Meds for neonatal apnea

Question 1

Methylxanthines

Answer 1

1st line of therapy for apnea

Question 2

Methylxanthines mechanisms of action

Answer 2

Respiratory center stimulation
Improvements in respiratory muscle contraction
improved cardiac output, improved oxygenation, anti-inflammatory action in immature lung

Question 3

Pharmacokinetics definition

Answer 3

what the body does to administered drug
Includes: absorption, distribution, metabolism, excretion, onset of action, duration of affect, biotransformation, and effects and routes of excretion of drug

Question 4

Drug monitoring

Answer 4

More critical for theophylline, not necessary for caffeine. 25% of theo is methylated to caffeine

Question 5

Half life of caffeine and theophylline

Answer 5

caffeine 100 hours

theophylline 30 hours

Question 6

Loading and maintenance dose of caffeine

Answer 6

10 mg/kg

2.5 mg/kg

Question 7

Dosing interval of theophylline

Answer 7

1-3 times a day with several side effects

Question 8

Preferred drug for apnea of prematurity

Answer 8

caffeine

Question 9

Both theophylline and caffeine can lead to urinary excretion of what

Answer 9

Calcium

Question 10

Are there long term effects of caffeine?

Answer 10

No

Question 11

Efficacy of methylxanthines

Answer 11

decrease in number of apneas, bradys, cyanotic spells, improvement in coordination between upper airway and respiratory muscles, less mech ventilation, improved weaning from PPV.

Question 12

BPD studies of caffeine

Answer 12

decrease in airway resistance and improved lung mechanics within 1 hour of caffeine therapy

Question 13

CAP trial of caffeine

Answer 13

decreased oxygen needs in caffeine group, significant decrease in PDA and surgical ligation

Question 14

Effects of cardiac function with caffeine

Answer 14

increased SV, HR and BP

Question 15

Apnea with hypoxic episodes is a risk factor for what?

Answer 15

NEC

Question 16

Doxapram

Answer 16

bc of safety and efficacy of methylxanthines, only used when they are not effective and only before considering more aggressive tx such as mechanical ventilation

Question 17

many believe AOP to be a diagnosis of….

Answer 17

exclusion. all causes must be considered first. Multicasual: metabolic, infection, neurologic