Critical Care Pharmacy Specialty Review Course, Workbook Chapters, and Practice Exam (No Recert Credit) (Cert #L249236)

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 5 groups of activities, containing a total of 20 topics (see table below) and provides up to 21.50 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: 

Group 1
ACPE #: 0217-9999-24-174-H04-P

Evolution and Validation of Practice Standards, Training, and Professional Development

• Describe landmark events in the evolution of critical care pharmacy as a specialty, including summarizing key published documents and primary evidence validating critical care pharmacy as a specialty.
• Identify the core knowledge areas for pharmacists caring for critically ill patients.
• Outline criteria for credentialing, conventional training pathways and mentorship, and standards of practice for clinical pharmacy in the critical care practice environment.
• Develop an approach to conducting a gap analysis relative to the principles and values of team-based care in a local critical care practice environment.
• Develop an approach to lifelong professional learning to maintain competency in critical care pharmacy practice using the principles of continuing personal professional development.
• Identify the avenues and processes for contributing to the critical care body of knowledge as a presenter, author, or peer reviewer. 

Research Design, Biostatistics, and Literature Evaluation

• Identify factors influencing the conduct of essential critical care research.
• Evaluate the appropriateness of various statistical tests for a set of data.
• Apply concepts of research design and analysis to clinical care. 

Fluids, Electrolytes, Acid-Base Disorders, and Nutrition Support

• Describe normal fluid requirements and common patient conditions that alter fluid needs and homeostasis.
• Develop an appropriate assessment and treatment plan for common electrolyte disorders in critically ill patients.
• Correctly identify complex acid-base disorders based on a patient's laboratory data and clinical course.
• Specify the appropriate route (parenteral or enteral) of nutrition administration, energy and protein needs, and key micronutrients to be provided to a critically ill patient.
• Develop an appropriate assessment of the tolerance, safety, and efficacy of an enteral or parenteral nutrition regimen. 

Protocol Development and Quality Improvement

• Determine the steps involved in the development of a guideline and/or policy.
• Design a medication use evaluation (MUE) with selection of an appropriate medication and/or medication-related process suitable for an MUE.
• Determine the appropriate quality improvement tool to use in order to optimize outcomes in a critically ill patient population.
• Identify processes or quality improvement initiatives that would benefit from a gap analysis.
• Describe the types of pharmacotherapeutic interventions and documentation processes to justify the value of clinical pharmacy services. 

Group 2
ACPE #: 0217-9999-24-175-H01-P

Pharmacoeconomics and Safe Medication Use

• Apply the principles of pharmacoeconomics to patient care.
• Differentiate between a medication error, an adverse drug event (ADE), a preventable ADE, and an adverse drug reaction (ADR).
• Design an ADE reporting program, including committee structure, committee reporting mechanisms, and methods of detecting, reporting, and managing ADEs.
• Provide recommendations for improving medication use safety using the 2017 SCCM Safe Medication Use Guidelines for the ICU.
• Provide safety measures for drug interaction detection and prevention.
• Develop a drug formulary proposal. 

Infectious Diseases I

• Develop risk factor-based empiric antibiotic regimens for patients with suspected ventilator-associated pneumonia.
• Develop empiric and definitive antimicrobial therapy plans for patients with central line-associated bloodstream infections and catheter-related urinary tract infections.
• Differentiate between location of intra-abdominal infections and respective empiric antimicrobial therapy, including the role of antibiotics in patients with acute pancreatitis.
• Develop a definitive management strategy for critically ill patients with severe Clostridioides difficile infection.
• Describe the role of pharmacotherapy and recommend appropriate therapy for patients with severe postoperative wound infection or severe cutaneous reactions.
• Identify a disease-specific and supportive care management plan for critically ill patients with severe influenza and novel severe acute respiratory syndrome coronavirus 2. 

