LUNG SURFACTANT

NEONATOLOGY TRACK
By
1.NSENGIYUMVA Richard:------------- 215042211
2.DUSABE Ruth: ------------------------ 218000547
3.BATAMULIZA Miriam:---------------- 218000236
4.KANKINDI Felicite: -------------------- 215042214
5.MUGANWA Kellen: ------------------ 215042773
6.MUREKATETE Claudine: ------------ 218000216
7.MUSABYEMARIYA Emerthe:------ 218232198
8.MUREKATETE Fatuma :------------- 216225590
9.UWIZEYIMANA Phoibe: ----------- 218000190
10.UWINGABIRE Emerence: ------- 215042772
11.MUKASHYAKA Joella :----------- 218000345
12.MUJAWIMANA Patricie : -------- 218000363
13.KABEZA Teddy-------------------------216341566
 Introduction
• Surfactant are lipoproteins containing lipids
and apoproteins
• reduce the surface tension within the alveoli
• allow expansion of the alveoli for gas exchange.

Three lung surfactants available for use are :

Beractant(Survanta), Calfactant (Infasurf), and
the newest drug, Poractant (Curosurf)
 Therapeutic Actions and Indications
• Used to replace the surfactant that is missing
in the lungs of neonates with RDS
• Calfactant (Infasurf ) is used to :
• Rescue treatment of infants who have RDS;
prophylactic
• treatment of infants at high risk for RDS (see
• prior entry for risks)
 Poractant (Curosurf )
• Rescue treatment of infants who have RDS;
this drug
• is being tried in the treatment of adult RDS
and with adults after near drowning
 Pharmacokinetics
Instilled directly into the trachea and begin
to act immediately on instillation.
 Metabolized in the lungs by the normal
surfactant metabolic pathways
does not enter systemic circulation from
normal, healthy lungs; unless alveolar lining is
disrupted, in infants with RDS
Eliminated in urine
 Adverse Effects
• Patent ductus arteriosus, bradycardia,
hypotension, intraventricular hemorrhage,
pneumothorax, pulmonary air leak,
hyperbilirubinemia, and sepsis.
• These effects may be related to the immaturity
of the patient, the invasive procedures used, or
reactions to the lipoprotein
 PROTOTYPE: Beractant(Survanta)
Indicated in :
• Rescue treatment of infants who have
respiratory
• Distress syndrome (RDS); prophylactic
treatment of
• infants at high risk for development of RDS
(birth
• weight of <1,350 g; birth weight >1,350 g who
have
• evidence of respiratory immaturity)
 Mechanism of action
• Beractant replenishes lung surfactant and
restores surface activity to the lungs by
lowering surface tension on alveolar surfaces
during respiration and stabilizing the alveoli
against collapse at resting transpulmonary
pressures.
 Side effects
• Pale skin; slow heartbeat; breathing that stops;
urinating less than usual; or
• Blood in the urine; noisy breathing; feeding or
bowel problems; or bleeding around the
endotracheal tube.
 Drug interaction
 Bretylium may increase the bradycardic activities
of Beractant;
 Beractant may increase the bradycardic
activities of Ceritinib
 Esmolol may increase the bradycardic activities
of Beractant
 Beractant may increase the bradycardic activities
of Ivabradine;
 Beractant may increase the atrioventricular
blocking (AV block) activities of Lacosamide
 Drug interaction……
Octreotide may increase the bradycardic
activities of Beractant

Ruxolitinib may increase the bradycardic

activities of Beractant
 Tofacitinib may increase the bradycardic
activities of Beractant
 Usual Dosage
1)Beractant (Survanta) 4 mL/kg birth weight,
instilled intratracheally,
may repeat up to four times in 48 h

2) Calfactant (Infasurf ) 3 mg/kg birth weight, as

soon as possible for
prophylaxis; 3 mg/kg birth weight, divided into
two doses, repeat up to a total of three doses
12 h apart, for rescue; instilled into trachea
 Usual Dosage contd
3)Poractant(Curosurf ) 2.5 mL/kg birth weight,
intratracheally, half in
each bronchus, may repeat with up to two
1.25-mL/kg doses at 12-h intervals
 .
• .
 Nursing Considerations
• Assessment: History and Examination
Assess for possible contraindications or
cautions:
-screen for time of birth and exact weight to
determine appropriate doses.
• Because this drug is used as an emergency
treatment, there are no contraindications to
screen for.
 .
 Perform a physical examination to :
-establish baseline data for assessing the
effectiveness of the drug and the occurrence
of any adverse effects associated with drug
therapy.
 Assess the skin temperature and color to
evaluate perfusion.
•
 .
• Monitor respirations, adventitious sounds,
endotracheal tube placement and patency,
and chest movements to evaluate the
effectiveness of the drug and
drug delivery.
 .
• Evaluate blood pressure, pulse, and arterial
pressure to monitor the status of the infant.

• Evaluate blood gases and oxygen saturation to

monitor drug effectiveness.
• Assess temperature and complete blood count
to monitor for sepsis.
 References
• KARCH, A. M. (2013) Focus on Nursing
Pharmacology. 2nd edition. Wolters Kluwer
Health |Lippincott Williams & Wilkins
• Goodman, L. S. et al. (2011) Goodman &
Gilman’s The Pharmacological Basis of
Therapeutics, Goodman Gilman’s The
Pharmacological Basis of Therapeutics.
•