Pharmacokinetic Alterations in Critically Ill Patients｜重症藥動學：重症病人體內藥物動力學的變化

Course Title: ICU Drug Issue – Pharmacokinetic Alterations in Critically Ill Patients Instructor: Ya-Han Lee, BCCCP, Wanfang Hospital 🔍 Course Overview Critically ill patients present unique pharmacokinetic and pharmacodynamic challenges. This course explains how critical illness alters drug absorption, distribution, metabolism, and elimination (ADME), and why standard dosing often fails in ICU settings. We introduce a practical framework to adjust drug regimens based on patient condition, disease severity, organ dysfunction, and extracorporeal support (ECMO, CRRT). 🎯 Learning Objectives By the end of this course, participants will be able to: Understand how critical illness alters drug PK/PD profiles Apply patient-specific and drug-specific variables to individualize dosing Recognize altered ADME patterns in ICU patients Identify CRRT and ECMO factors affecting drug elimination Use evidence-based strategies (loading dose, extended infusion, TDM) to optimize therapy 📚 Key Content 1. Altered Absorption in Critical Illness ↓ GI motility ↓ gut perfusion (vasopressors) ↑ gastric pH → reduced absorption of certain antifungals 2. Distribution Changes Fluid resuscitation, capillary leak → ↑ Vd for hydrophilic drugs Obesity → ↑ Vd for lipophilic drugs Hypoalbuminemia → ↑ free drug fraction → ↑ toxicity risk 3. Metabolism & Elimination Augmented renal clearance (ARC) Sepsis-induced organ dysfunction Altered hepatic extraction Drug–drug interactions (CYP450 changes) 4. Extracorporeal Therapy Effects ECMO: drug sequestration, ↑ Vd CRRT: variable clearance depending on flow rates, modality, pre/post-dilution 5. Practical ICU Dosing Strategies Use maximum approved dose in ARC Consider prolonged/continuous infusions Early loading dose, especially in ECMO Monitor residual renal function daily in CRRT Implement TDM where applicable 🩺 Who Should Take This Course? ICU physicians Critical care pharmacists Residents & ICU nurses Anyone managing medications in critically ill patients 重症藥動學：重症病人的藥物吸收、分布、代謝與排泄的改變 講者： 台北醫學大學萬芳醫院重症藥師 Ya-Han Lee, BCCCP 🔍 課程簡介 重症病患的生理變化極大，導致藥物的吸收、分布、代謝與排泄（ADME）完全不同於一般住院病患。本課程以臨床實務為核心，介紹重症病人常見的藥動學變化、器官功能衰竭的影響、ECMO 與 CRRT 對藥物清除率的改變，並提供可立即應用的劑量調整框架。 🎯 學習目標 完成課程後，學員將能： 理解重症對藥動學/藥效學造成的改變 依病患與藥物特性個別化調整劑量 認識 ICU 中改變的 ADME 機制 了解 CRRT 與 ECMO 對藥物的影響 使用 loading dose、延長輸注、TDM 等方法改善治療效果 📚 課程內容重點 1. 吸收的變化 腸胃蠕動下降 低灌流（升壓劑） 胃酸減少 → 某些抗黴菌藥吸收下降 2. 分布體積的改變 重症液體復甦 → ↑ Vd 肥胖病人對脂溶性藥物 Vd ↑ 低白蛋白血症 → 游離藥物增加、毒性上升 3. 代謝與排泄 增加型腎清除（ARC） 敗血症造成腎/肝功能變動 藥物交互作用（CYP450） 4. 體外治療的影響 ECMO： 藥物吸附、Vd CRRT： 清除率依流速、模式、濾器稀釋方式而異 5. ICU 劑量調整原則 ARC：採用核准最大劑量 使用延長或連續輸注 ECMO 優先給予 loading dose CRRT 每日評估剩餘腎功能 適用時使用 TDM 🩺 適合對象 重症醫師 重症藥師 住院醫師 ICU 護理師 所有需要管理重症藥物治療的醫療人員