paediatric drugs, its dose and dosage forms
TRANSCRIPT
![Page 1: Paediatric drugs, its dose and dosage forms](https://reader036.vdocuments.mx/reader036/viewer/2022062901/58f9b1a0760da3da068bc2a2/html5/thumbnails/1.jpg)
1
Paediatric Pharmacy Practice
![Page 2: Paediatric drugs, its dose and dosage forms](https://reader036.vdocuments.mx/reader036/viewer/2022062901/58f9b1a0760da3da068bc2a2/html5/thumbnails/2.jpg)
2
20 to 25% of total world populationPoorly developed organ functions and highest risk of toxicity and poor clinical response.Sulphanilamide elixir- death: Thalidomide tragedy.
Taste of Raspberries, Taste of DeathThe 1937 Elixir Sulfanilamide Incident
![Page 3: Paediatric drugs, its dose and dosage forms](https://reader036.vdocuments.mx/reader036/viewer/2022062901/58f9b1a0760da3da068bc2a2/html5/thumbnails/3.jpg)
3
Why Do We Need PaediatricPharmacists?
Children are at increased risk of adversedrug events (ADE’s) Pharmacologic factors
•Age-based variability in absorption,distribution, metabolism, and excretion
ofdrugs
Physiologic factors•Weight and/or body surface area
(BSA) needto be considered for each drug for eachpatient
![Page 4: Paediatric drugs, its dose and dosage forms](https://reader036.vdocuments.mx/reader036/viewer/2022062901/58f9b1a0760da3da068bc2a2/html5/thumbnails/4.jpg)
4
Process factors•Individualized dilution of stock
medicationsand fluids •Multiple concentrations of same drug• Dilution errors
Environmental factors•ICU settingWeight-based dosing
Error dosing rate Error rates inversely related to size or
weight of patient
![Page 5: Paediatric drugs, its dose and dosage forms](https://reader036.vdocuments.mx/reader036/viewer/2022062901/58f9b1a0760da3da068bc2a2/html5/thumbnails/5.jpg)
5
Paediatric medication orders are more proneto errors than adult orders Doses are not standard Math errors can occur when calculating the dose Suspensions often have to be compounded Tablets may have to be cut Dilutions need to be made to make amounts that are measurable However, children have less tolerance for errors
![Page 6: Paediatric drugs, its dose and dosage forms](https://reader036.vdocuments.mx/reader036/viewer/2022062901/58f9b1a0760da3da068bc2a2/html5/thumbnails/6.jpg)
6
Preemie <37 weeks gestation (gestationalage is the time from conception until Birth)
Full Term 37-42 weeks gestation
Neonate First 30 days of lifeInfant First year of life Toddler From 1 to 2 years of lifeChild Age 3-11 Adolescent Age Age 12 on
Definition of a child is based on age
![Page 7: Paediatric drugs, its dose and dosage forms](https://reader036.vdocuments.mx/reader036/viewer/2022062901/58f9b1a0760da3da068bc2a2/html5/thumbnails/7.jpg)
7
Special Challenges of Practicing in Pediatrics
Lack of published information on therapeutic uses and monitoring of drugs Lack of FDA approval for many drugs used in pediatrics Lack of appropriate commercially available dosage forms and concentrations of commonly used medications Inability of patients to communicate withcaregivers Interacting with parents
![Page 8: Paediatric drugs, its dose and dosage forms](https://reader036.vdocuments.mx/reader036/viewer/2022062901/58f9b1a0760da3da068bc2a2/html5/thumbnails/8.jpg)
8
Skills Necessary Dosage calculations Dosage-form selection Specialized drug preparation and administration techniques Understanding of PK/PD changes occurring with age Understanding of disease-specific conditionsaffecting drug choice or dose Understanding nature of medication errors inpediatric patients
![Page 9: Paediatric drugs, its dose and dosage forms](https://reader036.vdocuments.mx/reader036/viewer/2022062901/58f9b1a0760da3da068bc2a2/html5/thumbnails/9.jpg)
9
Role of the Paediatric PharmacistEnsure the patient receives the necessary drug in a manner that allows the intended therapeutic effect to be realized.
