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1、1,The clinical pharmacology of neonat,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,bo
2、rn,postnatal 28ds,4,Characteristic of neonat,1. functional underdevelopment of organ, underdevelopment of enzymatic system, slow drug metabolism and evacuation 2Variation of drug metabolism and evacuation velocity according to the birth weight, fetal age and postnatal days 3individual difference amo
3、ng the sick babies 4Function 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 nongastrointest
4、inal tract 1. hypodermic injection，intramuscular injection: regional flow, characteristic of medicine 2. intravenous injection：fast,6,Pay attention to neonatal intravenous injection,Administration according to specify velocity To bring about constitution necrosis by drug effusion To cause thrombophl
5、ebitis by injecting the same blood vessel repeatedlyInjection 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 dispo
6、sition 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
7、 binding with glucuronate or sulfate A decline of the accretion rate : low enzymatic activity of glucuronyl transferase of neonat,10,binding with glucuronate: indomethacin, salicylate, chloramphenicol Chloramphenicol graybaby syndrome sulfoconjugation glucuronate,Drug metabolism,11,Drug excretion,Or
8、gan: 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,Fetal age postnatal days pathologic condition individual difference Not according to ther
9、apeutic reaction Safety/toxis margin adverse reaction,drug metabolism,difference,13,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,14,Administration of breast milk feeding neonat,Banned in lactation Prudent in lactation sus
10、pend lactation,15,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,16,Haemolysis, jaundice, nuclear jaundice,physiological jaundice Drugs to evoke haemolysis/jaundice Pathway of haemolysis/
11、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,ne
12、onatal 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,19,Neonatal asphyxia,Common reason：fetal distress; respiratory center inhibited/damaged Drug treatment： 1. Retrieve acidosis 2. Intracardiac injection of cardiac 3. Supply of oxy
13、gen 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 1Retrieve h
14、ypoglycaemia 2Retrieve hypocalcemia 3Retrieve hypomagnesemia 4 . Retrieve VitB6 defect Anticonvulsant application 1Phenobarbital苯巴比妥 2phenytoin sodium苯妥英钠 3Diazepam地西泮 4chloral hydrate水合氯醛,22,Neonatal septicemia,High case-fatality rate Fast pathogenetic condition Intravenous injection,23,Neonatal se
15、pticemia,Coccobacteria blood-brain barrier purulent meningitis;suppurative meningitis Supportive treatment,amikacin,Third generation cephalosporin,7ds, bacillus,24,Respiratory distress syndrome of newborn,dyspneic respiration respiratory failure alveolar surfactant insufficient Characteristic of pat
16、hobiology： asphyxial membrane - pulmonary closure,hyaline membrane disease;membrane syndrome,25,Respiratory distress syndrome of newborn,Treatment：keep warm; oxygen; retrieve electrolyte disturbances and acidosis; infection prevention; depressurization Oxygen therapy: atomization;mask oxygen inhalation; 40concentration;interruption,26,SEE YOU,
