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Pediatric

Medications
Reported by:
Cababan, Lailene
Nacilla, Hershey
Rivera, Rein Casey

Objectives:
Classify

pediatrics by their age group

Identify

the pharmacokinetics and


pharmacodynamic considerations in
pediatrics

Calculate

pediatric dose based on body


weight, body surface area, and age of the
child

Pediatrics Medications
Pediatrics
Childhood
Branch
of medicine

that
deals with disease in
Adolescents
children from birth
Adults
through
adolescence

Age range

Neonates

Birth-1 month

Infants

1 month-1 yr

Child/children

1-12 y/o

a. Toddler

a. 1-3 y/o

b. Preschool
age

b. 3-6 y/o

c. School age

c. 6-12 y/o

Adolescents

13-18 y/o

Monitoring administration of
medications to the pediatric
population includes knowledge in:

Pharmacokinetics

Serum
drug
levels

Drug
dosing in
infants
and
children

Cognitive and
physiological
developmenta
l
considerations

Routes of
Administratio
n
1.
2.
3.
4.

Oral
Rectal
Topical
Parenteral
(SQ, IM, IV)

Special considerations in oral


administration:

In using
medication
dropper or
oral
syringe

In using
bottle
nipple

By adding
jelly or
honey

By not
adding to
milk
formula

Pharmacokinetics in infants:
Drug-metabolizing
Lower rates of drug absorption than in
Excretion
enzymes in the liver
are
children and adults
immature
Metabolis
Longer
gastrickidneys
time and
gastric
pH =
Infant
have
higher
m
More drugs in circulatory
diminished
absorption
resistance to blood flow,
Distributio
system = increase
Frequent
feeding
may
impede
the drug
n
lower
GFR
with
a
decreased

Low for
conc
of plasma proteins and diminished
Absorptio
potential
toxicity
absorption
ability to
concentrate
urine
n
protein
binding
capacity
=
drugs
more
available
in
Drug dosages must
Low be
intestinal
flora,
reduced
enzyme

Secrete
drugs
more
slowly,
the circulation
calculated
carefully
function
= decreased
absorption
increasing
risk
of
drug

permeability
to BBB = rapid access to
Drug Greater
levels and
clinical
Low peripheral
perfusion and
accumulation
CNS must be closely
responses
immature heat regulation = decrease

Total body water is 80% compared to adult 50%


monitored
absorption of parenteral medications
Higher doses of H20 soluble drugs may be needed

Pharmacokinetics in children:
Liver enzymes are more
effective at metabolizing
Excretion
drugs
Metabolis
Due to elevated
BMR,
Gastric pH is equal to adult by 2 to 3
m
some drugs are years
Distributio
old
metabolized more
n rapidly

Gastric
emptying rates are faster in
Absorptio
Children over 12 months of
Drug
dosages
relative
to
infants
n
age arereach
able adult
to excrete
Plasma
proteins
by
body weight may
need
to
Skin and blood-brain barrier levels
becomes
drugs effectively
age
1
be higher
more effective
Children
Drugs may need
to be up to age 2 years may require
higher dosages of water soluble drugs
more closely monitored

Developmental
Pharmacokinetics
Gastric pH is high in neonates at 2 yrs
Absorption:
This
is variable
It
is inversely
toin
theitthickness
old
graduallyofdeclines to its adult

neonates,
infants,
and
the stratum corneum
valuesand directly
young to
children
relate
the skin
hydration
Gastric
and intestinal motility is dec in
secondary
The
ratio oftoskinneonates
permeability
and and
infants but inc in older
Blood flow and
larger surface
area
andand
body
infants
children
Membrane
of
the
eye
are
thin,
vasomotor
weight
is observed
in neonates
particularly
Changing
biochemistry
of the
in
neonates
and
infants; it

instabilities
is
dependent
on
specific
and infants isBioavailability
developing
GUT within
the neonate
used
uncommon
eye
drops
to
cause

