药物不良应.ppt

1,Theclinicalpharmacologyofneonat,2,CharacteristicofmedicinereactionCharacteristicofpharmacokineticsSignificanceofdrugmonitoringMedicationofbreastmilkfeedingneonatSpecialreactionofneonatalmedicineRationaladministrationofneonatalcommondisease,3,Definitionofneonatal,born,postnatal28ds,4,Characteristicofneonat,1.functionalunderdevelopmentoforgan,underdevelopmentofenzymaticsystem,slowdrugmetabolismandevacuation2Variationofdrugmetabolismandevacuationvelocityaccordingtothebirthweight,fetalageandpostnataldays3individualdifferenceamongthesickbabies4FunctionweakenSo,dosage,dosingintervalandadministrationroutewillbedifferent,5,Drugabsorptionandrouteofadministration,Administrationbygastrointestinaltract(GI/GIT):gastricacidity,gastricemptyingtime,pathologicstatus(PS)Administrationbynongastrointestinaltract1.hypodermicinjection，intramuscularinjection:regionalflow,ravenousinjection：fast,6,Payattentiontoneonatalintravenousinjection,AdministrationaccordingtospecifyvelocityTobringaboutconstitutionnecrosisbydrugeffusionTocausethrombophlebitisbyinjectingthesamebloodvesselrepeatedlyInjectionsiteshouldbechangedToavoidusinghypso-concentration,7,Drugdisposition,Drugdistributetosysbybloodcirculationorganization,fat,pH;Liposolubility,molecularwieght,proteinbindingrate,barrier,8,Characteristicofdrugdispositionofneonat,MoretotalbodywaterandextracellularfluidvolumeLessfatmassLowdegreeofplasmaproteinbindingUnderdevelopmentofblood-brainbarrier,9,Drugmetabolism,Organ:liver;Accretionrate:sizeofhepar,metaboliccapabilityofenzymaticsystemLiposolublesubstances:excretedbybindingwithglucuronateorsulfateAdeclineoftheaccretionrate:lowenzymaticactivityofglucuronyltransferaseofneonat,10,bindingwithglucuronate:indomethacin,salicylate,chloramphenicolChloramphenicolgraybabysyndromesulfoconjugationglucuronate,Drugmetabolism,11,Drugexcretion,Organ:kidneyUnderdevelopmentofNephridialtissue;Fewerglomcrulusglomerularfiltrationtubularsecretionacid-basebalancewater-electrolytemetabolism,primetype,12,Significanceofdrugmonitoringofneonat,FetalagepostnataldayspathologicconditionindividualdifferenceNotaccordingtotherapeuticreactionSafety/toxismarginadversereaction,drugmetabolism,difference,13,Drugmonitoring,gentamicin庆大霉素；cefotaximesodium头孢噻肟钠；digoxin地高辛；Phenobarbital苯巴比妥；Aminophylline氨茶碱；chloramphenicol氯霉素,14,Administrationofbreastmilkfeedingneonat,BannedinlactationPrudentinlactationsuspendlactation,15,Unusualreaction,hypersensitivityHaemolysis,jaundice,nuclearjaundicemethemoglobinemia高铁血红蛋白症hemorrhage出血NStoxicreaction神经系统毒性反应graybabysyndrome灰婴综合征,16,Haemolysis,jaundice,nuclearjaundice,physiologicaljaundiceDrugstoevokehaemolysis/jaundicePathwayofhaemolysis/jaundiceNosogenesisofbilirubinencephalopathydrugtreatmentofneonataljaundice,17,Drugtreatmentofneonataljaundice,enzymeinducer:Phenobarbital,nikethamideInhibithaemolysis:prednisone,dermacortDiminishbilirubinInfusealbumin,18,Rationaladministrationofneonatalcommondisease,neonatalasphyxia新生儿窒息neonatalconvulsions新生儿惊厥neonatalsepticemia新生儿败血症neonatalrespiratory-distresssyndrome新生儿呼吸窘迫综合征,19,Neonatalasphyxia,Commonreason：fetaldistress;respiratorycenterinhibited/damagedDrugtreatment：1.Retrieveacidosis2.Intracardiacinjectionofcardiac3.Supplyofoxygen4.Infectionprevention,20,Neonatalconvulsions,Commonreason：hypoxic-ischemicencephalopathy,intracranialhemorrhage,hypocalcemiaDrugtreatment：treatprimarydisease,retrievemetabolicdisorder,anticonvulsant,21,Treatmentofneonatalconvulsions,Toretrievemetabolicdisorder1Retrievehypoglycaemia2Retrievehypocalcemia3Retrievehypomagnesemia4.RetrieveVitB6defectAnticonvulsantapplication1Phenobarbital苯巴比妥2phenytoinsodium苯妥英钠3Diazepam地西泮4chloralhydrate水合氯醛,22,Neonatalsepticemia,Highcase-fatalityrateFastpathogeneticconditionIntravenousinjection,23,Neonatalsepticemia,Coccobacteriablood-brainbarrierpurulentmeningitis;suppurativemeningitisSupportivetreatment,amikacin,Thirdgenerationcephalosporin,7ds,bacillus,24,Respiratorydistresssyndromeofnewborn,dyspneicrespirationrespiratoryfailurealveolarsurfactantinsufficientCharacteristicofpathobiology：asphyxialmembrane-pulmonaryclosure,hyalinemembranedisease;membranesyndrome,25,Respirator