Critical Care Pharmacy Review
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Questions and Answers

What is the importance of initiating enteral feeding in critically ill patients?

  • To prevent malnutrition and impaired immune function (correct)
  • To reduce the risk of bleeding
  • To prevent nosocomial pneumonia
  • To reduce the risk of decubitus ulcers

    • What is the goal of pain management in critically ill patients?

  • To promote sleep
  • To reduce anxiety
  • To minimize the acute stress response (correct)
  • To reduce the risk of VTE

    • What is the benefit of elevating the head of the bed in mechanically ventilated patients?

  • Reducing the risk of decubitus ulcers
  • Reducing the risk of stress ulcer prophylaxis
  • Reducing the risk of VTE
  • Reducing the occurrence of GI reflux and nosocomial pneumonia (correct)

    • What is the purpose of daily sedative interruption in critically ill patients?

    <p>To assess and reassess sedation levels</p> Signup and view all the answers

    Why is stress ulcer prophylaxis important in critically ill patients?

    <p>To prevent clinically significant bleeding</p> Signup and view all the answers

    What is the importance of thromboembolic prophylaxis in critically ill patients?

    <p>To reduce the risk of VTE</p> Signup and view all the answers

    What is the purpose of assessing pain regularly with a validated tool in critically ill patients?

    <p>To assess and manage pain effectively</p> Signup and view all the answers

    What is the benefit of maintaining light levels of sedation in critically ill patients?

    <p>To reduce the acute stress response</p> Signup and view all the answers

    Why is analgesia important in critically ill patients?

    <p>To minimize the acute stress response</p> Signup and view all the answers

    What is the importance of considerating VTE and bleeding risks when initiating thromboembolic prophylaxis?

    <p>To balance the risks of VTE and bleeding</p> Signup and view all the answers

    What is the recommended blood glucose level for acutely ill patients when blood glucose concentrations are ≥ 150 mg/dL?

    <p>140-180 mg/dL</p> Signup and view all the answers

    What is the primary importance of glycemic control in critically ill patients?

    <p>To decrease the incidence of complications</p> Signup and view all the answers

    What does the 'S' stand for in the updated FAST-HUGS BID mnemonic?

    <p>Spontaneous breathing trial</p> Signup and view all the answers

    What is the primary focus of the MAIDENS mnemonic?

    <p>Medication management</p> Signup and view all the answers

    What is the purpose of daily checklists in the FAST-HUG approach?

    <p>To provide a framework for standardization and regulation of interventions</p> Signup and view all the answers

    What is the 'I' component in the FAST-HUGS BID mnemonic?

    <p>Indwelling catheter removal</p> Signup and view all the answers

    What is the 'D' component in the MAIDENS mnemonic?

    <p>Drug dosing</p> Signup and view all the answers

    What is the 'N' component in the MAIDENS mnemonic?

    <p>No drug interactions, allergies, duplications, adverse effects</p> Signup and view all the answers

    Why is Sucralfate not recommended for routine use?

    <p>Due to adverse effects and interactions</p> Signup and view all the answers

    What is the main mechanism of action of H2RAs?

    <p>Competitive blockade of histamine receptors</p> Signup and view all the answers

    Why does tolerance occur with the use of H2RAs?

    <p>Due to the up-regulation of alternative pathways</p> Signup and view all the answers

    What is the effect of H2RAs on gastric pH?

    <p>An increase in gastric pH</p> Signup and view all the answers

    What is a potential benefit of H2RAs in animal models?

    <p>Attenuation of reperfusion injury</p> Signup and view all the answers

    What is the current practice for administering H2RAs?

    <p>Intermittent administration without pH monitoring</p> Signup and view all the answers

    What adjustment is required for H2RAs?

    <p>Renal dosing adjustment</p> Signup and view all the answers

    Why are Sucralfate and H2RAs used in SRMD-related bleeding?

    <p>To maintain a pH greater than 4</p> Signup and view all the answers

    What percentage of patients in the H2RA group received H2RA exclusively?

    <p>63.4%</p> Signup and view all the answers

    What is the definition of occult bleeding?

    <p>Presence of guaiac-positive stools or nasogastric aspirate</p> Signup and view all the answers

    What is the range of incidence of endoscopically evident mucosal damage in ICU patients?