Insufficient
muscle
drug
properties
and
the
time
during
Equivalent
percutaneous
dosing
leads toside
unpredictable
drug
absorption
systemic
effects
in
the
very
young
tone
and
it
is
exposed
to
rectal
mucosa;
may
lead
to systemic
availability
which
Diminished bile acid pool and biliary
contraction
few
drugs
are
suitable
for
rectal
and potential toxicity
function at birth gradually increases to
Decreased muscle
administration

Developmental Considerations in
Pediatric Medication:
Infants:1m
onths to 1
year

Head control
Hands
Physical
comfort
Precise
measurement
Initial
response
Administration
with
professional
watching

1-2 years

Choose a
position
Taste
Single
command
Familiarize
dosing device
Real challenge
Over
negotiation

Pre-school
age: 3-6
years
Unable to swallow
pills
Method of taking
medication
Show
understanding
Explain
Child should be
praised

School age:
6-12 years

Adolescent:
13-18 years

Swallow
capsules
and
tablets
Child
should be
praised
Sense of
control
Long term
benefits
Side
effects

Shouldbe
included in
decision
making
Explicit
explanatio
n
Minimize
dependent
drug
regimens

Methods of calculating
drug dosages of
pediatrics:

Body Weight

Body Surface Area (BSA)

Age

A. Calculating by Body Weight:

Clarks Rule
Most common method of administering the exact
amount of medication that a child needs

B. Calculating by Body Surface Area


(BSA):

Calculate dosages for infants and children up to 12


years of age
Calculate chemotherapeutic drugs for adults and
fluid volume for adults after open heart surgery,
burns, or renal disease

C. Calculating based on Age:

Youngs Rule

Cowling
s Rule

Frieds Rule

Order: Cefaclor 50mg


q.i.d.
The child weighs 15lbs.
Childs drug dosage:

Answer:

20-40mg/kg/day in
three divided doses.
Available drug: Ceclor
Is the oral
prescribed
dose
suspension
safe? 125mg/5mL

A. Calculating by Body Weight:

Order: Albuterol
0.1mg/kg/day P.O. in
four divided doses
(q6h).
The child weighs
86lbs.

Answer:

How many mg
should the patient
receive per dose?

A. Calculating by Body Weight:

Order: Garamycin IM tid


for a 3-yr-old child who is
36 inches tall and who
weighs 30lbs

Answer:

Supply: Garamycin
40mg/mL
Adult Dose: 40mg

B. Calculating by Body Surface Area

Order: Sulfisoxazole
2g/m2 in four divided
doses.
The child weighs 60lbs
and 50 inches tall.
Available: Sulfisoxazole
500mg/5mL

Answer:

How many mL should the


patient receive per dose?

