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Pediatric Therapeutics 2020 latest .pptx
- 1. Pediatric Therapeutics Genelynne J. Beley,RMT, MD, DPPS
- 2. Pediatric Therapeutics • Reviewyour CPGs (Clinical Practice Guidelines) • Get yourself a “bright notebook”/smart phone notes • Handbook for Pediatrics • Use MIMS to check on preparations, dosages, C.I., SE, Drug interactions
- 3. HOW WILL YOUBE ABLE TO MANAGE YOUR PATIENT WELL? • Correct DIAGNOSIS • Correct Choice of Drug • Correct Dosage, Interval and Duration of Treatment • Correct and Adequate Instructions
- 4. Peculiarities of PediatricPatients • Special groups: Neonates • Vulnerable groups: problems w/ research • Computation of dose based on weight child is growing • Younger age groups cannot verbalize their symptoms rely on parents or caregivers
- 5. Neonates Physiological Characteristics: Increasedphysiologic needs Immature organs/systems (renal & hepatic) Slow GI transit time & irreg. peristalsis Immature enzymes & metabolic processes Limited spectrum of responses Unable to actively participate in treatment process
- 6. PECULIARITIES OF NEONATES • Smallmuscle mass • Low % Body Fat • High % Water • Immature Gut Motility • Immature Kidneys • Immature Gut Enzymes • Decreased Circulating Proteins • Decreased Binding Affinity • Thin Skin
- 7. Medications for Neonates •Antibiotics are given at longer intervals • Eg. Ampicillin: instead of Q6h Q12h • Neonates being treated for infection are given antibiotics via IV or IM routes only • Neonates with jaundice: don’t give Ceftriaxone can cause ↑ serum bilirubin and SGPT • More transdermal absorption – due to thin skin
- 8. Dose adjustment ofDrugs in patients with significant renal problem • Especially for drugs that are nephrotoxic: • Eg. Aminoglycosides Dose is decreased &/or interval is prolonged • Adjustment depends on the creatinine clearance of the patient
- 9. Dose adjustment inpatients with Liver Disease • Drug dosage should be reduced according to the hepatic extraction of the drug • Normal: Drugs w/ increased hepatic extraction (low bioavailability in healthy subjects) • In liver Dse: bioavailability increases as hepatic clearance decreases
- 10. Common Pediatric Conditions •Acute Gastroenteritis • Upper Respiratory Tract Infection • Lower Respiratory Tract Infection • Pneumonia • Viral infections (eg. Influenza) • Dengue Fever
- 11. Common Pediatric Conditions • OtitisMedia • Rhinosinusitis • Fungal skin infection • Allergic Reactions: • Atopic dermatitis • Seborrheic dermatitis: cradle cap, dandruff • Cellulitis/abscess/Skin Infections
- 12. Computation of PediatricDosage Commonly used drugs: Paracetamol: 10 to 15 mg/kg/dose Brand Names: Tempra, Biogesic, Calpol, Rexidol Preparations: drops 100mg/ml; syrup 120mg/5ml; forte 250mg/5ml Ibuprofen ( Dolan): Dose: 10mg/kg/dose suspension: 100mg/5ml; Forte 200mg/5ml Domperidone: 0.2-0.4mg/kg/dose Brands: Vometa or Motilium Preparations: drops 5mg/ml; syrup 5mg/5ml In mg/kg/day or mg/kg/dose
