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KEY CONCEPTS

KEY CONCEPTS

ACUTE PANCREATITIS

  • imageFactors that can contribute to acute pancreatitis should be identified and corrected, including discontinuation of medications that could be potential causes.

  • imagePatients with acute pancreatitis should receive goal-directed fluid management to reduce the risks of persistent systemic inflammatory response syndrome (SIRS) and organ failure.

  • imageParenteral opioid analgesics are used to control abdominal pain associated with acute pancreatitis despite a lack of high-quality evidence to support the practice.

  • imageUse of prophylactic antibiotics is not recommended in patients with acute pancreatitis without signs or symptoms of infection, including those with predicted severe acute pancreatitis or necrotizing pancreatitis.

CHRONIC PANCREATITIS

  • imageChronic pain, malabsorption with resultant steatorrhea, and diabetes mellitus are the hallmark symptoms and complications of chronic pancreatitis.

  • imagePain from chronic pancreatitis may initially be treated with nonopioid analgesics, but adjuvant agents may be necessary as the disease progresses.

  • imagePancreatic enzyme and fat-soluble vitamin supplementation are the primary treatments for malabsorption due to chronic pancreatitis.

  • imageEnteric-coated pancreatic enzyme supplements are the preferred dosage form in the treatment of malabsorption and steatorrhea due to chronic pancreatitis.

  • imageThe addition of a histamine-2 receptor antagonist or proton pump inhibitor to pancreatic enzyme supplementation may increase the effectiveness of enzyme therapy for malabsorption and steatorrhea due to chronic pancreatitis.

BEYOND THE BOOK

BEYOND THE BOOK

  1. Robert Whipple is a 48-year-old man admitted to the intensive care unit (ICU) for acute pancreatitis. He weighs 89 kg. He has no signs or symptoms of infection. Which resuscitation fluid would you recommend for Mr. Whipple and why? What volume and rate of infusion would you recommend for his resuscitation fluid? What are the endpoints you recommend monitoring to determine adequate fluid resuscitation? These are the key decisions regarding the assess, plan, implement, and monitor aspects of the Pharmacist Patient Care Process concerning fluid resuscitation in patients with acute pancreatitis.

  2. Using available resources, determine the monthly cash prescription payment for a patient with exocrine pancreatic insufficiency from chronic pancreatitis who requires 60,000 USP units of lipase with each meal; the patient eats five meals a day, along with three snacks. Do this for all Food and Drug Administration (FDA)-approved pancrelipase products available in the United States. How would this information affect your recommendation of a pancrelipase product for this patient? Now locate the online formulary of a third-party prescription plan in your area. Determine if the plan’s coverage of the same pancrelipase products alters your decision in any way. This activity is to make you aware of not only the pill burden of patients with exocrine pancreatic insufficiency but also the cost related to these medications.

INTRODUCTION

Pancreatitis is inflammation of the pancreas with variable involvement of regional tissues or remote organ systems.1,2 Acute pancreatitis is characterized by severe pain in the upper abdomen and elevations of pancreatic enzymes in the blood.3,4 In the majority of patients, acute pancreatitis ...

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