Sight program gives parents and caregivers the information they need to store medicine safely and protect children."

Up and Away: 5 Tips for Storing Medicine Safely

HHS Secretary Kathleen Sebelius overruled FDA's decision to approve the OTC sale of emergency contraceptives to teenagers younger than 17. 

Federal officials ruled last week that the emergency contraceptive Plan B One-Step will stay exactly where it is—behind the counter.

In what some argue was a purely political move, US Health and Human Services (HHS) Secretary Kathleen Sebelius rejected FDA’s plan to lift the age restriction that prevents pharmacies from selling the drug on OTC shelves. The decision does not impact access to Plan B for women aged 17 years and older, who can already buy it without a prescription.

Sebelius said her objection to the plan stems from concerns about label comprehension—a problem pharmacists confront daily when dispensing complex medications to patients of all ages. Specifically, she questions whether girls aged 11 to 16 are capable of understanding a medicine label that explains how to use Plan B safely.

Should Plan B be available to women younger than 17 without a prescription? Does it belong behind the counter or in the OTC aisle? Share your thoughts in the comments or cast your vote in our 

The health secretary explained her reasoning: “The switch from prescription to over the counter for this product requires that we have enough evidence to show that those who use this medicine can understand the label and use the product appropriately,” she wrote in a 

 issued last Wednesday. “I do not believe that Teva’s application met that standard.”

Regulators at the FDA’s Center for Drug Evaluation and Research disagree. They approved a February 2011 request submitted by Teva Women’s Health to make the drug available to younger women.

In its review of the evidence, CDER determined that adolescent girls “understood the product was not for routine use” and that it doesn’t protect against sexually transmitted diseases. The data also showed that girls could use Plan B One-Step properly without the guidance of a physician, according to FDA Commissioner Margaret Hamburg, MD.

“I reviewed and thoughtfully considered the data, clinical information, and analysis provided by CDER,” said Dr. Hamburg, “and I agree with the Center that there is adequate and reasonable, well-supported, and science-based evidence that Plan B One-Step is safe and effective and should be approved for nonprescription use for all females of child-bearing potential.”

By and large, physicians and other primary care providers support CDER’s assertion that Plan B should be accessible without a prescription to women of all ages. Robert Block, MD, FAAP, president of the American Academy of Pediatrics, called HHS’ decision to uphold the age restriction for emergency contraceptives “medically inexplicable.”

“The AAP strongly encourages the use of contraception—including emergency contraception&mdash;by adolescents who choose sexual activity,” he wrote in joint statement by the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the Society of Adolescent Health and Medicine.

But many pharmacists share Sebelius’ doubts about whether teens are capable of using emergency contraception safely and appropriately without a professional’s guidance. Among the small number of pharmacists who responded to 

request for comment on the issue, most supported limiting access to Plan B:

“It’s already used as a regular form of birth control, which it’s not intended for. Going OTC will only result in further misuse and adverse effects from misuse.” 

“It should not be OTC or BTC [behind the counter]. It should require a prescription. It is much stronger than regular contraceptive products, yet those are prescription only. The only reason Plan B is BTC/OTC is purely political. If Plan B is to be OTC, then so should all oral contraceptives.” 

“I believe it should be available to minors at the age of consent. But it should still be behind pharmacy counters because it will be stolen so fast and the HIPPA factors will be really dangerous by allowing a teenage cashier to ring it up.” 

Other experts—including Kathleen Hill-Besinque, PharmD, MSEd, an assistant dean at the University of Southern California School of Pharmacy&mdash;say the drug’s risks are minimal. She told the 

 that “very few medications are this simple, convenient, and safe."

FDA to Investigate Bleeding Risk of Dabigatran

Health News: Best and Worst Sites for Patients

 to read the Redheaded Pharmacist's blog focusing on this issue.

Should Plan B Stay Behind the Counter?

As the FDA undertakes a new safety review of Pradaxa, pharmacists should educate patients who take the drug to recognize signs of serious bleeding.

	After receiving reports of serious bleeding events associated with Boehringer Ingelheim’s anticoagulant Pradaxa (dabigatran etexilate mesylate), the FDA announced December 7 that it plans to launch a 

	Bleeding is a well-documented side effect of all anticoagulants, the FDA noted. A previous clinical trial involving 18,000 patients found the risk of major bleeding with dabigatran comparable with that of warfarin. However, the agency said it is currently analyzing new reports of serious and fatal bleeding to determine whether the side effect occurs more frequently with Pradaxa than prior research indicates.

