Handbook of Drugs in Intensive Care Fifth Edition Downloaded from Cambridge Books Online by IP 142.150.190.39 on Sat Dec 20 06:55:29 GMT 2014. http://ebooks.cambridge.org/ebook.jsf?bid=CBO9781316182673 Cambridge Books Online © Cambridge University Press, 2014 This book is dedicated to Georgina Paw. Downloaded from Cambridge Books Online by IP 142.150.190.39 on Sat Dec 20 06:55:29 GMT 2014. http://ebooks.cambridge.org/ebook.jsf?bid=CBO9781316182673 Cambridge Books Online © Cambridge University Press, 2014 Handbook of Drugs in Intensive Care An A-Z Guide Fifth Edition Henry G W Paw BPharm MRPharmS MBBS FRCA FFICM Consultant in Intensive Care Medicine and Anaesthesia York Hospital York UK Rob Shulman BSc(Pharm) MRPharmS DipClinPharm DHC(Pharm) Lead Pharmacist in Critical Care Honorary Associate Professor in Clinical Pharmacy Practice UCL School of Pharmacy Honorary Lecturer, Department of Medicine, UCL University College London Hospitals London UK Downloaded from Cambridge Books Online by IP 142.150.190.39 on Sat Dec 20 06:55:29 GMT 2014. http://ebooks.cambridge.org/ebook.jsf?bid=CBO9781316182673 Cambridge Books Online © Cambridge University Press, 2014 University Printing House, Cambridge CB2 8BS, United Kingdom Published in the United States of America by Cambridge University Press, New York Cambridge University Press is part of the University of Cambridge. It furthers the University’s mission by disseminating knowledge in the pursuit of education, learning and research at the highest international levels of excellence. www.cambridge.org Information on this title: w ww.cambridge.org/9781107484030 © Henry Paw and Rob Shulman 2 013 This publication is in copyright. Subject to statutory exception and to the provisions of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press. First published 2 000 Second Edition 2002 Third Edition 2 006 Fourth Edition 2 009 Fifth Edition 2 013 Reprinted with corrections 2014 Printed in the United Kingdom by CPI Group Ltd, Croydon CR0 4YY A catalogue record for this publication is available from the British Library Library of Congress Cataloguing in Publication data ISBN 978-1-107-48403-0 paperback Cambridge University Press has no responsibility for the persistence or accuracy of URLs for external or third-party internet websites referred to in this publication, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. Every effort has been made in preparing this publication to provide accurate and up-to-date information which is in accord with accepted standards and practice at the time of publication. Although case histories are drawn from actual cases, every effort has been made to disguise the identities of the individuals involved. Nevertheless, the authors, editors and publishers can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation. The authors, editors and publishers therefore disclaim all liability for direct or consequential damages resulting from the use of mate- rial contained in this publication. Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use. Downloaded from Cambridge Books Online by IP 142.150.190.39 on Sat Dec 20 06:55:29 GMT 2014. http://ebooks.cambridge.org/ebook.jsf?bid=CBO9781316182673 Cambridge Books Online © Cambridge University Press, 2014 CONTENTS Introduction vii How to use this book viii Abbreviations x Acknowledgements xiii DRUGS: AN A–Z GUIDE 1 SHORT NOTES 243 Routes of administration 245 Loading dose 247 Drug metabolism 247 Enzyme systems 248 Drug excretion 248 Drug tolerance 249 Drug interactions 249 Therapeutic drug monitoring 250 Target range of concentration 251 Pharmacology in the critically ill 252 Cardiopulmonary resuscitation 254 Drugs in advanced life support 257 Management of acute major anaphylaxis 259 Management of severe hyperkalaemia 260 Management of malignant hyperthermia 261 Sedation, analgesia and neuromuscular blockade 263 A practical approach to sedation and analgesia 266 Opioid Conversion table 267 Management of status epilepticus 270 Prevention of delirium tremens and alcohol withdrawal syndrome 274 Prevention of Wernicke–Korsakoff syndrome 275 Anti-arrhythmic drugs 276 Inotropes and vasopressors 277 Bronchospasm 284 Anti-ulcer drugs 285 Immunonutrition in the ICU 285 Corticosteroids 286 Short synacthen test 287 Bone marrow rescue following nitrous oxide 287 Antioxidants 288 Post-splenectomy prophylaxis 289 Anti-microbial drugs 292 Bacterial gram staining 297 Antibiotics: sensitivities 298 Renal replacement therapy 300 Extracorporeal drug clearance: basic principles 304 Downloaded from Cambridge Books Online by IP 142.150.190.39 on Sat Dec 20 06:55:50 GMT 2014. http://ebooks.cambridge.org/ebook.jsf?bid=CBO9781316182673 Cambridge Books Online © Cambridge University Press, 2014 Drug doses in renal failure/renal replacement therapy 305 Chemical pleurodesis of malignant pleural eff usion 318 APPENDICES 321 Appendix A: Creatinine clearance 323 Appendix B: Weight conversion (stones/lb to kg) 324 Appendix C: Body mass index (BMI) calculator 325 Appendix D: Lean body weight charts 326 Appendix E: Infusion rate/dose calculation 328 Appendix F: Drug compatibility chart 329 Appendix G: Omeprazole administration record 