Drug Disposition in Critical Care Patients

Critically ill patients often present with life-threatening conditions, necessitating a range of treatments such as antimicrobials, analgesics, neuromuscular blockers, and inotropes. Indeed, a number of these critically ill patients also present with organ dysfunction. An understanding of how organ dysfunction affects drug pharmacokinetics is relevant for effective management of this group of patients. Pharmacokinetic parameters of certain drugs can change in conditions like hepatic and renal dysfunction, significantly impacting drug concentrations, and eventually efficacy. Therefore, a comprehension of pathophysiological changes that occur in critically ill patients and applying pharmacokinetic principles to optimize pharmacotherapy is vital. In critically ill patients, drug absorption, distribution, metabolism, and excretion could be altered. Variations in hepatic blood flow, glomerular filtration rate, and plasma protein binding can significantly affect drug disposition in critically ill patients. As such, patient-centered care, including therapeutic drug monitoring and dose adjustment may improve clinical outcomes. This chapter delves into drug disposition in critically ill patients, with emphasis on clinical studies and evidence-based dosing algorithms. Summary Critically ill patients often present with life-threatening conditions, necessitating a range of treatments such as antimicrobials, analgesics, neuromuscular blockers, and inotropes. Indeed, a number of these critically ill patients also present with organ dysfunction. An understanding of how organ dysfunction affects drug pharmacokinetics is relevant for effective management of this group of patients. Pharmacokinetic parameters of certain drugs can change in conditions like hepatic and renal dysfunction, significantly impacting drug concentrations, and eventually efficacy. Therefore, a comprehension of pathophysiological changes that occur in critically ill patients and applying pharmacokinetic principles to optimize pharmacotherapy is vital. In critically ill patients, drug absorption, distribution, metabolism, and excretion could be altered. Variations in hepatic blood flow, glomerular filtration rate, and plasma protein binding can significantly affect drug disposition in critically ill patients. As such, patient-centered care, including therapeutic drug monitoring and dose adjustment may improve clinical outcomes. This chapter delves into drug disposition in critically ill patients, with emphasis on clinical studies and evidence-based dosing algorithms. Summary Critically ill patients often present with life-threatening conditions, necessitating a range of treatments such as antimicrobials, analgesics, neuromuscular blockers, and inotropes. Indeed, a number of these critically ill patients also present with organ dysfunction. An understanding of how organ dysfunction affects drug pharmacokinetics is relevant for effective management of this group of patients. Pharmacokinetic parameters of certain drugs can change in conditions like hepatic and renal dysfunction, significantly impacting drug concentrations, and eventually efficacy. Therefore, a comprehension of pathophysiological changes that occur in critically ill patients and applying pharmacokinetic principles to optimize pharmacotherapy is vital. In critically ill patients, drug absorption, distribution, metabolism, and excretion could be altered. Variations in hepatic blood flow, glomerular filtration rate, and plasma protein binding can significantly affect drug disposition in critically ill patients. As such, patient-centered care, including therapeutic drug monitoring and dose adjustment may improve clinical outcomes. This chapter delves into drug disposition in critically ill patients, with emphasis on clinical studies and evidence-based dosing algorithms.