The main challenge when I embarked in writing the third edition has been to keep it down to size. This third edition remains a concise book that explains how to use drugs safely and effectively in a critical care setting. Doctors, nurses and other professionals caring for the critically ill patient will find it useful. It is intended to be small enough to fit in the pocket and to provide sufficient information about drug prescribing in the critically ill patient. To keep the book down to size has meant restricting the list of drugs to ones that I consider as common drugs. It is not intended to list every conceivable complication and problem that can occur with a drug but to concentrate on those the clinician is likely to encounter. These constraints mean that this pocket book should be seen as complementary to, rather than replacing, the standard textbooks.

The book is composed of two main sections. The A-Z guide is the major part and is arranged alphabetically by the non-proprietary name of the drug. This format has made it easier for the user to find a particular drug when in a hurry. The discussion on an individual drug is restricted to its use in the critically ill adult patient. The second part is comprised of short notes on relevant intensive care topics.

While every effort has been made to check drug dosages based on a 70 kg adult and information about every drug, it is still possible that errors may have crept in. I would therefore ask readers to check the information if it seems incorrect.

ADMINISTRATION OF DROTRECOGIN ALFA (activated)

Drotrecogin alfa (activated) (Activated Protein C, Xigris™) is a novel drug with anti-inflammatory, anticoagulant and pro-fibrinolytic properties. It has been shown to reduce mortality in septic patients, particularly in patients with multi-organ failure (defined by NICE as 2 or more major organs) when added to best standard care.

It is a very expensive drug and the Prescribing Criteria Checklist must be signed by the ICU Consultant to ensure the patient is eligible to receive drotrecogin alfa (activated) before the drug is made up and administered.

5 mg vial = £152 Treatment for an 80 kg patient will cost >£6000.

Dosage

• All patients should receive drotrecogin alfa (activated) at a dose of 24 microgram/kg/hour (use actual body weight) for up to 96 hours (4 days) by intravenous infusion.

• If the infusion is interrupted for any reason, Xigris should be restarted at the 24 microgram/kg/hour infusion rate and continued to complete the full recommended 96 hours of dosing administration.

• No dosage adjustment is required in acute renal or hepatic failure.

Prescription

Should state: Drotrecogin alfa (activated) 24 microgram/kg/hour for 96 hours xx kg

Preparation and Administration

• Drotrecogin alfa (activated) vials must be kept in the fridge

• Once reconstituted drotrecogin alfa (activated) is stable for up to 14 hours at room temperature so infusions must not run for longer than this

• Giving sets should be labelled with the time and date when the infusion was first started and changed every 48 hours

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