TTUHSC School of Pharmacy
Home SOP Faculty

Faculty & Staff

Self Governance » Faculty Meetings Committee

Course Approval

Cardiology Elective Clerkship PHAR4683


Syllabus


Course Title: Cardiology Elective Clerkship

Course Number: 4683

Team Leader:

Sara Brouse
Pharm.D., BCPS
Email: sarab@ama.ttuhsc.edu or sara.brouse@med.va.gov
Office: DFW Campus
Phone: 214-372-5300 x237

Team Members: James Tsikouris, Pharm.D.

Rotation Coordinator(s):

Clerkship Coordinator:

Loree Allen
School of Pharmacy
1300 Coulter, Rm. 206
Amarillo, TX 79106
Phone: 806/356-4000 Ext 306
Fax: 806/356-4018
Email: loree@cortex.ama.ttuhsc.edu

Daily Schedule: Students should participate in clerkship activities for a minimum of 40 hours per week. Schedule depends on clerkship rotation and site needs. Monday through Friday, generally 8 am - 5pm (site specific)

Outpatient Services: One half day per week, when available, (day and time site specific)

Textbook/Course Materials: Cardiology Elective Clerkship Manual

Prerequisites: P-4 standing as per Student Credentialing Committee

Catalog Description: Pharmaceutical care experiences in patients with cardiovascular disease.

Course Mission: The mission of this clerkship is to further develop the candidate's knowledge and competence in cardiology beyond what is covered in the required internal medicine clerkship. By providing specialized clinical pharmacy services to cardiology ICU and telemetry floor patients, this clerkship offers focused experiences in the management of acute myocardial infarction, decompensated heart failure exacerbation, and arrhythmias, among others. In addition, candidates have the opportunity to learn about and witness cardiac diagnostic and therapeutic procedures in the cardiac catheterization, echocardiography, and electrophysiology laboratories.

Course Objectives:

  1. Recognize and discuss the pathophysiology and therapeutic management of commonly encountered acute cardiac medical problems (see discussion topic lists) with pharmacists, physicians, or other healthcare providers.
  2. Compare/contrast the indications, adverse effects, pharmacology, and dosing utilized for commonly prescribed cardiac medications.
  3. Prevent, detect, and manage drug interactions and adverse drug reactions in cardiac patients.
  4. Evaluate cardiology primary literature, utilizing pertinent data, to provide pharmacotherapy guidance and drug information to physicians, patients, and affiliated healthcare professionals.
  5. Apply progress note-writing skills attained in previous clerkships to cardiac patient consultations for the medical team in the areas of drug therapy selection, pharmacokinetics, and therapeutic monitoring. Provide concise documentation of all clinical interventions and outcomes.

Tech's Top Ten:

Upon completion of this course, the candidates shall have practice and assessment in:

  1. COMMUNICATION: Establish professional rapport with other members of the medical team thus becoming an integral member of the team. Communicate education to patients at an appropriate level of understanding for the patients. Demonstrate depth of knowledge regarding drug therapy in order to effectively and assertively present therapeutic recommendations in the best interest of the patient.
  2. USE BASIC SCIENCE IN THE PRACTICE OF PHARMACY: Accurately perform pharmacokinetic calculations and adjust drug therapy accordingly. Demonstrate knowledge and assessment of the therapeutic goal / endpoint. Demonstrate ability to manage disease states and adverse drug reactions via appropriate drug therapy monitoring.
  3. PROBLEM PREVENTION and SOLVING: Identify, define, and present a solution to the problem while on the Internal Medicine Service.
  4. DISPENSING PHARMACEUTICALS: Intervene in correcting adverse drug events. Define the considerations in dosage form selection. Translate prescription instructions to patients in laymans' terms during discharge counseling. Validate a patients' understanding of prescription instructions during discharge counseling.
  5. PROVIDING PATIENT-SPECIFIC PHARMACEUTICAL CARE: Function as a pharmacist and a team member to develop a therapeutic plan for a patient, which includes consideration of the patient's quality of life. Prevent and manage undesired drug therapy outcomes. Detecting adverse drug reactions and drug therapy problems including adherence problems. Assess the progress made towards the therapeutic goal and the outcome of drug therapy.
  6. PROVIDING PHARMACEUTICAL CARE TO LARGE POPULATIONS: Demonstrate an understanding of the responsibilities of the pharmacist in the cardiac intensive care unit and internal medicine patient care settings. Consider the cost-benefit and cost-effectiveness of therapeutic interventions. Document clinical pharmacy services.
  7. MORAL REASONING, ETHICAL and LEGAL JUDGEMENT: Demonstrate empathy towards patients. Acknowledge the patient's rights to make decisions regarding care provided adequate provision of knowledge regarding all medical/ therapeutic options. Practice in an ethical manner.
  8. MANAGEMENT: Assess the outcome of pharmacotherapy and non-drug treatment. Assess the cost-effectiveness of a therapeutic approach. Document services and assess the effectiveness of interventions. Effectively manage time and prioritize several tasks.
  9. ADVANCING THE PROFESSION and PROMOTING GOOD HEALTH: Demonstrate the ability to define patient interest on the Internal Medicine Service. Demonstrate the ability to define the general interest of the profession of pharmacy on the Internal Medicine Service. Demonstrate sensitivity to the impact of external influences on the profession of pharmacy on the Internal Medicine Service. Demonstrate the ability to perform as a role model. Demonstrate the ability to influence colleagues.
  10. PERSONAL GROWTH: Demonstrate the ability and commitment to continuously learn, to work within personal limits, to work within professional limits, to follow when indicated, and to lead when indicated.

