Pharmacology Chapter 7- Pediatric Pharmacology

Which two components make it difficult to recruit a pediatric trial to collect research?
1. Research risk
2. Informed consent

Pediatric Research Equity Act and Best Pharmaceuticals Act of 2002
Require drug manufacturers to study pediatric medication use and offer incentives for pediatric pharmacology research; reinforce the need for pediatric research and safe guidelines for pediatric medication dosing, administration, and evaluation.

Factors that influence absorption of drug
– Child’s age, health status, underlying disease, hydration, and route of administration
– Children are still developing- organs aren’t always fully mature

Route of administration affects absorption
– For oral medications- Gastric acidity, gastric emptying, gastric motility, surface area, enzyme levels and intestinal flora mediate drug absorption
– Oral medications should not be given if the child is having GI issues

Intramuscular (IM) and subcutaneous (SubQ) injections
– usually avoided in children because of the pain and possibility of tissue damage
– the level of peripheral perfusion and effectiveness of circulation affects the medication’s ability to be absorbed

Topical medications
– Absorbed through the skin
– A child’s skin is thin and porous so absorption will be enhanced and greater than in adults

The distribution of medication throughout the body of a child is affected by factors such as:
– Body fluid composition
– Body tissue composition
– Protein-binding capability
– Effectiveness of barriers

Body fluid composition
In neonates and infants, the human body is about 70% water. As the child grows, this percentage will decrease.
* Children under the age of 2 should be given water-soluble drugs

Body tissue composition
Neonates and infants have less body fat than older children; therefore, neonates and infants should be given a very small dose of fat-soluble drugs if needed

Protein-binding capabilities
Neonates and infants have less albumin and fewer protein receptor sites; decreased dosage is needed to avoid too much free drug in the system

Effectiveness of barriers
– Skin: children’s skin is thin and porous so medication is absorbed more easily and more quickly
– Blood- brain barrier: Infants’ blood-brain barriers are immature, allowing medications to cross the barrier much easier; increases the likelihood of toxicity

Metabolism
Maturation level varies from child to child; Although, children inherently have higher metabolic rates than adults, causing metabolism to occur more rapidly (drug is eliminated faster).

First-pass effect in children
– For select medications, when the oral route is ordered, the first-pass effect must be considered in the calculation of doses
– Some medications are administered by the rectal route to avoid the hepatic first-pass effect

Monitoring drug levels in children is very important because…
children are more prone to toxicity because of maturation levels of organs and a higher likelihood to cross the blood-brain barrier

Excretion
The excretion of medications occurs in the kidneys, intestines, lungs, sweat glands, salivary glands, and mammary glands.

* infants have decreased renal blood flow, glomerular filtration rate, and renal tubular function

Since medications are excreted more slowly in children as a result of decreased renal function…
toxic accumulation can occur

Water is needed for effective excretion of medications…
so pediatric patients must be evaluated and monitored for dehydration

Pediatric pharmacodynamics
Mechanisms of action and effect of a drug on the body which includes the onset, peak, and duration of effect of a medication
– The half-life of a medication may be different in children than in adults
– Pediatric variables such as organ function, developmental factors, and administration issues affect how drugs affect the body

Nursing implications: Pediatric medication dosing/monitoring
– Pediatric patients are monitored closely for therapeutic effects and adverse reactions; blood serum level tests can be done to make sure levels are normal
– Calculations must be done correctly to avoid overdose and toxicity- weight will be measured in kilograms (kg)

Nursing implications: Pediatric medication administration
– Patient identification- make sure you have the correct patient
– Consider developmental and cognitive differences; nurse must differentiate the child’s developmental age from the chronological age because this has an impact on the child’s response to receiving the medication

Family-centered care
Teach toward the parent and child (if the child can understand the information)

Most pediatric medications are administered via which route?
Oral route; this route is the least invasive and easiest to use for family/home caregivers

Subcutaneous, intramuscular, and intravenous administration….
is typically avoided if possible; if necessary a topical anesthetic (such as LET; lidocaine, epinephrine, and tetracaine) can be applied before giving the injection to the child. In addition, distraction may help for pain and anxiety control

Atraumatic care
The delivery of therapeutic care through the implementation of interventions that eliminate or minimize the psychological and physical distress experienced by children and their families; child may be scared prior to treatment.

Intravenous sites
– Must be protected, especially in infants and toddlers, who do not understand the importance of maintaining the IV site.
– IV sites should be checked to see that the IV is open and flowing

Which sites are preferred for intramuscular (IM) injections?
1. Ventrogluteal (on the side, proximal to the hip)
2. Vastus lateralis (upper, outer thigh)

* The dorsogluteal site is no longer used because of the potential of sciatic nerve damage

Subcutaneous injections
The length of the needle depends on the child’s muscle mass, sub Q tissue, and the site of injection. Child may prefer subQ injections in the leg or upper arm rather than in the abdomen.

Considerations for adolescents
– Physical changes: growth and development compared to their peers
– Cognitive level and abilities: patient may be unaware of drug interactions, adverse reactions, etc. Patient teaching and good communication is very important.
– Emotional factors: formation of identity, questioning, risk-taking, influences from peers, need for independence
– Impact of chronic illness- allowing teens to make safe choices and have flexibility within the care plan, monitored medication regimen, emotional well-being.

Nursing process: Pediatric Assessment
– Age, weight, height
– Developmental age
– Health status
– History of drug use
– Nutritional/Hydration status
– Cognitive level
– Family/child understanding

A child receives a drug dose based on which 3 individual factors?
Age, weight, and height

Drug dose calculation equation
mg/kg/day

Patient teaching
– Report use of OTC products/herbal remedies
– Report side effects immediately
– Advise breastfeeding patient that a portion of most drugs will be excreted in breast milk
– Keep meds out of reach of children
– Use child-resistant containers for meds

Pediatric Classification Age Range < 38 weeks gestation= premie < 1 month = neonate or newborn 1 month-< 1 yr = infant 1 year - < 12 yrs. = child Pharmacokinetics Significant differences exist in the pediatric population Cause by ...

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