Pediatric
Medications
Reported by:
Cababan, Lailene
Nacilla, Hershey
Rivera, 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
Branch
of medicine
that
deals with disease in
Adolescents
children from birth
Adults
through
adolescence
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
Monitoring administration of
medications to the pediatric
population includes knowledge in:
Pharmacokinetics
Serum
drug
levels
Drug
dosing in
infants
and
children
Cognitive and
physiological
developmenta
l
considerations
Routes of
Administratio
n
1.
2.
3.
4.
Oral
Rectal
Topical
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:
Drug-metabolizing
Lower rates of drug absorption than in
Excretion
enzymes in the liver
are
children and adults
immature
Metabolis
Longer
gastrickidneys
time and
gastric
pH =
Infant
have
higher
m
More drugs in circulatory
diminished
absorption
resistance to blood flow,
Distributio
system = increase
Frequent
feeding
may
impede
the drug
n
lower
GFR
with
a
decreased
Low for
conc
of plasma proteins and diminished
Absorptio
potential
toxicity
absorption
ability to
concentrate
urine
n
protein
binding
capacity
=
drugs
more
available
in
Drug dosages must
Low be
intestinal
flora,
reduced
enzyme
Secrete
drugs
more
slowly,
the circulation
calculated
carefully
function
= decreased
absorption
increasing
risk
of
drug
permeability
to BBB = rapid access to
Drug Greater
levels and
clinical
Low peripheral
perfusion and
accumulation
CNS must be closely
responses
immature heat regulation = decrease
Total body water is 80% compared to adult 50%
monitored
absorption of parenteral medications
Higher doses of H20 soluble drugs may be needed
Pharmacokinetics in children:
Liver enzymes are more
effective at metabolizing
Excretion
drugs
Metabolis
Due to elevated
BMR,
Gastric pH is equal to adult by 2 to 3
m
some drugs are years
Distributio
old
metabolized more
n rapidly
Gastric
emptying rates are faster in
Absorptio
Children over 12 months of
Drug
dosages
relative
to
infants
n
age arereach
able adult
to excrete
Plasma
proteins
by
body weight may
need
to
Skin and blood-brain barrier levels
becomes
drugs effectively
age
1
be higher
more effective
Children
Drugs may need
to be up to age 2 years may require
higher dosages of water soluble drugs
more closely monitored
Developmental
Pharmacokinetics
Gastric pH is high in neonates at 2 yrs
Absorption:
This
is variable
It
is inversely
toin
theitthickness
old
graduallyofdeclines to its adult
neonates,
infants,
and
the stratum corneum
valuesand directly
young to
children
relate
the skin
hydration
Gastric
and intestinal motility is dec in
secondary
The
ratio oftoskinneonates
permeability
and and
infants but inc in older
Blood flow and
larger surface
area
andand
body
infants
children
Membrane
of
the
eye
are
thin,
vasomotor
weight
is observed
in neonates
particularly
Changing
biochemistry
of the
in
neonates
and
infants; it
instabilities
is
dependent
on
specific
and infants isBioavailability
developing
GUT within
the neonate
used
uncommon
eye
drops
to
cause
Insufficient
muscle
drug
properties
and
the
time
during
Equivalent
percutaneous
dosing
leads toside
unpredictable
drug
absorption
systemic
effects
in
the
very
young
tone
and
it
is
exposed
to
rectal
mucosa;
may
lead
to systemic
availability
which
Diminished bile acid pool and biliary
contraction
few
drugs
are
suitable
for
rectal
and potential toxicity
function at birth gradually increases to
Decreased muscle
administration
Developmental Considerations in
Pediatric Medication:
Infants:1m
onths 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
Adolescent:
13-18 years
Swallow
capsules
and
tablets
Child
should be
praised
Sense of
control
Long term
benefits
Side
effects
Shouldbe
included in
decision
making
Explicit
explanatio
n
Minimize
dependent
drug
regimens
Methods of calculating
drug dosages of
pediatrics:
Body Weight
Body Surface Area (BSA)
Age
A. Calculating by Body Weight:
Clarks Rule
Most common method of administering the exact
amount of medication that a child needs
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
C. Calculating based on Age:
Youngs Rule
Cowling
s Rule
Frieds Rule
Order: Cefaclor 50mg
q.i.d.
The child weighs 15lbs.
Childs drug dosage:
Answer:
20-40mg/kg/day in
three divided doses.
Available drug: Ceclor
Is the oral
prescribed
dose
suspension
safe? 125mg/5mL
A. Calculating by Body Weight:
Order: Albuterol
0.1mg/kg/day P.O. in
four divided doses
(q6h).
The child weighs
86lbs.
Answer:
How many mg
should the patient
receive per dose?
