Critical Care Pharmacy Specialty Literature Study: Module 2A-B (Cert # L189037)

ACPE Numbers: Various – see listing below
Release Date: 10/10/2018
Expiration Dates: 04/09/2019
Activity Type: Application-based
CE Credits: 10 hours
Activity Fee: $50 (ASHP member); $100 (non-member); $35 (Resident Member) 

Accreditation for Pharmacists

ASHP is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Target Audience

Target Audience

These recertification activities are intended for board certified pharmacists seeking to update their knowledge and skills in:

  • Corticosteroid Use in Critical Illness
    • Treatment of critical illness-related corticosteroid insufficiency
    • Use of corticosteroids in septic shock and acute respiratory distress syndrome
  • Management of Alcohol Withdrawal
    • Treatment of severe alcohol withdrawal including alcohol withdrawal syndrome
    • Treatment of electrolyte disturbances in patients with chronic alcohol-use disorder

Activity Overview

The Literature Study Module is intended for board certified pharmacists in need of recertification credit and is designed based on the content outline developed by the Board of Pharmacy Specialties (BPS). This module consists of 2 online home study activities (see table below). Each activity is designed to assess the learners’ ability to analyze and apply peer-selected contemporary articles to practice and includes a short video for enhanced learning and understanding. 

Module 2A - Corticosteroid Use in Critical Illness: This module focuses on the use of corticosteroids in patients with critical illness.  Topics include the treatment of critical illness-related corticosteroid insufficiency and use of corticosteroids in septic shock and acute respiratory distress syndrome. 

Module 2B: Management of Alcohol Withdrawal: This module focuses on the management of alcohol withdrawal.  Topics include the treatment of severe alcohol withdrawal including alcohol withdrawal syndrome and electrolyte disturbances in patients with chronic alcohol-use disorder. 

Learners will be required to review the content and complete the associated online assessments. The learner must be able to correctly answer the questions based upon their interpretation of the content, as well as “baseline specialty specific knowledge and/or easily retrievable information.” For purposes of this Literature Study, “baseline specialty specific knowledge and/or easily retrievable information” is defined as product labeling and well-established standards of practice in the specialty practice. 

These activities are part of the ASHP professional development program for BCCCP recertification approved by the BPS. 

Recertification Credit*

Board certified pharmacists are eligible to receive up to 10 hours of recertification credit for completing this module. To earn recertification credit, learners must review the activity content and successfully complete the online assessments by the deadline. Only completed assessments will be eligible for credit; no partial or incomplete assessments will be processed. You are allowed only one attempt to successfully complete this assessment.

Learning Activity

ACPE Number

Credit Hours

Specialty

*Assessment Pass Point

Critical Care Pharmacy Recertification Literature Study Module 1B: Corticosteroid Use in Critical Illness

0204-0000-18-912-H01-P

4

BCCCP

76%

Critical Care Pharmacy Recertification Literature Study Module 2B: Management of Alcohol Withdrawal

0204-0000-18-913-H01-P

6

BCCCP

80%

 

Articles and Learning Objectives 

Module 2A - Corticosteroid Use in Critical Illness

This module focuses on the use of corticosteroids in patients with critical illness.  Topics include the treatment of critical illness-related corticosteroid insufficiency and use of corticosteroids in septic shock and acute respiratory distress syndrome. 

Annane D, Pastores SM, Arlt W et al. Critical illness-related corticosteroid insufficiency (CIRCI): a narrative review from a multispecialty task force of the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM). Crit Care Med. 2017; 45:2089-98. 

Annane D, Pastores SM, Rochwerg B et al. Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (part I): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017. Crit Care Med. 2017; 45:2078-88. 

Pastores SM, Annane D, Rochwerg B, and the Corticosteroid Guideline Task Force of SCCM and ESICM. Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (part II): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017. Crit Care Med. 2018; 46:146-8. 

Learning Objectives:

  • Define and discuss the pathophysiology of critical illness-related corticosteroid insufficiency (CIRCI).
  • Describe the signs, symptoms, diagnosis, and use of corticosteroids in adults with critical illness-related corticosteroid insufficiency (CIRCI) and sepsis, acute respiratory distress syndrome (ARDS), major trauma, community-acquired pneumonia (CAP), influenza, or meningitis or who are undergoing cardiopulmonary bypass surgery or suffering a cardiac arrest.
  • Make recommendations for corticosteroid use in patients with critical illness-related corticosteroid insufficiency (CIRCI) and sepsis, acute respiratory distress syndrome (ARDS), major trauma, community-acquired pneumonia (CAP), influenza, or meningitis or who are undergoing cardiopulmonary bypass surgery or suffering a cardiac arrest. 

