1. Drug Therapy for Pediatric Clients Chapter 5

2. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 5 - 2 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.

3. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 5 - 3 Absorption Gastric acid (hydrochloric acid) secretion in infants Choosing the intramuscular injection site Topical drug absorption Intravenous drug administration

4. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 5 - 4 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

5. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 5 - 5 Metabolism Difficult to predict Maternal drug history is important

6. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 5 - 6 Excretion Kidney maturation  Excretion increases as the kidney matures  Drug toxicity decreases as the kidney matures

7. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 5 - 7 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.

8. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 5 - 8 Pediatric Dosages Determined by using a nomogram  Nomograms are generally accurate after the attainment of mature liver and kidney function.

9. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 5 - 9 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.

10. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 5 - 10 Administration Methods Liquid medications are administered using an infant dropper, syringe without a needle, or a small spoon

11. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 5 - 11 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

12. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 5 - 12 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.

13. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 5 - 13 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)

14. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 5 - 14 Anterior view of the location of the vastus lateralis muscle in a young child. (continued)

15. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 5 - 15 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.