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

LEARNING OBJECTIVES

 Understand the pharmacologic differences between children

and adults

 Recognize dosages for commonly used pediatric medications

OVERVIEW

 Differences between pediatrics and others  Dosing/calculations

PEDIATRICS

 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

BABIES/CHILDREN ARE NOT SMALL ADULTS

 ADME

 Different body composition  Some drug need to be dosed higher  When in double, ask

ABSORPTION

 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 - OTHERS

 Through the skin

 Hydration status  Weight  Maturity of skin layers

 Rectal

 Can be very useful

 N/V & seizures  Constipation

DISTRIBUTION

 Volume of distribution

 Mostly water and fat  Neonate

 Water 71%  Fat 12-16%

 Not similar to adults until 12-13 years

(pediatric packaging)

 Other factors

 Protein (albumin)  Binding sites  Binding affinity  pH  Availability of endogenous

substances

METABOLISM

 Liver

 Enzymes

 Depends on age, blood flow, &

affinity

 CYP enzymes

 Some concentrations peak before

adulthood

ELIMINATION/EXCRETION

 Kidney

 3-5 months = adults (GFR)

 Blood flow  Glomerulus  Protein

 30 weeks = adult

 Reabsorption

 Infant? Not really known

 Secretion

 Suspect kidney problems?

 Urine output

 1ml/kg/hr.

 Creatinine clearance

 24 hour urine collection

 Serum creatinine

MISTAKES CAN BE DEADLY

 Double check order/prescriptions  Double check your math

 Rx errors – 8th leading cause of

morbidity/mortality

 180,000 deaths & 1 million injuries

annually

 Unintentional poisoning

 Cough syrup  Vitamins

 OTC package dosing

 None for ages under 2 years  Children 2-12

COMMONLY USED MEDICATIONS

 Acetaminophen

 10-15 mg/kg/dose q4-6h

 Ibuprofen

 5-10 mg/kg/dose q6-8h

 Aspirin

 Avoid - Reye's syndrome

 Diphenhydramine - Children 2 to 12

years

 5 mg/kg/24h (interval q6-8h)

 Dextromethorphan

 1-3 months – 0.5-1 mg/q6-8h  3-6 months – 1-2 mg/ q6-8h  7 months – 1 yr – 2-4 mg/q6-8h  2-6 yrs- 2.5-7.5 mg/q4-8h  7-12 yrs – 15 mg/q6-8h

QUESTIONS