title: The effects of liver and renal dysfunction on the pharmacokinetics of sedatives and analgesics in the critically ill patient.
abstract: In critically ill patients, the duration of effect and dose-response relationship of sedative and analgesic drugs can be significantly affected by the presence of renal or hepatic dysfunction. Alterations in pharmacokinetics and pharmacodynamics vary according to the degree of organ impairment and presence of comorbid illnesses. This article reviews the principals that govern the absorption, distribution, metabolism, and elimination of sedatives and analgesics during renal and hepatic impairment. By anticipating changes in pharmacokinetics, and by routinely assessing the clinical response to therapy, unintended adverse consequences of sedative and analgesic drug therapy may be avoided.
authors.affiliation: Department of Pharmacy, University of Massachusetts Memorial Medical Center, Memorial Campus, Worcester, MA 01605, USA. yogaratd@ummhc.org
authors.forename: Dinesh
authors.initials: D
authors.lastname: Yogaratnam
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Miller
authors.forename: Brian S
authors.initials: BS
authors.lastname: Smith
mesh_terms: D000700:Analgesics / Q000378:metabolism / Q000493:pharmacokinetics*; D001682:Biological Availability; D001783:Blood Flow Velocity; D003422:Critical Care / Q000379:methods*; D016903:Drug Monitoring / Q000379:methods / Q000451:nursing; D006207:Half-Life; D006801:Humans; D006993:Hypnotics and Sedatives / Q000378:metabolism / Q000493:pharmacokinetics*; D007408:Intestinal Absorption; D007674:Kidney Diseases / Q000150:complications / Q000378:metabolism* / Q000503:physiopathology; D007677:Kidney Function Tests; D008107:Liver Diseases / Q000150:complications / Q000378:metabolism* / Q000503:physiopathology; D008111:Liver Function Tests; D008657:Metabolic Clearance Rate; D009730:Nursing Assessment / Q000379:methods; D014018:Tissue Distribution
chemical_list: D000700:Analgesics; D006993:Hypnotics and Sedatives