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Flashcards in Drug use in the neonate Deck (42)
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What is the most effective reliable method of drug administration to a neonate and why?

- you know exactly how much drug is being absorbed into circulation to have an effect
- removes variables such as vomiting and hepatic first pass effect


What factors affect the absorption of a drug given IM to a neonate?

- less muscle mass
- thinner cellular membranes and increased capillary density
- immature circulatory system


what other factors affect drug absorption in the neonate, particularly oral?

- immature GI tract - small surface area, altered pH changes ionisation, changes in bile salt pool
- decreased gastric emptying
- less bacterial colonisation of intestines
- vomiting/reflux
- reduced compliance


What factors influence drug distribution in the neonate?

- body water:fat percentage (low body fat: high body water)
- protein binding - lower plasma proteins, bilirubin competes for binding sites on proteins
- immature blood-brain barrier


What factors influence drug metabolism in the neonate?

- hepatic blood flow increases with age
- immature liver enzymes has variable effect


What factors influence drug elimination in the neonate?

- immature renal function - lower GFR, generally drugs excreted by liver have prolonged elimination half-life
- gestational age
- adequate fluid intake


Why are antimicrobials commonly used in neonates?

- immature immune systems
- excessive use has contributed to development of antibiotic resistance - consider judiciousness and safety


What are the risks associated with antimicrobial use in neonates?

- elimination of protective normal flora
- unknown long term impacts


Why are diuretic drugs used in neonates?

- hypertension
- congestive heart failure
- renal dysfunction


What are 2 risks of IV administration in neonates?

- potential for overdosage due to incorrect calculations
- potential for infection through IV access site


Why do neonates tend to be at higher risk of dosage calculation errors?

- complex factors influence pharmacokinetics
- individualised dosing calculations
- some drugs need to be diluted
- slow IV rates


What methods are used to calculate drug dosages in the neonate

- weight per kilogram
- body surface area


What is the formula for calculating neonatal drug dosages according to weight per kilogram?

dose to be given = recommended dose (mg/kg) x weight (kg)


What is the definition of a neonate?

A baby within it's first 28 days of life.


What strategies may decrease the risk of drug errors for neonates?

- double checking calculations
- accessible examples of calculations
- using standardised drug preparations and dosing
- asking questions about whether a drug should be administered
- volume should feel appropriate


What is the trade name for benzylpenicillin?



What is the usual indication for benzylpenicillin in neonates?

antibiotic for treatment of susceptible organisms (e.g GBS, congenital syphilis)


What is the stock strength and usual dosage of benzylpenicillin for neonates?

600mg vial (as powder for reconstitution with water for injection)
depending on and and indication around 50mg/kg/6-12 hrly
as IM or slow IV over 3-5 minutes


What adverse effects are associated with benzylpenicillin use in neonates?

- hypersensitiviy
- rash
- diarrhoea
- seizures at high doses
- haemolytic anaemia


What is the usual indication for gentamicin in neonates?

aminoglycoside antibiotic for treatment of infections caused by susceptible organisms e.g. e.coli, pseudomonas, klebsiella


What is the stock strength and usual dosage of gentamicin for neonates?

80mg/2ml ampoules
IV is given diluted as a 10mg/mL solution over 10 minutes
IM is used undiluted
dose depends on gestation, given 24-48 hourly


What precautions/side effects are associated with the use of gentamicin in neonates?

- high risk medication
- can cause renal impairment and deafness
- usually used with therapeutic drug monitoring loking at area under curve, peak and trough levels of drug over time


What is the trade name of caffeine citrate?



What is the usual indication for caffeine citrate in neonates?

- stimulates inspiratory drive and increases sensitive of medullary centre to CO2
- used for prevention or treatment of apnoea associated with prematurity, infection or anaesthesia and to aid extubation of ventilated babies


What is the stock strength and usual dosage of caffeine citrate for neonates?

available as oral solution 10mg/ml or 50mg/5 ml ampoule for IV infusions
loading dose is 20mg/kg with maintenance dose of 5-7.5mg/kg/day at least 24 hours later (need to dilute maintenance dose)
- give oral dose with feeds
- routine monitoring of drug levels not required


What adverse effects are associated with caffeine citrate?

- nausea/vomiting
- gastric irritation
- agitation
- tachycardia
- diuresis
- overdose - arrhythmias and seizures


What is the trade name of Vitamin K (phytomenadione)?



What is the usual indication for phytomenadione in neonates?

- prophylaxis for vitamin K deficiency bleeding in the newborn
- no colonisation of gut with bacteria that produce vitamin k, poorly transferred across placenta and low concentrations in breastmilk, vital for clotting pathways


When should phytomenadione be given to neonates?

- with maternal consent within 24 hours of birth


What is the usual stock strength, route and dose of phytomenadione in neonates?

2mg/0.2mL ampoules
Can be given IM (preferred) or orally in 3 doses
usual dose is 1mg (0.1ml) IM at birth
if orally 2mg(0.2ml) at birth, 3-5 days and 4 weeks, last dose omitted if formula fed