Infectious Diseases II

• Compose a plan to incorporate quality metrics (e.g., prevention of catheter-associated urinary tract infections and catheter-related bloodstream infections) into pre- and postsurgical care.
• Identify key members of common strategies and tools (including biomarkers and rapid diagnostic tests) used by an antimicrobial stewardship team.
• Provide empiric antibiotic therapy recommendations for critically ill patients with community-acquired or health care-associated meningitis.
• Evaluate therapeutic options for the treatment of multidrug-resistant pathogens in the intensive care unit (ICU).
• Devise an optimal treatment plan for critically ill immunocompromised patients with infectious diseases. 

Pharmacokinetics/Pharmacodynamics

• Describe the changes in critically ill patients that alter drug absorption.
• Explain how critical illness affects drug distribution.
• Depict the effects of changing hepatic blood flow, intrinsic activity, and protein binding on drug metabolism.
• Differentiate between different critically ill patient populations and the expected pharmacokinetic (PK) changes.
• Identify the desired pharmacodynamic variables associated with efficacy in select drugs. 

Group 3
ACPE #: 0217-9999-24-176-H01-P

Acute Kidney Injury and Kidney Replacement Therapy in the Critically Ill Patient

• Define acute kidney injury (AKI).
• Differentiate between common categories of drug-induced kidney disease. Discuss key principles of continuous kidney replacement therapy (KRT), including indications, timing, and circuit components.
• Apply drug-dosing concepts in continuous KRT to estimate a sieving coefficient, saturation coefficient, and/or drug clearance on the basis of drug characteristics and device settings. 

Neurocritical Care

• Identify pertinent pathophysiologic and laboratory changes that acutely occur after neurologic injuries and require therapeutic intervention.
• Describe monitoring devices commonly used in neurocritical care patients that help develop and optimize treatment strategies.
• Develop an evidence-based treatment strategy for neurocritical care patients that optimizes patient outcomes and reduces the risk of adverse drug effects and drug interactions.
• Recommend a monitoring plan to assess response to therapeutic regimens and specific therapeutic goals for neurocritical care patients.
• Develop new plans of care for neurocritical care patients according to therapeutic and adverse outcomes and progress toward therapeutic goals. 

Cardiovascular Critical Care I

• Develop an appropriate pharmacotherapeutic regimen based on a patient's hemodynamic status and objective cardiac findings.
• Design a treatment plan for patients with cardiogenic shock.
• Develop treatment plans for critically ill patients with cardiovascular diseases, including, but not limited to, coronary artery disease, arrhythmias, heart failure (HF), and valvular disease.
• Recognize the utility of mechanical circulatory support and heart transplantation for patients with advanced HF and cardiogenic shock. 

Cardiovascular Critical Care II

• Manage cardiac arrest from the initiation of basic life support to the use of post-cardiac arrest care.
• List the indications and special considerations for medication administration during cardiac arrest.
• Categorize the patient groups that should receive temperature control after cardiac arrest.
• Develop treatment plans for common complications of temperature control after cardiac arrest.
• Analyze the therapeutic goals and clinical indications for the medications used in hypertensive emergency. 

Group 4
ACPE #: 0217-9999-24-177-H01-P

Hepatic Failure/GI/Endocrine Emergencies

• Develop a treatment strategy to help manage and reduce the complications associated with acute liver failure (ALF).
• Construct a plan for pharmacologic, nutritional, and surgical management of acute pancreatitis based on the severity of an episode.
• Identify risk factors and treatment options for gastrointestinal fistulas, postoperative ileus, and postoperative nausea and vomiting.
• Design a treatment plan for patients who present with an acute upper gastrointestinal bleed.
• Differentiate between the main endocrine emergencies in the intensive care and their appropriate treatment regimens. 

Supportive and Preventive Medicine

• Identify the key components of intensive care medicine that can be applied to all critically ill patients.
• Recommend therapeutic options to prevent stress-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 and available resources.
• Examine the role of social determinants of heatlh in patient outcomes. 

