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Midwifery > Drug use in the neonate > Flashcards

Drug use in the neonate Flashcards

1
Q

What is the most effective reliable method of drug administration to a neonate and why?

A

Intravenous

  • you know exactly how much drug is being absorbed into circulation to have an effect
  • removes variables such as vomiting and hepatic first pass effect
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2
Q

What factors affect the absorption of a drug given IM to a neonate?

A
  • less muscle mass
  • thinner cellular membranes and increased capillary density
  • immature circulatory system
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3
Q

what other factors affect drug absorption in the neonate, particularly oral?

A
  • immature GI tract - small surface area, altered pH changes ionisation, changes in bile salt pool
  • decreased gastric emptying
  • less bacterial colonisation of intestines
  • vomiting/reflux
  • reduced compliance
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4
Q

What factors influence drug distribution in the neonate?

A
  • body water:fat percentage (low body fat: high body water)
  • protein binding - lower plasma proteins, bilirubin competes for binding sites on proteins
  • immature blood-brain barrier
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5
Q

What factors influence drug metabolism in the neonate?

A
  • hepatic blood flow increases with age

- immature liver enzymes has variable effect

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6
Q

What factors influence drug elimination in the neonate?

A
  • immature renal function - lower GFR, generally drugs excreted by liver have prolonged elimination half-life
  • gestational age
  • adequate fluid intake
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7
Q

Why are antimicrobials commonly used in neonates?

A
  • immature immune systems

- excessive use has contributed to development of antibiotic resistance - consider judiciousness and safety

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8
Q

What are the risks associated with antimicrobial use in neonates?

A
  • elimination of protective normal flora

- unknown long term impacts

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9
Q

Why are diuretic drugs used in neonates?

A
  • hypertension
  • congestive heart failure
  • renal dysfunction
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10
Q

What are 2 risks of IV administration in neonates?

A
  • potential for overdosage due to incorrect calculations

- potential for infection through IV access site

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11
Q

Why do neonates tend to be at higher risk of dosage calculation errors?

A
  • complex factors influence pharmacokinetics
  • individualised dosing calculations
  • some drugs need to be diluted
  • slow IV rates
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12
Q

What methods are used to calculate drug dosages in the neonate

A
  • weight per kilogram

- body surface area

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13
Q

What is the formula for calculating neonatal drug dosages according to weight per kilogram?

A

dose to be given = recommended dose (mg/kg) x weight (kg)

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14
Q

What is the definition of a neonate?

A

A baby within it’s first 28 days of life.

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15
Q

What strategies may decrease the risk of drug errors for neonates?

A
  • double checking calculations
  • accessible examples of calculations
  • using standardised drug preparations and dosing
  • asking questions about whether a drug should be administered
  • volume should feel appropriate
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16
Q

What is the trade name for benzylpenicillin?

A

BenPen

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17
Q

What is the usual indication for benzylpenicillin in neonates?

A

antibiotic for treatment of susceptible organisms (e.g GBS, congenital syphilis)

18
Q

What is the stock strength and usual dosage of benzylpenicillin for neonates?

A

600mg vial (as powder for reconstitution with water for injection)
depending on and and indication around 50mg/kg/6-12 hrly
as IM or slow IV over 3-5 minutes

19
Q

What adverse effects are associated with benzylpenicillin use in neonates?

A
  • hypersensitiviy
  • rash
  • diarrhoea
  • seizures at high doses
  • haemolytic anaemia
20
Q

What is the usual indication for gentamicin in neonates?

A

aminoglycoside antibiotic for treatment of infections caused by susceptible organisms e.g. e.coli, pseudomonas, klebsiella

21
Q

What is the stock strength and usual dosage of gentamicin for neonates?

A

80mg/2ml ampoules
IV is given diluted as a 10mg/mL solution over 10 minutes
IM is used undiluted
dose depends on gestation, given 24-48 hourly

22
Q

What precautions/side effects are associated with the use of gentamicin in neonates?

A
  • high risk medication
  • can cause renal impairment and deafness
  • usually used with therapeutic drug monitoring loking at area under curve, peak and trough levels of drug over time
23
Q

What is the trade name of caffeine citrate?

