ICU Primary PrepCast # Epi 58- ICU Primary Snippet 1 - Critical Illness and Pharmacokinetics
Jan 5, 2023
In this podcast, they discuss the impact of critical illness on pharmacokinetics, covering absorption, drug distribution, metabolism, clearance, and physiological states. They explore how conditions like shock and decreased GI perfusion affect drug absorption and elimination, providing insightful examples and explanations.
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Pharmacokinetics Broken Into Four Parts
- Pharmacokinetics comprises absorption, distribution, metabolism and elimination and defines drug movement through the body.
- Critical illness alters each component and can markedly change drug concentrations and effects.
Adjust For Reduced Oral Absorption
- Avoid assuming normal oral absorption in critically ill patients because reduced gut perfusion and motility lower bioavailability.
- Give drugs via alternative routes or adjust dosing when patients have shock, gastroparesis, or enteral feeds.
Critical Illness Alters Drug Distribution
- Fluid resuscitation and hypoalbuminaemia change volume of distribution differently for hydrophilic and protein-bound drugs.
- AAG rises in critical illness, lowering free fractions of AAG-bound drugs like lignocaine despite low albumin effects.