Pediatric Medications

Question 1

5 Rights

Answer 1

Right Drug
Right Dose
Right Route
Right Person
Right Time
ALLERGIES

Question 2

5 Pharmacokinetic Effects in Children

Answer 2

1) How they are absorbed
2) Protein binding capacity of the receiver (albumin is decreased in infants–>more free drug circulating)
3) Blood brain barrier
4) Liver function
5) Kidney function

Question 3

Medication Considerations for Infants Less than One Year Old

Answer 3

Skin and organs are less developed so absorption may be altered

Delayed gastric emptying increases absorption

IM very erratic and very slow

IV levels decline slowly because of liver and kidney immaturity

SQ increased intensity

Question 4

Medication Considerations in Children

Answer 4

Young children (up to 2 years old) do metabolize medications faster than in adults

Takes until puberty for rate to match adults

Consider the sites and developmental age when determining dose

Question 5

Double Check the Math for…

Answer 5

Digoxin
Heparin
Chemotherapeutic agents
Insulin
Epinephrine
Opioids
Sedatives

Question 6

Adult Dose to Pediatric Dose

Answer 6

BSA x Adult Dose/1.73m^2

Question 7

Right Route

Answer 7

Oral is the preferred route

TB often used for anything less than 1 mL

Place dropper or syringe to side of tongue to decrease risk of aspiration

Estimate what is spit out and replace

Question 8

Oral Route

Answer 8

Numb the tongue first

Pinch the nose

Follow with a chaser

Avoid putting into child’s favorite food

Let parents do it

Question 9

IM Route

Answer 9

Need to determine how much, what type of med, how often, how old, controllability of site

Needle size: 25-30 gauge is preferred

5/8 to 1 inch

No more than 1 mL in one site or 0.5 mL for small infants

Vastus lateralis is preferred site, ventrogluteal, deltoid

Dorsogluteal is NO LONGER an approved site

Question 10

SQ Route

Answer 10

Do not want to give into the muscle

45 degree angle is best

Insulin, some vaccines, allergy medications

Question 11

IV Route

Answer 11

22-23 gauge

Central line, intra-oseos, PICC

Quicker to react/take effect

NEVER COVER THIS SITE WITH GAUZE

ALWAYS USE A BURETROL

NEVER ENTER MORE THAN 2 HOURS TOTAL ON THE PUMP

ALWAYS USE A PUMP

NEVER HANG A 1000cc bag (100-500cc)

Question 12

Rectal Route

Answer 12

Absorption not as reliable

Often used when oral is not an option such as uncontrolled vomiting or NPO patients

Use water-soluble jelly or warm water to lubricate

Be quick

Hold buttocks together for 5-10 minutes to avoid expelling