Pediatric Dosing Flashcards
premature neonate
born before 37 weeks gestation
neonate
birth to younger than 28 days (4 weeks) of age if born full term
infant
28 days to younger than 12 months
child
1-12 years of age
• Young child 1-5 years of age
• Old child 6-11 years of age
adolescent
13 to 17 years of age (some agencies combine adolescents and young adults up to 24 years of age)
Given a pediatric patient’s age and medication, select the most accurate measuring device for oral liquid medications.
oral syringes are preferred (3 mL and 5 mL)
Given the description of a pediatric patient, identify the pharmacokinetic considerations to be used when designing a medication regimen.
GI Tract: no difference after neonatal age
Rectal admin: not preferred - expelled more quickly
Percutaneous absorption: high absorption in children - toxicity a concern
IM Admin: higher bioavailibilty
Distribution: neonates and young infants have mroe water = lower plasma concentration
Elimination: kidney fxn a factor up to 6 mos of age
Given one of the three dosing guidelines utilized in determining pediatric medication doses, identify the appropriate approach for a pediatric patient based on the age, medication selected and the advantages/disadvantages to use.
Age-based dosing regimen: less precise, do not use if weight based available
• Ex. Age 2-5: 2.5-5 mg PO every 4-6 hours
• Easy to use but assumes that maturation of ADME principles is the same in all patients
Bodyweight-based dosing regimen: much more precise, if available to use
• Ex. Neonates/infants: 20-30 mg/kg/day divided every 12 hours
• Most common dosing scheme used for children but no established cutoff for use of weight-based dosing, can result in doses exceeding adult recommendations
Body surface area (BSA)-based dosing regimens: more limited
• Ex. corticotropin- 150mg/m2 IM divided twice daily
• More precise dosing scheme for medications requiring exact dosage calculations, limits potential for overdosing based on actual weight
• More difficult calculations, requires knowledge of patient’s height, inconsistencies in calculating BSA, not a well-established approach
Calculate a dose for a patient when given the patient’s weight and dosing recommendations for a specific medication.
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Given a pediatric patient medication regimen, identify the potential issues regarding medication safety.
Transcription errors: inconsistent use of units of measure can result in significant errors
• Use of appropriate units (ie. mg vs. mcg)
• Decimal errors
Incorrect strength of a medication is selected
Calculation errors: when entering orders through an EMR
Dosing errors: *most common cause of pediatric medication errors
Selection/alteration of dosage form:
• Lack of commercially available pediatric dosage forms
Dosing recommendations for obese children not available
Given a pediatric patient, identify the factors that will affect medication adherence.
Caregiver’s ability and motivation:
• Inability or unavailable to administer drugs in a timely manner
• Overwhelmed by caregiver responsibility
• Forgetting to administer
• Resistance of child to take medication
Ability to calculate dose: math skills, measuring device used
Caregiver and/or personal beliefs regarding illness and medication use:
• Concern regarding adverse effects
• Education is very important for medication prescribed to kids
Socioeconomic limitations:
• Drug cost/co-pay
• Ability to store the drug appropriately
• Ability to read and interpret the label
Who is responsible for administering the medication: child, adolescent, family member, caregiver
Adverse drug effects
School policy concerning medication use at school:
• School’s policy on administering medication
• Can the child keep medication with them?
• School nurse
• Administrative office staff
Dosing frequency:
• Decreased adherence with increasing number of doses/day
• School age children- decreased adherence if have to take dose at school (try to keep dosage before and after school)
Palatability affects adherence: initial taste, texture, flavor, aftertaste
