PowerPoint 演示文稿 - 汕头大学医学院

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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 injection：fast
The clinical pharmacology of neonat
Zhou Yanqiong
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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

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Neonatal septicemia


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

Coccobacteria ﹢ bacillus
7ds
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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
amikacin Third generation cephalosporin

blood-brain barrier
purulent meningitis;suppurative meningitis

Supportive treatment
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Respiratory distress syndrome of newborn
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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
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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

Chloramphenicol
graybaby syndrome

sulfoconjugation
glucuronate
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Drug excretion



Organ: kidney
Underdevelopment of Nephridial tissue; Fewer glomcrulus glomerular filtration ＋tubular secretion
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Definition of neonatal
born
postnatal 28ds
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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
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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
dyspneic respiration respiratory failure alveolar surfactant insufficient Characteristic of pathobiology： asphyxial membrane --- pulmonary closure
hyaline membrane disease;membrane syndrome

More total body water and extracellular fluid volume Less fat mass Low degree of plasma protein binding Underdevelopment of blood-brain barrier
A decline of the accretion rate
neonat
: low enzymatic activity of glucuronyl transferase of
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Drug metabolism

binding with glucuronate: indomethacin,
salicylate, chloramphenicol
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Neonatal convulsions
Common reason： hypoxic-ischemic encephalopathy, intracranial hemorrhage, hypocalcemia Drug treatment： treat primary disease, retrieve metabolic disorder, anticonvulsant
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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
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Drug treatment of neonatal jaundice


enzyme inducer: Phenobarbital, nikethamide Inhibit haemolysis: prednisone , dermacort Diminish bilirubin Infuse albumin
prime lance ＋ water-electrolyte metabolism
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Significance of drug monitoring of neonat
Fetal age drug metabolism postnatal days difference pathologic condition individual difference Not according to therapeutic reaction Safety/toxis margin adverse reaction


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