Critical Care Pharmacy Review Course and Practice Exam Package (No Recert Credit) (Cert # L239332)

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

These activities are intended for pharmacists who are seeking to update their knowledge and skills commensurate with a board certification examination in the areas listed below.

This course consists of 20 activities (see table below) and provides up to 26 contact hours of continuing pharmacy education credit. The Review Course includes case-based presentations for application to real-life scenarios, a practice exam along with correct answers, and links to the reference sources, and domains, tasks, and knowledge statements. To help you further prepare, this package includes a compilation of practice questions in the same format and rigor to help you prepare for the BPS Specialty Examination.       

After participating in this CPE activity, learners should be able to: 

Complex Case: Antithrombotic-Associated Intracerebral Hemorrhage 
ACPE Number: 0204-0000-23-600-H01-P

• Develop treatment and monitoring plans for a complex critical care patient with antithrombotic-associated intracerebral hemorrhage (ICH).
• Select appropriate neurologic monitoring techniques.
• Recommend agents for acute volume resuscitation and hemostasis (e.g., blood products, hemostatic agents).
• Evaluate the impact of critical illness on preexisting conditions (e.g., cardiovascular diseases).
• Recommend fluid and electrolyte management based on patient-specific factors. 

Select Topics in Acid Base Disorders
ACPE Number: 0204-0000-23-601-H01-P

• For the following specific acid/base disorders - respiratory, metabolic acid base disorders including anion gap/non-anion gap acidosis, kidney tubular acidosis, as well as the delta gap equation:
  • Interpret laboratory and diagnostic tests.
  • Recommend the most appropriate treatment and monitoring plans based on patient-specific information and current guidelines. 

Complex Case: Sepsis
ACPE Number: 0204-0000-23-602-H01-P

• Develop treatment and monitoring plans for a complex critical care patient with an intra-abdominal infection, sepsis/SIRS, and shock.
• Select appropriate routes of administration for medications in critically ill patients.
• Modify treatment and monitoring plans related to alterations of pharmacodynamics and pharmacokinetics in the critically ill.
• Recommend agents for acute volume resuscitation and hemostasis (e.g., crystalloids, colloids). 

Alterations in Pharmacokinetics and Pharmacodynamics in Critical Care
ACPENumber: 0204-0000-23-603-H01-P

• Identify pharmacokinetic and pharmacodynamic (PK/PD) changes that occur in critical illness, and the impact on commonly administered medications in this setting.
• Apply knowledge of general PK/PD changes in critical illness to the following patient-specific factors that further complicate drug dosing:
  • Burns
  • Obesity
  • Pregnancy
  • Continuous kidney replacement therapy
  • Extracorporeal membrane oxygenation
• Develop a therapeutic strategy to optimize PK/PD for commonly used medications in the intensive care unit. 

Complex Case: GI Bleeding and Acute Kidney Failure
ACPE Number: 0204-0000-23-604-H01-P

• Develop treatment and monitoring plans for a complex critical care patient with gastrointestinal bleeding, alcohol withdrawal, refeeding syndrome, hepatorenal syndrome, cirrhosis, and acute kidney failure with kidney replacement therapy.
• Modify treatment and monitoring plans related to alterations of pharmacodynamics and pharmacokinetics in the critically ill.
• Select appropriate routes of administration for medications in critically ill patients.
• Recommend agents for acute volume resuscitation and hemostasis (e.g., blood products, hemostatic agents). 

Cardiac Arrhythmias and Advanced Cardiac Life Support
ACPE Number: 0204-0000-23-605-H01-P

• Interpret signs, symptoms, and diagnostic tests for cardiac arrhythmias.
• Identify drug-related problems, including drug interactions and adverse effects, associated with pharmacotherapy of cardiac arrhythmias.
• Identify strategies to prevent drug-induced arrhythmias.
• Recommend therapy and monitoring for cardiac arrhythmias based on patient-specific information, current guidelines, and Advanced Cardiac Life Support recommendations. 

