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1 Theclinical pharmacology of neonat The clinical pharmacology of neonat Zhou Yanqiong.
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Transcript of 1 Theclinical pharmacology of neonat The clinical pharmacology of neonat Zhou Yanqiong.
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TThehe clinicalclinical pharmacology of pharmacology of neonatneonat
Zhou Yanqiong
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Characteristic of medicine reaction Characteristic of pharmacokinetics Significance of drug monitoring Medication of breast milk feeding ne
onat Special reaction of neonatal medicine Rational administration of neonatal c
ommon disease
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DefinitionDefinition of neonatal of neonatal
born
postnatal 28ds
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Characteristic of neonat 1. functional underdevelopment of organ, und
erdevelopment 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 rout
e will be different
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Drug absorption and route of administration Administration by gastrointestinal tract (G
I/GIT): gastric acidity, gastric emptying time, pathologic status (PS)
Administration by nongastrointestinal tract 1. hypodermic injection , intramuscular inj
ection: regional flow, characteristic of medicine
2. intravenous injection : fast
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Pay attention to neonatal intravenous injection ①Administration according to specify velo
city ②To bring about constitution necrosis by d
rug effusion ③To cause thrombophlebitis by injecting t
he same blood vessel repeatedly→Injection site should be changed
④To avoid using hypso-concentration
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Drug disposition
Drug distribute to sys by blood circulation
organization, fat, pH;Liposolubility, molecular wieght, protein binding rate, barrier
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Characteristic of drug disposition of neonat More total body water and extracellular fl
uid volume Less fat mass Low degree of plasma protein binding Underdevelopment of blood-brain barrier
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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 enzy
matic activity of glucuronyl transferase of neonat
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binding with glucuronate: indomethacin, salicylate, chloramphenicol
Chloramphenicol graybaby syndrome sulfoconjugation glucuronate
Drug metabolism
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Drug excretion Organ: kidney Underdevelopment of Nephridial tissue; Fe
wer glomcrulus glomerular filtration + tubular secretion
acid-base balance + water-electrolyte metabolism
prime type
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Significance of drug monitoring of neonat
Fetal age
postnatal days
pathologic condition individual difference Not according to therapeutic reaction Safety/toxis margin adverse reaction
drug metabolismdifference
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Drug monitoring
gentamicin 庆大霉素; cefotaxime sodium 头孢噻肟钠; digoxin 地高辛; Phenobarbital 苯巴比妥; Aminophylline 氨茶碱; chloramphenicol 氯霉素
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Administration of breast milk feeding neonat
Banned in lactation Prudent in lactation suspend lactation
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Unusual reaction hypersensitivity Haemolysis, jaundice, nuclear jaundice methemoglobinemia 高铁血红蛋白症 hemorrhage 出血 NS toxic reaction 神经系统毒性反应 graybaby syndrome 灰婴综合征
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Haemolysis, jaundice, nuclear jaundice physiological jaundice Drugs to evoke haemolysis/jaundice Pathway of haemolysis/jaundice Nosogenesis of bilirubin encephalopa
thy drug treatment of neonatal jaundice
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Drug treatment of neonatal jaundice enzyme inducer: Phenobarbital, niket
hamide Inhibit haemolysis: prednisone , derm
acort Diminish bilirubin Infuse albumin
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Rational administration of neonatal common disease
neonatal asphyxia 新生儿窒息 neonatal convulsions 新生儿惊厥 neonatal septicemia 新生儿败血症 neonatal respiratory-distress syndrome
新生儿呼吸窘迫综合征
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Neonatal asphyxia Common reason : fetal distress; respiratory
center inhibited/damaged Drug treatment : 1. Retrieve acidosis 2. Intracardiac injection of cardiac 3. Supply of oxygen 4. Infection prevention
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Neonatal convulsionsCommon reason :
hypoxic-ischemic encephalopathy, intracranial hemorrhage, hypocalcemia
Drug treatment : treat primary disease, retrieve metabolic disorder, anticonvulsant
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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 苯巴比妥 2 . phenytoin sodium 苯妥英钠 3 . Diazepam 地西泮 4 . chloral hydrate 水合氯醛
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Neonatal septicemia
High case-fatality rate Fast pathogenetic condition Intravenous injection
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Neonatal septicemia
Coccobacteria
blood-brain barrier
purulent meningitis;suppurative meningitis Supportive treatment
amikacin
Third generation cephalosporin7ds ﹢ bacillus
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Respiratory distress syndrome of newborn
dyspneic respiration respiratory failure
alveolar surfactant insufficient
Characteristic of pathobiology :
asphyxial membrane --- pulmonary closure
hyaline membrane disease;membrane syndrome
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Respiratory distress syndrome of newborn
Treatment : keep warm; oxygen; retrieve electrolyte disturbances and acidosis; infection prevention; depressurization
Oxygen therapy: atomization;mask oxygen inhalation; 40 % concentration;interruption
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