Pulse Newsletter Epocrates
March 2012
In This Issue
Clinical Editorial: Textbooks, Tablet Computers, & Cadavers
Drug & Disease Updates
FDA MedWatch Alerts
Clinical Question of the Month
DocAlert Editor’s Pick
Epocrates 1-1-1 Donation Program
Match Day
iPhone Tips & Tutorials
App Highlight: Sylvius MR: Atlas of the Human Brain
EssentialPoints Mobile Details Programs
What's This Disease?

"To improve is to change, to be perfect is to change often." Winston Churchill may not have lived to download smartphone apps, but in the context of today’s educational climate, his words carry resonance.

The tides of change are high. In her Clinical Editorial, Dr. Anne Meneghetti discusses digital textbooks in the changing landscape of medical education. And, we’re pleased to share with you a guest editorial from Darragh O'Carroll—fourth year student at John A. Burns School of Medicine, University of Hawaii—aptly capturing a medley of emotions in prelude to Match Day.

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Clinical Editorial

Textbooks, Tablet Computers, & Cadavers
Anne Meneghetti, MD
Director, Clinical Communications, Epocrates

Who among us has the fortitude to toss out every medical textbook we ever purchased? Those books were a very costly investment, especially at a time when it was hard enough to keep up with rent and sustain a diet of ramen noodles and cheap pizza. A row of fat dusty textbooks on shelves creates an atmosphere of gravitas that simply cannot be matched by electronic editions of medical texts. Yet, digital media is precisely where we are all headed. Future generations of clinicians may need to find something else to fill their bookshelves.

Brown University’s Alpert Medical School and Stanford University are among the schools piloting paperless iPad® programs for first-year medical students. Syllabi, lecture slides, textbooks, medical journals, and apps are available digitally. During lectures, students can take notes directly on their device – instead of scribbling in the margins of a handout, they can tag areas of electronic text or images with highlighting and personal notations. Although some may still prefer a laptop or even pen and paper for some learning tasks, the portability of a tablet computer while moving from classroom to clinic to anatomy lab cannot be beat.

posterior abdominal wall modalityBody App

Posterior abdominal wall, modalityBODY app

Digital anatomy textbooks are among the most impressive and engaging. While nothing will ever replace the experience of cadaver dissection, there are some anatomical structures that are super challenging to visualize in situ. Like the pterygopalatine fossa. Modern apps can integrate radiologic views with interactive illustrations and photographs. Bonus functionality includes zooming, bookmarking, and quick searches. Do flash cards need to be 3x5 inches, bundled with a rubber band? Many apps come with quiz and flash-card functionality – they can even re-test you on the questions you missed the first time around.

Let’s face the fact that students today have an overwhelming amount of content to master compared with trainees a decade ago: more drugs, more genetics, more details on underlying mechanisms of disease. They deserve the ease of electronic media. Not only are digital textbooks better, they are often a little less expensive. Some books can even be rented, evaporating from your device at semester’s end. That means more money available for boxed macaroni and cheese, beverages, or even movie night – viewed via your tablet computer, of course.

  update Update (sync) your device to receive free clinical content, news and new drugs.
Updated Diseases and Conditions
Lichen planus
Discogenic low back pain
Evaluation of liver dysfunction
Evaluation of hypocalcemia
Erythema nodosum
Acute interstitial nephritis
Tricuspid stenosis

New Drug Monographs
Aleve-D Sinus & Headache
(naproxen sodium/pseudoephedrine)
Children's Dimetapp
Multi-Symptom Cold & Flu

Clear Eyes Cooling Comfort Itchy Eye Relief
(naphazoline/zinc sulfate/glycerin ophthalmic)
Clear Eyes Cooling Comfort Redness Relief
(naphazoline/glycerin ophthalmic)
Janumet XR
PediaCare Children’s 24 Hour Allergy
PediaCare Children’s Pain Reliever/Fever Reducer IB
PediaCare Infants’ Gas Relief Drops
PediaCare Infants’ Pain Reliever/Fever Reducer IB
(nitroglycerin intra-anal)
See More

