Special populations

What is the challenge for pediatric dosage forms?

Find the right drug and find something appropriate and convenient

What is a big factor in pediatric dosage forms?

functional and acceptability compliance

0-18 years old is a patient

pediatric

Born before 37 weeks of gestations is a _ patient

premature

1 day to 1 month old is a patient

neonate

1 month to 1 year is a _ patient

infant

12-18 years old is a patient

adolescent

What is a big factor for geriatric dosage forms?

functional compliance

65 years or older is a _ patient.

geriatric

True or False? Children are small adults.

False

True or False? Dosage forms that are targeted for pediatric patients are readily available

False

Inability to product hydrochloric acid and the stomach acid has a high pH.

Achlorhydria

Only ____% of medications have FDA approved pediatric indications

20%

A population that is often excluded from dosing guidelines.

Therapeutic orphan

_ are therapeutic orphans.

children

What 7 dosage forms are commonly used in pediatrics?

1. solid oral
2. liquid oral
3. injectable
4. dermatological
5. nasal
6. pulmonary
7. rectal

What two core considerations are used for pediatric dosage forms?

1. ability of patient to use
2. patient acceptance

Most children are unable to swallow tablets and capsules until about the age of .

6 years old

Chewable tablets are for children who .

eat solid foods

ODTs are for

older school aged children

What 2 reasons might a child prefer chewable tablets?

1. dose volume or taste
2. ease of administration and transportability

Oral granules can be _ for children to take.

mixed with fluids or other foods

What are the 3 problems with ethanol elixirs?

1. CNS depression
2. confusion
3. GI upset

What are the 3 problems with propylene glycol elixirs?

1. hypotension
2. arrhythmias
3. hemolysis

Concentrated drops are specifically designed for __.

infants or small children with stomach of smaller volumes

Suspension dosing is based on _ for children.

mg/kg

HBP stands for _.

high blood pressure

Things such as suspensions that contain water have a beyond use date (BUD) of .

14 days

Injectable dosage forms for children require a ___.

syringe pump

Injectable dosage forms for children have to be _ from the adult strength.

diluted

The intraosseous route is available until _.

6 years old

Why are transdermal patches hard to use in younger children (1 yr-5 yr)?

skin thickness and difference in hydration

Transdermal patches are more viable for teenagers because their skin has _.

more completely matured

In children younger than 4 years old, nasal should be used.

drops

In children older than 4 years old, nasal should be used.

sprays

Rectal dosage forms can a be a _ (good/bad) option for children.

good

Metered dose inhalers can be used with __.

spacers

Dry powder inhalers _ (have/do not have) propellants.

do not have

Adverse drug reactions are seen more in (pediatrics/geriatrics) patients

geriatrics

What 4 factors contribute to ADRs in geriatric patients?

1. poly pharmacy
2. increased chance for disease state drug interactions
3. poor adherence
4. altered PK/PD profiles

Most geriatric patients have __ or _ visual impairments.

glaucoma or cataracts

Arthritis is see in more than _% of geriatric patients.

50%

About ____% of geriatric patients have some form of dysphagia.

40%

What 3 chronic conditions are associated with dysphagia?

1. stroke
2. parkinsons disease
3. multiple sclerosis

Instead of do not crush medications, geriatrics patients should be given ___.

immediate release multiple times a day

What are the outcomes of CVD/stroke?

1. neurologic deficits
2. language impairments
3. motor control problems

For patients that cannot open child proof containers, the pharmacist can change to

non-safety lids

Liquid formulations are beneficial because (2 reasons)

1. unwilling or unable to swallow tablets or capsules
2. avoids the risk of obstruction

ODTs are suitable for geriatric patients that are suffering from __’and _.

dysphagia and dementia

In geriatrics, spacers help with for MDIs

coordination

or of medication for geriatric patients

unit dose blister or strip packaging

Pediatric patients have achlorhydria during the _ of life.

first 2 weeks

When does the gastric pH of pediatric patients start to decrease?

By age 2

For neonates and infants, GI motility and absorption can be _.

variable

What kind of skin do neonates and infants have?

thin and hydrated

Neonates have musculature

scarce

Infants have _ (increased/decreased) volume of distribution for water soluble drugs than adults

increased

Neonates have _ (increased/decreased) BBB permeability

increased

Infants (<6 months) have _ (increased/decreased) albumin.

decreased

Some enzymes are not fully developed until ____ years old.

4

Renal function for children generally approaches full capacity within __ of life.

first 6 months to 3 years

Geriatric patients have _ (increased/decreased) gastric pH.

increased

Geriatric patients have _ (increased/decreased) GI motility

decreased

Geriatric patients have _ (increased/decreased) intestinal blood flow

decreased

Geriatric patients have _ (increased/decreased) absorptive area

decreased

Geriatric patients have _ (increased/decreased) volume of distribution for fat soluble drugs

increased

Geriatric patients have _ (increased/decreased) hepatic blood flow

decreased

Geriatric patients have _ (increased/decreased) metabolic capacity

decreased

Geriatric patients have _ (increased/decreased) albumin

decreased

Geriatric patients have _ (increased/decreased) renal blood flow

decreased

Geriatric patients have _ (increased/decreased) renal glomerular filtration

decreased

What kind of skin do geriatric patients have?

thin and dry

Geriatric patients have musculature.

less

Can you use syringe pumps with neonates?

yes

Can you use diluted formulations with neonates?

yes

Can you use the intraosseous route with neonates?

yes

Can you use pastes with neonates?

yes

You can use liquid of volumes with infants.

small

You can use liquid of ___ volumes with younger children (1 yr-5 yr).

large

What solids can you use with older children (6 yr-12 yr)?

chewable tablets and ODTs

What solids can you use with adolescents?

adult formulations

Can you use syringe pumps with infants?

yes

Can you use diluted formulations with infants?

yes

Can you use the intraosseous route with infants?

yes

Can you use the intraosseous route with younger children (1 yr-5 yr)?

yes

Can you use the intraosseous route with older children (6 yr-12 yr)?

no

Can you use adult formulations for older children (6 yr-12 yr)?

yes

Can you use adult formulations for adolescents?

yes

Can you use pastes with neonate?

yes

What topical dosage forms can you use for infants?

ointments, pastes and creams

What topical dosage forms can you use for younger children (1 yr-5 yr)?

ointments, pastes and creams

What topical dosage forms can you use for older children (6 yr-12 yr)?

ointments, pastes, creams, and daytrana

What topical dosage forms can you use for adolescents?

ointments, pastes, creams, and patches

What nasal dosage forms can neonates use?

nasal drops

What nasal dosage forms can infants use?

nasal drops

What nasal dosage forms can younger children use (1 yr-5 yr)?

nasal sprays

What nasal dosage forms can older children use (6 yr-12 yr)?

nasal sprays

What nasal dosage forms can adolescents use?

nasal sprays

What pulmonary dosage forms can neonates use?

MDI with spacer

What pulmonary dosage forms can infants use?

MDI with spacer and nebulizers