Download Introduction to Pharmacology

Neonatal/Pediatric Pharmacology
Fred Hill, MA, RRT
Special Considerations
• Effects on developing fetus
• Special susceptibilities in neonates
and children for certain drugs
• ~25% of drugs are labeled as safe
and effective for children
Placental Drug Transfer
• How easily does a drug pass through the
placental barrier?
• What are known effects of drugs on fetus?
– Teratogens: drugs which are likely to cause
physical/mental developmental abnormalities:
spontaneous abortion, congenital
malformations, intauterine growth retardation,
mental retardation, carinogenesis.
– First trimester most critical time of avoidance.
Thalidamide & Teratogenesis
• Had been considered drug of choice for morning
sickness in pregnant women
• Thalidamide: 1956-1960s, >40,000 birth defects, 17
in U.S.
FDA Hero
Chemie GrÜenthal attempted introduction of
thalidomide into U. S. in 1961
Frances Kelsey repeatedly denied application.
Some Other Teratogens
• Alcohol: IUGR, microcephaly, dysmorphic facies, cleft palate, cardiac
anomalies
• ACE inhibitors (captopril, enalapril, Lisinopril): hypotension, oliguria
with renal failure, hyperkalemia, complications of oligohydramnios
• Carbamazepine: neural tube defects
• Cocaine: abruptio placentae, prematurity, microcephaly, limb defects,
etc.
• Coumarin anticoagulents
• Diethylstilbestrol
• Lithium
• Misoprostol
• Tetracyclines: yellow-brown discoloration of teeth during calcification
of teeth after 17th week
Special Neonatal/Pediatric
Applications
• Ribavirin: Anti-viral given by aerosolization for RSV.
Potential for teratogenicity
• Indomethacin: close patent ductus arteriosis (PDA), may
help prevent IVH
• Ibuprofen lysine (Neo Profen): close patent ductus
arteriosis (PDA)
• Alprostadil-Prostaglandin E1 (PGE1): maintain PDA in
certain heart defects
• Tolazoline: persistent pulmonary hypertension of the
newborn
• Methylxanthines (theophylline & caffeine): neonatal
apnea
Assessment of
Oxygenation/Ventilation
Fred Hill, MA, RRT
Sites of ABG Samples
• Umbilical artery catheter (UAC):
preferred source
• Radial artery
• Brachial artery
• Simultaneous UAC and right radial
sample when R → L shunting suspected
• Capillary samples (CBG) in place of
ABG: useful for pH and PCO2
Umbilical Artery Catheter
“Heel Stick”
Transcutaneous Monitoring
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Especially useful in neonates
May not correlate with ABG values
Useful for trending.
Many factors affect values
Thermal injury the major problem
– Maximum temperature = 44o C
– Change sites periodically
– Greater problem with premature infants