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Therapeutic Uses of Nikeethamide and Doxapram
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Therapeutic Uses of Nikeethamide and Doxapram

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Questions and Answers

What is the primary therapeutic use of doxapram?

  • As a local anesthetic
  • To induce euphoria
  • To treat epilepsy
  • To manage respiratory depression (correct)

    • Which of the following is a contraindication for the use of doxapram?

  • Severe bronchial asthma (correct)
  • Postanesthetic respiratory support
  • CNS depression
  • Psychological dependence

    • What effect does cocaine have on catecholamines?

  • It inhibits their synthesis in the brain.
  • It inhibits tissue uptake of catecholamines. (correct)
  • It has no effect on catecholamines.
  • It promotes tissue uptake of catecholamines.

    • Which of the following drugs is known for causing severe hallucinations?

    <p>LSD</p> Signup and view all the answers

    What is the main behavioral effect of cocaine compared to amphetamine?

    <p>Cocaine has similar behavioral effects to amphetamine.</p> Signup and view all the answers

    Which class of psychotropic drugs is known to affect thought and perception without influencing motor activity?

    <p>Psychotomimetic drugs</p> Signup and view all the answers

    What kind of dependency does cannabis typically cause?

    <p>Psychological dependence</p> Signup and view all the answers

    Which of the following adverse effects can be caused by high doses of doxapram?

    <p>Convulsions</p> Signup and view all the answers

    What defines specific analeptics used in treating respiratory depression?

    <p>They are naloxone and nalorphine.</p> Signup and view all the answers

    Which class of drugs primarily antagonizes GABA-mediated respiratory center depression?

    <p>Xanthines</p> Signup and view all the answers

    How do indirect analeptics stimulate the respiratory center?

    <p>By stimulating chemoreceptors in the carotid body.</p> Signup and view all the answers

    Which of the following is NOT classified as a non-specific analeptic?

    <p>Flumazenil</p> Signup and view all the answers

    Which of the following drugs is used to treat benzodiazepine toxicity?

    <p>Flumazenil</p> Signup and view all the answers

    What is the main role of specific analeptics in medical treatment?

    <p>Treat respiratory depression.</p> Signup and view all the answers

    Which of the following is a characteristic of xanthines?

    <p>They are used to treat respiratory depression indirectly.</p> Signup and view all the answers

    What distinguishes non-specific analeptics from specific analeptics?

    <p>Specific analeptics affect the respiratory center directly.</p> Signup and view all the answers

    Naloxone is used to treat respiratory depression caused by benzodiazepines.

    <p>False</p> Signup and view all the answers

    Caffeine is classified as a direct respiratory center stimulant.

    <p>True</p> Signup and view all the answers

    Flumazenil can be used to reverse the effects of nicotine toxicity.

    <p>False</p> Signup and view all the answers

    Xanthines can antagonize GABA-mediated respiratory center depression.

    <p>True</p> Signup and view all the answers

    Lobeline is classified as a specific analeptic.

    <p>False</p> Signup and view all the answers

    Ethamivan is a direct respiratory center stimulant that is also a xanthine.

    <p>False</p> Signup and view all the answers

    Nicotinic stimulation leads to indirect respiratory center stimulation through chemoreceptors.

    <p>True</p> Signup and view all the answers

    Analeptics primarily serve to depress the respiratory center.

    <p>False</p> Signup and view all the answers

    Cocaine is solely used for recreational purposes and has no medical applications.

    <p>False</p> Signup and view all the answers

    Psychotomimetic drugs have clinical applications accompanying their potential for drug abuse.

    <p>False</p> Signup and view all the answers

    Doxapram administration is contraindicated in patients with severe bronchial asthma to prevent exacerbation.

    <p>True</p> Signup and view all the answers

    The main effects of amphetamine and cocaine are entirely different.

    <p>False</p> Signup and view all the answers

    High doses of doxapram can cause tachypnea, tachycardia, and convulsions.

    <p>True</p> Signup and view all the answers

    LSD primarily stimulates dopamine receptors in the brain.

    <p>False</p> Signup and view all the answers

    Tachycardia is a common adverse effect associated with psychomotor stimulants.

    <p>True</p> Signup and view all the answers

    Cannabis induces physical dependence as a primary effect.

    <p>False</p> Signup and view all the answers

    What is a major risk associated with high doses of doxapram?

