RC 17 Chapter 10 &17 Review
You are in the room of a 26 week gestational baby that has just been born. the newborn weighs 1200 g. on assessment you find the baby has poor color, substernal retractions, nasal flaring, respiration rate of 45, heart rate of 140. You note that the baby is difficult to bag. Which of the following agents would you recommend
Beractant
Drug dosing with inhaled aerosols for neonatal and pediatric patients is NOT based on
Body size and blood level
Infant
Child between one month and one year of age
Infant
1 to 12 months
Child
1 to 12 years
Adolescent
12 to 18 years
Neonate
First month of postnatal life
You are in the room of 36 week gestation baby that has just been born. The newborn weighs 2200 g. On assessment you find the baby has good color, no retractions, no nasal flaring, a respiration rate of 25, a heart rate of 110, and a pulse ox of 96%. Which of the following would you choose
No indication for therapy at this time
What is an example of synthetic natural surfactant
None at present
Which of the following are currently used methods for delivering surfactant int infants
. installation through side port catheter . installation through catheter
What are possible hazards of surfactant administration
.Acute obstruction of infant airways .Desaturation .Bradycardia .Over oxygenation .Over ventilation .Apena .Pulmonary Hemorrhage .Puncture lung
How can natural surfactants be obtained from animals or humans
.Alveolar wash .Amniotic Fluid
What are some factors that affect penetration and deposition of medications with neonates and pediatrics
.Breathing pattern .Inspiratory flow rate .Tidal Volume .Respiratory Rate .Minute Ventilation .Tracheal diameter .Tracheal length
Which of the following are natural surfactant preparations
.Curosurf .Survanta .Infasurf
What is an example of synthetic surfactant
.Lucinactant (experimental only at this time)
Which of the following are approved indications for surfactant therapy
.Prophylaxis in very low birth weight (<1250 g infants) .Prophylaxis in infants of higher birth weight (>1250 g) but with immature lungs .Rescue treatments in infants with respiratory distress syndrome
What are some examples of natural surfactant
.Survanta (bovine) .Curosurf (porcine) .Infasurf (bovine)
Drug dosing with inhaled aerosols for neonatal and pediatric patients is based on
A target effect strategy with avoidance of toxicity.
Surfactant is produced by
Alveolar type II cells
Bovine
Cow
Another name for surface active agents is
Detergent
Aerosol doses to neonates or children are self limiting because of
Differences between pediatric and adult airway
The usual method of administering exogenous surfactant to babies is
Direct installation to the airway
All of the following are considered natural surfactants except:
Dornase Alfa
Nominal dose
Dose in delivery device
Inhaled or delivered dose
Dose reaching the patient's mouth or artificial airway
Lung dose
Dose reaching the trachea and beyond
Emitted Dose
Dose released by aerosol device
Lack of pulmonary surfactant in respiratory distress syndrome of the newborn results in
High surface tension
Natural surfactant is obtained by all of the following methods except
In vitro preparation
Surfactant is stored in
Lamellar bodies
Premature neonate
Less than 37 weeks of gestational age
The major stimulus for secretion of surfactant into the alveolus is
Lung inflation
Adult
Older than 18 years
Surfactant is composed primarily of
Phospholipids
Porcine
Pig
A new born weighing 1000 g exhibit symptoms of respiratory distress syndrome, including poor color, suprasternal retractions, nasal flaring, and desaturations. The therapist should recommend:
Poractant Alfa
For an alveolus, Laplace's law is written as
Pressure= 2x surface tension ÷ radius
What is the main clinical indication for the use of surfactant
RDS
What is a very important feature of Surfactant
Recycling
Neonatal
Refers to period of time between birth and first month of life
Pediatric
Refers to period of time between one month and 18 years of age
Natural surfactant
Surfactant from natural sources either human or animal with addition or removal of substances
Synthetic natural surfactant
Surfactant prepared in vitro by genetic engineering
Synthetic surfactant
Surfactant that is prepared by mixing in Vitro synthesized substances that may or may not be in natural surfactant
All of the following are hazards or complications of exogenous surfactants except
Tachycardia
Which of the following is considered the mode of action for surfactant
To replace missing surfactant
True/False It has been clearly documented that even a 0.5 cm gap between the mask and face reduces the inhaled drug in a pediatric lung model of spontaneous breathing up to 50%
True
True/False Off label use is common among neonates and pediatrics
True
Off label
Use of drugs with no FDA approved labeled use
The term used to describe surfactant produced outside of the patient's body is
exogenous