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

Описание: 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