paeds OTC Flashcards
what are common examples of off-label medicines in children?
- salbutamol in children <2 yrs
- paracetamol < 2months
what standards relate to childrens medicines?
childrens national service framework
standard 10- relates to medicines for children
what does standard 10 in the childrens national service framework say?
Children, Young people, their parents or carers and health care professionals in all settings should make decisions about medicines based on sound information about risk and benefit….. They have access to safe and effective medicines that are prescribed on the basis of best available evidence.”
what are the best routes for children for different formulations?
- Oral liquids - suspensions, solutions, syrups, elixirs
- Oral solid - tablets, capsules, granules, lozenges
- Inhaled –MDI (spacer!!!), powder devices, nebules
- Ear/Eye/Nose - drops (solutions, suspensions), ointments
- Skin - creams, ointments, sprays, lotions
- Injection - sub-cut, im, iv, it
- Rectal –suppositories, solutions, enemas, ointments
what considerations would you take into account when giving a medicine to a child?
- Age of the child –Syringe/spoon?
- Care not to give the dose too fast!
- Accuracy of dose?
- Formulation? –taste, sugar content,
stability, length of treatment? - Food? –Never mix in a babies bottle!
what should you consider with a ng/nj tube?
- liquids preferable* Newt Guidelines (Secondary care)
- some tablets may mix with water (See BNF/SmPC for
guidance) - Continuous feeding - some may mix with medicines
- may need to stop feed 15 mins before medicine
what must you consider when giving a child medicine to the eye?
- Eye - preparation must be sterile
- Preserved products, discard 4 weeks after first
opening - Unpreserved - usually 7 days
- Some may require refrigeration
- tilt the head back, drop into corner of the eye,
- mop up excess
- apply ointment to inner lower lid
may require two adults
what should you consider when giving a rectal medicine to a child?
- Rectal
- suitable for very young children, but less
acceptable in older children - suppositories may be lubricated before use
- splitting suppositories is not recommended
how are doses calculated for a child?
Children’s doses are usually standardised by weight or body surface area
(in m2).
* Young children may require a higher dose per kilogram than adults because of their higher metabolic rates
what are problems associated with dose calculations in children?
body-weight in the overweight child
may result in much higher doses being administered than necessary….in
such cases, use ideal weight, related to height and age (see inside back
cover of the BNF).
what patient information should be given ?
- Primarily how to give -information should be on the label AND explained/shown to the parent
- What is it used for?
- Certain drugs… caution may be needed, e.g. imipramine -nocturnal enuresis - caution with PIL
- What happens if a dose is missed?
- Consider frequency of dosing around child’s waking hours/school
- How long should the medicine be taken for?
- Further supplies?
what storage information should be given?
- Keep out of reach of children
- Child-resistant containers
- Refrigeration?
- Do not mix medications in the
same bottle - Keep in original container
can a child be given a medicine at school?
- May vary depending on short or long-term medication
- Will vary depending on age of child
- Staff may require education
- Medicines must be labelled with full details
- Some teaching unions indicate that school staff should not be required to administer medicines - not a legal requirement!!
- Most local education authorities issue guidance and schools should have a medication policy
- May be able to change dosing schedule to avoid administration at school
who are recommondations for immunisation based on?
advice from the Joint Committee on Vaccination and Immunisation (green book)
* Updates sent to professionals by CMO
what immunisations should a child have in their first year?
@ 8 weeks- 6 in 1 vaccine- diptheria, tetanus, shooping cough, polio, haemophilus influenza type b, and hepatitis
rotavirus-oral
men b
@12 weeks- 6 in 1 second dose
rotavirus 2nd dose
pneuomococcal vaccine- 1st
@ 16 weeks - 6 in 1 3rd dose
men b 2nd dose
what immunisations does a child recieved from 1-15 years?
1- Hib/men C, NMR, PVC, Men B
2-10- flu vaccine- nasal every year
3yrs and 4 months= MMR, 4 in1
12-13 years HPV- boys and girls
14 years- 3 in 1 teenage booster
what is rotavirus?
- Rotavirus is the commonest cause of gastroenteritis among infants and children
- The diarrhoea and vomiting associated with the virus can cause severe dehydration and results in a significant number of young children being admitted to hospital each year
when is rota virus most common?
- Infection is predominant January- March each year in the UK
how long do symptoms go on for?
3-8 days
when do you give rota virus vaccine?
A live vaccine given via the oral route at 8 weeks
* No restrictions on food or drink consumption before or after
administration
when would you postpone rotavirus admin?
no need due to minor illness but effectiveness can be reduced if it passes through intestine
too quickly!!!
* Therefore postpone if diarrhoea is present but first dose must be given between 6-15 weeks of age
when is the second dose of rota virus administered?
