NURSING RESOURCES
By Susan Fowler, MLIS, and Janet G. Schnall, MS, AHIP
TOXNET: Information on Toxicology and Environmental Health A reliable source of information about potentially harmful substances.
W
hen you are working with a nursing mother, where can you go to see if a medication she’s taking is safe? If you’re treating a school janitor with a skin rash, how can you determine the toxic potential of the cleaning products he’s using? Toxicology Data Network (TOXNET) is a free integrated system of databases on toxicology, environmental health, hazardous chemicals, toxic releases, and occupational health (see Figure 1). It is maintained by the National Library of Medicine as part of the Toxicology and Environmental Health Information Program of the U.S. Department of Health and Human Services’ Specialized Information Services. The d atabases themselves are supported by various entities, including the Environmental Protection Agency, the National Cancer Institute, and Toxicology Excellence for Risk Assessment.1 TOXNET is available online (http:// toxnet.nlm.nih.gov) and also has Figure 1. The TOXNET Home Page partial mobile access (http://toxnet. nlm.nih.gov/pda). It comprises a total of 15 databases that can be searched all at once or current and comprehensive information is now availindividually (see Table 11). All of the databases in able on the Internet . . . at LactMed.”2 TOXNET are valuable, full of useful information, LactMed includes information on the safety and most importantly, free! We highlight several of drugs and other chemicals—such as Prozac or below. caffeine—that an infant may be exposed to through breastfeeding. Each drug or chemical entry contains LACTMED a brief summary about safety during lactation, the A drugs and lactation database, LactMed is a useful levels passed from mother to infant during breastresource for health care providers and consumers feeding, the effects on infants and on lactation, alike. Nursing mothers have been advised for years to and alternatives to consider. Also, each entry ineither avoid taking certain medications or stop breastcludes sources for the information given as well feeding to keep their infants safe. But according to a as the dates of any revisions. You can look up a recent clinical report in Pediatrics, “This cautious apdrug or chemical by using its trade name, generic proach may be unnecessary in many cases. . . . More name, drug class, or Chemical Abstract Service [email protected]
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NURSING RESOURCES
Table 1. Resources Available at TOXNET1 Database
Type of Data
Content
Producing Organization
Mobile?
CCRIS
Toxicology
Chemical records of carcinogenicity, tumor promotion, and tumor inhibition test results
National Cancer Institute
Yes
ChemIDplus
Chemical
Chemical records, most with chemical structures
National Library of Medicine
No
CPDB
Toxicology
Analysis of potency of carcinogens
University of California, Berkeley; Lawrence Berkeley National Laboratory
No
CTD
Toxicology
Molecular mechanisms of environmental chemicals in human disease
North Carolina State University
No
DART
Toxicology Literature
Citations for literature covering reproductive and developmental toxicology
National Library of Medicine
Yes
GENETOX
Toxicology
Mutagenicity
Environmental Protection Agency
Yes
Haz-Map
Toxicology
Adverse effects of workplace exposure to chemical and biological agents
National Library of Medicine
No
Household Products
Toxicology
Potential health effects of common household products
National Library of Medicine
No
HSDB
Toxicology
Toxicology, human exposure, and emergency handling procedures
National Library of Medicine
Yes
IRIS
Toxicology
Health risk information on chemicals; sources are Environmental Protection Agency consensus statements
Environmental Protection Agency
Yes
ITER
Toxicology
Compares risk assessments of different organizations
Toxicology Excellence for Risk Assessment
Yes
LactMed
Toxicology
Levels of drugs and other chemicals in breast milk; possible adverse effects on infants
National Library of Medicine
Yes
TOXLINE
Toxicology Literature
Citations for literature on the effects of drugs and chemicals
National Library of Medicine
Yes
TOXMAP
Toxicology
Geographic information system shows amount and location of chemicals released into the environment
National Library of Medicine
No
TRI
Toxicology
Inventory of toxic waste release and management
National Library of Medicine
Yes
CCRIS = Chemical Carcinogenesis Research Information System; CPDB = Carcinogenic Potency Database; CTD = Comparative Toxicogenomics Database; DART = Developmental and Reproductive Toxicology; GENETOX = Genetic Toxicology; HSDB = Hazardous Substances Data Bank; IRIS = Integrated Risk Information System; ITER = International Toxicity Estimates for Risk; TRI = Toxics Release Inventory.
