Pharmacotherapeutics

Question 1

how should a child be positioned when administrating medication?

Answer 1

• standing or at least propped up to 45 degrees
• will reduce choking and gagging

Question 2

how to administer medication for young infants and toddlers?

Answer 2

• take syringe and deliver towards back and side of the mouth
• Otherwise, if in “cheek pouch,” it will get spit out

Question 3

how to administer a dissolvable tablet to a pediatric pt?

Answer 3

• place on back of tongue
• Less likely to get spit out

Question 4

what are ways you can alter a medication to make administration easier?

Answer 4

1. applesauce, peanut butter, chocolate pudding, apple juice, chocolate milk, marshmallow cream
2. Purchase flavoried meds
3. Refrigerate meds

Question 5

things/strategies to help with administering medication

environment, communication, routes, etc

Answer 5

1. Put them in a relaxing environment
2. Give them power of choice
3. Play “doctor” w/ stuffed animals
4. Tell them it will make them feel better
5. Don’t lie
6. Star charts with rewards
7. Make sure to praise them if/when they do
8. Injection option
9. Consider other routes - suppository
10. If all else fails, have someone hold them and give medication
11. Don’t negotiate though, they have to take it

Question 6

if a pt refuses a pill and wants an injection instead, what two options could they have?

Answer 6

Rocephin; bicillin

Question 7

as a provider, what are strategies to better the adherence of medication

Answer 7

1. Meds dosed once daily
2. Clearly written instructions for parents and children
3. indo about common SE and ways to deal w/ them
4. Incorporate into daily routine - Ex) ADHD meds

Question 8

American Academy of Pediatrics discourages children of what age from taking OTC medications for colds?

Answer 8

< 6 y/o

Question 9

Current FDA guidelines discourage children from taking OTC cough and cold medications at what age? why?

Answer 9

< 2 y/o
* No evidence of being safe and effective
* Have potential for enhanced toxicity in young children b/c metabolism, clearance, and drug effects may vary according to age

Question 10

what are the potential SE of OTC cough/cold meds if given to a pt < 2 y/o?

Answer 10

Tachycardia, convulsions, decreased LOC

Question 11

The AAP recommends using what as a standard dosing method (in place of tsp)

Answer 11

mL with a syringe

Question 12

Every medicine has an ___ ___, which treats the symptoms

Answer 12

active ingredient

Question 13

Do not give aspirin or aspirin-containing products to pts what age? why?

Answer 13

• kids under 18
• Reye’s Syndrome

Question 14

MOA of Sudafed

Answer 14

• Main ingredient: pseudoephedrine
• Decongestant
• Sympathomimetic
• Produces vasoconstriction by stimulating alpha receptors in mucosa of respiratory tract

Question 15

SE of sudafed

Answer 15

Dizziness, nervousness, difficulty sleeping, tachycardia, irritability, hypertension

Question 16

alternative of sudafed

Answer 16

Topical decongestant - Phenylephrine / oxymetazoline (Afrin)

Question 17

Topical decongestant has less systemic effects, however, can cause ?

Answer 17

rebound congestion

Question 18

MOA of Dextromethorphan

Robitussin / Delsym

Answer 18

• Acts on the cough center of the medulla to suppress cough
• Isomer of codeine

Question 19

SE of Dextromethorphan

Answer 19

Nausea, sedation, dizziness, abdominal pain

Question 20

MOA of Guaifenesin

Mucinex

Answer 20

• Increases rsp tract fluid secretions and helps loosen bronchial secretions by reducing viscosity, therefore increasing mucociliary clearance
• Nonproductive cough becomes more productive, less frequent, less irritating

Question 21

Other Cough & Cold Remedies

not Rx

Answer 21

1. Honey - Over age 1
2. Nasal saline
   - Keeps nasal passages moist and helps avoid stuffiness
   - Bulb suction will help suck out mucus
3. Elevate head of the bed
4. Cool mist vaporizer / humidifier
   - Helps nasal passages shrink and allow easier breathing
5. Antihistamines
6. Tylenol / acetaminophen - q4h for fever
7. Motrin / ibuprofen
   - F, aches and pains
   - Every 6-8 hours for fever
   - Pts has to be > 6 mos old
   - alternate Tylenol w/ Motrin q3h prn
8. Keep hydrated with water / pedialyte
9. Hand washing
10. Education on expected course - EXTREMELY IMPORTANT!

Question 22

differences between peditric vs adult population in terms of medication

Answer 22

1. Pediatric - dosage is by wt & age - wt specifically w/ liquid meds
2. Adult - fixed dosing
3. Compliance
4. Body composition and organ function changes over time, which effects dosage
5. Common disorders are different
6. stage of development can alter action of, and response to, a drug - a truly age-dependent difference in pharmacodynamics
   - Tetracyclines staining developing tooth enamel
7. Different ADME
8. Developmental PK
   - ↓GI but ↑IM absorption
   - ↑body H2O but ↓lipids
   - Limited protein binding
   - ↑liver/body wt ratio
   - Immature enzymes
   - ↑brain/body wt ratio; ↑blood brain barrier permeability
   - Immature renal function

Question 23

Utilize 3 key items for pediatric dosing:

Answer 23

1. Mostly dosed by wt in kg (wt in pounds divided by 2.2) - Liquids
2. All dosage amounts in mg / kg / day
3. All med amounts in mg / ml

Question 24

6 steps on how to do pediatric dosing

Answer 24

1. Find mg/kg dosing amount, along w/ mg/mL amount
2. Convert pt’s wt and to kg (lbs / 2.2)
3. Multiply dosage amount by kg (mg times kg)
4. Divide by how many times the med is taken per day
   - gives how many mg of med the pt will need
5. Convert to mL by dividing mg dose by amount of med in each 5 mL of med
6. Dispense amount
   - (mL / day) x (# of days med is given)