Complex Case: Oncologic Emergencies: Febrile Neutropenia, Tumor Lysis Syndrome, and Hypercalcemia of Malignancy
ACPE Number: 0204-0000-23-606-H01-P

• Develop treatment and monitoring plans for a complex critical care patient with febrile neutropenia, tumor lysis syndrome, or hypercalcemia of malignancy.
• Select fluid, electrolyte and acid/base management and monitoring based on patient-specific factors.
• Evaluate the impact of critical illness on pre-existing conditions (e.g., cancer). 

Select Topics in Pulmonary Disorders
ACPE Number: 0204-0000-23-607-H01-P

• For the following specific pulmonary disease topics: asthma exacerbation, acute exacerbation of chronic obstructive pulmonary disease, pulmonary embolism, and pulmonary arterial hypertension:
  • Interpret laboratory and diagnostic tests
  • Recommend the most appropriate treatment and monitoring plans based on patient-specific information and current guidelines. 

Fluid, Electrolytes, and Nutrition
ACPE Number: 0204-0000-23-608-H01-P

• Interpret laboratory and diagnostic tests for fluid, electrolyte, and nutrition status.
• Recommend the most appropriate therapy and monitoring in patients with fluid, electrolyte, and nutritional disorders based on patient-specific information and current guidelines.
• Apply strategies to manage drug-related electrolyte interactions and nutrient interactions. 

Practice Administration and Development Part 1
ACPE Number: 0204-0000-23-609-H04-P

• Develop a plan to monitor and evaluate compliance with, and impact of, policies and guidelines (e.g., institutional, evidence based).
• Describe the application and integration of evidence-based critical care literature into institutional guidelines and processes.
• Evaluate regulatory/IRB requirements relative to conducting critical care research.
• Select quality assurance methods and improvement activities, including needs assessment techniques, aimed at enhancing the safety and effectiveness of medication-use processes in the critical care area. 

Practice Administration and Development Part 2
ACPE Number: 0204-0000-23-610-H04-P

• Identify metrics for evaluating the quality of critical care pharmacy services (e.g., lengths of ICU stay, mortality, cost-effectiveness, ROI).
• Summarize the evidence-based literature that supports the value of critical care pharmacy.
• Summarize the factors that enhance the education and training of critical care pharmacists available in published documents from relevant professional societies (e.g., ASHP, ACCP, SCCM). 

Statistics, Evidence-Based Medicine and Clinical Trial Design
ACPE Number: 0204-0000-23-998-H04-P

• Determine quality and appropriateness of a study by examining study design, statistical analysis, sources of bias, quality of conclusions, and interpretation of graphs.
• Determine clinical and statistical significance of a study outcome.
• Determine whether the study applies to a specified patient population. 

Trauma/Burns
ACPE Number: 0204-0000-23-611-H01-P

• For the following specific trauma/burn topics (hemorrhagic shock; Surgical Care Improvement Project [SCIP] antibiotic considerations; fluid requirements; pain; toxic epidermal necrolysis syndrome [TENS]; venous thromboembolism [VTE] prophylaxis in trauma/surgery)
  • Interpret laboratory and diagnostic tests.
  • Recommend the most appropriate treatment and monitoring plans based on patient-specific information and current guidelines. 

Complex Case: Pneumonia
ACPE Number: 0204-0000-23-612-H01-P

• Develop treatment and monitoring plans for a complex critical care patient with multiple conditions, including pneumonia and acute respiratory distress syndrome (ARDS).
• Identify drug interactions and adverse drug events common in critical care and methods to document. 

Select Topics in Toxicology and Disaster Management
ACPE Number: 0204-0000-23-613-H01-P

• Interpret laboratory and diagnostic tests.
• In patients with toxicologic emergencies, recommend the most appropriate treatment and monitoring plans based on patient-specific information and current guidelines.
• Discuss clinical and practice management considerations for disaster management. 

