Introduction to Pediatrics Flashcards
Role of the pediatric pharmacist
Drug selection and use
Monitoring of effectiveness and toxicity
Prevention of medication errors
Patient/caregiver education
Contributions to knowledge through research
Knowledge of pediatric disease states and drug therapy
Skills to apply knowledge to practice
Most common chronic medical conditions in pediatrics
Asthma and ADHD
Signs of pain
Increased respiratory rate
Increased heart rate
Oxygen desaturations
*Hypothermia - indicates sepsis
Scales to measure pain
<4 yo = Neonate Infant Pain Scale (NIPS) or Face, Legs, Activity, Cry, Consolability (FLACC)
>4 yo = Wong-Baker FACES
>10 yo = Visual analog scale, numeric pain scale
Normal lab values in children vs. adults
DIFFERENT
BMI equation
[weight/(height^2)] x 10000
IBW equation
[(height^2) x 1.65]/1000
Bedside Schwartz
CrCl (mL/min/1.73m2) = (0.413 x height)/SCr
Challenges in Pediatric Pharmacotherapy
PK/PD differences
Psychosocial influences on drug therapy
Caregiver medication administration hesitance
Dosage formulation selections
Off-label medication use
How many drugs are indicated to be used in pediatric patients?
1/4
Limitations to off-label drug usage
Potential for denied insurance provider coverage
Liability for adverse effects
Limited experience in specific conditions or age groups
Limited available dosage formulations
Evidence considerations of off-label drug usage
Extrapolating adult data is not always accurate
Use guidelines when available
Use primary literature
Consequences of poor-/non-adherence
Delayed/absent clinical improvement
Worsening illness
unnecessary therapy modifications that can lead to adverse clinical outcomes
Reasons for non-adherence
Apprehension regarding medication adverse effects
Caregiver inability or unavailability to administer drugs
Caregivers may be overwhelmed/confused
Inappropriate measurements of medication dose
Missed doses due to resistance from the child
Strategies to improve adherence
Caregiver education should be reinforced at several points of healthcare visit
Ease of administration (palatable, lower frequency)
Decrease child resistance (reward systems, positive reinforcement)
Empowering older children/adolescents
Dosage form considerations: Parenteral
Volume of IV fluids
Vehicle safety
IV access
Dosage form considerations: Oral
Manufactured liquid preparations
Extemporaneously compounded liquid preparations
Volume of PO fluids
Chewable tablets
Tablets
Capsules
Granules
Dosage form considerations: Palatability
Children have different preferences
Mixing with food (chocolate syrup, peanut butter, crystal lite, applesauce)
Flavoring (FlavoRx)
Extemporaneous Preparation Resources
USP
Lexicomp: Pediatric & Neonatal Dosage Handbook
Micromedex
Pediatric Drug Formulations
Extemporaneous Formulations for Pediatric, Geriatric, and Special Needs Patients
When compounding/stability information is not available
USP: water containing formulations prepared from solid ingredients BUD no later than 14 days when stored between 2C-8C
Powder papers
Splitting/crushing tablets - ISMP do not crush list
Opening capsules
Injectable medications administered orally - OK if both oral and IV contain same salt form with similar bioavailability
Determining Pediatric Drug Dosages
Commonly based on mg/kg/dose OR mg/kg/day
mg/m2
Max pediatric dose = adult dose
May also be based on gestational age, actual age, patient weight ranges
Assessment of renal function
eGFR
Urine output
Ins = mL/kg/DAY
Outs = mL/kg/HOUR
Anuria = Zero output
Oliguria = <0.5-1 mL/kg/hour
Normal urine output = > 1 mL/kg/hour
Polyuria = > 4 mL/kg/hour
Dosing reference
Preference Lexicomp or Micromedex
