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Cardiovascular II Exam 3 > Intro to Pediatric Pharm - SRS > Flashcards

Intro to Pediatric Pharm - SRS Flashcards

1
Q

How does sulfonamide impact a baby?

A

—Displaces bilirubin from protein-binding sites, bilirubin deposits in the brain, results in encephalopathy and causing kernicterus.

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2
Q

What can chloramphenicol do to a baby?

A

grey baby syndrome

—Abdominal distension, vomiting, diarrhea, characteristic gray color, respiratory distress, hypotension, progressive shock

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3
Q

What drug causes phocomelia?

A

Thalidomide

—Congenital abnormalities; also: polyneuritis, nerve damage, mental retardation

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4
Q

Describe the oral drug absorption of drugs in neonates.

A
  • —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 ↑
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5
Q

What are some factors that influence IM drug absorption in neonates?

A

—Absorption inconsistent due to differences in:

¢Muscle mass

¢Poor perfusion (erratic blood flow)

¢Peripheral vasomotor instability

¢Insufficient muscle contractions

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6
Q

Transdermal drug absorption is directly related to what?

A

¢Degree of skin hydration

¢Relative absorptive area

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7
Q

Transdermal drug absorption is inversely related to?

A

Thickness of stratum corneum

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8
Q

What are some factors that cause substantially increased percutaneous absorption in these patients?

A

¢Underdeveloped epidermal barrier

¢Compromised skin integrity

¢Increased skin hydration

¢Ratio of BSA to total body weight highest in youngest

¢Relative systemic exposure higher

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9
Q

What are some cases where rectal drug administration is wise?

A

—May be important alternative site when oral agents cannot be used:

¢Nausea

¢Vomiting

¢Seizure activity

¢Preparation for surgery

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10
Q

The younger a patient is, the higher the volume of distribution will be. What does this mean for us?

A

Means we must give a higher dose per kg to younger patients for efficacy.

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11
Q

Why is ceftriaxone contraindicated in babies?

A

Can displace bilirubin from albumin and cause jaundice -> kernicterus

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12
Q

When does glomerular filtration hit maximum efficiency?

A

¢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

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13
Q

Neonatal sepsis incidence is inversely proportional to birth weight and gestational age. What are the risk factors?

A
  • —Preterm birth
  • —Maternal GBS colonization
  • —Rupture of membranes > 18 hours
  • —Maternal signs/symptoms of intra-amniotic infection
  • —Ethnicity
  • —Male sex
  • —Low Apgar scores
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14
Q

What are some common sources of medication errors?

A
  1. Weight based dosing calculation errors
  2. Unit conversions and decimal point errors
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15
Q

What are some methods to reduce potential errors for both in and outpatient settings?

A

¢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
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16
Q

What are some criteria for identifying chorioamnionitis?

A
  • —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

17
Q

What will ampicilling be useful for?

Gentamicin?

A

Gentimicin - Gram negatives

Ampicillin - Gram positives

18
Q

What is the MOA for ampicillin?

A

Inhibits bacterial wall synthesis

19
Q

MOA for gentamicin?

A

Inhibits bacterial protein synthesis

20
Q

MOA for third gen cephalosporin?

A

Inhibits bacterial cell wall synthesis

21
Q

MOA for Acyclovir?

A

Inhibits viral DNA synthesis and viral replication

22
Q

What characterizes the pathophysiology of the acute phase of viral myocarditis?

A

—Acute phase: inflammatory cell invasion of myocardium and myocardial necrosis and apoptosis

23
Q

When do T cells strike in viral myocarditis?

A

7-14 days later.

24
Q

What is the pathophysiology of the healing phase in viral myocarditis like?

A

—myocardial fibrosis; continued inflammation and persistent viremia may lead to left ventricular dysfunction and dilation

25
Q

What are the treatment protocols for acute phase viral myocarditis?

A
  • —Inotropes
  • —Afterload reduction
  • —Mechanical ventilation
  • —Extracorporeal membrane oxygenation (ECMO)
  • —Immune therapy
    • Intravenous immunoglobulin (IVIG)
    • Immunosuppressive agents
26
Q

What is the MOA of IVIG in tx of Viral myocarditis?

A

¢protects recipient against infection and suppresses inflammatory and immune mediated processes

27
Q

What are the adverse drug reactions of IVIG?

A
  • —Chills, fever, flushing, myalgia, malaise, headache
  • —Tachycardia, chest tightness, dyspnea, sense of doom
  • —Thrombotic complications
  • —Acute kidney injury
28
Q

What are the neonatal indications for extracorporeal membrane oxygenation (ECMO)?

(6)

A
  1. —Primary pulmonary hypertension
  2. —Meconium aspiration syndrome
  3. —Respiratory distress syndrome
  4. —Group B Streptococcal sepsis
  5. —Asphyxia
  6. —Congenital diaphragmatic hernia
29
Q

What aare some ECMO complications?

A

¢Clots in circuit (19%)

¢Oxygenator failure

¢Seizures

¢Intracranial bleeding

¢Hemolysis and coagulopathy

¢Arrhythmias

¢Oliguria (within 24-48 hours)

¢Metabolic acidosis

30
Q

What therapy must be included as adjunct to EMCO?

A

Antithrombotics

31
Q

What are some things you should think about when putting a patient on ECMO?

A

¢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

32
Q
A

Cardiovascular II Exam 3 (15 decks)

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