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Electronic Publishers
For Use with the Franklin
Digital Book System
IC-145
R
x
DIGITAL BOOK
The Medical Letter
HANDBOOK
OF
ADVERSE
DRUG
INTERACTIONS
F
User’s Manual
Page 2
License Agreement
READ THIS LICENSE AGREEMENT BEFORE USING THE
DIGITAL BOOK. YOUR USE OF THE DIGITAL BOOK DEEMS
THAT YOU ACCEPT THE TERMS OF THIS LICENSE. IF YOU
DO NOT AGREE WITH THESE TERMS, YOU MAY RETURN
THIS PACKAGE WITH PURCHASE RECEIPT TO THE DEALER
FROM WHICH YOU PURCHASED THE DIGITAL BOOK AND
YOUR PURCHASE PRICE WILL BE REFUNDED. DIGITAL BOOK
means the software product and documentation found in this
package and FRANKLIN means Franklin Electronic Publishers, Inc.
LIMITED USE LICENSE
All rights in the DIGITAL BOOK remain the property of FRANKLIN.
Through your purchase, FRANKLIN grants you a personal and
nonexclusive license to use the DIGITAL BOOK on a single
FRANKLIN Digital Book System at a time. You may not make any
copies of the DIGITAL BOOK or of the data stored therein, whether
in electronic or print format. Such copying would be in violation of
applicable copyright laws. Further, you may not modify, adapt,
disassemble, decompile, translate, create derivative works of, or in
any way reverse engineer the DIGITAL BOOK. You may not export
or re-export, directly or indirectly, the DIGITAL BOOK without
compliance with appropriate governmental regulations. The
DIGITAL BOOK contains Franklin’s confidential and propriety
information which you agree to take adequate steps to protect from
unauthorized disclosure or use. This license is effective until
terminated. This license terminates immediately without notice from
FRANKLIN if you fail to comply with any provision of this license.
This digital book was developed for use by medical professionals.
No other use of this digital book can substitute for consultation with
your physician.
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Contents
Introduction .......................................................3
Overview of Operation......................................5
Installing the Digital Book ................................7
Viewing a Demonstration .................................9
Selecting Drugs................................................10
Correcting Misspellings ..................................12
Finding Brands, Generics, Groups ................14
Finding Interactions........................................ 16
Between Many Drugs ..................................16
For a Single Drug........................................ 18
Viewing References ........................................ 20
Sending Words to Other Books..................... 22
Digital Book System
Limited Warranty............................................. 25
Product Specifications ................................... 26
®
.......................................23
Key Guide .........................................................27
Index..................................................................30
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Introduction
This handbook offers a quick guide to possible adverse effects
of drug interactions, with brief recommendations for precautionary measures. References are given to original reports that
provide more complete discussions of each interaction.
This book— lists adverse drug interactions, their mechanisms,
and recommendations for clinical management. These listings
are usually based on clinical reports in humans.
Reports of interactions between more than two drugs are
appearing in the medical literature with increasing frequency.
Where these have been documented, they are noted as
comments under interacting pairs of drugs. Interactions listed
for groups of drugs (such as “cephalosporins” or “antidepressants, tricyclic”) may not have been reported for every drug in
the group; known exceptions to the interaction are noted.
It is not possible to determine the frequency of most interactions. When an interaction is documented by one or two case
reports rather than by clinical studies or reports in many
patients, the year of each report is given as some indication of
frequency.
Omissions—Drugs for which we have no documented
interaction are not included. New adverse interactions are
continually being reported; the absence of an interaction does
not necessarily mean that drugs will not interact when given
concurrently. Interactions between general anesthetics and
drugs likely to be administered during surgery, such as
autonomic drugs and local anesthetics, are not included here.
Interactions useful in therapy, such as increased plasma
concentration of penicillin with concurrent use of probenecid,
are also not included.
