pharmacology and the care of infants and pediatric patients

adolescent

12-18 years old

physiologic

changes throughout development influence both the pharmacodynamic and pharmacokinetic actions of medications

child

1-12 years old

school age

4-5, 12-18

weight

the basis of pediatric drug dosing is

excretion (older adults)

Diminished renal blood flow/# of functioning nephrons/GFR and tubular secretion

pediatric patients

birth to age 18.

vaccines (infants/toddlers)

vastis lateralis in leg and deltoid muscle. primary site is vastis lateralis

BBW (children)

: antidepressants are deemed necessary in children and adolescents but there has been an increased risk of tendency to have suicidal ideations.

kidney fxn

BUN/CR

liver fxn

ALT/AST

absorption (pediatrics)

Age Intestinal motility/Gastric emptying Routes of administration Avoid IM (except vaccines) Skin permeability

strategies to prevent adverse drug reactions

Assess health hx/home meds Prescription, OTC AND herbals Ability to be accurate historian Lab values: BUN/CR ALT/AST

infants (med administration)

Correct dosages: Weight based calculations Safety in administration Education of parents.Communication with infant: look at oral meds have to be given by a dropper, if we give a med to a toddler may be able to give in a measuring cup with spoon or regular cup. Not all medicine tasted good, infant will usually take it, a 2 year old may spit it right back out bc it tastes gross. Safety and administration: if you give an infant an injection, may need to secure the limb bc they may jump and cause the needle to injure them. When looking at 4 weeks-1 year, desired is PO by dropper and suppository by vastis lateralis. You have the patient and the parent, make sure to include parent in all the instruction and providing them everything they need to reduce anxiety

distribution (older adults)

Diminished cardiac output Increase body fat/lean body mass and body fluid decreases Decrease serum albumin. less the heart pumps the less the blood gets pushed out into the body. If you have a low serum albumin and get a protein bound med, at risk for toxicity. a lot of things to think about when giving meds to older adults Rule of thumb is start low and go slow. Start them at lowest dose possible. Wait, see what happens, then raise at very small increments only if needed.

metabolism (pediatrics)

Enzyme Cytochrome P450 (CYP450). this is related to underdeveloped liver . in infants there will be even less. doses are going to be so much smaller.

school age & adolescent (med administration)

Explain medication use in more detail. Can take medications independently, but they need supervision. Educate on safe medication practices. BLACK BOX WARNING Use of antidepressants in children and adolescents ADHD medications

absorption (older adults)

GI tract changes Decrease circulation Decreased muscle mass *** slow absorption rates = changes in peak serum drug levels

metabolism (older adults)

Hepatic changes Genetic determinants

elimination (pediatrics)

Immature kidneys, reduced GFR, slower renal clearance

pharmacodynamics (older adults)

Involves drug actions on target cells resulting in alterations in cellular reactions and functions

pharmacodynamics

Involves drug actions on target cells resulting in alterations in cellular reactions and functions Immature organ systems Body composition Vary widely in growth and maturation Genetic makeup

distribution (pediatrics)

Percent of body water Total body water: intra/extracellular, gastro & urinary Hepatic function/Protein binding Blood Brain Barrier

beers criteria

Published by the American Geriatric Society (AGS) list of potentially inappropriate use of medications in Older adults r/t disease or drug syndrome interactions (updated every 3 yrs) gives guidelines and drugs that we know can cause problems, drugs that should be reassessed. 66% of adverse drug events that result in hospitalization are due to accidental overdoses. Maybe they have had changed in liver function or kidney function, fluid volume status, dehydrated, etc. need to really watch dosing of their medications. As they age, sometimes have to reduce doses.

asymptomatic (older adults)

a lot of pts when they start to feel better think they no longer need the med. They need to know that even if they feel better and want to stop, that the med is dosed appropriately and they need to take the full dose and bottle of their pills as prescribed.

adult years (19-64)

age-related changes begin in the

birth

aging is a natural process that begins at

start slow, low

always want to _____ with ____ doses

prescriber vs administration nurse

dr doses the medication, they know what the standards are, we give the medication. If the dr orders a med that will cause the pts BP to drop, its up to us to know to check BP before giving the medication. If we do harm with a med by error or admission, that's on us. Always be sure to know drug, dose, route, time its suppose to be given.

variables

in absorption, distribution, metabolism and excretion further complicate the medication process.

toddler and preschooler (med administration)

involve lego or smiley face ranking of pain. explanations should be short and simple. adults need to control administration. They are mobile, fast and curious. 1-5 years old. Make sure that the child is on the parents lap for injection, but ensure you won't stick the parent or anything. Make sure everyones secure, secure the limb. Make sure parent is involved.

economic factors (older adults)

medicines are expensive. Most elders are on fixed incomes and sometimes meds or food are their choice. They have Medicaid which can help. There are ways to help get people their meds. A lot of companies are doing pay assistance or reduced price assistance

cardiovascular disease

number one cause of death in adults, including older adults.

Barbituates

one drug you should not give to elders. some are used for seizure prevention too, but the rational is that there is a higher rate or physical dependence and OD at low doses.

older adults

people 65 and older are the largest consumers of health care. "frequent flyers"/readmissions. They are prone to antibiotic resistance. Greater risk of being sick. Frequent flyers: people who have comorbidities (cardiac diabetes etc) they get better, but then they can get worse and come back to hospital to get IV meds to help them again.

skin permeability (pediatrics)

skin is still developing

polypharmacy

the use of multiple medications. make sure all the meds they're getting they still need. Medication holiday: going to take off this med, but keep you on these and see what happens

risk/benefit ratio (older adults)

they increase as pt ages. Make sure we are looking at pts meds that they are on, is there something they don't need anymore. Are they taking all their meds? Has something changed in their mental status and they missed a week of meds? Seeing an increase of elder pt age wise, people are living longer. Doesn't mean they are living better, but they are living longer. Also see a lot of adults taking care of their parents.

dehydration

when peds get sick, in general the rule of thumb is that they are at a huge risk for