Medications Flashcards
(164 cards)
1
Q
Bronchodilators are used to…
A
decrease airway resistance & increase compliance
2
Q
Albuterol is a selective _____agonist.
A
beta-adrenergic
3
Q
Albuterol’s actions are:
A
relaxes smooth muscle, bronchodilation, drives K+ intracellularly (??? use with hyperkalemic events), increases intracellular binding of Ca++
4
Q
Albuterol’s peak response is in ____ minutes & can cause…
A
30: hypocalcemia, tachycardia, tolerance (use acutely)
5
Q
Racemic Epi stimulates ____ & ____ adrenergic receptors.
A
alpha, beta
6
Q
Racemic Epi acts on…
A
vascular smooth muscle to produce vasoconstriction which decreases blood flow at the cap level, shrinking upper resp mucosa, reduce edema
7
Q
Racemic Epi is useful on patients with ____ which is caused by ____.
A
postextubation stridor; ET causes edema in subglottis (narrowest region in newborn)
8
Q
Side effects of racemic epi
A
tachycardia, metabolic acidosis, hypercalcemia, hyperglycemia
9
Q
Ipatropium Bromide does…
A
bronchodilation in infants with BPD, decreased resp resistance
10
Q
Ipatropium Bromide used in conjunction with _____ is good for treatment of _____ due to _____.
A
albuterol; CLD; presence of functional muscarinic receptors in premies
11
Q
These are hard to get into small airways and their use is not evidence-based
A
Inhaled steroids
12
Q
Direct pulmonary vasodilator
A
iNO
13
Q
What iNO does and the usual starting dose and duration
A
potent, selective, sustained pulm vasodilation, decreases pulm vascular resistance, improves oxygenation: 20ppm for <5days (long term use may have neg sequelae)
14
Q
Best for use in PPHN without excess ‘debris’ as in MAS
A
iNO
15
Q
When methylxanthines were 1st reported as effective
A
1970’s
16
Q
Mechanism of action of methylxanthines
A
resp center stimulation, improvement in resp muscle contraction, altered sleep states, metabolic rate, CO, metabolic homeostasis, potentiation of catecholamine effect (may increase oxygenation), anti-inflame action
17
Q
Caffeine & theophylline are used to…
A
increase minute ventilation, antagonize depressive effects of codeine/MSO4, increase diaphragmatic efficiency, improved recovery of fatigued muscles, increased FRC
18
Q
Which has the shortest T 1/2: caffeine or theophylline?
A
Theophylline which is why we can give caffeine more sparingly
19
Q
Pharmacokinetics is…
A
the study of the action of the body on drugs
20
Q
Loading and maintenance doses for caffeine and theophylline
A
caffeine 10mg/kg, 2.5mg/kg: theophylline 5-6mg/kg, 2-4mg/kg
21
Q
Why is caffeine the preferred drug for infants with apnea?
A
wider therapeutic range, ease of dosing, easy IV to PO transition, no need for drug monitoring
22
Q
Both caffeine and theophylline increase the excretion of…
A
Ca++
23
Q
Benefits of methylxanthines
A
numerous studies/clinical trials, decreasing number of A/B’s, decreasing cyanotic spells, decreased use of mechanical ventilation, improved weaning from mechanical ventilation, possible improvement in coordination b/t upper airway & respiratory muscles
24
Q
Effects of methylxanthines
A
decreased PDA’s, CNS stimulation, increased SV, HR, & BP, decreased BPD, smooth muscle relaxation, increased catecholamine release, diuresis, increased metabolic rate, increase lung compliance
25
Doxapram
respiratory stimulant only used when methylxanthines aren't effective
26
Causes of apnea of prematurity
multicausal: metabolic, infectious, neurologic, other-disorder of exclusion
27
What is surfactant?
surface-active lipoprotein complex formed by type II alveolar cells, lines alveoli & bronchioles
28
How is surfactant produced?
in type II cells during the terminal sac stage (17-26 weeks), stored in lamellar bodies that appear in cytoplasm about 20 weeks
29
What % of surfactant is recycled? What breaks it down?