Common additive effects, such as occur with the use of two
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Introduction
antihypertensive agents or two central-nervous-system
depressants, are generally not included. Effects expected from
the mechanism of a drug’s action, such as that of potassium on
digitalis glycosides or calcium on calcium-entry blockers, and
useful antagonist effects, such as that between a poison and an
antidote, are not listed. Most interactions of drugs with foods,
beverages, or other nutrients are not included, but foods
interacting with monoamine oxidase inhibitors are included.
Mechanisms of Interaction—Genetic differences can affect
drug metabolism and interactions. Drugs can interact by
changing the metabolism of other drugs, either through
inhibition or induction of any of several hepatic enzyme
activities or through alterations in hepatic blood flow; by altering
the binding of other drugs to plasma proteins or tissue
receptors; by altering the distribution of drugs to active receptor
sites; by delaying or enhancing excretion; or by causing additive
or synergistic effects.
Recommendations—Monitoring is most important when one of
the interacting drugs is stopped or started. Some experienced
clinicians may prefer to monitor the patient’s clinical status
rather than follow serum concentration of drugs.
Important Notice: The Medical Letter Drug Interactions
Program reports interactions occurring in people, which
can be documented primarily by published reports.
These may not include interactions mentioned in other
sources, such as the manufacturer’s package insert,
which are extrapolated from animal studies or interac-
tions reported for related drugs.
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Overview of Operation
What the
The Medical Letter® Handbook of Adverse Drug
Interactions
digital book, you can. . .
• find brand name drugs, generic drugs, drug
groups, and food groups,
• correct drug name misspellings,
• find foods that interact with MAO inhibitors,
• select up to 20 drugs and view a list of the
interactions between them,
• select a single drug and view a list of the drugs
with which it interacts,
• read descriptions and references about drug
interactions, and
• look up drugs and words in related digital books.
Read this User’s Manual to learn how.
Handbook
is a powerful reference. Using this
Can Do
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Overview of Operation
How the
The
Handbook
Highlight the HADI symbol and press .
At the main drug list, As you type, the drug
type a drug name. name is highlighted.
Then press .
Type another drug You see a message
name. Press . to “
Press . You see the interactions,
Press . You see a description of
Press . You’re ready to find
Handbook
is easy to use. Here are the basics.
ENTER
ENTER
ENTER
ENTER
CLEAR
Works
SHOW INTERACTIONS.
if any, between the drugs.
the interaction.
other interactions.
ENTER
✓ About Illustrations in this Manual
Some screen shots in this User’s Manual may
vary slightly from what you see on screen. These
variations do not mean that this digital book or
your Digital Book System is malfunctioning.
”
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Installing the Digital Book
Before you can use this digital book, you must install
it. Warning: If you install a digital book
Digital Book System on, information that you entered
in other currently installed digital books may be erased.
1. Turn the Digital Book System off.
2. Install the digital book into a slot on the
back of the Digital Book System.
Align the tabs on the digital book with the notches
in the slot. Make sure its metal contacts face down.
while the
3. Press .
ON/OFF
4. Turn the wheel on the side of the Digital Book
System to adjust the screen contrast.
5. Press .
CARD
6. Press or to highlight the HADI symbol.
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Installing the Digital Book
7. Press .
ENTER
This is the main drug list, where you select drugs
to find interactions.
✓ Resuming Where You Left Off
While using this digital book, you can turn off
the Digital Book System at any time. When you
turn the Digital Book System on again, the
screen that you last viewed appears. Any drugs
entered in your query list are saved, too.
✓ Clearing the Main Drug List
You can always return to the main drug list by
pressing .
drugs in your query list are also cleared.
You can return to the previous screen without
clearing your query list by pressing .
8
CLEAR
Note:
When you do, the
BACK
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Viewing a Demonstration
Before you start using this digital book, you may
want to view a brief demonstration of what it can do.
1. Press at the main drug list.
MENU
2. Press to highlight “Demo.”
3. Press to start the demonstration.
4. Press to stop the demonstration.
ENTER
CLEAR
✓ Help is Always at Hand
Except during the demonstration, you can view
a help message at any screen by pressing .
To read the help message, press . To exit it,
press .
