Critical Care Pharmacy Specialty Recertification Literature Study: Module 1A-B (Cert # L199122)

ACPE Numbers: Various – see listing below
Release Date: 4/17/2019
Expiration Dates: 10/15/2019
Activity Type: Application-based
CE Credits: 11 hours

Accreditation for Pharmacists

The American Society of Health-System Pharmacists is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Target Audience

These Literature Studies are designed to help board-certified pharmacy practitioners who are seeking recertification credit hours to maintain their Board of Pharmacy Specialties (BPS) Board Certification.

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.

Module 1A – Neurology: This module focuses on the management of stroke. Topics include the guidelines for acute ischemic stroke, the use of tenecteplase before thrombectomy for ischemic stroke and clopidogrel and aspirin use in acute ischemic stroke.

Module 1B – Critical Care Update: This module focuses on updates in the management of critically ill patients. Topics include fluid management, the use of procalcitonin guidance and angiotensin II use in patients with shock.

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 and professional development program for BCCCP recertification approved by the BPS. 

 

Recertification Credit*

Board certified pharmacists are eligible to receive up to 8 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

*Assessment Pass Point

Pharmacotherapy and Critical Care Pharmacy Recertification Literature Study Module 1A: Neurology

0204-0000-19-936-H01-P

5

80%

Critical Care Pharmacy Recertification Literature Study Module 1B: Critical Care Update

0204-0000-19-943-H01-P

6

76%

 

Articles and Learning Objectives 

Module 1A - Neurology
0204-0000-19-936-H01-P

This module focuses on the management of stroke. Topics include the guidelines for acute ischemic stroke, the use of tenecteplase before thrombectomy for ischemic stroke and clopidogrel and aspirin use in acute ischemic stroke.

Campbell BCV, Mitchell PJ, Churilov L et al. Tenecteplase versus alteplase before thrombectomy for ischemic stroke. N Engl J Med. 2018; 378:1573-82.

Learning Objectives:

  • Explain the rationale, methodology, findings, limitations, and implications of the Tenecteplase versus Alteplase before Endovascular Therapy for Ischemic Stroke (EXTEND-IA TNK) study
  • Make recommendations for the use of thrombolytic therapy before endovascular thrombectomy in patients with ischemic stroke

Johnston SC, Easton JD, Farrant M et al. Clopidogrel and aspirin in acute ischemic stroke and high-risk TIA. N Engl J Med. 2018; 379:215-25.

Learning Objectives:

  • Explain the rationale, methodology, findings, limitations, and implications of the Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) study
  • Make recommendations for antiplatelet therapy in patients with a minor acute ischemic stroke or high-risk transient ischemic attack (TIA)

Powers WJ, Rabinstein AA, Ackerson T et al. 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018; 49:e46-e110.

Learning Objectives:

  • Describe the 2018 American Heart Association (AHA)/American Stroke Association (ASA) guidelines for early management of patients with acute ischemic stroke pertaining to prehospital care, emergency evaluation and treatment, and in-hospital care
  • Make recommendations for prehospital care, general supportive care, and emergency treatment of adults with acute ischemic stroke
  • Make recommendations for in-hospital general supportive care, treatment of acute complications, and secondary prevention measures for adults with acute ischemic stroke

Module 1B - Critical Care Update
0204-0000-19-943-H01-P

This module focuses on updates in the management of critically ill patients. Topics include fluid management, the use of procalcitonin guidance and angiotensin II use in patients with shock.

Monnet X, Marik PE, Teboul JL. Prediction of fluid responsiveness: an update. Ann Intensive Care. 2016; 6:111

Learning Objectives:

  • Describe the advantages and disadvantages of various tests used to predict preload (i.e., fluid) responsiveness in critically ill patients with acute circulatory failure
  • Recommend methods for testing preload responsiveness to guide fluid management in critically ill patients with acute circulatory failure

Semler MW, Self WH, Wanderer JP et al. Balanced crystalloids versus saline in critically ill adults. N Engl J Med. 2018; 378:829-3

Learning Objectives:

  • Explain the rationale, methodology, and limitations of the Isotonic Solutions and Major Adverse Renal Events Trial (SMART) comparing balanced crystalloids with saline for intravenous fluid administration in critically ill adults in intensive care units
  • Discuss the findings and implications of the Isotonic Solutions and Major Adverse Renal Events Trial (SMART) for fluid resuscitation therapy in critically ill adults in intensive care units 

Huang DT, Yealy DM, Filbin MR et al. Procalcitonin-guided use of antibiotics for lower respiratory tract infection. N Engl J Med. 2018; 379:236-49

Learning Objectives:

  • Explain the rationale, methodology, findings, limitations, and implications of the Procalcitonin Antibiotic Consensus Trial (ProACT)
  • Make recommendations for the use of procalcitonin levels to guide antibiotic therapy in adults with suspected lower respiratory tract infection

Iankova I, Thompson-Leduc P, Kirson NY et al. Efficacy and safety of procalcitonin guidance in patients with suspected or confirmed sepsis: a systematic review and meta-analysis. Crit Care Med. 2018; 46:691-8 

Learning Objectives:

  • Explain the rationale, methodology, findings, limitations, and implications of the systematic review and meta-analysis of studies of procalcitonin use to guide antibiotic therapy in adults with suspected or confirmed sepsis
  • Make recommendations for the use of procalcitonin levels to guide antibiotic therapy in adults with suspected or confirmed sepsis 