    <p>75%-100%</p> Signup and view all the answers

    What is the relative risk of clinically important bleeding with PPI versus H2RA?

    <p>0.73</p> Signup and view all the answers

    What is the primary cause of stress ulcer-related bleeding?

    <p>Hypovolemia and decreased cardiac output</p> Signup and view all the answers

    Which of the following is a mechanism common to critical illness that leads to reduced splanchnic blood flow?

    <p>Proinflammatory mediator release</p> Signup and view all the answers

    What is the percentage of patients in the PPI group who received PPI exclusively?

    <p>82.5%</p> Signup and view all the answers

    What is a risk factor for stress-related bleeding?

    <p>Respiratory failure requiring mechanical ventilation for 48 hours or longer</p> Signup and view all the answers

    What is the definition of overt or clinically evident bleeding?

    <p>Hematemesis, melena, or hematochezia</p> Signup and view all the answers

    What is the range of incidence of clinically important bleeding in ICU patients?

    <p>1%-5%</p> Signup and view all the answers

    What is the result of decreased gastric blood flow and mucosal ischemia?

    <p>Stress ulcer-related bleeding</p> Signup and view all the answers

    Why may increases in gastric pH lead to infectious complications?

    <p>Due to promotion of bacterial overgrowth</p> Signup and view all the answers

    What is a consequence of reperfusion injury after prolonged periods of hypoperfusion?

    <p>Stress ulcer-related bleeding</p> Signup and view all the answers

    What is the incidence of bleeding in patients with at least one risk factor?

    <p>3.7%</p> Signup and view all the answers

    What is the result of acid back-diffusion in the stomach?

    <p>Stress ulcer-related bleeding</p> Signup and view all the answers

    What is the difference between peptic ulcers and stress ulcers?

    <p>Cause of the lesions</p> Signup and view all the answers

    Study Notes

    Supportive and Preventive Medicine

    • The FAST-HUG mnemonic emphasizes important aspects of ICU medicine that can be applied daily to all critically ill patients to ensure safe, effective, and efficient care.
    • Key elements of the FAST-HUG approach include:
      • Feeding: initiate enteral feeding as soon as possible, typically within the first 24-48 hours after stabilization
      • Analgesia: optimize patient comfort and minimize acute stress response
      • Sedation: assess and reassess with a validated tool, maintain light levels of sedation, and consider daily sedative interruption
      • Thromboembolic prophylaxis: initiate appropriate prophylaxis, considering VTE and bleeding risks
      • Head of bed elevation: elevate the head and thorax above bed to a 30-45 degree angle to reduce the occurrence of GI reflux and nosocomial pneumonia
      • Stress ulcer prophylaxis: consider discontinuing acid-suppressive medications when risk factors are no longer present
      • Glycemic control: maintain blood glucose at 140-180 mg/dL in critically ill patients

    Additional Mnemonics

    • FAST-HUGS BID: a mnemonic that includes spontaneous breathing trials, bowel regimen, indwelling catheter removal, and de-escalation of antimicrobials
    • MAIDENS: a mnemonic with a medication focus that includes medication reconciliation, antibiotics or anti-infectives, indications for medications, drug dosing, electrolytes, and no drug interactions, allergies, duplications, or adverse effects
    • Decreased gastric blood flow and mucosal ischemia are the primary causes of SRMD-related bleeding
    • Additional factors leading to SRMD-related bleeding include:
      • Decreased gastric mucosal bicarbonate production
      • Decreased gastric emptying of irritants and acidic contents
      • Acid back-diffusion
      • Reperfusion injury
    • Independent risk factors for SRMD and bleeding include respiratory failure requiring mechanical ventilation for 48 hours or longer and coagulopathy
    • Prevention strategies include:
      • Sucralfate (Carafate): not recommended for routine use due to adverse effects and interactions
      • H2RAs: competitive blockade of histamine receptors on the basolateral membrane of the parietal cells, not reliably inhibiting vagally induced acid secretion
      • PPIs: reduce the incidence of clinically important bleeding compared to H2RAs

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    Description

    Review critical care pharmacy topics, including general care of critically ill patients, with a focus on the FAST-HUG mnemonic and other essential concepts. Prepare for the ACCP Updates in Therapeutics 2022 exam with this comprehensive review.

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