This chapter focuses on selected pharmacologic topics that play an important role in patient care in the neurointensive care unit. The role of a clinical pharmacist in maximizing patient care in the ICU is discussed. Medication classes that are reviewed include antiplatelet and antithrombotic agents, and antiepileptics. The pharmacologic properties of these agents, including mechanism of action, dosing, side effects, drug interactions, and pharmacokinetic parameters, are discussed in this chapter. More detailed information and in-depth discussion regarding use of these medication classes in specific neurologic and neurosurgical situations is provided in other chapters within this text.

THE PHARMACIST'S ROLE IN THE ICU

As health care evolves and becomes more varied and complex, so must the roles of its professionals. The focus of a pharmacist's place in health care is shifting from the more reactionary established activities of preparation and dispensing to more proactive and influential participation in total patient care. Although physicians are educated in the fundamentals of medication therapy, the specialized training and education of clinical pharmacists allows them to serve as medication experts who are better equipped to recognize, understand, and prevent medication errors. While assuming an increasing responsibility for pharmacotherapeutic outcomes, pharmacists are well suited to aid physicians in drug therapy selection, monitoring, and decision making. Including pharmacists as proactive members of the multidisciplinary healthcare team can maximize drug selection in many ways, including:

1. ▪ Prevention and monitoring of drug interactions and/or adverse drug events (ADEs)

2. ▪ Medication dose adjustments for renal and/or hepatic dysfunction, age, or obesity

3. ▪ Selection of appropriate medication route of Administration

4. ▪ Determination of intravenous fluid, medication, and IV line compatibility

5. ▪ Identification and recommendation of cost-effective therapeutic options