1

Content 1 min

Supportive and Preventive Medicine Megan Feeney, Pharm.D., BCCCP Boston Medical Center Boston, Massachusetts…

2

Content 1 min

Supportive and Preventive Medicine Supportive and Preventive Medicine Megan Feeney, Pharm.D., BCCCP Boston Medical Center Boston, Massachusetts…

3

Learning Objectives 4 min

Supportive and Preventive Medicine Learning Objectives 1. Identify the key components of intensive care medi- cine that can be applied to all critically ill patients. 2. Recommend therapeutic option…

4

Content 4 min

Supportive and Preventive Medicine A. PPIs are a potential risk factor for CDI by pro- ducing hypochlorhydria and increasing the host susceptibility to infections. B. Prospective randomized control…

5

Exam Content Outline 1 min

Supportive and Preventive Medicine BPS Critical Care Pharmacy Examination Content Outline This chapter covers the following sections of the Critical Care Pharmacy Examination Content Outline: 1. Doma…

6

Data Tables 3 min

Supportive and Preventive Medicine I.  KEY ASPECTS IN THE GENERAL CARE OF ALL CRITICALLY ILL PATIENTS A. The FAST-HUG mnemonic emphasizes important aspects of ICU medicine that can be applied at leas…

7

Data Tables 2 min

Supportive and Preventive Medicine Element Importance Considerations Stress Ulcer prophylaxis Critically ill patients develop stress-related mucosal damage, potentially leading to clinically signi…

8

Content 3 min

Supportive and Preventive Medicine Patient Case 1. A 68-year-old man (weight 85 kg) is admitted to the ICU for the management of severe hypoxemic respira- tory failure associated with community-acqui…

9

Data Tables 2 min

Supportive and Preventive Medicine Table 2. Stress Ulcers vs. Peptic Ulcers Stress Ulcers Peptic Ulcers Several superficial lesions at the proximal stomach bulb; involves superficial capillaries; res…

10

Data Tables 3 min

Supportive and Preventive Medicine Study Design and Population Independent Risk Factors for Bleeding Notes Crit Care Med 1999;27:2812-7 • Multicenter, prospective cohort study of 1200 mechanically…

11

Content 3 min

Supportive and Preventive Medicine E. Pharmacologic Therapy for Preventing Stress Ulcers 1. Antacids a. Dose-dependent neutralization of gastric acid b. Not recommended for routine use because of…

12

Data Tables 3 min

Supportive and Preventive Medicine e. Despite short elimination half-lives, PPIs suppress acid secretion for 20 hours or more, permitting once-daily dosing without requiring gastric pH monitoring. f…

13

Data Tables 2 min

Supportive and Preventive Medicine b. Antacids, sucralfate, H2RAs, and PPIs have all reduced clinically significant SRMD-related bleeding compared with placebo. 3. Studies evaluating interventions…

14

Data Tables 4 min

Supportive and Preventive Medicine Comparison Study Design Population CIB Notes PPI vs placebo “SUP-ICU” trial. N Engl J Med 2018;379:2199- RCTs 3298 ICU patients • CIB reduced with PPI (RR, 0…

15

Content 4 min

Supportive and Preventive Medicine b. Meta-analyses have failed to show an association between H2RAs and PPIs on the risk of pneumonia (Crit Care Med 2013;41:693-705; Am J Gastroenterol 2012;107:507…

16

Content 3 min

Supportive and Preventive Medicine 4. In 2016, the Surviving Sepsis guidelines recommended PPIs or H2RAs in patients at risk (Crit Care Med 2017;45:486-552). 5. The 2020 clinical practice guideline…

17

Content 3 min

Supportive and Preventive Medicine III.  PROPHYLAXIS AGAINST DEEP VENOUS THROMBOSIS OR PULMONARY EMBOLISM A. Epidemiology 1. Reported occurrence of DVT is 10%–80% (J Crit Care 2002;17:95-104). Preci…

18

Data Tables 3 min

Supportive and Preventive Medicine d. The PREVENT trial randomized 2003 critically ill patients to receive either pharmacological prophylaxis alone or pharmacological prophylaxis with intermittent p…

19

Data Tables 3 min

Supportive and Preventive Medicine Citation Study Type Population Intervention Screening Methods VTE Rates Major Bleeding Rates Blood Coagul Fibrinolysis 2010;21:57-61 Single- center, double-bli…

20

Data Tables 2 min

Supportive and Preventive Medicine Table 8. VTE Prophylaxis Recommendations in the General and Abdominal-Pelvic Surgical Patient Risk Level for VTE Risk of Bleeding Prophylaxis Very low (< 0.5%; Roge…

