Pocket Guide to Critical Care Pharmacotherapy

Transcription

1 Pocket Guide to Critical Care Pharmacotherapy

2 Pocket Guide to Critical Care Pharmacotherapy By John Papadopoulos, BS, PharmD, FCCM, BCNSP Associate Professor of Pharmacy Practice Arnold & Marie Schwartz College of Pharmacy and Health Sciences Brooklyn, New York and Critical Care Pharmacist Clinical Instructor of Medicine Department of Medicine New York University Medical Center New York, New York

3 2008 Humana Press Inc., a part of Springer Science+Business Media 999 Riverview Drive, Suite 208 Totowa, New Jersey humanapress.com All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise without written permission from the Publisher. All papers, comments, opinions, conclusions, or recommendations are those of the author(s), and do not necessarily reflect the views of the publisher. Due diligence has been taken by the publishers, editors, and authors of this book to assure the accuracy of the information published and to describe generally accepted practices. The contributors herein have carefully checked to ensure that the drug selections and dosages set forth in this text are accurate and in accord with the standards accepted at the time of publication. Notwithstanding, as new research, changes in government regulations, and knowledge from clinical experience relating to drug therapy and drug reactions constantly occurs, the reader is advised to check the product information provided by the manufacturer of each drug for any change in dosages or for additional warnings and contraindications. This is of utmost importance when the recommended drug herein is a new or infrequently used drug. It is the responsibility of the treating physician to determine dosages and treatment strategies for individual patients. Further it is the responsibility of the health care provider to ascertain the Food and Drug Administration status of each drug or device used in their clinical practice. The publisher, editors, and authors are not responsible for errors or omissions or for any consequences from the application of the information presented in this book and make no warranty, express or implied, with respect to the contents in this publication. This publication is printed on acid-free paper. ANSI Z (American Standards Institute) Permanence of Paper for Printed Library Materials. Cover design by Karen Schulz Production Editor: Amy Thau For additional copies, pricing for bulk purchases, and/or information about other Humana titles, contact Humana at the above address or at any of the following numbers: Tel.: SPRINGER; Fax: ; or visit our Website: Photocopy Authorization Policy: Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by Humana Press Inc., provided that the base fee of US $30.00 per copy is paid directly to the Copyright Clearance Center at 222 Rosewood Drive, Danvers, MA For those organizations that have been granted a photocopy license from the CCC, a separate system of payment has been arranged and is acceptable to Humana Press Inc. The fee code for users of the Transactional Reporting Service is: [ /08 $30.00]. Printed in the United States of America eisbn 13: Library of Congress Control Number:

4 This handbook is dedicated to my wife Maria, my children, Theodore Thomas and Eleni Thalia, and my mother Eleni. I am grateful for your collective understanding of my professional commitment.

5 Preface Critical care medicine is a cutting-edge medical field that is highly evidence-based. Studies are continuously published that alter the approach to patient care. As a critical care clinician, I am aware of the tremendous commitment required to provide optimal evidence-based care. Pocket Guide to Critical Care Pharmacotherapy covers the most common ailments observed in adult critically-ill patients. I utilize an algorithmic, easy-to-follow, systematic approach. Additionally, I provide references and web links for many disease states, for clinicians who want to review the available literature in greater detail. The contents of this handbook should be utilized as a guide and in addition to sound clinical judgment. Consult full prescribing information and take into consideration each drug s pharmacokinetic profile, contraindications, warnings, precautions, adverse reactions, potential drug interactions, and monitoring parameters before use. Every effort was made to ensure the accuracy of Pocket Guide to Critical Care Pharmacotherapy. The author, editor, and publisher are not responsible for errors or omissions or for any consequences associated with the utilization of the contents of this handbook. John Papadopoulos, BS, PharmD, FCCM, BCNSP vii

6 Contents Preface... vii Editor... xi List of Tables... xiii 1. Advance Cardiac Life Support Cardiovascular Cerebrovascular Critical Care Dermatology Endocrinology Gastrointestinal Hematology Infectious Disease Neurology Nutrition Psychiatric Disorders Pulmonary Renal Index ix

7 Editor David R. Schwartz, MD Section Chief, Critical Care Medicine, Assistant Professor of Medicine, Department of Medicine, New York University Medical Center, New York, New York xi

8 List of Tables Chapter ACLS Pulseless Arrest Algorithm 1.2. Ventricular Fibrillation/Pulseless Ventricular Tachycardia Algorithm 1.3. Pulseless Electrical Activity Algorithm 1.4. Asystole Algorithm 1.5. Bradycardia Algorithm (slow [HR <60 bpm] or Relatively Slow) 1.6. Tachycardia Algorithm Overview 1.7. Management of Stable Atrial Fibrillation/ Atrial Flutter 1.8. Management of Narrow Complex Stable Supraventricular Tachycardia (QRS < 0.12 s) 1.9. Management of Stable Ventricular Tachycardia Synchronized Cardioversion Algorithm for the Management of Symptomatic Tachycardia Common Drugs Utilized During ACLS Pulseless Electrical Activity: Causes (HATCH HMO ph) and Management Pharmacological Management of Anaphylaxis/Anaphylactoid Reactions viii

