Pharmacology for peds (Kinder)

Question 1

Chlorampehenicol

Answer 1

gray baby syndrome

o Abdominal distention, vomiting, diarrhea, gray color, resp distress, hypotension, progressive shock

Question 2

thalidomide

Answer 2

phocomelia

congenital abnormalities
polyneuritis, nerve damage, mental retardation

Question 3

sulfonamide

Answer 3

kernicterus

bilirubin deposits in the brain

Question 4

benzyl alcohol

Answer 4

gasping baby syndrome

Question 5

gastric pH in babies (full term vs. preterm)

Answer 5

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

Question 6

gastric empyting in neonatal period

Answer 6

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

Question 7

IM injections in babies

Answer 7

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

Question 8

skin absorption in babies

Answer 8

related to skin hydration and relative absorption area

substantially increased percutaneous absorption- underdeveloped epidermal barrier

compromised skin integrity
increased skin hydration

Question 9

rectal absorption in babies?

Answer 9

indicated if there is nausea, vomiting, seizures, or being prepared for surgeries

Question 10

total body water in fetus

Answer 10

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

Question 11

protein binding in neonate

Answer 11

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

Question 12

sulfation pathway in babies

Answer 12

well developed

acetaminophen can be used in young children b/c of this

Question 13

gucuronidation pathway is underdeveloped

Answer 13

morphine–> need higher serum concentrations

however, clearance quadruples

Question 14

Glomerular filatruation
tubular secretion
tubular absorption

Answer 14

don’t develop fully until later and can affect drug metabolism

Question 15

Neonatla sepsis common bacterial pathogens

what antimicrobial agents do you use?

Answer 15

group b strep
e coli
listeria monocytogenes

use:
ampicillin
gentamicin
third generation cephalosporin
acyclovir (not routinely used)

Question 16

ampicillin

MOA

Answer 16

MOA: inhibits bacterial cell wall synthesis. leads to cell wall lysis

dosing by birth weight

Question 17

meningitis treatment?

Answer 17

cover for at least 14 days

Question 18

gentamicin

Answer 18

MOA - covers gram negative
inhibits bacterial protein synthesis
results in defective cell membrane

age (gestational age) and weight based dosing

Question 19

Cefotaxime

Answer 19

inhibits bacterial cell wall synthesis. Inhibits PBP–> leads to bacteral cell wall lysis

dosing on birth weight

Question 20

acyclovir

Answer 20

inhibits viral DNA synthesis and viral replication

dosing 20 mg/kg/dose IV every 8 hours

Question 21

viral myocarditis

phases?

Answer 21

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….

Question 22

treatment in the acute phase of viral myocarditis

Answer 22

inotropes

afterload reduction
mechanical ventilation
ECMO
immune therapy –> IVIG, immunosuppressive agents

Question 23

Intravenous immunoglobulin

Answer 23

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

Question 24

ECMO

Answer 24

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

Question 25

gentamicin dose adjustment in ECMO

Answer 25

2.5 mg/kg/dose every 18-24 hrs

Question 26

vancomycin dose adjustment in ECMO ?

Answer 26

15-20 mg/kg/dose every 18-24 hrs

Question 27

Vasopressors adjustment in ECMO?

Answer 27

no change in dosing in ECMO