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FDA MedWatch Safety Alerts

Prescription drugs: Proton Pump Inhibitors: Can be associated with Clostridium difficile-associated diarrhea. Victrelis (boceprevir) and Ritonavir-Boosted HIV Protease Inhibitor Drugs: Interactions between the two can potentially reduce effectiveness. Avastin (bevacizumab): Counterfeit version does not contain bevacizumab. Acetylcysteine Solution, USP (Roxane Laboratories, Inc.): Recall - glass particles in vial. Treanda (bendamustine HCL): Recall - particulate matter in vial. Gris-PEG (griseofulvin ultramicrosize): Tablets from one product may have carried over into packaging of another product. Lo/Ovral-28 (Norgestrel/EthinylEstradiol) Tablets: Recall – possibility of inexact counts or out-of-sequence tablets.

OTC products: Infants’ TYLENOL Oral Suspension, 1 oz. Grape: Recall - dosing system complaints. Proton Pump Inhibitors (OTC): Can be associated with Clostridium difficile-associated diarrhea. Wholistic Herbs, Inc. "Koff and Kold" and "Kold Sore" Spray: Recall - nonsterile products. Vitaflo USA Renastart: Recall - possible health risk due to incorrectly labeled cans. Healthy People Co. Dietary Supplements: Recall - undeclared drug ingredient. RegenArouse: Recall - undeclared drug ingredient.

Medical devices: Spinbrush Powered Toothbrush by Arm and Hammer or Crest: Choking hazard and serious injuries. Salter Labs 7600 Bubble Humidifier used with Supplemental O2 Therapy: Recall - humidifier lids fail to pop off at intended pressure. H & P Industries Povidone Iodine Prep Pads: Recall - potential microbial contamination. Handheld Dental X-Ray Units: Unreviewed product.

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Clinical Question of the Month

Joshua L. Conrad, Pharm.D.
Managing Editor, Medical Information, Epocrates

Q: How do I interpret your renal dosing?

A: Epocrates generally uses one of the following notations to describe the action to take when dosing adjustments are necessary in patients with renal dysfunction.

(1) adjust dose amount
(2) adjust dose frequency
(3) adjust dose amount, frequency
(4) adjust infusion rate

The notation "adjust dose amount" is used when an adjustment is required to the amount of each dose, but not to how frequently the doses are given. The notation "adjust dose frequency" is used when an adjustment is required to the frequency of dosing, but not to the amount of each dose. The notation "adjust dose amount, frequency" is used when adjustments are required to both the amount of each dose and the frequency of dosing. The notation "adjust infusion rate" is used when a drug is given as an infusion and the infusion rate must be altered. (If no adjustment is necessary, we include the statement "no adjustment".)

In patients undergoing hemodialysis (HD) or peritoneal dialysis (PD), it is important to remember that renal function and dialysis both play a role in proper drug dosing. In these patients, the renal function usually still guides the maintenance dosing; whereas, the process of dialysis may necessitate post-dialysis supplemental doses, depending on the amount to which the drug is dialyzed. When a patient has significant renal dysfunction and is undergoing HD or PD, a drug may require one of the following changes in its regimen.

(1) adjustment to the maintenance dose and supplemental doses
(2) adjustment to the maintenance dose, but no supplemental doses
(3) no adjustment to the maintenance dose, but supplemental doses
(4) no adjustment to the maintenance dose and no supplemental doses

The notation "no supplement" after HD or PD means that a supplemental dose is not required following the dialysis session or period. If a supplement dose is necessary after dialysis, this will be noted. For instance, "HD: give 50% usual dose as supplement" would mean to give half of the normal dose as a supplement after hemodialysis. (The implication is that this drug is at least partially dialyzable and, therefore, replacement is necessary after a dialysis session.) If maintenance dose changes are required, these will generally be dictated by the renal function and presented in the renal dosing section.

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DocAlert Editor’s Pick

DocAlertInfluenza virion structure, CDC/ Dan Higgins

CDC Updates 2012 Child and Adult Immunization Schedules

Pediatric Immunization Schedule: Substitute Tdap for a single dose of Td in the catch-up series for 7-10 yo. HPV4 recommended for 11-12 yo males (catch-up 13-21 yo). MCV4-D age minimum lowered to 9 mo. Clarification of HAV 2nd dose to be given 6 to 18 months after dose 1.