Complex Case: Hyperglycemic Emergency and Community-Acquired Pneumonia
ACPE Number: 0204-0000-23-614-H01-P

• Develop treatment and monitoring plans for a complex critical care patient with hyperglycemic emergency and community-acquired pneumonia.
• Select appropriate routes and methods of administration for medications in critically ill patients.
• Select fluid, electrolyte and acid/base management and monitoring based on patient-specific factors.
• Choose agents for acute volume resuscitation.
• Identify medication safety issues patients requiring care in the ICU.
• Explain nutrition support in the critically ill patient.  

Selected Topics in Neurology
ACPE Number: 0204-0000-23-615-H01-P

• For the following specific critical care topics:  status epilepticus, traumatic brain injury, ischemic stroke, subarachnoid hemorrhage:
  • Interpret laboratory and diagnostic tests.
  • Evaluate benefits and risks of drug therapy considering other medication, and other patient-specific factors.
  • Recommend the most appropriate treatment and monitoring plans based on patient-specific information and current guidelines. 

Select Topics in Infectious Disease
ACPE Number: 0204-0000-23-616-H01-P

• For the following specific infectious disease topics: urinary tract infections, meningitis, catheter related infections, bacteremia and infective endocarditis:
  • Interpret laboratory and diagnostic tests
  • Recommend the most appropriate treatment and monitoring plans based on patient-specific information and current guidelines. 

Complex Case: Complications after Cardiac Surgery – Glucose, Sedation, and Thrombocytopenia
ACPE Number: 0204-0000-23-617-H01-P

• Develop treatment and monitoring plans for a complex post-cardiac surgery patient to include pain, agitation and delirium, glucose management, and heparin-induced thrombocytopenia.
• Evaluate the impact of critical illness on pre-existing conditions (e.g., endocrine disorders, pain).
• Summarize quality assurance and process improvement methods relevant to critical care.
• Assess the relationship between institutional guideline development and evidence-based critical care literature. 

Complex Case: Acute Coronary Syndrome
ACPE Number: 0204-0000-23-618-H01-P

• Develop treatment and monitoring plans for a complex critical care patient with acute coronary syndrome.
• Modify treatment and monitoring plans related to alterations of pharmacodynamics and pharmacokinetics in the critically ill.
• Select devices required for treatment and monitoring of a critical care patient.
• Select fluid, electrolyte and acid/base management and monitoring based on patient-specific factors.

The Core Therapeutic Modules Review Package consists of 10 activities in which faculty review clinical topics and practice skills using a case-based approach. The activities are designed to assist the learner in identifying knowledge gaps in preparation for a pharmacy specialty board examination. In addition to a recorded presentation, each activity includes links to resources for further self-study and a practice test developed in the same format and rigor as the specialty exam.

After participating in these CPE activities, learners should be able to:

Select Topics in Acid-Base Disorders
ACPE #: 0204-0000-21-610-H01-P

For the following specific acid/base disorders - respiratory, metabolic acid base disorders including anion gap/non-anion gap acidosis, renal tubular acidosis, as well as delta gap equation:

•  Interpret laboratory and diagnostic tests.
• Recommend the most appropriate treatment and monitoring plans based on patient-specific information and current guidelines

Select Topics in Infectious Diseases in Critical Care Patients
ACPE #: 0204-0000-22-643-H01-P

For the following specific infectious disease topics: urinary tract infections, meningitis, catheter related infections, bacteremia, and infective endocarditis:

• Interpret laboratory and diagnostic tests.
• Recommend the most appropriate treatment and monitoring plans based on patient-specific information and current guidelines.

Select Neurology Topics in Critical Care Patients
ACPE #: 0204-0000-20-990-H01-P

• For the following specific critical care topics: status epilepticus, traumatic brain injury, ischemic stroke, subarachnoid hemorrhage:
  • Interpret laboratory and diagnostic tests.
  • Evaluate benefits and risks of drug therapy considering other medication, and other patient-specific factors.
  • Recommend the most appropriate treatment and monitoring plans based on patient-specific information and current guidelines.

