Overcoming barriers to optimal drug dosing during ECMO in critically ill adult patients

Introduction: One major challenge to achieving optimal patient outcome in extracorporeal membrane oxygenation (ECMO) is the development of effective dosing strategies in this critically ill patient population. Suboptimal drug dosing impacts on patient outcome as patients on ECMO often require revers...

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Main Authors:	Cheng, Vesa, Abdul-Aziz, Mohd Hafiz, Roberts, Jason A., Shekar, Kiran
Format:	Article
Language:	English English English
Published:	Taylor & Francis 2019
Subjects:	RM Therapeutics. Pharmacology RM300 Drugs and their action RS Pharmacy and materia medica
Online Access:	http://irep.iium.edu.my/72299/ http://irep.iium.edu.my/72299/ http://irep.iium.edu.my/72299/ http://irep.iium.edu.my/72299/1/72299_Overcoming%20barriers%20to%20optimal%20drug_article.pdf http://irep.iium.edu.my/72299/2/72299_Overcoming%20barriers%20to%20optimal%20drug_wos.pdf http://irep.iium.edu.my/72299/3/72299_Overcoming%20barriers%20to%20optimal%20drug_scopus.pdf

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recordtype	eprints
spelling	iium-722992019-11-17T18:37:55Z http://irep.iium.edu.my/72299/ Overcoming barriers to optimal drug dosing during ECMO in critically ill adult patients Cheng, Vesa Abdul-Aziz, Mohd Hafiz Roberts, Jason A. Shekar, Kiran RM Therapeutics. Pharmacology RM300 Drugs and their action RS Pharmacy and materia medica Introduction: One major challenge to achieving optimal patient outcome in extracorporeal membrane oxygenation (ECMO) is the development of effective dosing strategies in this critically ill patient population. Suboptimal drug dosing impacts on patient outcome as patients on ECMO often require reversal of the underlying pathology with effective pharmacotherapy in order to be liberated of the life-support device. Areas covered: This article provides a concise review of the effective use of antibiotics, analgesics, and sedative by characterizing the specific changes in PK secondary to the introduction of the ECMO support. We also discuss the barriers to achieving optimal pharmacotherapy in patients on ECMO and also the current and potential research that can be undertaken to address these clinical challenges. Expert opinion: Decreased bioavailability due to sequestration of drugs in the ECMO circuit and ECMO induced PK alterations are both significant barriers to optimal drug dosing. Evidence-based drug choices may minimize sequestration in the circuit and would enable safety and efficacy to be maintained. More work to characterize ECMO related pharmacodynamic alterations such as effects of ECMO on hepatic cytochrome system are still needed. Novel techniques to increase target site concentrations should also be explored. Taylor & Francis 2019-02-01 Article PeerReviewed application/pdf en http://irep.iium.edu.my/72299/1/72299_Overcoming%20barriers%20to%20optimal%20drug_article.pdf application/pdf en http://irep.iium.edu.my/72299/2/72299_Overcoming%20barriers%20to%20optimal%20drug_wos.pdf application/pdf en http://irep.iium.edu.my/72299/3/72299_Overcoming%20barriers%20to%20optimal%20drug_scopus.pdf Cheng, Vesa and Abdul-Aziz, Mohd Hafiz and Roberts, Jason A. and Shekar, Kiran (2019) Overcoming barriers to optimal drug dosing during ECMO in critically ill adult patients. Expert Opinion on Drug Metabolism and Toxicology, 15 (2). pp. 103-112. ISSN 1742-5255 https://www.tandfonline.com/doi/abs/10.1080/17425255.2019.1563596?journalCode=iemt20 10.1080/17425255.2019.1563596
repository_type	Digital Repository
institution_category	Local University
institution	International Islamic University Malaysia
building	IIUM Repository
collection	Online Access
language	English English English
topic	RM Therapeutics. Pharmacology RM300 Drugs and their action RS Pharmacy and materia medica
spellingShingle	RM Therapeutics. Pharmacology RM300 Drugs and their action RS Pharmacy and materia medica Cheng, Vesa Abdul-Aziz, Mohd Hafiz Roberts, Jason A. Shekar, Kiran Overcoming barriers to optimal drug dosing during ECMO in critically ill adult patients
description	Introduction: One major challenge to achieving optimal patient outcome in extracorporeal membrane oxygenation (ECMO) is the development of effective dosing strategies in this critically ill patient population. Suboptimal drug dosing impacts on patient outcome as patients on ECMO often require reversal of the underlying pathology with effective pharmacotherapy in order to be liberated of the life-support device. Areas covered: This article provides a concise review of the effective use of antibiotics, analgesics, and sedative by characterizing the specific changes in PK secondary to the introduction of the ECMO support. We also discuss the barriers to achieving optimal pharmacotherapy in patients on ECMO and also the current and potential research that can be undertaken to address these clinical challenges. Expert opinion: Decreased bioavailability due to sequestration of drugs in the ECMO circuit and ECMO induced PK alterations are both significant barriers to optimal drug dosing. Evidence-based drug choices may minimize sequestration in the circuit and would enable safety and efficacy to be maintained. More work to characterize ECMO related pharmacodynamic alterations such as effects of ECMO on hepatic cytochrome system are still needed. Novel techniques to increase target site concentrations should also be explored.
format	Article
author	Cheng, Vesa Abdul-Aziz, Mohd Hafiz Roberts, Jason A. Shekar, Kiran
author_facet	Cheng, Vesa Abdul-Aziz, Mohd Hafiz Roberts, Jason A. Shekar, Kiran
author_sort	Cheng, Vesa
title	Overcoming barriers to optimal drug dosing during ECMO in critically ill adult patients
title_short	Overcoming barriers to optimal drug dosing during ECMO in critically ill adult patients
title_full	Overcoming barriers to optimal drug dosing during ECMO in critically ill adult patients
title_fullStr	Overcoming barriers to optimal drug dosing during ECMO in critically ill adult patients
title_full_unstemmed	Overcoming barriers to optimal drug dosing during ECMO in critically ill adult patients
title_sort	overcoming barriers to optimal drug dosing during ecmo in critically ill adult patients
publisher	Taylor & Francis
publishDate	2019
url	http://irep.iium.edu.my/72299/ http://irep.iium.edu.my/72299/ http://irep.iium.edu.my/72299/ http://irep.iium.edu.my/72299/1/72299_Overcoming%20barriers%20to%20optimal%20drug_article.pdf http://irep.iium.edu.my/72299/2/72299_Overcoming%20barriers%20to%20optimal%20drug_wos.pdf http://irep.iium.edu.my/72299/3/72299_Overcoming%20barriers%20to%20optimal%20drug_scopus.pdf
first_indexed	2023-09-18T21:42:26Z
last_indexed	2023-09-18T21:42:26Z
_version_	1777413229306183680

Overcoming barriers to optimal drug dosing during ECMO in critically ill adult patients

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