![Page 10: Paediatric drugs, its dose and dosage forms](https://reader036.vdocuments.mx/reader036/viewer/2022062901/58f9b1a0760da3da068bc2a2/html5/thumbnails/10.jpg)
10
Patient interviews Medication history
•Inquiring about OTC and herbal medications Allergy history
•True allergic reaction? Immunization history
•Can make recommendations to MD if patient is not up-to-date on immunizations
![Page 11: Paediatric drugs, its dose and dosage forms](https://reader036.vdocuments.mx/reader036/viewer/2022062901/58f9b1a0760da3da068bc2a2/html5/thumbnails/11.jpg)
11
Discharge counselling Administration & use of appropriate
measuring device dosage Preparation of form at home, if necessary Attention to taste of liquid medications Prevention of accidental ingestions School / day-care issues directed at patient and/or caregiver
![Page 12: Paediatric drugs, its dose and dosage forms](https://reader036.vdocuments.mx/reader036/viewer/2022062901/58f9b1a0760da3da068bc2a2/html5/thumbnails/12.jpg)
12
Drug Information Influence selection of drug therapy in initial phase of patient care
•Consult with physician and patient Provide current, unbiased and relevant drug information Assist with finding literature supporting use of drugs for unlabeled indications
![Page 13: Paediatric drugs, its dose and dosage forms](https://reader036.vdocuments.mx/reader036/viewer/2022062901/58f9b1a0760da3da068bc2a2/html5/thumbnails/13.jpg)
13
Therapeutic Drug Monitoring Understanding timing / indication of monitoring to prevent unnecessary blood draws on children Account for age-related differences indosage Documentation in patient chart Monitor steps of the medication use processReduce drug costs Avoidance of medication errors resulting from over- or underdosing
![Page 14: Paediatric drugs, its dose and dosage forms](https://reader036.vdocuments.mx/reader036/viewer/2022062901/58f9b1a0760da3da068bc2a2/html5/thumbnails/14.jpg)
14
Reduce Medication Errors Report medication errors Encourage others to report medication errors or suspected ADE’s Participation in quality-improvement committees Develop and enforce policies and procedures for safe medication practices
![Page 15: Paediatric drugs, its dose and dosage forms](https://reader036.vdocuments.mx/reader036/viewer/2022062901/58f9b1a0760da3da068bc2a2/html5/thumbnails/15.jpg)
15
Drug Use Evaluation Low therapeutic index drugs
Those responsible for serious medication errors High frequency of preventable adverse drug reactions Expensive medications
Education Patients Nursing unit staff Physicians Pharmacy students and residents
![Page 16: Paediatric drugs, its dose and dosage forms](https://reader036.vdocuments.mx/reader036/viewer/2022062901/58f9b1a0760da3da068bc2a2/html5/thumbnails/16.jpg)
16
Research Pediatric patients are “therapeutic
orphans” Insufficient research in pediatric patients Expansion of adult diseases into the pediatric population (i.e. AIDS) Use of therapeutic agents in children without FDA approval
![Page 17: Paediatric drugs, its dose and dosage forms](https://reader036.vdocuments.mx/reader036/viewer/2022062901/58f9b1a0760da3da068bc2a2/html5/thumbnails/17.jpg)
17
Pharmacokinetic considerations
![Page 18: Paediatric drugs, its dose and dosage forms](https://reader036.vdocuments.mx/reader036/viewer/2022062901/58f9b1a0760da3da068bc2a2/html5/thumbnails/18.jpg)
18
Absorption– Gastrointestinal pH- gastric acid output maturity is related to postnatal age andapproaches adult values by 3 months of age GI motility- neonates have a delay in gastric emptying time, adult values are reached at 6-8 months of age GI contents- develops rapidly within the first year of life, underdeveloped flora can increase absorption of drugs (digoxin)–
![Page 19: Paediatric drugs, its dose and dosage forms](https://reader036.vdocuments.mx/reader036/viewer/2022062901/58f9b1a0760da3da068bc2a2/html5/thumbnails/19.jpg)
19
Percutaneous Absorption is increased in the newborn due to immatureepidermal barrier and increased skin hydration during the first 2 weeks of life Increased surface area to weight ratio increases percutaneousabsorption
![Page 20: Paediatric drugs, its dose and dosage forms](https://reader036.vdocuments.mx/reader036/viewer/2022062901/58f9b1a0760da3da068bc2a2/html5/thumbnails/20.jpg)
20
Distribution–Body Water• Neonates are 80% body water compared to 55% in adults• Vd is increased for drugs that distribute to aqueous parts of the body (aminoglycosides)• Total body fat is 1% in a 29 wk neonate• Total body fat is 15% in a full term baby• Total body fat is 20-25% in 2yo toddler• Fat content tends to increase between 5-10 years followed by a decrease through age 17• Vd is increased for drugs that are highly lipid soluble
![Page 21: Paediatric drugs, its dose and dosage forms](https://reader036.vdocuments.mx/reader036/viewer/2022062901/58f9b1a0760da3da068bc2a2/html5/thumbnails/21.jpg)
21
– Plasma Protein Binding• Neonates have decreased plasma protein which increases unbound concentrations (ex: Phenytoin may only be 70% bound in a neonate compared to 90% in an adult)– Blood Brain Barrier• An immature BBB due to incomplete CNS myelination results in increased CNS drug penetration
![Page 22: Paediatric drugs, its dose and dosage forms](https://reader036.vdocuments.mx/reader036/viewer/2022062901/58f9b1a0760da3da068bc2a2/html5/thumbnails/22.jpg)
22
Metabolism– Neonates have decreased activity of many enzyme pathways, that is why drug dosages are decreased for neonates P450 activity is 50% of adult levels Decreased hydroxylation activity leads to decreased metabolism of phenobarbital, phenytoin, lidocaine Children have increased hepatic enzyme activity between 2-4 years of age. This may be due to large liver size compared to total body weight. Doses are increased during this time for theophylline, phenytoin, and phenobarbital.
