ECMO Pharmacology and Drug Management Flashcards
6 cards from real ECMO practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 ECMO Pharmacology and Drug Management flashcards as text
Which pharmacokinetic property makes a drug most susceptible to sequestration in an ECMO circuit?
Answer: High lipophilicity and high protein binding
Lipophilic, highly protein-bound drugs bind to PVC tubing and the oxygenator membrane, significantly increasing apparent volume of distribution.
Which antibiotic requires the most aggressive therapeutic drug monitoring (TDM) in ECMO patients due to significant circuit sequestration?
Answer: Vancomycin
Vancomycin is highly protein-bound and binds to ECMO circuit components, necessitating TDM to ensure therapeutic levels.
Which antifungal agent demonstrates clinically significant sequestration in ECMO circuits due to its lipophilic properties?
Answer: Voriconazole
Voriconazole is highly lipophilic and binds extensively to ECMO circuit materials, requiring dose escalation and TDM.
What is the preferred alternative anticoagulant for ECMO patients diagnosed with heparin-induced thrombocytopenia (HIT)?
Answer: Bivalirudin
Bivalirudin is a direct thrombin inhibitor that does not cross-react with HIT antibodies and is the preferred heparin alternative during ECMO.
Fentanyl is significantly sequestered in ECMO circuits primarily because it is:
Answer: Highly lipophilic with high protein binding
Fentanyl's high lipophilicity and protein binding cause it to adsorb onto ECMO tubing and the oxygenator, reducing effective plasma concentrations.
Which vasopressor is considered first-line for maintaining mean arterial pressure (MAP) in VA-ECMO patients with vasodilatory shock?
Answer: Norepinephrine
Norepinephrine is the first-line vasopressor in VA-ECMO due to its potent alpha-adrenergic vasoconstriction with modest beta-1 activity.