lecture 21 - the pharmacist in critical care Flashcards
what are the aims of critical care?
To preserve life and prevent, reverse or minimise damage to vital organs
To optimise cardiovascular and respiratory function to maximise oxygen delivery to tissues
principles of critical care
looking after patients who suffer from life threatening conditions or at risk of developing them
higher staffing ratios
advanced monitoring and organ support
quality improvement areas in ICU
lung protection ventilation
delirium reduction
sedation reduction
discharge pause
critical care pharmacist follow up
what are pharmaceutical care issues to consider in ICU?
Feeding
Analgesia
Sedation
Tthromoprophylaxis
HOB/ hypo ro hyperactive delirium
Ulcer prophylaxis form stres
Glucose control
Medicines reconciliation
Antibiotics
Indicatiosn for medicines
Drug dosing
Electrolytes, haematology and other tests
No drug interactions
Stop dates
what do we need to inside in DVT prophylaxis treatment ?
LWMH I appropriate (alternative TED stockings)
monitor platelet and INR
consider patient weight as always changing
what are stress ulcers?
Stress ulcers in the upper gastrointestinal (GI) tract are related to critical illness.
An injury to the mucosa within the GI tract whose most likely cause is gastric mucosal ischaemia which leads to a failure in the secretion of the protective mucous.
what should be considered in renal impairment?
If CrCl <50ml/min or urine output decreased or receiving dialysis/haemofiltration then review drug doses and identify possible drug causes
what drugs should be taken care of if LFTS are deranged or known history of liver disease or impairment ?
Identify possible drug causes
Hepatocellular – amiodarone, flucloxacillin, fluconazole
Cholestatic jaundice – co-amoxiclav
what is a central line?
Inserted into a large vein in the patient;
Neck (jugular) vein,
subclavian vein (the vein lying beneath the collar bone)
femoral vein (large vein in the groin)
Branches off into smaller lines (or lumens). This provides ports where intravenous fluids, drugs and monitoring can be attached. Each lumen can be treated as separate line when considering compatibilities
Higher osmolarity solutions can be given.
what is an arterial line?
Inserted into an artery (usually in the wrist or the groin)
NOT FOR DRUG ADMINSTRATION only monitoring
It is attached to a system to measure BP etc
It is set up to enable easy, frequent arterial blood sampling, with no stress to the patient.
what are complications of these lines?
Phlebitis
Infiltration/extravasation
Infection
Thrombosis
what are Administration issues to consider?
Increased intravenous access
Central vs peripheral administration
Pharmaceutical compatibilities
Oral/enteral administration
IV to oral switch
Fluid balance and minimum volumes
Drug expenditure
Availability
what are indications for sedation ?
Reduce anxiety and distress
Alleviation of pain
Tolerate ventilation and interventions
Primary Therapy (reduce intracranial pressure, refractory status epilepticus
During neuromuscular blockade
what are different sedations and alagesias
Anaesthetic (propofol, midazolam etc)
Analgesia (alfentanil, remifentanil, fentanyl, morphine etc)
what are muscle relaxants ?
atracurium
cisatracurium
rocuronium
peritoneal heamodialysis
docusate and Senna
what are methods of ventilation ?
ETT or endotracheal tube is placed in the mouth and into the trachea. can be very uncomfortable and the patient can be sedated to tolerate it
a tracheostomy is when an opening is made into a trachea and allowing for ventilation support for minimal or no sedation.
disadvantages are bleeding and communication problems. both methods can cause ventilator associated pneumonia