90%; macrophages
30
Size of surfactant storage pool in term infant v. premie
100mg/kg in term, 4-5mg/kg in premies
31
What has a negative impact on surfactant production?
hyperinsulinism, MAS, acidosis
32
What does surfactant do?
increases pulm compliance, reduces surface tension, recruits collapsed airways, protects pulm epithelium, prevent atelectasis at end expiration, increases oxygenation, decreases mechanical ventilation, increases FRC, decreases V/Q mismatch
33
Surfactant becomes distributed when alveoli...
increase in size-also helps all alveoli in lungs to expand at the same rate
34
Surface tension draws fluid from the _____ to the _____.
capillaries; alveolar spaces-reducing surface tension keeps fluid in the capillaries
35
Composition of surfactant
40% DPPC (Lecithin), 40% other phospholipids, 5% SP-A, B, C, D, cholesterol, traces of other substances
36
Diseases related to surfactant deficiency
RDS, congenital surfactant deficiency, pulm alveolar proteinosis, pulm hemorrhage, pneumonia
37
MAS _____ the production of surfactant production.
inhibits
38
Types of Surfactant
Synthetic with or without proteins (exosurf), animal derived (bovine-infasurf, survanta or porcine-curosurf), human amniotic fluid derived survanta
39
Dosage & administration of surfactant
depends on type given; ET instillation, ?? use LMA, ?? inhaled
40
Things to monitor with surfactant use
ET patency & position, 02 saturation, EKG, BP (watch for postdose hyperoxia, hypocarbia, & overventilation), blocked airway
41
Adverse effects/precautions with surfactant use
reflux up the ET, desats, pulm hemorrhage (more common with animal surfactant), brady, hyperoxia, hypocarbia, pneumothorax, over ventilation
42
Early malnutrition may predispose us to...
an increased risk for chronic diseases later in life like CV disease
43
Nutritional supplements are essential for...
growth, differentiation, development
44
What is a supplement?
a product that contains 1 or more of: vitamin, mineral, herb or other plant derived substance, AA, concentrate, metabolite, constituent, or extract
45
Supplements are meant to be consumed via...
pill, capsule, tablet, or liquid form but not as a conventional food or as a sole item of a meal/diet
46
Most widely accepted dietary supplement
vitamins & minerals
47
Supplement use is associated with...
higher income, smoke-free environment, lower BMI, less daily TV/video time
48
Vit A (Retinoid) is needed for...
transduction of light, needed for the cornea--plays an important role in vision
49
Vit A is a ____ soluble compound and is known to decrease _____.
fat; decrease risk of macular degeneration & cataracts, some cancers, & some CV events
50
Vit A is also important in the development of...
vertebrae & spinal cord, limb development, & formation of the heart, eyes, & ears
51
Vit A is known to increase...
macrophage phagocytic activity & increases cytokines that mediate T & B lymphocyte production
52
Vit A is found in...
liver, dairy products, fish, colorful fruits & veggies, some oily plant---preterm BM is low in Vit A
53
Vit A supplementation in VLBW infants showed...
reduced death or O2 requirements at 1 month of age & O2 requirement at 36weeks for BW <1kg, may prevent lung injury & promote healing, decreased BPD
54
Low Vit A levels increased the risk of...
maternal to child HIV transmission
55
Vit A deficiency is _____. _____ infants will need fortification.
rare in the US---usually related to fat malabsorption; preterm (if being fed BM)
56
Vit D (Calciferol) is essential for...
proper growth & development of the skeletal system
57
How is Vit D synthesized and what does it work with?
synthesized in skin (can be in body too); works with PTH to maintain serum calcium & phosphate conc
58
What is required for the conversion of precursors to active Vit D?