9 xiv List of Tables Chapter Thrombolysis in Myocardial Infarction (TIMI) Grade Flows 2.2. TIMI Risk Score 2.3. Short-Term Risk of Death of Nonfatal Myocardial Infarction in Patients Presenting with Unstable Angina (Note: Low-Risk Omitted) 2.4. Acute Pharmacological Management of Unstable Angina and Non-ST Elevation Myocardial Infarction 2.5. Acute Pharmacological Management of ST-Elevation Myocardial Infarction (Non-Invasive or Conservative Strategy) 2.6. Considerations in Patients with Right Ventricular Infarctions 2.7. Contraindications to Fibrinolytic Therapy in Patients with ST-Elevation Myocardial Infarction 2.8. Management of Acute Decompensated Heart Failure 2.9. Vaughan Williams Classification of Antiarrhythmics Antithrombotic Pharmacotherapy for Patients with Various Diseases Causes and Management of Acquired Torsades de Pointes Hypertensive Crises Management of Catecholamine Extravasation Prevention of Venous Thromboembolism in the ICU Patient

10 List of Tables xv Management of Deep-Vein Thrombosis and Pulmonary Embolism Management of Elevated INRs in Patients Receiving Warfarin Pharmacotherapy Chapter General Supportive Care for Patients with an Acute Cerebrovascular Accident 3.2. Blood Pressure Management in the Setting of an Acute Cerebrovascular Accident 3.3. Alteplase Inclusion and Exclusion Criteria for CVA Indication 3.4. Modified National Institute of Health Stroke Scale 3.5. Alteplase Administration Protocol for CVA Indication 3.6. Management of an Alteplase-Induced Intracranial Hemorrhage 3.7. Management of Intracranial Hypertension (ICP > 20 mmhg) Chapter General Drug Utilization Principles in ICU Care 4.2. Management of Severe Sepsis and Septic Shock 4.3. Sedation, Analgesia, and Delirium Guidelines 4.4. Modified Ramsey Sedation Scale 4.5. Riker Sedation-Agitation Scale 4.6. Confusion Assessment Method for the Diagnosis of Delirium in ICU Patients 4.7. Neuromuscular Blocker Use in the Intensive Care Unit

11 xvi List of Tables 4.8. Reversal of Nondepolarizing Neuromuscular Blockers 4.9. Factors that Alter the Effects of Neuromuscular Blockers Management of Malignant Hyperthermia Use of Packed Red Blood Cell Transfusions and Erythropoietin in Critically-Ill Patients Propylene Glycol Content of Commonly Utilized Intravenous Medications Drug-Induced Fever Pharmaceutical Dosage Forms That Should Not Be Crushed Stress-Related Mucosal Damage Prophylaxis Protocol Therapeutic Drug Monitoring Select Antidotes for Toxicological Emergencies Chapter Drug-Induced Dermatological Reactions Chapter Management of Diabetic Ketoacidosis 6.2. Management of Hyperglycemic Hyperosmolar Nonketotic Syndrome 6.3. Management of Thyrotoxic Crisis and Myxedema Coma Chapter Management of Acute Nonvariceal Upper Gastrointestinal Bleeding 7.2. Causes of Diarrhea in the Intensive Care Unit Patient 7.3. Managing the Complications of Cirrhosis

12 List of Tables xvii 7.4. Drug-Induced Hepatotoxicity 7.5. Drug-Induced Pancreatitis Chapter Drug-Induced Hematological Disorders 8.2. Management of Heparin-Induced Thrombocytopenia 8.3. Management of Methemoglobinemia Chapter Common Causes of Fever in ICU Patients 9.2. Prevention of Hospital-Acquired and Ventilator-Associated Pneumonia 9.3. Management of Hospital-Acquired and Ventilator-Associated Pneumonia 9.4. Clinical Pulmonary Infection Score Calculation Chapter Management of Convulsive Status Epilepticus Medications That May Exacerbate Weakness in Myasthenia Gravis Chapter Nutrition Assessment Principles of Parenteral Nutrition Select Drug-Nutrient Interactions Strategies to Minimize Aspiration of Gastric Contents during Enteral Nutrition Chapter Management of Alcohol Withdrawal Management of Serotonin Syndrome

13 xviii List of Tables Management of Neuroleptic Malignant Syndrome Chapter Management of Chronic Obstructive Pulmonary Disease Management of Acute Asthma Exacerbations Drug-Induced Pulmonary Diseases Chapter Contrast-Induced Nephropathy Prevention Strategy Pharmacological Management of Acute Renal Failure Management of Acute Uremic Bleeding Drug-Induced Renal Diseases Management of Acute Hypocalcemia (Serum Calcium <8.5 mg/dl) Management of Acute Hypercalcemia (Serum Calcium >12 mg/dl) Management of Acute Hypokalemia (Serum Potassium <3.5 meq/l) Management of Acute Hyperkalemia (Serum Potassium >5.5 meq/l) Management of Acute Hypomagnesemia (Serum Magnesium <1.4 meq/l) Management of Acute Hypermagnesemia (Serum Magnesium >2 meq/l) Management of Acute Hyponatremia (Serum Sodium <135 meq/l) Management of Acute Hypernatremia (Serum Sodium >145 meq/l) Management of Acute Hypophosphatemia (<2 mg/dl)

14 List of Tables xix Management of Hyperphosphatemia (>5 mg/dl) Management of Acute Primary Metabolic Acidosis (ph < 7.35) Management of Acute Primary Metabolic Alkalosis (ph > 7.45) Dosing of Selected Intravenous Anti- Infectives in Patients Receiving Continuous Renal Replacement Therapy