- 13. • Carbocisteine: Brands:Loviscol, Solmux • Preparations: drops 50mg/ml; syrup: 100mg/5ml; 250mg/5ml • Dose: <2mos: 0.3ml; 3-6mos 0.6ml; 7 to 12mos 0.9ml; 13 to 24mos 1.2ml (DROPS) • Syrup: 1-3yo: 5 to 7.5ml: 4 to 7yo: 7.5 to 10ml QID • Ambroxol: Brands: Ambrolex, Zobrixol • Preparations: drops 6mg/ml; syrup 15mg/5ml; 30mg/5ml • Dose: 1.2-1.6mg/kg/day <6mos 0.5ml; 7-12mos 1ml TID or BID (drops)
- 14. • *Phenylpropanolamine (PPA);Brands: Disudrin, Nasatapp • Preparations: drops 6.25mg/ml; syrup 12.5mg/5ml • Dose: Drops:1-3 mos: 0.25ml; 4-6mos: 0.5ml; 7-12mos: 0.75ml; 1-2yrs: 1ml; Syrup: 2-6yrs: ½ tsp; 7-12 yrs: 1tsp every 6 hrs • *Phenylephrine usually combined w/ Chlorpheniramine • Drops: 1mg/0.8mg/ml; Syrup: 5mg/1mg/5ml • Dose: Drops: 1-6mos 0.5 to 0.75ml; 6 to 12mos 0.75 to 1ml: Syrup: 2-6yo: 2.5ml; 7to12yo: 5ml TID to QID • *US FDA: recommended only for children 2 yrs & up
- 15. • Pseudoephedrine: *for6 mos and up • Brands: Dimetapp; Sudafed; Triaminic • PREPARATIONS: Drops: 7.5mg/0.8ml; syrup:15mg/5ml • *use only under 6 mos if congestion is affecting feeding or sleeping • Can cause drying of nasal passages use saline spray & humidifier
- 16. Oral Antibiotics 40mg/kg/day Cephalexin Co-Amoxyclav Sultamicillin Metronidazole Penicillin Cloxacillin Erythromycin 20-30mg/kg/day Cefuroxime
- 17. Intravenous Antibiotics • Usualdose: for moderate to severe infections: 100mg/kg/day • See if there’s a need to give the drug by slow IV or by infusion: • Eg. Ceftriaxone is usually given in 10 to 30 minute infusion • See to it that the intravenous access is patent, without induration extravasation chemical burn
- 18. Dosage Computation • Ifyou are giving syrup or suspension: • Eg. Dose: 5ml every 8hrs for 1 week • How many bottles should you prescribe? 2- 60ml bottles • How to compute the dose in ml? Wt. x dose / preparation = total volume in ml/frequency= DOSE in ml per intake Or wt x dose x reverse of preparation = dose in ml/freq
- 19. • Wt =10kg • Dose: eg. Amoxycillin= 50mg/kg /day • Preparation: 250mg/5ml • Frequency: every 8 hours • Total Dose=10 x 50 ÷ 250/5 =500 x 5/250 = 10 ml • Total dose ÷ frequency = dose per intake • 10ml÷2= 5ml every 12 hrs
- 20. Practice: A 2 yearold boy came in due to cough and fever of 1week duration. On PE, you noted coarse crackles and rhonchi on both lung fields. He was previously given Amoxicillin for 3 days. You decided to shift the medication to Cefuroxime p.o.. (Recommended dose: 20mg/kg/day in two divided doses) The wt. is 10kg. Show your dosage and computation. Make your prescription.
- 21. Computation: • 10kgs x20 = 200 x 5/250 (prep: 250mg/5ml) = 4 ml (total daily dose in ml) = 4 ÷ 2 = 2 ml every 12 hrs
- 22.
