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Pharmacology #1 > 307B Midterm > Flashcards

307B Midterm Flashcards

(83 cards)

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1
Q

What drug and class of drugs can cause kernicterus in neonates?

A

sulfanomides, ceftriaxone

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2
Q

What drug causes grey baby syndrome?

A

chloramhenicol

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3
Q

What drug can cause gasping syndrome in babies?

A

benzyl alchol

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4
Q

Pharmacokinetics is?

A

what the body does to the drug

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5
Q

ADME stands for?

A

absorption, distribution, metabolism and elimination

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6
Q

Elimination Half Life(T 1/2)

A

time needed for drug concentration to decrease by 1/2

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7
Q

Routes of Absorption (7)

A

IV, GI (PO/PT), Rectal (PR), IM, Percutaneous, IO, Intrapulmonary/Inhaled

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8
Q

Definition of Bioavailability absorption-(F)

A

how much drug enters systemic circulation

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9
Q

For IV medications F = ?

A

1 (100%)

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10
Q

For PO medications, F = ?

A

<1

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11
Q

Rate of absorption is not the same as ?

A

bioavailability

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12
Q

Oral liquids in neonates have a faster/slower rate of absorption than adults?

A

faster

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13
Q

Physiochemical factors that affect drug absorption?

A

molecular weight, pKa stability in stomach pH, lipid solubility, and formulation of medication (sustained-release, disintegration, & dissolution)

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14
Q

Patient factors that affect drug absorption:

A

1st pass metabolism, co-administration with food, gastric content and emptying time, GUT pH, surface area, size of bile salt pool, bacterial colonization, underlying disease state (SBS)

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15
Q

What patient factor is lessened in neonates?

A

1st pass metabolism due to hepatic immaturity

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16
Q

1st pass metabolism is

A

gut metabolism + liver metabolism (drugs absorbed thru gut–hepatic vein–liver)

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17
Q

Gastric emptying in infants is:

A

erratic, slower, reflux, affected by caloric density and the slower emptying affects the time it takes the drug to reach small intestine

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18
Q

Small intestine is ?

A

major site for drug absorption

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19
Q

Gastric motility in infants:

A

irregular, uncoordinated peristalsis, longer transit time

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20
Q

When does gastric emptying reach adult levels?

A

6-8 months

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21
Q

Transit time for infants

A

8-96 hours vs 4-12 in adults

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22
Q

Infants gastric pH is ? compared to adults?

A

higher (less acid production)

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23
Q

Term baby pH range at birth, within 24 hours?

A

birth: 6-8, within 24 hours: 1-3

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24
Q

A preterm baby takes how long for the gastric pH to normalize?

A

~3 weeks (due to immature gastric acid secretion)

