Drug Therapy for Pediatric Clients Chapter 5

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Pediatric Drug Therapy Approximately 75% of all prescription drugs in the U.S. lack full approval by the FDA because most drugs are not studied on children. Studying the effects of drugs in children is a problem.

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Absorption Gastric acid (hydrochloric acid) secretion in infants Choosing the intramuscular injection site Topical drug absorption Intravenous drug administration

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Distribution Dependent upon the amount of water and/or fat present in the child, as well as plasma affinity of the drug and protein-binding activity  Water-soluble drugs effectively utilized  Protein binding capacity is less

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Metabolism Difficult to predict Maternal drug history is important

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Excretion Kidney maturation  Excretion increases as the kidney matures  Drug toxicity decreases as the kidney matures

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Pediatric Drug Sensitivity Central nervous system drugs  Barbiturates and morphine  Depressant effects are exaggerated  Lowering body temperature  Acetaminophen Becomes toxic easily with large doses  Salicylates Do not give to children under the age of 12.

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Pediatric Dosages Determined by using a nomogram  Nomograms are generally accurate after the attainment of mature liver and kidney function.

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Rights to Follow Allow adequate time for drug administration. Gain the child’s trust.  Never lie to the child. Consider the child’s developmental level. Prevent choking.

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Administration Methods Liquid medications are administered using an infant dropper, syringe without a needle, or a small spoon

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Parenteral Medications Explain the procedure to the child and to the parents. Use additional materials such as:  Booklets  Coloring books  Puppets  Dolls  IV setup with colored water

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Painful Procedures Allow the parents to stay. Painful procedures should be done in a separate room designated as the “owie” room. Use a firm positive manner. Assemble equipment first. Maintain the child’s safety.

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Intramuscular Injections Vastus lateralis is the preferred site for children under the age of 3. Ventrogluteal site is the preferred site for children over the age of 3.  The child should be walking. (continues)

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Anterior view of the location of the vastus lateralis muscle in a young child. (continued)

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Final Step in Administering Drugs Evaluate drug action Remember  Children are vulnerable.  Be kind and patient.  Enjoy the children; you will receive more than you give.