Paeds Pharmacotherapy Workup Flashcards
What are the most common DTP’s in paeds?
dose too low
dose too high
adverse drug reaction
adherence
What is the main issue with the DTP dose too low?
impacts effectiveness
-very common DTP
-ALWAYS double check the dose and do it multiple times
PK considerations
-children clear medication better than adults
Why is dose too low a common DTP in paeds?
dosing references an be confusing
What is the main risk with the DTP dose too high?
impacts risk of experiencing an adverse effect
What are some examples of medications that should be avoided in children?
codeine (resp depression risk, especially post tonsillectomy)
tetracyclines (bone and teeth development)
fluoroquinolones
ASA (in most cases, risk of Reyes syndrome)
What are some examples of excipients that should be avoided in children and why?
benzyl alcohol, propylene glycol
cant be metabolized or might metabolize them into harmful by products
What are the 3 main categories of issues for adherence in paeds?
administration
-drug factors: tablets, taste, volume, spitting up
-caregiver factors: well-being, health literacy, ability to measure
funding
-private insurance, SK drug plan, Special Support, Jordan’s Principle
supply
-uncommon commercial liquids, compounding availability
What are some potential solutions for a child that is struggling with solid dosage forms?
try to change to a suitable liquid or dissolveable formulation
-try this step first before compounding
-crush tablets if able to (some say dont crush, use your judgement)
partial tablets, opening capsules and mixing into a vehicle
-vehicle: applesauce, water, juice, etc.
-issue: stability of some drugs
dissolve and dose
-known amount of drug is mixed into water to make a solution and then dosed
What is an important piece of counselling information if you are advising a caregiver to administer the medication via vehicle?
the child must eat/drink all of the food/liquid to ensure the full dose is taken
What are some potential solutions if a child is struggling with the taste of a medication?
mask with a stronger flavour (e.g. chocolate, raspberry)
compounded suspensions
give a popsicle/freezie before administration
mix into food
What are some potential solutions if a child is struggling with the volume of medication?
try to use concentrated formulations when able
dissolve solid dosage forms
What should be done if a child has spit up their medication?
re-dose if within 30-60 minutes
What are some examples of the many possible medication errors in children?
incorrect ordering, dispensing or administration
weight based dosing
diverse formulations (lack of standardization)
lack of evidence: optimal dosing, safety and efficacy
polypharmacy
drug interactions
poor labeling of liquid medications
multiple prescribers and caregivers
transitions of care
How can we help to set up caregivers with success?
measuring device comfort
marking the syringe with a line
What are some of the pressures that caregivers face which may impact their ability to care for a child?
personal health
other responsibilities
funding for medications
