The LITFL Critical Care Compendium is a comprehensive collection of pages concisely covering the core topics and controversies of critical care.
GI Drug Absorption in Critical Illness; multi-factorial determinants influence the bioavailability of drugs; governed by factors altering transport of substances across cell membranes (diffusion, active transport, ultrafiltration)
Gentamicin; aminoglycoside; irreversible binding to bacterial ribosomal proteins -> inhibits protein synthesis; Antimicrobial cover: gram negative rods (including Pseudomonas)
Hypertonic Saline: concentrated Sodium chloride with elevation of the serum Na+
Heparin: anticoagulant; unfractionated heparin (UFH) is a sulfated polysaccharide with a molecular weight range of 3 to 30 kDa
carbapenem (imipenem + cilastatin); inhibition of bacterial cell wall synthesis; cilastatin reduces renal metabolism -> increases effective concentration and decreases nephrotoxicity
Ketamine: phencyclidine derivative hypnotic and analgesic. NMDA receptor antagonist resulting in dissociative anaesthesia (profound analgesia with superficial sleep); interacts with opioid receptors - mu, delta and kappa
COMPARISON EVIDENCE Mebazza, (2007) SURVIVE – Levosimendan vs Dobutamine in patients with acute decompensated heart failure, JAMA References and Links
Levosimendan: Calcium sensitizer (novel inotrope, also considered an inodilator like milrinone)
Lignocaine: local anaesthetic and membrane stabilising anti-arrhythmic; binds selectively to refractory Na+ channels -> preferentially when cells are depolarised (ie. in ischaemia)
Linezolid: oxazolidinone; blocks ribosomal function required for translation
Lithium: mood stabiliser; element of the alkali metal group; exact mechanism of action in mania is unknown
Low Molecular Weight Heparin (LMWH): anticoagulant; potentiates the action of antithrombin III on Xa