Quiz 3

Question 1

What is the mechanism of action of inhaled nitric oxide (iNO)?

Answer 1

Induction of smooth muscle relaxation

iNO selectively relaxes pulmonary vascular smooth muscle via the cGMP pathway.

Question 2

What should be done if urine output significantly decreases after the second dose of Indomethacin?

Answer 2

Hold the third dose until urine output improves

This is to prevent renal injury.

Question 3

List four common side effects of PGE1 (Alprostadil).

Answer 3

• Apnea
• Hypotension
• Flushing
• Fever

These side effects are due to smooth muscle relaxation and CNS effects.

Question 4

What is the most likely diagnosis for a term neonate with a heart rate of 250 bpm?

Answer 4

SVT

Treatment includes vagal maneuvers, then adenosine 0.1–0.2 mg/kg IV push.

Question 5

How is digoxin dosing adjusted?

Answer 5

Based on patient response

Adjustments are made based on clinical improvement, not age or peak levels.

Question 6

What medication is preferred for a former 28-weeker now 16 weeks old with SBP >110?

Answer 6

Captopril

ACE inhibitors are preferred for chronic neonatal hypertension.

Question 7

Where is inhaled nitric oxide (iNO) cleared from the body?

Answer 7

Lungs

iNO is inactivated by hemoglobin in pulmonary circulation.

Question 8

What are the beta and alpha-adrenergic effects of dopamine?

Answer 8

• Beta: ↑ HR and contractility (β1)
• Alpha: Vasoconstriction (↑ SVR) at high doses

Side effects include tachyarrhythmia, tissue ischemia, hypertension.

Question 9

What are two indications for milrinone?

Answer 9

• PPHN
• Low cardiac output syndrome

Adverse effects include hypotension, which can be prevented by slow titration and ensuring volume status.

Question 10

What is preload in the context of maternal abruption?

Answer 10

Volume returning to the heart

Preload can be improved with isotonic fluid boluses and possibly PRBCs if anemic.

Question 11

What is the mechanism of action of propranolol?

Answer 11

Non-selective β-blocker

β1 decreases HR/contractility; β2 decreases vasodilation.

Question 12

How do neonates increase cardiac output?

Answer 12

By increasing heart rate

Stroke volume is fixed; CO depends on HR.

Question 13

What drug is used for PDA that does not increase bleeding risk?

Answer 13

Acetaminophen

Unlike NSAIDs, acetaminophen does not inhibit platelet function.

Question 14

What dangerous electrolyte effect is associated with ACE inhibitors?

Answer 14

Hyperkalemia

ACE inhibition reduces aldosterone, leading to potassium retention.

Question 15

What effect do beta-blockers have on glucose levels?

Answer 15

Hypoglycemia

β2 blockade inhibits glycogenolysis and masks symptoms of low glucose.

Question 16

What is the mechanism of action of adenosine?

Answer 16

Conduction through AV node

It causes transient AV nodal block, terminating AV node–dependent SVT.

Question 17

What is a simple summary of the RAAS system and ACE inhibitors?

Answer 17

The RAAS system raises BP; enalapril blocks it to relax vessels and reduce fluid

This explanation can help parents understand the treatment.

Question 18

Which vasopressor should be avoided in PPHN?

Answer 18

Milrinone

It may worsen hypotension in PPHN due to systemic vasodilation.

Question 19

What is true about ibuprofen in comparison to indomethacin?

Answer 19

It has similar renal adverse effects

Both NSAIDs reduce prostaglandins and renal perfusion.

Question 20

List three important discharge actions for propranolol.

Answer 20

• Caregiver education (dosing, hypoglycemia signs)
• Cardiology and PCP follow-up
• Emergency plan and symptom awareness

These actions ensure safe management after discharge.