BACK
HELP
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Selecting Drugs
The main drug list contains brand and generic drugs,
foods, as well as drug and food groups. Y ou select
an item from the main drug list by typing it and then
pressing . Usually you need to type only a
few letters to highlight an item. Try this example.
1. Type “META” at the main drug list.
ENTER
To erase a letter, press .
2. Press to select the drug
ENTER
BACK
and add it to the query list.
3. Press to clear the query.
CLEAR
✓ Drug Selecting Tips
You do not need to type capital letters or
punctuation. However, you can type numbers at
the main drug list.
“drug” refers to any item on the main drug list.
10
Note:
In this User’s Manual,
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Selecting Drugs
✓ Using the Direction Keys
You can use these keys to move up and down
the main drug list, the query list, and other lists.
To. . . Press. . .
Scroll up and down Hold or
Page up and down UP or DN
Zoom to the top or + or *
bottom of a list
* Hold while pressing the other key, or
press and then the other key. The second
method displays a G at the bottom of the
screen.
✓ Follow the Arrows
The flashing arrows at the top right of the
screen indicate which direction keys you can
press to move around the screen.
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Correcting Misspellings
Don’t worry if you misspell a word. The spellcorrection mode automatically appears. Try this.
1. Type “PSEUDOFED” at the main drug list.
To exit spell-correction, press repeatedly.
2. Press .
ENTER
BACK
3. Press to highlight a drug.
4. Press to select the drug
ENTER
and add it to the query list.
5. Press to add the related drug.
6. Press to clear the query.
Y
ENTER
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Correcting Misspellings
✓ Finding Letters in Words
If you are not sure how to spell a word, type a
question mark in place of each unknown letter
or an asterisk in place of a series of unknown
letters. Here are two examples.
• Type “CIM?T?DINE” and press .
ENTER
The correct spelling, CIMETIDINE, appears.
• Type “CORTI*.” To type the asterisk, hold
and press . Then press .
? *
ENTER
SHIFT
a list of drug and group names beginning with
“CORTI” appears.
Note:
You can type more than one question
mark or asterisk in a word, and you can type
both in one word. However, you cannot type two
consecutive asterisks in a word.
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Finding Brands, Generics, Groups
By highlighting a drug name on the main drug list
and pressing , you can see its generic or
brand names and any drug or food groups to which it
belongs. In this example, we’ll find the brand names
and drug group of penicillin G.
1. Type “PENICILLIN G” at the main drug list.
SPEC
2. Press .
SPEC
3. Press repeatedly to view the brands.
Or hold and press .
At the bottom of the list, notice that penicillin G belongs to the drug group, penicillins.
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Finding Brands, Generics, Groups
4. Press to view the drugs in the group.
ENTER
5. Press to scroll down.
6. Press twice to go back
BACK
to the main drug list.
✓ Finding MAO Inhibitor Interactions
When you highlight a food name on the main
drug list, pressing shows if that food
interacts with MAO inhibitors. Try this example.
1. Type “AVOCADOS”.
2. Press . “MAO Inhibitor info” is
SPEC
highlighted.
3. Press . A description of
ENTER
avocados and MAO inhibitors appears.
SPEC
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Finding Interactions
Y ou can find adverse interactions by selecting drugs
from the main drug list and then pressing
at “✻SHOW INTERACTIONS✻.” Then you can view a
description of each interaction.
Between Many Drugs
You can select up to 20 drugs at time to find interactions between them. In this example, we’ll find the
interactions between alcohol and acetaminophen.
1. Select “ALCOHOL” from the main drug list.
2. Select “ACETAMINOPHEN.”
ENTER
3. Press to view the interactions. Or
press and select “Query interactions.”
ENTER
MENU
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Finding Interactions
4. If more than one interaction is listed,
press to highlight one.
Note:
You can return to the main drug list now by
pressing .
5. Press at a highlighted interaction.
BACK
ENTER
This is an interaction description. The hand points
to a comment or recommendation.
6. Press or the DN key to move down.
To. . . Press. . .