    <p>Convulsions can occur with high doses of doxapram.</p> Signup and view all the answers

    Which type of receptors does LSD primarily stimulate?

    <p>LSD primarily stimulates central 5-HT receptors.</p> Signup and view all the answers

    What are the behavioral effects of cocaine in comparison to amphetamines?

    <p>Cocaine produces behavioral effects similar to those of amphetamines.</p> Signup and view all the answers

    In what case might doxapram be contraindicated due to its effects on the cardiovascular system?

    <p>Doxapram is contraindicated in severe hypertension to avoid cardiac arrhythmias.</p> Signup and view all the answers

    What is the primary cause of psychological dependence associated with cannabis?

    <p>Cannabis mainly leads to psychological dependence without causing physical dependence.</p> Signup and view all the answers

    What class of drugs is known for inducing euphoria while increasing motor activity?

    <p>Psychomotor stimulants are known for these effects.</p> Signup and view all the answers

    What unique effect does cannabis have on perception?

    <p>Cannabis causes a loss of judgment of time and place.</p> Signup and view all the answers

    Which condition is directly affected by the use of psychotomimetic drugs like LSD?

    <p>Psychotomimetic drugs can cause severe hallucinations and delusions.</p> Signup and view all the answers

    What is the primary distinction between specific and non-specific analeptics?

    <p>Specific analeptics target specific causes of respiratory depression, while non-specific analeptics stimulate the respiratory center indirectly.</p> Signup and view all the answers

    Explain the role of xanthines as an analeptic.

    <p>Xanthines, like caffeine and theophylline, act as direct stimulants of the respiratory center by antagonizing GABA-mediated depression.</p> Signup and view all the answers

    Why is naloxone specifically used for opioid-related respiratory depression?

    <p>Naloxone is a specific analeptic that reverses the effects of opioids by restoring respiratory function.</p> Signup and view all the answers

    What is the mechanism by which indirect analeptics stimulate the respiratory center?

    <p>Indirect analeptics, such as nicotine and lobeline, stimulate the respiratory center by activating chemoreceptors in the carotid body.</p> Signup and view all the answers

    List two specific analeptics and their corresponding therapeutic uses.

    <p>Naloxone is used for opioid respiratory depression, and flumazenil is utilized for benzodiazepine toxicity.</p> Signup and view all the answers

    How do xanthines impact GABA-mediated respiratory center depression?

    <p>Xanthines antagonize GABA-mediated depression, thus enhancing respiratory drive.</p> Signup and view all the answers

    Identify the types of reflex stimulation involved with non-specific analeptics.

    <p>Non-specific analeptics can lead to reflex stimulation through the activation of peripheral chemoreceptors.</p> Signup and view all the answers

    What effect does Ethamivan have as a respiratory stimulant?

    <p>Ethamivan acts as a direct respiratory center stimulant, enhancing respiration.</p> Signup and view all the answers

    Specific analeptics such as Naloxone and nalorphine are used to treat opiate-induced respiratory ______.

    <p>depression</p> Signup and view all the answers

    Flumazenil is used to treat benzodiazepine ______.

    <p>toxicity</p> Signup and view all the answers

    Direct respiratory center stimulants include xanthines like caffeine and ______.

    <p>theophylline</p> Signup and view all the answers

    Indirect respiratory center stimulation can be achieved through agents such as nicotine and ______.

    <p>lobeline</p> Signup and view all the answers

    Analeptics primarily serve to ______ the respiratory center.

    <p>stimulate</p> Signup and view all the answers

    Ethamivan is categorized as a direct respiratory center ______.

    <p>stimulant</p> Signup and view all the answers

    Xanthines can antagonize the ______-mediated respiratory center depression.

    <p>GABA</p> Signup and view all the answers

    Non-specific analeptics involve reflex stimulation through chemoreceptors in the ______ body.

    <p>carotid</p> Signup and view all the answers

    Cocaine inhibits tissue uptake of ______.

    <p>catecholamines</p> Signup and view all the answers

    LSD stimulates central ______ receptors, leading to hallucinations.

    <p>5-HT</p> Signup and view all the answers

    Cannabis acts on cannabinoid receptors in the ______.

    <p>CNS</p> Signup and view all the answers

    High doses of doxapram can cause ______, tachycardia, and hypertension.