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(CAS) registry number.3 LactMed is also available via mobile app, making it a great tool for health practitioners for ready access while treating patients or for any nursing mother while shopping in the drug aisle.
encountered in the workplace. Users can search for agents such as asbestos or latex, the symptoms and diseases they cause, and the jobs or industries that are most likely to use them. The most valuable part of this database is that it provides a direct link be-
TOXNET provides in-depth information on drugs and chemicals that is immediately available for health care professionals’ use in providing patient care, preventing illness, and making informed decisions. HOUSEHOLD PRODUCTS
The Household Products database lists more than 12,000 consumer brands, including household cleaners, pesticides, yard and personal care products, and pet care and auto products. A search of any product brings up its health effects, which come from its product information or Material Safety Data Sheet; the percentage of each chemical in a product; the manufacturer’s contact information; and information on handling and disposal. Health effects include warnings, acute and chronic health problems, carcinogenicity, and first aid in case of inhalation, ingestion, and eye and skin exposure. Clicking on a hyperlink will take you to a glossary. You can search by product name, product type, ingredient, manufacturer, or health effect. In addition, the database has a Product Recalls section that explains why a particular product was recalled.4
HSDB
Click on HSDB, the Hazardous Substances Data Bank, to locate more than 5,000 records on the toxicology of potentially hazardous chemicals. The records contain sections on human health effects, emergency medical treatment, animal toxicity, pharmacokinetics, pharmacology, and environmental fate and exposure, among others, along with citations for all sources and dates of last review and revision. Most entries have been peer-reviewed by HSDB’s scientific review panel of 16 experts in such fields as toxicology, chemistry, and environmental science. The information comes from many sources, including books, government documents, technical reports, and journal articles.5 The HSDB is also available via mobile app.
HAZ-MAP
Haz-Map is designed for both health care professionals and consumers as a resource for information on the adverse effects of hazardous agents [email protected]
tween hazardous agents and occupational diseases based on scientific evidence from textbooks, journal articles, the Documentation of the Threshold Limit Values published by the American Conference of Governmental Industrial Hygienists, and online databases including the HSDB.6
CURRENT, AUTHORITATIVE, AND UNBIASED INFORMATION
TOXNET provides free access to in-depth information on drugs and chemicals that is immediately available for health care professionals’ use in providing patient care, preventing illness, and making informed decisions. For additional resources on toxicology, see the “Essential Nursing Resources” section of the Interagency Council on Information Resources in Nursing Web site (www. icirn.org). ▼
Susan Fowler is a medical librarian at the Washington University School of Medicine in St. Louis. Janet G. Schnall is an information management librarian at the University of Washington (UW) Health Sciences Library and an affiliate instructor at the UW School of Nursing in Seattle; she also coordinates Nursing Resources: [email protected].
REFERENCES 1. U.S. National Library of Medicine. Fact sheet: TOXNET— Toxicology Data Network. Bethesda, MD; 2005/2012. http://www.nlm.nih.gov/pubs/factsheets/toxnetfs.html. 2. Sachs HC. The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics 2013;132(3):e796-e809. 3. U.S. National Library of Medicine. Fact sheet: drugs and lactation database (LactMed). Bethesda, MD; 2006/2011. http://www.nlm.nih.gov/pubs/factsheets/lactmedfs.html. 4. U.S. National Library of Medicine. Fact sheet: Household Products database. Bethesda, MD; 2003/2012. http://www. nlm.nih.gov/pubs/factsheets/householdproducts.html. 5. U.S. National Library of Medicine. Fact sheet: Hazardous Substances Data Bank (HSDB). Bethesda, MD; 1994/2010. http://www.nlm.nih.gov/pubs/factsheets/hsdbfs.html. 6. U.S. National Library of Medicine. Fact sheet: Haz-Map. Bethesda, MD; 2003/2011. http://www.nlm.nih.gov/pubs/ factsheets/hazmap.html.