UV-B light-known as sunshine vitamin
59
Vit D can be found in...
egg yolks, butter, whole milk, fatty fish, fish oils, mushrooms, breakfast cereals (human milk is low unless mom receiving high doses)
60
Vit D deficiency leads to...
rickets (impaired skeletal mineralization, widened ribs, osteomalcia, craniotobes)--it is more common in areas with limited sun exposure
61
Disrupts normal kidney function resulting in polydipsia & polyuria
hypercalcemia & hypervitaminosis D
62
AAP recommends _____ fed infants be supplemented with Vit D.
breast; formula fed infants need to consume 1L of vit D fortified formula/day (125ml/fdg if eating 8x/d)
63
Functions as a chain-breaking antioxidant to prevent free radical damage
Vit E; especially important in cells that are exposed to O2 (lungs & RBCs)
64
Dietary sources of Vit E
whole grains, nuts, veg oils, meats, wheat germ, safflower & sunflower oil, human milk
65
Vit E deficiency is ____ in the US but can lead to...
rare (usually fat malabsorption related); peripheral neuropathy, hemolytic anemia, abnormalities in platelet function
66
Fat soluble vitamin that functions as a coenzyme for the synthesis of biologically active proteins involved in blood coagulation & bone metabolism
Vit K
67
Proteins dependent on Vit K
factors II, VII, IX, X, proteins C & S
68
Vit K is obtained from...
diet (green leafy veggies, veg oils, margarine) & synthesis of intestinal flora---low levels in BM
69
Vit K deficiency leads to...
bleeding during first weeks of life---poor placental transfer of Vit K with little to no reserves
70
Categories of Vit K deficiency
Early (1st 24 hours of life-mom may have been treated with anticoagulant or anticonvulsant), classic (day 2-7, see umb stump, circ, or GI bleeding), late (day 7-3 months, see ICH)
71
Toxicity and adverse effects of Vit K
toxicity is rare and no adverse effects reported, no relationship between Vit K at birth and development of cancer & leukemia in children
72
Most abundant mineral in the body
Calcium--99% in bones, 1% in plasma & soft tissue
73
Calcium levels are regulated by & low levels usually imply...
several hormones including PTH & calcitonin; abnormal parathyroid function or kidney failure
74
Calcium is responsible for...
vasoconstriction, vasodilation, nerve impulses, contractility, hormone secretion, main structural component of the skeletal system
75
Calcium is mainly found in...
dairy products, dark green veggies, legumes, fortified foods
76
____ infants have a higher calcium need than ____ infants.
preterm; term
77
Calcium from this type of milk leads to greater retention of calcium
breast v. formula
78
LBW infants are at risk for these biochemical abnormalities when calcium deficiencies
rickets, low rates of bone mineralization, reduced linear growth, low net mineral retention, hypophosphatemia, reduced bone mass & subsequent osteoporosis
79
Ways to supplement preterm infants calcium consumption
HMF, premature formulas, multivitamins
80
Essential mineral that constitutes several classes of proteins
Iron
81
Classes of proteins that iron is a constituent of...
heme proteins (required for transport of O2), iron-sulfur, nonheme enzymes (flavoproteins), enzymes involved iron storage & transport, plays role in DNA synthesis
82
Best known deficiency resulting in 50% of the anemia issues in the world
Iron
83
Iron deficiency can cause...
poor cognitive and neurodevelopmental outcomes
84
Iron homeostasis is maintained by...
coordinated regulation of absorption & transport
85
Sources of dietary iron
foods of animal origin, grain, fruits, veggies, BM (cow milk iron is less well absorbed)
86
According to the AAP, iron supplementation should start at _____ for term infants and ____ for preterm infants
4-6 months (preferably with complementary foods); 1 month of age
87
Most common cause of poisoning in children <6 in US
Iron
88
Adverse effects of excessive administration of iron
promotion of cellular oxidation, impaired resistance to infection, GI abnormalities, behavioral disturbances, interferes with absorption or metabolism of other nutrients
89
Essential trace mineral with numerous physiologic & biochemical functions including catalytic, structural, and/or regulatory component of nearly 300 enzymes important in gene expression
Zinc
90
Dietary sources of zinc
primarily in animal sources (red meat, oysters, poultry, liver), also beans, nuts, whole grains, fortified cereals, legumes
91
Zinc is more bioavailable in ____ milk v. ____ milk and is less absorbed from ____ milk than ____ & ___ milk.
breast (although conc decreases as lactation progresses); bovine; soy; milk-based formula; breast
92
Characteristics of zinc deficiency
growth retardation, alopecia, diarrhea, delayed sexual maturation, impotence, eye & skin lesions, loss of appetite, behavior (ADHD)
93
Excessive chronic intake of zinc leads to...
suppression of immune response, decreased high-density lipoprotein cholesterol, reduced copper status (competes for receptor sites)
94
Acute zinc toxicity signs
epigastric pain, diarrhea, N/V
95
Zinc requirements are high between what ages?
