Transcript Pearls of Pediatric Pharmacotherapy

Pediatric Pharmacotherapy
Clinical Pearls
Caitlin Lozorak, PharmD
PGY2 Pediatric Pharmacy Resident
Palmetto Health Children’s Hospital
March 13, 2016
Disclosure
I have no disclosures or conflicts of interest at this time
regarding the subject matter of this presentation.
Please note that this Power Point presentation is an
educational tool that is general in nature. It is not
intended to be an exhaustive review of the subject
matter or the opinion of Palmetto Health. Materials
presented in this presentation should not be
considered a substitute for actual statutory or
regulatory language. Always refer to your legal counsel
and the current edition of a referenced statute, code
and/or regulation for precise language.
Objectives
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Upon completion of this program, the participant
should be able to:
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Explain principles of basic pediatric pharmacology including:
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Weight-based dosing
Developmental pharmacology
Drugs in Pregnancy/Breastfeeding
Pediatric pharmacotherapy references
Weight-based Dosing
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Primary dosing method for pediatrics
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Be mindful of MAXIMUM doses
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unit (mcg,mg,gram) / kg (weight) / DOSE
unit (mcg,mg,gram) / kg (weight) / DAY
Do not exceed adult maximum doses
Patients >12 years old and/or > 50 kg
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Similar to adult dosing
Developmental Pharmacology
“Pediatrics does not deal with miniature men
and women, with reduced doses and the
same class of disease in smaller bodies, but…
has its own independent range and horizon.”
- Dr. Abraham Jacobi, the father of American Pediatrics
N Engl J Med 2003;349:1157-67.
Absorption
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Enteral Absorption
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Changes in pH
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Immature biliary function
Delayed gastric emptying
Delayed intestinal motility
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Elevated in neonates
Decreased rate of absorption
Intramuscular Absorption
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Reduced skeletal-muscle blood flow
Decreased muscle movement for drug dispersion
N Engl J Med 2003;349:1157-67.
Absorption
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Rectal Absorption
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Contractions may cause expulsion of drug
Good blood flow and absorption
Topical
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Increased absorption
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Use with caution
Intrapulmonary
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Systemic exposure may occur
N Engl J Med 2003;349:1157-67.
Distribution
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 volume of distribution for hydrophilic
medications
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 protein binding
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Especially neonates and young infants
Increased free drug
 distribution across blood brain barrier
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Immature blood brain barrier in neonates and young
infants
N Engl J Med 2003;349:1157-67.
Metabolism
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Delayed maturation of drug-metabolizing
enzymes
Phase I
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Cytochrome P-450’s
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Phase II
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Conjugation and glucuronidation decreased
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Change remarkedly during development
Increases with age
Blood esterases
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Decreased in neonates
N Engl J Med 2003;349:1157-67.
Elimination
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Renal
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Decreased GFR
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Renal maturation  GFR increases with age
Adult values at 8-12 months of age
N Engl J Med 2003;349:1157-67.
Drugs in Pregnancy/Breastfeeding
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Recent change to “Pregnancy and Lactation
Labeling Rule”
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Effective June 2015
No longer A,B,C,D,X
Based off of human vs.
animal data
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Instead of lettering
system narrative risk
summary
 Allows patients and physicians to decide risk vs.
benefit on their own
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Image: www.fda.gov
Pediatric Drug References
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Comprehensive drug references
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Lexicomp / Pediatric and Neonatal Lexi-Drugs
Micromedex / Neofax
Pediatric and Neonatal Dosage Handbook / Drug Information
Handbook
Harriet Lane Handbook
Pediatric Pharmacotherapy Textbook (ACCP)
Intravenous Resources
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Pediatric Injectable Drugs (Teddy Bear book)
Handbook of Injectable Drugs (Trissel’s)
Gahart’s Intravenous Medications
Pediatric Drug References
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Infectious Disease
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Drugs in Pregnancy & Lactation
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Red Book
Guidelines (IDSA, AAP, etc.)
Nelson’s Pediatric Antimicrobial Therapy
Harriet Lane Handbook on Antimicrobial Therapy
Brigg’s
Miscellaneous
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Guidelines on specific disease states
Journal Articles
Questions??
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[email protected]