GENERAL PRESCRIBING GUIDELINES FOR PAEDIATRIC PATIENTS.pptx

a brief presentation about general prescribing guidelines for pediatric patients

1. GENERAL PRESCRIBING GUIDELINES FOR PAEDIATRIC PATIENTS PREPARED BY P.KAVITHARANI NACHIYA M.PHARM PHARMACY PRACTICE FIRST YEAR

2. Use of medicine in children is a challenge Children and particularly neonates , differ from adults in their response to drugs Special care is needed in ensuring the drug prescribes is appropriate and that the correct dosage is given ,especially in the neonatal period In children , the organs are not mature The development of organs continue until atleast to the age of 12 years

3. Classification of paediatric patients: Preterm neonate: less than 37 weeks of gestation Neonate : from birth to 27 days Infant and toddlers: 28 days to 23 months young child : 2 to 5 years Older child : 6 to 11 years adolescent: 12 to 18 years

4. PRESCRIPTION WRITING Should be written according to the prescription writing guidelines. It should state the dose ,age ,frequency , route of administration and duration. Body weight and height should be stated prefer oral route where it is possible Do not prescribe oral liquids in teaspoon measurement Do not mix the drug with food/infants feed Reduce the dose frequency where it is possible. Advice parents about the child’s medication and to keep medicine away from the children

5. PAEDIATRIC PRESCRIPTION

6. ROUTES OF ADMINISTRATION IN PAEDIATRICS ORAL ROUTE OF ADMINISTRATION RECTAL ROUTE OF ADMINISTRATION TOPICAL ROUTE OF ADMINISTRATION PARENTRAL ROUTE OF ADMINISTRATION

7. ORAL ROUTE OF ADMINISTRATION It is the most preferred method unless other specific indications. Liquid preparations are mostly preferred. In Prolonged therapy, sugar free preparations must be used(to avoid tooth decay) Do not prescribe teaspoon doses Do not mix it up with the food If the dose is less than 5 ml , dilute it with suitable vehicle to 5ml

8. RECTAL ROUTE OF ADMINISTRATION the absorption is erractic Not preferred method

9. TOPICAL ROUTE OF ADMINISTRATION Care should be taken as the drug may be absorbed in significant quantity. Avoid use of topical antibiotics due to danger of sensitization

10. PARENTRAL ROUTE OF ADMINISTRATION IM is not preferred –if necessary outer aspect of the thigh is preferred During IM or IV administration second person should be present to hold the child Syringe should be prepared out of the child’s sight Sterile techinique is needed Alcohol used for cleaning should be allowed to dry before injecting to avoid burning pain Should not be used, unless in the case of emergency or severe conditions

11. Choose different sites if repeated injections are required Other than IM or IV ,intradermal can be considered

12. FACTORS AFFECTING DRUG DISPOSITION IN CHILDREN ORAL ABSORPTION compared to adults ,children have variable gastric and intestinal transit time, Gastric PH

13. PHYSIOLOGICAL VARIABLES WITH EXAMPLE PHYSIOLOGICAL VARIABLE AGE GROUP PHARMACOKINETIC RESULT EXAMPLE U GASTRIC PH NEONATES,INFANTS, YOUNG CHILDREN BA of basic drugs and acid labile drugs BA of acidic drugs AMPICILLIN, PENICILLIN G PHENOBARBITAL (ACIDIC) GASTRIC AND INTESTINAL MOTILITY NEONATES,INFANTS UNPREDICTABLE BA DIGOXIN GASTRIC AND INTESTINAL MOTILITY OLDER INFANTS,CHILDREN UNPREDICTABLE BA DIGOXIN BILE ACID PRODUCTION NEONATES BA VITAMIN E VITAMIN K BACTERIAL FLORA NEONATES,INFANTS BA DIGOXIN

14. RELATIVE GI ABSORPTION OF SELECTED DRUGS IN INFANTS AND ADULTS INCREASED IN NEWBORNS PENICILLIN AMPICILLIN ERYTHROMYCIN DIGOXIN ZIDOVUDINE GASTROINTESTINAL DRUG ABSORPTION INFANTS=ADULTS THEOPHYLLINE SULFONAMIDES DECREASED IN NEWBORNS PHENYTOIN ACETAMINOPHEN PHENOBARBITAL

15. PERCUTANEOUS ABSORPTION Absorption of drugs through skin is enhanced in infants and young children owing to better hydration of the epidermis and the greater perfusion of the subcutaneous layer In preterm neonates ,the stratum corneum is also thinner, further increasing the potential for the absorption of topical products This route of administration should be used with caution in infants and young children to avoid overdosage

