Intro to Pediatric Pharm - SRS Flashcards
How does sulfonamide impact a baby?
Displaces bilirubin from protein-binding sites, bilirubin deposits in the brain, results in encephalopathy and causing kernicterus.
What can chloramphenicol do to a baby?
grey baby syndrome
Abdominal distension, vomiting, diarrhea, characteristic gray color, respiratory distress, hypotension, progressive shock
What drug causes phocomelia?
Thalidomide
Congenital abnormalities; also: polyneuritis, nerve damage, mental retardation
Describe the oral drug absorption of drugs in neonates.
- Gastric volume ↓
- Gastric acid ↓ (gastric pH ↑)
- Increased absorption of acid labile drugs (penicillin G, erythromycin)
- Decreased absorption of weakly acidic drugs (phenobarbital, phenytoin)
- Extrauterine factors (nutrition) most likely responsible for initiating acid production
- Transport of bile acids ↓
- Gastric emptying ↓, intestinal transit time ↑
What are some factors that influence IM drug absorption in neonates?
Absorption inconsistent due to differences in:
¢Muscle mass
¢Poor perfusion (erratic blood flow)
¢Peripheral vasomotor instability
¢Insufficient muscle contractions
Transdermal drug absorption is directly related to what?
¢Degree of skin hydration
¢Relative absorptive area
Transdermal drug absorption is inversely related to?
Thickness of stratum corneum
What are some factors that cause substantially increased percutaneous absorption in these patients?
¢Underdeveloped epidermal barrier
¢Compromised skin integrity
¢Increased skin hydration
¢Ratio of BSA to total body weight highest in youngest
¢Relative systemic exposure higher
What are some cases where rectal drug administration is wise?
May be important alternative site when oral agents cannot be used:
¢Nausea
¢Vomiting
¢Seizure activity
¢Preparation for surgery
The younger a patient is, the higher the volume of distribution will be. What does this mean for us?
Means we must give a higher dose per kg to younger patients for efficacy.
Why is ceftriaxone contraindicated in babies?
Can displace bilirubin from albumin and cause jaundice -> kernicterus
When does glomerular filtration hit maximum efficiency?
¢Ability to filter, excrete, reabsorb not maximized until 1 year
¢Rapid rise in GFR:
¢Increased renal blood flow
¢Increased function of nephrons
¢Appearance of additional nephrons
Neonatal sepsis incidence is inversely proportional to birth weight and gestational age. What are the risk factors?
- Preterm birth
- Maternal GBS colonization
- Rupture of membranes > 18 hours
- Maternal signs/symptoms of intra-amniotic infection
- Ethnicity
- Male sex
- Low Apgar scores
What are some common sources of medication errors?
- Weight based dosing calculation errors
- Unit conversions and decimal point errors
What are some methods to reduce potential errors for both in and outpatient settings?
¢Methods to Reduce Potential Medication Errors:
- Standard concentrations
- Smart pump technology
- Barcoding
- Electronic prescribing
¢Outpatient Setting:
- Patient specific information on Rx
- Appropriate medication measurement tools
What are some criteria for identifying chorioamnionitis?
- Clinical diagnosis – maternal fever (≥ 38 ˚C; 100.4 ˚ F)
- Other criteria used in clinical trials (2 of the following):
¢Maternal leukocytosis > 15,000 cells/mm3
¢Maternal tachycardia > 100 bpm
¢Fetal tachycardia > 160 bpm
¢Uterine tenderness
¢Foul odor of amniotic fluid
What will ampicilling be useful for?
Gentamicin?
Gentimicin - Gram negatives
Ampicillin - Gram positives
What is the MOA for ampicillin?
Inhibits bacterial wall synthesis
MOA for gentamicin?
Inhibits bacterial protein synthesis
MOA for third gen cephalosporin?
Inhibits bacterial cell wall synthesis
MOA for Acyclovir?
Inhibits viral DNA synthesis and viral replication
What characterizes the pathophysiology of the acute phase of viral myocarditis?
Acute phase: inflammatory cell invasion of myocardium and myocardial necrosis and apoptosis
When do T cells strike in viral myocarditis?
7-14 days later.
What is the pathophysiology of the healing phase in viral myocarditis like?
myocardial fibrosis; continued inflammation and persistent viremia may lead to left ventricular dysfunction and dilation
What are the treatment protocols for acute phase viral myocarditis?
- Inotropes
- Afterload reduction
- Mechanical ventilation
- Extracorporeal membrane oxygenation (ECMO)
- Immune therapy
- Intravenous immunoglobulin (IVIG)
- Immunosuppressive agents
What is the MOA of IVIG in tx of Viral myocarditis?
¢protects recipient against infection and suppresses inflammatory and immune mediated processes
What are the adverse drug reactions of IVIG?
- Chills, fever, flushing, myalgia, malaise, headache
- Tachycardia, chest tightness, dyspnea, sense of doom
- Thrombotic complications
- Acute kidney injury
What are the neonatal indications for extracorporeal membrane oxygenation (ECMO)?
(6)
- Primary pulmonary hypertension
- Meconium aspiration syndrome
- Respiratory distress syndrome
- Group B Streptococcal sepsis
- Asphyxia
- Congenital diaphragmatic hernia
What aare some ECMO complications?
¢Clots in circuit (19%)
¢Oxygenator failure
¢Seizures
¢Intracranial bleeding
¢Hemolysis and coagulopathy
¢Arrhythmias
¢Oliguria (within 24-48 hours)
¢Metabolic acidosis
What therapy must be included as adjunct to EMCO?
Antithrombotics
What are some things you should think about when putting a patient on ECMO?
¢Site of drug delivery
Directly into patient?
Proximal, distal, or directly into venous reservoir?
¢Hemodilution
Circulating blood volume will double (blood mixing with priming solution) affecting drugs with small volumes of distribution and those that are highly protein bound
¢Drug binding interactions with the circuit
Adsorption and sequestration onto plastic cannula and/or silicone oxygenator
¢Altered renal, hepatic, and cerebral blood flow
Non-pulsatile blood flow
