Pediatric Rx Considerations - OTC Flashcards
Pharmacokinetics in Children
- Absorption & Children
- ↓ peristalsis = delayed drug absorption
- ↑ pH in the stomach = avoid tablets
- Thin skin + large surface area (relative to the drug)
= topically administered drugs are enhanced
Why do kids have an increased risk of drug toxicity?
- ↑body water = ↑distribution of hydrophilic drugs
- ↓ plasma proteins = drugs bound by plasma proteins
- ↑ free fraction of drug
- ↑pharmacologic effect
- ↑risk of drug toxicity
Younger the child = Risk of ___ drug metabolism
↓
CYP450 enzymes in children
Low at birth, then ↑ 1st few months of life
Black Box Warning for Aminoglycosides
& Children
- Ototoxic
- Neurotoxic
- Nephrotoxic
Full-term babies have ____% of normal eGFR
30%
* ↑ elimination half-life of a renal dependent drugs
Most reliable info for pediatric dosing
= manufacturer product insert
* Many drugs are not specifically approved for kids
* Lack of data
* ↓ $$ incentive to evaluate drugs for kids
How to calculate pediatric dose recommendations if there is no specific recommendation given
- Calculate based on age, weight, or surface area
- Not preferred
- Should NEVER > adult doses
Do not use OTC cough & cold products in children < _____
4 years old
(changed from < 2 years old)
Acute APAP overdose in children
- < 6 years old >200 mg/kg/dose
- > 6 years old >200 mg/kg/dose or 10 g/dose (whichever is less)
- Absorption takes ~4 hours
- Use the Rumack-Matthew nomogram assess the need for treatment
What is the Rumack-Matthew
Nomogram and what is it used for?
Acetaminophen poisoning
* Time coordinates refer to time after ingestion,
serum concentrations obtained before 4 hours
are not interpretable.
* Use only in relation to a single acute ingestion
with a known time of ingestion.
Never give ibuprofen to an infant < ____
6 mo-old
Ask your clinician before giving ibuprofen for these conditions
If your child has a kidney disease, asthma, ulcer, or another chronic illness
Aspirin in children
- Never give aspirin to a child unless cleared by a clinician
- Aspirin can cause serious liver disease
- Reye syndrome
- Especially true when given to children
with influenza or chickenpox
The “Five Rights” of Drug Administration
Right Drug
Right Dose
Right Patient
Right Route
Right Time
Signs of readiness for pill swallowing
- Follow instructions
- Swallows ‘chunky’, textured foods (e.g. oatmeal) without gagging
- Swallows mouthfuls of liquid without spilling or coughing/gagging
- Train with ”Shapping”
What does it mean to make sure the dosing is practical?
- ↓ frequency = more compliance
- ↑ frequency = less compliance
What is a “teaspoon?”
- 2.5 – 7.8 mL
- Use a calibrated medicine
spoon or syringe
Why is it harmful if Parents discontinue medicine because child “felt better.”
“Feeling better” ≠ “Cured” - need to take the whole amount
Tablets: Advantages and Disadvantages in pediatric dosing
Advantage: ↓ problems with taste
Disadvantage: Difficult for children to swallow pills, possible choking hazard
Extended-release tablets: Advantages and DIsadvantages
Advantage: Slow absorption &
prolonged effect
Disadvantage: Usually contain large amounts of drug. DO NOT CRUSH OR CHEW. Difficult for children to swallow
pills, possible choking hazard
Parenteral Solutions
IV, IM, SQ, & Intradermal: Advantages and Disadvantages
Advantage: Rapid effect
Disadvantage: Medications & method for
administration must be sterile
Dermatological Creams, Lotions,
Ointments & Gels
Topically to epidermis: Advantages and Disadvantages
Advantage: Exert effect locally with
minimal systemic absorption, but may
have systemic effect
Disadvantages: Dose is formulation specific, drug may be passed via contact,
difficult to maintain precise “dosing”
Chewable tablets: Advantages and Disadvantages
Advantage: Eliminate swallowing
difficulties
Disadvantage: ↑problems with taste, children may think of them like candy =
possible overdose
