Pharmacotherapeutics

Question 1

How should a pediatric patient be positioned when administering medication?

Answer 1

Standing or propped up to 45 degree angle

reduces choking and gagging

Question 2

How do you deliver a liquid medication to a young infant or toddler?

Answer 2

Deliver to back of mouth with syringe

Don’t let it get in the cheek pouch to be spit at you!

Question 3

How would you administer a dissolving tablet to a pediatric patient?

Answer 3

Place on back of tongue

Question 4

What are some options to make medications more pallatable for pediatric patients?

Answer 4

• Cover with applesauce, peanut butter, chocolate pudding, apple juice, chocolate milk, or marshmallow cream
• Pharmacies can compound meds into gummy bears, etc
• Purchase flavored meds
• Refrigerate meds

Question 5

What are some techniques that can help pediatric patients be more comfortable receiving meds?

Answer 5

• Relaxing environment
• Let them choose
• Play doctor with stuffed animals
• Tell will make them feel better
• Don’t lie
• Reward with star charts, praise

Question 6

What can you consider if a certain medication is not able to be administered as prescribed?

Answer 6

• Injection options
• Suppository
• Have someone hold to give medication
• No negotiation!

Question 7

What techniques can providers use to increase adherence to medications in pediatrics?

Answer 7

• Once daily dosing
• Clearly written instructions
• Info about side effects and how to deal with them (ie probiotics for antibiotics)
• advise to incorporate into daily routine

Question 8

What is the cut off for OTC cough and cold medications in pediatrics?

Answer 8

2 (AAP says 6)

Question 9

Why aren’t OTC cough and cold meds safe in under 2?

Answer 9

• Serious side effects
• May give too much of ingredient, particularly in combo meds
• Potential for enhanced toxicity in young children d/t metabolism, clearance, and drug effects

Question 10

What resource was launched in 2008 related to cough and cold medications and what was their conclusion?

Answer 10

Pediatric Cough and Cold Safety Surveillance System
Most adverse effects d/t med error or accidental ingestion

Question 11

What should parents follow in order to give their child the right dose?

Answer 11

• Check drug facts for correct dose
• Use device that comes with med
• Read directions each time
• Use mL in a syringe rather than tsp

Question 12

How can you prevent adverse effects in pediatrics?

Answer 12

• Educate on side effects
• Do not give 2 meds with same active ingredient
• Only use med that treats symptoms or condition
• Safely store meds
• Keep number for poison control
• Do not give adult med to child
• Do not give aspirin containing products

Question 13

What is the mechanism of action of sudafed?

Answer 13

Sympathomimetic
* Vasoconstricts by stimulating alpha receptors in mucosa of respiratory tract

Question 14

What is the main ingredient and purpose of sudafed?

Answer 14

Pseudoephedrine
Decongestant

Question 15

What are side effects of sudafed?

Answer 15

• Dizziness
• Nervousness
• Difficulty sleeping
• Tachycardia
• Irritability
• Hypertension

Question 16

What are alternatives to sudafed?

Answer 16

• Topical decongestants: phenylephrine/oxymetazoline (afrin) –> less systemic effects but can have rebound congestion
• Saline and suctioning

Question 17

What is the active ingredient in robitussin/delsym?

Answer 17

Dextromethorphan

Question 18

What is the mechanism of action of dextromethorphan?

Answer 18

• Acts on cough center of medulla to suppress cough
• Isomer of codeine

Question 19

What are side effects of robitussin/delsym?

Answer 19

Nausea, sedation, dizziness, abdominal pain

Question 20

Who should not receive dextromethorphan?

Answer 20

Productive cough, CF, asthma

Question 21

What is the mechanism of action of guaifenesin?

Answer 21

• Increased respiratory tract secretions
• Loosens bronchial secretions by decreasing viscosity –> increased mucociliary clearance
• Causes nonproductive cough to become more productive, less frequent, less irritating

Question 22

What are other cough and cold remedies that can be used?

Answer 22

• Honey
• Nasal saline
• Elevate head of bed
• Cool mist vaporizer/humidifier
• Antihistamines
• Tylenol/acetaminophen
• motrin/ibuprofen
• Hydration
• Hand washing
• Education on expected course

Question 23

What age can honey be used?

Answer 23

Over 1 year

Question 24

How often can tylenol be used?

Answer 24

every 4 hours

Question 25

How often can motrin/ibuprofen be used?

Answer 25

Every 6-8 hours

Question 26

How old does a patient have to be to be able to receive motrin?

Answer 26

6 months

Question 27

A patient is still having pain and fever with ibuprofen every 6-8 hours. What can you recommend?

Answer 27

Alternating tylenol and motrin every 3 hours

Question 28

How can stage of development impact drug effects?

Answer 28

Can alter action of and response to (EX tetracyclines stain enamel)

Question 29

What are changes in pharmacokinetics seen in the pediatric population?

Answer 29

• Decreased GI absorption but increased IM absorption
• Increased body water and decreased lipids
• Limited protein binding
• Increased liver/body wt ratio
• Immature enzymes
• Increased brain/body weight ratio
• Increased blood brain barrier permeability
• Immature renal function

Question 30

Reminder to practice pediatric dosing!