The Critical Analysis on the Pediatric Pharmacology

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Pediatric Pharmacology

Anna D. Busby MSN, APRN

Nursing Instructor

Pharmacodynamics versus Pharmacokinetics

Pharmacodynamics

– Behavior of medication at the cellular level

– Affected by the physiologic immaturity of some body systems in a child

compared to adults; response may vary based on genetic makeup

Pharmacokinetics

– Movement of drugs over time throughout the body via absorption, distribution,

metabolism, and excretion

– Affected by the child’s age, weight, body surface area, body composition, and

diseases affecting related organs (liver, kidney)

Factors Affecting Absorption of Medications in Children versus Adults

Oral medications: slower gastric emptying, increased intestinal motility, a

proportionately larger small intestine surface area, higher gastric pH, and

decreased lipase and amylase secretion compared with adults

Intramuscular absorption: decreased due to smaller muscle mass, muscle tone;

other individual factors are perfusion and vasomotor instability

Subcutaneous absorption:

any decreased perfusion = decreased absorption

Topical absorption of medications: increased due to greater body surface area

and greater permeability of infant’s skin

Factors Affecting Distribution of Medication in Children versus Adults

Higher percentage of body water than adults (amount of water relative to the

amount of body fat)

More rapid extracellular fluid exchange

Decreased body fat

Liver immaturity, altering first-pass elimination

Decreased amounts of plasma proteins available for drug binding

Immature blood–brain barrier, especially neonates, allowing movement of

certain medications into the CSF

Digitalizing Dose –

Physiological Factors Affecting Metabolism of Medications in Children

Differences in hepatic enzyme production or renal clearance

Increased metabolic rate

Biotransformation

oIs affected by the same variations affecting distribution in children

Eight Rights of Medication Administration

1. _____________________

2. _____________________

3. _____________________

4. _____________________

5. _____________________

6. _____________________

7. _____________________

8. _____________________

Dispensing Correct Dose Q/A (see pp)

Correct Route Administration

Oral

Tools: oral syringe, med cup

IV- direct access to vascular system

Common sites (arm, hand, feet, scalp)

IM: most traumatic

Offer topical anesthetic (30 min prior)

Choose site

Choose needle

25g neonate

23g infant

20 to 22g older children

Rectal : emotional trauma

Unpredictable absorption

Do not cut if possible …if must cut –lengthwise

Left lateral position

Ophthalmic

Room temperature

Cleanse eye with cotton ball

Place dominate hand on forehead; pull down lower eyelid with other hand

Instill drops into conjunctival sac

If ointment instill thin ribbon along conjunctival sac

Keep eye closed for 1 minute

Do not share ophthalmic medication

Administering Oral Medications(see pp)

Administering Otic Medication(see pp)

Q/A(see pp)

Guidelines to Determine BSA

1. Measure the child’s height.

2. Determine the child’s weight.

3. Using the nomogram, draw a line to connect the height measurement in the left

column and the weight measurement in the right column.

4. Determine the point where this line intersects the line in the surface area column.

This is the BSA, expressed in meters squared (m2).

Developmental Considerations (see pp)

Guidelines for Administering Medications via Gastrostomy or Jejunostomy

Tubes

Verify placement of tube.

Give liquid medications directly via syringe along with small amount of air.

Mix powdered medication with warm water; crush pills as finely as possible and

mix with water prior to adding to tube.

Open up capsules and mix with water to dissolve contents.

Flush tube with water after administering medications.

Intramuscular Injection Sites (see pp)

Providing Atraumatic Care When Administering Medications

Using comforting positions

Using topical anesthetic prior to injections

Educating the child and parents

Preventing medication errors

Factors Affecting the Choice of Equipment for IV Therapy

The type of solution or medication to be administered

The duration of the therapy

The age and developmental level of the child

The child’s status

The condition of the child’s veins

Rule of thumb: select the smallest gauge for the shortest length of time necessary

to minimize trauma to the veins.

Principles of Atraumatic Care Managing IV Therapy

Gather equipment before approaching child.

Select hand rather than wrist or upper arm veins.

Ensure adequate pain relief.

Allow anesthetic-prepared site to dry.

Prepare the site using aseptic techniques using terms the child can understand.

Use a barrier to avoid pinching the skin.

If needed, use a device to trans illuminate the vein.

Principles of Atraumatic Care Managing IV Therapy (cont.)

Make only two attempts to gain access. Seek additional help if unsuccessful.

Encourage parental participation to hold and comfort child.

Coordinate care with other departments.

Secure line with minimal amount of tape.

Protect the site from accidental bumping.

Assess the insertion site at regular intervals.

Common Conversions

grains (gr) to milligrams (mg) –

Pounds to Kilograms –

Buretrol or Volume Control Chamber –

Parenteral Pediatric Medications

Example #1

Child: 5 years

Weight 44 lbs

Prescribed: famotidine 5 mg IV bid

Available: famotidine 20mg/2mL vial

Drug Guide Information

Dosage:

0.5 mg / kg / day divided twice daily (maximum 40 mg / day)

Administration: May be administered IV push over a period not less than 2

minutes or as an intermittent infusion over 15 to 30 minutes

Final concentration not to exceed 4 mg/mL

Nutritional Support

Enteral

–Orogastric, nasogastric, nasojejunal, or nasoduodenal (tubes inserted along

existing anatomy)

–Gastrosotomy, or jejunostomy (tubes inserted directly into the GI tract through a

surgical opening in the abdomen)

–Indicated in patients with a functioning GI tract but cannot consume enough

calories orally

Parenteral

–Additional fluids via peripheral IV

–Total peripheral nutrition (TPN) via central line

–May be used in the absence of a functioning GI tract

Nursing Care of the Child with an Enteral Tube

Placement must be confirmed prior to adding anything.

Nonradiologic methods to check include:

–checking color and pH of aspirate

–checking external markings on the tube and verifying external tube length

Always assessing for signs indicative of feeding tube misplacement.

–unexplained gagging, vomiting, or coughing;

–signs and symptoms of respiratory distress;

Be aware of developmental needs that may be inhibited by tube feedings.

Measures to Reduce Complications With TPN

Monitor the child’s vital signs closely for changes.

Adhere to strict aseptic technique; monitor insertion site.

Ensure that the system remains a closed system at all times.

Use occlusive dressings; monitor insertion site at dressing change.

Adhere to agency policy for flushing of the catheter and maintaining catheter

patency.

Assess intake and output frequently.

Monitor blood glucose levels and obtain laboratory tests as ordered to evaluate

for changes in fluid and electrolytes.

Replacing NG Fluid Loss

NG – mL/mL Replacement

Nasogastric Output

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