Teaching Methods: This experiential course will be delivered in practice settings where students will provide clinical services under the supervision of pharmacy practice faculty / preceptors. The responsibilities of the Pharm.D. candidate include both patient care and education. Pharm.D. candidates will conduct daily patient evaluations prior to rounds each morning and develop their own therapeutic plan. Students will provide pharmaceutical care to cardiology intensive care unit patients by attending rounds with the medical team on a daily basis, meeting with preceptors daily to discuss patients, and making recommendations on the selection, implementation, and modification of drug therapy in the patients on the service. Students will also be responsible for medication-related patient education for patients discharged from the cardiology service. In addition, Pharm.D. candidates are required to be an active participant in disease state discussions with preceptors by completing reading assignments in advance, delivering case presentations, answering drug information requests from the medical team and completing cardiology intensive care-related projects to increase their knowledge of this area.

Attendance: Standard

Class Timeliness/Tardiness: Standard

Assessment Methods: Grading will be based on overall performance, professional performance and assignments. Students will complete a minimum of 3 graded assignments during the Cardiology Clerkship Rotation:

  1. Literature Interpretation / Evaluation: Student will be assigned a journal club presentation or written drug information question on a cardiology topic
  2. Educational Inservice: for pharmacy, nursing, or medical staff on a new cardiology drug or on a group of commonly used cardiac medications (glycoprotein IIb/IIIa inhibitors, thrombolytics, etc.)
  3. Patient care or quality improvement project: to be assigned by preceptor. Examples include but are not limited to the following: a clinical case presentation of an interesting patient seeing during the rotation and review of patient's disease state and primary literature evaluating drug therapy for this disease state, cardiology medication use evaluation, cardiology drug monograph for formulary evaluation, or other activity.

It is the responsibility of the candidate to turn in all assignments on time. An approximate timeline for preparing and turning in assignments is noted below:

Activity Timeframe
1. Journal club or written drug information question by the end of week 3
2. Midterm Evaluation by the end of week 3
3. Educational inservice by the end of week 5
4. Patient care or quality improvement project by the end of week 6
5. Clinical intervention documentation report by the end of week 6
6. Final Evaluation by the end of week 6

Grading:

Professional Performance

60%

Assignments #1 Journal Club or Written DI Question

#2 Inservice

#3 Patient Care or Quality Improvement Project

#4 Clinical Intervention Documentation/Report

10%

5%

15%

0%

TSBP Intern-Clerkship Evaluation Form

10%

Total

100%

Intellectual Integrity: Standard

48 Hour Turnaround Policy: Standard

Second Chance Policy: There is NO second chance policy regarding this clerkship. If a student fails this course, they must retake it at the next opportunity when it can be rescheduled.