	Approved in October 2010, Pradaxa is a relative newcomer compared with warfarin—the 50-year old medication that is the “gold standard” for lowering stroke risk in patients with atrial fibrillation. The age gap makes comparing the 2 drugs’ safety profiles complicated. Because severe bleeding is a well-known risk of warfarin, health professionals and patients are unlikely to report it, according to the FDA.  

	To get a more accurate picture of the risk associated with Pradaxa, the FDA investigators will need to rule out other possible causes of bleeding, such as inappropriate dosing or drug interactions. The agency also plans to examine whether new users of Pradaxa are more likely than new users of warfarin to be hospitalized for bleeding. 

	Despite its concerns about dabigatran, the FDA said it believes that “the benefits of Pradaxa continue to exceed the potential risks when the drug is used appropriately following the approved drug label.” Patients should not stop taking it without first consulting a health professional, the notice warned. 

	In the meantime, pharmacists who dispense the drug should teach patients to look for signs of bleeding and know when to seek immediate care. These include: 

		Heavy periods or other vaginal bleeding 

		Unexplained bruises or bruises that expand

Patients should also be advised to report any serious adverse events to their primary care provider and to the FDA using the MedWatch program’s online form for 

As FDA undertakes a new safety review of Pradaxa, pharmacists should educate patients who take the drug to recognize signs of serious bleeding.

In a critical review of major news organizations' online health coverage, some sites fared better than others.

Thanks to popular health sites like WebMD and extensive health reporting by major news outlets and magazines, it’s easier than ever for patients to stay in the know about the latest treatment breakthroughs, clinical trial results, and screening recommendations.

But the 24-hour stream of online health news cuts both ways.

Although it’s created a generation of more educated patients, it also provides more opportunities for sub-par reporting to influence patients’ decisions about their care. That’s the philosophy behind the newly upgraded 

 to evaluate online news stories about medical treatments, tests, products, and procedures.

Published by veteran health journalist Gary Schwitzer and funded by the 

Foundation for Informed Medical Decision Making

, the project is run by an interdisciplinary panel of 30 journalists, physicians, health researchers, and public health experts. Reviews target only stories that make claims of efficacy or safety—information patients are most likely to consider when choosing whether to get screened or try a new drug.

Teaching patients the ABCs of reliable data

, 59% of US adults search the Web for information about medical treatments, diseases, and doctors. But Schwitzer says say too many medical news stories lack the “ABCs” of good journalism: accuracy, balance, and completeness.

Whether it’s an overblown claim about a “miracle” cancer treatment or an experimental “wonder drug” that hasn’t been tested in humans, articles that turn up in searches are often misleading or fail to answer critical questions. Schwitzer and his crew of skeptics aim to help people do their own research more effectively by teaching them to see the news through a critical lens.

Ultimately, they hope the project will lead to better health reporting. “We hold the bar high for quality in health care journalism because it plays a major role in educating consumers,” the site explains.

Grading the news: Which sites measure up?

Health News Review recently underwent a makeover, complete with a 

 ranking 20 news organizations according to how well they’ve scored over time. Stories that earn 5 stars answer all or most of the following questions about a treatment or procedure:

Dave DeBronkart, who writes about participatory medicine for the blog 

, used the new chart to find out which sites make the grade and which fall short. His analysis revealed that, out of 1650 total stories reviewed, top performers included the 

Associated Press, New York Times, National Public Radio,

. Each earned 4 to 5 stars at least 52% of the time and 0 to 2 stars between 18% and 24% of the time.

 earned 4 to 5 stars 39% of the time and 0 to 2 stars 34% of the time.

 earned 4 to 5 stars 36% of the time and 0 to 2 stars 34% of the time.

 earned 4 to 5 stars 19% of the time and 0 to 2 stars 26% of the time.

 earned 4 to 5 stars 39% of the time and 0 to 2 stars 43% of the time.

stories reviewed, two had 5 stars, four had 3 stars, and four had 2 stars. 

, Schwitzer said the variability of the scores shows why patients need to take a measured, questioning approach to any news story about a new test or treatment. Even news outlets that typically do a good job of fulfilling the 10 criteria received 0 to 2 stars 18% of the time, he noted.

“Someday perhaps your doctor’s office will have an ‘information coach,’ but even then, Health News Review will still be more accessible,” Schwitzer wrote. “You really do need to evaluate each story separately."