Pharmacology Flashcards
Covers: Neonatal Considerations; Neonatal Therapeutics
Neonates have slower or faster absorption when compared to adults.
(Slower)
Neonates have higher or lower absorption when compared to adults.
(Higher)
Neonates have higher or lower bioavailability when compared to adults.
(Higher)
Which of the following does not lead to increased bioavailability associated with neonates when compared to adults?
A - Decreased efflux pumps
B - Decreased metabolizing enzymes
C - Being on a milk diet
D - Increased intestinal permeability
E - Incomplete GI flora
(C) - Being on a milk diet
Which of the following neonatal characteristics leads to decreased activation of prodrugs?
A - Decreased efflux pumps
B - Decreased metabolizing enzymes
C - Being on a milk diet
D - Increased intestinal permeability
E - Incomplete GI flora
(B) - Decreased metabolizing enzymes
How does the larger extracellular fluid compartment of neonates impact water soluble drugs?
(Effects the dose needed to be administered to get the same effect, you will need a HIGHER dose in neonates to get the same plasma concentration as you would in adults on a normal dose)
How does the larger extracellular fluid compartment of neonates impact lipid soluble drugs?
(It doesn’t, there is a smaller intracellular fluid compartment but the difference in concentrations reached is much smaller for lipid soluble drugs and dose adjustments are not often needed)
What results from leaky vessels, lack of p-glycoprotein efflux pumps, and lack of metabolizing enzymes in neonates?
(Incomplete diffusion barriers such as the BBB)
Why is there no significant difference in renal elimination between neonates and adults in horses, cattle, and sheep?
(Bc the neonatal kidneys have a similar GFR and RBF to adults by the first few days of life in those species)
Are weak acids excreted slower or faster in neonates?
(Slower, neonates have acidic urine when compared to adults so the weak acids will not be ionized in urine so they can be reabsorbed easier)
Are weak bases excreted slower or faster in neonates?
(Faster, neonates have acidic urine when compared to adults so the weak bases will be more readily ionized in the urine and will get trapped and excreted)
What is the preferred route of medication administration in a septic neonate?
(IV; PO and SC are crappy, IM ain’t great; IO is a possibility)
What drug category can be used to improve the hemodynamic status of neonates and may improve absorption of other drugs?
(Pressors i.e. dobutamine, norepinephrine, vasopressin, etc.)
Why do increased portions of drugs reach the brain and heart in a neonate with sepsis?
(Blood is being shunted away from the less important organs such as the kidneys, spleen, and gut and instead shunted to the brain and heart)
What is the ‘third spacing’ phenomenon?
(Interstitial edema results from increased capillary permeability in patients with endothelial damage, water soluble drugs can distribute to that edema and cause a need for higher drug doses to get an adequate plasma concentration)