- 23. • Name ofthe patient • Age & Sex • Date • Weight of the pt (esp. in pediatrics) • Generic name of the drug • Brand name of the drug (optional) • Preparation or strength of the drug • Quantity of the drug to be purchased • Instruction on how to take the drug & how long • Name and License number of the Physician • PTR (Professional Tax Regulation)number • S2 number: for regulated drugs
- 24. (Header) Name:________________ Date:_____________ Address:_______________ Age:____Sex:_____ Rx GenericName of Drug, Preparation, Quantity (Brand Name-optional) Sig. (Direction: how the drug will be taken and for how long?) Name of the doctor Lic. No: _________ PTR No:_________ S2 No:__________
- 25. DMSF Hospital Medical SchoolDrive, Bajada, Davao city Tel #:_____________ Name: Ayn Beley Date: March 23, 2018 Address: Cabantian, Davao City Age: 8yo Sex: F Rx Paracetamol 250mg/5ml Bot. # 1 (Tempra Forte) Sig. 5ml every 4 hours as needed for fever (Signature) Genelynne Beley, MD Lic. #: 0708996 PTR #: 001768
- 26. • Directions: prn @h.s.(horasomni) tid ("ter in die”) qid (quater in die) od p.c. q 8h, q 4h, q 12h, etc Using these shortcuts: for pharmacists: ok for patients: No *Instructions for the patients should be written on a separate paper with simple understandable words
- 27. • Preparations: eg. Paracetamol:drops 100mg/ml syrup 125mg/5ml syrup forte 250mg/5ml Suspension vs syrup Vial vs ampule Tablet vs capsule Ointment vs cream Enteric coated tablets: do not crush or break
- 31. Quantity IV medications Write onlymeds good for 1 day for admitted patients eg. Dose: 500mg every 8 hrs 1 day = 1.5 grams ( 3- 500mg vials or 2-1000mg or 1g vials) Oral Outpatient: Give Full course eg. 1 cap every 8 hrs x 1 week 21 caps
- 32. • If youare giving syrup or suspension: • Eg. Dose: 5ml every 8hrs for 1 week • How many bottles should you prescribe? 2-60ml bottles • How to compute the dose in ml? Wt. x dose / preparation = total volume in ml/frequency= DOSE in ml per intake
- 33. • Wt: 15kg • Dose: eg. CLARITHROMYCIN= 15mg/kg /day • Preparation: 125mg/5ml • Frequency: every 12 hours
- 34. • Total Dose=15x 15 ÷ 125/5 =300 x 5/125 = 9 ml • Total dose ÷ frequency = dose per intake • 9 ml÷2= 4.5 ml every 12 hrs
- 35. You are havingfever: Make yourself a Prescription of Paracetamol.
- 36. Thank you foryour attention!
Editor's Notes
- #1 Going to your clinical rotation is like going to a battle. You should be ready! How do you prepare? Equip yourself with “ammunitions”
- #2 “Ammunitions”: Handbooks: eg. Pea Brain series; Harriet Lane Handbook; Infectious dse handbook CPGs eg. Algorithms for the mgt of different conditions
- #3 Choice of Drug: consider efficacy and palatability, cost
- #4 Neonates: 0 to 28 days Vulnerable groups – bec they still lack autonomy, they cannot decide for themselves yet thus they are protected
- #5 Physiologic needs for growth Kidneys – full fxnal and anatomical maturity at the end of 3rd decade of life; after birth – there is continued increase in renal mass Liver – full fxnal maturity @ 2years of life; GIT – matures at 2 to 3yo
- #6 % body fats: At birth 13% --At 3 mos 24 %; at 4 mos 31% % body water: adults : 60% newborns: 70 to 80% Immature gut motility:SLOW & ERRATIC ENTERAL ABSORPTION OF DRUGS HIGHER % OF FREE DRUGS IN THE CIRCULATION; SLOWER METABOLISM OF DRUGS Immature kidney: SLOWER ELIMINATION AND EXCRETION OF DRUGS MORE TRANSDERMAL ABSORPTION
- #7 To address these potential problems: (slide) Longer interval is due to immature enzymes & metabolic processes; immature kidneys and liver slow metabolism/excretion of drugs; IV/IM only due to immature GI tract slow GI transit time & erratic peristalsis -- slow & erratic absorption of oral drugs; Ceftriaxone competes with albumin bindingcan worsen hyperbilirubinemia
- #8 Adjustment of drug dosage according to creatinine clearance of the patient c/o pediatric handbooks
- #10 The lower the creatinine clearance, the more problematic is the kidney
- #12 Generally: In Liver dse: dosage of drugs should be decreased
- #15 Domperidone: Dopamine antagonist; MOA: increases lower esophageal pressure; improve antroduodenal activity; accelerate gastric emptying Has a lot of drug interactions: CI Macrolides; prolactinoma; high dose can cause EPS
- #16 Sometimes dose can be arbitrary: Usually, we start to use syrup for children 2 yrs and up
- #19 Amoxicillin 50 to 90 mg/kg/day
- #21 When you divide fractions invert the divisor and multiply
- #22 when you divide fraction invert the divisor and multiply
- #27 Latin word Signa means direction; Rx – symbol for medical prescription
- #36 when you divide fraction invert the divisor and multiply