NURS 232 Pharmacologic Considerations for Infants & Children (1)

Pharmacologic Considerations for Infants & Children

Differences from Adults

  • Children are not mini-adults.

  • Variables differ due to developmental stages.

Pharmacotherapeutics

  • Many drugs safe for adults are not labeled safe for children.

  • About 75% of drugs prescribed for children in the US lack pediatric labeling.

  • Off-label drug use is common due to incomplete testing in children.

Pediatric Drug Dosage

  • Dosing typically based on weight in kilograms.

  • Protocols apply until age 8-10 or until weight resembles a small adult.

  • Pediatric doses should never exceed adult doses.

Calculation Example

  • Question: Calculate dosage for a 20 kg child; dosage is 30 mg/kg/day.

    • Answers:

      • A. 200 mg/day

      • B. 300 mg/day

      • C. 600 mg/day (Correct)

      • D. 800 mg/day

  • Rationale: 20 kg x 30 mg/kg/day = 600 mg/day.

Pharmacodynamics

  • Concerns what the drug does to the body.

  • Immature organ systems in young children may result in less than optimal functioning.

Pharmacokinetics

  • Focuses on what the body does to the drug.

Absorption

  • Infant GI tract pH is higher (less acidic) than adults.

  • Gastric pH decreases to adult levels around 1 year.

Distribution

  • Higher body water and lower fat concentrations.

  • Immature liver produces fewer plasma proteins.

  • Underdeveloped blood-brain barrier in neonates.

Metabolism

  • Immature liver function increases risk for drug toxicity.

Excretion

  • Renal excretion is slow in neonates, especially preterm infants.

Adverse Effects and Drug Interactions

  • Severe adverse effects likely due to immature body systems.

  • Infants may be affected by maternal medication use.

Health Status Impact

  • Disease processes can affect GI drug absorption.

  • Conditions like diarrhea reduce absorption.

  • Hepatic or renal disease complicates drug metabolism/excretion.

Preventing Medication Errors

  • Common in situations involving:

    • Children under 2 years.

    • Intensive care units.

    • Emergency departments.

    • Chemotherapy and IV medication recipients.

    • Unrecorded weights.

Causes of Errors

  • Miscalculating dosages due to:

    • Poor math skills.

    • Inexperience in calculations.

Prevention Strategies

  • Weigh children before administering medications.

  • Standardize procedures.

  • Utilize computerized ordering systems.

  • Consult reliable drug references.

  • Double-check all calculated doses for precision.