Paediatric - Pharmacology

Question 1

Safety issues involved in administration of medication to children

Answer 1

• doses based upon body weight / body surface area - weight should be written on medication chart
• immature system, longer half life of drugs, immature kidneys / ability to excrete, higher volumes of water within body
• doses need to be calculated accurately
• know current medications, allergies & interactions
• drugs quoted in micrograms, word micrograms should be used
• liquid medications ordered by weight of active ingredients

Question 2

Medication & IV fluid dosage calculations

Answer 2

• mg/kg/dose or mg/kg/day
• 20mg/kg given as IV bolus over 20 minutes for fluids
• maintainance fluids calculated based on individual fluid requirements of the child & response to treatment, re-calculated 8 hourly

Question 3

Pain Medications

Answer 3

• paracetamol
  
  • oral/rectal - 15mg/kg/dose up to 90mg/kg/24 hours
• codiene - analgesia and antitussive
  
  • IM/oral
• ibuprofen - pain / fever / juvenile chronic arthritis
  
  • oral
  • only for use in children over 6 months old, avoid in suspected group A streptococcal infection

Question 4

Antibiotics

Answer 4

• should be given as narrow spectrum where possible
• for UTI
  
  • if sick or under 6 months - benzyl penicillin IV and gentamycin IV
  • if not sick and over 6 months - trimetoprim oral
• for tonsilitis
  
  • penicillin oral - 12 hourly for 10 days
• for otitis media
  
  • amoxycillin oral

Question 5

Sedatives

Answer 5

• midazolam
  
  • conscious sedation
  • induction of anesthesia
  • sedation
  • seizures
• fentanyl
  
  • analgesia - IV/PCA
  • used with caution in under 6 months old
• morphine
  
  • analgesia - IV/PCA
  • used with caution in under 3 months
  • doses will need filtration depending on condition / response
• PCA use
  
  • controlled by parent or child old enough to comprehend use of PCA

Question 6

IV Fluid Therapy

Answer 6

• indicated when child is unable to ingest sufficient amounts of fluid & electrolytes orally
• dehydration occurs quickly due to high water content in children
• isotonic solutions used - do not cause fluid shifts into the cells, or fluid to be pulled out of cells
• give 20mg/kg as bolus, subsequent therapy based on needs of child, calculated 8 hourly
• 3-10kgs - 100mls/kg/day IV or 150mls/kg/day oral
• 10-20kgs - 1000mls + 50mls/kg for each kg over 10kg per day
• > 20kgs - 1500mls + 20mls/kg for each kg over 20kgs per day

Question 7

Care implications & considerations for children receiving medications

Answer 7

• parents need to be educated & provide consent
• provide family centred care
• information given to child needs to be at age appropriate level
• PCA use only if parents are able to control or child is old enough to comprehend use
• young children may not have been exposed to medications, risks of allergic reactions
• first, do no harm