RT Book, Section
A1 Barreto, Erin F.
A1 Dzierba, Amy L.
A2 DiPiro, Joseph T.
A2 Yee, Gary C.
A2 Posey, L. Michael
A2 Haines, Stuart T.
A2 Nolin, Thomas D.
A2 Ellingrod, Vicki
SR Print(0)
ID 1182428911
T1 Critical Care: Considerations in Drug Selection, Dosing, Monitoring, and Safety
T2 Pharmacotherapy: A Pathophysiologic Approach, 11e
YR 2020
FD 2020
PB McGraw-Hill Education
PP New York, NY
SN 9781260116816
LK accesspharmacy.mhmedical.com/content.aspx?aid=1182428911
RD 2024/04/19
AB KEY  CONCEPTS  Intensive  care  units  are  designed  to  support  the  complex  needs  of  critically  ill  patients  with  acute  organ  dysfunction  in  need  of  a  higher  level  of  monitoring  and  treatment.  The  four  phases  of  critical  illness  include  rescue,  optimization,  stabilization,  and  de-escalation,  each  of  which  can  affect  drug  selection,  dosing,  and  monitoring.  Ideal  medications  for  use  in  the  ICU  have  predictable  bioavailability,  fast  onset,  rapid  titratability,  and  a  wide  therapeutic  window.  Critically  ill  patients  exhibit  a  uniquely  complex  pharmacokinetic  profile  and  response  to  therapies  that  needs  to  be  considered  when  individualizing  drug  regimens.  Acute  changes  to  end-organ  function  occur  more  commonly  in  the  ICU  and  affect  drugs  in  a  dynamic  way.  Perfusion  deficits  and  iatrogenic  exposures  can  decrease  enteral,  subcutaneous,  and  intramuscular  drug  bioavailability  which  makes  the  intravenous  route  preferred  in  acutely  ill  unstable  patients  in  the  ICU.  The  use  of  advanced  organ  support  devices  is  common  in  the  ICU  and  each  device  differentially  affects  the  pharmacokinetics  and  pharmacodynamics  of  medications.  Key  properties  of  drugs  susceptible  to  sequestration  in  the  ECMO  circuit  include  high  percentage  of  protein  binding  and  high  degree  of  lipophilicity.  Highly  protein  bound  drugs  are  readily  cleared  by  MARS  and  TPE,  but  not  efficiently  cleared  by  renal  replacement  therapies.  Many  patient,  provider,  and  environmental  factors  increase  an  ICU  patient’s  vulnerability  to  medical  errors,  adverse  drug  events,  and  their  related  consequences,  relative  to  their  noncritically  ill  counterparts.