Shock Syndromes I: Introduction, Vasodilatory, and Sepsis

• Distinguish between the various shock syndromes on the basis of a patient's clinical and hemodynamic parameters.
• Interpret hemodynamic data from monitoring devices and markers of perfusion.
• Devise a treatment strategy for when to use intravenous fluids and/or vasopressors in a patient with shock.
• Develop a treatment pathway for the care of patients with sepsis or septic shock that incorporates current evidence and the Surviving Sepsis Campaign guideline recommendations. 

Shock Syndromes II: Hypovolemic, Critical Bleeding, and Obstructive

• Identify critical determinants affecting oxygen delivery and the physiologic response to hypovolemic and obstructive shock.
• Evaluate resuscitation strategies and end points in the management of hypovolemic, hemorrhagic, and obstructive shock.
• Devise a treatment strategy for pharmacotherapy adjuncts in the management of bleeding and acute coagulopathy when treating patients with hemorrhagic shock.
• Develop a treatment pathway for the care of patients receiving anticoagulants and antiplatelet agents for a life-threatening hemorrhage or critical bleeding that incorporates current evidence and guideline recommendations.
• Apply risk stratification to guide the effective and safe use of thrombolytic agents in the management of acute pulmonary embolism. 

Group 5
ACPE: 0217-9999-24-178-H01-P

Pain, Agitation/Sedation, Delirium, Immobility, Sleep Disruption, and Neuromuscular Blockade

• Develop a management strategy for the prevention and treatment of pain, agitation/sedation, and delirium, immobility, and sleep disruption (PADIS) in an intensive care unit (ICU) patient with various comorbidities.
• Discuss relevant pharmacokinetic and pharmacodynamic considerations of PADIS medications as they pertain to disturbances in critical care physiology.
• Identify relevant adverse effects, drug interactions, and drug withdrawal syndromes in the management of PADIS.
• Evaluate patients in the ICU for PADIS using a validated screening tool.
• Construct a plan for the management of delirium.
• Identify the long-term effects of critical illness in adult ICU patients.
• Create a management strategy for PADIS-related medications that are continued beyond ICU discharge.
• Describe a treatment and monitoring plan for critically ill patients receiving neuromuscular blockade. 

Pulmonary Disorders I

• Evaluate the role of pharmacologic management options in acute respiratory distress syndrome.
• Review clinical practice guidelines pertaining to acute respiratory distress syndrome.
• Recommend an evidence-based approach for nonpharmacologic therapy in managing critically ill patients with acute respiratory distress syndrome.
• Evaluate key variables and commonly used modes for treatment with mechanical ventilation.
• Assess appropriateness of drug therapy for endotracheal intubation, including agents for premedication, induction, and neuromuscular blockade. 

Pulmonary Disorders II

• Design a treatment plan for a cystic fibrosis (CF) exacerbation.
• Compare treatment strategies for pulmonary hypertension (PH) using the clinical classifications of PH.
• Describe classifications and risk factors for increased severity of asthma exacerbation and treatment plans for patients with acute respiratory failure caused by asthma exacerbation.
• Recognize evidence-based treatment options for acute exacerbations of chronic obstructive pulmonary disease (COPD). 

Toxicology

• Distinguish between the common clinical toxidromes associated with acute poisonings.
• Describe the general management of a patient with an acute overdose.
• Determine the best options for the management of selected toxins.
• Develop a patient care plan for a patient presenting with an acute overdose.
• Identify the adverse effects and monitoring of the patient who is poisoned. 

