Chapter 10: Drug Therapy in Pediatric Patients Lehne's Pharm 10ed

A child will receive 750 mg of an antibiotic for 10 days. The child attends day care. The drug may be dosed in several ways and is available in two concentrations. Which dosing regimen will the nurse discuss with the child's provider? a. 250 mg/5 mL-375 mg PO twice daily b. 250 mg/5 mL-250 mg PO three times daily c. 500 mg/5 mL-250 mg PO three times daily d. 500 mg/5 mL-375 mg PO twice daily

ANS: D To promote adherence to a drug regimen in children, it is important to consider the size and timing of the dose. In this case the preparation containing 500 mg/5 mL means that a smaller volume can be given, which is more palatable to a child. Twice daily dosing is more convenient for parents, especially when a child is in day care or school; it also helps prevent the problem of the medication being left either at home or at school.

A pediatric nurse is teaching nursing students to calculate medication doses for children using a formula based on body surface area. Which statement by a nursing student indicates understanding of the teaching? a. "This formula helps approximate the first dose; other doses should be based on clinical observations." b. "This formula accounts for pharmacokinetic factors that are different in children." c. "Using this formula will prevent side effects of medications in children." d. "This formula can determine medication dosing for a child of any age."

ANS: A This formula helps determine an approximate first dose for a child that is extrapolated from an adult dose; subsequent doses should be adjusted based on clinical outcome and serum plasma levels. The formula accounts only for differences in weight and not for differences in pharmacokinetic factors. The formula helps determine an effective dose but cannot account for unusual side effects that may occur in children. It may not be effective for all ages because of rapid changes in pharmacokinetics.

The parents of a child with asthma ask the nurse why their child cannot use oral corticosteroids more often, because they are so effective. The nurse will offer which information that is true for children? a. Chronic steroid use can inhibit growth. b. Frequent use of this drug may lead to a decreased response. c. A hypersensitivity reaction to this drug may occur. d. Systemic steroids are more toxic in children.

ANS: A A specific age-related reaction to a drug is growth suppression caused by glucocorticoids. Children with asthma may need these from time to time for acute exacerbations, but chronic use is not recommended. None of the other three effects occurs in either adults or children.

A pediatric nurse is teaching nursing students about medication administration in children. Which statement by a student indicates an understanding of the teaching? a. "Drugs effective in adults may not work in children, even if the dose is proportional for weight and size." b. "Infants metabolize drugs more quickly than do older children and adults." c. "Side effects of drugs in children are similar to side effects of drugs in adults." d. "The known differences in drug effects in children versus those in adults are related to the size of the patient."

ANS: A Drugs have different effects in children for many reasons besides simply the amount of drug per unit of weight. Because two-thirds of drugs used in children have never been tested in children, most of our knowledge of their effects is anecdotal and requires research. Infants metabolize drugs more slowly because of immaturity of organ systems that metabolize drugs. Because of differences in metabolism, absorption, and excretion of drugs in infants and children, side effects of drugs also differ. Again, the differences in drug effects are related to many factors, not just size and relative dose.

A prescriber has ordered medication for a newborn. The medication is eliminated primarily by hepatic metabolism. The nurse expects the prescriber to: a. order a dose that is lower than an adult dose. b. order a dose that is higher than an adult dose. c. increase the frequency of medication dosing. d. discontinue the drug after one or two doses.

ANS: A The drug-metabolizing capacity of newborns is low. As a result, neonates are especially sensitive to drugs that are eliminated primarily by hepatic metabolism. When these drugs are used, dosages must be reduced. Because of the decreased ability of hepatic metabolism in the newborn, a lower dose is required, not a higher dose, and the frequency will not be increased. The medication dosage should be adjusted, not discontinued, for the newborn.

An infant has allergies and often develops a pruritic rash when exposed to allergens. The infant's parents ask the nurse about using a topical antihistamine. What should the nurse tell them? a. Antihistamines given by this route are not absorbed as well in children. b. Applying an antihistamine to the skin can cause toxicity in this age group. c. The child will also need oral medication to achieve effective results. d. Topical medications have fewer side effects than those given by other routes.

