Free BCCCP Exam Flashcards

SIRS (Systemic Inflammatory Response Syndrome) - a nonspecific inflammatory response requiring 2 or more of these vital/lab criteria. SIRS plus a confirmed or suspected infection source raises concern for sepsis, though SIRS alone does not require infection.

Sepsis is life-threatening organ dysfunction from a dysregulated host response to infection (SOFA score increase of 2+). Septic shock adds a vasopressor requirement to maintain MAP 65 mmHg or higher plus a lactate above 2 mmol/L despite adequate fluid resuscitation.

With PEEP of at least 5 cmH2O: mild ARDS is P/F 200-300, moderate is 100-200, and severe is under 100. Onset must be within one week of a known insult with bilateral opacities not fully explained by cardiac failure or fluid overload.

Hypovolemic (fluid/blood loss), cardiogenic (pump failure), distributive (septic, anaphylactic, neurogenic - vasodilation), and obstructive (tension pneumothorax, tamponade, massive PE - physical flow obstruction). Each requires a different primary treatment strategy.

Post-Intensive Care Syndrome - new or worsening physical, cognitive, or mental health impairment that persists after critical illness. It drives long-term functional decline and is a key reason ICU teams emphasize early mobility and sedation minimization.

Critical illness polyneuropathy (CIP) and critical illness myopathy (CIM). Risk factors include prolonged mechanical ventilation, sepsis, corticosteroid exposure, neuromuscular blocking agents, and prolonged immobility.

Multi-organ dysfunction syndrome - progressive dysfunction of two or more organ systems in an acutely ill patient, most commonly triggered by sepsis, trauma, or major surgery. It is a marker of critical illness severity used throughout ICU scoring systems.

It inflates during diastole to augment coronary artery perfusion, then deflates just before systole to reduce afterload and myocardial oxygen demand. Timing is synchronized to the ECG or arterial pressure waveform.

VA (veno-arterial) ECMO supports both the heart and lungs and is used for cardiogenic shock or combined cardiopulmonary failure. VV (veno-venous) ECMO supports gas exchange only, preserving native cardiac output, and is used for isolated severe respiratory failure.

CRRT is preferred in hemodynamically unstable patients because it removes fluid and solutes slowly and continuously, avoiding the rapid shifts that can cause hypotension. IHD is used in stable patients who need faster clearance (e.g., severe hyperkalemia or toxin removal).

CVP (central venous pressure) reflects right heart filling pressure/preload. PAOP (pulmonary artery occlusion/wedge pressure) reflects left heart (LV) filling pressure. Confusing the two is a classic exam trap when interpreting volume status.

AC (assist-control): full ventilator support on every breath. SIMV: mandatory breaths plus unsupported spontaneous breaths. PSV: spontaneous breaths augmented by set pressure only. PRVC: hybrid mode targeting a set tidal volume while limiting pressure.

Capillary leak and aggressive fluid resuscitation expand the volume of distribution (Vd) for hydrophilic drugs like beta-lactams, aminoglycosides, and vancomycin, diluting the initial concentration. Standard doses can be subtherapeutic unless adjusted upward.

ARC is a creatinine clearance above 130 mL/min/1.73m2 seen in younger patients with trauma, burns, or sepsis who have a hyperdynamic circulation and preserved kidney function. It can cause subtherapeutic levels of renally cleared drugs (e.g., beta-lactams, vancomycin) at standard doses.

Enteral is preferred whenever GI function is intact - it is lower cost and preserves gut mucosal integrity, and early enteral nutrition (within 24-48 hours) is guideline-recommended. Parenteral routes are reserved for hemodynamic instability, ileus, or when enteral access is not feasible.

Inappropriate continuation of ICU-only therapies (e.g., stress ulcer prophylaxis, sedatives started for intubation) that are never reassessed after transfer. Thorough medication reconciliation at each transition point is essential to stop therapies no longer indicated.

Phenytoin is highly protein-bound, so hypoalbuminemia increases the free (unbound, active) fraction even when the total measured concentration looks normal or low. The Sheiner-Tozer equation (or a direct free level) corrects for this.

A loading dose is calculated from volume of distribution, not clearance, so it rapidly achieves a therapeutic concentration regardless of the patient's renal or hepatic function - critical for drugs with long half-lives where maintenance dosing alone would take too long to reach steady state.

Narrowing empiric broad-spectrum antibiotics to a pathogen-directed regimen once culture and susceptibility data return, typically at 48-72 hours. It is a core antimicrobial stewardship practice that reduces resistance pressure without compromising outcomes.

At least 30 mL/kg of IV crystalloid within the first 3 hours, per Surviving Sepsis Campaign guidelines, for patients with hypotension or a lactate at or above 4 mmol/L.

Norepinephrine is the first-line vasopressor for septic shock. Vasopressin is added as a fixed low-dose second agent to reduce the norepinephrine dose ('catecholamine-sparing') in patients with persistent shock, not used as monotherapy.

Analgosedation treats pain with opioids before adding a sedative, rather than sedating first and assuming pain is controlled. It reduces oversedation, shortens ventilator days, and is a core piece of the ABCDEF ICU liberation bundle.

RASS scores depth of sedation/agitation on a scale from -5 (unarousable) to +4 (combative). CAM-ICU is a separate screening tool that determines whether delirium is present or absent; it is only interpretable once RASS is -3 or higher.

