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Pharmacology Test 3 > Pharmacology in ICU (Shih) > Flashcards

Pharmacology in ICU (Shih) Flashcards

1
Q

Venous shunts

A

open and close depending on need

  • organs
  • muscles
  • skin
  • fat
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2
Q

hypovolemic shock

A
  1. Body compensates shuts down peripheral circulation
  • venous shunt closes
  • main arteries and vessels are closed
    • inc blood pressure
  1. Selective organ perfusion
  • sacrifices
    • skeletal muscles
    • intestines
  • keep central perfusion
    • brain
    • heart
    • lung
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3
Q

Distributive shock

A

Body loses ability to select what is important

  • venous shunt opens everywhere
  • hypoperfusion => hyperdynamic stage of sepsis
  • volume of distribution is HUGE: pressure crashes
  1. Infection / sepsis
  2. Anaphylactic shock
  3. heat stroke
  4. pancreatitis
  5. inflammation
  6. cancer
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4
Q

Volume of distribution in ICU

A
  1. Hypovolemic shock: reduction in Vd (volume of distribution)
  2. Distributive shock: increase in Vd
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5
Q

Stab wounds you….

A

Concentrate your blood

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6
Q

Sepsis you ……

A

Dilate too much

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7
Q

volume of distribution, percent blood volume per body weight

A

20%

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8
Q

change in volume of distribution wil change…

A

Cmax (max concentration of drug)

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9
Q

Volume of distribution

  1. Hemoabd
  2. Post burn
  3. Aspiration pneumonia
  4. Abdominal exploritory
  5. Anesthetized patient, lar par
  6. CKD (UTI)
  7. Septic abdomen
  8. Collapse (post CPR)
A
  1. Hemoabdomen: lower
  2. Post burn: can be higher or lower
  • loss of skin = loss of water = usually lower
  • in sepsis = higher
  1. Aspiration pneumonia: high (sepsis)
  2. Abdominal exploritory: low (lose volume to evaporation)
  3. Anesthetized patient, lar par: High isofluorene simulates sepsis (vasodilator)
  4. CKD (UTI): low, dehydrated, cant concentrate urine
  5. Septic abdomen: high
  6. Collapse (post CPR): high, reperfusion injury because CPR doesn’t circulate as well as the heart
    * serous inflammatory response syndrome
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10
Q

patient dose of drug

A

[(Standard dose) X Vd] / (normal Vd of patient)

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11
Q

Solubility of Rx in ICU

  1. Hypovolemic shock: …
  2. Distributive shock: …
  3. Lipossoluble Rx: …
  4. Hydrossoluble Rx: …
A
  1. Hypovolemic shock: reduction Vd
  2. Distribution shock: increase Vd
  3. Lipossoluble Rx: no change Cmax
  4. Hydrossoluble Rx: drop in Cmax
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12
Q
  1. Liposoluble drugs go to…..
  2. Hydrosoluble drugs go …
A
  1. Whole body
  2. Where blood goes
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13
Q

Low Vd =

A

concentratin of blood

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14
Q

Septic shock (change in Vd)

A
  1. Trying to perfuse the whole body
  • huge Vd
  • hydrosoluble drug
  1. Liposoluble: no change in Cmax
  2. Hydrosoluble: Drop of Cmax
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15
Q
  1. Septic shock = …..in Vd
  2. Hemorrhagic shock =…in Vd
A
  1. Septic shock = drop in Vd
  2. Hemorrhagic shock = inc in Vd
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16
Q

Liposoluble antibiotics

A
  1. Chloranfenicol
  2. TMS
17
Q

Hydrosoluble antibiotics

A
  1. Beta Lactams
  2. Aminoglycosides
18
Q

Amikacin

A

hydrosoluble:

am I going to inc cmax in this patient is it going to be too high?

*enrofloxacin has less side effects

19
Q

Protein binding in ICU

affected

A

Loss

Redistribution

Lack of production

20
Q

Conditions prone to low protein

  1. Hemoab:
  2. Burn:
  3. Post CPR inflamed dog:
  4. Septic abdomen:
  5. Aspiration pneumonia:
  6. Abdom explore:
  7. Anesthesia:
  8. CKD (UTI):
A
  1. Hemoab: low
  2. Burn: low
  3. Post CPR inflamed dog: low
  4. Septic abdomen: low
  5. Aspiration pneumonia: low
  6. Abdominal explore: low
  7. Anesthesia: normal
  8. CKD (UTI): low
21
Q

Protein and the BBB

A

Drug bound to protein does not cross the BBB

22
Q

When do we worry about low protein and drugs?

A

Drugs that have a low therapeutic index

  • aminoglycosides
23
Q

Low protein in blood allows:

A

Higher % free drug in plasma

Higher chance of side effects

More effected the blood

24
Q

Drugs that require protein binding to work

A

Propofol

Digoxin

25
Q

Dz states prone to low clearance

  1. Hemoabdomen:
  2. Burn:
  3. Septic abdomen:
  4. CKD (UTI)
  5. Anesthesia
  6. Abdominal explore:
  7. Aspiration pneumonia:
A

1. Hemoabdomen: yes

  1. Burn: yes
  2. Septic abdomen: yes
  3. CKD (UTI): yes
  4. Anesthesia: yes
  5. Abdominal explore (GDV): yes
  6. Aspiration pneumonia: yes
26
Q

If a patient is prone to low clearance….

A

Reduce dose

or

Increase interval

Pharmacology Test 3 (12 decks)

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