A

Cafnea

24
Q

What is the usual indication for caffeine citrate in neonates?

A
  • stimulates inspiratory drive and increases sensitive of medullary centre to CO2
  • used for prevention or treatment of apnoea associated with prematurity, infection or anaesthesia and to aid extubation of ventilated babies
25
Q

What is the stock strength and usual dosage of caffeine citrate for neonates?

A

available as oral solution 10mg/ml or 50mg/5 ml ampoule for IV infusions
loading dose is 20mg/kg with maintenance dose of 5-7.5mg/kg/day at least 24 hours later (need to dilute maintenance dose)
- give oral dose with feeds
- routine monitoring of drug levels not required

26
Q

What adverse effects are associated with caffeine citrate?

A
  • nausea/vomiting
  • gastric irritation
  • agitation
  • tachycardia
  • diuresis
  • overdose - arrhythmias and seizures
27
Q

What is the trade name of Vitamin K (phytomenadione)?

A

Konakion

28
Q

What is the usual indication for phytomenadione in neonates?

A
  • prophylaxis for vitamin K deficiency bleeding in the newborn
  • no colonisation of gut with bacteria that produce vitamin k, poorly transferred across placenta and low concentrations in breastmilk, vital for clotting pathways
29
Q

When should phytomenadione be given to neonates?

A
  • with maternal consent within 24 hours of birth
30
Q

What is the usual stock strength, route and dose of phytomenadione in neonates?

A

2mg/0.2mL ampoules
Can be given IM (preferred) or orally in 3 doses
usual dose is 1mg (0.1ml) IM at birth
if orally 2mg(0.2ml) at birth, 3-5 days and 4 weeks, last dose omitted if formula fed

31
Q

What adverse effects are associated with phytomenadione?

A
  • very few
  • facial flushing, sweating and unusual taste
  • rarely anaphylaxis or injection site reactions
32
Q

What is the protocol if there is a neonatal drug error or near miss?

A
  • location specific
  • assess clinical situation
  • report incident to shift coordinator and medical officer
  • seek advice from pharmacy
  • inform patient as appropriate
  • documentation
33
Q

What is therapeutic drug monitoring?

A

Therapeutic drug monitoring is the individualisation of dosage by maintaining plasma or blood drug concentrations within a target therapeutic range to maximise therapeutic effects and avoid adverse effects

34
Q

Which neonatal drugs are often used with TDM?

A
  • caffeine citrate
  • phenobarbitol
  • phenytoin
  • gentamicin
  • vancomycin
  • digoxin
35
Q

What 7 pieces of information are required to accurately perform TDM?

A
  • Time of sample in relation to last dose
  • Duration of treatment at the current dose levels
  • Dosing schedule
  • Age and gender of patient
  • Other concurrent drug therapies
  • Relevant disease states
  • Reason TDM requested i.e. suspected toxicity or lack of efficacy.
36
Q

What is the trade name of beractant? and what is its usual indication in neonates?

A
  • Survanta

- pulmonary surfactant used for prevention or treatment of respiratory distress syndrome

37
Q

What is the stock strength and usual dose of beractant in neonates?

A
  • 25mg/8mL vial stored in refridgerator, warm to room temp before use
  • usual dose is 4mL/kg/dose administered through intratracheal tube
  • up to 4 doses at 6 hourly invervals
38
Q

What adverse effects may be associated with beractant?

A
  • transient bradycardia
  • oxygen desaturation
  • ETT reflux
  • pallor
  • vasoconstriction
  • hypo/hypertension
  • apnoea
39
Q

What is the definition of apnoea in neonates?

A
  • no effective respiratory effort for 20 seconds or shorter if associated with bradycardia
40
Q

What is the usual management for apnoea in neonates?

A

caffeine citrate

41
Q

Why may sucrose be given to neonates?

A
  • for relief of procedural pain
  • effect lasts 5-8 minutes
  • more effective if combined with sucking
42
Q

What is the usual dose for sucrose in the healthy term neonate?

A

stock strength 33% sucrose solution

0.2-1mL PO max dose 5ml

Midwifery (27 decks)

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