Pediatric Pharmacology

Question 1

What aspects regarding drug disposition are impacted by immaturity?

Answer 1

1. absorption
2. distribution
3. metabolism
4. elimination

Question 2

Factors affecting drug absorption

Answer 2

1. gastric pH- delayed acid prodution in preterms
2. GI motility- slower motility
3. rectal anatomy- small size; increases 1st pass clearance

Question 3

Thin skin does what to absorption?

Answer 3

promotes increased absorption

Question 4

Intramuscular or subcutaneous absorption is decreased when?

Answer 4

perfusion is decreased

Question 5

Factors affecting drug distribution

Answer 5

1. body composition- more water, less fat
2. protein binding- less protein in sicker infants makes drugs more bioavailable
3. lower plasma pH
4. bilirubin
5. disease states

Question 6

Factors affecting drug metabolism

Answer 6

reduced hepatic enzyme function

Question 7

Factors affecting drug elimination

Answer 7

1. decreased GI motliity

2. renal immaturity

Question 8

If you are concerned about possible sepsis, what drug combo do you choose?

Answer 8

ampicillin (gram +) and gentamicin (gram -)

Question 9

Adverse effects of gent?

Answer 9

nephrotoxicity and ototoxicity

Question 10

Importance of monitoring gent levels

Answer 10

“peak kills the bug, trough kills the kidney” so monitor trough level carefully

Question 11

After ampicillin and gent, nosocomial infection suspected, what antibiotic do you use?

Answer 11

1. Add Vancomycin (gram +) because MRSA and staph epidermidis coverage
2. Add cefotaxime (gram -)

Question 12

Why monitor vanc levels?

Answer 12

1. high trough is important for clinical effect

Question 13

For fungal infections such as candida consider what antibiotics?

Answer 13

1. Amp B
2. Fluconazole
3. Echinocandins

Question 14

26 week infant in resp distress requring intubation and mechanical ventilation like needs?

Answer 14

Surfactant (curosurf, infasurf, survanta)

Question 15

What are potential side effects of endotracheal surfactant administration?

Answer 15

bradycardia and oxygen desaturation

Question 16

Is synthetic surfactant more or less effective form of therapy

Answer 16

Less

Question 17

Another drug that can be given to mom before delivery of premature to help with lungs?

Answer 17

betamethasone

Question 18

Drug to treat patent ductus arteriosus?

Answer 18

Indomethacin- prostaglandin synthesis inhibitor

Question 19

Episodes of apnea with bradycardia and desats is apnea of prematurity, how to treat it?

Answer 19

Methylxanthine therapy- caffeine citrate, theophylline

Question 20

Bronchopulmonary dysplasia treatment

Answer 20

1. diuretics
2. corticosteroids
3. b-agonist aerosols

Question 21

Infant with meconium-stained fluid, resp distress tachypnea, retractions, cyanosis with pulm HTN might benefit from what drug?

Answer 21

NO- pulmonary vasodilator contraindicated in infants with right to left shunt

Question 22

Effortless tachypnea (no retraction or grunting) associated with transposition of great vessels treated with

Answer 22

Prostaglandin E- dilates ductus arteriosus for ductal shunting with good oxygenation and perfusion until surgery