Venkatesh B, Finfer S, Cohen J et al. Adjunctive glucocorticoid therapy in patients with septic shock. N Engl J Med. 2018; 378:797-808.

Learning Objectives:

  • Explain the rationale, methodology, findings, limitations, and implications of the Adjunctive Corticosteroid Treatment in Critically Ill Patients with Septic Shock (ADRENAL) trial.
  • Make recommendations for the use of adjunctive corticosteroid therapy in critically ill adults with septic shock. 

Annane D, Renault A, Brun-Buisson C et al for the CRICS-TRIGGERSEP Network. Hydrocortisone plus fludrocortisone for adults with septic shock. N Engl J Med. 2018; 378: 809-18. 

Learning Objectives:

  • Explain the rationale, methodology, findings, limitations, and implications of the Activated Protein C and Corticosteroids for Human Septic Shock (APROCCHSS) trial.
  • Make recommendations for the use of adjunctive corticosteroid therapy in critically ill adults with septic shock.

Module 2B – Management of Alcohol Withdrawal

This module focuses on the management of alcohol withdrawal.  Topics include the treatment of severe alcohol withdrawal including alcohol withdrawal syndrome and electrolyte disturbances in patients with chronic alcohol-use disorder. 

Schmidt KJ, Doshi MR, Holzhausen JM et al. Treatment of severe alcohol withdrawal. Ann Pharmacother. 2016; 50(5):389-401. 

Learning Objectives:

  • Describe the risk factors, pathophysiology, patient presentation, and tools used for screening for alcohol withdrawal syndrome (AWS) in critically ill patients.
  • Make recommendations for supportive care and pharmacologic treatment of alcohol withdrawal syndrome (AWS) in critically ill. 

Hammond DA, Rowe JM, Wong A, et al. Patient outcomes associated with phenobarbital use with or without benzodiazepines for alcohol withdrawal syndrome: a systematic review. Hosp Pharm. 2017;52(9):607-616. 

Learning Objectives:

  • Explain the rationale, methodology, findings, limitations, and implications of the systematic review of phenobarbital use with or without benzodiazepines for alcohol withdrawal syndrome (AWS).
  • Make recommendations for the use of phenobarbital with or without benzodiazepines in patients with alcohol withdrawal syndrome (AWS). 

Bielka K, Kuchyn I, Glumcher F. Addition of dexmedetomidine to benzodiazepines for patients with alcohol withdrawal syndrome in the intensive care unit: a randomized controlled study. Ann Intensive Care. 2015; 5:33. 

Learning Objectives:

  • Explain the rationale, methodology, findings, limitations, and implications of the study of dexmedetomidine for the treatment of alcohol withdrawal syndrome (AWS) in patients in the intensive care unit (ICU).
  • Make recommendations for the use of dexmedetomidine for the treatment of alcohol withdrawal syndrome (AWS) in patients in the intensive care unit (ICU). 

Sen S, Grgurich P, Tulolo A et al. A symptom-triggered benzodiazepine protocol utilizing SAS and CIWA-Ar scoring for the treatment of alcohol withdrawal syndrome in the critically ill. Ann Pharmacother. 2017; 51 (2):101-10. 

Learning Objectives:

  • Explain the rationale, methodology, findings, limitations, and implications of the study of symptom-triggered benzodiazepine for the treatment of alcohol withdrawal syndrome (AWS) in critically ill patients in the medical intensive care unit.
  • Make a recommendation for an institutional protocol for benzodiazepine treatment of alcohol withdrawal syndrome (AWS) in critically ill patients in the intensive care unit. 

Palmer BF, Clegg DJ. Electrolyte disturbances in patients with chronic alcohol-use disorder. N Engl J Med. 2017; 377(14):1368-77. 

Learning Objectives:

  • Describe the pathogenesis, manifestations, and treatment of electrolyte disturbances in patients with chronic alcohol-use disorder.
  • Make recommendations for the treatment of electrolyte disturbances in patients with chronic alcohol-use disorder. 

Flannery AH, Adkins DA, Cook AM. Unpeeling the evidence for the banana bag: evidence-based recommendations for the management of alcohol-associated vitamin and electrolyte deficiencies in the ICU. Crit Care Med. 2016; 44(8):1545-52. 

