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p. 1204

HOME MEDICATIONS IN THE INTENSIVE CARE UNIT

Medications used to treat chronic conditions are often administered in

the intensive care unit (ICU) as long as it does not provide harm to the

patient. The decision to continue or hold medications that cause bleeding

(e.g., warfarin, clopidogrel), have hemodynamic effects (e.g., blood

pressure medication), have hypoglycemic effects (e.g., diabetes

medications), and/or that can potentially interact with medications

administered in the ICU is made on an individual basis based on risk and

benefit.

Case 56-1 (Question 1),

Case 56-2 (Question 1)

PHARMACOKINETICS OVERVIEW AND DRUG SELECTION

Available pharmacokinetic data are often determined in healthy subjects.

Critically ill patients may have significant changes in all (ADME)

pharmacokinetic parameters. The clinician should be attuned to those

disease states most likely to induce alterations and to develop

appropriate monitoring and management strategies for specific

medications.

Case 56-3 (Questions 1–8)

PAIN, AGITATION, AND DELERIUM

Pain, agitation, and delirium commonly occur in critically ill patients for a

variety of reasons. Clinicians should vigilantly assess patients for pain

and provide adequate analgesia. They should attempt to identify and

address underlying conditions leading to agitation and delirium.

Case 56-4 (Questions 1, 2),

Case 56-5 (Question 1),

Case 56-6 (Question 1),

Table 56-1

Opioids are the most commonly used analgesics in the ICU. Patientspecific characteristics and differences between hydromorphone,

fentanyl, and morphine should be considered when designing the optimal

analgesic regimen for a patient.

Case 56-4 (Question 3),