Paediatric pharmacy by bm1991

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									   PHR222


PAEDIATRIC
PHARMACY
                     Outline

 Definitions
 Overview
 Liquid medicine dispenser
 Paediatric med administration: Unique
  characteristics
 Common disease & condition
 Summary
                         Pediatric

                        From birth to ≈age 18

 Neonate       Infant            Child             Adolescent


Birth       1 month            1yr              12 yrs          18 yrs
(newborn)
                     Overview

 Children = miniature adults
 A drug undergoes same processes in a child as it does
  in an adult. But, a child’s body is distinctive &
  constantly changing, which affects how it responds
  to a drug.
 Eg, some barbiturates, which make adults feel
  sluggish, will make a child hyperactive.
  Amphetamines, which stimulate adults can calm a
  children.
 A label does not contain a pediatric
  dose, do not assume drug is safe for
  anyone < 12 yrs of age
 Pediatric drug dose must be adjusted
  for the characteristics of indv drug &
  pt’s age, body wt, BSA, disease state &
  indv needs to prevent ineffective tx or
  toxicity
 Accurate preparation & administration of meds to
  pediatric pts requires an accurate & current wt (
  dosage are given per unit of wt)
 Inpts should be weighed daily. Hence, doses of meds
  can be adjusted for rapid wt gains & losses occur
  with children.
 Children are at particularly high risk of medication
  errors
 Many factors contribute to this risk, including:
    Weight –based dosing
    Need fro stock medicine dilution
    ↓ communication abilities of children
    Inability to self-administer medications
    High vulnerability of young, critically ill children to injury
     from meds, particularly those with immature renal & hepatic
     systems
    Adolescents with chronic diseases eg. Diabetes may be at
     particular risk as they begin to self-administer meds.
 Systemic antibiotics are the most widely used drugs.
 Other frequently used drugs were analgesics,
 corticosteroids for dermatologic use, antihistamines
 and antiasthmatics.
Liquid medicine
   dispenser
  a) Hypodermic syringes without needles

Advantages:
 -convenient for infants who can’t drink from a cup
 -dose can be measured accurately
 - Parent can squirt the medicine in the back of the
 child’s mouth where it’s less likely to spill out.
                 b) Oral syringes

 Always remove the cap before administering the
 medication into child’s mouth
                 c) Oral droppers

 Safe and easy to use with the infants and children too
 young to drink from a cup. Be sure to measure at eye
 level and administer quickly, because droppers tend
 to drip.
                  d) Dosing spoons

 Convinient for children who can drink from a cup
  but are likely to spill. Small children can hold long
  handle easily.
 Small spoon fits easily in their mouths.
e) Double duty spoons
            f) Plastic medicine cups

 Convenient for children who can drink from a cup
 without spilling. Be sure to check the numbers
 carefully on the side, and measure out liquid
 medicine with the cup at eye level on a flat surface
      Pediatric med administration: Unique
                 characteristics

a) Absorption
  May adsorb oral drugs at different rate & to different
   degree than adult
  Differences in GI motility, gastric acidity etc.

  IM drug absorption may be erratic

  Dermal & s/c drug absorption remarkably enhanced in
   newborns & young infants
  Eg: topical epinephrine may cause systemic hypertension
b) Distribution
  - change in drug distribution during growth
  parallel changes in body composition
  - total no. of body water in newborns> in adults
  - water soluble drugs given in ↓doses ( per kg) with
  advancing postnatal age.
c) Metabolism
  Metabolism   very slow in newborn, ↑
   progressively during 1st few months of life & >
   adult rates by 1st few years of life
  Eg; phenytoin, barbiturates, analgesics, cardiac
   glycosides have plasma t1/2 up to 3x longer in
   newborn than in adult.
d) Excretion
  Renal immaturity may cause slower drug excretion & ↑
   risk of drug toxicity in child.
  Renal excretion is the primary route for antibiotics, which
   are the most commonly used drugs in newborns & young
   children.
  Drug excretion still slow during adolescence & probably
   attains adult rate by late puberty.
         Common disease and condition

 a) Fever
   30% visits to pediatricians are fever related

   Defined as rectal temp> 38°c in infants 0-3 mths & rectal
    temp > 38.3°c in children > 3 mths.
   Current evidence still suggests acetaminophen (
    paracetamol) is drug of choice for antipyresis in children.
   Ibuprofen is another option. It provides a greater temp
    decrement in febrile children & a longer duration of
    antipyresis than equal dose of aceraminophen.
 b) Otitis media
 - Inflammation of middle ear (≤ 6 years)
 - 1st line antibiotic: Amoxycillin or Ampicillin
 - Penicillin- allergic pt: Erythromycin + Co-
 trimoxazole
 c) Seizure disorders
   Seizure: sudden, transient alteration in brain function as result
    of abnormal neuronal activity & excessive cerebral electrical
    discharge
   Causes of seizure: infectious disease, febrile illness, trauma,
    neoplasm etc.
   Epilepsy: disorder characterized by recurrent, unprovoked
    seizure.
   Treatment: antiepileptic drugs
     phenytoin
     carbamazepine
     sodium valproate
 d) Diarrhea
   Defined as inrease in frequency, fluidity & volume of feces

   Will experience 1-3 x acute, severe episodes of diarrhea by
    infectious agents
   Severe diarrhea requires hospitalization for antibiotic & fluid
    therapy ( rehydration)
   Symptomatic treatment
     eg; antipyretic for fever.
     ORS
     Diphenoxylate
 e) Iron-deficiency anemia (IDA)
   After 6-9 mths of age ( full term born of nonanemic mother),
    iron must be available from diets to meet child’s nutritional
    needs. If dietary iron intake insufficient, iron deficiency
    anemia results
   Preterm infants, infants with significant perinatal blood loss or
    infants born of poorly nourished mother with iron deficiency-
    inadequate iron store & increase risk for IDA < 6 months of
    age.
i)    Prevention
      - encourage mother breastfeeding until 6 months, eat
      food rich in iron, take iron fortified prenatal vitamin
ii)      Treatment
   - oral iron in doses of 2-3mg/kg of elemental iron
   - Vit.C must be administered simultaneously with iron.
   - Iron best absorbed when taken 1 hour before meal &
   should continue for a minimum of 6 weeks after anemia
   is corrected to replenish iron stores.
                      Summary

 Effective & safe drug therapy in paediatrics requires
  understanding of the differences in drug action,
  metabolism & disposition that are apparent during
  growth & development
 Paediatric drug dosage regimens must be adjusted
  for age, wt, BSA, disease state & individual needs.
 Failure for adjustments may lead to ineffective or
  even toxicity

								
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