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The clinical pharmacology of neonat

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The clinical pharmacology of neonat Zhou Yanqiong Characteristic of medicine reaction Characteristic of pharmacokinetics Significance of drug monitoring Medication of ... – PowerPoint PPT presentation

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Title: The clinical pharmacology of neonat


1
The clinical pharmacology of neonat

Zhou Yanqiong
2
  • Characteristic of medicine reaction
  • Characteristic of pharmacokinetics
  • Significance of drug monitoring
  • Medication of breast milk feeding neonat
  • Special reaction of neonatal medicine
  • Rational administration of neonatal common disease

3
Definition of neonatal
born
postnatal 28ds
4
Characteristic of neonat
  • 1. functional underdevelopment of organ,
    underdevelopment of enzymatic system,
  • slow drug metabolism and evacuation
  • 2.Variation of drug metabolism and evacuation
    velocity according to the birth weight, fetal age
    and postnatal days
  • 3.individual difference among the sick babies
  • 4.Function weaken
  • So, dosage, dosing interval and administration
    route will be different

5
Drug absorption and route of administration
  • Administration by gastrointestinal tract
    (GI/GIT) gastric acidity, gastric emptying time,
    pathologic status (PS)
  • Administration by nongastrointestinal tract
  • 1. hypodermic injection,intramuscular
    injection regional flow, characteristic of
    medicine
  • 2. intravenous injectionfast

6
Pay attention to neonatal intravenous injection
  • ?Administration according to specify velocity
  • ?To bring about constitution necrosis by drug
    effusion
  • ?To cause thrombophlebitis by injecting the same
    blood vessel repeatedly?Injection site should be
    changed
  • ?To avoid using hypso-concentration

7
Drug disposition
  • Drug distribute to sys by blood circulation
  • organization, fat, pH
  • Liposolubility, molecular wieght,
  • protein binding rate, barrier

8
Characteristic of drug disposition of neonat
  • More total body water and extracellular fluid
    volume
  • Less fat mass
  • Low degree of plasma protein binding
  • Underdevelopment of blood-brain barrier

9
Drug metabolism
  • Organ liver
  • Accretion rate size of hepar, metabolic
    capability of enzymatic system
  • Liposoluble substances excreted by binding with
    glucuronate or sulfate
  • A decline of the accretion rate low enzymatic
    activity of glucuronyl transferase of neonat

10
Drug metabolism
  • binding with glucuronate indomethacin,
    salicylate, chloramphenicol
  • Chloramphenicol graybaby syndrome
  • sulfoconjugation glucuronate

11
Drug excretion
  • Organ kidney
  • Underdevelopment of Nephridial tissue Fewer
    glomcrulus
  • glomerular filtration tubular secretion
  • acid-base balance water-electrolyte metabolism

prime type
12
Significance of drug monitoring of neonat
drug metabolism
  • Fetal age
  • postnatal days
  • pathologic condition
  • individual difference
  • Not according to therapeutic reaction
  • Safety/toxis margin
  • adverse reaction

difference
13
Drug monitoring
  • gentamicin????
  • cefotaxime sodium?????
  • digoxin???
  • Phenobarbital????
  • Aminophylline???
  • chloramphenicol???

14
Administration of breast milk feeding neonat
  • Banned in lactation
  • Prudent in lactation
  • suspend lactation

15
Unusual reaction
  • hypersensitivity
  • Haemolysis, jaundice, nuclear jaundice
  • methemoglobinemia???????
  • hemorrhage??
  • NS toxic reaction????????
  • graybaby syndrome?????

16
Haemolysis, jaundice, nuclear jaundice
  • physiological jaundice
  • Drugs to evoke haemolysis/jaundice
  • Pathway of haemolysis/jaundice
  • Nosogenesis of bilirubin encephalopathy
  • drug treatment of neonatal jaundice

17
Drug treatment of neonatal jaundice
  • enzyme inducer Phenobarbital, nikethamide
  • Inhibit haemolysis prednisone , dermacort
  • Diminish bilirubin
  • Infuse albumin

18
Rational administration of neonatal common disease
  • neonatal asphyxia?????
  • neonatal convulsions?????
  • neonatal septicemia??????
  • neonatal respiratory-distress syndrome??????????

19
Neonatal asphyxia
  • Common reasonfetal distress respiratory center
    inhibited/damaged
  • Drug treatment
  • 1. Retrieve acidosis
  • 2. Intracardiac injection of cardiac
  • 3. Supply of oxygen
  • 4. Infection prevention

20
Neonatal convulsions
  • Common reason
  • hypoxic-ischemic encephalopathy,
  • intracranial hemorrhage,
  • hypocalcemia
  • Drug treatment
  • treat primary disease,
  • retrieve metabolic disorder,
  • anticonvulsant

21
Treatment of neonatal convulsions
  • To retrieve metabolic disorder
  • 1.Retrieve hypoglycaemia
  • 2.Retrieve hypocalcemia
  • 3.Retrieve hypomagnesemia
  • 4 . Retrieve VitB6 defect
  • Anticonvulsant application
  • 1.Phenobarbital????
  • 2.phenytoin sodium????
  • 3.Diazepam???
  • 4.chloral hydrate????

22
Neonatal septicemia
  • High case-fatality rate
  • Fast pathogenetic condition
  • Intravenous injection

23
Neonatal septicemia
  • Coccobacteria
  • blood-brain barrier
  • purulent meningitissuppurative meningitis
  • Supportive treatment

amikacin
7ds
? bacillus
Third generation cephalosporin
24
Respiratory distress syndrome of newborn
  • dyspneic respiration respiratory
    failure
  • alveolar surfactant insufficient
  • Characteristic of pathobiology
  • asphyxial membrane --- pulmonary closure

hyaline membrane diseasemembrane syndrome
25
Respiratory distress syndrome of newborn
  • Treatmentkeep warm oxygen retrieve electrolyte
    disturbances and acidosis infection prevention
    depressurization
  • Oxygen therapy atomizationmask oxygen
    inhalation 40concentrationinterruption

26
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