ANS: B Drug absorption through the skin is more rapid in infants, because their skin is thinner and has greater blood flow; therefore, infants are at increased risk of toxicity from topical drugs. Because of increased drug absorption through the skin, infants should not be given additional drugs via other routes. If a drug is more likely to be absorbed rapidly, it will have more side effects.

A nurse is caring for an infant after a surgical procedure. After ensuring that the ordered dose is appropriate for the infant's age and weight, the nurse administers a narcotic analgesic intravenously. When assessing the infant 15 minutes later, the nurse notes respirations of 22 breaths per minute and a heart rate of 110 beats per minute. The infant is asleep in the parent's arms and does not awaken when vital signs are assessed. The nurse understands that these findings are the result of: a. an allergic reaction to the medication. b. immaturity of the blood-brain barrier in the infant. c. toxic effects of the narcotic, requiring naloxone as an antidote. d. unexpected side effects of medications in infants.

ANS: B The blood-brain barrier is not as well developed in infants, making them more susceptible to CNS effects of medications. This assessment of the patient reveals no signs of an allergic reaction. Although this infant is somnolent, the vital signs are stable, so toxicity is not a concern. CNS effects are not unexpected with narcotic analgesics, but they may be more pronounced in infants.

Parents ask the nurse why an over-the-counter cough suppressant with sedative side effects is not recommended for infants. Which response by the nurse is correct? a. "Babies have a more rapid gastric emptying time and don't absorb drugs well." b. "Cough medicine tastes bad, and infants usually won't take it." c. "Infants are more susceptible to central nervous system effects than are adults." d. "Infants metabolize drugs too rapidly, so drugs aren't as effective."

ANS: C Drugs cross the blood-brain barrier more readily in infants, making these patients more susceptible to central nervous system (CNS) side effects. Infants have a prolonged and irregular gastric emptying time and absorb drugs in the stomach more quickly. Although it may be true that cough medicines taste bad and are difficult to administer, this is not a contraindication to giving them. Infants metabolize drugs more slowly.

A nurse is teaching nursing students about pediatric medication administration. What will the nurse include when discussing pediatric drug research? a. Early studies revealed that less than 10% of drugs known to be effective in adults were effective in children. b. Research findings show that drug doses may be safely calculated by extrapolating adult dosing. c. Studies showed a significant percentage of unanticipated and potentially lethal side effects in children. d. There is no need to continue with pediatric-specific drug research, since early studies were reassuring.

ANS: C In early studies, about 30% of drugs caused unanticipated side effects, some of them potentially lethal. These same studies revealed that about 20% of drugs were ineffective in children and that about 20% of drugs required doses different from those extrapolated from adult dosing. Because the early studies showed that there is much to learn, the BPCA and PREA were permanently reauthorized by Congress in 2012.

An infant is receiving a medication that has a narrow therapeutic range. The nurse reviews the medication information and learns that the drug is excreted by the kidneys. When giving the medication, the nurse will assess the infant for: a. decreased effectiveness of the drug. b. shorter period of the drug's effects. c. signs of drug toxicity. d. unusual CNS effects.

ANS: C Renal drug excretion is lower in infants, so drugs that are eliminated primarily by renal excretion should be given in reduced doses or at longer intervals. Drugs with a narrow therapeutic range should be monitored closely for toxicity. This drug likely will have intensified effects and be present for a longer time. Nothing indicates that unusual CNS effects will occur because of this alteration in excretion.

A nurse caring for a 5-year-old child notes that the child has discoloration of several teeth. When taking a medication history, the nurse will ask about which group of medications? a. Glucocorticoids b. Salicylates c. Sulfonamides d. Tetracyclines

ANS: D Tetracyclines cause discoloration in developing teeth in children. Glucocorticoids are associated with growth suppression. Salicylates are associated with Reye's syndrome. Sulfonamides are associated with kernicterus in newborns.