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

Mahmoud A. Ammar, PharmD, FCCM, BCPS, BCCCP
Senior Critical Care Clinical Pharmacy Specialist
Yale New Haven Hospital
New Haven, Connecticut 

Stephanie N. Bass, PharmD, FCCP, BCPS, BCCCP*
Medical ICU Clinical Pharmacist
Cleveland Clinic
Cleveland, Ohio 

Grace E. Benanti, PharmD, BCCCP
Critical Care Clinical Pharmacist – Medical ICU
Loyola University Medical Center
Chicago, Illinois 

Scott T. Benken, PharmD, MHPE, FCCP, FCCM, BCPS – AQ Cardiology*
Clinical Associate Professor
University of Illinois Chicago College of Pharmacy;
Clinical Pharmacist
University of Illinois Health
Chicago, Illinois 

Mitchell S. Buckley, PharmD, FCCP, FASHP, FCCM, BCCCP
Clinical Pharmacist
Banner Health
Phoenix, Arizona 

Christopher Allen Droege, PharmD, FCCP, FASHP, FCCM, BCCCP
Manager, Clinical Pharmacy and Infusion Services
University of Cincinnati Health – University of Cincinnati Medical Center;
Adjunct Assistant Professor of Pharmacy Practice and Administrative Sciences
University of Cincinnati
James L. Winkle College of Pharmacy
Cincinnati, Ohio 

Stephanie Dwyer Kaluzna, PharmD, BCCP
Clinical Assistant Professor
University of Illinois Chicago College of Pharmacy;
Cardiovascular Clinical Pharmacist
University of Illinois Hospital and Health Sciences System
Chicago, Illinois 

Julie E. Farrar, PharmD, BCCCP
Assistant Professor
University of Tennessee Health Science Center College of Pharmacy
Memphis, Tennessee 

Gabrielle A. Gibson, PharmD, BCPS, BCCCP
Clinical Pharmacy Specialist
Barnes-Jewish Hospital
St. Louis, Missouri 

Jamie Robenolt Gray, PharmD, FCCM, BCCCP
System Director of Medication Safety and Policy
Temple University Health System;
PGY1 Residency Program Director
Temple University Health System
Philadelphia, Pennsylvania 

David M. Hill, PharmD, FCCM, BCPS, BCCCP
Clinical Pharmacist
Director of Burn Research
Regional One Health
Memphis, Tennessee 

Mollie G. Lumpkin, PharmD, BCPS, BCCCP
Clinical Pharmacist
Cleveland Clinic
Cleveland, Ohio 

Casey C. May, PharmD, FNCS, BCCCP
Associate Professor – Clinical
The Ohio State University College of Pharmacy;
Specialty Practice Pharmacist – Neurocritical Care
The Ohio State University Wexner Medical Center
Columbus, Ohio 

Eric W. Mueller, PharmD, FCCM, FCCP*
Director, Acute Care and Infusion Pharmacy Services
UC Health – University of Cincinnati Medical Center & West Chester Hospital;
Adjunct Professor of Pharmacy Practice and Administrative Sciences
University of Cincinnati
Cincinnati, Ohio 

Diana Wells Mulherin, PharmD, FCCM, FASPEN, BCNSP, BCCCP
Clinical Pharmacy Specialist, Nutrition Support
Vanderbilt University Medical Center
Nashville, Tennessee 

Andrea M. Nei, PharmD, FCCM, BCPS, BCCCP
Critical Care Pharmacist
Mayo Clinic Hospital – Rochester;
Assistant Professor of Pharmacy
Mayo Clinic College of Medicine & Science
Rochester, Minnesota 

Sara Radparvar, PharmD, BCPS, BCCCP
Director of Clinical Pharmacy Services
The Mount Sinai Hospital
New York, New York 

Gretchen L. Sacha, PharmD, FCCM, BCCCP*
Critical Care Clinical Pharmacist
Cleveland Clinic
Cleveland, Ohio 

Jacob S. Schwarz, PharmD, MBA, FAzPA, BCIDP, BCPS, BCCCP
Critical Care Pharmacist
Mayo Clinic
Phoenix, Arizona 

Keaton S. Smetana, PharmD, MBA, FCCM, FNCS, BCCCP
Clinical Pharmacy Manager
OhioHealth Riverside Methodist Hospital
Columbus, Ohio 

