Download Less common or more complex presentations and conditions

BASIC TRAINING
Knowledge Guide
Pharmacology, Toxicology and Addiction Medicine
COMMON
PRESENTATIONS
AND CONDITIONS
Basic Trainees will
require a sufficient depth
of knowledge of these
presentations and
conditions.
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LESS COMMON OR
MORE COMPLEX
PRESENTATIONS
AND CONDITIONS
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Analgesia management
Common poisonings (including
severe types such as sodium
channel blockade)
Diseases and disorders associated
with substance abuse
Management of overanticoagulation
Overdose/toxic effects of alcohol
and illicit drug use:
» alcohol
» amphetamines
» benzodiazepines
» cannabis
» cocaine
» ecstasy
» nicotine
» opioids
» other prescription medications
» paracetamol
» solvents
» zolpidem
» zopiclone
Presentations associated with an
adverse drug reaction (including
severe cutaneous reactions) or
adverse drug event
Presentations associated with drug
interactions
Recognition of the withdrawal state
and management of acute
withdrawal of:
» alcohol
» benzodiazepine
» nicotine
» opioids
Complex drug interactions
Recognise unusual adverse drug
reactions
Uncommon poisonings
Basic Trainees will need
to have an awareness
of, and an understanding
of appropriate resources
that should be used to
help manage patients
with these presentations
and conditions.
RACP Basic Training Curriculum
Adult Internal Medicine
For all common presentations,
Basic Trainees will need to know
how to:
Synthesise
» incorporate epidemiology,
pathophysiology and clinical
science
» recognise the clinical
presentation
» take a relevant clinical history
» conduct an appropriate
examination
» establish a differential diagnosis
» plan and arrange appropriate
investigations
Manage
» provide initial, evidence-based
management
» discuss the principles of
ongoing management
» apply quality use of medicines
» recognise potential
complications of the disease
and its management, and
initiate preventative strategies
» refer appropriately
Consider other factors
» identify broader considerations
and their impact on diagnosis
and management
For all less common and more
complex presentations, Basic
Trainees will need to know how to:
Synthesise
» incorporate epidemiology,
pathophysiology and clinical
science
» recognise the clinical
presentation
» take a relevant clinical history
» conduct an appropriate
examination
Pharmacology, Toxicology and
Addiction Medicine
Knowledge Guide
Page 1
BASIC TRAINING
Knowledge Guide
Pharmacology, Toxicology and Addiction Medicine
» establish a provisional diagnosis
» plan and arrange appropriate
initial investigations
Manage
» initiate therapy in consultation
» discuss broad therapeutic
options
» recognise potential
complications
» refer appropriately
Consider other factors
» identify broader considerations
and their impact on diagnosis
and management
EPIDEMIOLOGY,
PATHOPHYSIOLOGY
AND CLINICAL
SCIENCE
Basic Trainees will be
able to describe the
principles of the
foundational sciences.
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Accepted healthy alcohol intake according to sex and age, including
pregnant women
Actions of neurotransmitters
Appropriate drug dose adjustments in disease, ageing and pregnancy
Best practice for self-monitoring in chronic disease e.g. diabetes,
hypertension, respiratory disease
Categories of drug safety in pregnancy and their impact on prescribing
Common and life-threatening drug interactions and common presentations
of drug-induced disease and adverse drug reactions
Common interactions between prescription and non-prescription
medications and complementary therapies
Corticosteroid use
» actions and indications
» relative potencies
» monitoring
» adverse effects and prevention
Delivery techniques for specific medicines
Describe the mode of action, adverse effects, interactions,
pharmacokinetics of antipsychotics, benzodiazepines, antidepressants
Effect of ageing, pregnancy and lactation on pharmacokinetics
Factors predisposing to polypharmacy including therapeutic cascade and
reasons for overprescribing and de-prescribing
Factors increasing the risk of medication error
Factors that affecting adherence
Indications for monitoring plasma concentrations or pharmacological
effects of specific drugs
Impact of organ dysfunction on pharmacokinetics and dose modification
Importance of genetic alterations in drug metabolism
Mechanism of drug actions at the receptor and intracellular level
Mode of action, antimicrobial spectrum, adverse effects, interactions,
pharmacokinetics of common classes of antimicrobials
Nature and specific manifestations of addiction
Non-pharmacological alternatives to psychotropic medication
Patient factors impacting on prescribing, such as allergy, age, pregnancy
Pharmacological basis of drug interactions
Pharmacology of drugs of abuse including:
RACP Basic Training Curriculum
Adult Internal Medicine
Pharmacology, Toxicology and
Addiction Medicine
Knowledge Guide
Page 2
BASIC TRAINING
Knowledge Guide
Pharmacology, Toxicology and Addiction Medicine
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INVESTIGATIONS
AND PROCEDURES
Basic Trainees will know
how to select and
interpret the results of
these investigations and
procedures.
