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PEDIATRIC PRESCRIBING PowerPoint Presentation

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Description : Check out this medical presentation on Pediatrics, which is titled "PEDIATRIC PRESCRIBING", to know about use of medicines in children.

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Published on : Aug 03, 2021 | Views : 3007 | Downloads : 2

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PEDIATRIC PRESCRIBING By Dr. M. RAMESH M. Pharm, PhD, DipClinPharm, FICP (Australia) Professor Department of Pharmacy Practice JSS College of Pharmacy, Mysore
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Introduction Use of medicines in children is a challenge They react differently from adults to drugs Pharmacokinetic variation -- Change in body compartments -- Vd is high for neonates and infants -- Protein binding is less in neonates and infants Lack of clinical trials
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Pediatric age group Neonates -- Birth to 1 month Infants -- 1 month to 1 year Children -- 1 year to 12 years Adolescent -- 12 to 18 years
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Prescription writing Should be written according to prescription writing guidelines Should state age, dose, frequency, route of administration and duration Body wt and height should be stated
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Prescription writing Prefer oral route where possible Should state the strength of cap/tab and concentration of oral liquids Do not prescribe oral liquids in teaspoon measurement
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Prescription writing Where possible reduce the dosing frequency Use inhaler aids and spacers for inhaled drugs Do not mix the drug with food /infants feed
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Prescription writing Advice parents about child’s medication Advise the parents to keep the medicines out of reach of children
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Factors to be considered Age Dose Dosing frequency Routes of administration
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Age Variable in kinetics Neonates -- Decrease in clearance Infants -- Increase in clearance Children -- Decrease to reach adult rate of clearance Neonatal skin is highly permeable IM injection is painful (less muscle mass)
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DoseDosing methods Body surface area (BSA) Body weight (mg/kg) Percentage of adult dose (based on age)
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Dosing method Body surface area (BSA) More accurate method BSA (m2) = Ht (cm) X Wt (kg) 3600 or Ht (in) X Wt (lb) 3131 Child’s dose = BSA 1.73 X Adult dose
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Dosing method Body weight (mg/kg) Most commonly approached method i) Augsberger’s rule: Child’s approximate dose = (1.5 X Wt in Kg + 10) % of adult dose
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Dosing method Body weight (mg/kg) ii) Clark’s rule: Child’s approximate dose = Wt (in pounds) 150 X Adult dose
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Dosing method Ideal body weight (mg/kg) Useful in patients with large variations from ideal body weight Children 1 to 18 years: IBW (kg) = (Ht2 (cm) X 1.65) 1000
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Dosing method Ideal body weight (mg/kg) Children 5 feet and taller Male = 39 + (2.27 X Ht in inches) Female = 42. 2 + (2.27 X Ht in inches) Use adult dose if -- Dose exceeds adult dose -- Child weighs >40 Kg or >12 years
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Percentage of adult dose (based on age) Age % of adult dose New born 12.5 1 month 14.5 3 months 18
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Percentage of adult dose (based on age) Age % of adult dose 6 months 22 1 year 25 3 years 33
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Percentage of adult dose (based on age) Age % of adult dose 5 years 40 7 years 50 12 years 75
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Dose calculation Never guess or roughly estimate Consider BSA where possible Adjust the dose according to body weight
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Dose calculation Individualize the dose Consider other factors (renal/hepatic status)
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Dosing frequency Reduce the dosing frequency when possible Consider some flexibility in frequency
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Routes of administrationOral Preferred method unless other specific indication Liquid preparations are most preferred In prolonged therapy sugar free preparation should be used (to avoid tooth decay)
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Routes of administrationOral If the dose is <5ml, dilute it with suitable vehicle to 5ml Do not prescribe teaspoon doses (dose may vary) Do not prescribe 1 or 2 tab (mention the strength) Do not mix it up with food/milk
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Routes of administrationRectal Absorption is erratic Not preferred method
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Routes of administrationTopical Care should be taken as the drug may be absorbed in significant quantity Avoid use of topical antibiotics due to danger of sensitization
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Routes of administrationParenteral IM is not preferred -- if necessary outer aspect of thigh is preferred During IM/IV administration second person should be present to hold the child Syringe should be prepared out of the child’s sight
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Routes of administrationParenteral Should be prepared for anaphylactic / other untoward reaction Sterile technique is needed Alcohol used for cleaning should be allowed to dry before injecting to avoid burning pain
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Routes of administrationParenteral Choose different sites if repeated injections are required Other than IM/IV, intradermal injection can be considered