Pediatric MedicationsReported by:

Cababan, LaileneNacilla, HersheyRivera, Rein Casey

Objectives:

Classify pediatrics by their age group Identify the pharmacokinetics and pharmacodynamic considerations in pediatrics

Calculate pediatric dose based on body weight, body surface area, and age of the child

Pediatrics Medications

Pediatrics Childhood Adolescents Adults

Age range

Neonates Birth-1 month

Infants 1 month-1 yr

Child/children 1-12 y/o

a. Toddler a. 1-3 y/o

b. Preschool age

b. 3-6 y/o

c. School age c. 6-12 y/o

Adolescents 13-18 y/o

Branch of medicine that deals with disease in children from birth through adolescence

Monitoring administration of medications to the pediatric population includes knowledge in:

Pharmaco-kinetics

Serum drug levels

Drug dosing in infants and children

Cognitive and physiological developmental considerations

Routes of Administration

1. Oral 2. Rectal3. Topical4. Parenteral (SQ, IM, IV)

Special considerations in oral administration:

In using medication dropper or oral syringe

In using bottle nipple

By adding jelly or honey

By not adding to milk formula

Pharmacokinetics in infants:

Absorption

Distribution

Metabolism

Excretion• Lower rates of drug absorption than in

children and adults• Longer gastric time and gastric pH =

diminished absorption• Frequent feeding may impede the drug

absorption• Low intestinal flora, reduced enzyme

function = decreased absorption• Low peripheral perfusion and

immature heat regulation = decrease absorption of parenteral medications

• Low conc of plasma proteins and diminished protein binding capacity = drugs more available in the circulation

• Greater permeability to BBB = rapid access to CNS

• Total body water is 80% compared to adult 50%• Higher doses of H20 soluble drugs may be needed

to achieve therapeutic effects

• Drug-metabolizing enzymes in the liver are immature• More drugs in circulatory

system = increase potential for toxicity• Drug dosages must be

calculated carefully • Drug levels and clinical

responses must be closely monitored

• Infant kidneys have higher resistance to blood flow, lower GFR with a decreased ability to concentrate urine• Secrete drugs more slowly,

increasing risk of drug accumulation

Absorption

Distribution

Metabolism

Excretion

Pharmacokinetics in children:

• Gastric pH is equal to adult by 2 to 3 years old• Gastric emptying rates are faster in

infants • Skin and blood-brain barrier becomes

more effective

• Plasma proteins reach adult levels by age 1

• Children up to age 2 years may require higher dosages of water soluble drugs

• Liver enzymes are more effective at metabolizing drugs• Due to elevated BMR,

some drugs are metabolized more rapidly • Drug dosages relative to

body weight may need to be higher • Drugs may need to be

more closely monitored

• Children over 12 months of age are able to excrete drugs effectively

Developmental PharmacokineticsAbsorption:

Gastro-intestinalRectal Intra-muscular

Percuta-neousIntra-ocular

• Gastric pH is high in neonates at 2 yrs old it gradually declines to its adult values

• Gastric and intestinal motility is dec in neonates and infants but inc in older infants and children

• Changing biochemistry of the developing GUT within the neonate leads to unpredictable drug absorption

• Diminished bile acid pool and biliary function at birth gradually increases to full capacity over the first several months of life

• Bioavailability is dependent on specific drug properties and the time during which it is exposed to rectal mucosa; few drugs are suitable for rectal administration

• This is variable in neonates, infants, and young children secondary to Blood flow and

vasomotor instabilities

Insufficient muscle tone and contraction

Decreased muscle oxygenation

• It is inversely to the thickness of the stratum corneum and directly relate to the skin hydration• The ratio of skin permeability and

larger surface area and body weight is observed in neonates and infants• Equivalent percutaneous dosing

may lead to systemic availability and potential toxicity

• Membrane of the eye are thin, particularly in neonates and infants; it is used uncommon eye drops to cause systemic side effects in the very young

Developmental Considerations in Pediatric Medication:

Infants:1months to 1 year

• Head control• Hands• Physical

comfort• Precise

measurement • Initial

response • Administration

with professional watching

1-2 years

• Choose a position

• Taste• Single

command • Familiarize

dosing device • Real challenge • Over

negotiation

Pre-school age: 3-6 years

• Unable to swallow pills

• Method of taking medication

• Show understanding

• Explain • Child should be

praised

School age: 6-12 years

• Swallow capsules and tablets

• Child should be praised

• Sense of control

• Long term benefits

• Side effects

Adolescent: 13-18 years

• Shouldbe included in decision making

• Explicit explanation

• Minimize dependent drug regimens

Methods of calculating drug dosages of pediatrics:

