Who should attend:

• Clinical faculty from the University of Pittsburgh School of Pharmacy
• Clinical staff pharmacists employed by the University of Pittsburgh Medical Center and deployed throughout the hospital campus in unit based roles and centrally in the department of pharmacy's main pharmacy
• Student pharmacy interns currently working within the department of pharmacy
• Certified Pharmacy Technicians

Upon successful completion of this continuing pharmacy education program, the participant should be able to:

• Describe the current recommendations on vasopressor use in septic shock.
• Discuss the current literature on vasoactive sparing agents in septic shock.
• Explain the mechanism of action of each vasoactive sparing agent and relavent safety concerns in the critically ill patient population.

Pharmacy Continuing Education Credits This program is sponsored by the University of Pittsburgh Center for Continuing Education in the Health Sciences. The University of Pittsburgh Center for Continuing Education in the Health Sciences is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a Provider of continuing pharmacy education. The assigned universal program number(s) is 0481-0000-18-140-H04-P.

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2. Vasostrict (vasopressin) [package insert]. Spring Valley, NY: Par Pharmaceutical Companies, Inc; 2014.
3. Patel BM, Chittock DR, Russell JA, Walley KR. Beneficial effects of short-term vasopressin infusion during severe shock. Anesthesiology 2002:96:576-82.
4. Obritsch MD, Jung R Fish, DN, MacLaren R. Effects of continuous vasopressin infusion in patients with septic shock. Ann Pharmacother 2004; 38:1117-22.
5. Russell JA, Walley KR, Singer J, et al. Vasopressin versus norepinephrine infusion in patients with septic shock. N Engl J Med 2008;358:877-87.
6. Khanna A, English SW, Wang XS, et al. Angiotensin II for the Treatment of Vasodilatory Shock. N Engl J Med. 2017; 377: 419 – 430.
7. GiaprezaTM (angiotensin II) [package insert]. San Diego, CA: La Jolla Pharmaceutical Company; 2017.
8. Annane D, Pastores SM, Rochwerg B, et al. Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part I): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017. Intensive Care Med 2017; 43:1751.
9. Annane D, Sébille V, Charpentier C, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 2002; 288:862.
10. Sprung CL, Annane D, Keh D, et al. Hydrocortisone therapy for patients with septic shock. N Engl J Med 2008; 358:111.

Abstract:


According to the 2016 Surviving Sepsis Campaign, sepsis is a leading cause of morbidity, mortality, and expense, contributing to one-third to half of deaths in hospitalized patients. Septic shock is sepsis that results in tissue hypoperfusion, hypotension, and elevated lactate levels. Patients who are hypotensive because of septic shock often require vasopressors to maintain adequate organ perfusion. Depending on the severity of septic shock, high dose vasopressors may be necessary to achieve targeted hemodynamic goals. Higher doses increase the risk for vasopressor-induced adverse events such as ischemia, arrhythmias, and loss of extremities from vasoconstriction. In addition, after stabilization, some patients are unable to be weaned off vasopressors to be transferred from the intensive care unit. To minimize adverse effects and to aid in transitions of care, vasopressor sparing agents could be considered to achieve targeted hemodynamics while minimizing vasopressor doses. This presentation aims to discuss vasoactive sparing agents in septic shock. This will include a review of current literature for both intravenous and oral agents such as angiotensin II, methylene blue, midodrine, and pseudoephedrine. It will also include an in-depth discussion on the mechanism of action and safety concerns for each agent in the critically ill population.