Joanna L. Stollings, PharmD, FCCP, FCCM, BCPS, BCCCP
MICU Clinical Pharmacy Specialist
Vanderbilt University Medical Center
Nashville, Tennessee 

Joseph M. Swanson, PharmD, FCCP, FCCM
Professor of Clinical Pharmacy and Translational Science
Assistant Director of Experiential Education and International Programs
University of Tennessee Health Science Center College of Pharmacy
Memphis, Tennessee 

Kyle A. Weant, PharmD, FCCP, BCPS, BCCCP
Clinical Assistant Professor
Department of Clinical Pharmacy and Outcome Sciences
University of South Carolina College of Pharmacy;
Emergency Medicine Clinical Pharmacy Specialist
Department of Pharmacy
Prisma Health-Midlands
Columbia, South Carolina 

Adrian Wong, PharmD, MPH, FCCP, FCCM, BCCCP*
Clinical Pharmacist, Medical ICU
Beth Israel Deaconess Medical Center;
Adjunct Associate Professor of Pharmacy Practice
MCPHS University
Boston, Massachusetts

*Content Matter Experts

Abdullah M. Alhammad
Emily Alsbury
Lolowa M. Alswaidan
Rosario Ruth Avelino
Czarina Bock
Mark Brockway
Austin Camp
Stephanie R. L. Ciapala
Erin Dickert Creech
Bethany J. Crouse
Shereen Ahmad Dasuqi
Mohamed Tharwat Ibrahim Eltantawi
Sonia Shaw Everhart
Kristin Griebe
Payal K. Gurnani
Julie M. Haase
Leslie A. Hamilton
Lawahidh Fali Hasham
Mercy Hoang-Ngyuen
Miranda Howland
Paul Juang
Janell Krack
Kimberly E. Levasseur-Franklin
Lauren Lozano
Melanie R. Madorsky
Amber Marie Ooley
Dipti Patel
Alyssa B. Polotti
Jennifer Leigh Polyniak
Alia A. Poore
Kerry Anne Rambaran
Michael J. Reichert
Luke Smedley
Zachary Smith
Alicia Surber
Jodi L. Taylor
Stephanie Tchen
Jessica A. Ward
Laurence Weiss

In accordance with our accreditor’s Standards of Integrity and Independence in Accredited Continuing Education, ASHP requires that all individuals in control of content disclose all financial relationships with ineligible companies. An individual has a relevant financial relationship if they have had a financial relationship with an ineligible company in any dollar amount in the past 24 months and the educational content that the individual controls is related to the business lines or products of the ineligible company. 

An ineligible company is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. The presence or absence of relevant financial relationships will be disclosed to the activity audience. 

The following persons in control of this activity’s content have relevant financial relationships:

Advisory Board: Diana Wells Mulherin (Baxter Healthcare), Kyle A. Weant (GlaxoSmithKline)
Consultant: Stephanie Bass (AbbVie), Gretchen L. Sacha (Wolters Kluwer)
Speaker’s Bureau: Stephanie Bass (Mallinckrodt), Scott T. Benken (Innoviva Therapeutics), Gabrielle A. Gibson (AstraZeneca), David M. Hill (Access Pro Medical), Diana Wells Mulherin (Baxter Healthcare)
Grants/Research: Christopher Allen Droege (Department of Defense, En Route Care Division), David M. Hill (Access Pro Medical; Medline Industries, LP; Trevena)
Grants/Research: Paul Juang (Merck)
Stockholder: Rosario Ruth Avelino (Pfizer, Takeda Pharmaceuticals, Johnson & Johnson, Novavax), Michael J. Reichert (Eli Lilly, Pfizer) 

All other persons in control of content do not have any relevant financial relationships with an ineligible company. 

As required by the Standards of Integrity and Independence in Accredited Continuing Education, all relevant financial relationships have been mitigated prior to the CPE 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. 

ASHP and ASHP collaborate on critical care activities.

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.