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By Susan Fowler, MLIS, and Janet G. Schnall, MS, AHIP
TOXNET: Information on Toxicology and Environmental Health A reliable source of information about potentially harmful substances.
W
hen you are working with a nursing mother, where can you go to see if a medication she’s taking is safe? If you’re treating a school janitor with a skin rash, how can you determine the toxic potential of the cleaning products he’s using? Toxicology Data Network (TOXNET) is a free integrated system of databases on toxicology, environmental health, hazardous chemicals, toxic releases, and occupational health (see Figure 1). It is maintained by the National Library of Medicine as part of the Toxicology and Environmental Health Information Program of the U.S. Department of Health and Human Services’ Specialized Information Services. The d atabases themselves are supported by various entities, including the Environmental Protection Agency, the National Cancer Institute, and Toxicology Excellence for Risk Assessment.1 TOXNET is available online (http:// toxnet.nlm.nih.gov) and also has Figure 1. The TOXNET Home Page partial mobile access (http://toxnet. nlm.nih.gov/pda). It comprises a total of 15 databases that can be searched all at once or current and comprehensive information is now availindividually (see Table 11). All of the databases in able on the Internet . . . at LactMed.”2 TOXNET are valuable, full of useful information, LactMed includes information on the safety and most importantly, free! We highlight several of drugs and other chemicals—such as Prozac or below. caffeine—that an infant may be exposed to through breastfeeding. Each drug or chemical entry contains LACTMED a brief summary about safety during lactation, the A drugs and lactation database, LactMed is a useful levels passed from mother to infant during breastresource for health care providers and consumers feeding, the effects on infants and on lactation, alike. Nursing mothers have been advised for years to and alternatives to consider. Also, each entry ineither avoid taking certain medications or stop breastcludes sources for the information given as well feeding to keep their infants safe. But according to a as the dates of any revisions. You can look up a recent clinical report in Pediatrics, “This cautious apdrug or chemical by using its trade name, generic proach may be unnecessary in many cases. . . . More name, drug class, or Chemical Abstract Service [email protected]
AJN ▼ February 2014
▼
Vol. 114, No. 2
61
NURSING RESOURCES
Table 1. Resources Available at TOXNET1 Database
Type of Data
Content
Producing Organization
Mobile?
CCRIS
Toxicology
Chemical records of carcinogenicity, tumor promotion, and tumor inhibition test results
National Cancer Institute
Yes
ChemIDplus
Chemical
Chemical records, most with chemical structures
National Library of Medicine
No
CPDB
Toxicology
Analysis of potency of carcinogens
University of California, Berkeley; Lawrence Berkeley National Laboratory
No
CTD
Toxicology
Molecular mechanisms of environmental chemicals in human disease
North Carolina State University
No
DART
Toxicology Literature
Citations for literature covering reproductive and developmental toxicology
National Library of Medicine
Yes
GENETOX
Toxicology
Mutagenicity
Environmental Protection Agency
Yes
Haz-Map
Toxicology
Adverse effects of workplace exposure to chemical and biological agents
National Library of Medicine
No
Household Products
Toxicology
Potential health effects of common household products
National Library of Medicine
No
HSDB
Toxicology
Toxicology, human exposure, and emergency handling procedures
National Library of Medicine
Yes
IRIS
Toxicology
Health risk information on chemicals; sources are Environmental Protection Agency consensus statements
Environmental Protection Agency
Yes
ITER
Toxicology
Compares risk assessments of different organizations
Toxicology Excellence for Risk Assessment
Yes
LactMed
Toxicology
Levels of drugs and other chemicals in breast milk; possible adverse effects on infants
National Library of Medicine
Yes
TOXLINE
Toxicology Literature
Citations for literature on the effects of drugs and chemicals
National Library of Medicine
Yes
TOXMAP
Toxicology
Geographic information system shows amount and location of chemicals released into the environment
National Library of Medicine
No
TRI
Toxicology
Inventory of toxic waste release and management
National Library of Medicine
Yes
CCRIS = Chemical Carcinogenesis Research Information System; CPDB = Carcinogenic Potency Database; CTD = Comparative Toxicogenomics Database; DART = Developmental and Reproductive Toxicology; GENETOX = Genetic Toxicology; HSDB = Hazardous Substances Data Bank; IRIS = Integrated Risk Information System; ITER = International Toxicity Estimates for Risk; TRI = Toxics Release Inventory.
