How To Use Emdex Drug Reference Book

Emdex (Essential Medicine Index) is a drug and therapeutic reference book designed in Nigeria for Nigeria health sector. Since it's first release in 1991 as Nigeria Essential Drugs (NED) guide, it has regularly been updated yearly. The information it provide is supported by several reference and clinical guide such as World Health Organisation (WHO). The book have been endorsed by the Pharmacist Council of Nigeria, PCN. This book is very good for both pharmacist and the other health care teams. Fortunately, there is an electronic format available for download from Google play store, the company website, apple store or Jumia and Konga at a particular price.

Emdex

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How To Use Emdex

The book is big with plenty of valuable information. A stranger may find it hard to locate information in it. A good navigation is essential to get the best out of this book. It is always handy.
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The book contains several section. Each section compliment the others. The beginning of the book contain ads of various drugs. Before the table of content, the mission and vision statement is summarise. All other information about the producers can be found in this region. How to use Emdex is suppose to be found in this region too but unfortunately, all the Emdex I was fortunate to check did not contain it. Maybe, future Emdex will add it.
Nigeria National drug policy guide is summarise too in the opening pages of the book. The general advice to prescribers is valuable when you are new to the world of pharmacy especially interns students. It discuss on how drugs act and how to write prescription.
Looking at the table of content, it is clear how the book is organised. The drug information pages are group into chapter. Each chapter covers ailments that affect a particular area of the body. The area is further broken down to smaller area. For example, chapter one is about central nervous system (CNS) drugs. Anxiety and sleep disorders are part of the CNS. Others include parkinsonism, etc. The drugs use in treating each of these conditions are arranged in alphabetical order. There is a table of content for each chapter. There is a general introductory notes for each class of drugs.  For example, drugs use in treating anxiety and sleep disorders have Bromazepam as the first drug there. It begins with letter B. The next drug is Diazepam which begins with D and so on and so forth. If there is one that begins with the letter A, that would have started it.
Knowing the area of the body one is dealing with makes it easy to locate where drugs use in treating it can be found.
The table of content is not arrange in any particular order. So when looking up at a disease condition, it is easy to look at the area of the body the disease affect and look it up from the table of content.
Some drugs have two Indications. In such cases, the drug may be discuss in one of the indication fully and referenced in the other or vice versa.
The information encountered for drugs include;
Indication: what the drug can treat, sometimes more than one use
Synonyms: another name(s)
Therapeutic category: class of the drug
Pharmacology: how the drug works
Contraindication: conditions the drug must not be use to treat or when such conditions coexist with the main indication
Precaution: use with care in these cases
Adverse effects: possible effects to encounter during usage of the drug and when to seek medical help
Interactions: what the drug interactions with either positively or negatively
Administration: how to take the drug
Nursing action: how to give the drug
Action: what to do in different situations when taking this medication
Advise to patients: some home activities to enhance the effect of he drug or improve on living condition
Dose: dosage and administration (very important)
Producers: name of different products in the market, dosage forms, strength, and producers

Appendix

Towards the end of the book are some very valuable resource. Labeled appendix one to 8, these information are relevant to prevent some unwanted effects from wrong prescription.

Appendix one: Drug interactions

Two or more drugs given at some time may interact with each other. The interaction may be potentiation or antagonism of one drug by another or occasionally some other effects. This interaction can be pharmacodynamic or pharmacokinetic.
The drug that have other drugs that can interact with it are arranged in alphabetical order. All the drugs that interact with the drug are written with it stating the nature and type of interaction. They are not arrange in allhabalphab order. For potentially hazardous interactions, an asterisk mark is attached with it. This means that the drug combination should be avoided by all means possible or taken with caution or appropriate monitoring.
The first on the list is abacavir waiting to be dethrone by another. It is always the first when drugs are arranged in alphabetical order. The last on the list is zinc sulphate.

Appendix two: Pregnancy

During pregnancy, the mother and the fetus form a non-seperable functional units. This page provide information about drugs believe to be teratogenic to the fetus or  the ftoxic to the mother. The only time the drugs in this page can be use is when the benefits to the mother outweigh the risk to the fetus in critical conditions.
The list includes drugs that have been found to be dangerous to either mother and child alone or separately in human studies. In other cases, animal studies showed the possibility of harmful effects to other mother and child is also included. It also states the stage some of the drugs are dangerous and when not to use it. Some cases even involve animals studies which shows it is safe but no human studies.

Appendix three: Breastfeeding

Not every drug can be use by a nursing mother. Some of the drugs enter into the breast milk. If the drug is dangerous to children, such drugs can harm the child. Whereas some other drugs that are dangerous to children can be taken by the nursing mother if it does not enter into the breast milk.
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Because if the nature of effects different drugs have in the child, Emdex came up with a table explaining drugs;
1. Which can be use with caution or which are contraindicated in breastfeeding for the reasons given below,
2. Which on present evidence, maybe given to the mother during breastfeeding because they appear in milk in amounts which are small to be harmful to the infant,
3. Who are not known to be harmful to the infant although they are present in milk in significant amounts
The table is also arranged in alphabetical order to make search easy. A comment is attached to each drug as to it stands in breastfeeding

Appendix four: Renal impairment

Reduced renal function may cause problems with drug therapy for the following reason;
1. Failure to excrete the drugs or its metabolites which may produce toxicity
2. Sensitivity to some drugs is increased even if renal elimination is unimpaired
3. The tolerance to adverse effects maybe impaired
4. The efficacy of some drug may be diminished
The degree of renal impairment determine dose adjustment for many drugs. This appendix gives guidelines on drugs to be adjusted or avoid. When it gives caution, it gives the degree of impairment as moderate, mild to severe.
It is arrange in alphabetical order to ease search.

Appendix five: Hepatic impairment

Liver disease may alter the response to drugs. It includes
1. Impaired intrinsic hepatic elimination (metabolizing) capacity due to lack of function of hepatocyte.
2. Impaired biliary elimination due to biliary obstruction or transport abnormalities
3. Impaired hepatic blood flow due to surgical shunting, collateral circulation or poor perfusion with cirrhosis portal hypertension
4. Altered volume of distribution of drugs due to increased in extracellular fluids and decreased muscle mass
5. Decrease protein binding and toxicity of drugs highly bounds to proteins due to impaired albumin production
6. Increased bioavailability through decreased first pass metabolism
7. Decreased bioavailability due to malabsorption of data in cholesteric liver disease
To enhance better adsorption without adverse effects from drug, the emdex gave advice in prescribing in hepatic impairment either for the drug to be avoided or use with caution.
The drugs are so arrange in alphabetical order.

Appendix six: Caution and advice to patients on the use of dispensed medicines

It is valuable to pharmacist as it explains the meaning of each warning label in drug use.

Appendix seven: Abbreviations

Looking for any medical abbreviations? Search no further.

Appendix eight: Guide to drug administration

A comprehensive notes on the various routes of drug administration, advantages and disadvantages included. The information here is for personal consumption as it may not be needed in times of urgency.
The index of pharmaceutical manufacturers and importers is very valuable for community pharmacist. With their contact address attached, they can be contacted for business any time any day.
The last item is the general index. This is one of the most important attachment in the emdex. So many people use it alot including me. All the noun words found in the book have been arrange in an alphabetical order. This ease the search for items found in the book. If it is not here, it is not in the book.
To search for anything in the book, use either the table of content or the general index. The number page is always attached to the word

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