RT Book, Section
A1 Schwinghammer, Terry L.
A1 DiPiro, Joseph T.
A1 Ellingrod, Vicki L.
A1 DiPiro, Cecily V.
SR Print(0)
ID 1178899262
T1 Critical Care: Patient Assessment and Pharmacotherapy
T2 Pharmacotherapy Handbook, 11e
YR 2021
FD 2021
PB McGraw Hill
PP New York, NY
SN 9781260116694
LK accesspharmacy.mhmedical.com/content.aspx?aid=1178899262
RD 2024/04/19
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.