View the drug names of then
SPEC
the interaction description
View the next or previous + UP or DN
description, if any
Return to the interactions
7. Press to clear the queries.
CLEAR
BACK
BACK
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Finding Interactions
For a Single Drug
You can select a single drug from the main drug list
and quickly find the drugs with which it interacts. In
this example, we’ll find the interactions for heparin.
1. Type “HEPARIN” at the main drug list.
2. Press .
3. Press to view your query list.
4. Press . Or press and select
ENTER
LIST
O
MENU
“Other interacting items.”
These are the interactions for heparin.
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Finding Interactions
5. Press to highlight an interaction.
6. Press to view its description.
ENTER
✓ Using the Query List
Whenever you select a drug from the main drug
list, it is saved in the query list. To view your
queries, press . Once at the query list,
you can use these keys.
To. . . Press. . .
Delete a highlighted item
View the interactions
between all the items
View all the interactions
for a highlighted item
Go to main drug list
and
save
your queries
Go to main drug list
and
clear
your queries
Note:
Your queries are saved between sessions
unless you reset the Digital Book System or
remove its batteries.
LIST
D
Q
O
A
CLEAR
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Viewing References
Whenever you see a reference mark (✝) in an interaction description, you can view its journal reference.
1. At the start of an interaction description
with a
Notice that the ✝ is highlighted.
If you’re below or to the left of the ✝, hold
and press . If the description has other reference marks, hold and press to highlight
the next reference mark.
✝, hold and press .
2. Press to view the reference.
ENTER
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Viewing References
3. Hold to scroll down.
4. Hold and press the DN key repeatedly
to view more references, if any.
To view a previous reference, hold
and press the UP key .
5. Press to go back to the description.
BACK
✓ Viewing Next or Previous References
Once at a reference, you can view the next or
previous reference, if any, in an interaction
description by holding and pressing the UP
or the DN key.
✓ Viewing Complete Drug Names
Pressing or at an interaction list,
?
*
an interaction description, or a reference
displays the full names of the drugs involved in
the interaction. Then press to go back to
previous screen.
SPEC
BACK
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Sending Words to Other Books
Y ou can send drug names and other words from this
digital book to other installed digital books. For example, you can look up a drug from the
The Washington Manual
digital book.
Handbook
in
1. Highlight a word in the
Handbook
.
To. . . Press. . .
Highlight a drug or
or item in a list
Highlight a word and then
ENTER
in a description the arrow keys
Turn off highlight
BACK
in a description
2. Hold and press .
CARD
3. Highlight the symbol of the digital book
to which you want to send the word.
4. Press .
ENTER
To look up the word, follow the instructions for that
book. In many cases, you simply press .
To return to the
Handbook
, press ,
highlight its symbol and then press .
ENTER
CARD
ENTER
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Digital Book System
®
Resetting the Digital Book System
CLEAR
CLEAR
while
and then
To reset the Digital Book System, hold
pressing
ON/OFF
. Or press the recessed reset button on
the back of the Digital Book System. (Read its Basic
Operating Guide for details.)
Warning:
Resetting the Digital Book System may permanently erase information, such as notes, that you
have entered in the installed digital books.
Note:
If the keyboard fails to respond or the screen
performs erratically, you can press
ON/OFF
press
rather than resetting the Digital Book
System. If nothing happens, then reset.
Protecting and Cleaning
• Do not touch the metal contacts on the back of digital
books or the rubber contacts on the Digital Book System with statically charged objects. Statically charged
objects may erase information that you entered in the
digital books.
• Do not put excessive weight on digital books or the
Digital Book System, or expose them to extreme or
prolonged heat, cold, or other adverse conditions.
• To clean digital books, apply isopropyl alcohol with
cotton swab. To clean the Digital Book System,
apply a mild household cleaner with a soft cloth.
Caution:
tal Book System may damage them.
Spraying liquids on digital books or the Digi-
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Digital Book System
Replacing the Batteries
The DBS-1 and DBS-2 use four 3-volt, CR2032 lithium batteries. The DBS-2D uses four 1.5-volt, AA
batteries.