16. there are numerous accounts of toxicity resulting from the percutaneous absorption DRUG USE TOXICITY HEXOCHLOROPHENE SKIN CLEANSER SEIZURES IN PRETERM BABIES POVIDINE IODINE TO PREPARE THE SKIN FOR SURGERY OR STERILE PROCEDURE IODINE TOXICITY IN INFANTS TOPICAL HYDROCORTISONE USED FOR DIAPER RASH OR ECZEMA ADRENAL AXIS SUPPRESSION AFTER 2 WEEKS OF USE IN AN INFANTS

17. INTRAMUSCULAR ABSORPTION The absorption of drug administered by this route may be reduced in infants as a result of reduced blood flow to skeletal muscles IM administration of drug is generally discouraged in paedriatric population due to the pain Vitamin k, vaccines and occasionaly antibiotics are given when intravenous access is not available. If it is used it must not exceed 0.5 ml for infants and younger children and 1.0ml for older children

18. RECTAL ABSORPTION Absorption by this route is fairly reliable even for preterm neonates Administration may be complicated because of the increased number of contraction results in expulsion of the suppository more likely

19. PULMONARY ABSORPTION Inhalation of medication is increasingly being used in infants and older children to avoid systemic exposure This produces faster onset of action This site of action decreases the dose required for the therapeutic effect Glucocorticoids ,bronchodilators ,antibiotics and mucolytic agents are used

20. DRUG DISTRIBUTION Growth and maturation effect many factors thata determine drug distribution including Bodywater content Fat stored Plasma protein concentration Organ size and perfusion Hemodynamic stability Tissue perforation Acid-base balance Cell membrane permeability

21. BODY WATER ANF FAT CONTENT Total body water content decreases with increase in age Approximately 80% percentage of the newborn’s bodyweight is water By 1 year of age it declines to 60% , similar to that of an adult Highly water soluble drug s like gentamicin , have larger volume of distribution in neonates than in older children So, larger milligram per kilogram are often needed to achieve desired therapeutic effect

22. Body fat increases with age from 1% to 2% in a preterm neonate,10% to 15% term neonate and 20% and 25% in a 1 year old So lipophilic drugs , such as diazepam have a smaller volume of distribution in infants than in older children and adults

23. PROTEIN BINDING POINTS TO REMEBER Acid drugs binds to ALBUMIN Basic drugs bind to ALPHA-ACID GLYCOPROTEIN FREE-FRACTION is usually the portion that EXERTS THE PHARMACOLGICAL ACTION

24. The quantity of the plasma protein including both of these substance is reduced in neonates and infants So , this results in increase in the free fraction of many drugs Increase in the free fraction of the drug increases the pharamacological activity of the drug “The relative decrease in serum protein may also produce increased competiton by drugs and endogeneous substances such as bilirubin for binding sites” Drugs that are highly bound to albumin such as sulphonamides may displace bilirubin and allow deposition the brain causing the condition called KERNICTERUS

25. AMPICILLIN DIGOXIN DIAZEPAM LIDOCAINE MORPHINE NAFCILLIN PENICILLI –G PHENOBARBITAL PHENYTOIN PROPRANOLOL THEOPHYLLINE PROTEIN BOUND DRUGS WITH A HIGH FREE FRACTION IN NEONATES

26. METABOLISM Due to the growth and development and under developed organs , pediatric patients are poor metabolisers And they are also prone to many adverse effects Phase 1 and phase 2 metabolism in neonates a re poor except sulfation

27. ELIMINATION Nephrons of the kidney begin to form from the 9 th week to 36 th week of gestation Even though the functional units are present, the GFR of the neonates is half of that of adults It reaches the adult’s level at 12 months(1 yr old) Immature renal function results In significant alterations in the elimination of many drugs So, longer dosing intervals are needed

28. PAEDIATRIC DRUG ADMINISTRATION AND MONITORING Accurate dosage calculation are critical in the care of infants and children so instead of calculating the dose by body weight body surface area (BSA) should be considered Dosage form may be altered Medications must be stored appropriately IV may be prepared in more concentrated solution because of the little amount of fluid administration to infants and young children  

29. REFERENCES https:// www.slideshare.net/AnkitGaur18/general-prescribing-guidelines-for-pediatrics-geriatrics-and-pregnancy Comprehensive pharmacy review 8 th edition by l eon shargel Clinical pharmacy and therapeutics 6 th edition by cate ,Karen hodson https://www.pharmdguru.com/general-prescribing-guidelines-for-paediatric-patients / https:// patient.info/doctor/prescribing-for-children