Supportive and Preventive Medicine

Learning Objectives

Identify the key components of intensive care medi-

cine that can be applied to all critically ill patients.

related mucosal disease.

Recommend therapeutic options to prevent venous

thromboembolism in a critically ill patient.

Compare therapeutic options for patients with

heparin-induced thrombocytopenia.

Discuss medications that can be used to comfort a

critically ill patient at the end of life.

Examine the pharmacists’ role in disaster response.

Examine the role of social determinants of health in

patient outcomes.

aPTT

Activated partial thromboplastin time

BPS

Behavioral Pain Scale

Clostridioides difficile infection

CPOT

Critical-Care Pain Observation Tool

DOAC

Direct oral anticoagulant

DVT

Deep venous thrombosis

H2RA

Histamine-2 receptor antagonist

HIT

Heparin-induced thrombocytopenia

ICU

Intensive care unit

NGT

Nasogastric tube

PF4

Platelet factor 4

Plt

Platelet count

PPI

Proton pump inhibitor

RASS

Richmond Agitation-Sedation Scale

SRMD

Stress-related mucosal disease

SUP

Stress ulcer prophylaxis

VTE

Venous thromboembolism

Self-Assessment Questions

Answers and explanations to these questions may be

found at the end of this chapter.

On rounds, you have a “checklist” of interventions

that will benefit all critically ill patients in an inten-

sive care unit (ICU). Which interventions would be

most effective?

patients who are admitted to the ICU, and if

appropriate, discontinue sedation.

mechanical venous thromboembolism (VTE)

prophylaxis.

and ensure that patients’ heads are elevated 45

degrees above the bed, if not contraindicated.

admitted to the ICU, and initiate an insulin infu-

sion to maintain a blood glucose of 120 mg/dL.

related mucosal injury, which is most appropriate?

histamine-2 receptor antagonists (H2RAs) in

preventing clinically significant bleeding.

administration.

times daily.

A 66-year-old man is admitted to the ICU with

abdominal pain, nausea, and altered mental sta-

tus. He has a history of cirrhosis, atrial fibrillation,

chronic kidney diease, and erosive esophagitis.

He is intubated and stabilized on the ventilator. A

nasogastric tube (NGT) is placed, and the patient

is tolerating enteral tube feedings. Which would

be best to recommend for preventing stress-related

bleeding?

NGT.

A 51-year-old woman is admitted to the ICU for

hypovolemic shock secondary to severe dehydra-

tion. She reports a 5-day history of diarrhea and

malaise. She has no recent history of illnesses or

contact with health care personnel. Her medical his-

tory includes hypothyroidism and gastroesophageal

reflux disease. Her medications include levothyrox-

ine 25 mcg orally daily and famotidine 20 mg orally

at bedtime. Recently, her primary care physician

changed famotidine to omeprazole 20 mg orally at

bedtime for increased gastroesophageal reflux dis-

ease symptoms. While she is in the ICU, testing for

Clostridioides difficile infection (CDI) returns posi-

tive. Which would be most appropriate regarding

PPI use and CDI?