PEDIATRICS PHARMACOLOGY University of Hawaii Hilo Pre -Nursing - PowerPoint PPT Presentation

PEDIATRICS PHARMACOLOGY University of Hawai‘i Hilo Pre -Nursing Program NURS 203 – General Pharmacology Danita Narciso Pharm D

 Understand the pharmacologic differences between children and adults  Recognize dosages for commonly used pediatric medications LEARNING OBJECTIVES

 Differences between pediatrics and others  Dosing/calculations OVERVIEW

 Neonate  Up to 28 days  Infant  Neonate to 12 months  Toddler  1-3 years  Pre-school  3-5 years  School age  6-10 years  Adolescent  11-14 years PEDIATRICS

 ADME  Different body composition  Some drug need to be dosed higher  When in double, ask BABIES/CHILDREN ARE NOT SMALL ADULTS

 Oral  Stomach emptying  6-8 months = adults  Enzymes (that aid in absorption) vary  pH  Value varies dependent upon age ABSORPTION

 Injection  Muscle  Blood flow  Surface area ABSORPTION

 Through the skin  Rectal  Hydration status  Can be very useful  Weight  N/V & seizures  Constipation  Maturity of skin layers ABSORPTION - OTHERS

 Other factors  Volume of distribution  Protein (albumin)  Mostly water and fat  Binding sites  Neonate  Binding affinity  Water 71%  Fat 12-16%  pH  Not similar to adults until 12-13 years  Availability of endogenous (pediatric packaging) substances DISTRIBUTION

 Liver  Enzymes  Depends on age, blood flow, & affinity  CYP enzymes  Some concentrations peak before adulthood METABOLISM

 Kidney  3-5 months = adults (GFR)  Suspect kidney problems?  Blood flow  Urine output  Glomerulus  1ml/kg/hr.  Protein  Creatinine clearance  30 weeks = adult  24 hour urine collection  Reabsorption  Serum creatinine  Infant? Not really known  Secretion ELIMINATION/EXCRETION

 Double check order/prescriptions  Double check your math  Rx errors – 8 th leading cause of  OTC package dosing morbidity/mortality  None for ages under 2 years  180,000 deaths & 1 million injuries annually  Children 2-12  Unintentional poisoning  Cough syrup  Vitamins MISTAKES CAN BE DEADLY

 Diphenhydramine - Children 2 to 12 years  Acetaminophen  5 mg/kg/24h (interval q6-8h)  10-15 mg/kg/dose q4-6h  Dextromethorphan  Ibuprofen  1-3 months – 0.5-1 mg/q6-8h  5-10 mg/kg/dose q6-8h  3-6 months – 1-2 mg/ q6-8h  Aspirin  7 months – 1 yr – 2-4 mg/q6-8h  Avoid - Reye's syndrome  2-6 yrs- 2.5-7.5 mg/q4-8h  7-12 yrs – 15 mg/q6-8h COMMONLY USED MEDICATIONS

QUESTIONS