Pharmacology & Therapeutic Management Flashcards

A 32-week neonate receives their first dose of gentamicin. When should the initial trough level be drawn to guide extended-interval dosing?

Answer: 30 minutes before the second dose

For extended-interval aminoglycoside dosing, a trough level is drawn just before the next scheduled dose to ensure adequate drug clearance and prevent accumulation.

Surfactant replacement therapy is ordered for a 26-week neonate with RDS. Which finding indicates the surfactant was effective?

Answer: Improvement in lung compliance with decreased ventilator pressures

Effective surfactant therapy reduces alveolar surface tension, improving lung compliance and allowing ventilator pressure requirements to decrease.

Which vitamin K preparation is recommended for prophylaxis against hemorrhagic disease of the newborn?

Answer: Phytonadione (vitamin K1) IM

Phytonadione (vitamin K1) 0.5–1 mg IM within 6 hours of birth is the standard prophylaxis for vitamin K deficiency bleeding (VKDB) in all newborns.

A neonate with NEC is receiving ampicillin, gentamicin, and metronidazole. What is the primary rationale for including metronidazole in this regimen?

Answer: Coverage of anaerobic bacteria

Metronidazole provides anaerobic bacterial coverage, which is critical in NEC because intestinal flora including Bacteroides and Clostridium species contribute to the infection.

A nurse administers dexamethasone to a ventilator-dependent VLBW neonate for chronic lung disease. Which adverse effect is of greatest long-term concern?

Answer: Impaired neurodevelopmental outcomes

Postnatal systemic corticosteroids, particularly dexamethasone, are associated with increased risk of cerebral palsy and adverse neurodevelopmental outcomes, limiting their use.

A term neonate with seizures unresponsive to phenobarbital is given fosphenytoin. Which cardiac monitor finding requires immediate dose interruption?

Answer: QTc interval of 490 ms

Fosphenytoin can cause QT prolongation and serious arrhythmias; a QTc >450–500 ms signals cardiac toxicity requiring immediate dose interruption.

Prostaglandin E1 (alprostadil) is infusing to maintain ductal patency in a neonate with critical pulmonary stenosis. Which adverse effect is most unique to prostaglandin E1 infusion?

Answer: Apnea

Apnea is a well-recognized and potentially life-threatening adverse effect specific to PGE1 infusions, occurring in approximately 10–12% of neonates, and requires close respiratory monitoring.