330 Appendix H: Sodium content of oral medications 332 Appendix I: Drug management of the brain-stem-dead donor 334 Appendix J: Vancomycin by continuous infusion 335 Appendix K: Child-Pugh score 337 Appendix L: Severe sepsis algorithm 338 DRUG INDEX 339 Inside back cover: IV compatibility chart Downloaded from Cambridge Books Online by IP 142.150.190.39 on Sat Dec 20 06:55:50 GMT 2014. http://ebooks.cambridge.org/ebook.jsf?bid=CBO9781316182673 Cambridge Books Online © Cambridge University Press, 2014 INTRODUCTION Since the publication of the fourth edition in 2010, there have been several new drugs introduced to the critical care setting. This book has now been extensively updated. The main purpose of this book is to provide a practical guide that explains how to use drugs safely and eff ectively in a critical care setting. Doctors, nurses, pharmacists and other healthcare professionals caring for the critically ill patient will fi nd it useful. It is not intended to list every conceivable complication and problem that can occur with a drug but to concentrate on those the clinician is likely to encounter. The book should be seen as com- plementary to, rather than replacing, the standard textbooks. The book is composed of two main sections. The A-Z guide is the major part and is arranged alphabetically by the non-proprietary name of the drug. This format has made it easier for the user to fi nd a par- ticular drug when in a hurry. The discussion on an individual drug is I N restricted to its use in the critically ill adult patient. The second part is T R comprised of short notes on relevant intensive care topics. Inside the O D back cover is a colour fold-out chart showing drug compatibility for U intravenous administration. C T I O I am very fortunate to have on board a senior ICU pharmacist for this N edition. While every eff ort has been made to check drug dosages based on a 70 kg adult and information about every drug, it is still possible that errors may have crept in. I would therefore ask readers to check the information if it seems incorrect. In addition, I would be pleased to hear from any readers with suggestions about how this book can be improved. Comments should be sent via e-mail to: henry.paw@york. nhs.uk. HGWP York 2013 vii Downloaded from Cambridge Books Online by IP 142.150.190.39 on Sat Dec 20 06:56:21 GMT 2014. http://dx.doi.org/10.1017/CBO9781316182673.001 Cambridge Books Online © Cambridge University Press, 2014 HOW TO USE THIS BOOK European law (directive 92/27/EEC) requires the use of the Recom- mended International Non-proprietary Name (rINN) in place of the British Approved Name (BAN). For a small number of drugs these names are diff erent. The Department of Health requires the use of BAN to cease and be replaced by rINN with the exceptions of adren- aline and noradrenaline. For these two drugs both their BAN and rINN will continue to be used. The format of this book was chosen to make it more ‘user friendly’ – allowing the information to be readily available to the reader in times H of need. For each drug there is a brief introduction, followed by the OW following categories: T O Uses U This is the indication for the drug’s use in the critically ill. There will S E be some unlicensed use included and this will be indicated in brackets. T H IS Contraindications B This includes conditions or circumstances in which the drug should O O not be used – the contraindications. For every drug, this includes K known hypersensitivity to the particular drug or its constituents. Administration This includes the route and dosage for a 70 kg adult. For obese patients, estimated ideal body weight should be used in the calculation of the dosage (Appendix D). It also advises on dilutions and situations where dosage may have to be modifi ed. To make up a dilution, the instruction ‘made up to 50 ml with 0.9% sodium chloride’ means that the fi nal volume is 50 ml. In contrast, the instruction ‘to dilute with 50 ml 0.9% sodium chloride’ could result in a total volume >50 ml. It is recom- mended that no drug should be stored for >24 h after reconstitution or dilution. How not to use … Describes administration techniques or solutions for dilution which are not recommended. Adverse eff ects These are eff ects other than those desired. Cautions Warns of situations when the use of the drug is not contraindicated but needs to be carefully watched. This will include key drug-drug interactions. viii Downloaded from Cambridge Books Online by IP 142.150.190.39 on Sat Dec 20 06:56:42 GMT 2014. http://dx.doi.org/10.1017/CBO9781316182673.002 Cambridge Books Online © Cambridge University Press, 2014 Organ failure Highlights any specifi c problems that may occur when using the drug in a particular organ failure. Renal replacement therapy Provides guidance on the eff ects of haemofi ltration/dialysis on the handling of the drug. For some drugs, data are either limited or not available. H O W T O U S E T H I S B O O K ix Downloaded from Cambridge Books Online by IP 142.150.190.39 on Sat Dec 20 06:56:42 GMT 2014. http://dx.doi.org/10.1017/CBO9781316182673.002 Cambridge Books Online © Cambridge University Press, 2014