Pocket Guide to Critical Care Pharmacotherapy Pocket Guide to Critical Care Pharmacotherapy
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Pocket Guide to Critical Care Pharmacotherapy 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 © 2008 Humana Press Inc., a part of Springer Science+Business Media 999 Riverview Drive, Suite 208 Totowa, New Jersey 07512 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 infre- quently 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 Z39.48-1984 (American Standards Institute) Permanence of Paper for Printed Library Materials. 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Printed in the United States of America. 10 9 8 7 6 5 4 3 2 1 eISBN 13: 978-1-59745-488-9 Library of Congress Control Number: 2007938421 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. 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 criti- cal care clinician, I am aware of the tremendous commit- ment 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, system- atic 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, edi- tor, and publisher are not responsible for errors or omis- sions or for any consequences associated with the utilization of the contents of this handbook. John Papadopoulos, BS, PharmD, FCCM, BCNSP vii Contents Preface .......................................................................... vii Editor ............................................................................. xi List of Tables .............................................................. xiii 1. Advance Cardiac Life Support ........................ 1 2. Cardiovascular.................................................. 21 3. Cerebrovascular ............................................... 55 4. Critical Care ...................................................... 65 5. Dermatology ...................................................101 6. Endocrinology ................................................103 7. Gastrointestinal ..............................................109 8. Hematology .....................................................119 9. Infectious Disease ..........................................125 10. Neurology ........................................................131 11. Nutrition ..........................................................137 12. Psychiatric Disorders.....................................143 13. Pulmonary .......................................................149 14. Renal .................................................................155 Index ............................................................................183 ix 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 List of Tables Chapter 1 1.1. 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 1.10. Synchronized Cardioversion Algorithm for the Management of Symptomatic Tachycardia 1.11. Common Drugs Utilized During ACLS 1.12. Pulseless Electrical Activity: Causes (HATCH HMO pH) and Management 1.13. Pharmacological Management of Anaphylaxis/Anaphylactoid Reactions viii xiv List of Tables Chapter 2 2.1. 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 2.10. Antithrombotic Pharmacotherapy for Patients with Various Diseases 2.11. Causes and Management of Acquired Torsades de Pointes 2.12. Hypertensive Crises 2.13. Management of Catecholamine Extravasation 2.14. Prevention of Venous Thromboembolism in the ICU Patient List of Tables xv 2.15. Management of Deep-Vein Thrombosis and Pulmonary Embolism 2.16. Management of Elevated INRs in Patients Receiving Warfarin Pharmacotherapy Chapter 3 3.1. 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 Intrac- ranial Hemorrhage 3.7. Management of Intracranial Hypertension (ICP > 20 mmHg) Chapter 4 4.1. 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 xvi List of Tables 4.8. Reversal of Nondepolarizing Neuromuscular Blockers 4.9. Factors that Alter the Effects of Neuromuscu- lar Blockers 4.10. Management of Malignant Hyperthermia 4.11. Use of Packed Red Blood Cell Transfusions and Erythropoietin in Critically-Ill Patients 4.12.