Special Populations Flashcards
Pediatric Dosing Rules
- Dose based on weight
- mg/kg/DOSE vs. mg/kg/DAY
- Do not exceed adult maximum dose (regardless of weight)
3 Key Questions for Pediatric Patients
- Alert
- Drinking
- Peeing
Pediatric: Refer Immediately If…
- Refuses to nurse / accept fluids
- Has difficulty breathing or is bluish around the lips
- Is =< 3 mo with rectal temp => 100.4F
- Has blood in sputum, urine, feces
Pediatric: Cough and Cold, Sx & Referral
- Self-limited viral infections occurring 6-8 times/year
- Symptoms: stuffy/runny nose, sneezing, sore throat, cough, post nasal drip
When to refer kids >3 months old
- “No” to any of the 3 key questions
- SOB or difficulty breathing
- Complaining of ear pain
- No improvement in cold symptoms after 1 week
- Children ≤ 3 months should be referred
Pediatrics: Cough and Cold, Non-Pharm
First line therapy for children!
- Humidifiers or cool mist vapors
- Bulb syringe ± saline nasal drops
- Head elevation
- Increased fluid intake
- Pediatric specific fluids
- Rest
Pediatrics: Cough and Cold, Drug Therapy
No sufficient data for common C&C drugs!
2008 FDA rec: do not administer OTC cough/cold preps to children <2 years
- Introduced child-resistant packaging
- New measuring devices
- Voluntary removal of infant combination products
- Warning against using antihistamines for sedation
What if the pediatrician recommends cough/cold treatment?
- Only recommend medications labeled for children
- Single agents are preferred
- Check the active ingredients to avoid duplication
- Follow the directions as labeled in the Drug Facts
- Be extra careful if giving more than one medication
- Only use measuring devices that come with the medicine or those specifically made for measuring medications
Pediatrics: Fever (Acet/Ibu Dosing)
- Common clinical symptom
- Determine whether treatment is indicated
- Refer to Fever lecture for treatment options: Non-drug therapy, Anti-pyretics: APAP, ibuprofen
- Acetaminophen: 160mg/5mL; 10-15 mg/kg/dose
- Ibuprofen: C-100mg/5mL; I-50mg/1.25mL; 5-10 mg/kg/dose
Fever: When to Refer Kids
- Oral temp ≥ 103 F (or equivalent)
- Any infant ≤3 months with rectal temp ≥ 100.4 F
- Persistent fever >3 days ± treatment
- Refer children <2 years with fever for >24 hours
Children who are:
- Refusing or not taking in enough liquids (decreased UOP)
- Unusually sleepy, irritable or hard to wake up
- Repeated vomiting or diarrhea
- Seizures or history of febrile seizures
- Spots, rash or stiff neck
Pediatrics: Pain
- Typically acute pain due to injury, illness, procedures
Barriers
- Myth that children do not experience pain the way adults do
- Lack of assessment and reassessment of pain
- Communication difficulty
- Adverse results of pain: increased anxiety, avoidance, suffering, parent distress
Pediatrics: When to Refer for Pain
When to refer (Dr. Atayee)
- <2 years old with musculoskeletal pain
- <8 years old with headache
- Use with caution and shortest duration for kids <18 years
Treatment
- Analgesics: acetaminophen or ibuprofen
- Distraction
- Massage
- External application of heat or cold: cold (inflammation or swelling), heat (stiffness or chronic pain)
Teething Pain
- Onset: Typically ~6 months (as early as 3 months)
- Symptoms: increase in drool, irritability, desire to chew on things, disrupted sleep, tender/swollen gums
Treatment options:
- Massage gums with finger
- Cool teething ring or washcloth
- Wipe drool to prevent rash
DO NOT RECOMMEND
- Benzocaine products for age <2 yrs
- Hylands Teething Tablets
Pediatrics: Vomiting and Diarrhea, When To Refer
- Age <6 months
- Severe or worsening symptoms
- Unable to keep fluids down
- Severe abdominal pain
- Signs of dehydration
Pediatrics: Vomiting/Diarrhea, Treatment
Infants
- Continue nursing if tolerated
- ORS: 1-2 tsp every 15 minutes, may increase if no vomiting.
- If no vomiting, resume nursing after 4 hours or formula after 8 hrs
Children >1 year
- ORS: 2-3 tsp every 15 minutes, may increase if no vomiting
- If no vomiting for 8 hours, resume regular fluids then add solids
- Resume regular diet after 24-48 hours
Diaper Rash: Non-drug Therapy
- Frequent diaper changes
- Increase airflow
- Properly cleaning and drying of diaper area
- Change in diaper size, brands
Diaper Rash, Treatment
Mild/Moderate
- Barrier Creams:
- Zinc oxide (10-40%) (desitin, triple paste)
- Petrolatum ointment (A&D ointment)
Severe
- Hydrocortisone 0.5-1% (apply sparingly twice a day)
- Antifungal cream BID-TID (clotrimazole, terbinafine)
Older Adults
Defined as age ≥65 years
Challenges of OTC therapy in older adults
- Use more Rx and OTC meds than any other age group
- Account for ~30-40% of all OTC purchases
- Altered pharmacokinetics and sensitivity to meds
- More comorbid conditions
- Significantly more likely to experience ADEs
- Lower health literacy
BEERS Criteria
Identifies ”potentially inappropriate” medications for older adults
- 1st generation antihistamines
- NSAIDs
- Proton pump inhibitors (PPIs)
- H2 blockers
- Mineral oil
Strategies for Educating Older Adults (Cog.)
Provide short, concise health messages that detail the specific action to achieve desired health goal
Cognitive Challenges
- Focus on key points
- Communicate directions that need to be followed
- Use plain language
- Use reminders to aid memory (i.e. brochures, med lists)
- Repeat essential information
Strategies for Educating Older Adults (V/H)
Visual Challenges
- Minimize the amount of text
- Make information easy to see and read
- Use black text on a non-glossy white background.
- Use 16 to 18 point font with space between lines
- Consider providing audio information
Hearing Challenges
- Talk face to face
- Limit background noise
- Speak clearly with more volume as needed
- Do not chew gum or eat while speaking
Optimizing OTC use in Older Adults
- Conservatively assess eligibility for self-care
- Consider organ impairment and drug interactions
- Screen for duplicate therapy
- Identify preferred formulations and storage
- Design regimens that are convenient and easy to follow
- Provide clear education to patients and caregivers: (read labels for duplicate ingredients, consider written instructions, address health literacy)
- Update and encourage use of complete medication lists
