ped pharm

Question 1

premature infant

Answer 1

an infant that was born at <37 weeks post conception (gestational age)

Question 2

Neonate/newborn

Answer 2

0-4 weeks of age

Question 3

infant

Answer 3

4 weeks to 12 months of age

Question 4

when does pharmacologic maturation occur?

Answer 4

between 3-6 months of age

Question 5

what happens during 3-6months of pharmacologic maturation?

Answer 5

rapid physical growth and maturation take place, changing factors involved in UPTAKE, distribution, redistribution, metabolism, and excretion of drugs

Question 6

T/F: There is no structural difference between infants, children, and adults that affect GI absorption of drugs

Answer 6

True

Question 7

Difference in the neonate related to gastric ph, gastric emptying, and gastric transit time?

Answer 7

pH (less acidic), gastric emptying and gastric transit time (markedly slower)

Question 8

Drug distribution

Answer 8

The amount of drug that reaches specific body compartments or tissues (the concentration of drug at the receptor site) is regulated by the distribution process

Question 9

IV drugs distribution are influenced by

Answer 9

Protein binding,
RBC binding,
Tissue volumes,
Tissue solubility coefficients,
Tissue blood flow

Question 10

The neonate has a _______ and quantitative _______ in protein binding. There is a _____ in the number of plasma proteins and a _____ in the affinity of proteins for drugs in the neonate. This contributes to the apparent _____ volume of distribution in comparison to adult proportions.

Answer 10

qualitative,
reduction,
decrease,
decrease,
LARGER

Question 11

Premature infant (1.5kg) Total body water, extracellular fluid, blood volume, intracellular water, muscle mass, and fat

Answer 11

Total body water-83%,(% body weight )
Extracellular fluid-62%,
Blood volume-60mL/kg,
Intracellular water-25%,
Muscle mass-15%
Fat-3%

Question 12

Full-term infant (3.5kg) total body water, extracellular fluid, blood volume, intracellular water, muscle mass, and fat

Answer 12

TBW-73%
ECF-44%,
Blood volume-85-105mL/kg,
Intracellular water-33%
Muscle mass-20%,
Fat-12%

Question 13

Adult (70kg) TBW, ECF, blood volume, intracellular water, muscle mass, fat

Answer 13

TBW-60%,
ECF-20%,
Blood volume-70mL/kg,
Intracellular water-40%,
Muscle mass-50%
Fat-18%

Question 14

Infants go through a period of anemia following birth (__-__ months) with the ________ of fetal hgb and the concurrent but slow _______ of RBCs. This is referred to as the physiologic _______ of hemoglobin.

Answer 14

3-6months,
destruction,
production,
physiologic NADIR of hgb
(RBC binding)

Question 15

Total body water, ECF, and blood volume are relatively ______ when comparing the neonate with the child or or adult on a per kg scale. This initial ______ volume of distribution may explain why the neonate requires ______ per kg dose of drugs to reach the desired effect.

Answer 15

larger,
larger,
higher,
(tissue volumes)

Question 16

The blood brain barrier is ________. _______ soluble drugs diffuse easily. Rate of entry=____ ______. The infant’s _____ receives a large proportion of CO (in comparison to the adult) and the resultant _____ concentration of many drugs is _______ in the infant than in the adult.

Answer 16

Immature,
Lipid,
Blood flow,
Brain,
brain,
Higher
(tissue solubility)

Question 17

Smaller muscle mass and fat stores (in relation to adults on a per kg basis) provide ____ uptake to inactive sites and tend to keep plasma levels ______. A high proportion of CO is distributed to the vessel rich group-particularly the _____.

Answer 17

less,
higher,
brain
(tissue perfusion)

Question 18

The ability to metabolize drugs develops to _______ degrees in _______ time period after birth in premature infant and the full term infant. What age is more important in determining maturity of drug metabolism?

Answer 18

Same,
Same,
postnatal age (not gestational age)
ex:baby born at 28wks presents at 3 months.

Question 19

Hepatic enzymes at birth?
Phase I and II processes development?
Conjugation reactions are developed by?

Answer 19

incompletely developed or absent at birth,
phase 1 and 2 limited but develop a few days after birth.
by 3 months

Question 20

The ultimate elimination of most drugs or their metabolites is by _____ _______. Drug clearance may be _________ in the neonate. Clearance by most drugs reaches adult values by __ months of age.

Answer 20

renal excretion,
reduced,
3 months

Question 21

Why is the uptake of inhaled anesthetics more rapid in infants in small children than in adults?

Answer 21

major differences are related to:
alveolar ventilation,
distribution of CO,
body composition,
B:G solubility coefficients,
tissue solubility coefficients

Question 22

Tidal volume of infant and adult?

Answer 22

7mL/kg (relatively constant throughout life)

Question 23

infant alveolar ventilation in relation to FRC vs adult

Answer 23

Va/FRC
5:1 in infants,
1.4:1 in adults
(important)

Question 24

The infant has ____ muscle mass (on a per kg scale in relation to adults) and a _____ of the proportion of CO perfusing muscle. Distribution of CO is _____ to the vessel-rich group (brain) vs. adults

Answer 24

less,
reduction,
higher

Question 25

Shunting is more pronounced with ______ agents such as N2O and ________.

Answer 25

insoluble,

Sevoflurane

Question 26

Effects of R>L shunting

Answer 26

SLOWS UPTAKE OF AGENT,
partial pressure of agents increases more slowly,
over-pressuring can be dangerous,
SLOW on means slow OFF!!

Question 27

patients that have right to left shunt

Answer 27

tetralogy of fallot, transposition of the great arteries, tricuspid atresia, total anomalous pulmonary venous return

Question 28

patients that have left to right shunt

Answer 28

atrial septal defect, ventricular septal defect, Patent ductus arteriosus, Blalock-Taussig shunt

Question 29

Effects L>R shunt

Answer 29

UPTAKE IS FASTER,
Increase depends on size of shunt,
Large (>80%) more rapid increase in agent partial pressure,
small (<50%) change is negligible

Question 30

There is _______ relationship between MAC of inhalation agents and age. Studies show that MAC of fetal lamb is ______ than that of newborn lamb. MAC _____ the first month of life. MAC starts to ________ after __ months of life.

Answer 30

inverse,
lower,
increases,
decrease,
6 months