62
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(CAS) registry number.3 LactMed is also available via mobile app, making it a great tool for health practitioners for ready access while treating patients or for any nursing mother while shopping in the drug aisle.
encountered in the workplace. Users can search for agents such as asbestos or latex, the symptoms and diseases they cause, and the jobs or industries that are most likely to use them. The most valuable part of this database is that it provides a direct link be-
TOXNET provides in-depth information on drugs and chemicals that is immediately available for health care professionals’ use in providing patient care, preventing illness, and making informed decisions. HOUSEHOLD PRODUCTS
The Household Products database lists more than 12,000 consumer brands, including household cleaners, pesticides, yard and personal care products, and pet care and auto products. A search of any product brings up its health effects, which come from its product information or Material Safety Data Sheet; the percentage of each chemical in a product; the manufacturer’s contact information; and information on handling and disposal. Health effects include warnings, acute and chronic health problems, carcinogenicity, and first aid in case of inhalation, ingestion, and eye and skin exposure. Clicking on a hyperlink will take you to a glossary. You can search by product name, product type, ingredient, manufacturer, or health effect. In addition, the database has a Product Recalls section that explains why a particular product was recalled.4
HSDB
Click on HSDB, the Hazardous Substances Data Bank, to locate more than 5,000 records on the toxicology of potentially hazardous chemicals. The records contain sections on human health effects, emergency medical treatment, animal toxicity, pharmacokinetics, pharmacology, and environmental fate and exposure, among others, along with citations for all sources and dates of last review and revision. Most entries have been peer-reviewed by HSDB’s scientific review panel of 16 experts in such fields as toxicology, chemistry, and environmental science. The information comes from many sources, including books, government documents, technical reports, and journal articles.5 The HSDB is also available via mobile app.
HAZ-MAP
Haz-Map is designed for both health care professionals and consumers as a resource for information on the adverse effects of hazardous agents [email protected]
tween hazardous agents and occupational diseases based on scientific evidence from textbooks, journal articles, the Documentation of the Threshold Limit Values published by the American Conference of Governmental Industrial Hygienists, and online databases including the HSDB.6
CURRENT, AUTHORITATIVE, AND UNBIASED INFORMATION
TOXNET provides free access to in-depth information on drugs and chemicals that is immediately available for health care professionals’ use in providing patient care, preventing illness, and making informed decisions. For additional resources on toxicology, see the “Essential Nursing Resources” section of the Interagency Council on Information Resources in Nursing Web site (www. icirn.org). ▼
Susan Fowler is a medical librarian at the Washington University School of Medicine in St. Louis. Janet G. Schnall is an information management librarian at the University of Washington (UW) Health Sciences Library and an affiliate instructor at the UW School of Nursing in Seattle; she also coordinates Nursing Resources: [email protected].
REFERENCES 1. U.S. National Library of Medicine. Fact sheet: TOXNET— Toxicology Data Network. Bethesda, MD; 2005/2012. http://www.nlm.nih.gov/pubs/factsheets/toxnetfs.html. 2. Sachs HC. The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics 2013;132(3):e796-e809. 3. U.S. National Library of Medicine. Fact sheet: drugs and lactation database (LactMed). Bethesda, MD; 2006/2011. http://www.nlm.nih.gov/pubs/factsheets/lactmedfs.html. 4. U.S. National Library of Medicine. Fact sheet: Household Products database. Bethesda, MD; 2003/2012. http://www. nlm.nih.gov/pubs/factsheets/householdproducts.html. 5. U.S. National Library of Medicine. Fact sheet: Hazardous Substances Data Bank (HSDB). Bethesda, MD; 1994/2010. http://www.nlm.nih.gov/pubs/factsheets/hsdbfs.html. 6. U.S. National Library of Medicine. Fact sheet: Haz-Map. Bethesda, MD; 2003/2011. http://www.nlm.nih.gov/pubs/ factsheets/hazmap.html.
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