Drugs used in the acutely ill patient

Critical care encompasses many different areas of medicine, from pulmonary and cardiac medicine to anesthesia and neuropsychiatry. Each discipline has somewhat unique approaches to pharmacology. The therapeutic modalities are discussed in the textbooks and journals that are specific for that discipline. Therefore, the pharmacology and therapeutics needed by the physician or medical personnel who provide critical care services are not easily accessed in a timely fashion. The intent of this monograph is to provide a readily accessible format for information regarding the pharmacology of drugs used frequently in the critical care arena. This information includes categorization of drugs by therapeutic and pharmacologic classification, mechanisms of action of the drugs, frequent or unusual adverse effects that attend the use of the drugs, and indications for use of the agents that are acceptable to the medical community as described in the medical literature. Tables are provided to outline the most common doses of the drugs, their routes of administration, expected onset of action where applicable, mechanisms and times for elimination, and duration of action. Tables are also included to describe frequent or expected drug interactions, which increase dramatically as the number of concomitant drugs used increases. The drugs that are amenable to monitoring, and the optimal methods to provide such monitoring, are outlined. Common developing signs or symptoms in patients during stays in a critical care environment are outlined in terms of differential diagnosis and drugs capable of causing those signs or symptoms. Drugs overlap in terms of therapeutic indication, and this fact is handled by inclusion of a table of drug classification that shows the therapeutic categories in which the drugs are included. The drug is discussed in only one area, with cross-references in other areas. All indications for use of a particular drug in the area of critical care are outlined in the appropriate subsection for each drug. This monograph may be used to determine a drug-related cause for a given clinical manifestation, to predict dosing and duration of action for a given patient with possible organ dysfunction, to understand the mechanism of action for a drug and so choose additional therapy that will not interfere or overlap with the drug, to learn guidelines for monitoring drug therapy, or to select drugs that will not potentiate adverse drug effects by negative drug interactions.(ABSTRACT TRUNCATED AT 400 WORDS)