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43 Cards in this Set

  • Front
  • Back
thiopental crosses the placenta very slowly
T/F
false

Thiopental crosses the placenta almost immediately

can produce sedation / apnea in newborn
what kind of drugs tend to diffuse readily acress the placenta and enter the fetal circulation?
lipophilic
succinylcholine & tubocurarine cross the placenta slowly
T/F
true

highly ionized drugs cross slowly and achieve very low conc. in fetus
drugs with molecular wt of 250-500 can cross placenta easily
T/F
true
drugs greater than ___ mol. wt. cross very poorly
>1000

250-500 = easy
500-1000 = more difficult
>1000 = poorly
this transporter pumps drugs back into the maternal circulation and may cause drug accumulation in the fetus
P-gp encoded by MDR1 gene
protein binding has a greater affect on:
a. poorly lipid-soluble / ionized drugs
b. very lipid soluble drugs
greater affect on A, pooly lipid-soluble / ionized drugs bc they transfer slowly and will be impeded by their binding to maternal plasma proteins

very lipid soluble drugs with NOT be affected greatly by protein binging bc they cross so rapidy
what are the roles of the placenta?
semi-permiable barrier
site of metabolism of some drugs:
phenobarbital
toxic metabolites of ethanol & benzos
drugs that cross placenta enter fetal circulation via ___?
umbilical v.
40-60% umbilical venous blood flow enters fetal LIVER
rest enters general fetal circulation
what are some drugs that may be given during preg?
maternal drug actions:
cardiac glycosides & diuretics = HF
insulin = gestational DM
why would you give mother corticosteroids? phenobarbital?
therapeutic drug action in the fetus: give to mom with fetus as intended target

corticosteroids? stumulate lung
phenobarbital? induce fetal hepatic enzymes --> lower incidence of jaundice
what is thalidomide?
a teratogen
single exposure to drug can affect limb developement (4th-7th week)
what are some teratogenic mechanisms?
- secondary or indirect effect on fetus
- interfere with passage of O2 --> effects on most rapidly metab tissues
- processes of differentiation in developing tissues
- deficiency of critical substance
define teratogen
-characteristic set of malformation indicating selectivity for certain tissue organs
- particular stage of developement
- dose-dependent incidence
fewer than ___ drugs have been identifies as human teratogen for all trimesters
30

(just over 40 with teratogenic effects)
risk of teratogen?
3%
drug absorption in infants and kids can be affected by?
blood flow at site of administration
GI fxn
blood flow at site of administration changes how with shock, vasoconstriction, HF?

sick, preterm infants?
these may reduce blood flow, decreasing drug conc.

k, preterm infants have little m mass and diminished peripheral perfusion making absorption irregular and difficult to predicts

sudden improvement in perfusion can result in unpredictable increase in amount of drug entering circulation --> high and potentially tox conc
GI changes in fxning
big changes shortly after birth
gastic emptying time up to 6-8 hrs first day after delivery, meaning drug absorbed mostly in stomach may be more completly absorbed than expected and drugs absorbed in intestine have delayed effect

peristalsis in neonate is irregular and may be slow, meaning sm int drugs may be unpredictable, more drug may be absorbed
GI enzyme activities tend to be ___ in newborn?
GI enzyme activities tend to be lower in newborn, may have low conc. of bile acids and lipase with decrease absorption of lipid-sol drugs
which drugs have DECREASED oral absorption?
acetaminophen
phenobarbital
phenytoin
which drugs have NORMAL oral absorption?
diazepam
digoxin
sulfonamides
which drugs have INCREASED oral absorption?
ampicillin
penicillin G
acetaminophen oral absorption?
decreased
what % of neonate body wt is water?

what % extracellular water?
70-75% TBW

40% extracellular
preterm vs. term body fat %
preterm vs. term
1% vs 15%
is protein binding in neonate increased or decreased?
reduced
p450 and clearance rates in newborns?
lower and slower

also prolonged 1/2 lives
GFR in newborn is what % of adult?

what about toddler?
30-40% of the adult value--- much lower in newborns
renal elimination drugs are cleared slowly in first weeks of life

toddlers increased renal elimination = shorter 1/2 life
why would indomethacin be given to neonate?
indomethacin
causes rapid closure of patent ductus arteriosus
prostaglandin E1?

side effect?
PGE1
causes ductus to remain open
life-saving in infant with transposition of great vessels or tetralogy of Fallot

antral hyperplasia with gastic outlet obstruction as clinical maniestation
what is elixir?
elixirs
alcoholic solutions in which drug molecules are dissolved and evenly distributed
suspensions?
suspensions
contain undissolved particles of drug that must be shaken

phenytoin suspensions = uneven distribution potential cause of ineffecacy or tox
T/F you can detect almost all drugs mom takes by breast milk
true
when should you take a relatively safe drug??
30 min after nursing and 3-4 hours before next feeding
T/F
antibiotics CANNOT be detected in milk
false
most can
T/F
sedatives and hypnotics conc sufficient to produce effect in some infants
true
T/F
nicotine is in milk
LOW levels
no effects on baby
T/F
caffeine very small effects
true
T/F
lithium is undetectable in milk
false
levels equal to maternal serum!
radioactive substances may increase risk of tyroid cancer
T/F
true
what is the most adequate measurement to base doses on?
surface area
formulas:
Young's Rule
Clarks Rule
dose = adult dose * (age / age + 12)

dose = adult dose * (wt / 150)