Chapter 6 An ADE is broadly defined in human medicine as “any noxious, unintended, and undesired effect of a drug, which occurs at doses used in humans for prophylaxis, diagnosis, or therapy… [This excludes] therapeutic failures, intentional or accidental poisoning or drug abuse, and adverse effects due to errors in administration or compliance” (Bowman, Carlstedt, and Black, 1994). These ADEs can be dose-dependent (predictable) or dose-independent (unpredictable) and are relatively common in human ICUs, reported at approximately 29.7 per 100 ICU admissions (WHO, 2000). There are no data available about the incidence of ADEs in veterinary ICU patients. TABLE 6-2 Drug Interactions and Suggested Therapeutic Adjustments in Commonly Used Drugs in Critically Ill Patients *Consider interval adjustment for concentration-dependent antibiotics: †New dose = Standard dose × (Normal serum creatinine / Patient’s serum creatinine). ‡Consider dose adjustment for time-dependent antibiotics: New dose = Standard dose × (Normal serum creatinine / Patient’s serum creatinine). §Mirtazapine 1.88 mg/cat every 48 hours is recommended dose in cats with chronic kidney disease (Quimby et al, 2011).
Drug Incompatibilities and Drug-Drug Interactions in the ICU Patient
Adverse Drug Events
New interval = Standard interval × [1 ÷ (Normal serum creatinine / Patient’s serum creatinine)]
Clinical signs consistent with serotonin syndrome include agitation, tachycardia, hyperthermia, mydriasis, muscle twitching, vomiting, or diarrhea.
Liver Disease
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