Peds pharm test Flashcards
The change that occurs to the drug. More soluble, More or less potent, to an inactive form. (Primary in liver/ age influence metabolism, infants low)
Affects- Enzymes system maturation (absent at birth) i.e. Reflux medication; Altered metabolic pathways; High metabolic rates (may need more frequent dosing than adults)
metabolism
Movement of drug from site of administration to various tissue of the body. (How drug is pulled into the body i.e. IM or oral)
Affects- Variable gastric and intestinal transit times; increased gastric pH; Other: stomach contents, disease processes, drug interactions
absorption
Movement of drug by the circulatory system to intend site of action. (Takes it wherever it needs to go)
Affects- Increased total body water; decreased plasma protein binding (kids have higher amount of total body water)
distribution
Elimination of the drug. GI tract: feces; Skin: sweat; Kidneys: Urine; Lungs: Exhalation
Affects- Renal function mature at 6-8 months (checking kidney function when on potent medication)
excretion
- Greater risks for dehydration: Greater portion of water in extracellular space; higher risk for fluid loss
- Keep accurate Intake/Output measurement
- Fluid Loss: Insensible- skin, respiratory system; Urinary; Fecal
special concerns for peds
Use of a drug that is not included in the approved labeling (or package insert) for that drug; DOES NOT mean illegal, improper, investigational, or contraindicated; Not a lot of information for the use in pediatrics (Ethical reasons, no testing on children, Might not be information in drug book; Purpose of off-label use: to benefit the individual patient; Evidence and experience are the gold standards for prescribing; Ex: Sildenafil ( Viagra) in neonates to treat persistent pulmonary hypertension
off label drug use
Increased sensitivity to GI (lots of diarrhea) and CNS side effects; Limit usage due to side effects of super infections (i.e. thrush r/t antibiotic use); Some are contraindicated due to effects on development (bone cartilage); Ear infections controversial (decongestants, anti-inflammatories)
hesitancy to use abx
Occur when the body forms antibodies to drug; Causes immune response when re-exposed; Cannot be allergic to a drug that has never been taken; May have cross-allergies to drug in same class.
drug allergies
• Anaphylactic reaction- immediate reactions i.e. swelling, bronchial constriction, respiratory distress;
• Cytotoxic reaction- Not immediate (over a few days) i.e. antibodies circulate and cause cell death; low hct, hgb, WBC, plts, elevated LFTs, poor renal function
• Serum sickness reaction- Up to 1 week or more after exposure i.e. damage to tissues, rash, fever, swollen, lymph nodes, edema of face
• Delayed allergic reaction- several hours after exposure i.e. rash hives, swollen joints
Nursing interventions: Assessment questions, differentiate between true allergy and side effects i.e. Hives vs. rash (Amococillin & Penicillin)
(More precise medication dosing with Body surface area; High risk medications: cytotoxic drugs; overweight patients)
types of drug allergies
: Bronchodialtors (beta2-adrenergic agonist)
• Route: inhalation
• Therapeutic use: Prevention of asthma, treatment of bronchospasm, histamine release is inhibited, ciliary motility is increased
• side effects: tachycardia, tremors
• Nursing interventions: monitor patient, education
albuterol
anticholinergics - inhalation, treat allergen-induced and exercise-induced asthma and relieve bronchospasms
• adverse effects: dry mouth, hoarseness
• nursing interventions: education on side effects, prevention of side effects
atrovent (ipratropium)
long term prophylaxis, short term oral to treat manifestation following an acute asthma
• prevent inflammation, suppress airway mucus production and promote responsiveness of beta2receptors in bronchial tree
• therapeutic use: long term prophylaxis, short term oral to treat manifestation following an acute asthma
• adverse effects: Hoarseness, candidiasis, Suppression of adrenal gland function, Hyperglycemia, Infection
• nursing interventions: monitor s/e (candidiasis, hyperglycemia, and infection)
Anti-inflammatories – glucocorticoids and leukotriene modifiers Beclomethasone inhalation (QVAR) and Prednisone (oral)-
oral long term therapy of asthma, prevent exercise induced bronchospasm
Singulair (Leukotriene modifiers montelukast)
inhalation, oral, iv – treatment of cystic fibrosis, used in clients who have acute/chronic pulmonary disorders exacerbated by large amounts of secretions
• adverse effects: aspiration, bronchospasm
• nursing interventions: educate on smell, prepare for suction if aspiration occurs
mucomyst
serotonin antagonist
• side effects: headache, diarrhea, dizziness
odansetron (zofran)
dopamine antagonist
• side effects: restlessness, anxiety, spasm of face and neck
metoclopramide (reglan)
osmotic laxative, adjust dose as needed for peanut butter stools
o side effects: diarrhea
constipation: polyethylene glycol (miralax)
decrease intestinal motility increase absorptions and sodium,
o side effects: euphoria, blurred vision, dry mouth, constipation, tachycardia, urinary retention, Monitor I&O
antidiarrheal: loperamide (Imodium)
use 1 hour before procedure), allergic reaction - observe for signs or reaction, baby for immunizations, circumcision, post op, etc)
• side effects of medications and how to treat, signs of withdrawal, age range for specific medications
local anesthetics:
upocaine, EMLA cream
relief of moderate/ severe pain, sedation, reduction of bowel motility
• side effects: respiratory depression, constipation, orthostatic hypotension, urinary retention, sedation, overdose
• Nursing interventions: Monitor VS, have naxolone (narcan) at bedside, increase fluid intake, provide assistance w/ambulation, monitor I&O, encourage voiding every 4 hrs, have resuscitative equipment at bedside
Fentanyl (IV, IM), Morphine (oral sub q, IM, rectal, IV, epidural, intraileccecol):
educate that drug is not a cure, initial therapy requires many dosage changes, monitor labs
antiepilectic drugs
go to for seizures (partial seizures); general tonic-clonic seizures
o Side effects: irritability, hyperactivity
barbiturates: pentobarbital (luminal)
all major forms of epilepsy
o side effects: nystagmus, confusion, sedation, bleeding gums
hydantoins:
phenytoin (Dilantin)
good for active seizing, status epilepticus
o side effects: Respiratory depression
Benzodiazepines:
Diazepram ((valium)