Body Weight

Body Surface Area (BSA)

Age

A. Calculating by Body Weight:

𝑃𝑒𝑑𝑖𝑎𝑡𝑟𝑖𝑐 𝐷𝑜𝑠𝑒 (𝑚𝑔)=𝑝𝑒𝑑𝑖𝑎𝑡𝑟𝑖𝑐𝑤𝑡 (𝑘𝑔 )𝑥 (𝐷𝑟𝑢𝑔𝑑𝑜𝑠𝑒 (𝑚𝑔)

1𝑘𝑔)

𝑃𝑒𝑑𝑖𝑎𝑡𝑟𝑖𝑐 𝐷𝑜𝑠𝑒=𝑤𝑡 (𝑙𝑏)𝑥 𝑎𝑑𝑢𝑙𝑡 𝑑𝑜𝑠𝑒

150 (𝑎𝑣𝑒𝑤𝑡𝑖𝑛𝑎𝑑𝑢𝑙𝑡 𝑖𝑛𝑙𝑏)

• Most common method of administering the exact amount of medication that a child needs

Clark’s Rule

B. Calculating by Body Surface Area (BSA):

¿

• Calculate dosages for infants and children up to 12 years of age

• Calculate chemotherapeutic drugs for adults and fluid volume for adults after open heart surgery, burns, or renal disease

𝐵𝑆𝐴=√ ht (cm ) 𝑥𝑤𝑡 (𝑘𝑔)3600

C. Calculating based on Age:

𝑃𝑒𝑑𝑖𝑎𝑡𝑟𝑖𝑐 𝑑𝑜𝑠𝑒=𝑎𝑔𝑒

𝑎𝑔𝑒+12𝑥 𝑎𝑑𝑢𝑙𝑡𝑑𝑜𝑠𝑒

𝑃𝑒𝑑𝑖𝑎𝑡𝑟𝑖𝑐 𝑑𝑜𝑠𝑒=𝑎𝑔𝑒𝑎𝑡𝑛𝑒𝑥𝑡 h𝑏𝑖𝑟𝑡 𝑑𝑎𝑦 (𝑖𝑛 𝑦𝑟𝑠)

24𝑥 𝐴𝑑𝑢𝑙𝑡 𝑑𝑜𝑠𝑒

𝐼𝑛𝑓𝑎𝑛𝑡𝑠 𝑑𝑜𝑠𝑒=𝑎𝑔𝑒𝑖𝑛 h𝑚𝑜𝑛𝑡 𝑠

150𝑥 𝐴𝑑𝑢𝑙𝑡 𝑑𝑜𝑠𝑒 Fried’s Rule

Young’s Rule

Cowling’s Rule

𝑃𝑒𝑑𝑖𝑎𝑡𝑟𝑖𝑐 𝑑𝑜𝑠𝑒=𝑎𝑔𝑒𝑎𝑡𝑛𝑒𝑥𝑡 h𝑏𝑖𝑟𝑡 𝑑𝑎𝑦 (𝑖𝑛 𝑦𝑟𝑠)

24𝑥 𝐴𝑑𝑢𝑙𝑡 𝑑𝑜𝑠𝑒

Answer:Order: Cefaclor 50mg q.i.d. The child weighs 15lbs.

Child’s drug dosage:

20-40mg/kg/day in three divided doses.

Available drug: Ceclor oral suspension 125mg/5mL

Is the prescribed dose safe?

A. Calculating by Body Weight:

Order: Albuterol 0.1mg/kg/day P.O. in four divided doses (q6h). The child weighs 86lbs.

How many mg

should the patient receive per dose?

A. Calculating by Body Weight:

Answer:

Order: Garamycin IM tid for a 3-yr-old child who is 36 inches tall and who weighs 30lbs

Supply: Garamycin

40mg/mL

Adult Dose: 40mg

B. Calculating by Body Surface Area (BSA):

Answer:

Order: Sulfisoxazole 2g/m2 in four divided doses.The child weighs 60lbs and 50 inches tall.

Available: Sulfisoxazole 500mg/5mL

B. Calculating by Body Surface Area (BSA):

How many mL should the patient receive per dose?

