Lec 3 Flashcards
standardized, structured approach to identifying drug-related problems in the ICU
FASTHUG-MAIDENS
F is for
F is for Feeding
Patients in the ICU may receive nutrition by a variety of methods, such as
parenteral nutrition, tube feeding, sips of fluids, diet as tolerated, and no oral intake.
This variety means there are severa
opportunities to optimize drug therapy, such as changing medications to the oral route from the parenteral route or vice versa,
sustained-release medications administered in a form
cannot be crushed
alternative dosage form,
liquid formulation or an immediate-release form, could be recom- mended to achieve equivalent total daily doses
If the patient is not tolerating enteral feeding and is experiencing high gastric residual volumes,
Prokinetic agents such as metoclopramide or erythromycin
possibility of an interaction between a drug and a nutritional formulation administered by feeding tube that might affect
absorption of the drug
For patients receiving parenteral nutrition, the pharmacist can monitor
laboratory parameters
A is for
A is for Analgesia
Pain can be readily assessed with a
pain scale, and the patient’s level of pain should be checked routinely
the patient’s situation and make suggestions about the most appropriate method for delivering analgesic medications, such as
infusions,
regularly scheduled intermittent doses,
or longer-acting forms combined with as-needed doses.
S is for
S is for Sedation
The most common type of sedative used in the ICU is
benzodiazepines, including drugs such as midazolam and lorazepam
only short-term sedation.
propofol
longer-term sedation
benzodiazepines
checked routinely
For A
The pharmacist should assess each patient daily
For S
T is for
T is for Thromboembolic prophylaxis
critically ill patients may not be receiving chemical thromboembolic prophylaxis
because of certain medical conditions (e.g., intracranial or active gastrointestinal bleeding)
For ill how cannot tak T what should ph do
plan for the timing of initiation of appropriate thromboembolic prophylactic medications
The various types of prophylactic therapy include
low-molecular-weight heparins, unfractionated heparin, sequential compression devices, and intravascular filters.
H is for
H is for Hyperactive or Hypoactive delirium
Untreated delirium can lead to
an increased length of stay in the ICU, as well as increases in costs, morbidity, and mortality
Tools such as for HeHeHeHe
Intensive Care Delirium Screening Checklist9 or the Confusion Assessment Method
Treatments involving for HeHeHeHe
supportive and environmental measure and pharmacological intervention with an
antipsychotic and routinely assess
U is for
U is for stress Ulcer prophylaxis
risk of stress ulcers
receiving mechanical ventilation
most commonly used agents for
this indication for U
histamine receptor antagonists and proton pump inhibitors.
Once the patient’s condition improves and
there is no longer a risk of stress ulcers
prophylactic agent can be discontinued
G is for
G is for Glucose control
the blood glucose concentration of an ICU patient may fluctuate
glucocorticoids, propofol, and atypical antipsychotics.
M is for
M is for Medication reconciliation
What ph should do for M
reviewing medications that the patient was receiving before
admission and deciding which drugs need to be restarted
Ideally, medication reconciliation is performed
upon admission and before discharge.
medications taken before admission are not restarted
acute medical conditions preclude their use
dentifying discontinued medications for which there is a high risk of experiencing withdrawal symptoms
benzodiazepines and selective serotonin reuptake inhibitors).14 Typically, these medications should be restarted
A is for
A is for Antibiotics or Anti-infective
agents
pharmacists can play a crucial role in antimi- crobial
stewardship selecting the optimal antimicrobial agent and de-escalating treatment once culture and susceptibility results are available
I is for
I is for Indications for medications
D is for
D is for drug Dosing
renal and hepatic function may
fluctuate frequently
For D
pharmacist is in an ideal position to
suggest dose adjustments based on
clinical parameters
adjust doses as the patient’s condition begins to improve,
prevent underdosing.
E is for
E is for Electrolytes, hematology, and other
laboratory tests
N is for
N is for No drug interactions, allergies,
duplication, or side effects
S is for
S is for Stop dates
drugs that may require a
stop or reassessment date include (but are not limited to)
corticosteroids and anti-infective agents
Benefit
essential aspects
of pharmaceutical care are met consistently.
reduce anxiety and apprehension among pharmacists not familiar with the ICU setting by providing a
stepwise approach to identifying drug-related problem
good teaching tool for hospital pharmacy
students and residents with little or no ICU experience
