Pediatric Drug Delivery and Dosage Forms Flashcards
Challenges in drug delivery for pediatric patients
May require manipulation of a dosage form tailored to ability to swallow
May require dosage forms available tailored to a smaller dose
May require alterations in stability if dosage form requires alteration
May NOT be palatable for PO administration
~56% of children ages 6-11 can’t swallow a tablet
Solid dosage forms
Tablets, capsules
Manipulating tablets
Make sure it’s feasible and see whether or not it alters medication delivery when you split or crush it
Manipulating capsules
Must determine the formulation of the capsule and its contents
Liquid dosage forms
Solutions/suspensions
Pros of liquid dosage forms
Dose flexibility, easy to swallow
Cons of liquid dosage forms
lack of controlled release mechanisms, volume required for dose, accuracy in measuring devices
Challenge of liquid dosage forms
not all are commercially available, single concentration vs. extemporaneous compounded: various available concentrations → at risk for medication errors
Pro of chewable tablets
Minimizes need for additional liquid
Con of chewable tablets
relies on ability to chew, can’t utilize with ER meds, may not mask taste, may be difficult to control dosage
Pro of mini tablets
eases need for swallowing tablets
Con of mini tablets
limited dosage flexibility, maximum mg/tablet –> may need large # of tabs to make the dose
Pro of ODTs
allows for quick dissolving without need for additional liquid
Con of ODTs
Can’t easily split (limits dose flexibility), challenge with masking taste
Pro of ODFs
offer dose flexibility (strip-cutting mechanism)
Con of ODFs
Hard to mask taste, higher cost to pack and make
Pro of powder packets
eliminates need for crushing tablets, ready to use manufactured packets
Con of powder packets
may require significant volume to mix, not easily titratable
Pro of sprinkle capsules/granules
ease in administration with food
Con of sprinkle capsules/granules
limited dose flexibility
Primary source of noncompliance
Palatability
How to get past noncompliance from palatability
Preferences of the individual patient taken into consideration
Manipulation can change the taste
FlavoRx
Mix with food/drinks: chocolate syrup, peanut butter, applesauce
Considerations when administering meds through a feeding tube
What is the site of absorption?
Can the medication contact plastic?
Will the medication clog the tube based on formulation?
Most common parenteral adminsitration
IV
IV administration allows for what?
Immediate entry into the bloodstream
IM/SQ administration considerations
muscle mass/fat mass is a factor, but can utilize in emergency or for single medication administration such as vaccines, limitations to volume allowed based on age
Considerations for parenteral formulation use in general
Volume
IV access
Compatibility with other meds
Other formulation challenges: inhalation
devices commonly designed for adults; use of nebulizers can be cumbersome/require patient education
Other formulation challenges: nasal
commonly designed for adults, difficult to administer based on age
Other formulation challenges: rectal
limited dosage forms, neonates/infants size restrictions and increased stool count
Other formulation challenges: topical
consider BSA ratio, potential for systemic absorption
Other formulation challenges: transdermal
limited dosage forms available for pediatrics, ability to cut/cover, age limitations
Benzoyl alcohol risks in peds
Neurotoxicity and metabolic acidosis (esp. in neonates)
Ethanol risk in peds
Neurotoxicity
Polysorbate 20, 80 risks in peds
Liver and kidney failure; thrombocytopenia, ascites, pulmonary deterioration in neonates
Propylene glycol risks in peds
Seizures, hyperosmolarity, metabolic acidosis, neurotoxicity
Sorbitol risk in peds
Osmotic diarrhea
Extemporaneous preparations:
Powder papers
Injectable medications administered enterally
Compounding PO suspensions with products like bulk powders, tablets, powder-filled capsules
Beyond Use Dating
USP <795> for extemporaneous preparations that don’t have available, published literature related to stability
