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28 Cards in this Set
- Front
- Back
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enteral route compromised (4)
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1. GI hypomotility
2. no bowel sounds or peristalsis 3. bowel edema 4. ↓ perfusion to GIT |
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pH alterations implications & drugs affected (2)
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↓ absorption w/ PPIs or H2-blockers
ketoconazole & itraconazole |
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enteral feeding interactions & drugs affected (2)
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chelation & ↓ absorption
1. FQs 2. phenytoin |
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SQ drugs (4) & impairment states
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1. heparin, LMWH, insulin, EPO, etc.
2. edema or vasopressors |
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blood flow in shock states (2)
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1. ↑ heart, brain, lungs
2. ↓ kidneys, gut, spleen, skin |
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preferred route of administration in ICU
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IV
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distribution factors (6)
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1. blood flow
2. protein binding 3. tissue penetration 4. lipid solubility 5. pH 6. pKa of drug |
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↑ in Vd implications
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↓ Cmax & possible therapeutic failure
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lipophilic drugs & their implications
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accumulated in fat until saturated, where it then redistributes to the blood for prolonged sedation
midazolam (replace w/ lorazepam) |
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OH-midazolam
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less active
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M6G
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highly active
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NAPQI
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toxic
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reduction in hepatic metabolism in ICU (2)
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1. mediated by inflammatory cytokines (IL-6)
2. extremely sensitive to hypoxemia |
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children study w/ hepatic metabolism (2)
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1. sepsis: 2x reduction in antipyrine metabolism
2. multiple organ failure: 4x fold reduction in antipyrine metabolism |
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lipophilic drugs & excretion (4)
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lipophilic drugs must be metabolized to hydrophilic compounds in order to be excreted
1. macrolides 2. FQs 3. rifampin 4. azoles |
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hydrophilic drugs (3)
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1. AGs
2. β-lactams 3. glycopeptides |
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theophylline & ciprofloxacin CYP450
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theophylline: CYP1A2 substrate
ciprofloxacin: CYP1A2 inhibitor combination ↑ theophylline levels |
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high extraction ratio
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> 0.7
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low extraction ratio
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< 0.3
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high extraction drugs dependent on...
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hepatic blood flow
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hyperdynamic circulation (3)
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1. adaptive mechanism in septic shock
2. ↑ CO & ↑ renal blood flow 3. ↑ GFR & tubular secretion |
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example of hyperdynamic circulation
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aminoglycoside clearance during gram (-) sepsis
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hemodynamically active drugs (HAD) (3)
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1. vasopressors (dopamine, norepinephrine, etc.)
2. inotropes (dobutamine) 3. diuretics |
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HAD & ↑ renal clearance (3)
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1. β-lactams
2. aminoglycosides 3. vancomycin |
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head trauma implications
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changes in protein binding and drug metabolism
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↑ unbound acidic drugs with ↓ albumin (2)
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1. phenytoin
2. diazepam |
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↓ unbound basic drugs with ↑ AAG (3)
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1. meperidine
2. propranolol 3. lidocaine |
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phenytoin in head trauma
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7 days max for prophylaxis in head trauma
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