Apnea Medications Flashcards
Methylxanthines
Mechanism of Action
Several Mechanisms are responsible; resp center stimulation; improvement in resp muscle contraction, altered sleep states, metabolic rate, cardiac output, metabolic homeostasis, potentiation of catecholamine effect; may also provide an antiinflammatory action
Pharmacokinetics and monitoring
plasma clearance and elimination are prolinged in newborns
Plasma half-life of Caffeine is 100 hours
Desires plasma level of Caffeine is 50-20 mg/L
Plasma Half-Life of Theophylline is 10 hours
desired plasma level of theophylline is 5-15 mg/L
Caffeine Dosing:
Loading Dose is: 10 mg/kg
Maintenance dose : 2.5 mg/kg
Theophylline
Loading Dose: 5-6 kg/kg
maintenance dose: 2-4 mg/kg
Comparison of the methylxanthines
Caffeine is the preferred alternative in infants with apnea of prematurity.
Variable Caffeine Theophylline
Efficacy Yes Yes
Side Effects Few Several
Drug clearance Very slow Slow
Plasma level @ steady state Stable Fluctuating
Need for drug monitoring No Yes
Dosing interval Once/day 1-3 times/day
Which drug is preferred for apnea of prematurity?
Caffeine
Efficacy: Numerous studies and clinical trials have documented the following benefits:
Decreasing the number of Apnea; decreasing the number of bradycardias, decreasing cyanotic spells; possible improvement in coordination between upper airway and respiratory muscles; less use of mechanical ventilation, and improved weaning off the vent
Effects
Lung Function: animal studies demonstrate better lng function, higher compliance, significant decrease in ventilator support; PDA, Cardiac Function
Long-Term Effects
animal models suggest some long-term effects; in human infants, there is no independent adverse effect of caffeine on long-term outcome; several studies showed no long-term effects
(I think the long-term effect is that you didn’t DIE FROM APNEA) LOLOLOLOLOLOL
APnea in summary
Multicausal: metabolic, infectious, neurologic and “otherO