1. Have new batteries ready .
2. Turn the Digital Book System off.
3. Slide the battery cover off the back.
4. Remove all the batteries.
5. Place new batteries in the cavities, with the +’s
oriented correctly. (In the DBS-1 and DBS-2,
the +’s should face up.)
6. Replace the battery cover
✓ Battery Precautions
When you replace batteries, follow these precautions to avoid erasing information on your installed digital books.
• Replace the batteries before they lose power.
• Once batteries have been removed,
install new ones within two minutes.
• Do not mix old and new batteries.
• Never remove batteries with the unit on.
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Limited Warranty (U.S.A only)
FRANKLIN warrants to you that the DIGITAL BOOK will be free from defects in materials and
workmanship for one year from purchase. In the case of such a defect in your DIGITAL
BOOK, FRANKLIN will repair or replace it without charge on return, with purchase receipt,
to the dealer from which you made your purchase or Franklin Electronic Publishers, Inc., 122
Burrs Road, Mt. Holly, NJ 08060, within one year of purchase. Alternatively, FRANKLIN may,
at its option, refund your purchase price.
Data contained in the DIGITAL BOOK may be provided under license to FRANKLIN.
FRANKLIN makes no warranty with respect to the accuracy of data in the DIGITAL BOOK.
No warranty is made that the DIGITAL BOOK will run uninterrupted or error free. You assume
all risk of any damage or loss from your use of the DIGITAL BOOK.
This warranty does not apply if, in the sole discretion of FRANKLIN, the DIGITAL BOOK has
been tampered with, damaged by accident, abuse, misuse, or misapplication, or as a result
of service or modification by any party, including any dealer, other than FRANKLIN. This
warranty applies only to products manufactured by or for FRANKLIN. Batteries, corrosion or
battery contacts and any damage caused by batteries are not covered by this warranty. NO
FRANKLIN DEALER, AGENT, OR EMPLOYEE IS AUTHORIZED TO MAKE ANY
ADDITIONAL WARRANTY IN THIS REGARD OR TO MAKE ANY MODIFICATION OR
EXTENSION OF THIS EXPRESS WARRANTY.
THE FOREGOING WARRANTY IS EXCLUSIVE AND IS IN LIEU OF ALL OTHER EXPRESS
OR IMPLIED WARRANTIES, WRITTEN OR ORAL, INCLUDING, BUT NOT LIMITED TO,
WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE.
YOUR SOLE AND EXCLUSIVE REMEDY SHALL BE FRANKLIN’S OBLIGATION TO
REPLACE OR REFUND AS SET FORTH ABOVE IN THIS WARRANTY. Some States do
not allow the exclusion of implied warranties, or limitations on how long a warranty lasts. This
warranty gives you specific rights; you may also have additional rights which vary from State
to State. This warranty shall not be applicable to the extent that enforcement of any provision
may be prohibited by applicable law.
FRANKLIN SHALL IN NO EVENT BE LIABLE TO YOU OR TO ANY OTHER PERSON FOR
ANY SPECIAL, INCIDENTAL, OR CONSEQUENTIAL DAMAGES, OR ANY OTHER
INDIRECT LOSS OR DAMAGE, ARISING OUT OF YOUR PURCHASE, THE
MANUFACTURE OR SALE OF THE DIGITAL BOOK, THIS LICENSE, OR ANY
OBLIGATION RESULTING THEREFROM OR THE USE OR PERFORMANCE OF THE
DIGITAL BOOK UNDER ANY LEGAL THEORY, WHETHER BREACH OF CONTRACT,
TORT, STRICT LIABILITY OR ANY OTHER CAUSE OF ACTION OR PROCEEDING,
WHICH DAMAGES SHALL INCLUDE, BUT NOT BE LIMITED TO, LOST PROFITS,
DAMAGES TO PROPERTY, OR PERSONAL INJURY (BUT ONLY TO THE EXTENT
PERMITTED BY LAW). FRANKLIN’S ENTIRE LIABILITY FOR ANY CLAIM OR LOSS,
DAMAGE, OR EXPENSE FROM ANY SUCH CAUSE SHALL IN NO EVENT EXCEED THE
PRICE PAID FOR THE DIGITAL BOOK. THIS CLAUSE SHALL SURVIVE FAILURE OF AN
EXCLUSIVE REMEDY.
