TY - CHAP M1 - Book, Section TI - Critical Care: Patient Assessment and Pharmacotherapy A1 - Schwinghammer, Terry L. A1 - DiPiro, Joseph T. A1 - Ellingrod, Vicki L. A1 - DiPiro, Cecily V. Y1 - 2021 N1 - T2 - Pharmacotherapy Handbook, 11e AB - Table Graphic Jump LocationTABLE A3-1Pharmacokinetic Changes in Critical IllnessView Table||Download (.pdf)TABLE A3-1Pharmacokinetic Changes in Critical IllnessPharmacokinetic ParameterChanges in the Critically IllEtiologiesExample Drugs AffectedAbsorption↓ AbsorptionPerfusion abnormalitiesDecreased GI motilityAltered gastric pHBowel wall edemaDrug–nutrient interactionsEnteral, intramuscular, or subcutaneous drugsItraconazole (capsules need an acidic medium for absorption), phenytoin (significant drug–nutrient interactions), subcutaneous enoxaparin (incompletely absorbed in the setting of vasopressors and edema)Distribution↑ VdLarge-volume resuscitationCapillary leak syndromeAscitesMechanical ventilationHydrophilic drugsAminoglycosides, beta-lactams, daptomycin, hydromorphone, morphine, vancomycinHypoalbuminemiaAlbumin-bound drugsAmiodarone, ceftriaxone, midazolam, morphine, phenytoin, propofol, valproic acid, warfarinExtracorporeal circuits with expansive surface area (ECMO)Lipophilic drugsDiazepam, fentanyl, fluoroquinolones, macrolides, midazolam, propofol↓ VdDecreased α1-acid glycoproteinDrugs bound to α1-acid glycoproteinAzithromycin, carvedilol, fentanyl, lidocaine, olanzapine, phenobarbitalMetabolism↑ MetabolismHepatic enzyme inductionAugmented hepatic blood flowFlow-dependent drugs (hepatic extraction ratio >0.7)Propofol, midazolam, morphine, metoprolol↓ MetabolismHepatic enzyme inhibitionDecreased hepatic blood flowFlow-independent drugs (hepatic extraction ratio <0.3)Warfarin, diazepam, phenytoinExcretion↑ ClearanceAugmented renal clearanceExtracorporeal removalRenally eliminated medicationsBeta-lactam antibiotics, vancomycin, enoxaparin, gabapentin, levetiracetam↓ ClearanceAcute kidney injuryNephrotoxic medicationsAminoglycosides, NSAIDs, antivirals, contrastECMO, extracorporeal membrane oxygenation; GI, gastrointestinal; NSAIDs, non-steroidal anti-inflammatory drugs; Vd, volume of distribution. SN - PB - McGraw Hill CY - New York, NY Y2 - 2024/03/28 UR - accesspharmacy.mhmedical.com/content.aspx?aid=1178899262 ER -