Chapter 6 Pediatric Pharmacology Flashcards
Pediatric Pharmacokinetics
Absorption
Influencing factors
-Child’s age, health status, weight, route of administration
-Nutritional habits, physical maturity, hormonal differences
-Hydration, underlying disease, GI disorders
Route of administration
-Gastric acidity, emptying, motility, surface area, enzyme levels, intestinal flora
IM/subQ
-Peripheral perfusion
-Effectiveness of circulation
Topical
-Children’s skin is thin and porous; risk for toxicity
Pediatric Pharmacokinetics
Distribution Influencing factors Body fluid composition Neonates and infants have 75% water. Body tissue composition Neonates and infants have less body fat. Protein-binding capability Neonates and infants have less albumin and fewer protein receptor sites. Effectiveness of barriers Skin Blood-brain barrier
Pediatric Pharmacokinetics
Metabolism Influencing factors -Maturational level of child -Liver metabolism -Higher metabolic rate
Pediatric Pharmacokinetics
Excretion Kidneys Infants have decreased renal blood flow. glomerular filtration rate. renal tubular function.
Pediatric Pharmacodynamics
Mechanisms of action and effect of a drug on the body
Includes the onset, peak, and duration of effect of a medication.
Intensity of therapeutic effects and adverse effects
Drug dosing for Pediatrics
Drug Dosing and Monitoring: Because of the changes in pharmacokinetics and pharmacodynamics inherent in pediatric patients, a key nursing role is to monitor the patient for therapeutic effect and adverse reactions. Remember that therapeutic ranges for many drugs are based on adult studies, therefore close monitoring of serum drug levels can assist in establishing appropriate dosages, schedules, and routes of administration.
Pediatric medication dosages are ordered based on the child’s weight in kilograms or body surface area.
Drug Administration: Developmental and cognitive differences must always be considered in pediatric drug administration. The family or caregiver should be involved as much as possible in the administration of medication as well as in the monitoring of the patient as they are more readily able to identify therapeutic/sub-therapeutic results, adverse reactions, etc.
Most pediatric medications are administered via the oral route. Most oral medications are administered to children via oral syringe for correct dosing. It should be administered to the side of the mouth. Nurses may need to crush pills or dissolve capsules in fluid for administration to pediatric patients.
The administration of subQ, IM, or IV medications to children recommend “atraumatic care” (delivery of the medication minimizing physical and psychological distress). Based on the cognitive level of the child, distraction and other non-pharmacological methods of pain or control can decrease the perception of pain. IV infusion sites must be protected, especially in infants/toddlers who do not understand the rationale/importance of maintaining an IV site.
The ventrogluteal or vastus lateralis are preferred sites for pediatric IM injections. For small infants, only the vastus lateralis should be used.
When administering to toddlers: use a simple explanation, firm approach, and imagination through play (such as having the toddler pretend to give a shot to their teddy bear).
Preschoolers: allow some level of choice or control
School-age children: should be permitted even more control, involvement in the process, and information
Nursing Implications
Pediatric drug administration
Teaching is directed toward family or caregivers and patients.
Side effects may be difficult to evaluate.
Assess pediatric patient for ability to understand the reason for drug.
Consider level of knowledge, developmental age, cultural factors, anxiety level, when communicating with pediatric patient and family.
Nursing Implications
Pediatric drug administration Atraumatic care Oral administration Subcutaneous, intramuscular, and intravenous Eutectic mixture of local anesthetics Decreasing pain and anxiety Distraction, diversion, relaxation Creative imagery
Pediatric drug administration
Intravenous sites Basic rules Honesty, respect Age-appropriate teaching and explanations Positive reinforcement
Adolescent Considerations
Considerations for adolescents Need individualized care specific to developmental stage Physical changes Cognitive level and abilities Social, reasoning, and decision-making skill development Emotional factors Independence from parents Self-care behaviors Impact of chronic illness