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25
Acid correlates with what?
PNA and not PCA
26
Give three examples of drugs that are acid-labile (increased absorption in acidic environment)
penicillin G, amp and nafcillin
27
pH affects drug absorption how?
affects stability and degree of ionization of drug
28
Gut surface area in infants
decrease vs adults
29
Pancreatic function in neonates?
decreased rate of synthesis, pool size and intestinal transport (even more decreased in CF pt)
30
Maturity of gut flora in infants is affected by?
age, delivery method, feeding type and drug therapy (acid suppression)
31
Immaturity of the gut flora reduces the metabolism of what drug?
digoxin
32
Disease states that affect GI absorption
reflux, SBS, cardiac defects and hypo/hyperthyroidism
33
Cardiac defects affects GI absorption by ?
shunting blood away from gut
34
Advantages of rectal absorption
less 1st pass metabolism, alternative to IV or PO (emesis, seizure, aspiration, NPO)
35
Where in the rectum is the drug absorbed?
hemorrhoid veins
36
Lower rectum absorption
directly into system
37
Upper rectum absorption
into portal vein (1st pass)
38
Disadvantage of rectal absorption
erratic absorption, infant dosage forms are not commercially available, dose often expelled before fully absorbed
39
IM absorption is determined by
blood flow to injection site, muscle mass, and muscle activity
40
IM absorption is altered in preemies due to
less muscle mass, poor perfusion to various muscles, peripheral vasomotor instability, insufficient muscle contractions
41
Percutaneous absorption in neonates is enhanced due to:
thinner stratum corneum, increased blood flow to skin, increased total body surface area
42
Aquaphor's benefits
increases skin integrity, and decreases losses
43
Up to what age is the marrow vascular
5 years
44
Goal of intrapulmonary absorption
local effect
45
Examples of systemic absorption of inhaled drugs:
dexamethasone, budesonide and TOBI
46
Drug distribution is determined by
binding affinity of drug for proteins, hydrophobic vs lipophilic, body comp, molecular weight, degree of ionization at body pH, hemodynamic factors
47
Classic examples in the NICU of infections difficult to treat:
osteomyelitis, menigitis, endocarditis
48
Definition of volume of distribution
the volume in which the amount of drug would need to be uniformly distributed to produce the observed blood concentration
49
Binding of drugs to protein is decreased in infants due to:
decreased amounts of plasma proteins, lower binding capacity, decreased affinity for proteins, competition for binding sites (bili---kernicterus)
50
Less protein binding =
more "free" active drug
51
What drug must you monitor "free" levels?
phenytoin
52
More free drug =
increased volume of distribution
53
Increased in ECF =
large Vd for some drugs
54
drugs that are hydrophilic will have larger
Vd
55
Examples of drugs that are hydrophilic
aminoglycoside (gent, tobra and amikacin)
56
NICU gent dosing?
4-5mg/kg
57
In premature infants with less body fat, what type of drug will have a small Vd?
lipophilic
58
ECMO does what to the volume of a baby?
doubles the blood volume
59
Clearance of most drugs is dependent on:
initial hepatic metabolism, followed by excretion of parent drug/metabolites by liver or kidney
60
Most drugs are metabolized by:
liver
61
Other routes of metabolism
kidneys, intestine, lungs, skin
62
Infants have delayed maturation of what type of enzymes?
Phase 1 and 2 drug-metabolizing enzymes
63
Phase 1 (CPY) metabolizing enzyme functions
oxidation, hydrolysis, hydroxylation, reduction
64
Phase 2 (synthetic metabolism) functions
conjugation, glucuronidation, sulfation
65
Examples of drug biotransformation
non-polar, lipid soluble transformed to polar, water-soluble, active metabolites, and inactive parent drug (prodrug) to active drug
66
In infants the absolute mass of phase 1 enzymes is:
decreased, different enzymes mature at different times
67
Absolute mass of enzymes is measured as:
percent of liver weight
68
Diazepam is metabolized by what function which is deficient and results in a longer half-life in preemies and term infants
hydroxilation
69
What metabolism function is present in infants but not adults
methylation
70
What is an example of methylation in infants
theophylline is methylated into caffein
71
When does the oxidative pathways of infants mature which results in increased clearance of caffeine (shortened half life)
4-6 months
72
Adults metabolize theophylline into a metabolite by what enzyme ?
CYP1A2
73
Caffeine is excreted how in infants and is prolonged?
excreted renally
74
What phase 2 metabolism pathway is mature by birth
sulfation
75
Example of mature sulfation in infants
acetaminophen--less susceptible to toxicity from overdose
76
Infants conjugate tylenol with what compared to adults?
infants conjugate with sulfate compared to adults who conjugate with glucuronic acid
77
What harmful metabolite does the conjugation of tylenol produce in adults?
NAPQI
78
What phase 2 metabolism pathway does not mature until 3 years of age
glucuronidation
79
What is a drug metabolized by glucuronidation
chloramphenicol-doses not adjusted for decreased clearance related to decreased glucuronidation
80
What other phase 2 pathway doesn't matter until age 5
alcohol dehydrogenase
81
What is an drug example that is metabolize by alcohol dehydrogenase know to cause gasping syndrome
benzyl alcohol
82
Clearance definition
measure of drug elimination, volume of blood from which drug is completely removed per unit of time
83
What two organs are responsible for most drug
kidney and liver

Pharmacology #1 (4 decks)

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