![Page 23: Paediatric drugs, its dose and dosage forms](https://reader036.vdocuments.mx/reader036/viewer/2022062901/58f9b1a0760da3da068bc2a2/html5/thumbnails/23.jpg)
23
At birth, kidney function is decreased, GFR matures first, then tubular secretion, and lastly tubular reabsorption GFR at birth is 2-4 ml/min, which is 0.5% of an adult level After the first week of life, a significant increase in GFR is seen, this explains why recommended doses change after 7 days of lifeAt 1 year, GFR reaches 70 ml/min/m2 Around 12-24 month of age, GFR and tubular secretion are more mature than tubular reabsorption and cause an increased renal clearance of drugs (digoxin)
Excretion
![Page 24: Paediatric drugs, its dose and dosage forms](https://reader036.vdocuments.mx/reader036/viewer/2022062901/58f9b1a0760da3da068bc2a2/html5/thumbnails/24.jpg)
24
Administering Medications to Children
![Page 25: Paediatric drugs, its dose and dosage forms](https://reader036.vdocuments.mx/reader036/viewer/2022062901/58f9b1a0760da3da068bc2a2/html5/thumbnails/25.jpg)
25
• Safe pediatric dosages calculated by: – Body weight
• Measured in mg per kg, mcg per kg, etc. – Body surface area (BSA)
• Measured in m2
Remember 1 kg = 2.2 lb – When converting pounds to kilograms, round kilogram weight to one decimal place
• Tenths 1 lb = 16 oz
![Page 26: Paediatric drugs, its dose and dosage forms](https://reader036.vdocuments.mx/reader036/viewer/2022062901/58f9b1a0760da3da068bc2a2/html5/thumbnails/26.jpg)
26
Dosage is optimally calculated by using thechild’s body weight or mass and the appropriate dose in milligrams per kilogram (mg/kg). A. Fried’s rule for infants age (in months) X adult dose ............................ =
dose for infant 150
![Page 27: Paediatric drugs, its dose and dosage forms](https://reader036.vdocuments.mx/reader036/viewer/2022062901/58f9b1a0760da3da068bc2a2/html5/thumbnails/27.jpg)
27
age (in years)............................. X adult dose = age (in years) + 12
dose for child
Young’s rule for children 2 years old or older
weight (lb) X adult dose........................................ = dose for child 150 lb (avg wt of adult)
Clark’s rule
![Page 28: Paediatric drugs, its dose and dosage forms](https://reader036.vdocuments.mx/reader036/viewer/2022062901/58f9b1a0760da3da068bc2a2/html5/thumbnails/28.jpg)
28
BSA of child (m)2 X adult dose ............................................... = 1.73 m2 (avg adult BSA)
approximate dose for child
Child’s dosage based on body surface area (BSA)
In the case of some drugs, such as chemotherapy, doses are based on body surface area (BSA). This value can be determined from the patient’s height andweight, using either a nomogram or the following equation:
height (cm) X weight (kg)BSA (m)2 = .......................................
3600
![Page 29: Paediatric drugs, its dose and dosage forms](https://reader036.vdocuments.mx/reader036/viewer/2022062901/58f9b1a0760da3da068bc2a2/html5/thumbnails/29.jpg)
29
Although the total body water content of an adult accounts for approximately 60% of body weight, the total body water content of a healthy newborn is(A) 40%.(B) 50%.(C) 70%.(D) 80%.(E) 90%.
![Page 30: Paediatric drugs, its dose and dosage forms](https://reader036.vdocuments.mx/reader036/viewer/2022062901/58f9b1a0760da3da068bc2a2/html5/thumbnails/30.jpg)
30
THANK YOU