Critical Care Flashcards
Why is the risk of medication errors high even if managed by a few clinicians?
Chances of such errors are always high
What do systems minimizing medication errors in the ICU depend on?
Careful, timely, and regular review of medications
What can rare medication errors involve?
Administration of wrong medication or doses
What is a common cause of dosing errors in critical care?
Without accounting patients’ age, size, weight, renal & hepatic functions
How do medication error rates in critical care compare to other hospital settings?
High
How can ADRs affect patients in critical care? What are some frequently encountered ADRs?
Worsen existing condition, affect outcomes, result in new problems
Nephrotoxicity, hepatotoxicity, cardiac toxicities, electrolyte abnormalities
What is the main focus of adverse effects from drugs?
Vital organs e.g., kidney, liver, heart, CNS, vascular system etc.
How can pharmacokinetic interactions occur? What can cause pharmaceutical interactions?
- Due to alteration in absorption, distribution, metabolism and elimination
- Incompatibilities of drugs
Why is the potential for drug-drug interactions high in critical care?
Due to a greater number of medications prescribed
When is therapeutic drug monitoring needed?
For agents with narrow therapeutic window
What can happen to medications due to impaired liver or renal functions?
They can be contraindicated
What parameters are important to consider for adjusting drug therapies?
CrCL, LFT, RP
Why do medications often require dosage adjustments in critical care?
Due to renal and liver impairments
What patient conditions might lead to low albumin levels, impacting protein binding of drugs?
Trauma, sepsis, liver injuries, burn and impaired nutrition
How can fluid overload affect drug concentrations in critical care patients?
It can increase volume of distribution (may cause ineffective drug concentrations like Digoxin)
What route of medication administration is often preferred in critical care? Why might SC/IM medications have unreliable absorption in critical care patients?
IV
Due to decreased perfusion
What distinguishes critical care from other specialties that focus on a particular body system?
Critical care addresses a wide spectrum of illnesses
What are practitioners in critical care often called? What fields are they often specialists in?
Intensivists
Pulmonary, cardiac, nephrology, anesthesiology, pediatrics, surgery
What additional training can pharmacists pursue to become certified in critical care?
Postgraduate residency
What are the key concepts of critical care?
- Early Identification of Problems
- Effective Use of the Problem-Oriented Medical Record
- Monitoring & Data Display
- Supportive and Preventive care
- Attention to psychological and other needs of patients
- Understand the limits of critical care
- Use of protocols and practice guidelines
- Quality assurance and errors monitoring
- Infection control
- Education & communication
- Outcomes and alternatives
What renal condition is managed within critical care? What type of respiratory issue might require critical care?
Acute renal failure
Airway or respiratory compromise
What is a potentially lethal cardiac issue addressed in critical care?
Cardiac arrhythmias
Which systems are the focus of critical care?
- Cardiovascular system
- Central nervous system
- Endocrine system
- Gastro-intestinal tract (including nutritional aspects)
- Hematology
- Microbiology (including sepsis status)
- Peripheries and skin
- Renal and metabolic
- Respiratory system
What type of medications are critical care patients frequently prescribed?
Antimicrobials, vasopressors, antiarrhythmics, sedatives, muscle relaxants
Why are medication errors or drug-related problems more common in critical care?
ICU patients receive twice as many drugs
What percentage of IV medications have errors in preparation, dosage, or infusion rate?
Up to 10%
Why is the site of drug absorption crucial in critical care? How can prolonged stays in critical care affect drug absorption?
Bioavailability may be impaired due to low cardiac output
Result in intestinal atrophy and decrease motility
How might enteral nutrition impact the absorption of orally administered drugs?
May cause malabsorption
What types of pharmacological response can result from pharmacodynamic interactions?
Synergistic (together combined effect is greater than on own)
Additive (combined effect is the same as individual effect)
Antagonistic (no effect as blocked)