This license and warranty is governed by the laws of the United States and the State of New
Jersey.
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Product Specifications
Model IC-145
• Data: More than 1,150 interactions; 2,600 refer ences; 2,400 brand names; 800 drug, food, and
group names; and MAO inhibitor/food reactions.
• Alphanumeric searching
• A user query list holding up to 20 drug names
• Spelling correction
• Self-demonstration.
• Context-sensitive help messages
• size: 2-1/4” x 1-1/4” x 1/4”
• weight: 0.3 oz.
Copyrights, Trademarks, Patents, ISBN
© 1992-94 Franklin Electronic Publishers, Inc.
All rights reserved.
© 1994 The Medical Letter, Inc. All rights reserved.
MatchMaker is a trademark of Franklin Electronic
Publishers, Inc. The Medical Letter is a registered
trademark of the Medical Letter, Inc.
U.S. Patent 4,490, 811; 4,830,618; 5,113,340;
5,218,536. European Patent 0 136 379.
Patents Pending.
ISBN 1-56712-096-2
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Function Keys
Key Guide
CLEAR
Clears your queries and
shows the main drug list.
MENU
GAMES
MORE
LIST
SPEC
CARD
Shows menus.
No effect.
No effect.
Shows the query list.
Shows brands, generics, groups.
Exits the digital book.
Gold Key Combinations
+ number keys Type numbers.
+
CARD
Sends a word to another book.
+ Zooms to the start or end of a list,
section, description, or reference.
+ UP or DN Shows the next or previous
description or reference.
+ Highlights a reference mark in a
description.
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Key Guide
Direction Keys
Move the highlight.
Scroll through lists and text,
or move the highlight.
UP or DN Page up or down.
MatchMaker™ Key
? *
SHIFT
+ At the main drug list, types a ✻
At the main drug list, types a ?
to find a letter in a word.
? *
to find a series of letters in a
word.
Query List Keys
These functions apply only in the query list.
A
D
O
Q
Shows the main drug list.
Deletes a highlighted item.
Shows interactions for an item.
Shows the interactions
between all the items.
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Other Keys
Key Guide
A
BACK
ENTER
HELP
ON/OFF
, -
? *
SHIFT
SPACE
Z
:
;
Type letters.
Erases a letter, backs up,
deletes an entry, or turns off the
highlight in interaction descriptions.
Make an entry. In descriptions,
highlight a word.
Shows a help message.
Turns unit on or off.
Types punctuation.
Except at the main drug list,
acts the same as .
Shifts keys.
Types a space.
SPEC
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Index
Arrows 11
Backing up 8
Batteries 24
Brand names 14
Clearing
to the main drug list 8
your query list 19
Comments 17
Deleting
drugs from query list 19
entries 10
Demonstration 9
Direction keys 11
Drug groups 14
Drugs
brand and generic 14
correcting spellings 12
displaying full names 17
entering 10
finding 14
finding spellings 13
specifying 21
Erasing letters 10
Finding
brand names 14
comments & recommenda-
tions 17
drug groups 14
foods 10
food groups 14
generic names 14
help messages 9
inhibitors 14
interactions
between many drugs 16
for a single drug 18
letters in words 13
references 20
Foods 10, 14, 15
Food groups 14
Generic names 14
Help messages 9
Highlighting
drug names 22
words in descriptions &
references 22
Installation 7
Interactions
between many drugs 16
for a single drug 18
specifying 21
Main drug list
clearing to 8
using 10, 14
MAO inhibitors 15
Menu 9
Query list 19
clearing 19
deleting a drug 19
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entering a drug 10
returning to initial
screen 19
seeing interactions from 19
Recommendations 17
References 20
Resuming sessions 8
Scrolling
descriptions 17
lists 11
references 21
Sending words to
books 22
Spellings
correcting 112
finding 13
Index
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FCR -28052-00 Printed in China
P/N 7201767 Rev. A
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Electronic Publishers
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