Etiquette: Standard

Clerkship Confidentiality: Standard

Name Tags and Professional Attire: Standard

Candidate Disability: Standard

Ethical Standards: Standard

Facilities: Standard

Candidate Inquiries: Standard

Communication: Standard

Autobiographical Data Form: Standard

Immunizations: Standard

Removal From Practice Site: Standard

Maternity Notification: Standard

Exposure Reporting: Standard

Candidate Professional Leave Policy: Standard

CARDIOLOGY ELECTIVE CLERKSHIP

TOPIC DISCUSSION LIST


  1. Differentiate between pathophysiology and drug therapy utilized for the following commonly-encountered cardiac disease states in the Coronary Care Unit and telemetry units:
    1. Acute Myocardial Infarction (ST Elevation MI and Non-ST Elevation MI)
    2. Unstable Angina
    3. Stable Angina
    4. Congestive Heart Failure (stable and decompensated)
    5. Arrhythmias (Afib, Aflutter, Vtach, Vfib)
    6. Hypertension / Hypertensive urgency and emergency
    7. Hypotension / hemodynamic instability
    8. Dyslipidemia
    9. Cardiopulmonary resuscitation
    10. Cardiac Infections (ex. endocarditis)
  2. Describe the pathophysiology and drug therapy of other disease states in the Coronary Care Unit and telemetry units:
    1. Pneumonia (CAP, nosocomial, aspiration, COPD)
    2. Respiratory failure
    3. Sepsis and shock (esp. cardiogenic)
    4. Catheter-related infections
    5. Renal failure
    6. Hyperglycemia / hypoglycemia
    7. Stroke / transient ischemic attacks
    8. DIC / coagulopathy / venous thromboembolic disorders (DVT, PE)
    9. Nutrition
    10. Analgesia / anxiety / ICU psychosis
  3. Identify and utilize the following hemodynamic and physiologic monitoring procedures and devices within a cardiology ICU patient.
    1. Hemodynamic monitoring (pulmonary artery catheter)
    2. Oxygen delivery / arterial blood gas (ABG) analysis
    3. Non-invasive monitoring parameters
    4. Physiologic scoring indices
    5. Electrocardiogram interpretation / implications
    6. Pharmacokinetic monitoring

CARDIOLOGY ELECTIVE CLERKSHIP

MEDICATION DISCUSSION LIST


  1. Compare/contrast the mechanism of action, place in therapy, and monitoring parameters for the following medications corresponding to their respective disease state:
    1. Acute Myocardial Infarction and Unstable Angina
      • Anticoagulants: Unfractionated heparin, Low molecular weight heparin, Direct thrombin inhibitors
      • Antiplatelets: Aspirin, Clopidogrel
      • Glycoprotein IIb/IIIa Inhibitors: Abciximab, Eptifibatide, Tirofiban
      • Thrombolytics: Alteplase, Reteplase, Tenecteplase, Streptokinase
      • Oxygen, Morphine, Beta-blockers, Nitrates
    2. Stable Angina
      • Beta-blockers, Nitrates, Calcium Channel Blockers
    3. Congestive Heart Failure, Stable and Decompensated
      • ACE Inhibitors, Angiotensin II Receptor Antagonists, Beta-blockers, Digoxin, Spironolactone, Hydralazine, Isosorbide dinitrate
      • Diuretics, Inotropic Agents (Dobutamine, Milrinone), Nitrovasodilators (Nesiritide, Sodium Nitroprusside)
    4. Arrhythmias (Afib, Aflutter, Vtach, Vfib)
      • Class I Antiarrhythmics (Quinidine, Procainamide, Disopyramide, Lidocaine, Mexilitene, Propafenone, Flecainide)
      • Class III Antiarrhythmics (Amiodarone, Sotalol, Dofetilide, Bretylium, Ibutilide)
      • Rate-Controlling Agents: Beta-blockers, Calcium Channel Blockers, Digoxin
    5. Hypertension / Hypertensive Urgency and Emergency
      • IV Antihypertensives (Sodium Nitroprusside, Hydralazine, Labetolol, Enalaprilat, Fenoldopam)
    6. Hypotension / Hemodynamic Instability
      • Vasopressors (Dopamine, Norepinephrine, Phenylephrine)
    7. Dyslipidemia
      • Statins
    8. Cardiopulmonary resuscitation
      • Vasopressin, Epinephrine, Amiodarone, Lidocaine, Atropine

Back to Top