Pharmacology for peds (Kinder) Flashcards
Chlorampehenicol
gray baby syndrome
o Abdominal distention, vomiting, diarrhea, gray color, resp distress, hypotension, progressive shock
thalidomide
phocomelia
congenital abnormalities
polyneuritis, nerve damage, mental retardation
sulfonamide
kernicterus
bilirubin deposits in the brain
benzyl alcohol
gasping baby syndrome
gastric pH in babies (full term vs. preterm)
full term infant –> 6-8 at birth
drops 1-3 within 24 hours
premature infants –> immature acid secretion so their pH tends to remain elevated
once the babies begin to be fed, gastric acid production begins leading to gastric pH ‘s approaching adult levels
gastric empyting in neonatal period
irregular and unpredictable
most orally absorbed drugs are absorbed in the intestine and this can be affected in the baby!
slow/prolonged gastric emptying in premature infants –> prolonged contact time
inverse relationship b/w gestational age and gastric retention
IM injections in babies
inconsistent absorption in ped’s patients -
- relative muscle mass (low in neonate)
- poor perfusion -(low CO or resp distress which means poor blood flow at the site of injection)
- peripheral vasomotor instability
- insufficient muscle contractions
IM is reserved for emergencies when IV access cannot be obtained
skin absorption in babies
related to skin hydration and relative absorption area
substantially increased percutaneous absorption- underdeveloped epidermal barrier
compromised skin integrity
increased skin hydration
rectal absorption in babies?
indicated if there is nausea, vomiting, seizures, or being prepared for surgeries
total body water in fetus
94%
premature infants 85%
full term 78%
adults 60%
must use higher doses per kg of body weight to achieve comparable plasma and tissue concentrations
protein binding in neonate
decreased due to decreased plasma protein concentration b/c albumin don’t reach higher levels until 10-12 months of age
alpha-acid glycoprotein levels decreased (basic drugs)
lower binding capacity of proteins in baby
decreased affinity for drug binding
competition for certain binding sites by endogenous compounds
sulfation pathway in babies
well developed
acetaminophen can be used in young children b/c of this
gucuronidation pathway is underdeveloped
morphine–> need higher serum concentrations
however, clearance quadruples
Glomerular filatruation
tubular secretion
tubular absorption
don’t develop fully until later and can affect drug metabolism
Neonatla sepsis common bacterial pathogens
what antimicrobial agents do you use?
group b strep
e coli
listeria monocytogenes
use: ampicillin gentamicin third generation cephalosporin acyclovir (not routinely used)
ampicillin
MOA
MOA: inhibits bacterial cell wall synthesis. leads to cell wall lysis
dosing by birth weight
meningitis treatment?
cover for at least 14 days
gentamicin
MOA - covers gram negative
inhibits bacterial protein synthesis
results in defective cell membrane
age (gestational age) and weight based dosing
Cefotaxime
inhibits bacterial cell wall synthesis. Inhibits PBP–> leads to bacteral cell wall lysis
dosing on birth weight
acyclovir
inhibits viral DNA synthesis and viral replication
dosing 20 mg/kg/dose IV every 8 hours
viral myocarditis
phases?
acute phase–> inflammatory cell invasion of myocardium and mycoardial necrosis and apoptosis
T-cell invasion–> most destructive 7-14 days after inoculation
Healing phase–> myocardial fibrosis, continued inflammation and persistent viremia may lead to LV dysfunction and dilation
may need transplant….
treatment in the acute phase of viral myocarditis
inotropes
afterload reduction
mechanical ventilation
ECMO
immune therapy –> IVIG, immunosuppressive agents
Intravenous immunoglobulin
sterile solution of human immune globulin
primarily IgG with trace IgA and IgM
protects against infection, suppress inflammatory processes
replace primary and secondary immunodeficiencies
dosing–> 2 g/Kg IV as a single dose over 24 hrs
provide immediate antibody levels and can last 3-4 weeks
SENSE OF DOOM
ECMO
prolonged cardiopulmonary bypass (3-10 days)
neonatal indications:
- pulmonary HTN
- meconium aspiration syndrome
- resp distress syndrome
- group B strep
complications!!
-drug binding interactions with the circuit