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IMPORTANT
SPECIFIC ISSUES
Basic Trainees will be
able to identify important
specialty-specific issues
and their impact on
diagnosis and
management.
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effects
side effects and interactions
toxicological aspects where relevant
Pharmacology of opioid replacement drugs e.g. methadone,
buprenorphine
Principles of absorption, distribution, metabolism and excretion of drugs
Principles of addiction and tolerance
Principles of dose titration
Techniques for enhancing medication safety
Administer simple drug use screening tools
Drug monitoring including development of common adverse drug
reactions such as monitoring of renal or hepatic function
Investigations identifying drug efficacy or toxicity, such as ECG in digoxin
treatment/poisoning, ECG in tricyclic antidepressant poisoning
Mental state examination
Liver function and impact on drug clearance
Renal function and impact on drug clearance
Acquire history of drug use
Adjust therapy to achieve target ranges and monitor therapy appropriately
Conduct brief interventions to reduce harm from drug or alcohol use
Describe actions and indications of anticoagulants both prophylactic and
therapeutic
Describe legislation regarding prescribing of controlled and restricted
drugs
Describe common adverse effects and drug interactions for specific drug
classes
Discuss classes of commonly available analgesics with respect to mode of
action, pharmacokinetics, potency and efficacy in various pain syndromes
Discuss drug interactions, adverse effects, pharmacokinetics, monitoring
of anticoagulation
Discuss strategies to enhance patient adherence and techniques for
encouraging self-management of health and chronic disease
Discuss the prevalence of substance use and abuse and their onset
Initiate anticoagulation with appropriate agent at an appropriate dose
taking patient factors into consideration e.g. age, comorbid conditions
Initiate empiric antimicrobial therapy with appropriate agent at appropriate
dose taking patient factors into consideration e.g. age, comorbid
conditions
Know when and how to use therapeutic drug monitoring
Liaise and communicate with community, health, drug and alcohol,
education and welfare practitioners as appropriate
Monitor efficacy of treatment and adjust regimen appropriately
Prescribe corticosteroid therapy appropriately including dose reduction
and escalation of dose in acute illness
Prescribe medications safely and accurately, and monitor for efficacy and
toxicity
Prescribe analgesia with reference to
» underlying cause, severity, co-morbidities and co-medications
RACP Basic Training Curriculum
Adult Internal Medicine
Pharmacology, Toxicology and
Addiction Medicine
Knowledge Guide
Page 3
BASIC TRAINING
Knowledge Guide
Pharmacology, Toxicology and Addiction Medicine
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LEARNING
METHODS
Suggested opportunities,
activities, and resources
to assist with learning.
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acute and chronic pain management
non-pharmacological strategies
adjuvant therapies
use of pain-scoring tools
safe prescribing of opioids
Prescribe medications in patients with altered physiology e.g. age and
pregnancy
Prescribe adjuvant therapy where appropriate
Prescribe psychotropic medications safely avoiding serious side effects
including QT prolongation and serotonergic syndrome
Prescribes medications in renal and/or liver failure
Provide advice on judicious prescribing
Recognise polypharmacy and strategies to de-prescribe
Recognise signs of drug abuse on general history and examination and
impact on presentation
Recognise when steroids are not appropriate
Obtain accurate medication history including drug allergies and
complementary and alternative medicines
Understand factors that can impact on compliance
Understand local and national medication guidelines and their limitations
Understand the regulatory and funding framework in which medicines are
made available
Clinical experience in Pharmacology, Toxicology and Addiction medicine
in a range of settings
Textbooks
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Birkett DJ. Pharmacokinetics Made Easy. 2nd ed. Australia: McGraw-Hill
Education; 2010.
Other
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American Geriatrics Society Beer’s criteria for Potentially Inappropriate
Medication Use in Older Adults
www.americangeriatrics.org
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Australian Commission on Quality and Safety in Healthcare-Medication
Reconciliation www.safetyandquality.gov.au/our-work/medicationsafety/medication-reconciliation
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Interactive Clinical Pharmacology www.icp.org.nz/index.html
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National Prescribing Service –Prescribing Competencies Framework
www.nps.org.au/health-professionals/cpd/prescribing-competenciesframework
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National Health and Medical Research Council (NHMRC) Alcohol
Guidelines www.nhmrc.gov.au/your-health/alcohol-guidelines
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WHO Guide to Good Prescribing
apps.who.int/medicinedocs/en/d/Jwhozip23e/3.html
RACP Basic Training Curriculum
Adult Internal Medicine
Pharmacology, Toxicology and
Addiction Medicine
Knowledge Guide
Page 4