Chapter 10: Drug Therapy in Pediatric Patients

The liver's capacity to metabolize many drugs increases rapidly about (blank) month(s) after birth.

1 month after birth; the ability to metabolize at the adult level happens a few months after this

True or false? Drugs eliminated primarily by renal excretion must be given in reduced dosage and/or at longer dosing intervals.

True

Infants have an immature state of these 5 pharmacokinetic processes:

absorption, protein binding of drugs, BBB, hepatic metabolism, renal drug excretion

Complete liver maturation occurs by...

age 1 (this still does not mean they can be given adult doses)

Pediatric patients

all patients under the age of 16; they don't metabolize drugs like adults do, they are more sensitive to drugs because of organ immaturity, increased risk for ADR's

Hepatic metabolism in infants and neonates

drug metabolization capability is low in newborns, neonates are sensitive to drugs that are eliminated primarily by the hepatic system (the liver),

Promoting adherence

effectively educate on the dosage and timing, route and technique of administration, duration of treatment, drug storage, time course of desired and adverse responses

Determining the intensity of the duration of response

elevated drug levels= more intense response, delayed elimination= prolonged response, immaturity of the organs put patients at risk for both of these responses

Absorption: PO administration of drugs for infants and neonates

have a prolonged and irregular gastric emptying time; reach adult function at 6-8 months

Drugs respond to (blank) acidity.

high

Transdermal absorption in infants and neonates

more rapid and complete for infants than older children and adults, infants skin are very thin, blood flow to skin is better in infants than in older adults, infants are at increased risk for toxicity from topical drugs

How we determine dosages for children

most commonly based on surface area, initial peds dosages are approximations, some dosages may need to be adjusted

Pharmacokinetics in children 1 and older

most pharmacokinetic parameters are similar to adults, drug sensitivity is the same as adults

Renal excretion in neonates and infants

significantly reduced at birth, low renal blood flow, glomerular filtration, and active tubular secretion adult level of renal function is achieved at 1 yeard old

Absorption in infants and neonates: IM administration

slow and erratic, delated absorption as a result of low blood flow during the first few days of life, during early infancy absorption of IM drugs is more rapid than in neonates and adults

Distribution: BBB in neonates and infants

the BBB isn't fully developed at birth, drugs and other chemicals can cross and get into the CNS, infants are sensitive to drugs that affect the CNS, drugs used for outside of the CNS that can produce toxicity to CNS should be limited

Absorption in neonates and infants: PO drugs

the gastric emptying time in infants and neonates is prolonged and irregular; it reaches adult function at 6-8 months old

Why do babies get jaundice?

the liver isn't mature yet so it cannot filter out broken red blood cells

Distribution: Endogenous compounds

these compete with drugs for available binding sites; there is limited drug/protein binding in infants, reduced dosage is needed, will have adult binding capacity by 10-12 months of age

Absorption in infants and neonates: gastric acidity

very low 24 hours after birth, doesn't reach adult value until age 2, low acidity causes drugs dependent on acidity to have to be increased

Which statements about transdermal absorption are correct? (Select all that apply.) A. The stratum corneum of the infant's skin is very thin. B. Transdermal administration is the safest route of administration. C. Blood flow to the skin is greater in infants than in older patients D. Infants are at increased risk of toxicity from topical drugs. E. Absorption through the skin is more rapid and complete with infants.

A, C, D, and E

The nurse is teaching young parents about medication administration in their child. Which statements are appropriate to include in the teaching plan? (Select all that apply.) A. "Guard against spills and spitting to ensure that your child gets an accurate dose." B. "Do not mix your child's medication with food or drink." C. "This calibrated spoon will help your child get an accurate dose." D. "Keep a medication record to make sure you do not give more than one dose at a time." E. "If your child spits some medication out, give another full dose at that time."

A, C, and D

A nurse is preparing to administer medications to a 4 month old infant. Which of the following pharmacokinetic principles should the nurse consider when administering medications to this client? (select that apply) A. infants have a more rapid gastric emptying time B. infants have immature liver function C. infants' BBB is poorly developed D. infants have an increased ability to absorb topical meds E. infants have an increased number of protein binding sites

B, C, and D Rationale: infants have a decreased number of protein binding sites, and gastric emptying time is longer and inconsistent in infants

A 2 y/o child is prescribed a PO drug that is eliminated by metabolism in the liver. Based on the child's age the nurse would expect to make which adjustment? A. the drug may need to be administered more frequently B. the dosage may need to be decreased C. the route should be changed from PO to IM D. the drug should be administered on an empty stomach

