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Category: Critical Care Medicine-Pharmacology and Toxicology--->Basic Pharmacologic Principles
Page: 1

Question 1# Print Question

A 52-year-old woman is admitted to the ICU, who is s/p orthotopic liver transplant 2 weeks ago, for septic shock requiring vasopressor support. Pertinent past medical history includes an unprovoked pulmonary embolism 3 months ago for which she takes apixaban 5 mg twice daily at home. Review of systems reveals normal renal function, active bowel sounds with two recent bowel movements, and a Glasgow Coma Score of 15. In the presence of distributive shock requiring vasopressor support, with regard to absorption, which scheduled medications would you be most concerned about?

A. Subcutaneous enoxaparin
B. Sublingual tacrolimus
C. Intravenous hydrocortisone
D. Oral mycophenolate


Question 2# Print Question

A 49-year-old man is admitted to the ICU for hemodynamic instability and ventilator weaning following surgery for a bowel perforation. His past medical history includes Crohn disease for which he takes adalimumab 40 mg once weekly. He was hospitalized 2 weeks ago for medical management of a bowel obstruction. He is started empirically on piperacillin/tazobactam and vancomycin, and 5 µg/min of norepinephrine to maintain a mean arterial pressure of at least 65 mm Hg. Over next 24 hours, the patient decompensates and is now requiring 37 µg/min of norepinephrine and 0.03 units/min of vasopressin to maintain a mean arterial pressure of 65 mm Hg, despite fluid resuscitation with 3 L of lactated ringers. He is currently anuric, is not responsive to fluids, and appears volume overloaded. Given his risk factors for multidrug-resistant organisms, his antibiotic regimen is broadened to meropenem, amikacin, daptomycin, and micafungin.

When determining dose of amikacin for this patient, what considerations should be made?

A. Decrease the dose because of diminished renal clearance
B. Increase the dosing frequency because of the increased volume of distribution
C. Increase the dose because of the increased volume of distribution
D. Decrease the dose because of decreased protein binding


Question 3# Print Question

Which pathophysiological change seen in critically ill patients most frequently makes medication dosage adjustment necessary?

A. Decreased plasma protein binding
B. Decreased renal clearance
C. Diminished GI or subcutaneous perfusion
D. Inhibition of hepatic enzymes


Question 4# Print Question

Fentanyl, a drug with a high extraction ratio, will be most influenced by which critical illness–related metabolic abnormality?

A. Decreased hepatic blood flow
B. Decreased intrinsic clearance
C. Decreased protein binding
D. Decreased functional hepatocytes


Question 5# Print Question

Phenytoin, a drug with a low extraction ratio, will be most influenced by which critical illness–related metabolic abnormality?

A. Decreased hepatic blood flow
B. Decreased intrinsic clearance
C. Decreased protein binding
D. Decreased acetylation




Category: Critical Care Medicine-Pharmacology and Toxicology--->Basic Pharmacologic Principles
Page: 1 of 2