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