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Flashcards in Intro to Pediatric Pharm - SRS Deck (32):

How does sulfonamide impact a baby?

—Displaces bilirubin from protein-binding sites, bilirubin deposits in the brain, results in encephalopathy and causing kernicterus.



What can chloramphenicol do to a baby?

grey baby syndrome

—Abdominal distension, vomiting, diarrhea, characteristic gray color, respiratory distress, hypotension, progressive shock


What drug causes phocomelia?


—Congenital abnormalities; also: polyneuritis, nerve damage, mental retardation


Describe the oral drug absorption of drugs in neonates.

  • —Gastric volume ↓
  • —Gastric acid ↓ (gastric pH ↑)
    • Increased absorption of acid labile drugs (penicillin G, erythromycin)
    • Decreased absorption of weakly acidic drugs (phenobarbital, phenytoin)
    • Extrauterine factors (nutrition) most likely responsible for initiating acid production
  • —Transport of bile acids ↓
  • —Gastric emptying ↓, intestinal transit time ↑


What are some factors that influence IM drug absorption in neonates?

—Absorption inconsistent due to differences in:

¢Muscle mass

¢Poor perfusion (erratic blood flow)

¢Peripheral vasomotor instability

¢Insufficient muscle contractions


Transdermal drug absorption is directly related to what?

¢Degree of skin hydration

¢Relative absorptive area


Transdermal drug absorption is inversely related to?

Thickness of stratum corneum


What are some factors that cause substantially increased percutaneous absorption in these patients?

¢Underdeveloped epidermal barrier

¢Compromised skin integrity

¢Increased skin hydration

¢Ratio of BSA to total body weight highest in youngest

¢Relative systemic exposure higher


What are some cases where rectal drug administration is wise?

—May be important alternative site when oral agents cannot be used:



¢Seizure activity

¢Preparation for surgery


The younger a patient is, the higher the volume of distribution will be.  What does this mean for us?

Means we must give a higher dose per kg to younger patients for efficacy.


Why is ceftriaxone contraindicated in babies?

Can displace bilirubin from albumin and cause jaundice -> kernicterus


When does glomerular filtration hit maximum efficiency?

¢Ability to filter, excrete, reabsorb not maximized until 1 year

¢Rapid rise in GFR:

¢Increased renal blood flow

¢Increased function of nephrons

¢Appearance of additional nephrons


Neonatal sepsis incidence is inversely proportional to birth weight and gestational age.  What are the risk factors?

  • —Preterm birth
  • —Maternal GBS colonization
  • —Rupture of membranes > 18 hours
  • —Maternal signs/symptoms of intra-amniotic infection
  • —Ethnicity
  • —Male sex
  • —Low Apgar scores


What are some common sources of medication errors?

  1. Weight based dosing calculation errors
  2. Unit conversions and decimal point errors


What are some methods to reduce potential errors for both in and outpatient settings?

¢Methods to Reduce Potential Medication Errors:

  • —Standard concentrations
  • —Smart pump technology
  • —Barcoding
  • —Electronic prescribing

¢Outpatient Setting:

  • —Patient specific information on Rx
  • —Appropriate medication measurement tools


What are some criteria for identifying chorioamnionitis?

  • —Clinical diagnosis – maternal fever (≥ 38 ˚C; 100.4 ˚ F)
  • —Other criteria used in clinical trials (2 of the following):

¢Maternal leukocytosis > 15,000 cells/mm3

¢Maternal tachycardia > 100 bpm

¢Fetal tachycardia > 160 bpm

¢Uterine tenderness

¢Foul odor of amniotic fluid


What will ampicilling be useful for?


Gentimicin - Gram negatives

Ampicillin - Gram positives


What is the MOA for ampicillin?

Inhibits bacterial wall synthesis


MOA for gentamicin?

Inhibits bacterial protein synthesis


MOA for third gen cephalosporin?

Inhibits bacterial cell wall synthesis


MOA for Acyclovir?

Inhibits viral DNA synthesis and viral replication


What characterizes the pathophysiology of the acute phase of viral myocarditis?

—Acute phase: inflammatory cell invasion of myocardium and myocardial necrosis and apoptosis


When do T cells strike in viral myocarditis?

7-14 days later.


What is the pathophysiology of the healing phase in viral myocarditis like?

—myocardial fibrosis; continued inflammation and persistent viremia may lead to left ventricular dysfunction and dilation


What are the treatment protocols for acute phase viral myocarditis?

  • —Inotropes
  • —Afterload reduction
  • —Mechanical ventilation
  • —Extracorporeal membrane oxygenation (ECMO)
  • —Immune therapy
    • Intravenous immunoglobulin (IVIG)
    • Immunosuppressive agents


What is the MOA of IVIG in tx of Viral myocarditis?

¢protects recipient against infection and suppresses inflammatory and immune mediated processes


What are the adverse drug reactions of IVIG?

  • —Chills, fever, flushing, myalgia, malaise, headache
  • —Tachycardia, chest tightness, dyspnea, sense of doom
  • —Thrombotic complications
  • —Acute kidney injury


What are the neonatal indications for extracorporeal membrane oxygenation (ECMO)?


  1. —Primary pulmonary hypertension
  2. —Meconium aspiration syndrome
  3. —Respiratory distress syndrome
  4. —Group B Streptococcal sepsis
  5. —Asphyxia
  6. —Congenital diaphragmatic hernia


What aare some ECMO complications?

¢Clots in circuit (19%)

¢Oxygenator failure


¢Intracranial bleeding

¢Hemolysis and coagulopathy


¢Oliguria (within 24-48 hours)

¢Metabolic acidosis


What therapy must be included as adjunct to EMCO?



What are some things you should think about when putting a patient on ECMO?

¢Site of drug delivery

—Directly into patient?

—Proximal, distal, or directly into venous reservoir?


—Circulating blood volume will double (blood mixing with priming solution) affecting drugs with small volumes of distribution and those that are highly protein bound

¢Drug binding interactions with the circuit

—Adsorption and sequestration onto plastic cannula and/or silicone oxygenator

¢Altered renal, hepatic, and cerebral blood flow

—Non-pulsatile blood flow