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4.1 - Principles of Safe Prescription of Drugs and Therapeutics (Including Pharmacokinetics, Pharmacodynamics and Drug Monitoring)

from Section 4 - Therapeutic Interventions and Organ Support

Published online by Cambridge University Press:  27 July 2023

Ned Gilbert-Kawai
Affiliation:
The Royal Liverpool Hospital
Debashish Dutta
Affiliation:
Princess Alexandra Hospital NHS Trust, Harlow
Carl Waldmann
Affiliation:
Royal Berkshire Hospital, Reading
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Summary

Key Learning Points

  1. 1. Understanding how the patient will handle a drug (pharmacokinetics) and how the drug will affect the patient (pharmacodynamics) is crucial to prescribing any drug safely.

  2. 2. It is important to consider both how the drugs may interact with other drugs being co-administered and how their effect/handling may be affected by the patient’s critical illness and associated organ dysfunction.

  3. 3. The loading dose, repeat doses and/or dosing interval may need to be adjusted, and in some cases monitoring of drug levels may be possible/necessary.

  4. 4. Critical illness is a rapidly changing dynamic state. Daily medication chart review, considering if drugs are still indicated and/or if their dosing needs reviewing, depending on the changing clinical condition of the patient, is essential.

  5. 5. Prescribing in critical illness can be a complex area; however, there are comprehensive resources available to guide practice. Seeking support and advice from your pharmacist when in doubt is a very useful and sensible approach.

Type
Chapter
Information
Intensive Care Medicine
The Essential Guide
, pp. 457 - 460
Publisher: Cambridge University Press
Print publication year: 2021

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References

References and Further Reading

Ashley, C, Dunleavy, A. The Renal Drug Handbook: The Ultimate Prescribing Guide for Renal Practitioners, 4th edn. London: Radcliffe Publishing; 2014.Google Scholar
Bangash, MN, Kong, ML, Pearse, RM. Use of inotropes and vasopressor agents in critically ill patients. Br J Pharmacol 2012;165:2015–33Google Scholar
Peck, TE, Hill, S, Williams, M. Pharmacology for Anaesthesia and Intensive Care, 3rd edn. Cambridge: Cambridge University Press; 2008.Google Scholar
Rowe, K, Fletcher, S. Sedation in the intensive care unit. Contin Educ Anaesth Crit Care Pain 2008;8:50–5.CrossRefGoogle Scholar
Varley, AJ, Sule, J, Absalom, AR. Principles of antibiotic therapy. Contin Educ Anaesth Crit Care Pain 2009;9:184–8.CrossRefGoogle Scholar

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