21

Content 4 min

Supportive and Preventive Medicine 2. Dosing frequency of LDUH (twice vs. thrice daily): Meta-analyses suggest no difference in thrombosis or major bleeding rates with twice-daily regimens compared…

22

Content 3 min

Supportive and Preventive Medicine 3. Rivaroxaban 10 mg orally once daily was compared with enoxaparin 40 mg subcutaneously daily for 10 days, followed by placebo in acutely ill hospitalized patient…

23

Content 3 min

Supportive and Preventive Medicine b. HEP (HIT Expert Probability) score i. Incorporates more clinical features than the 4T score ii. More complex (time-consuming) and evaluation studies limited (n…

24

Data Tables 2 min

Supportive and Preventive Medicine c. Initiate warfarin once the Plt has recovered and is within normal limits (at least 150,000/mm3) and after at least 5 days of therapy with an alternative parente…

25

Content 3 min

Supportive and Preventive Medicine Patient Cases 5. A 93-year-old man (weight 45 kg) confined to his bed is admitted from a nursing home with a chronic obstructive pulmonary disease exacerbation req…

26

Content 3 min

Supportive and Preventive Medicine C. Goals of Palliative Care 1. Provides relief from pain and other distressing symptoms. 2. Affirms life and regards dying as a normal process. 3. Intends neithe…

27

Content 3 min

Supportive and Preventive Medicine e. Suggested goals include keeping the respiratory rate at or below 30 breaths/minute and keeping the patient pain free. Pain assessment should include using the v…

28

Content 3 min

Supportive and Preventive Medicine c. Lorazepam can be considered as an adjunct, especially with anticipatory vomiting. d. Use of more than one agent from different classes may be necessary for symp…

29

Content 3 min

Supportive and Preventive Medicine V.  DISASTER MANAGEMENT A. The Federal Emergency Management Association (FEMA) defines a disaster as any occurrence that results in property damage, deaths or inju…

30

Content 3 min

Supportive and Preventive Medicine v. Vaccine administration vi. Telehealth and telepharmacy services c. Medication supply i. Identify necessary antidotes, critical medications and alternatives, a…

31

Content 2 min

Supportive and Preventive Medicine C. Studies evaluating SDoH in the critically ill population are limited and often rely on claims data for their conclusions; it is often difficult to identify the…

32

Content 4 min

Supportive and Preventive Medicine REFERENCES Key Aspects in the General Care of All Critically Ill Patients Haynes AB, Weiser TG, Berry WR, et al. A surgical safety checklist to reduce morbidity an…

33

Content 4 min

Supportive and Preventive Medicine Crit Care Med. 1999;27(12):2812-2817. https://doi. org/10.1097/00003246-199912000-00034 Cook DJ, Fuller HD, Guyatt GH, et al. Risk fac- tors for gastrointestinal ble…

34

Content 3 min

Supportive and Preventive Medicine practice guideline. BMJ. 2020;368:l6722. https://doi. org/10.1136/bmj.l6722 Prophylaxis Against Deep Venous Thrombosis or Pulmonary Embolism Arabi YM, Al-Hameed F,…

35

Content 3 min

Supportive and Preventive Medicine Pharmacotherapy. 2006;26(4):452-460. https://doi. org/10.1592/phco.26.4.452 Ley EJ, Brown CVR, Moore EE, et al. Updated guide- lines to reduce venous thromboemboli…

36

Content 3 min

Supportive and Preventive Medicine Truog RD, Campbell ML, Curtis JR, et al. Recommendations for end-of-life care in the intensive care unit: a consensus statement by the American College of Critica…

37

Answers & Explanations 4 min

Supportive and Preventive Medicine ANSWERS AND EXPLANATIONS TO PATIENT CASES 1. Answer: A The mnemonic FAST-HUG stands for Feeding, Analgesia, Sedation, Thromboembolic prophylaxis, Head of bed elev…

38

Content 2 min

Supportive and Preventive Medicine 7. Answer: D Warfarin can be initiated (Answer C is incorrect) once the Plt has recovered to at least 150,000/mm3 and after at least 5 days of therapy with an alt…

39

Self-Assessment 4 min

Supportive and Preventive Medicine ANSWERS AND EXPLANATIONS TO SELF-ASSESSMENT QUESTIONS 1. Answer: C The FAST-HUG mnemonic can serve as a checklist for every patient admitted to the ICU. Every pati…

40

Content 2 min

Supportive and Preventive Medicine Clinical prediction rules to help determine the probabil- ity of HIT (e.g., 4Ts score) have been developed. Patients with a low 4Ts score (0–3) have a very low prob…

No pages match your search