Critical Care Pharmacy Overview

Overview of Critical Care Pharmacy

• Critical care pharmacy is a specialized field of pharmacy practice that focuses on the care of critically ill patients in intensive care units (ICUs) and other high-acuity settings.
• Critical care pharmacists work as part of a multidisciplinary team to optimize patient outcomes, improve safety, and reduce healthcare costs.

Key Responsibilities of Critical Care Pharmacists

• Participate in bedside rounds with the ICU team to provide pharmaceutical care and make recommendations on medication therapy.
• Monitor and manage medication therapy for critically ill patients, including those with complex medical conditions and multiple organ dysfunction.
• Develop and implement medication protocols and guidelines for ICU patients.
• Provide education and training to healthcare professionals on medication therapy and pharmacological principles.
• Participate in quality improvement initiatives to improve patient outcomes and reduce medication errors.

Key Skills and Knowledge Required

• In-depth knowledge of pharmacology, pharmacokinetics, and pharmacodynamics.
• Strong understanding of critical care medicine, including pathophysiology, diagnosis, and treatment of critically ill patients.
• Ability to interpret and apply evidence-based medicine to patient care.
• Excellent communication and teamwork skills.
• Ability to work effectively in a fast-paced, high-stress environment.

Common Medications and Therapies in Critical Care

• Vasopressors (e.g., dopamine, norepinephrine, vasopressin) for hemodynamic support.
• Sedatives and analgesics (e.g., propofol, midazolam, fentanyl) for pain and anxiety management.
• Antimicrobials (e.g., vancomycin, meropenem) for infection management.
• Cardiovascular medications (e.g., beta blockers, ACE inhibitors) for cardiovascular support.
• Nutritional support and total parenteral nutrition (TPN).

Common Critical Care Conditions and Syndromes

• Sepsis and septic shock
• Acute respiratory distress syndrome (ARDS)
• Cardiogenic shock
• Acute kidney injury (AKI)
• Neurocritical care (e.g., stroke, traumatic brain injury)

Technology and Tools Used in Critical Care Pharmacy

• Electronic health records (EHRs) and computerized provider order entry (CPOE) systems.
• Automated dispensing cabinets (ADCs) and barcode medication administration (BCMA) systems.
• Infusion pumps and smart pumps for medication delivery.
• Pharmacokinetic software and apps for medication dosing and monitoring.

Critical Care Pharmacy Overview

• Focuses on care of critically ill patients in ICUs and high-acuity settings
• Critical care pharmacists work with a multidisciplinary team to optimize patient outcomes, safety, and healthcare costs

Key Responsibilities

• Participate in bedside rounds with ICU teams to provide pharmaceutical care and make recommendations
• Monitor and manage medication therapy for critically ill patients
• Develop and implement medication protocols and guidelines for ICU patients
• Provide education and training to healthcare professionals on medication therapy and pharmacological principles
• Participate in quality improvement initiatives to improve patient outcomes and reduce medication errors

Key Skills and Knowledge

• In-depth knowledge of pharmacology, pharmacokinetics, and pharmacodynamics
• Strong understanding of critical care medicine, including pathophysiology, diagnosis, and treatment of critically ill patients
• Ability to interpret and apply evidence-based medicine to patient care
• Excellent communication and teamwork skills
• Ability to work effectively in a fast-paced, high-stress environment

Common Medications and Therapies

• Vasopressors (e.g., dopamine, norepinephrine, vasopressin) for hemodynamic support
• Sedatives and analgesics (e.g., propofol, midazolam, fentanyl) for pain and anxiety management
• Antimicrobials (e.g., vancomycin, meropenem) for infection management
• Cardiovascular medications (e.g., beta blockers, ACE inhibitors) for cardiovascular support
• Nutritional support and total parenteral nutrition (TPN)

Common Critical Care Conditions and Syndromes

• Sepsis and septic shock
• Acute respiratory distress syndrome (ARDS)
• Cardiogenic shock
• Acute kidney injury (AKI)
• Neurocritical care (e.g., stroke, traumatic brain injury)

Technology and Tools

• Electronic health records (EHRs) and computerized provider order entry (CPOE) systems
• Automated dispensing cabinets (ADCs) and barcode medication administration (BCMA) systems
• Infusion pumps and smart pumps for medication delivery
• Pharmacokinetic software and apps for medication dosing and monitoring

Neuroanatomy

• Cerebrum divided into two hemispheres (left and right)
• Cerebellum coordinates muscle movements
• Brainstem connects cerebrum to spinal cord
• Anterior circulation supplied by internal carotid arteries
• Posterior circulation supplied by vertebral and basilar arteries
• Cerebrospinal fluid (CSF) produced in ventricles
• CSF flows through cerebral aqueduct
• CSF absorbed into bloodstream

Cerebral Edema Management

• Vasogenic edema: increased permeability of blood-brain barrier
• Cytotoxic edema: cellular swelling
• Osmotherapy involves administering mannitol or hypertonic saline
• Elevation of head of bed helps manage edema
• Control of blood pressure and oxygenation crucial
• Steroids (dexamethasone) used in specific cases

Intracranial Pressure Monitoring

• Invasive monitoring methods: intraparenchymal probes (e.g., Camino or Codman) and ventriculostomy
• Non-invasive monitoring methods: transcranial Doppler (TCD) and ICP calculation using CT or MRI
• Normal ICP: 0-10 mmHg
• Elevated ICP: 11-20 mmHg
• Critical ICP: >20 mmHg

Neurotransmitters and Pharmacology

• Excitatory neurotransmitters: glutamate and aspartate
• Inhibitory neurotransmitters: GABA and glycine
• Sedatives and anesthetics: propofol, midazolam, and fentanyl
• Neuroprotective agents: barbiturates (e.g., pentobarbital) and hypothermia

Stroke Management

• Ischemic stroke management: thrombolysis (tPA) within 3-4.5 hours and mechanical thrombectomy
• Hemorrhagic stroke management: blood pressure control and surgical evacuation of hematoma
• Neurocritical care involves airway management, cardiovascular support, and temperature control (normothermia)