Test 3 Flashcards
Chapter 14: Pharmacology
What are the major mechanisms by which drugs cross the placenta?
- Ultrafiltration
- Simple diffusion
- Active transport
- Breaks in the placental villi
Chapter 14: Pharmacology
Drugs that are known to cause physical and/or mental development abnormalities in the embryo or fetus.
Teratogens, or teratogenic substances
Chapter 14: Pharmacology
__________ occurs as the placenta acts as a semipermeable membrane with maternal hydrostatic forces pushing drugs with low molecular weight through the fetal side.
Ultrafiltration
Chapter 14: Pharmacology
When the transfer of a drug across the placenta is aided by proteins in the membrane, it is called ____.
Facilitated diffusion
Chapter 14: Pharmacology
Uses energy from ATP to move drugs across the placenta membranes against the concentration gradient.
Active transport
Chapter 14: Pharmacology
Drug transfer across the placenta is determined by ________.
- Concentration difference across the placenta
- Lipid solubility of drug
- Degree of ionization of drug
- Molecular weight of drug
Chapter 14: Pharmacology
Some substances readily pass through the placenta to the fetus by _________, which is often the result of a concentration gradient existing between the mother and fetus.
Simple diffusion
Chapter 14: Pharmacology
Teratogens may cause:
- Spontaneous abortion
- Congenital malformations
- Intrauterine growth retardation
- Mental retardation
- Carcinogenesis
Chapter 14: Pharmacology
Which trimester is the most critical time for teratogens to have an effect?
First
Chapter 14: Pharmacology
Effects of teratogens depend on what factors?
- Dose that reaches fetus
- Length of exposure
- Gestational age of fetus at time of exposure
- Other drugs being taken by mother
Chapter 14: Pharmacology
What drug is linked to autism and NOT recommended to be taken during pregnancy?
Ibuprofen
Chapter 14: Pharmacology
General term for the process by which drugs enter the body (absorption), are distributed throughout the system (distribution), are changed or altered from original compound (metabolism) and eventually leave the body (excretion).
Pharmacokinetics
Chapter 14: Pharmacology
The primary site within the system where drug metabolism takes place is the ______.
Liver
- Also other areas such as the plasma, kidney and GI tract.
Chapter 14: Pharmacology
Medication used for supraventricular tachycardia
Adenosine
Chapter 14: Pharmacology
Used to reverse sinus bradycardia
Atropine
Chapter 14: Pharmacology
Used during resuscitation for the treatment of acute cardiovascular collapse.
Epinephrine
Chapter 14: Pharmacology
Used for atrial fibrillation, atrial flutter, paroxysmal atrial tachycardia, cardiogenic shock and all degrees of CHF.
Digoxin (Lanoxin)
Chapter 14: Pharmacology
Used to close a hemodynamically significant patent ductus arteriosus.
Indomethacin Sodium Trihydrate (Indocin IV)
Chapter 14: Pharmacology
Indicated for short-term treatment to increase CO due to decreased contractility from organ heart disease or cardiac surgical procedures
Dobutamine (Dobutrex)
__________ is indicated to maintain the patency of the ductus arteriosus until corrective surgery can be performed.
Alprostadil
_________ is indicated for the correction of hemodynamic imbalances present in the shock syndrome due to decreased cardiac function in congestive heart failure, trauma, endotoxic septicemia, renal failure, and myocardial infarction.
Dopamine
__________ is indicated for the treatment of persistent pulmonary hyper- tension of the newborn.
Tolazoline
Bumetanide is a ______ used in patients with congestive heart failure, renal insufficiency, or edema that is refractory to furosemide.
diuretic
As a diuretic, acetazolamide is often used in conjunction with furose- mide to slow the progression of _______ in patients who are not candidates for surgery.
hydrocephalus
_______ is a diuretic used to treat mild to moderate edema and hypertension.
Chlorothiazide
_____ is indicated for the treatment of fluid overload, symptomatic patent ductus arteriosus, hypertension, and pulmonary interstitial edema.
Furosemide
Furosemide is contraindicated in patients with _______.
anuria, a cessation of urine output, or who are hypersensitive to the drug.
_______ is used in combination with other diuretics in the treatment of congestive heart failure and BPD.
Spironolactone (Aldactone®)
TRUE OR FALSE.