Answer:

Name of the drug Dosage form Dose Therapeutic use

AmantadineFilm-coated tab 1 tab daily for first 4-7 days Antiparkinsonian drug

AmoxapineTab 25 mg q8-12hr Antidepressants TCA

AmphetaminesTab, cap 5 mg PO qDay; may increase by 5-10

mg/day qWeekStimulants ADHD agetnts

Beta-adrenergic blockersInj, tab 100 mg/day PO q12hr Beta blockers, beta 1

selective

BuspironeTab 10-15 mg/day PO divided q8-12hr Anxiolytics,

Nonbenzodiazipines

Ca-channel blockersTab 5 mg/day PO initially Anti anginal agents

ChlorpromazineFilm-coated tab 25mg tid or 75mg at bedtime Antipsychotics

ChloroquineTab 500 mg (300 mg base) PO once/week Antimalarials/

anthelmintics

ClonidineTab , ampule 75-150mcg bid Antihypertensives

ClozapineTab 12.5mg once bid Antipsychotics

ColchicinesTab 1mg initially followed by 500mcg 2-3

hrlyAnti-gout/ hyperuricemia

CyclobenzaprinesTab, cap 5 mg PO q8hr Skeletal muscle

relaxants

Name of the drug Dosage form Dose Therapeutic use

Diflunisal tablet 500mg every 8 hours NSAIDs

Disopyramide Capsule, tablet 100-150mg every 6-8hrs Cardiac drugs

Fluoxetine Capsule 20mg daily Antidepressants

Haloperidol Soln for inj 25-75mg daily Antipsychotics

Hydroxychloroquine Tablet 400mg daily DMARDs

Hypoglycemic agents Tablet 1-2mg once daily Antidiabetic

Lithium Tablet 1.5-2g daily Antipsychotics

Lomotil ® Tablet 2 tab Antidiarrheals

Loxapine Tablet, capsule,

solution

20-50mg/day Antipsychotics

LSD tablet hallucinogens

Mefenamic acid Tablet 250-500mg tid NSAIDs

Meprobate tablets 1200-1600 mg/day Anxiolytics

Name of the drug Dosage form Dose Therapeutic use

Minoxidil Lotion 1-1.5 ml bid For alopecia

Molindone tab 50-75 mg/day antipsychotic agents

MAOI tab, cap 5 mg PO at breakfast & 5 mg at lunch (10 mg/day)

MAO type B inhibitors

Nifedepine SR Tab 1 tab bid Cardiac drugs

Phenothiazines tab, supp, inj 5-10 mg q6-8hr Anti psychotics

Prazosin tab 1 mg PO q8-12hr Anti-hypertension

Procainamide Tab/vials 0.5-1 g IM q4-8hr antiarrhythmic

Quinine/quinidine Tab 1-2 tab daily Anti-malarials

Terazosin Tab 1mg at bedtime Antihypertensive

Theophylline Elixir 15 ml (adult); 5-10 ml (children) Anti-asthma

Trazadone tab 150 mg/day PO divided q8-12hr

Anti-depressant

Tricyclic antidepressants tab 75mg PO qDay initially Anti-depressant

Questions to Answer

1. What is the importance of knowing how to compute pediatric medication dosing?

 A dosage that’s too low may not have the desired effect, while too much of a particular drug can cause unwanted side effects or even death.

So being able to calculate pediatric dosage correctly is essential for anyone prescribing or administering medication to children.

2. What is the difference between drops and other liquid preparations intended for older children?

Drops are intended for infants which have more body water which can be easy diluted by its body, unlike older children which have lesser body water.

Drops may have high concentrations that an older children cant handle, that’s why other liquid preparations are made for older children.

3. Is it possible to give drops to older children?

Explain

No.

Giving your toddler a smaller dose of medicine meant for an adult is as dangerous as giving a higher dose of medicine meant for an infant

 Many parents don't realize that infant drops are more concentrated than liquid medicine intended for older children.

If the label doesn't indicate an appropriate dose for the weight and age of your child, don't give that medication to your toddler.

4. What are the major aspects to be included when teaching a mother or a family about medications for her/their child?

Parents, and patients will need to know what the medication looks like, exactly how and when to give-or take-the medication,

how to use the correct administration devices, the importance of using the correct administration device to avoid over- or underdosing

the importance of using the correct administration device to avoid over- or underdosing, what to do if a dose is missed or if the child spits out the medication or can't or won't take the solid form