1. Miracle, Vickie RN, EdD, CCRN, CCNS, CCR, Editor-in-Chief, DCCN

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Pharmacology of the Critically Ill Park G, Shelly M. London, UK: BMJ Books; 2001.


Another pharmacology book.


This was my initial thought when I was given this book to review. However, as I read the book, it became apparent that this is not just another pharmacology book. As noted in the preface, many books about medications discuss treating a condition. As all critical care nurses know, we very seldom see a patient with only one diagnosis. This book discusses the interaction of various medications commonly used in the critical care setting in patients with multiple health problems. The editors also note that the number of medications available to treat these various conditions has increased significantly in the past few years and will only continue to grow.


The book is divided into 11 chapters. The first chapter discusses basic pharmacology while the next chapter provides an overview of pharmacokinetics and pharmacodynamics. Chapter 3 discusses drug actions, how they work to target cells or proteins, the use of preservatives, how to measure drug concentrations in body fluids, drug reactions and interactions, drug effects on multiple systems, mechanisms of drug action, and responses of individual patients to medications. Each patient may react differently to the same medication. While these chapters are rich in scientific jargon and chemistry, they are written in an easy-to-read style.


Chapters 4 through 9 discuss medications used to treat various healthcare problems according to the body system such as congestive heart failure, renal failure, and respiratory failure. In addition to discussing the most commonly used medication to treat these common critical care problems, each chapter also features the potential effects of the medications on other body systems. For example, the authors discuss the effects of sedatives in patients with renal disease, possible interactions in patients with liver failure, and various effects of certain groups of medications in the patient with heart failure.


The special pharmacologic needs of children are discussed in Chapter 10. We must remember that children are not just small adults. They have age-specific needs that must be considered when giving medications. This chapter focuses on age and drug distribution, body compartments, protein binding, drug metabolism, and drug excretion. Healthcare providers need to be aware of these aspects when administering medications to children. Remember, many medications approved for use in adults may not be approved for use in children.


The book closes with a section on safe drug prescribing for the critically ill patient. The authors present several questions to consider when administering medications that go beyond the who, what, and type of medication. We must question the necessity of the medication, its indications and contraindications, and how it may interfere with other medications. Also, consider the effects of the medication on other body systems. Drug interactions can be lethal.


Overall, Pharmacology of the Critically Ill is a well-written book that focuses mostly on interactions of drugs in patients with multiple health problems. The authors effectively describe potential interactions between medications given to patients on multiple-drug therapy.