The aerosolized bronchodilators, as with other drugs given to neonates, are not spe- cifically approved for use in neonates, so extreme care and caution must be used when administering these drugs.
TRUE
Sympathomimetics
- Albuterol (Proventil, Ventolin)
- Metaproterenol Sulfate (Alupent)
- Terbutaline (Brethine, Bricanyl, Brethaire)
- Racemic epinephrine (Micronephrine, Vaponephrine)
Parasympatholytics
- Atropine
- Ipratropium bromide (Atrovent)
- Glycopyrrolate (Robinul)
- Tiotropium Bromide Monohydrate (Spiriva)
- Aclidinium Bromide (Tudorza Pressair)
Corticosteroids
- Beclomethasone (Vanceril, Beclovent)
- Budesonide (Pulmicort Respules)
- Flunisolide (Aerobid)
- Dexamethasone (Respihaler)
- Triamcinolone (Azmacort)
An antibiotic specifically used for the prophylactic treatment of protozoan infections. In particular, it has been designated for prophylactic treatment of Pneumocystis jirovecii pneumonia (PCP) in patients infected with HIV. Must be delivered via a special nebulizer.
Pentamidine Isethionate (Nebupent, Pentam 300)
________ are indicated for the treatment and management of neonatal apnea and for the treatment of acute and chronic bronchospasm.
Caffeine and theophylline
Classification of caffeine and theophylline
Methylxanthines
___ are a diverse group of drugs used to control seizures.
Anticonvulsants
Sympathomimetics are also called beta-adrenergics. The name adrenergic comes from their ability to act like adrenalin on the beta sites and cause _______.
smooth muscle relaxation leading to bronchodilation
Aerosolized drugs are divided into four groups:
sympathomimetics, parasympatholytics, corticosteroids, and other drugs.
All sympathomimetic drugs share the same indication for use, that is, the prevention and treatment of _____.
reversible bronchospasm
Adverse reactions of sympathomimetic drugs include:
- Tremors
- Nervousness
- Dizziness
- Insomnia
- Headache
- Tachycardia
- Palpitations
- Hypertension
- Nausea
- Vomiting
The action of the parasympatholytic drugs is to block what?
the cholinergic receptor site to acetylcholine. Drugs that exert this effect are called cholinergic blockers or para- sympatholytic drugs.
The use of ____ in respiratory disorders is usually reserved for those cases in which other methods have not produced the desired results.
steroids
When aerosolized and delivered to the respiratory tract, steroids appear to reduce the inflammatory response of ____.
asthma
- Used in neonates for treatment of tracheal edema, cerebral edema, and bronchopulmonary dysplasia (BPD).
- Also used in pediatric bronchial asthma
Dexamethasone (Decadron)
Dexamethasone (Decadron) Adverse Reactions
- HTN
- Adrenal suppression
- Anaphylactic reaction
- Sodium and fluid retention
Dexamethasone therapy should be monitored by observing the patient for what?
Weight increase, edema, and HTN.
Intravenous Respiratory drugs:
Theophylline and caffeine citrate are given how often?
8-12 hours
Effects of theophylline and caffeine citrate:
- Stimulates the CNS
- Acts as a bronchodilator by causing the relaxation of smooth muscle in the bronchi and pulmonary blood vessels
- Induces diuresis
- Increases gastric acid secretions
Contraindications of theophylline and caffeine citrate:
- Severe cardiac disease
- CHF
- Severe HTN
How are respiratory drug given?
- Given via nebulization (aerosolized)
- Intravenous
Corticosteroids side effects
Have serious side effects:
- Suppression of the immune and inflammatory response
- Adrenal insufficiency
- Prone to candida infection
Commonly used Parasympatholytics:
- Ipratropium bromide (Atrovent)
- Levalbuterol (Xopenex)
- Aclidinium bromide (Tudorza pressair)
Teratogens can cause:
- Spontaneous abortion
- Congenital malformation
- Increase the chance of birth defects
- Premature babies
- Underweight babies
- Mental retardation
- Stillborn babies
- Referred to as cholinergic blockers
- Reacts opposite of the sympathetic system
- Directly stimulates the muscarinic structure by blocking cholinergic receptors sites to acetylcholine
Parasympatholytics
Parasympatholytics adverse reactions
- Dry mouth
- Blurred vision
- Palpitations
- Drying effect on secretions
Fetal Alcohol Syndrome facial characteristics
- Small eye openings
- Smooth philtrum
- Thin upper lip
- Antibiotic specific for the treatment of pseudomonas infections
- Delivers medication directly to the bronchial tree where the organisms colonize
Tobramycin
- Used to treat bacterial infections caused by susceptible gram-negative bacteria
- Example: VAP
Colistin
Used to treat bacterial infections such as stable non-cystic fibrosis (non-CF), bronchiectasis, and chronic bronchial infections
Gentamicin
How long does pentamidine treatments take?
