Neuropharmacotherapy

In the neurologically injured patient, it is extremely important to optimize and individualize pharmacotherapeutic strategies to improve patient outcomes. Therefore, understanding the pharmacology, pharmacokinetics, and pharmacodynamics of medications used in neurocritical care patients, as well as the impact of the acute illness and comorbid states on these characteristics, is essential. This chapter provides practical information on medications and treatment strategies commonly used in patients with neurological injuries, including recommendations to optimize therapeutic strategies and avoid unwanted adverse effects and drug interactions. Specific medications and treatment strategies discussed include hyperosmolar therapy with mannitol and hypertonic saline for management of intracranial pressure, anticonvulsant treatments for status epilepticus and refractory status epilepticus, reversal strategies for oral anticoagulant agents, , shivering control agents for use during therapeutic temperature management and induced hypothermia, and vasoactive therapies to maintain hemodynamic control. The pharmacology, pharmacokinetic and pharmacodynamic characteristics, and clinical pearls of these commonly used treatments in neurocritical care patients will also be highlighted.