    <p>tachypnea</p> Signup and view all the answers

    Psychomotor stimulants are known to induce ______ with increased motor activity.

    <p>euphoria</p> Signup and view all the answers

    Patients with ______ should avoid the use of doxapram to prevent CNS stimulation.

    <p>epilepsy</p> Signup and view all the answers

    Cannabis does not cause physical dependence but can lead to ______ dependence.

    <p>psychological</p> Signup and view all the answers

    Cocaine's behavioral effects are very similar to those of ______.

    <p>amphetamine</p> Signup and view all the answers

    Match the following specific analeptics with their therapeutic use:

    <p>Naloxone = Treats opioid-induced respiratory depression Nalorphine = Treats opioid-induced respiratory depression Flumazenil = Treats benzodiazepine toxicity Doxapram = Stimulates respiratory center in severe cases</p> Signup and view all the answers

    Match the following non-specific analeptics with their mechanism of action:

    <p>Caffeine = Direct stimulation of respiratory center Theophylline = Antagonizes GABA-mediated depression Nicotine = Indirect stimulation via chemoreceptors Lobeline = Indirect stimulation via chemoreceptors</p> Signup and view all the answers

    Match the following classifications of analeptics with their descriptions:

    <p>Specific analeptics = Used for targeted treatment of respiratory depression Non-specific analeptics = Work through indirect stimulation of respiratory functions Xanthines = A class that includes caffeine and theophylline Direct RC stimulants = Act directly on the respiratory center</p> Signup and view all the answers

    Match the following respiratory stimulants with their types:

    <p>Ethamivan = Direct respiratory center stimulant Theophylline = Xanthine and direct stimulant Flumazenil = Specific analeptic Lobeline = Indirect respiratory stimulant</p> Signup and view all the answers

    Match the following drugs with their effect on the respiratory center:

    <p>Caffeine = Stimulates the central nervous system Ethamivan = Directly stimulates the respiratory center Naloxone = Reverses opioid respiratory depression Flumazenil = Reverses benzodiazepine respiratory depression</p> Signup and view all the answers

    Match the following terms with their correct definitions:

    <p>Analeptics = Drugs that stimulate the respiratory center Respiratory center = Area of the brain responsible for breathing control GABA = Neurotransmitter that inhibits the respiratory center Chemoreceptors = Cells that detect changes in blood chemical composition</p> Signup and view all the answers

    Match the following indirect stimulants with their primary action:

    <p>Nicotine = Stimulates chemoreceptors in the carotid body Lobeline = Stimulates chemoreceptors to increase respiratory rate Naloxone = Antagonizes effects of opioids Flumazenil = Antagonizes effects of benzodiazepines</p> Signup and view all the answers

    Match the following agents with their specific applications:

    <p>Naloxone = Used in opioid overdose cases Flumazenil = Used in benzodiazepine overdose cases Caffeine = Stimulates respiratory drive in newborns Theophylline = Used in the management of asthma</p> Signup and view all the answers

    Match the following psychotropic drugs with their definitions:

    <p>Amphetamine = Drugs that induce euphoria with increased motor activity Cocaine = Inhibits tissue uptake of catecholamines LSD = Stimulates central 5-HT receptors causing hallucinations Cannabis = Acts on cannabinoid receptors causing a dream-like state</p> Signup and view all the answers

    Match the following contraindications with the corresponding drugs:

    <p>Doxapram = Severe bronchial asthma Cocaine = History of severe hypertension LSD = Known psychotic disorders Cannabis = Pregnancy-related health risks</p> Signup and view all the answers

    Match the following adverse effects with their associated drugs:

    <p>Doxapram = Tachycardia and convulsions Cocaine = Severe anxiety and paranoia Cannabis = Psychological dependence LSD = Delusions resembling acute schizophrenia</p> Signup and view all the answers

    Match the following uses with psychomotor stimulants:

    <p>Doxapram = Treating respiratory depression Amphetamine = ADHD treatment Cocaine = Topical anesthetic LSD = Experimental psychology research</p> Signup and view all the answers

    Match the following types of dependence with their associated drugs:

    <p>Cannabis = Psychological dependence Cocaine = Psychological and physical dependence Amphetamine = Physical dependence LSD = No dependence</p> Signup and view all the answers

    Match the following drugs with their misuse potential:

    <p>Cocaine = High potential for addiction Amphetamine = Potential for abuse and dependency Doxapram = Low misuse potential LSD = Known for recreational use but low physical dependence</p> Signup and view all the answers

    Match the following drugs to their primary mechanism of action:

    <p>Cocaine = Inhibits catecholamine reuptake LSD = Stimulates serotonin receptors Cannabis = Modulates cannabinoid receptors Amphetamine = Releases catecholamines from storage sites</p> Signup and view all the answers

    Match the following adverse effects with their risk:

    <p>High doses of Doxapram = Convulsions Cocaine use = Hypertension LSD consumption = Hallucinogen persisting perception disorder Cannabis usage = Impaired judgment</p> Signup and view all the answers

    Study Notes

    CNS Stimulants

    • Classification
      • Divided into respiratory stimulants (analeptics) and psychomotor stimulants.

    Respiratory Stimulants (Analeptics)

    • Definition

      • Drugs that stimulate the depressed respiratory center (RC).

    • Specific Analeptics

      • Naloxone and Nalorphine: Treat opiate-induced respiratory depression.
      • Flumazenil: Used for benzodiazepine toxicity.

    • Non-specific Analeptics

      • Direct RC Stimulation:
        • Examples include xanthines such as caffeine and theophylline, and drugs like Ethamivan and Heptamino.
        • These antagonize GABA-mediated respiratory depression.
      • Indirect RC Stimulation:
        • Examples include nicotine and lobeline, which stimulate RC indirectly by activating chemoreceptors in the carotid body.
      • Combined Mechanisms:
        • Drugs like Nikethamide and Doxapram stimulate the RC both directly and indirectly.

    • Therapeutic Uses

      • Indicated for respiratory depression from various causes (e.g., post-anesthesia, CNS depressants, COPD, premature infants).

    • Adverse Effects

      • May cause tachypnea, tachycardia, hypertension, and at high doses, convulsions.

    • Contraindications

      • Avoid in patients with epilepsy, severe hypertension, arrhythmias, ischemic heart disease, thyrotoxicosis, and severe bronchial asthma.

    Psychomotor Stimulants

    • Definition

      • Drugs that induce euphoria and increased motor activity.

    • Classification

      • Amphetamines: Stimulants that enhance catecholamine activity.
      • Cocaine: Inhibits tissue uptake of catecholamines, produces effects similar to amphetamines, and is used topically as a local anesthetic (in eye drops).

    • Xanthines: Refer to previous respiratory pharmacology discussions.

    Psychotomimetic Drugs (Hallucinogens)

    • Definition

      • Drugs affecting thought, perception, and mood without impacting motor functions.

    • Clinical Applications

      • Largely lacking; significant relevance to drug abuse.

    • Examples and Mechanisms

      • LSD (Lysergic acid diethylamide): Stimulates central 5-HT receptors, leading to hallucinations and delusions akin to acute schizophrenia.
      • Cannabis (hashish, marijuana): Acts on cannabinoid receptors (CB1) in the CNS, causing altered judgment of time and place, along with dream-like experiences. Does not cause physical dependence but can lead to psychological dependence.

    CNS Stimulants

    • Classification
      • Divided into respiratory stimulants (analeptics) and psychomotor stimulants.

    Respiratory Stimulants (Analeptics)

    • Definition

      • Drugs that stimulate the depressed respiratory center (RC).

    • Specific Analeptics

      • Naloxone and Nalorphine: Treat opiate-induced respiratory depression.
      • Flumazenil: Used for benzodiazepine toxicity.

    • Non-specific Analeptics

      • Direct RC Stimulation:
        • Examples include xanthines such as caffeine and theophylline, and drugs like Ethamivan and Heptamino.
        • These antagonize GABA-mediated respiratory depression.
      • Indirect RC Stimulation:
        • Examples include nicotine and lobeline, which stimulate RC indirectly by activating chemoreceptors in the carotid body.
      • Combined Mechanisms:
        • Drugs like Nikethamide and Doxapram stimulate the RC both directly and indirectly.

    • Therapeutic Uses

      • Indicated for respiratory depression from various causes (e.g., post-anesthesia, CNS depressants, COPD, premature infants).

    • Adverse Effects

      • May cause tachypnea, tachycardia, hypertension, and at high doses, convulsions.