30-45 minutes
Pentamidine
is delivered via ________, utilizes one-way valves and filter to minimize the release of aerosol droplets
Specialized Respirgard 2 Nebulizer
Pentamidine precautions
- Pregnant or potentially pregnant females should avoid exposure
- Patients need to be screened and anti-tb therapy initiated before beginning therapy
The process by which drugs enter the body (GI tract, intramuscular, respiratory tract, and intravenous)
Absorption
Following absorption drugs are distributed throughout the system into interstitial, cellular, and extracellular fluids.
Distribution
Drugs are changed or altered from the original compound through the liver, kidneys, plasma, and GI tract.
Metabolism
Renal function in both premature and full-term infants are underdeveloped at the time of birth. Renal function does not achieve the same level as adults until infant is ___.
6 months - 1 year old
Drugs that are not fully metabolized are more difficult to eliminate and are excreted more slowly in premature.
Excretion
Pentamidine adverse effects
- Coughing
- Bronchospasm
- SOB
- Chest pain
- Congestion
- Hyperventilation
- Tachypnea
When administering pentamidine, what should be given prior?
Bronchodilator
Used to treat pain
Opioids
Opioids
- Attaches to the CNS and GI tract
- Decreases perception of pain and increase pain tolerance
- _________ is commonly used during delivery
Butorphanol (stadol)
Side effects of opioids
- Respiratory depression
- Sedation
Used to enhance sedation and reduction in anxiety as well as inducing sleep
Benzodiazepines
Used to calm agitation and to aid in sleep
Chloral Hydrate (Noctec)
Used to relieve anxiety, sedation, and as an anticonvulsant
Diazepam (valium)
Short-acting benzodiazepine that has a rapid onset producing sedative/hypnotic trance and/or anesthesia to reduce anxiety during an invasive procedure such as intubation.
Midazolam (versed)
Used for pain, sedation, and reduction in withdrawal symptoms. Also used to induce respiratory depression to enhance mechanical ventilation
Morphine sulfate
Used to produce analgesia, sedation, and anesthesia.Often used before performing an invasive procedure such as bronchoscopy
Fentanyl citrate
Short acting barbiturate used primarily during procedures
Pentobarbital
- Succinylcholine (anectine)
- Neuromuscular blocking drugs
- Resistant to stimulation by acetylcholine
- Skeletal muscle relaxation and facilitate intubation
- Also used as a muscle relaxant in concert with anesthesia
Paralytics
Paralytics should also be refrained in patients with ____.
Myopathies
Epiglottitis: Age
2-6 years
Epiglottitis: Rate of onset
Rapid
Epiglottitis: Origin
H. Influenzae type B
Epiglottitis: Clinical Presentation
- High fever
- Anxious
- Leaning forward
- Drooling
- Low-pitched stridor
- Muffled voice
- No cough
Epiglottitis: X-Ray
Thumb sign
Epiglottitis: Seasonal incidence
Any season
Croup: Age
6 months-3 years
Croup: Rate of Onset
Slow (2-3 days)
Croup: Origin
Parainfluenza virus
Croup: Clinical presentation
- May be afebrile or febrile
- Hoarse
- Barky cough
- Tight upper airway stridor
How to correct ventilation with pediatrics?
HHFNC
Croup: CXR
Narrow steeple sign
Complications of UAC
- UAC remain in place 3-4 weeks
- Some babies may require ventilation or supplemental O2 for months
- Air embolism, blood clots, infection, HTN, hemorrhage, vessel perforation and possible NEC.