Alterations in Pharmacokinetics and Pharmacodynamics in Critical Care
ACPE #: 0204-0000-21-611-H01-P

• Identify pharmacokinetic and pharmacodynamic (PK/PD) changes that occur in critical illness, and the impact on commonly administered medications in this setting.
• Apply knowledge of general PK/PD changes in critical illness to the following patient-specific factors that further complicate drug dosing:
  • Burns
  • Obesity
  • Pregnancy
  • Continuous renal replacement therapy (CRRT)
  • Extracorporeal membrane oxygenation (ECMO)

• Develop a therapeutic strategy to optimize PK/PK for commonly used medications in the intensive care unit. "

Select Topics in Prevention and Supportive Care in Critical Care Patients
ACPE #: 0204-0000-20-991-H01-P

For the following specific critical care topics─stress ulcer prophylaxis (SUP), venous thromboembolism (VTE) prophylaxis, bowel regimens, and ventilator associated pneumonia (VAP) prevention:

• Interpret laboratory and diagnostic tests.
• Recommend the most appropriate treatment and monitoring plans based on patient-specific information and current guidelines.

Select Topics in Toxicology
ACPE #: 0204-0000-21-612-H01-P

For the following specific toxicology topics: acetaminophen, toxic alcohols, calcium channel blockers, beta blockers, opioids, and ecstasy:

• Interpret laboratory and diagnostic tests
• Recommend the most appropriate treatment and monitoring plans based on patient-specific information and current guidelines.

Select Topics in Pulmonary Disorders
ACPE #: 0204-0000-22-644-H01-P

For the following specific pulmonary disease topics: asthma exacerbation, acute exacerbation of chronic obstructive pulmonary disease, pulmonary embolism, and pulmonary arterial hypertension:

• Interpret laboratory and diagnostic tests.
• Recommend the most appropriate treatment and monitoring plans based on patient-specific information and current guidelines.

Cardiac Arrhythmias and Advanced Cardiac Life Support
ACPE #: 0204-0000-20-992-H01-P

• Interpret signs, symptoms and diagnostic tests for cardiac arrhythmias.
• Identify drug-related problems, including drug interactions and adverse effects, associated with pharmacotherapy of cardiac arrhythmias.
• Identify strategies to prevent drug-induced arrhythmias.
• Recommend therapy and monitoring for cardiac arrhythmias based on patient-specific information, current guidelines and Advanced Cardiac Life Support guided therapies.

Pharmacotherapy Considerations in the Management of Shock
ACPE #: 0204-0000-20-993-H01-P

• Interpret diagnostic and/or laboratory tests, vital signs, and clinical presentation in order to differentiate types of shock (hypovolemic, distributive, cardiogenic)
• Compare and contrast the pharmacologic agents utilized in shock
• Recommend therapy and monitoring based on patient-specific information and current guidelines for the treatment of shock

Fluid, Electrolytes, and Nutrition
ACPE #: 0204-0000-22-617-H01-P

• Interpret laboratory and diagnostic tests for fluid, electrolyte, and nutrition status.
• Recommend the most appropriate therapy and monitoring in patients with fluid, electrolyte, and nutritional disorders based on patient-specific information and current guidelines.
• Apply strategies to manage drug-related electrolyte interactions and nutrient interactions.

