Download - Pediatric Medications
Pediatric MedicationsReported by:
Cababan, LaileneNacilla, HersheyRivera, Rein Casey
Objectives:
Classify pediatrics by their age group Identify the pharmacokinetics and pharmacodynamic considerations in pediatrics
Calculate pediatric dose based on body weight, body surface area, and age of the child
Pediatrics Medications
Pediatrics Childhood Adolescents Adults
Age range
Neonates Birth-1 month
Infants 1 month-1 yr
Child/children 1-12 y/o
a. Toddler a. 1-3 y/o
b. Preschool age
b. 3-6 y/o
c. School age c. 6-12 y/o
Adolescents 13-18 y/o
Branch of medicine that deals with disease in children from birth through adolescence
Monitoring administration of medications to the pediatric population includes knowledge in:
Pharmaco-kinetics
Serum drug levels
Drug dosing in infants and children
Cognitive and physiological developmental considerations
Routes of Administration
1. Oral 2. Rectal3. Topical4. Parenteral (SQ, IM, IV)
Special considerations in oral administration:
In using medication dropper or oral syringe
In using bottle nipple
By adding jelly or honey
By not adding to milk formula
Pharmacokinetics in infants:
Absorption
Distribution
Metabolism
Excretion• Lower rates of drug absorption than in
children and adults• Longer gastric time and gastric pH =
diminished absorption• Frequent feeding may impede the drug
absorption• Low intestinal flora, reduced enzyme
function = decreased absorption• Low peripheral perfusion and
immature heat regulation = decrease absorption of parenteral medications
• Low conc of plasma proteins and diminished protein binding capacity = drugs more available in the circulation
• Greater permeability to BBB = rapid access to CNS
• Total body water is 80% compared to adult 50%• Higher doses of H20 soluble drugs may be needed
to achieve therapeutic effects
• Drug-metabolizing enzymes in the liver are immature• More drugs in circulatory
system = increase potential for toxicity• Drug dosages must be
calculated carefully • Drug levels and clinical
responses must be closely monitored
• Infant kidneys have higher resistance to blood flow, lower GFR with a decreased ability to concentrate urine• Secrete drugs more slowly,
increasing risk of drug accumulation
Absorption
Distribution
Metabolism
Excretion
Pharmacokinetics in children:
• Gastric pH is equal to adult by 2 to 3 years old• Gastric emptying rates are faster in
infants • Skin and blood-brain barrier becomes
more effective
• Plasma proteins reach adult levels by age 1
• Children up to age 2 years may require higher dosages of water soluble drugs
• Liver enzymes are more effective at metabolizing drugs• Due to elevated BMR,
some drugs are metabolized more rapidly • Drug dosages relative to
body weight may need to be higher • Drugs may need to be
more closely monitored
• Children over 12 months of age are able to excrete drugs effectively
Developmental PharmacokineticsAbsorption:
Gastro-intestinalRectal Intra-muscular
Percuta-neousIntra-ocular
• Gastric pH is high in neonates at 2 yrs old it gradually declines to its adult values
• Gastric and intestinal motility is dec in neonates and infants but inc in older infants and children
• Changing biochemistry of the developing GUT within the neonate leads to unpredictable drug absorption