    • Contraindications

      • Avoid in patients with epilepsy, severe hypertension, arrhythmias, ischemic heart disease, thyrotoxicosis, and severe bronchial asthma.

    Psychomotor Stimulants

    • Definition

      • Drugs that induce euphoria and increased motor activity.

    • Classification

      • Amphetamines: Stimulants that enhance catecholamine activity.
      • Cocaine: Inhibits tissue uptake of catecholamines, produces effects similar to amphetamines, and is used topically as a local anesthetic (in eye drops).

    • Xanthines: Refer to previous respiratory pharmacology discussions.

    Psychotomimetic Drugs (Hallucinogens)

    • Definition

      • Drugs affecting thought, perception, and mood without impacting motor functions.

    • Clinical Applications

      • Largely lacking; significant relevance to drug abuse.

    • Examples and Mechanisms

      • LSD (Lysergic acid diethylamide): Stimulates central 5-HT receptors, leading to hallucinations and delusions akin to acute schizophrenia.
      • Cannabis (hashish, marijuana): Acts on cannabinoid receptors (CB1) in the CNS, causing altered judgment of time and place, along with dream-like experiences. Does not cause physical dependence but can lead to psychological dependence.

    CNS Stimulants

    • Classification
      • Divided into respiratory stimulants (analeptics) and psychomotor stimulants.

    Respiratory Stimulants (Analeptics)

    • Definition

      • Drugs that stimulate the depressed respiratory center (RC).

    • Specific Analeptics

      • Naloxone and Nalorphine: Treat opiate-induced respiratory depression.
      • Flumazenil: Used for benzodiazepine toxicity.

    • Non-specific Analeptics

      • Direct RC Stimulation:
        • Examples include xanthines such as caffeine and theophylline, and drugs like Ethamivan and Heptamino.
        • These antagonize GABA-mediated respiratory depression.
      • Indirect RC Stimulation:
        • Examples include nicotine and lobeline, which stimulate RC indirectly by activating chemoreceptors in the carotid body.
      • Combined Mechanisms:
        • Drugs like Nikethamide and Doxapram stimulate the RC both directly and indirectly.

    • Therapeutic Uses

      • Indicated for respiratory depression from various causes (e.g., post-anesthesia, CNS depressants, COPD, premature infants).

    • Adverse Effects

      • May cause tachypnea, tachycardia, hypertension, and at high doses, convulsions.

    • Contraindications

      • Avoid in patients with epilepsy, severe hypertension, arrhythmias, ischemic heart disease, thyrotoxicosis, and severe bronchial asthma.

    Psychomotor Stimulants

    • Definition

      • Drugs that induce euphoria and increased motor activity.

    • Classification

      • Amphetamines: Stimulants that enhance catecholamine activity.
      • Cocaine: Inhibits tissue uptake of catecholamines, produces effects similar to amphetamines, and is used topically as a local anesthetic (in eye drops).

    • Xanthines: Refer to previous respiratory pharmacology discussions.

    Psychotomimetic Drugs (Hallucinogens)

    • Definition

      • Drugs affecting thought, perception, and mood without impacting motor functions.

    • Clinical Applications

      • Largely lacking; significant relevance to drug abuse.

    • Examples and Mechanisms

      • LSD (Lysergic acid diethylamide): Stimulates central 5-HT receptors, leading to hallucinations and delusions akin to acute schizophrenia.
      • Cannabis (hashish, marijuana): Acts on cannabinoid receptors (CB1) in the CNS, causing altered judgment of time and place, along with dream-like experiences. Does not cause physical dependence but can lead to psychological dependence.

    CNS Stimulants

    • Classification
      • Divided into respiratory stimulants (analeptics) and psychomotor stimulants.

    Respiratory Stimulants (Analeptics)

    • Definition

      • Drugs that stimulate the depressed respiratory center (RC).

    • Specific Analeptics

      • Naloxone and Nalorphine: Treat opiate-induced respiratory depression.
      • Flumazenil: Used for benzodiazepine toxicity.

    • Non-specific Analeptics

      • Direct RC Stimulation:
        • Examples include xanthines such as caffeine and theophylline, and drugs like Ethamivan and Heptamino.
        • These antagonize GABA-mediated respiratory depression.
      • Indirect RC Stimulation:
        • Examples include nicotine and lobeline, which stimulate RC indirectly by activating chemoreceptors in the carotid body.
      • Combined Mechanisms:
        • Drugs like Nikethamide and Doxapram stimulate the RC both directly and indirectly.

