Gray Baby Syndrome is a side effect of which drug?

Appeared in: Punjab CHO - 2021

Explanation

Gray Baby Syndrome is a life-threatening condition seen in newborns (especially premature infants) who are treated with Chloramphenicol.
It is caused by the infant's inability to properly metabolize and excrete the drug due to an immature liver (lacking the enzyme glucuronyl transferase) and underdeveloped kidneys.
This leads to a toxic accumulation of the drug, causing symptoms like an ashen-gray skin color, limpness (hypotonia), low body temperature, and cardiovascular collapse.

Option A: Amoxicillin is a penicillin-class antibiotic. Its most common and well-known side effects are hypersensitivity reactions, ranging from a mild rash to severe anaphylaxis, as well as gastrointestinal disturbances.
Option B: Ciprofloxacin is a fluoroquinolone antibiotic. Its characteristic toxicities include tendinitis and tendon rupture (especially in the elderly) and potential damage to cartilage, which is why its use is restricted in children.
Option C: Metronidazole is an antibiotic and antiprotozoal agent. Its notable side effects include a distinct metallic taste in the mouth and a disulfiram-like reaction (severe nausea, vomiting, flushing) if consumed with alcohol.

Clinical Relevance

Nursing practice connection: Knowing Pharmacology: Adverse drug reactions helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Chloramphenicol is generally contraindicated in neonates and premature infants due to the high and well-documented risk of Gray Baby Syndrome.
A critical nursing responsibility is to question any prescription of chloramphenicol for a newborn. If its use is deemed absolutely necessary (e.g., for a life-threatening infection with no alternative), the nurse must vigilantly monitor the infant for the earliest signs of toxicity, such as feeding refusal, vomiting, or changes in skin color.
What if? If a lactating mother requires chloramphenicol, the drug is excreted into breast milk. The infant must be monitored closely for adverse effects like poor feeding or loose stools, and breastfeeding may need to be temporarily discontinued.

How to Approach the Question

First, identify the key term in the question stem: 'Gray Baby Syndrome'.
Recognize this as a factual recall question from pharmacology, focusing on a specific, unique adverse drug reaction.
Access your memory of classic drug-toxicity associations. 'Gray Baby Syndrome' is a hallmark adverse effect taught alongside its causative agent.
Systematically evaluate the options based on their most common or severe side effects:
Amoxicillin is primarily associated with allergies.
Ciprofloxacin is known for causing tendon problems.

Concept Tested & Keywords

Q8Sl6ojNydrqSSZyAGQAta

E6 Pharmacology KD Tripathi Essentials 9e Part 3 pp. 72-74, 71-73

E6 Medicine Harrison 22e Part 1 p. 1212-1214

Practise the full Punjab CHO - 2021

Attempt every question from this paper in a timed mock, then review the full solution for each one.