Drug dosing considerations for the critically ill patient with liver disease.
Hepatic dysfunction in the critically ill patient presents a unique challenge to clinicians when designing pharmacotherapeutic treatment plans. Overall, the literature regarding drug dosing in critically ill patients with hepatic dysfunction is incomplete and current tools available to bedside clinicians have limitations. Despite these challenges, rational drug regimens can be implemented by critical care nurses who consider the potential impact of hepatic dysfunction on drug pharmacokinetics. This information can be applied clinically and careful monitoring plans can be implemented to assess a drug for efficacy and safety. This article reviews the pharmacokinetic changes that can occur in hepatic failure, identifies practical ways to quantify the severity of dysfunction, and discusses general drug dosing strategies in this patient population.
Lin
Sonia
S
Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, 41 Lower College Road, Fogarty Hall, Kingston, RI 02881, USA. SLin@uri.edu
Smith
Brian S
BS
D000042:Absorption / Q000187:drug effects; D001682:Biological Availability; D016638:Critical Illness; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007408:Intestinal Absorption / Q000187:drug effects; D008102:Liver Circulation; D017093:Liver Failure / Q000188:drug therapy* / Q000378:metabolism*; D008111:Liver Function Tests; D010599:Pharmacokinetics; D012720:Severity of Illness Index