Pediatric Rx Considerations - OTC

Question 1

Pharmacokinetics in Children

Answer 1

• 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

Question 2

Why do kids have an increased risk of drug toxicity?

Answer 2

• ↑body water = ↑distribution of hydrophilic drugs
• ↓ plasma proteins = drugs bound by plasma proteins
• ↑ free fraction of drug
• ↑pharmacologic effect
• ↑risk of drug toxicity

Question 3

Younger the child = Risk of ___ drug metabolism

Answer 3

↓

Question 4

CYP450 enzymes in children

Answer 4

Low at birth, then ↑ 1st few months of life

Question 5

Black Box Warning for Aminoglycosides
& Children

Answer 5

• Ototoxic
• Neurotoxic
• Nephrotoxic

Question 6

Full-term babies have ____% of normal eGFR

Answer 6

30%
* ↑ elimination half-life of a renal dependent drugs

Question 7

Most reliable info for pediatric dosing

Answer 7

= manufacturer product insert
* Many drugs are not specifically approved for kids
* Lack of data
* ↓ $$ incentive to evaluate drugs for kids

Question 8

How to calculate pediatric dose recommendations if there is no specific recommendation given

Answer 8

• Calculate based on age, weight, or surface area
• Not preferred
• Should NEVER > adult doses

Question 9

Do not use OTC cough & cold products in children < _____

Answer 9

4 years old
(changed from < 2 years old)

Question 10

Acute APAP overdose in children

Answer 10

• < 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

Question 11

What is the Rumack-Matthew
Nomogram and what is it used for?

Answer 11

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.

Question 12

Never give ibuprofen to an infant < ____

Answer 12

6 mo-old

Question 13

Ask your clinician before giving ibuprofen for these conditions

Answer 13

If your child has a kidney disease, asthma, ulcer, or another chronic illness

Question 14

Aspirin in children

Answer 14

• 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

Question 15

The “Five Rights” of Drug Administration

Answer 15

Right Drug
Right Dose
Right Patient
Right Route
Right Time

Question 16

Signs of readiness for pill swallowing

Answer 16

• Follow instructions
• Swallows ‘chunky’, textured foods (e.g. oatmeal) without gagging
• Swallows mouthfuls of liquid without spilling or coughing/gagging
• Train with ”Shapping”

Question 17

What does it mean to make sure the dosing is practical?

Answer 17

• ↓ frequency = more compliance
• ↑ frequency = less compliance

Question 18

What is a “teaspoon?”

Answer 18

• 2.5 – 7.8 mL
• Use a calibrated medicine
  spoon or syringe

Question 19

Why is it harmful if Parents discontinue medicine because child “felt better.”

Answer 19

“Feeling better” ≠ “Cured” - need to take the whole amount

Question 20

Tablets: Advantages and Disadvantages in pediatric dosing

Answer 20

Advantage: ↓ problems with taste
Disadvantage: Difficult for children to swallow pills, possible choking hazard

Question 21

Extended-release tablets: Advantages and DIsadvantages

Answer 21

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

Question 22

Parenteral Solutions
IV, IM, SQ, & Intradermal: Advantages and Disadvantages

Answer 22

Advantage: Rapid effect
Disadvantage: Medications & method for
administration must be sterile

Question 23

Dermatological Creams, Lotions,
Ointments & Gels
Topically to epidermis: Advantages and Disadvantages

Answer 23

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”

Question 24

Chewable tablets: Advantages and Disadvantages

Answer 24

Advantage: Eliminate swallowing
difficulties
Disadvantage: ↑problems with taste, children may think of them like candy =
possible overdose