B. Calculating by Body Surface Area

Name of the drug


Amantadine

Dosage form Dose


Film-coated
1 tab daily for first 4-7 days
tab

Therapeutic use
Antiparkinsonian
drug

Amoxapine

Tab

25 mg q8-12hr

Antidepressants
TCA

Amphetamines

Tab, cap

5 mg PO qDay; may increase


by 5-10 mg/day qWeek

Stimulants ADHD
agetnts

Beta-adrenergic

Inj, tab

100 mg/day PO q12hr

blockers
Buspirone

Beta blockers,
beta 1 selective

Tab

10-15 mg/day PO divided q812hr

Anxiolytics,
Nonbenzodiazipin
es

Ca-channel blockers

Tab

5 mg/day PO initially

Anti anginal
agents

Chlorpromazine

Film-coated
tab

25mg tid or 75mg at bedtime

Antipsychotics

Chloroquine

Tab

500 mg (300 mg base) PO


once/week

Antimalarials/
anthelmintics

Clonidine

Tab , ampule

75-150mcg bid

Antihypertensives

Clozapine

Tab

12.5mg once bid

Antipsychotics

Colchicines

Tab

1mg initially followed by


500mcg 2-3 hrly

Anti-gout/
hyperuricemia

Cyclobenzaprines

Tab, cap

5 mg PO q8hr

Skeletal muscle

Name of the drug

Dosage form

Dose

Therapeutic use

Diflunisal

tablet

500mg every 8

NSAIDs

hours
Disopyramide

Capsule, tablet

100-150mg every 6- Cardiac drugs


8hrs

Fluoxetine

Capsule

20mg daily

Antidepressants

Haloperidol

Soln for inj

25-75mg daily

Antipsychotics

Hydroxychloroquine

Tablet

400mg daily

DMARDs

Hypoglycemic agents

Tablet

1-2mg once daily

Antidiabetic

Lithium

Tablet

1.5-2g daily

Antipsychotics

Lomotil

Tablet

2 tab

Antidiarrheals

Loxapine

Tablet, capsule,

20-50mg/day

Antipsychotics

solution
LSD

tablet

hallucinogens

Mefenamic acid

Tablet

250-500mg tid

NSAIDs

Meprobate

tablets

1200-1600 mg/day

Anxiolytics

Name of the drug

Dosage

Dose

Therapeutic use

Minoxidil

form
Lotion

1-1.5 ml bid

For alopecia

Molindone

tab

50-75 mg/day

antipsychotic

5 mg PO at breakfast & 5

agents
MAO type B

MAOI

tab, cap

mg at lunch (10 mg/day)


Nifedepine SR

Tab

1 tab bid

inhibitors
Cardiac drugs

Phenothiazines

tab, supp,

5-10 mg q6-8hr

Anti psychotics

Prazosin

inj
tab

1 mg PO q8-12hr

Anti-hypertension

Procainamide

Tab/vials

0.5-1 g IM q4-8hr

antiarrhythmic

Quinine/quinidine

Tab

1-2 tab daily

Anti-malarials

Terazosin

Tab

1mg at bedtime

Antihypertensive

Theophylline

Elixir

15 ml (adult); 5-10 ml

Anti-asthma

Trazadone

tab

Tricyclic antidepressants

tab

(children)
150 mg/day PO divided q8- Anti-depressant
12hr
75mg PO qDay initially
Anti-depressant

Questions to Answer

1. What is
the
importance
of knowing
how to
compute
pediatric
medication
dosing?

A dosage thats
So being able to
too low may not
calculate
have the desired
pediatric dosage
effect, while too
correctly is
much of a
essential for
particular drug
anyone
can cause
prescribing or
unwanted side
administering
effects or even
medication to
death.
children.

2. What is the
difference
between
drops and
other liquid
preparations
intended for
older
children?

Drops may have


Drops are
high
intended for
concentrations
infants which have
that an older
more body water
children cant
which can be easy
handle, thats
diluted by its
why other liquid
body, unlike older
preparations are
children which
made for older
have lesser body
children.
water.

3. Is it
possible to
give drops
to older
children?
Explain

Many parents
Giving
your
If the label
toddler
don't
realize
a
doesn't indicate
smaller
that
infant
dose of
an appropriate
medicine
drops
are meant
more
dose for the
for an adult is
concentrated
weight and age
as dangerous
than
liquid
of your child,
as giving a
medicine
don't give that
higher dose
intended
for of
medication to
medicine
older
children.
meant
your toddler.
for an infant

No.

4. What are
the major
aspects to be
included
when
teaching a
mother or a
family about
medications
for her/their
child?

the
of
Parents,
andthe
howimportance
to use
using
the will
correct
patients
correct
administration
need
administration
to know
device to avoid
what
devices,
the the
over- or
medication
importance
of
underdosing,looks
what
like,
using
to
doexactly
ifthe
a dosehow
is
missed
or ifto
the
and
correct
when
child
spits
out the
give-or
administration
take-the
medication or
medication,
device to avoid
can't or won't take
overor form
the solid
underdosing

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