THERAPEUTIC DRUG MONITORING TO ASSESS CLINICAL RESPONSE TO SEDATIVE MEDICATIONS IN THE INTENSIVE CARE UNIT: A CASE REPORT AND DISCUSSION
Main Article Content
Keywords
Shock, hypotension, bacterial infections, midazolam, interactions
Abstract
We describe the pharmacological evaluation of a 60 year old female admitted to the intensive care unit with severe necrotizing fasciitis not responding to excessive dosages of intravenous sedatives and analgesics. This evaluation revealed the first to be reported midazolam-ketamine drug interaction in the medical literature and explains how we were able to answer a relevant clinical question using pharmacokinetics and pharmacodynamics analysis of serum drug levels.
References
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19. Morgan ET, Goralski KB, Piquette-Miller M, et al. Regulation of drug-metabolizing enzymes and transporters in infection, inflammation, and cancer. Drug Metab Dispos 2008;36(2):205-16.
20. Renton KW. Regulation of drug metabolism and disposition during inflammation and infection. Expert Opin Drug Metab Toxicol 2005;1(4):629-40.
21. Renton KW. Cytochrome P450 regulation and drug biotransformation during inflammation and infection. Curr Drug Metab 2004;5(3):235-43.
22. Morgan ET, Li-Masters T, Cheng PY. Mechanisms of cytochrome P450 regulation by inflammatory mediators. Toxicology 2002;181-182:207-10.
23. Garcia Del Busto Cano E, Renton KW. Modulation of hepatic cytochrome P450 during Listeria monocytogenes infection of the brain. J Pharm Sci 2003;92(9):1860-8.
24. Goralski KB, Hartmann G, Piquette-Miller M, Renton KW. Downregulation of mdr1a expression in the brain and liver during CNS inflammation alters the in vivo disposition of digoxin. Br J Pharmacol 2003;139(1):35-48
2. Lin YS, Lockwood GF, Graham MA, et al. In-vivo phenotyping for CYP3A by a single-point determination of midazolam plasma concentration. Pharmacogenetics 2001;11(9):781-91.
3. Krupka E, Venisse N, Lafay C, et al. Probe of CYP3A by a single-point blood measurement after oral administration of midazolam in healthy elderly volunteers. Eur J Clin Pharmacol 2006;62(8):653-9.
4. Greenblatt DJ, Locniskar A, Ochs HR, Lauven PM. Automated gas chromatography for studies of midazolam pharmacokinetics. Anesthesiology 1981;55(2):176-9.
5. Albrecht S, Ihmsen H, Hering W, et al. The effect of age on the pharmacokinetics and pharmacodynamics of midazolam. Clin Pharmacol Ther 1999;65(6):630-9.
6. Greenblatt DJ, Abernethy DR, Locniskar A, Harmatz JS, Limjuco RA, Shader RI. Effect of age, gender, and obesity on midazolam kinetics. Anesthesiology 1984;61(1):27-35.
7. Loch JM, Potter J, Bachmann KA. The influence of anesthetic agents on rat hepatic cytochromes P450 in vivo. Pharmacology 1995;50(3):146-53.
8. Uhing MR, Beno DW, Jiyamapa-Serna VA, et al. The effect of anesthesia and surgery on CYP3A activity in rats. Drug Metab Dispos 2004;32(11):1325-30.
9. Pentikainen PJ, Valisalmi L, Himberg JJ, Crevoisier C. Pharmacokinetics of midazolam following intravenous and oral administration in patients with chronic liver disease and in healthy subjects. J Clin Pharmacol 1989;29(3):272-7.
10. Verbeeck RK. Pharmacokinetics and dosage adjustment in patients with hepatic dysfunction. Eur J Clin Pharmacol 2008;64(12):1147-61.
11. Dundee JW, Halliday NJ, Harper KW, Brogden RN. Midazolam. A review of its pharmacological properties and therapeutic use. Drugs 1984;28(6):519-43.
12. Dresser GK, Schwarz UI, Wilkinson GR, Kim RB. Coordinate induction of both cytochrome P4503A and MDR1 by St John's wort in healthy subjects. Clin Pharmacol Ther 2003;73(1):41-50.
13. Dresser GK, Spence JD, Bailey DG. Pharmacokinetic-pharmacodynamic consequences and clinical relevance of cytochrome P450 3A4 inhibition. Clin Pharmacokinet 2000;38(1):41-57.
14. Malacrida R, Fritz ME, Suter PM, Crevoisier C. Pharmacokinetics of midazolam administered by continuous intravenous infusion to intensive care patients. Crit Care Med 1992;20(8):1123-6.
15. Wills RJ, Khoo KC, Soni PP, Patel IH. Increased volume of distribution prolongs midazolam half-life. Br J Clin Pharmacol 1990;29(2):269-72.
16. Kirwan CJ, MacPhee IA, Lee T, Holt DW, Philips BJ. Acute kidney injury reduces the hepatic metabolism of midazolam in critically ill patients. Intensive Care Med 2012;38(1):76-84.
17. Guengerich FP. Cytochrome P-450 3A4: regulation and role in drug metabolism. Annu Rev Pharmacol Toxicol 1999;39:1-17.
18. Paulussen A, Lavrijsen K, Bohets H, et al. Two linked mutations in transcriptional regulatory elements of the CYP3A5 gene constitute the major genetic determinant of polymorphic activity in humans. Pharmacogenetics 2000;10(5):415-24.
19. Morgan ET, Goralski KB, Piquette-Miller M, et al. Regulation of drug-metabolizing enzymes and transporters in infection, inflammation, and cancer. Drug Metab Dispos 2008;36(2):205-16.
20. Renton KW. Regulation of drug metabolism and disposition during inflammation and infection. Expert Opin Drug Metab Toxicol 2005;1(4):629-40.
21. Renton KW. Cytochrome P450 regulation and drug biotransformation during inflammation and infection. Curr Drug Metab 2004;5(3):235-43.
22. Morgan ET, Li-Masters T, Cheng PY. Mechanisms of cytochrome P450 regulation by inflammatory mediators. Toxicology 2002;181-182:207-10.
23. Garcia Del Busto Cano E, Renton KW. Modulation of hepatic cytochrome P450 during Listeria monocytogenes infection of the brain. J Pharm Sci 2003;92(9):1860-8.
24. Goralski KB, Hartmann G, Piquette-Miller M, Renton KW. Downregulation of mdr1a expression in the brain and liver during CNS inflammation alters the in vivo disposition of digoxin. Br J Pharmacol 2003;139(1):35-48