Amiodarone is generally preferred because it has a favorable hemodynamic stability profile compared to other antiarrhythmics, making it suitable for both pulseless VT/VF (ACLS) and unstable atrial fibrillation in the ICU.

Dobutamine is a beta-1 agonist inotrope that requires intact beta receptors and is renally neutral. Milrinone is a PDE-3 inhibitor 'inodilator' that works independent of beta receptors but is renally cleared and causes more hypotension, requiring caution in renal impairment.

Tidal volume of 6 mL/kg predicted body weight and plateau pressure kept under 30 cmH2O, accepting permissive hypercapnia if needed to avoid ventilator-induced lung injury.

Prone positioning is indicated for severe ARDS (P/F ratio under 150) and improves mortality per the PROSEVA trial. Sessions should last at least 12-16 hours per day to achieve benefit.

ICP should generally be kept under 22 mmHg. Cerebral perfusion pressure (CPP) equals MAP minus ICP, with a typical goal range of 60-70 mmHg to ensure adequate cerebral blood flow without worsening edema.

Within 3 hours of symptom onset for standard eligibility, extended to 4.5 hours for select patients who meet additional extended-window criteria per AHA/ASA guidelines.

20-25 mL/kg/hr of effluent flow, based on KDIGO guidance and RENAL trial data, to ensure adequate solute clearance without over-dosing renal replacement therapy.

First, calcium gluconate or chloride to stabilize the cardiac membrane (does not lower potassium). Then insulin plus glucose and beta-agonists (e.g., albuterol) to shift potassium intracellularly. Finally, use diuretics, binding resins, or dialysis to actually remove potassium from the body.

N-acetylcysteine (NAC), which replenishes hepatic glutathione stores to detoxify the reactive metabolite NAPQI. The Rumack-Matthew nomogram guides the need for treatment after a single acute ingestion.

High-dose insulin euglycemia therapy (HIET), which improves myocardial contractility by shifting cardiac metabolism to carbohydrate use. Calcium is added for CCB overdose, and glucagon is classically added for beta-blocker overdose since it bypasses the blocked beta-receptor.

DKA features significant ketosis and anion-gap metabolic acidosis, more common in type 1 diabetes, usually with glucose under 600. HHS features minimal ketosis with extreme hyperglycemia (often over 600-1000) and higher osmolality, more common in type 2 diabetes.

A restrictive strategy transfusing at hemoglobin under 7 g/dL, per the TRICC trial and current guidelines, with a higher threshold around 8 g/dL considered for patients with active cardiac ischemia.

AUC/MIC-guided dosing (target ratio of at least 400), per the 2020 consensus guidelines, using Bayesian software or two-level PK sampling - replacing the older trough-only target of 15-20 mcg/mL, which underestimated nephrotoxicity risk.

Peak levels confirm efficacy because aminoglycosides exhibit concentration-dependent killing; trough levels confirm safety by keeping nephrotoxicity and ototoxicity risk low. Extended-interval (once-daily) dosing is preferred in most patients to exploit this concentration-dependent effect.

Anti-Xa is preferred in patients with antiphospholipid antibodies/lupus anticoagulant, obesity, renal impairment, or pregnancy - situations where aPTT is unreliable. It directly measures factor Xa inhibition rather than a downstream clotting time.

A decrease of at least 10-20% in serial lactate levels over 2-6 hours indicates adequate response to resuscitation and is associated with improved survival, making trended lactate more useful than a single value.

Viscoelastic testing (TEG/ROTEM) gives a real-time global picture of clot formation, strength, and lysis, allowing goal-directed blood product transfusion during active bleeding - conventional coagulation tests are too slow and don't capture platelet/fibrinolysis function.

A Risk Evaluation and Mitigation Strategy - an FDA-mandated safety program required for high-risk medications (e.g., clozapine, isotretinoin) to ensure their benefits outweigh their risks, often involving prescriber/pharmacy certification and patient monitoring.

FMEA (Failure Mode and Effects Analysis) is a proactive process performed before an error occurs, identifying potential failure points in a system. RCA (Root Cause Analysis) is reactive, performed after an adverse event to determine its underlying causes.

Safe handling standards for hazardous drugs to protect healthcare personnel, covering PPE, closed-system transfer devices, and safe receiving, storage, compounding, administration, and disposal practices.

Leadership commitment, accountability (usually pharmacist-led drug expertise), action (interventions like prospective audit-and-feedback or prior authorization), tracking, reporting, and education - per the CDC core elements framework.

The Surviving Sepsis Campaign guidelines - they define the 1-hour and 3-hour sepsis bundles used for hospital quality reporting and are the primary evidence-based framework tested for sepsis management on the exam.

The Pharmacy and Therapeutics committee reviews medication use evaluations and safety/efficacy/cost evidence to decide formulary additions, restrictions, and therapeutic interchange policies within a health system.

Board-certified critical care pharmacists frequently precept PGY1/PGY2 residents and pharmacy students, an interprofessional education activity that falls under the practice management portion of the Professional Practice domain.

NNT (number needed to treat) is the number of patients treated to achieve one additional beneficial outcome - lower is better. NNH (number needed to harm) is the number treated to cause one additional harmful outcome - higher is safer.

High sensitivity rules a disease OUT when the test is negative (SnNOUT), because it correctly catches true positives. High specificity rules a disease IN when the test is positive (SpPIN), because it correctly catches true negatives.

Randomization minimizes confounding and selection bias, allowing a stronger causal inference than observational designs like cohort, case-control, or case series studies, which sit lower on the evidence hierarchy.