Critical Care Pharmacy

Question 1

What conditions would you consider prophylaxis for in ICU?

Answer 1

1. DVT - LMWH
2. Stress Ulcer Prophylaxis - ranitdine, PPI
   Risk Factors: Invasive ventilation >48hours, coagulopathy, multiple organ failure, sepsis, renal impairment, recent GI bleed, head or spinal injury, shock, burns

Question 2

What medications should be continued?

Answer 2

Steroids, asthma, COPD, NOACs, levothyroxine, parkinsons drugs

Question 3

What should be usually stopped?

Answer 3

aspirin, ramipril, bisoprolol, statin?, antidiabetics replace with sliding scale insulin

Question 4

Increase BP?

How are patients sedated?

Answer 4

Noradrenaline
Sedative e.g. dexmedetomidine, propofol
and opioid e.g. morphine, alfentanil

Question 5

When would you stop stress ulcer prophylaxis

Answer 5

increased risk of ventilation associated pneumonia due to acid change in stomach

Question 6

when would you escalate stress ulcer prophylaxis?

Answer 6

coffee-ground aspirates

Question 7

where would you find dosing information in renal impairment?

Answer 7

Renal drug handbook
Avoid morphine (change to fentanyl)
reduce enoxaparin

Question 8

Fluid balance - how to rectify?

Answer 8

change oral to central line

Question 9

How to check patient is absorbing nasogastric feed?

Answer 9

aspirate nasogastric feed. No more than 200mls should come out

Question 10

Issues with amiodarone and infusion bags?

Answer 10

Amiodarone reacts with saline

Question 11

Treating rigidity associated with parkinsons

Answer 11

apomorphine S/C or IV and rotigitine patches (these contain aluminium - remove prior to MRI)

Question 12

interpretation of phenytoin doses in ICU

Answer 12

Albumin is changed. Phenytoin is heavily protein bound therefore skewed results