Lam SW, Bauer SR, Fowler R, Duggal A. Systematic review and meta-analysis of procalcitonin-guidance versus usual care for antimicrobial management in critically ill patients: focus on subgroups based on antibiotic initiation, cessation, or mixed strategies. Crit Care Med. 2018; 46:684-90 

Learning Objectives:

  • Explain the rationale, methodology, findings, limitations, and implications of the systematic review and meta-analysis of studies of procalcitonin use to guide antibiotic therapy in critically ill adults
  • Make recommendations for the use of procalcitonin levels to guide antibiotic therapy in critically ill adults 

Bissell BD, Browder K, McKenzie M, Flannery AH. A blast from the past: revival of angiotensin II for vasodilatory shock. Ann Pharmacother. 2018; 52:920-7 

Learning Objectives:

  • Explain the rationale, methodology, findings, limitations, and implications of studies of angiotensin II for the treatment of vasodilatory shock
  • Make recommendations for the use of angiotensin II in patients with vasodilatory shock 

Khanna A, English SW, Wang XS et al. Angiotensin II for the treatment of vasodilatory shock. N Engl J Med. 2017; 377:419-30 

Learning Objectives:

  • Explain the rationale, methodology, findings, limitations, and implications of the phase 3 Angiotensin II for the Treatment of High-Output Shock (ATHOS-3) study
  • Make recommendations for the use of angiotensin II in patients with catecholamine-resistant vasodilatory shock 

Tumlin JA, Murugan R, Deane AM et al. Outcomes in patients with vasodilatory shock and renal replacement therapy treated with intravenous angiotensin II. Crit Care Med. 2018; 46:949-57 

Learning Objectives:

  • Explain the rationale, methodology, findings, limitations, and implications of the post-hoc analysis of the phase 3 Angiotensin II for the Treatment of High-Output Shock (ATHOS-3) study
  • Make recommendations for the use of angiotensin II in patients with vasodilatory shock and acute kidney injury requiring renal replacement therapy

Faculty

Salia Farrokh, Pharm.D., BCPS, BCCCP
Neuro ICU Clinical Pharmacist Specialist
Johns Hopkins Hospital
Baltimore, MD 

Lauren Igneri, Pharm.D., BCPS, BCCCP
Clinical Pharmacy Specialist
Cooper University Health Care
Camden, NJ 

Brianne Ritchie, Pharm.D., M.B.A., BCPS, BCCCP
Clinical Pharmacist
Mayo Clinic
Rochester, MN 

Amy Sipe, R.Ph.
Clinical Pharmacist
Kansas City VA Medical Center
Kansas City, MO 

Heather Torbic, Pharm.D., BCPS, BCCCP
Clinical Pharmacy Specialist
Cleveland Clinic
Cleveland, OH

Sarah Welch, Pharm.D., BCPS
Clinical Pharmacy Specialist
Cleveland Clinic
Cleveland, OH 

Content Matter Experts

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

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

Snehal Bhatt, Pharm.D., AACC, BCPS-AQ Cardiology, FASHP
Associate Professor of Pharmacy Practice
MCPHS University School of Pharmacy Boston
Clinical Pharmacist
Beth Israel Deaconess Medical Center
Boston, Massachusetts 

Angela L. Bingham, Pharm.D., BCCCP, BCNSP, BCPS
Associate Professor of Clinical Pharmacy
Philadelphia College of Pharmacy - University of the Sciences
Philadelphia, PA 

Christopher Betz, Pharm.D., BCPS, FASHP, FKSHP
Professor, Sullivan University College of Pharmacy
Cardiovascular Clinical Pharmacy Specialist
Jewish Hospital Rudd Heart & Lung Center - KentuckyOne Health
Louisville, Kentucky 

Reviewers

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

Field Testers

Nancy Balch, Pharm.D., BCCCP
Dominique Brewster, Pharm. D., BCPS, BCGP, AAHHIVP
Kristin Buechler, Pharm.D., BCCCP
Amanda Cantin, Pharm.D., BCCCP
Fady Faltas, Pharm.D. BCPS
Coral Iserhienrhien, Pharm.D., BCCCP
Alexis Kasniunas, Pharm.D., BCCCP
Shiao Hui Lim, M.Pharm, BCCCP
Mary Newell, Pharm.D., BCCCP
Cody Null, Pharm.D., BCCCP, BCPS
Nathan Pingle, Pharm.D, BCCCP
Julie Stephens, Pharm.D., BCCCP, BCPS
Khalid Al Sulaiman, BSc. Pharm, SSC-PhP, SCC-CCP, BCCCP, BCNSP
Sara Swearingen, Pharm.D., BCPS
Jennifer Ting-Chan, BCCCP BCPS
Barbara Wiggins, Pharm.D., BCPS, BCCCP, BCCP
Paul Wong, Pharm.D., BCCCP
Kara Zacholski, Pharm.D., BCCCP
Alan Zhao, Pharm.D., BCPS, 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.

  • Snehal Bhatt: Advisor, Portola Pharmaceuticals; Speaker Bureau, Janssen Pharmaceuticals, Inc.
  • All other planners, presenters, and reviewers of this session 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.