A. Calculating by Body Weight:
Order: Garamycin IM tid
for a 3-yr-old child who is
36 inches tall and who
weighs 30lbs
Answer:
Supply: Garamycin
40mg/mL
Adult Dose: 40mg
B. Calculating by Body Surface Area
Order: Sulfisoxazole
2g/m2 in four divided
doses.
The child weighs 60lbs
and 50 inches tall.
Available: Sulfisoxazole
500mg/5mL
Answer:
How many mL should the
patient receive per dose?
B. Calculating by Body Surface Area
Name of the drug
Amantadine
Dosage form Dose
Film-coated
1 tab daily for first 4-7 days
tab
Therapeutic use
Antiparkinsonian
drug
Amoxapine
Tab
25 mg q8-12hr
Antidepressants
TCA
Amphetamines
Tab, cap
5 mg PO qDay; may increase
by 5-10 mg/day qWeek
Stimulants ADHD
agetnts
Beta-adrenergic
Inj, tab
100 mg/day PO q12hr
blockers
Buspirone
Beta blockers,
beta 1 selective
Tab
10-15 mg/day PO divided q812hr
Anxiolytics,
Nonbenzodiazipin
es
Ca-channel blockers
Tab
5 mg/day PO initially
Anti anginal
agents
Chlorpromazine
Film-coated
tab
25mg tid or 75mg at bedtime
Antipsychotics
Chloroquine
Tab
500 mg (300 mg base) PO
once/week
Antimalarials/
anthelmintics
Clonidine
Tab , ampule
75-150mcg bid
Antihypertensives
Clozapine
Tab
12.5mg once bid
Antipsychotics
Colchicines
Tab
1mg initially followed by
500mcg 2-3 hrly
Anti-gout/
hyperuricemia
Cyclobenzaprines
Tab, cap
5 mg PO q8hr
Skeletal muscle
Name of the drug
Dosage form
Dose
Therapeutic use
Diflunisal
tablet
500mg every 8
NSAIDs
hours
Disopyramide
Capsule, tablet
100-150mg every 6- Cardiac drugs
8hrs
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,
20-50mg/day
Antipsychotics
solution
LSD
tablet
hallucinogens
Mefenamic acid
Tablet
250-500mg tid
NSAIDs
Meprobate
tablets
1200-1600 mg/day
Anxiolytics
Name of the drug
Dosage
Dose
Therapeutic use
Minoxidil
form
Lotion
1-1.5 ml bid
For alopecia
Molindone
tab
50-75 mg/day
antipsychotic
5 mg PO at breakfast & 5
agents
MAO type B
MAOI
tab, cap
mg at lunch (10 mg/day)
Nifedepine SR
Tab
1 tab bid
inhibitors
Cardiac drugs
Phenothiazines
tab, supp,
5-10 mg q6-8hr
Anti psychotics
Prazosin
inj
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
Anti-asthma
Trazadone
tab
Tricyclic antidepressants
tab
(children)
150 mg/day PO divided q8- Anti-depressant
12hr
75mg PO qDay initially
Anti-depressant
Questions to Answer
1. What is
the
importance
of knowing
how to
compute
pediatric
medication
dosing?
A dosage thats
So being able to
too low may not
calculate
have the desired
pediatric dosage
effect, while too
correctly is
much of a
essential for
particular drug
anyone
can cause
prescribing or
unwanted side
administering
effects or even
medication to
death.
children.
2. What is the
difference
between
drops and
other liquid
preparations
intended for
older
children?
Drops may have
Drops are
high
intended for
concentrations
infants which have
that an older
more body water
children cant
which can be easy
handle, thats
diluted by its
why other liquid
body, unlike older
preparations are
children which
made for older
have lesser body
children.
water.
3. Is it
possible to
give drops
to older
children?
Explain
Many parents
Giving
your
If the label
toddler
don't
realize
a
doesn't indicate
smaller
that
infant
dose of
an appropriate
medicine
drops
are meant
more
dose for the
for an adult is
concentrated
weight and age
as dangerous
than
liquid
of your child,
as giving a
medicine
don't give that
higher dose
intended
for of
medication to
medicine
older
children.
meant
your toddler.
for an infant
No.
4. What are
the major
aspects to be
included
when
teaching a
mother or a
family about
medications
for her/their
child?
the
of
Parents,
andthe
howimportance
to use
using
the will
correct
patients
correct
administration
need
administration
to know
device to avoid
what
devices,
the the
over- or
medication
importance
of
underdosing,looks
what
like,
using
to
doexactly
ifthe
a dosehow
is
missed
or ifto
the
and
correct
when
child
spits
out the
give-or
administration
take-the
medication or
medication,
device to avoid
can't or won't take
overor form
the solid
underdosing
