HIV Medicine
Preceptor: Ryan Bromander, PharmD
The HIV Medicine rotation is a one-month long elective rotation for pharmacy
practice residents at Clinic 42, the HIV Clinic affiliated with Abbott Northwestern
Hospital.
The other members of the health care team include physicians, nurses, case managers,
social workers, a dietitian, and a psychologist. Clinic 42 has approximately
300 active patients; 10 - 15 patients/day are seen, Monday - Thursday.
The preceptor will serve as a role model and a learning resource for the resident,
but also will provide the opportunity for independent practice. The resident
will be encouraged to take initiative in assisting to direct the learning experience
during the rotation to optimize his/her personal development.
Daily activities will include:
- Reviewing patient charts before clinic to evaluate the appropriateness of
each medication, screening for correct dosage, indication, adverse effects,
and drug interactions, etc.
- Updating medication profiles or completing a profile for new patients
- Participation in daily clinic rounds
- Counseling patients about their medication regimens
- Other adherence activities including making individualized medication lists
and instructing patients in the operation of pill boxes and timers with alarms
- Monitoring the clinical course of HIV+ patients admitted to the hospital
General educational objectives:
1. Review the epidemiology, microbiology, pathophysiology, diagnosis, and prognosis
of HIV infection. Be able to identify typical presenting clinical syndromes of HIV infection.
2. Understand the pharmacology, including mechanism of action, pharmacokinetics,
usual dosage, adverse effects, drug interactions, and monitoring parameters of antiretroviral medications.
3. Assess patient specific data (past medical and medication history, current problems, present medication regimen, allergies, pertinent laboratory values)
and develop a plan if changes are indicated.
Evaluate current medication therapy regimen for:
- Adherence
- Adverse effects, including abnormal laboratory values
- Efficacy & appropriateness in light of genotype or phenotype data
- Financial problems potentially limiting access to prescriptions
- Presence of investigational agents
- Presence of therapeutic duplication
- Presence of clinically significant drug interactions
- Document complete past antiretroviral medication history
- Document current use of herbal and alternative therapies
- Quantify use of ethanol, marijuana, street drugs
- Determine presence of medical conditions not being adequately treated, for
example, depression
4. Develop a patient-specific plan for improving or reinforcing medication adherence:
- Be able to explain medication information at an appropriate education level
- Explain the importance of medication adherence
- Evaluate patients current adherence to medication regimen
- Use effective strategies for communicating with blind, deaf, non-English-speaking
or cognitively-impaired patients
5. Identify patient-specific supportive care issues and create an appropriate
plan for:
- Management of nausea, diarrhea, constipation
- Nutritional management and wasting syndrome
- HIV-related endocrine disorders including hyperlipidemia
- Pain and neuropathy
- Depression
6. Understand how to tailor a multi-drug regimen of HAART (highly active antiretroviral
therapy) to individual patients. This involves synthesis of information in objectives
2-4 above as well as consideration of patient lifestyle, scheduling preferences,
and patient ability or desire to manage complicated regimens.
7. Monitor the clinical course of HIV-positive patients admitted to the hospital:
- Continue to evaluate and monitor HAART
- Review the epidemiology, microbiology, pathophysiology, diagnosis, presenting
clinical syndromes, and prognosis of applicable opportunistic infection or
other conditions which result in hospital admission
8. Through active participation in patient care and disease state topic discussions,
the resident will gain an understanding of the pathophysiology, treatment, and
monitoring of the following disease states, emphasing patient specific pharmacotherapy:
- Pneumocystis carinii and other causes of pneumonia
- Cytomegalovirus infections
- Mycobacterial infections including tuberculosis
- Fungal infections
- Hepatitis C co-infection
- Kaposi sarcoma
9. Develop good communication skills and rapport with physicians, nurses, and other clinic and hospital professionals. When appropriate, make recommendations for changes in drug therapy or monitoring to staff.
10. Provide concise and timely responses to requests for drug information from health care providers and patients. Be able to identify the best sources of information for the question.
11. Attend educational presentations related to HIV Medicine, including Twin Cities AIDS Clinicians, monthly VPCI Cancer Pain conference, and other appropriate seminars.
12. Complete a project related to HIV Medicine as directed by the preceptor. Appropriate topics might include a literature review, inservice presentation to staff, data collection for identified studies, or patient information handouts.
13. Complete pertinent readings as assigned.
Orientation to the rotation - the preceptor will:
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