    • Therapeutic Uses

      • Indicated for respiratory depression from various causes (e.g., post-anesthesia, CNS depressants, COPD, premature infants).

    • Adverse Effects

      • May cause tachypnea, tachycardia, hypertension, and at high doses, convulsions.

    • Contraindications

      • Avoid in patients with epilepsy, severe hypertension, arrhythmias, ischemic heart disease, thyrotoxicosis, and severe bronchial asthma.

    Psychomotor Stimulants

    • Definition

      • Drugs that induce euphoria and increased motor activity.

    • Classification

      • Amphetamines: Stimulants that enhance catecholamine activity.
      • Cocaine: Inhibits tissue uptake of catecholamines, produces effects similar to amphetamines, and is used topically as a local anesthetic (in eye drops).

    • Xanthines: Refer to previous respiratory pharmacology discussions.

    Psychotomimetic Drugs (Hallucinogens)

    • Definition

      • Drugs affecting thought, perception, and mood without impacting motor functions.

    • Clinical Applications

      • Largely lacking; significant relevance to drug abuse.

    • Examples and Mechanisms

      • LSD (Lysergic acid diethylamide): Stimulates central 5-HT receptors, leading to hallucinations and delusions akin to acute schizophrenia.
      • Cannabis (hashish, marijuana): Acts on cannabinoid receptors (CB1) in the CNS, causing altered judgment of time and place, along with dream-like experiences. Does not cause physical dependence but can lead to psychological dependence.

    CNS Stimulants

    • Classification
      • Divided into respiratory stimulants (analeptics) and psychomotor stimulants.

    Respiratory Stimulants (Analeptics)

    • Definition

      • Drugs that stimulate the depressed respiratory center (RC).

    • Specific Analeptics

      • Naloxone and Nalorphine: Treat opiate-induced respiratory depression.
      • Flumazenil: Used for benzodiazepine toxicity.

    • Non-specific Analeptics

      • Direct RC Stimulation:
        • Examples include xanthines such as caffeine and theophylline, and drugs like Ethamivan and Heptamino.
        • These antagonize GABA-mediated respiratory depression.
      • Indirect RC Stimulation:
        • Examples include nicotine and lobeline, which stimulate RC indirectly by activating chemoreceptors in the carotid body.
      • Combined Mechanisms:
        • Drugs like Nikethamide and Doxapram stimulate the RC both directly and indirectly.

    • Therapeutic Uses

      • Indicated for respiratory depression from various causes (e.g., post-anesthesia, CNS depressants, COPD, premature infants).

    • Adverse Effects

      • May cause tachypnea, tachycardia, hypertension, and at high doses, convulsions.

    • Contraindications

      • Avoid in patients with epilepsy, severe hypertension, arrhythmias, ischemic heart disease, thyrotoxicosis, and severe bronchial asthma.

    Psychomotor Stimulants

    • Definition

      • Drugs that induce euphoria and increased motor activity.

    • Classification

      • Amphetamines: Stimulants that enhance catecholamine activity.
      • Cocaine: Inhibits tissue uptake of catecholamines, produces effects similar to amphetamines, and is used topically as a local anesthetic (in eye drops).

    • Xanthines: Refer to previous respiratory pharmacology discussions.

    Psychotomimetic Drugs (Hallucinogens)

    • Definition

      • Drugs affecting thought, perception, and mood without impacting motor functions.

    • Clinical Applications

      • Largely lacking; significant relevance to drug abuse.

    • Examples and Mechanisms

      • LSD (Lysergic acid diethylamide): Stimulates central 5-HT receptors, leading to hallucinations and delusions akin to acute schizophrenia.
      • Cannabis (hashish, marijuana): Acts on cannabinoid receptors (CB1) in the CNS, causing altered judgment of time and place, along with dream-like experiences. Does not cause physical dependence but can lead to psychological dependence.

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    Description

    This quiz covers the therapeutic uses of Nikeethamide and Doxapram, focusing on their applications in treating respiratory depression from various causes including post-anesthetic effects and CNS depressants. It also explores their utility in cases like COPD and prematurity in neonates.

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