• Diminished bile acid pool and biliary function at birth gradually increases to full capacity over the first several months of life
• Bioavailability is dependent on specific drug properties and the time during which it is exposed to rectal mucosa; few drugs are suitable for rectal administration
• This is variable in neonates, infants, and young children secondary to Blood flow and
vasomotor instabilities
Insufficient muscle tone and contraction
Decreased muscle oxygenation
• It is inversely to the thickness of the stratum corneum and directly relate to the skin hydration• The ratio of skin permeability and
larger surface area and body weight is observed in neonates and infants• Equivalent percutaneous dosing
may lead to systemic availability and potential toxicity
• Membrane of the eye are thin, particularly in neonates and infants; it is used uncommon eye drops to cause systemic side effects in the very young
Developmental Considerations in Pediatric Medication:
Infants:1months to 1 year
• Head control• Hands• Physical
comfort• Precise
measurement • Initial
response • Administration
with professional watching
1-2 years
• Choose a position
• Taste• Single
command • Familiarize
dosing device • Real challenge • Over
negotiation
Pre-school age: 3-6 years
• Unable to swallow pills
• Method of taking medication
• Show understanding
• Explain • Child should be
praised
School age: 6-12 years
• Swallow capsules and tablets
• Child should be praised
• Sense of control
• Long term benefits
• Side effects
Adolescent: 13-18 years
• Shouldbe included in decision making
• Explicit explanation
• Minimize dependent drug regimens
Methods of calculating drug dosages of pediatrics:
Body Weight
Body Surface Area (BSA)
Age
A. Calculating by Body Weight:
𝑃𝑒𝑑𝑖𝑎𝑡𝑟𝑖𝑐 𝐷𝑜𝑠𝑒 (𝑚𝑔)=𝑝𝑒𝑑𝑖𝑎𝑡𝑟𝑖𝑐𝑤𝑡 (𝑘𝑔 )𝑥 (𝐷𝑟𝑢𝑔𝑑𝑜𝑠𝑒 (𝑚𝑔)
1𝑘𝑔)
𝑃𝑒𝑑𝑖𝑎𝑡𝑟𝑖𝑐 𝐷𝑜𝑠𝑒=𝑤𝑡 (𝑙𝑏)𝑥 𝑎𝑑𝑢𝑙𝑡 𝑑𝑜𝑠𝑒
150 (𝑎𝑣𝑒𝑤𝑡𝑖𝑛𝑎𝑑𝑢𝑙𝑡 𝑖𝑛𝑙𝑏)
• Most common method of administering the exact amount of medication that a child needs
Clark’s Rule
B. Calculating by Body Surface Area (BSA):
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• Calculate dosages for infants and children up to 12 years of age
• Calculate chemotherapeutic drugs for adults and fluid volume for adults after open heart surgery, burns, or renal disease
𝐵𝑆𝐴=√ ht (cm ) 𝑥𝑤𝑡 (𝑘𝑔)3600
C. Calculating based on Age:
𝑃𝑒𝑑𝑖𝑎𝑡𝑟𝑖𝑐 𝑑𝑜𝑠𝑒=𝑎𝑔𝑒
𝑎𝑔𝑒+12𝑥 𝑎𝑑𝑢𝑙𝑡𝑑𝑜𝑠𝑒
𝑃𝑒𝑑𝑖𝑎𝑡𝑟𝑖𝑐 𝑑𝑜𝑠𝑒=𝑎𝑔𝑒𝑎𝑡𝑛𝑒𝑥𝑡 h𝑏𝑖𝑟𝑡 𝑑𝑎𝑦 (𝑖𝑛 𝑦𝑟𝑠)
24𝑥 𝐴𝑑𝑢𝑙𝑡 𝑑𝑜𝑠𝑒
𝐼𝑛𝑓𝑎𝑛𝑡𝑠 𝑑𝑜𝑠𝑒=𝑎𝑔𝑒𝑖𝑛 h𝑚𝑜𝑛𝑡 𝑠
150𝑥 𝐴𝑑𝑢𝑙𝑡 𝑑𝑜𝑠𝑒 Fried’s Rule
Young’s Rule
Cowling’s Rule
𝑃𝑒𝑑𝑖𝑎𝑡𝑟𝑖𝑐 𝑑𝑜𝑠𝑒=𝑎𝑔𝑒𝑎𝑡𝑛𝑒𝑥𝑡 h𝑏𝑖𝑟𝑡 𝑑𝑎𝑦 (𝑖𝑛 𝑦𝑟𝑠)
24𝑥 𝐴𝑑𝑢𝑙𝑡 𝑑𝑜𝑠𝑒
Answer:Order: Cefaclor 50mg q.i.d. The child weighs 15lbs.
Child’s drug dosage:
20-40mg/kg/day in three divided doses.
Available drug: Ceclor oral suspension 125mg/5mL
Is the prescribed dose safe?
A. Calculating by Body Weight:
Order: Albuterol 0.1mg/kg/day P.O. in four divided doses (q6h). The child weighs 86lbs.
How many mg
should the patient receive per dose?
A. Calculating by Body Weight:
Answer:
Order: Garamycin IM tid for a 3-yr-old child who is 36 inches tall and who weighs 30lbs
Supply: Garamycin
40mg/mL
Adult Dose: 40mg
B. Calculating by Body Surface Area (BSA):
Answer:
Order: Sulfisoxazole 2g/m2 in four divided doses.The child weighs 60lbs and 50 inches tall.
Available: Sulfisoxazole 500mg/5mL
B. Calculating by Body Surface Area (BSA):
How many mL should the patient receive per dose?