6 months to 1 year
96
AAP recommends what intake of zinc which can be received from preterm formulas and HMF?
1-3mg/kg/day
97
Trace mineral essential for the synthesis of thyroid hormones T4 & T3
Iodine
98
Thyroid hormones are important for...
human growth, metabolism, reproduction
99
Sources of iodine (which is rapidly absorbed & removed from the body)
depends on water & soil content---ocean fish & mollusks, iodized salt, BM (depends on mom's intake), bovine milk, formula
100
Inadequate intake of iodine can lead to
goiter, mental retardation, hypothyroidism, cretinism, growth & developmental abnormalities
101
Dietary mineral associated with the prevention of dental caries & stimulation of new bone formation
fluoride
102
Few foods contain _____ naturally
fluoride; marine fish, some teas, artificially fluoridated water supplies
103
Is present in saliva & dental plaque but can inhibit plaque formation
Fluoride
104
What % of fluoride can be retained by the developing skeleton & teeth of young children?
80
105
Inadequate fluoride intake results in...
increase risk for dental caries
106
Important for visual & neurological development
Omega-3 fatty acids
107
Functions of omega-3 fatty acids
protection from inflammation, optimal immune function, decreasing risk for a variety of chronic degenerative diseases (i.e. CV disease)
108
Omega-3 fatty acids can be found in...
oils (canola & flax see), meats, eggs, BM is dependent on mom's intake, usually low in formula
109
Inadequate intake of omega-3 fatty acids can lead to...
decreased cognitive & behavioral performance but more study is needed
110
Excessive intake of omega-3 fatty acids can lead to...
possible increase in risk of conditions associated with oxidative damage (BPD, NEC)
111
Children with greatest need of micronutrient supplementation to improve overall health
preterm, LBW infants, and/or children living in endemic regions
112
What is Erythropoietin?
an endogenous glycoprotein that regulates erythrocyte production
113
How does Epo work?
maintains RBC production by inhibiting apoptosis of erythroid progenitors & by stimulating their proliferation & differentiation into normoblasts
114
Where is Epo produced & does it cross the placenta?
yolk sac->liver->kidneys (around time of birth); does not cross the placenta
115
What regulates Epo & when is the nadir for newborns?
regulated by tissue oxygenation; nadir about 4-6 weeks (earlier and lower for preterm infants)-reaches adult levels about 10-12 weeks of age
116
What are indications for rEpo (recombinant erythropoietin)
used to treat or prevent anemia due to a variety of causes including renal failure & prematurity-want to see increased erythropoiesis
117
Clinical trials of rEpo have involved which diagnoses?
anemia of prematurity, hyporegenerative anemia of neonates with Rh- hemolytic disease, anemia of BPD, CHD
118
What must be given concomitantly with Epo?
Iron (6-8 mg/kg/day of elemental iron)
119
Why do preterm infants require higher doses of Epo?
increased plasma clearance, increased volume of distribution
120
What are the recommended doses of rEpo?
400U/kg 3x/wk SQ for min. of 2 weeks; 200U/kg QDay IV for min of 2 weeks
121
What is Aranesp?
similar to rEpo; once per week dosing but few studies in babies
122
Adverse effects of Epo
in adults (not seen in infants): hypertension, thrombus formation, polycythemia, bone pain, red cell aplasia
123
Potential effects of Epo on ROP
may have protective effect on retina by ameliorating the first stage of ROP
124
Side effects of Epo
potential effect on iron balance (important for proteins & cellular oxidation)
125
Endogenous iron supplies are usually depleted by what age?
