ECMO ECMO Pharmacology and Drug Management 3

Question 1

Which pharmacokinetic parameter is most significantly increased by ECMO in critically ill patients?

Accepted Answer

Volume of distribution (Vd)

Answer

Renal clearance

Answer

Protein binding affinity

Answer

Hepatic extraction ratio

Question 2

Corticosteroid therapy in VA-ECMO patients with refractory vasodilatory shock is aimed at treating:

Accepted Answer

Critical illness-related corticosteroid insufficiency (CIRCI)

Answer

ECMO circuit-induced immunosuppression

Answer

Coagulopathy of critical illness

Answer

Oxygenator membrane inflammation

Question 3

Argatroban, used in HIT patients on ECMO, is monitored using which laboratory test?

Accepted Answer

Activated clotting time (ACT) or aPTT

Answer

Anti-Xa level

Answer

Thromboelastography (TEG) only

Answer

Platelet function assay

Question 4

Milrinone is sometimes used in ECMO patients because it improves cardiac function by:

Accepted Answer

Inhibiting phosphodiesterase III to increase cAMP and improve contractility with vasodilation

Answer

Activating alpha-adrenergic receptors to increase afterload

Answer

Blocking beta-receptors to reduce myocardial oxygen demand

Answer

Directly stimulating myocardial calcium channels

Question 5

Which packed red blood cell (pRBC) transfusion threshold is commonly targeted in stable VV-ECMO patients without active hemorrhage?

Accepted Answer

Hgb <10 g/dL

Answer

Hgb <7 g/dL

Answer

Hgb <12 g/dL

Answer

Hgb <14 g/dL

Question 6

Prolonged aminoglycoside use in ECMO patients requires monitoring for which organ-specific toxicity?

Accepted Answer

Nephrotoxicity and ototoxicity

Answer

Hepatotoxicity

Answer

Pulmonary fibrosis

Answer

Bone marrow suppression