Faculty Bios

Kevin E. Anger, PharmD, BCPS
Clinical Pharmacy Specialist
Brigham and Women's Hospital
Boston, Massachusetts 

Angela L. Bingham, PharmD, BCPS, BCNSP, BCCCP, FASPEN, FCCP, FASHP*
Vice Chair and Associate Professor of Clinical Pharmacy
Philadelphia College of Pharmacy
Philadelphia, Pennsylvania  

Caitlin S. Brown, PharmD, FCCM, BCCCP
Assistant Professor of Emergency Medicine & Pharmacy
Mayo School of Medicine
Rochester, Minnesota 

Quinn Czosnowski, PharmD, BCCCP
Clinical Pharmacy Specialist, Critical Care
Indiana University Health - Methodist Hospital
Indianapolis, Indiana 

Brian Dee, PharmD, BCCCP, BCNSP, FCCM
Clinical Pharmacy Specialist - Critical Care/Nutrition Support
The University of Texas MD Anderson Cancer Center
Houston, Texas 

Mary M. Hess, PharmD, BSPharm, BCCCP, FASHP, FCCM, FCCP*
Associate Dean
Professor, Pharmacy Practice
Jefferson College of Pharmacy
Philadelphia, Pennsylvania 

David Hill, PharmD, BCPS, BCCCP, FCCM
Critical Care Pharmacist; Director of Burn Research
Regional One Health
Memphis, Tennessee 

Lauren A. Igneri, PharmD, BCPS, BCCCP
Critical Care Clinical Pharmacy Specialist
Cooper University Healthcare
Camden, New Jersey 

Patricia Kienle, MPA, BCSCP, FASHP
Director, Accreditation and Medication Safety
Cardinal Health
Wilkes-Barre, Pennsylvania 

Kristi Kim, PharmD, BCCCP
Clinical Pharmacy Specialist, Critical Care
Cooper University Health Care
Camden, New Jersey 

Paul Reynolds, PharmD, BCCCP
Critical Care Pharmacist
University Hospital Atrium Pharmacy
Aurora, Colorado 

Christina Rose, PharmD, BCCCP
Clinical Professor in Pharmacy Practice
Temple University School of Pharmacy
Philadelphia, Pennsylvania 

Susan E. Smith, PharmD, BCCCP, BCPS
Clinical Associate Professor
Clinical and Administrative Pharmacy
University of Georgia
Athens, Georgia 

Diana Solomon, PharmD, BCCCP
Critical Care Clinical Pharmacy Specialist
St. Joseph’s Hospital and Medical Center
Phoenix, Arizona 

Jill Starykowicz, PharmD, BCCCP 
Clinical Pharmacy Specialist, Cardiology/Medical Intensive Care
Advocate Lutheran General Hospital 
Park Ridge, Illinois 

Lauren Sutton, PharmD, BCCCP
Neurology/Neurosurgery ICU Clinical Pharmacist
Barnes-Jewish Hospital
St Louis, Missouri 

Rachel Swope, PharmD, BCCCP
Clinical Pharmacy Manager
Norton Healthcare
Louisville, Kentucky 

Paul Szumita, PharmD, FCCM, FASHP, BCCCP, BCPS*
Director, Clinical Pharmacy Services
Boston, Massachusetts 

Heather Torbic, PharmD, BCPS, BCCCP, FCCM
Medical ICU Clinical Pharmacy Specialist, Critical Care PGY2 Program Director
Cleveland Clinic
Cleveland, Ohio 

Andrew Webb, PharmD, BCCCP
Clinical Pharmacist, Neurocritical Care
Massachusetts General Hospital
Boston, Massachusetts

*Content Matter Experts

Susan R. Dombrowski, MS, RPh
Amy Holmes, PharmD, BCPPS, FPPA

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 other planners, presenters, and reviewers of this session report no financial relationships relevant to this activity.

Activities can be completed in any order. Each activity consists of audio, video, and/or PDFs and evaluations. Learners must review all content and complete the evaluations to receive continuing pharmacy education credit for each activity. 

Follow the prompts to claim, view, or print the statement of credit within 60 days after completing the activity. 

These activities were developed by ASHP.

To maintain its strict, independent standards for certification, BPS does NOT endorse or provide review information, preparatory courses, or study guides for Board Certification Examinations.