6 months
126
What are some other possible effects of Epo?
neuroprotection (prevents neuronal apoptosis), protection of other organs such as the heart & kidneys
127
A physiologic regulator of neutrophil production and function
G-CSF
128
What does G-CSF do?
multiple effects on WBC maturation & function, enhances neutrophil functions (chemotaxis, phagocytosis, superoxide prod, bactericidal activity)
129
Used to facilitate recovery after bone marrow transplant
G-CSF
130
Clinical trials of G-CSF have been done with the what diagnoses?
infants with bacterial sepsis, infants with moms with PIH, alloimmune neutropenia, autoimmune neutropenia, chronic idiopathic neutropenia
131
Adverse effects of G-CSF
rare; thrombocytopenia, osteoporosis, contraindicated in patients with known hypersensitivity to E-Coli derived proteins (is produced by E. Coli)
132
What is rGM-CSF?
Granulocyte-macrophage colony-stimulating factor-increases neutrophil counts & may decrease mortality due to sepsis when used prophylactically, enhances monocyte function, increases ANC within 48 hours of admin
133
Clinical trials for rGM-CSF have been in patients with...
neonatal sepsis (decreased mortality), prophylaxis against nosocomial infections (no difference)
134
Adverse effects of rGM-CSF
not been reported, needs long-term studies
135
2 categories of analgesic agents
opioid and nonopioid
136
Opioids include...
naturally occurring (opium alkaloids), synthetic opioid agonists that elicit morphine like activity (codeine, oxycodone, methadone, morphine, hydromorphone, meperidine, fentanyl)
137
Mechanisms of action for opioids
activation of receptors within the CNS, decreased neurotransmitter release from nociceptive neurons, altering perception & response to pain
138
Opioid receptors are located...
spinal or supra-spinal & outside the CNS on dorsal root ganglia & peripheral terminals of primary afferent neurons
139
Most common opioids used in the NICU
fentanyl & morphine
140
For mild pain, the WHO analgesic ladder suggests what kind of treatment?
non-opioid
141
The WHO analgesic ladder recommends reserving opioids for what type of pain?
moderate to severe
142
Adverse effects of opioids
respiratory depression, hypotension, glottis & chest wall rigidity, constipation (with long term use), urinary retention, seizures, sedation, bradycardia
143
You can minimize adverse effects by...
ensuring right drug and right dose is used
144
Competitive opioid receptor agonist that reverses many of the opioid side effects & antagonizes the endorphin effects
Naloxone
145
Who should not receive Naloxone?
infant of opioid abuser
146
What is the half life of Naloxone?
T 1/2=70 minutes, may be shorter than the T 1/2 of the narcotic
147
Most common opioid
Morphine
148
Morphine is soluble in _____, and it's metabolites are cleared by the _____.
water; kidneys and partly by biliary excretion
149
CL rates of morphine reach adult levels by ____ unless there is renal dysfunction, leading to ____.
6-12 months of age; accumulation of the drug
150
Side effects of morphine
hypotension, bradycardia, flushing=part of histamine response if given rapidly
151
Peak response and duration of morphine
45-90 minutes; 4-5 hours
152
Synthetic opioid with an analgesic potency similar to morphine with rapid distribution but slower elimination
Methadone
153
Used in opioid withdrawal in neonates
methadone
154
synthetic opioid with 50- to 100-fold greater potency than morphine
Fentanyl
155
Onset and duration of fentanyl
3-4 minutes; 30 minutes
156
Fentanyl is metabolized by the ____ and is _____ soluble.
liver; lipid
157
May be preferred in babies with hemodynamic instability, good choice for procedure pain relief, wide margin of safety, propensity for muscle rigidity
fentanyl
158
Benzodiazepine that offers sedation, anxiolysis, hypnosis, & amnesia but NOT analgesia
Midazolam
159
Why does midazolam have a rapid onset of action?
penetrates the BBB rapidly
160
Side effects of midazolam
respiratory depression if administered rapidly, hypotension, seizure-like myoclonus reported in premies receiving cont. infusions
161
Widely used for management of pain & fever but lacks anti-inflame effects
acetaminophen
162
anti-pyretic, analgesic, & anti-inflame effects
NSAIDs
163
NSAIDs can interfere with...
platelet aggregation but this is reversible
164
Non-pharmacologic interventions
sucrose, NNS, kangaroo care, facilitated tucking, music therapy, BM/breast feeding, multisensorial stimulation