2nd dose - 3 months of age or at least 4 weeks after the 1st dose –must be received before 24 weeks of age!
* Ideally both doses prior to 16 weeks in order to deliver full protection before main risk of infection.
can the virus be transmitted via the vaccine?
The vaccine is excreted in the stools so may be transmitted to close contacts….carers of the baby should be advised re hand washing etc
what is fluenz and who is it offered to?
- Offered to children 2-16 years
A nasal vaccine of LAIV strains that are genetically altered via 3
mechanisms: - Cold adapted to stimulate immune system in the nose where cooler temperatures are found
- Temp sensitive so cannot infect the lungs or warmer nasal passages
- Attenuated….replicates to provoke a full immune response without clinical
symptoms
what are the contraindications for the flu vaccine?
▪ Immunocompromised…eg. Leukaemia’s, lymphoma, untreated HIV, high dose steroids
▪ Under 2 years of age
▪ Receiving aspirin or salicylates (increased risk of Reyes)
▪ Egg or gelatin allergy
▪ Pregnancy (note some exceptions –flu/whooping cough)
▪ Children actively wheezing or those with severe asthma
where and why is the MEN B vaccine given?
Single injection into the left thigh…SPC states babies are at an increased risk of fever when Bexsero is administered at the same time as other vaccines
what should be given after the men B vaccine?
- Give 3 doses of infant paracetamol as a prophylactic measure against
fever… - 1 dose at the time of vaccination or shortly afterwards and then 2 further doses in four to six hour intervals.
- Note this exceeds and overides the current licensing terms of infant paracetamol (120mg/5ml) which is restricted to a maximum of 2 doses post-immunisation in babies aged 2-4 months.
what are the general immunisation issues?
adverse reactions- most are not serious
loclised pain and swelling
fever- prophylactic paractemol is not recommended unless men B is given at same time
what is rectal body temp?
Rectal temperature is 0.5 degrees higher than oral temperature, underarm is 0.5 lower. (in general).
what is pyrexia?
Fever is caused as a result of pyrogens resulting from viral or bacterial infections causing the body to increase the set body temperature.
what is a typical presentation of pyrexia?
- Irritability
- Not eating
- “clingy” or seeking greater parental attention
- Symptoms of a cough or cold
- Increased respiratory rate
what questions would you ask with suspected pyrexia?
Age- any child under 3 months should be automatically referred –unless post immunisation!
* How is the child? Don’t just presume the higher the temperature the more ill the child.
* What is the general perception of the parent?
* What other symptoms are present?
* Remember UTIs are damaging and can be asymptomatic apart from a mild pyrexia.
what are the differential diagnosis of pyrexia?
URTI- usually viral and self limiting. Look for symptoms of earache which may suggest a bacterial infection.
* UTI- asymptomatic pyrexia, is common and can lead to the development of scarring in the urinary tract.-Refer.
* Meningitis- clearly a dangerous disease which invariably is fatal if untreated-Refer. Typically presents with
* Photophobia
* Stiff neck
* Lethargy/drowsiness
* Petechial rash
what treatment do you give for pyrexia?
- Paracetamol- established, evidence based
- Licensed from 2 months for injection pyrexia.
- Licensed from 3 months for general pyrexia and pain.
- Ibuprofen- again established and evidence based.
- Only licensed from 3 months of age and >5kg.
what are the standard doses of paracetamol for children?
– Age 3 - 5 months: 60 mg every 4–6 hours (maximum of four doses in 24 hours).[2.5ml]
– Age 6 - 23 months: 120 mg every 4–6 hours (maximum of four doses in 24 hours).[5ml]
– Age 2 - 3 years: 180 mg every 4–6 hours (maximum of four doses in 24 hours).[7.5ml]
– Age 4 - 5 years: 240 mg every 4–6 hours (maximum of four doses in 24 hours).[10ml]
– Age 6 - 7 years: 250 mg every 4–6 hours (maximum of four doses in 24 hours).[5ml]
– Age 8 - 9 years: 375 mg every 4–6 hours (maximum of four doses in 24 hours).[7.5ml]
– Age 10 -11 years: 500 mg every 4–6 hours (maximum of four doses in 24 hours) [10ml]
what is the standard doses for ibuprofen?
– Age 3 - 5 months: 50 mg three times a day (maximum of three doses in 24 hours, do not use for more than 24 hours).[2.5ml]
– Age 6 months to 1 year: 50 mg three to four times a day. [2.5ml]
– Age 1 - 3 years: 100 mg three times a day.[5ml]
– Age 4 - 6 years: 150 mg three times a day.[7.5ml]
– Age 7 -10 years: 200 mg three times a day.[10ml]
