Extra Pharm Flashcards
1
Q
What factors are unique about neonatal devo pharmacokinetics?
A
- Slower GI, but faster IM absorption
- More body water than lipid in early life
- Limited protein binding
- Larger liver/body weight ratio (and brain/body weight)
- Immature enzymes
- Higher BBB permeability
- Immature renal function
2
Q
How can drug 1/2 lives vary in neonates/young children?
A
- Half-lives are longer in the neonate than the young child or adult
- Dose adjustment may be necessary on an ongoing basis: ex of Phenytoin pharmacokinetics changing as the neonate ages, even over a period of days
3
Q
How should drugs be adjusted for neonates?
A
- Based on weight or surface area ratio to adults
4
Q
How does breast milk affect drug transfer to the infant?
A
- Acidic pH and high fat content, so will concentrate bases and lipid-soluble drugs
- Lower transfer of highly protein-bound drugs
- Drugs with shorter half-lives preferred; dose immediately after feeding, allowing levels to decline
- Most cautious in early post-partum -> alveolar cells in breast milk buds mature in response to prolactin, reducing drug transfer to milk
5
Q
Breastfeeding: Chloral hydrate
A
Drowsiness if fed at peak concentrations
6
Q
Breastfeeding: Chloramphenicol
A
- Antimicrobial
- Grey baby syndrome if given directly to infant: vomiting, grey skin, hypotension, CV collapse, etc.
- Blood dyscrasias and bone marrow suppression if exposed via breast milk
7
Q
Breastfeeding: Diazepam
A
Sedation; accumulation in neonates
8
Q
Breastfeeding: Heroin
A
Can produce narcotic dependence
9
Q
Breastfeeding: Iodine (labeled)
A
Thyroid suppression
10
Q
Breastfeeding: Lithium
A
Avoid unless levels quantitated
11
Q
Breastfeeding: Methadone
A
Withdrawal if drug interrupted
12
Q
Breastfeeding: PTU
A
Thyroid suppressed
13
Q
Oxytocin
A
- Most common drug used to induce labor
- Half-life 10-12 minutes; discontinuation of the drug an effective way to alleviate adverse effects (MC: uterine hyperstimulation)
- Excessive doses can predispose to post-partum bleeding
1. Can also cause hyponatremia due to anti-diuretic effect
14
Q
Dinoprostone
A
- PGE2: timed-release suppository left in place for 12 hours -> can be removed if hyperstimulation occurs
- Cervical ripening
- GI side effects and fever uncommon with vaginal administration
- Can start Oxytocin 30-60 min after removal
15
Q
Misoprostol
A
- PGE1
- Intravaginal tablets Q3-6 hrs
- Oxytocin should NOT be given within 4 hours of last dose
16
Q
Carboprost tromethamine
A
- PGF-2-alpha
- Oxytocic properties (labor induction), and can reduce post-partum bleeding
17
Q
Magnesium sulfate
A
- Parenteral: anti-convulsant that depresses the CNS and blocks peripheral neuromuscular transmission
- To treat hypomagnesemia
- Prevent/control preeclampsia/eclampsia; contraindicated in women with Myasthenia Gravis
- IV: immediate effect, lasting 30 minutes
1. IM: onset in 1 hour, and lasts around 4 hours - Crosses placenta, and excreted into breast milk, but no reported problems
- Renal excretion: Mg reabsorbed -> impaired renal function can lead to toxicity, characterized by flushing, nausea, blurry vision, headache, hypotension, and pulm edema
- Orally: laxative effect
18
Q
Indomethacin
A
- Non-selective COX INH: delays/prevents premature parturition
- Loading dose, followed by more doses Q6hrs
- Maternal side effects: related to GI tract (N/V, gastritis, reflux), platelet dysfunction
- Fetal side effects: premature closure of ductus arteriosus, oligohydramnios
- Seems to be safe and effective as a tocolytic when used for a short period of time
19
Q
Menotropin
A
- From urine of post-menopausal women
- Contains FSH, LH (IM injection) -> INFERTILITY TX
- Recombinant FSH also used subq
20
Q
How does estrogen affect protein synthesis?
A
- INC synthesis of several hepatic proteins: TBG, transcortin, SHBG, clotting factors
21
Q
Ethinyl estradiol
A
- Synthetic estrogen -> ethinyl groups greatly reduce hepatic metabolism (can’t give native estrogens orally)
22
Q
Clomiphene/Fulvestrant
A
- Ovulation induction for infertility in anovulatory women
- Anti-estrogens (SERD’s)
- Act on ER’s in the hypothalamus to block feedback INH of natural estrogens and stimulate release of GnRH, which stimulates pituitary to INC LH and FSH secretion, leading to ovulation
- Can be used to treat PCOS
23
Q
Minipill
A
- Low-dose progestin: blocks ovulation in 60-80% of cycles
- Impairs sperm transport by thickening cervical mucus
- DEC motility of ovules in oviduct, altering endo to impair implantation
- Taken daily and continuously
- Best for women who are breastfeeding or over 35 and smoke
- May cause acne and weight gain
24
Q
How can combo pills be used to treat PCOS?
A
- Used “off-label”
- Reduced dysfunctional uterine bleeding, and dysmenorrhea
- Menstrual regularity, INC hemoglobin
- Raise SHBG, DEC androgens, so less hirsutism and acne
25
Who can't use the transdermal combo patch?
- Women \>90kg because too much adipose tissue
26
Depo-provera
- Progesterone only =\> usually medroxyprogesterone
- _Injected every 3 months_
- Amenorrhea common, but irregular bleeding can occur
- AE's: weight gain, headache, _DEC bone density_
- Discontinue after 2 years, unless no other alternative -\> _6-12 mo delayed fertility_
27
Copper IUD
- 10-15 years
- Spermicidal -\> fertility quickly restored upon removal
- FDA-approved for dysmenorrhea bc \< blood loss
- AE's: copper may cause cramping
28
Mifepristone
- Blocks binding of progesterone to its receptor
- FDA-approved for termination of pregnancy
- Main side effect is abdominal cramping
29
Spironolactone
- Primarily used as an aldosterone antagonist for the tx of primary or secondary hyperaldosterism or as an antihypertensive (diuretic)
- Competes for testosterone receptor
- Used as a treatment for hirsuitism in women
