Lecture 1 Flashcards
(19 cards)
What factors should you consider when prescribing tasks to children?
2 considerations are
consider wider principles of prescribing for all groups of pts
Consider issues unique to specific groups of pts
Who are the specific groups of people ?
Neonates, infants, children, young people
People with renal impairment and hepatic impairment
Elderly pts
pregnant women
Breastfeeding women
Travelers, immigrants, refugees
People whose first language is not English(ethnic minorities )
Patients who do not have the capacity
Tterminally ill or end of life pts
Pts with other co-morbidities
Pts who cannot give consent to the treatement
What are the factors to consider before prescribing children?
Age
Weight
Clinical indication
Organ maturity
What are the issues with prescribing for children ?
Altered pharmacokinetics and pharmacodynamics
Issues around compliance and route of administration
Medication errors can be made if the dose is miscalculated
Less likely to have polypharmacy
What is ABCD while prescribing for Children ?
Absorption
Biology
Clearance
Distribution
What is Absorption ?
Is when the drug is absorbed into the bloodstream and it refers to all the routes of administration include
Oral
Rectal
IM
SC
inhalation
Topical except IV which passes through absorption
When the drug absorbs quicker, the higher concentration will be and it will have a quicker
therapeutic effect and side effects.
Intake of fluids in infants are not guaranteed, affected by gastric emptying, gut motility and milk in the stomach.
Avoid IM as less muscle in children and variable absorption and is painful
Rectal is possible
Skin absorption is possible but can cause toxicity in preterm for e.g alcohol and iodine
What is Biology ?
Avoid medications that cause ADR in children for example. aspirin and Reyes
Mechanisms can vary between adults and children e.g. paracetamol is metabolized faster in adults and slower process in a neonates
Certain drug’s effects can affect the growth and development e.g. steroids
What is Clearance ?
Some drugs need to be monitored
What are the differences because of differences ?
Body weight
Body composition
Body surface area
Nutritional status
Organ and enzyme maturation
Definitions of childhood?
Preterm - < 37 weeks
Term neonates btw 37-42
Post-term - >42 weeks
Neonates 0-28/first 4 weeks
Infants 2 years to 24 months
Child 2 years to 12 years
Adult 12 yrs to 18 yrs
What are the classes of medicine ?
An unlicensed medicine
An off -label medicine
What is off- label medicine ?
This is when the medicine is used outside the terms of its marketing authorization
e.g age, indication, dose, route, or patient population, conta-indication are different to what is there
What are adverse drug reaction ?
unwanted or harmful reactions experienced following the administration of a drug or combination of drugs under normal conditions of use12.ADRs can cause serious conditions such as2:
Toxic epidermal necrolysis (TEN)
Anaphylaxis
What are the drug errors that could occur ?
When the child receives the wrong medication or the wrong dosage every eight minutes in the US.
Most common errors are duplicate administration & measuring of liquids
What are the reason for errors ?
Doses can be complex since it is based on the calculation of the patient’s age, weight, or body surface area.
inadequate information
Not available of appropriate dosage forms and concentrations
Fewer internal reserves to buffer any medication errors that may occur
weight changes over time and recalculation of drug dose is required particularly in neonates
Dosage can be based on ?
Body weight
Body Surface area
Obese child -calculate the dosage using the ideal weight for height and age
Age / combination of all of above
A quick note on advising parents not to use ibuprofen?
has had an allergic reaction to ibuprofen
has asthma
has signs dehydration
has inflammatory bowel disease such as Chron’s and UC
Do not give ibuprofen for chickenpox
if there is increased risk of bleeding
has had a stomach, heart, liver/kidney problems