Adult Immunization Schedule: Tdap recommended once for close contacts of infants <1 yo. Hep B recommended for adults with diabetes <60 yo. HPV4 recommended for all males 11-21 years and MSM through age 26. Meningococcal recommended for 1st-yr college students <21 yo living in residence halls (if no previous dose received on/after 16th birthday); 1 dose for military recruits.

Source: cdc.gov/vaccines


Epocrates 1-1-1 Donation Program

“Epocrates has saved me countless hours of time which I can now devote to patient care. Thank you for all your years of assisting in the care of needy patients.”

– Dr. Voss, Medical Director,
Volunteers in Medicine Clinic

“Epocrates Essentials has given physicians in the island nations confidence to practice more evidence-based medicine. Your reference has demonstrated to be indispensable for them during clinics, ward rounds, consultations and case presentations.”

– Sunny Chin, Ocean Medicine Foundation

1 Percent Million Year

Calling all non-profits! Epocrates has launched a new product donation program aiming to assist U.S.-based non-profit organizations whose healthcare professionals work to benefit underserved populations. Is there a medical non-profit organization you contribute to or admire? No matter how big or small, we want to support them through a donation of 1-year subscriptions to Epocrates Essentials. Recommend our program to an organization you know or apply today.

Apply or Recommend


Match Day
Darragh O'Carroll
John A. Burns School of Medicine, MD 2012
University of Hawaii

March 16th has long been a day circled on every 4th year student’s calendar (except the lucky urologists and ophthalmologists). Some say it is the day of reckoning. Some look forward to it like eager children on Christmas Eve. Whatever view we have, with the four previous years of hard work and sleepless nights at stake, is it possible NOT to feel nervous? Judging by the palpitations I experienced when submitting my rank list, I would say no.


Many of our experiences will be similar around the country. After sitting in eager anticipation we will finally get that letter in our hands. I only hope that I am not the first one called upon; waiting for the rest of my class to get their letters before I open mine might be all the torment I can handle. By and large, we will all be happy with whatever the letter says, yet some might not receive the letter they ideally want. I am trying to remember that wherever we end up, I know there will be terrific faculty who want to teach the future doctors of America.

Students on the East Coast will celebrate with an early dinner or late lunch, students on the West Coast will feast on a hefty brunch, and we way over in Hawaii will gulp down our third cup of coffee. Our class has rented an open-air Waikiki trolley to drive us around Honolulu that evening and facilitate the letting down of our hair. In many ways, it will be the sign that we have landed in the world of medicine with two feet; the first foot touched down four years ago during our white coat ceremony. Residency will give us our balance.

It is absolutely amazing to reflect back on how far we have come from being terrified first-year students. Equally amazing is how far we must travel to become the doctors we want to be. Bring it on March 16th, bring it on.


iPhone Tips & Tutorials

I have to tell you, that the new app is a major advance over previous versions. It’s entirely user friendly, and as intuitive to navigate as my iPhone! The layout is superb, and fewer clicks are required to obtain key information needed at point of care, which is essential for a pediatrician like me working in a busy pediatric practice

     - Philip Goldstein MD, MPH, FAAP Pediatric Medical Associates, Rydal, PA

The newest version of Epocrates for iOS offers a clean UI and added features to enhance the point-of-care resources you already use. Visit our Tips & Tutorials page to get oriented—click on a home screen icon to view its description or demo video.

Learn More

iphone tips

Sylvius MR: Atlas of the Human Brain

Navigate through 85+ sagittal, coronal and axial T1-weighted magnetic resonance images containing 2,000+ structure annotations and audio pronunciations. Please note that an Epocrates account is required to use this app.

Learn More

All content © Pyramis Studios, Inc.


EssentialPoints Mobile Detail Programs  

EssentialPoints Mobile Detail Programs

EssentialPoints Mobile Detail Programs are quick, self-guided, on-demand clinical learning activities on iPhone and Android devices. Earn a free month of Epocrates Essentials clinical reference suite with the completion of any qualifying activity.


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