Pharmacotherapeutics Flashcards
How should a pediatric patient be positioned when administering medication?
Standing or propped up to 45 degree angle
reduces choking and gagging
How do you deliver a liquid medication to a young infant or toddler?
Deliver to back of mouth with syringe
Don’t let it get in the cheek pouch to be spit at you!
How would you administer a dissolving tablet to a pediatric patient?
Place on back of tongue
What are some options to make medications more pallatable for pediatric patients?
- Cover with applesauce, peanut butter, chocolate pudding, apple juice, chocolate milk, or marshmallow cream
- Pharmacies can compound meds into gummy bears, etc
- Purchase flavored meds
- Refrigerate meds
What are some techniques that can help pediatric patients be more comfortable receiving meds?
- Relaxing environment
- Let them choose
- Play doctor with stuffed animals
- Tell will make them feel better
- Don’t lie
- Reward with star charts, praise
What can you consider if a certain medication is not able to be administered as prescribed?
- Injection options
- Suppository
- Have someone hold to give medication
- No negotiation!
What techniques can providers use to increase adherence to medications in pediatrics?
- Once daily dosing
- Clearly written instructions
- Info about side effects and how to deal with them (ie probiotics for antibiotics)
- advise to incorporate into daily routine
What is the cut off for OTC cough and cold medications in pediatrics?
2 (AAP says 6)
Why aren’t OTC cough and cold meds safe in under 2?
- Serious side effects
- May give too much of ingredient, particularly in combo meds
- Potential for enhanced toxicity in young children d/t metabolism, clearance, and drug effects
What resource was launched in 2008 related to cough and cold medications and what was their conclusion?
Pediatric Cough and Cold Safety Surveillance System
Most adverse effects d/t med error or accidental ingestion
What should parents follow in order to give their child the right dose?
- Check drug facts for correct dose
- Use device that comes with med
- Read directions each time
- Use mL in a syringe rather than tsp
How can you prevent adverse effects in pediatrics?
- Educate on side effects
- Do not give 2 meds with same active ingredient
- Only use med that treats symptoms or condition
- Safely store meds
- Keep number for poison control
- Do not give adult med to child
- Do not give aspirin containing products
What is the mechanism of action of sudafed?
Sympathomimetic
* Vasoconstricts by stimulating alpha receptors in mucosa of respiratory tract
What is the main ingredient and purpose of sudafed?
Pseudoephedrine
Decongestant
What are side effects of sudafed?
- Dizziness
- Nervousness
- Difficulty sleeping
- Tachycardia
- Irritability
- Hypertension
What are alternatives to sudafed?
- Topical decongestants: phenylephrine/oxymetazoline (afrin) –> less systemic effects but can have rebound congestion
- Saline and suctioning
What is the active ingredient in robitussin/delsym?
Dextromethorphan
What is the mechanism of action of dextromethorphan?
- Acts on cough center of medulla to suppress cough
- Isomer of codeine
What are side effects of robitussin/delsym?
Nausea, sedation, dizziness, abdominal pain
Who should not receive dextromethorphan?
Productive cough, CF, asthma
What is the mechanism of action of guaifenesin?
- Increased respiratory tract secretions
- Loosens bronchial secretions by decreasing viscosity –> increased mucociliary clearance
- Causes nonproductive cough to become more productive, less frequent, less irritating
What are other cough and cold remedies that can be used?
- Honey
- Nasal saline
- Elevate head of bed
- Cool mist vaporizer/humidifier
- Antihistamines
- Tylenol/acetaminophen
- motrin/ibuprofen
- Hydration
- Hand washing
- Education on expected course
What age can honey be used?
Over 1 year
How often can tylenol be used?
every 4 hours
How often can motrin/ibuprofen be used?
Every 6-8 hours
How old does a patient have to be to be able to receive motrin?
6 months
A patient is still having pain and fever with ibuprofen every 6-8 hours. What can you recommend?
Alternating tylenol and motrin every 3 hours
How can stage of development impact drug effects?
Can alter action of and response to (EX tetracyclines stain enamel)
What are changes in pharmacokinetics seen in the pediatric population?
- Decreased GI absorption but increased IM absorption
- Increased body water and decreased lipids
- Limited protein binding
- Increased liver/body wt ratio
- Immature enzymes
- Increased brain/body weight ratio
- Increased blood brain barrier permeability
- Immature renal function
Reminder to practice pediatric dosing!
