DICP : the annals of pharmacotherapy
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The critically ill patient is at high risk for developing complications and, consequently, higher costs of treatment. Because of the high costs associated with these patients, healthcare payers are demanding the development of criteria to ensure cost-effective care. Pharmacists can play an important role in ensuring cost-effective and appropriate care of critically ill patients. ⋯ Pharmacists can use newer tools such as cost-effective analysis and clinical decision analysis to identify and utilize drug therapies that result in decreased complications and decreased length of hospital stay, as measured by decreased costs. Equally important is the development of criteria for the appropriate use of drug therapies. Pharmacists must take an active role in working with physicians, nurses, payers, and risk managers.
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Ketorolac tromethamine is a pyrrolo-pyrrole nonsteroidal antiinflammatory drug (NSAID) with potent analgesic effects when administered intramuscularly for the treatment of acute pain. Ketorolac is well absorbed and has a rapid onset of action. Maximum plasma concentrations are achieved in 45-50 minutes and peak analgesic effects in about one to two hours following intramuscular injection. ⋯ It can cause dose-related gastric ulcerations, even when administered parenterally. Ketorolac is a promising parenteral alternative to oral NSAIDs and a nonnarcotic alternative to opioid analgesics. Additional multiple-dose studies are needed to more clearly define its place in therapy.
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Nausea and vomiting are serious problems for patients receiving cancer chemotherapy. Dopamine receptor and cholinergic receptor antagonism have been the target mechanism for agents used to combat drug-induced nausea and vomiting; more recently, blockade of serotonin receptors has been used for this indication. Current therapies are limited by extrapyramidal adverse effects, as well as drowsiness, sedation, respiratory depression, and cardiac effects. ⋯ Ondansetron appears to be well tolerated, with the possible exception of headaches and transient increases in liver enzymes. No extrapyramidal toxicities have been reported with this agent. While ondansetron looks promising, further studies are needed to fully define its role as an antiemetic.
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Among the many advances made in intensive care therapeutics in recent years, few have rivaled the impact of mechanical ventilators. Their expanded use affects all who practice in the critical care setting. ⋯ A basic introduction is made into ventilator set up, weaning techniques, adjunctive drug therapy, and complications. The pharmacotherapy specialist who understands interactions between patients and ventilators, and the effects of mechanical ventilation on cardiopulmonary function will be best equipped to individualize drug therapy.