We did evaluate high-risk drugs according to the ISMP’s list; however we did not report the results for drugs such as diazepam, digoxin, enoxaparin, eptifibatide, or morphine. For these medications, less selleckchem than 15 orders were available for analysis after the dosing exclusion criteria (scheduled regimens) were applied, thus making conclusions about dosing from such a small sample challenging. Second, because this was an observational study, it was difficult to control for confounding factors. While we did exclude certain patients from the study, such as those with renal and/or hepatic failure, we could not account for some other confounders. These factors include additional disease states, severity of illness, and concomitant medications. Third, we were unaware of the type of weight used for dosing the study patients.

While we recorded the patients’ actual body weight during data collection, this may not always have been the weight used for dosing by the clinician. IBW, adjusted bodyweight, and total body weight are all used in clinical practice depending on a medication’s pharmacokinetic parameters. Given the various dosing weights, we attempted to standardize our data by recording the patients’ actual body weight and reporting recommended dosing regimens in terms of actual body weight. Finally, doses were difficult to record for some medications such as vasoactive drugs, which are constantly being titrated to a desired clinical effect. In order to control, in part, for these frequent dose changes, data were recorded for the last dose received by a patient in a 24-hour period.

This precaution limited the amount of data recorded for each patient in order to avoid skewing the average dose and range. The emphasis of this study was assessment of dosing, so we did evaluate daily doses and their impact of ineffectiveness and ADRs, thus including more than one dose per patient.5. ConclusionA wide variance was seen in the doses provided by continuous infusion of high-risk medications used across different weight classifications in critically ill adult patients. The vasoactive drugs were within the dosing range provided in the package inserts, regardless of weight classification; while heparin and the sedatives were typically dosed outside the recommendations.

The number of ADRs cannot be overlooked as there was a tendency for the ADRs to occur in overweight patients, but this does not necessarily appear to be a function of higher doses used based on weight. Still, the medications reviewed in this study are commonly associated with ADRs and have been labeled as high-risk drugs by the ISMP. The frequency of dosing changes due to ineffectiveness in patients with higher BMIs presents additional safety concerns. Given the medications’ increased propensity to cause harm, institutions should aggressively monitor these Carfilzomib medications; especially in overweight patients.