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Critically Ill > PK/PD ICU > Flashcards

PK/PD ICU Flashcards

1
Q

What must be true about renal function to use Cockcroft-Gault and other equations?

A

must be stable

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2
Q

What type of dose should not be adjusted in AKI?

A

loading dose

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3
Q

What can increase hepatic blood flow and metabolism?

A
  1. early sepsis–> increased CO
  2. vasodilators
  3. inotropes
  4. TBI
  5. burn injuries
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4
Q

What can decrease hepatic blood flow and metabolism?

A
  1. vasopressors
  2. hypovolemic shock
  3. decreased cardiac output CO
  4. mechanical ventilation
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5
Q

What is augmented renal clearance?

A

kidney hyperfiltration above baseline leads to subtherapeutic concentrations
males CrCl: >130
females CrCl: >120

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6
Q

Why do critically ill patients tend to have decreased absorption due to decreased perfusion/blood flow?

A

the body shunts blood to vital organs

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7
Q

What dosage form can volume overload and edema effect the absorption of?

A

SQ
IM

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8
Q

What do we base loading doses off of?

A

Volume of distribution

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9
Q

What are causes of changes in distribution?

A
  1. fluid volume- edema, third spacing
  2. capillary permeability- third spacing
  3. lipophilic drugs have wider distribution
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10
Q

When Vd increases, what happens to drugs at their target tissues?

A

decrease concentrations

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11
Q

What happens to patients with lower levels of albumin when taking highly protein-bound drugs?

A

higher level of free, active drug –> supratherapeutic concentrations

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12
Q

What is the normal range of albumin?

A

3.5-5

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13
Q

What is hypoalbuminemia?

A

<2.5

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14
Q

What is the total PHT range?

A

10-20

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15
Q

What is the free PHT range?

A

1-2

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16
Q

When do we use the adjusted PHT equation?

A

low albumin and only have a total level
ALWAYS use free PHT level if you have it

17
Q

What is the adjusted PHT equation?

A

(Z x serum albumin) + 0.1

18
Q

How is Z determined for the PHT equation?

A

Z= 0.2 in patients with hypoalbuminemia
Z= 0.1 in patients with hypoalbuminemia and ESRD or HD-dependent

19
Q

What is the total range for Valproic Acid?

A

50-100

20
Q

What is the free range for valproic acid?

A

6-22

21
Q

How does hypoalbuminemia effect hydrophilic antibiotic dosing?

A

Increased fraction of free drug- increased clearance
Vd will increase- decreased drug to target tissues
–> underdosing

22
Q

How are alternative ways to dose antibiotics in hypoalbuminemia?

A
  1. loading doses/ aggressive initial regimen
  2. extended infusion time for t>MIC (time-dependent antibiotics)
23
Q

What is ECMO?

A

device used in cardiac/respiratory failure that directly removes CO2 from the blood and oxygenates it as it passes through the circuit

24
Q

How does ECMO affect drugs?

A

highly protein-bound and highly lipophilic drugs tend to become sequestered in the ECMO circuit leading to lower systemic concentrations

25
Q

Which highly lipophilic drugs may be effected by increased Vd and also may become sequestered due to ECMO?

A
  1. Fentanyl
  2. Propofol
  3. Midazolam
  4. Fluoroquinolones
  5. Piperacillin/Tazobactam
  6. Ceftriaxone
  7. Vancomycin
26
Q

What should all patients on ECMO have?

A

DVT treatment (preferably IV heparin)

27
Q

What is important when applying literature to critically ill patients?

A

seeing if the patient population was or included critically ill patients

28
Q

What is the duration of action of single IV doses of drugs in critically ill patients a function of?

A

distribution > clearance

Critically Ill (20 decks)

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