ECMO ECMO Pharmacology and Drug Management

Question 1

Which pharmacokinetic property makes a drug most susceptible to sequestration in an ECMO circuit?

Accepted Answer

High lipophilicity and high protein binding

Answer

Lipophilic, highly protein-bound drugs bind to PVC tubing and the oxygenator membrane, significantly increasing apparent volume of distribution.

Question 2

Which antibiotic requires the most aggressive therapeutic drug monitoring (TDM) in ECMO patients due to significant circuit sequestration?

Accepted Answer

Vancomycin

Answer

Vancomycin is highly protein-bound and binds to ECMO circuit components, necessitating TDM to ensure therapeutic levels.

Question 3

Which antifungal agent demonstrates clinically significant sequestration in ECMO circuits due to its lipophilic properties?

Accepted Answer

Voriconazole

Answer

Voriconazole is highly lipophilic and binds extensively to ECMO circuit materials, requiring dose escalation and TDM.

Question 4

What is the preferred alternative anticoagulant for ECMO patients diagnosed with heparin-induced thrombocytopenia (HIT)?

Accepted Answer

Bivalirudin

Answer

Bivalirudin is a direct thrombin inhibitor that does not cross-react with HIT antibodies and is the preferred heparin alternative during ECMO.

Question 5

Fentanyl is significantly sequestered in ECMO circuits primarily because it is:

Accepted Answer

Highly lipophilic with high protein binding

Answer

Fentanyl's high lipophilicity and protein binding cause it to adsorb onto ECMO tubing and the oxygenator, reducing effective plasma concentrations.

ECMO - Extracorporeal Membrane Oxygenation Practice Test