The other day I had a drug information query when I was nowhere near the traditional resources a pharmacy would have; no medicines on the shelves to pull out the package insert, no reference books, no colleagues… but yes, I had the Internet, and some time to go exploring.

A newly diagnosed female hypertensive had been dispensed a month's supply of TarkaŽ, and was about to go on holiday to northern KwaZulu-Natal armed with some mefloquine. Not only did we need to check what the components of the antihypertensive were (being somewhat out of touch with trade names), but also whether this represented a logical therapeutic approach, whether there were any side effects, drug interactions and other information that the patient should have in order to be fully informed of her situation.

Particularly on the Internet, an information search of this nature does not necessarily take place according to some recipe or set of directions. Rather, starting from some defined starting points, a net is thrown out and returns an ever-expanding catch of information - each result is assessed for quality according to a number of criteria including the currency of the information, the source, and its degree of correlation with known facts.

Firstly it made sense to track down the electronic package insert to find out what this medication contained, and also to find the registered side effects and drug interactions - the South African Electronic Package Inserts web site ( home.intekom.com/pharm/  ) and SAMF 3^rd ed ( http://www.uct.ac.za/depts/pha/samf/p01part2.htm#P01B ) confirmed the active ingredients as verapamil and trandolapril, and raised the concern of cardiac side effects with the concomitant use of a calcium channel blocker and mefloquine.

A quick search through the drug interactions database on Medscape ( www.medscape.com ) and on Pubmed - Internet-based Medline ( http://www.ncbi.nlm.nih.gov/PubMed/ ) - did not yield any helpful information on this particular issue, although the Medline search provided some useful background on hypertension trials involving these drugs and the Medscape site did have lots and lots of information on the general area. Another clearly commercial web site ( www.planetrx.com ) also did not show an interaction between verapamil and mefloquine, but playing with the drug interaction finder was an interesting experience nonetheless.

The Knoll web site ( www.knoll.de ) wasn't a particularly productive route either - although I eventually found some product information it wasn't any more detailed than the basic package insert, and most of the site was in German - although one could try out one of the translation utilities (e.g. http://translator.go.com/ ) I could understand enough to see what information was available.

Of course the hypertension standard treatment guideline (1.03) of the PHC EDL ( www.sadap.org.za/edl/phc/ ) confirmed that this combination treatment was not indicated as first line therapy for hypertension, and provided a useful approach to therapy that could be given to the patient's doctor. The National Guideline Clearinghouse (www.guideline.gov) is an American-based public resource for evidence-based clinical practice guidelines, and includes several guidelines pertaining to hypertension.

RxList - the Internet Drug Index ( http://www.rxlist.com/ ) provided reasonable patient information sheets on individual drugs. The hypertension resource area on the Pharminfo.com web site provides a very useful and in-depth array of information on hypertension, including lifestyle modification, comparative treatment information and patient information, as well as links to other Internet resources.

Of course, if I'd had less time at my disposal and been less interested in doing the background research, an email to the Medicines Information Centre (micguest@uctgsh1.uct.ac.za) would no doubt have given me the same answers in much less time!

It is an interesting concept to consider that any pharmacist who has Internet access also has access to all these drug information resources, and YET, unless one knows where to find them one may as well have nothing. Thus when speculating about whether access to online resources would circumvent the need for some bulky and expensive textbooks, one must conclude that without demonstration of ability to use the resource it doesn't mean much! There will always be the need for books and places like drug information centres that can synthesise the vast knowledge base out there and present a concise answer in response to a specific question.

Another message to be learned from the above expedition is that Internet information searches are by no means always fruitful - with some experience and intelligent searching one can maximise the amount of useful information found, but one invariably has to wade through a few poor sites before finding the good ones!

If the title had you confused, you need a little light-hearted education! According to http://www.worldkids.net/pooh/welcome.html   "Expotition" is Winnie the Pooh's word for a special adventure. It's like an expedition but MORE FUN! A good place for Pooh fans to start is the 100% Pooh page   http://www.geocities.com/Tokyo/Flats/7337/ with links to lots of other sites (some of the links are old).