Learning Objectives:

  • Discuss the etiology of vitamin and electrolyte deficiencies and alcoholic ketoacidosis and the role of supplementation in critically ill patients with chronic alcohol use disorders.
  • Explain challenges in diagnosing and preventing or treating Wernicke's encephalopathy in critically ill patients with chronic alcohol use disorders.
  • Recommend the type and doses of micronutrients and electrolytes and the type of intravenous fluid for a critically ill patient with a chronic alcohol use disorder. 

Faculty

Rebecca Bickley, Pharm.D., BCCCP, BCPS
Assistant Professor of Pharmacy Practice
Presbyterian College School of Pharmacy
Clinton, South Carolina 

Lauren Igneri, Pharm.D., BCCCP, BCPS
Critical Care Clinical Pharmacist
Cooper University Hospital
Clinton, New Jersey 

Leigh Ann Scherrer, Pharm.D., BCCCP, BCPS
Clinical Pharmacist
University Hospital
Louisville, Kentucky 

Sarah Welch, Pharm.D, BCCCP
Critical Care Clinical Pharmacy Specialist, Surgical Intensive Care Unit
Cleveland Clinic Department of Pharmacy
Cleveland, Ohio 

Content Matter Experts

Mary M. Hess, Pharm.D., BCCCP, FASHP, FCCM, FCCP
Associate Dean, Student Affairs
Jefferson School of Pharmacy
Philadelphia, Pennsylvania 

Bryan Lizza, Pharm.D., BCCCP, BCPS
Clinical Pharmacist - Critical Care
Northwestern Medicine
Chicago, Illinois 

Paul Szumita, Pharm.D., BCCCP, BCPS, FASHP, FCCM
Clinical Pharmacy Practice Manager
Brigham & Women's Hospital
Boston, Massachusetts
 

Reviewers

Holly L. Byrnes , Pharm D., BCPS
Susan R. Dombrowski, M.S., R.Ph.
Anna M. Wodlinger Jackson, Pharm.D., BCPS 

Field Testers

Amanda Cantin, Pharm.D., BCCCP
Bryan Casciere, Pharm.D., BCCCP
Laura Celmins, Pharm.D., BCPS, BCCCP
Jessica Crow, Pharm.D., BCCCP, BCPS-AQ Cardiology, CNSC
Karly Erickson, Pharm.D., BCPS, BCCCP
Alyssa Fixl, Pharm.D., BCCCP
Mercedes Fraga , Pharm.D., BCPS, BCCCP
Eman Halal, Pharm.D., BCPS, BCCP
Kirsten Hawbaker, Pharm.D., BCPS, BCCCP
Heather Johnson, Pharm.D., BCCCP
Shiao Hui Lim, Master in Clinical Pharmacy, BCCCP
Stephanie Sexton, Pharm.D., BCCCP
Hassan Al Tomy, BSPharm, M.S., BCCCP               

Disclosures

In accordance with the Accreditation Council for Continuing Medical Education’s Standards for Commercial Support and the Accreditation Council for Pharmacy Education’s Standards for Commercial Support, ASHP requires that all individuals involved in the development of activity content disclose their relevant financial relationships. A person has a relevant financial relationship if the individual of his or her spouse/partner has a financial relationship (e.g. employee, consultant, research grant recipient, speakers bureau, or stockholder) in any amount occurring the in the last 12 months with a commercial interest whose products or series may be discussed in the educational activity content over which the individual has control. The existence of these relationships is provided for the information of participants and should not be assumed to have an adverse impact on the content.

All faculty and planners for ASHP education activities are qualified and selected by ASHP and required to disclose any relevant financial relationships with commercial interests. ASHP identifies and resolves conflicts of interest prior to an individual’s participation in development of content for an educational activity. Anyone who refuses to disclose relevant financial relationships must be disqualified from any involvement with a continuing pharmacy education activity.

  • All faculty and planners report no financial relationships relevant to this activity. 

Methods and CE Requirements

Activity consists of audio/ video/PDF files, an attestation statement, assessment, and activity evaluation. In order to receive continuing pharmacy education credit, learners must:

  • Complete the attestation statement
  • Review all content
  • Complete and pass the assessment
  • Complete the evaluation
  • Follow the prompts to claim, view, or print the statement of credit within 60 days after completing the activity.

Note: Learner must complete and pass the assessment in order to claim continuing pharmacy education credit. 

System Technical Requirements

Courses and learning activities are delivered via your Web browser and Acrobat PDF. For all activities, you should have a basic comfort level using a computer and navigating web sites.

View the minimum technical and system requirements for learning activities.

Development

These activities were developed by ASHP.