- UAC may reflect a low PaO2 in presence of ductal shunt
- Increased FIO2 leads to increased cranial pressures and ROP
Methods of Obtaining Blood Gases in Neonates
- UAC
- Radial artery catheter
- Capillary Samples
When the others aren’t available:
Radial puncture
Brachial puncture
What is the preferred site for obtaining a blood gas in nenonates and why?
Umbilical Artery catheter (UAC), no pain
Note: Pain causes crying and fussing and can alter results
Assesses integrity of the lung to diffuse O2 across the alveolar capillary membrane (gas exchange)
a/A ratio
a/A ratio normal range
(80-100) values <80 determine a diffuse defect limiting gas exchange
Pressure difference between alveolar to arterial O2 tension
A-a Gradient
A-a Gradient normal
20-65
A-a gradient widens with the ______.
need for O2
A-a gradient increases 5-7 mmHg with every _____.
10% increase in FIO2
A-a gradient >400 indicates _____.
Severe distress
Pediatrics Normal Respiratory Rate Range
24-30 bpm
Neonates Normal Respiratory Rate Range
40-60 bpm
Crackles or rhonchi indicative of _____.
Fluids, excessive secretions or V/Q mismatch
WOB/Dyspnea
- Anxiety, pain, or V/Q mismatch in pulmonary disease
- Use of accessory muscles (substernal, intercostal, and/or supraclavicular)
- Characterized as increased WOB
Arterial Capillary Samples
- Reliable for pH & CO2 but not reliable for PaO2
- Rule of thumb for estimating PaO2 (PaO2+30)
Arterial Capillary Samples
Heel should be warmed for _____ mins to encourage blood flow and the capillary refill.
5-7
If a right to left shunt is suspected through the patient’s ductus arteriosus (PDA), what should happen?
a preductal arterial sample should be taken simultaneously with the UAC blood to compare the pressure of oxygen in each sample.
Transcutaneous monitoring (TCM)
- Noninvasive solution to continuous monitoring of O2 and CO2 values.
- Utilizes heat for the diffusion of oxygen, release of oxygen from red blood cells and vasodilation of capillaries.
Limits of Transcutaneous monitoring (TCM)
Underestimates PaO2
Burns & blistering
Must be periodically correlated with
ABGs
Clinical uses of Transcutaneous monitoring (TCM)
Trending
Weaning
Shunting
Neontates: Radial Artery Catheter
- AKA Peripheral arterial line (PAL)
- Reflects preductal PaO2
- Thrombosis is less common
- Hazards: air embolism, infections, arterial occlusion, nerve damage, bleeding, hematoma
Arterial Capillary Samples:
According to the AARC Guidelines Capillary Samples should not be performed at or through posterior curvature of the heel. Should not be performed on fingers, or previously punctured sites; swollen, infected or edematous tissues, cyanotic or poorly perfused sites, peripheral arteries or patients less than 24 hrs
Okay
Arterial Capillary Samples:
Complications often related to ____.
Improper procedure
Keep in mind frequent gasses can deplete blood supply.
Average newborn has ___ mL of blood per kg
75
The safest and most common site for sampling pediatric arterial blood.
Radial
Main advantage of radial artery catheter
The artery is accessible when the UAC has to be pulled out
PaO2 Neonatal Safe Range
50-70 mmHg
PaO2 Pediatric Safe Range
80-100 mmHg (sea level)
55-80 (5k ft.)
PaCO2 Neonatal/Pediatric Safe Range
35-45 mmHg
<60 Chronic disease
pH neonatal and pediatric
safe range
7.35 to 7.45
pH neonatal and pediatric
acceptable range
7.30 to 7.50
HCO3 Normal range
22-26 mEq/L
The pathophysiology of BPD appears to be linked to four factors:
1) oxygen toxicity
2) barotrauma
3) presence of a PDA
4) fluid overload
_______ is a quick method of diagnosing a pneumothorax.
Transillumination
Exposure to high concentrations of oxygen leads to local inflammation, edema, and thickening of the alveolar membrane. As the exposure is prolonged, the alveolar tissues hemorrhage and become necrotic. The interstitial spaces become fibrotic as the disease progresses. As the lung attempts to heal itself, the new cells are damaged by the same factors, and the disease is perpetuated.
BDP