Answer:
Name of the drug Dosage form Dose Therapeutic use
AmantadineFilm-coated tab 1 tab daily for first 4-7 days Antiparkinsonian drug
AmoxapineTab 25 mg q8-12hr Antidepressants TCA
AmphetaminesTab, cap 5 mg PO qDay; may increase by 5-10
mg/day qWeekStimulants ADHD agetnts
Beta-adrenergic blockersInj, tab 100 mg/day PO q12hr Beta blockers, beta 1
selective
BuspironeTab 10-15 mg/day PO divided q8-12hr Anxiolytics,
Nonbenzodiazipines
Ca-channel blockersTab 5 mg/day PO initially Anti anginal agents
ChlorpromazineFilm-coated tab 25mg tid or 75mg at bedtime Antipsychotics
ChloroquineTab 500 mg (300 mg base) PO once/week Antimalarials/
anthelmintics
ClonidineTab , ampule 75-150mcg bid Antihypertensives
ClozapineTab 12.5mg once bid Antipsychotics
ColchicinesTab 1mg initially followed by 500mcg 2-3
hrlyAnti-gout/ hyperuricemia
CyclobenzaprinesTab, cap 5 mg PO q8hr Skeletal muscle
relaxants
Name of the drug Dosage form Dose Therapeutic use
Diflunisal tablet 500mg every 8 hours NSAIDs
Disopyramide Capsule, tablet 100-150mg every 6-8hrs Cardiac drugs
Fluoxetine Capsule 20mg daily Antidepressants
Haloperidol Soln for inj 25-75mg daily Antipsychotics
Hydroxychloroquine Tablet 400mg daily DMARDs
Hypoglycemic agents Tablet 1-2mg once daily Antidiabetic
Lithium Tablet 1.5-2g daily Antipsychotics
Lomotil ® Tablet 2 tab Antidiarrheals
Loxapine Tablet, capsule,
solution
20-50mg/day Antipsychotics
LSD tablet hallucinogens
Mefenamic acid Tablet 250-500mg tid NSAIDs
Meprobate tablets 1200-1600 mg/day Anxiolytics
Name of the drug Dosage form Dose Therapeutic use
Minoxidil Lotion 1-1.5 ml bid For alopecia
Molindone tab 50-75 mg/day antipsychotic agents
MAOI tab, cap 5 mg PO at breakfast & 5 mg at lunch (10 mg/day)
MAO type B inhibitors
Nifedepine SR Tab 1 tab bid Cardiac drugs
Phenothiazines tab, supp, inj 5-10 mg q6-8hr Anti psychotics
Prazosin tab 1 mg PO q8-12hr Anti-hypertension
Procainamide Tab/vials 0.5-1 g IM q4-8hr antiarrhythmic
Quinine/quinidine Tab 1-2 tab daily Anti-malarials
Terazosin Tab 1mg at bedtime Antihypertensive
Theophylline Elixir 15 ml (adult); 5-10 ml (children) Anti-asthma
Trazadone tab 150 mg/day PO divided q8-12hr
Anti-depressant
Tricyclic antidepressants tab 75mg PO qDay initially Anti-depressant
Questions to Answer
1. What is the importance of knowing how to compute pediatric medication dosing?
A dosage that’s too low may not have the desired effect, while too much of a particular drug can cause unwanted side effects or even death.
So being able to calculate pediatric dosage correctly is essential for anyone prescribing or administering medication to children.
2. What is the difference between drops and other liquid preparations intended for older children?
Drops are intended for infants which have more body water which can be easy diluted by its body, unlike older children which have lesser body water.
Drops may have high concentrations that an older children cant handle, that’s why other liquid preparations are made for older children.
3. Is it possible to give drops to older children?
Explain
No.
Giving your toddler a smaller dose of medicine meant for an adult is as dangerous as giving a higher dose of medicine meant for an infant
Many parents don't realize that infant drops are more concentrated than liquid medicine intended for older children.
If the label doesn't indicate an appropriate dose for the weight and age of your child, don't give that medication to your toddler.
4. What are the major aspects to be included when teaching a mother or a family about medications for her/their child?
Parents, and patients will need to know what the medication looks like, exactly how and when to give-or take-the medication,
how to use the correct administration devices, the importance of using the correct administration device to avoid over- or underdosing
the importance of using the correct administration device to avoid over- or underdosing, what to do if a dose is missed or if the child spits out the medication or can't or won't take the solid form