Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
-
Anasthesiol Intensivmed Notfallmed Schmerzther · May 2020
[Perioperative Drug Interactions - What Should Be Considered by Anesthetists].
Drug interactions cause numerous hospital admissions and even death. Administration of multiple therapeutic drugs increases the risk of relevant interactions. Pharmacologist consultation and also IT-based drug-interaction examination focus on this risk and may improve the safety and quality of the medical therapy. ⋯ Thus on the one hand modern narcosis uses drug interactions in performing "balanced anesthesia" and on the other hand it is essential to know about unwanted interactions that might arise of several mechanisms like chemical interactions as well as pharmacokinetic and pharmacodynamic ways. In this context, phenomena as the pharmaceutic influence on the QT-time have to be known as well as the so called serotonine syndrome for example. A detailed insight into the metabolism of administered drugs including elimination pathways like p-glycoprotein or enzymes of the cytochrome-p-450 family is helpful to maintain a basic survey.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · May 2020
[Barriers to Conversations About Death and Dying in the Medicine].
Conversations about death, dying and the end of life are usually difficult. They can turn out to be both a burden and a challenge for those engaging in these talks. There is evidence that talking early about end-of-life-topics shows positive effects concerning medical and psychological conditions of patients. ⋯ In daily medical routine end of life topics should be addressed early and actively. Especially the readiness for these conversations should be tested repeatedly and talks should be offered regularly. Critical events such as relapse, modulating therapy concepts and knowledge of unrealistic treatment expectations should be regarded as prompts to offer conversations about dying and end-of-life care actively.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · May 2020
[Drug Interactions in Emergency Medicine].
Unwanted drug interactions are responsible for a high rate of hospitalization. The rate of unwanted interactions increases with the number of drugs taken. ⋯ They can be caused by an emergency treatment and can be the cause of a necessary emergency treatment. To avoid unwanted drug interactions, electronic databases and smartphone apps could be helpful.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · May 2020
[Drug-drug Interactions in Intensive Care].
Drug-drug interactions are common problems in intensive care units. Numerous studies could demonstrate the impact of the total amount of prescribed drugs and the occurrence of potential respectively manifest drug-drug interactions in critically ill patients. The average number of clinically used drugs in this setting is approximately 25 - 35 per patient, thus the profound knowledge of pharmacodynamic and pharmakokinetic mechanisms regarding drug interplay is important for treatment safety. ⋯ The most important drug classes noted in this context are analgesics and sedatives, antibiotics, antimycotics, antiepileptics, immune suppressive drugs, prokinetics and gastric acid regulating drugs. Furthermore, some pharmacodynamic interactions are described like QTc prolongation or serotonin syndrome. Additionally, a clinical case is demonstrated regarding the malignant impact of rifampin co-medication in a patient suffering from severe hypertension with the use of several antihypertensive drugs.