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Neonatal Pharmacology > GI > Flashcards

GI Flashcards

1
Q

True/False:

Pharmacology of GI drugs in children esp <1 yr there is a significant knowledge gap

A

True

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2
Q

True/false:

Many GI drugs used in neonates have not been thoroughly studied.

A

True

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3
Q

In what situation are anti-emetics in neonates used?

A

Surgical pts

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4
Q

Where is vomiting controlled in the brain?

It has input from what 4 sources?

A

the Vomiting center of the Medulla

  1. Chemoreceptor trigger zone
  2. Cortex
  3. Vestibular apparatus
  4. GI tract
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5
Q

Name 2 anti-emetic agents

A
  1. Promehtazine (most common in U.S.)
    s/e’s: hallucinations, sedation, seizures, HTN, tachycardia
  2. Metoclopramide (Reglan)
    s/e’s: sedation, anti-cholinergic, extrapyramidal (dyskinesia/dystonia) symptoms
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6
Q

There are 4 types of antacids-name them.

A
  1. Sodium Bicarbonate
  2. Calcium Carbonate
  3. Magnesium-containing
  4. Aluminum-containing
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7
Q

Chronic use of Sodium bicarbonate antacids is a/w?

A

Na+ retetion, systemic Alkalosis, milk-alkali syndrome

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8
Q

Which 2 antacid types are most potent and are rapid-acting?

A

Sodium Bicarbonate

Calcium Carbonate

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9
Q

Calcium carbonate has a longer/shorter duration of action than Sodium carbonate but is a/w what adverse side effects?

A

Longer

Hypercalcemia, hypercalciuria, Renal calcium deposits, compromised renal fxn, gastric acid Hyper-secretion.

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10
Q

Magnesium-containing antacids are a/w?

A

Diarrhea, Hypermagnesemia (esp w/compromised renal function)

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11
Q

Aluminum-containing antacids have what s/e’s?

A

Constipation, Hypocalcemia, & Hypophosphatemia

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12
Q

Concomitant use of antacids with other meds may do what?

A

Decrease drug absorption due to alteration in gastric pH.

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13
Q

When should antacids be administered?

A
  • 2 hrs after other drugs to avoid alteration in pH and drug absorption
  • 1 hr after meals
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14
Q

Peds pts who require long-term therapy should be monitored closely for?

A

Adverse effects

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15
Q

Prokinetic Agents do what?

A

Improve Gastric motility

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16
Q

Name 3 examples of Prokinetic Agents

A
  1. Metoclopramide (reglan)
  2. Cisapride
  3. Erythromycin
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17
Q

Which Prokinetic is most commonly used in the NICU?

A

Metoclopramide

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18
Q

Metoclopramide has a combination of central and peripheral __________ antagonism

A

Dopamine antagonism

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19
Q

Metoclopramide works by?

A

Augmentation of acetylcholine release from postganglionic nerve terminals is likely responsible for it’s effect on smooth muscle.

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20
Q

Does Metocloprmaide increase gastric acid secretion, endogenous gastrin release or salivation?

A

No

21
Q

Does Metoclopramide promote the coordination of gastric, pyloric, and duodenal motor function?

A

Yes

22
Q

How does Metocloprmaide accelerate gastric emptying?

A

by increasing gastric tone

23
Q

True/False: Large-scale clinical trials need to be done to test the efficacy and safety of Reglan?

A

True, only small studies have been done.

24
Q

What is significant about Cisapride?

A

Removed from U.S. and Canadian markets d/t safety concerns: Prolonged Q-T interval with associated V. Arrhythmias, underlying cardiac dz, electrolyte disturbances, renal insufficiency, hepatic dysfunction, and concurrent therapy with meds known to alter cardiac conduction intervals.

25
Q

Is Cisapride widely available in other parts of the world?

A

Yes

26
Q

Erythromycin is thought to increase what ?

A

Lower esophageal sphincter tone in the duration but not amplitude of contractions of the distal esophagus in adults with GER

27
Q

The dose of Erythromycin is Larger/Smaller than the dose for antimicrobial therapy?

A

Smaller

28
Q

The effect of EES is similar to the polypeptide hormone ________ (promoting movement of nutrients)

A

Motilin

29
Q

The association with Erythromycin and what condition is a concern?

A

Hypertrophic Pyloric Stenosis

30
Q

When was the association of Erythromycin with pyloric stenosis discovered?

A

After wide-spread use of Erythromycin for Pertussis outbreak in a community–>7x increased rate of pyloric stenosis

31
Q

Is low-dose Erythromycin a/w pyloric stenosis?

A

No

32
Q

H-2 receptor antagonists are the most commonly used drugs in children for?

A
  • Reflux
  • Treatment of gastric/duodenal ulcers
  • Treatment/prophylaxis against GI hemorrhage
33
Q

There are how many H-2 receptor antagonists available for clinical use?

How many for children?

What are they?

A

4

2

Ranitidine & Famotidine

34
Q

H-2 Receptor Antagonists reduce?

A

Gastric acid secretion by inhibiting Histamine at the H2 receptor site.

35
Q

H-2 Receptor Antagonists decrease?

A

Acid-secretory response of parietal cells

36
Q

H-2 Receptor Antagonists are particulary effective in suppressing…?

A

Nocturnal acid production

esp important in those at risk for Duodenal ulcers

37
Q

True/False: H-2 Receptor Antagonists are frequently used in NICU as prophylaxis for gastric stress ulcers

A

True

38
Q

Routine use of H-2 Receptor Antagonists has lead to what concerns?

A

Alteration of gastric pH

may allow for over-growth of pathogenic bacteria and in LWB’s–NEC

39
Q

What are the s/e’s of H-2 Receptor Antagonists?

A

Most common:GI symptoms, Rash, Dizziness

Also: Mania, seizures, gynecomastia, galactorrhea, impotence, possible decrease in spermatogenesis, thrombocytopenia, agranulocytosis

40
Q

True/FalseProton-Pump Inhibitors are the most common GI medication used in the NICU?

A

True

41
Q

Which PPI is the most commonly used?

A

Prevacid (Lansoprazole)

42
Q

There are how many approved PPI’s in the U.S.?

Do any have approved labeling for children <1 y/o?

A

4

No

43
Q

What is Prevacid (Lansoprazole) used for?

A

Tx of reflux esophagitis
Inhibits gastric acid secretion (inhibits H+/K+/ATPase–enzyme responsible for production of HCl- by parietal cells of proton pump)

44
Q

Where is Prevacid metabolized?

A

Liver

45
Q

Onset of action of Prevacid is w/in?
Max effect w/in?
Average T2?

A

1 hr

  1. 5 hrs
  2. 5 hrs
46
Q

Inhibition of Acid secretion is about ___% of maximum at 24 hrs of age with duration of action about ___ hrs.

A

50%

72 hours

47
Q

What are the most common s/e’s of Prevacid?

A

Headache, Nausea, Diarrhea

48
Q

True/False: there is questionable a/w VLBW and late-onset gram negative sepsis

A

True

Neonatal Pharmacology (17 decks)

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