A. Rationale: children between ages 1 and 12 metabolize drugs faster than adults. They may need increased dosage or a dosage interval reduction for drugs that are eliminated by the hepatic system (kidneys)

Which intervention would the nurse choose to minimize the risk of drug toxicity in neonates and infants? A. reduced the amount of drug given B. administer the meds before meals C. shorten the interval between doses D. administer the medication IV

A. Rationale: neonates and infants have a lower binding capacity so more free drug is available in the body

When administering a mediations known to be metabolized by the liver, the nurse will closely monitor for ADR's in which patient? A. a 3 month old infant B. a 12 month old infant C. an 18 month old toddler D. a 13 y/o adolescent

A. Rationale: neonates are especially sensitive to drugs eliminated by the liver; the capacity of the liver to metabolize drugs increases rapidly 1 month after birth and reaches adult levels a few months later; the liver is fully mature by 1 year of age

The nurse is caring for a group of very young patients receiving a variety of fo medications. Which concept guides the nurse's care of these patients? A. drugs given IV leave the body more quickly in infants B. drugs given SC remain in the body longer in infants than older adults C. gastric emptying time is shorter in infants than in children and adults D. the BBB protects the infant's brains from toxic drugs

B. Rationale: drugs given by this route stay in their system longer than adults, and IV leaves the body more slowly in them than adults; their gastric emptying time is prolonger and the BBB isn't fully developed

Why are infants especially sensitive to drugs that affect CNS function? A. The blood-brain barrier is especially strong in infants. B. The blood-brain barrier does not exist until 1 year of age. C. The blood-brain barrier is not fully developed at birth. D. The blood-brain barrier is weakened by the birth process.

C.

Which statement about excretion in infants is true? A. renal blood flow is high during infancy B. renal drug excretion is significantly increased at birth C. adult levels of renal function are achieved by 1 year D. drugs that are eliminated primarily by renal excretion must be given in higher doses

C. Rationale: renal blood flow is low during infancy, renal excretion is decreased at birth, and these drugs must be given in small doses or at longer intervals

A toddler has been prescribed a medication that does not have an established pediatric dose. To calculate the appropriate dose, the nurse should consider what info? A. the child's weight B. the child's height C. the body surface area D. the child's age

C. Rationale: the formula for the child dose is based on the body surface area of a child

A 15 month old patient develops chemotherapy induced nausea and vomiting. Which medication, if ordered by the provider, should the nurse question? A. Ondansetron (Zofran) B. Dexamethasone (Decadron) C. Promethazine (Phenergan) D. Metoclopramide (reglan)

C. Rationale: this drug is contraindicated in children younger than 2 because respiratory depression may occur

Which of the following is not an example of age-related adverse drug effects? A. growth suppression B. discoloration of the teeth C. kernicterus D. toxicity

D.

Which statement about IM administration is correct? A. drug absorption following IM injection in the neonate is slow and erratic B. absorption of IM drugs becomes more rapid in infancy than in neonates C. neonates experience low blood flow through the muscle during the first days of life D. absorption of IM drugs becomes slow and more erratic in infancy than in neonates

D. Rationale: A is true because of low blood flow; by early infancy absorption of IM drugs becomes more rapid in neonates than later in them and adults

The nurse provides teaching for the caregiver of a 2 month old infant and a 3 year old child. Both children will be taking oral ampicillin (an acid-labile drug) to treat a bacterial infection. The nurse determines that teaching is successful if the caregiver makes which of the following statements. A. the dose will not be different, but the baby will take the drug for 7 days instead of 10 days B. the dose will be higher for the baby because the infection is more serious C. the dose will be the sane because my children have the same infection D. the dose will be smaller in the baby because the drug will be absorbed better in the stomach

D. Rationale: gastric acidity is very low in the first 24 hours after birth and doesn't reach adult values for 2 years. Because of the low acidity, the absorption of an acid-labile(drug that is easily destroyed in high acidity areas) drug is increased

True or false? Because children over the age of 1 have pharmacokinetic functions similar to adults they can be given adult doses.

FALSE: their organs might be mature but they still have tiny little bodies

Distribution: Protein binding in infants

binding of drugs to albumin and other plasma proteins is limited in the infant, the amount of serum albumin is VERY LOW

ADR's in children

children are vulnerable unique adverse effects related to organ immaturity and ongoing growth and development; these can include growth suppression, discoloration of developing teeth, and kernicterus which is the discoloration of the sclera of the eyes

One important difference in pharmacokinetics in children over the age of 1

children in this group metabolize drugs faster than adults; faster until the age of 2 and then decline after that, has a sharp decline at puberty, and may need increased dosages or decreased interval between the doses