Antiretroviral Checklist

Antiretroviral Checklist

1. Validate Home Regimen

  • Patient interview
  • Admission medication reconciliation
  • External fill history
  • Community pharmacy
  • Records from previous hospitalizations (don't forget historical in Powerchart, Theradoc)

If updated information is obtained, be sure to document on Medication List

Assess need for opportunistic infection prophylaxis

2. Assess Dose & Frequency

Check if regimen requires dose adjustment for renal or hepatic insufficiency or drug interactions

Confirm appropriate frequency of medication

  • If anticipating quick recovery, it may not be necessary to adjust ART dosing (especially NNRTIs or PIs)
  • Tenofovir disoproxil fumarate should always be renally dose adjusted to prevent further exacerbation of AKI

3. Check for Drug Interactions

Caution with:

  • Anti-tuberculosis agents
  • Anti-seizure medications
  • Acid suppressive agents
  • Chemotherapy (vincristine)

Check for interactions with all home medications as well as active inpatient orders

If significant interactions are present which necessitate change in home medications or require specific timing of administration, educate patient!

4. Choose Time of Administration

  • Time all ART doses to be given together
  • Link orders
  • Refer to SOP 0006 Medication Administration Time Schedules

When indicated, time ART administration to be at meal time

  • Ask patient when last dose prior to admission was taken to ensure no missed dose when admitted to the hospital

5. Additional Considerations

  • Missed doses should be avoided when feasible
  • Refer to DHHS Guidelines on Discontinuation or Interruption in ART
  • NPO? Severe nausea/vomiting? Tube feeds?
    • Check if regimen can be crushed
    • Change to formulation to oral liquid
  • If no enteral access is available or if formulation not compatible with NG/OG administration, discontinue entire ART regimen.