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Neonatal Pharmacology > GI > Flashcards

GI Flashcards

(48 cards)

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1
Q

True/False:

Pharmacology of GI drugs in children esp <1 yr there is a significant knowledge gap

A

True

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2
Q

True/false:

Many GI drugs used in neonates have not been thoroughly studied.

A

True

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3
Q

In what situation are anti-emetics in neonates used?

A

Surgical pts

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4
Q

Where is vomiting controlled in the brain?

It has input from what 4 sources?

A

the Vomiting center of the Medulla

  1. Chemoreceptor trigger zone
  2. Cortex
  3. Vestibular apparatus
  4. GI tract
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5
Q

Name 2 anti-emetic agents

A
  1. Promehtazine (most common in U.S.)
    s/e’s: hallucinations, sedation, seizures, HTN, tachycardia
  2. Metoclopramide (Reglan)
    s/e’s: sedation, anti-cholinergic, extrapyramidal (dyskinesia/dystonia) symptoms
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6
Q

There are 4 types of antacids-name them.

A
  1. Sodium Bicarbonate
  2. Calcium Carbonate
  3. Magnesium-containing
  4. Aluminum-containing
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7
Q

Chronic use of Sodium bicarbonate antacids is a/w?

A

Na+ retetion, systemic Alkalosis, milk-alkali syndrome

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8
Q

Which 2 antacid types are most potent and are rapid-acting?

A

Sodium Bicarbonate

Calcium Carbonate

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9
Q

Calcium carbonate has a longer/shorter duration of action than Sodium carbonate but is a/w what adverse side effects?

A

Longer

Hypercalcemia, hypercalciuria, Renal calcium deposits, compromised renal fxn, gastric acid Hyper-secretion.

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10
Q

Magnesium-containing antacids are a/w?

A

Diarrhea, Hypermagnesemia (esp w/compromised renal function)

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11
Q

Aluminum-containing antacids have what s/e’s?

A

Constipation, Hypocalcemia, & Hypophosphatemia

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12
Q

Concomitant use of antacids with other meds may do what?

A

Decrease drug absorption due to alteration in gastric pH.

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13
Q

When should antacids be administered?

A
  • 2 hrs after other drugs to avoid alteration in pH and drug absorption
  • 1 hr after meals
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14
Q

Peds pts who require long-term therapy should be monitored closely for?

A

Adverse effects

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15
Q

Prokinetic Agents do what?

A

Improve Gastric motility

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16
Q

Name 3 examples of Prokinetic Agents

A
  1. Metoclopramide (reglan)
  2. Cisapride
  3. Erythromycin
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17
Q

Which Prokinetic is most commonly used in the NICU?

A

Metoclopramide

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18
Q

Metoclopramide has a combination of central and peripheral __________ antagonism

A

Dopamine antagonism

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19
Q

Metoclopramide works by?

A

Augmentation of acetylcholine release from postganglionic nerve terminals is likely responsible for it’s effect on smooth muscle.

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20
Q

Does Metocloprmaide increase gastric acid secretion, endogenous gastrin release or salivation?

21
Q

Does Metoclopramide promote the coordination of gastric, pyloric, and duodenal motor function?

22
Q

How does Metocloprmaide accelerate gastric emptying?

Study These Flashcards
A

by increasing gastric tone

23
Q

True/False: Large-scale clinical trials need to be done to test the efficacy and safety of Reglan?

Study These Flashcards
A

True, only small studies have been done.

24
Q

What is significant about Cisapride?

Study These Flashcards
A

Removed from U.S. and Canadian markets d/t safety concerns: Prolonged Q-T interval with associated V. Arrhythmias, underlying cardiac dz, electrolyte disturbances, renal insufficiency, hepatic dysfunction, and concurrent therapy with meds known to alter cardiac conduction intervals.

25
Is Cisapride widely available in other parts of the world?
Yes
26
Erythromycin is thought to increase what ?
Lower esophageal sphincter tone in the duration but not amplitude of contractions of the distal esophagus in adults with GER
27
The dose of Erythromycin is Larger/Smaller than the dose for antimicrobial therapy?
Smaller
28
The effect of EES is similar to the polypeptide hormone ________ (promoting movement of nutrients)
Motilin
29
The association with Erythromycin and what condition is a concern?
Hypertrophic Pyloric Stenosis
30
When was the association of Erythromycin with pyloric stenosis discovered?
After wide-spread use of Erythromycin for Pertussis outbreak in a community-->7x increased rate of pyloric stenosis
31
Is low-dose Erythromycin a/w pyloric stenosis?
No
32
H-2 receptor antagonists are the most commonly used drugs in children for?
- Reflux - Treatment of gastric/duodenal ulcers - Treatment/prophylaxis against GI hemorrhage
33
There are how many H-2 receptor antagonists available for clinical use? How many for children? What are they?
4 2 Ranitidine & Famotidine
34
H-2 Receptor Antagonists reduce?
Gastric acid secretion by inhibiting Histamine at the H2 receptor site.
35
H-2 Receptor Antagonists decrease?
Acid-secretory response of parietal cells
36
H-2 Receptor Antagonists are particulary effective in suppressing...?
Nocturnal acid production | esp important in those at risk for Duodenal ulcers
37
True/False: H-2 Receptor Antagonists are frequently used in NICU as prophylaxis for gastric stress ulcers
True
38
Routine use of H-2 Receptor Antagonists has lead to what concerns?
Alteration of gastric pH | may allow for over-growth of pathogenic bacteria and in LWB's--NEC
39
What are the s/e's of H-2 Receptor Antagonists?
Most common:GI symptoms, Rash, Dizziness Also: Mania, seizures, gynecomastia, galactorrhea, impotence, possible decrease in spermatogenesis, thrombocytopenia, agranulocytosis
40
True/FalseProton-Pump Inhibitors are the most common GI medication used in the NICU?
True
41
Which PPI is the most commonly used?
Prevacid (Lansoprazole)
42
There are how many approved PPI's in the U.S.? | Do any have approved labeling for children <1 y/o?
4 No
43
What is Prevacid (Lansoprazole) used for?
Tx of reflux esophagitis Inhibits gastric acid secretion (inhibits H+/K+/ATPase--enzyme responsible for production of HCl- by parietal cells of proton pump)
44
Where is Prevacid metabolized?
Liver
45
Onset of action of Prevacid is w/in? Max effect w/in? Average T2?
1 hr 1. 5 hrs 1. 5 hrs
46
Inhibition of Acid secretion is about ___% of maximum at 24 hrs of age with duration of action about ___ hrs.
50% 72 hours
47
What are the most common s/e's of Prevacid?
Headache, Nausea, Diarrhea
48
True/False: there is questionable a/w VLBW and late-onset gram negative sepsis
True

Neonatal Pharmacology (17 decks)

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