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Emergency Neurological Life Support: Pharmacotherapy

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Abstract

The appropriate use of medications during Emergency Neurological Life Support (ENLS) is essential to optimize patient care. Important considerations when choosing the appropriate agent include the patient’s organ function and medication allergies, potential adverse drug effects, drug interactions, and critical illness and aging pathophysiologic changes. Critical medications used during ENLS include hyperosmolar therapy, anticonvulsants, antithrombotics, anticoagulant reversal and hemostatic agents, anti-shivering agents, neuromuscular blockers, antihypertensive agents, sedatives, vasopressors and inotropes, and antimicrobials. This article focuses on the important pharmacokinetic and pharmacodynamics characteristics, advantages and disadvantages, and clinical pearls of these therapies, providing practitioners with essential drug information to optimize pharmacotherapy in acutely ill neurocritical care patients.

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Disclosures

Dr. Gretchen Brophy is an advisory board member/consultant/speaker for UCB, Medicines Company, Grifols, Edge Therapeutics, Cumberland, and Mallinckrodt; has received research funding from NIH, DoD, Astellas and Otsuka; and is an executive officer for the Neurocritical Care Society. Dr. Theresa Human is an advisory board member/consultant/speaker for Cumberland Pharmacueticals, UCB, Medicines Company, Ostuka Pharmaceuticals; has received research funding from Astellas and Otsuka; and is the Pharmacy Section Chair for the Neurocritical Care Society. Dr. Lori Shutter is a consultant/drug safety board member for UCB, has received research funding from NIH, DoD, and UCB; and is an executive officer for the Neurocritical Care Society.

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Authors and Affiliations

  1. Departments of Pharmacotherapy & Outcomes Science and Neurosurgery, Virginia Commonwealth University, Richmond, VA, USA

    Gretchen M. Brophy

  2. Department of Clinical Pharmacy, Barnes-Jewish Hospital, Washington University in St. Louis, St. Louis, MO, USA

    Theresa Human

  3. Departments of Critical Care Medicine, Neurology & Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Lori Shutter

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  1. Gretchen M. Brophy
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  2. Theresa Human
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  3. Lori Shutter
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Correspondence to Gretchen M. Brophy.

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Brophy, G.M., Human, T. & Shutter, L. Emergency Neurological Life Support: Pharmacotherapy. Neurocrit Care 23 (Suppl 2), 48–68 (2015). https://doi.org/10.1007/s12028-015-0158-1

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