Core Patient Variables

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Core Patient Variables

• Lifespan Children

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• Pharmacotherapeutics indications
• Pharmacodynamics the drugs action
• Pharmacokinectics changes in the drug as it
  moves within the body

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Pharmacotherapeutics(Indications)

• The same indications as for adults except that
  the dosage is different
• Based on the surface area (m2) or weigh (kgs)
• Surface area is inversely proportional to length

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• BSA (Weigh in Kg ) X (height in
  cm) 3600

Example What is the BSA of a child who weighs
10kgs and is 45 cm tall ?
10 x 45 3600
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BSA
0.35 m
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Pharmacodynamics (drug action)
Same as adults however since the organs are not
fully developed yet the response of that organ
to the drug may be diminished. Therefore drug
dosage needs to be adjusted.
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Pharmacokinetics (drug changes in the body)

• Absorption
• Enteral route infants up to 1 year have less
  acidity in the GIT
• Parenteral route affected by age due to
• underdeveloped muscles
• erratic blood flow
• However due to increased surface area and skin
  permeability enhanced absorption of drugs by
  topical route

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Distribution

• In child this is affected because of difference
  in
• body fat and water content
• Less plasma proteins
• Immature blood brain barrier

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• Metabolism
• immature liver leads to decreased
• or incomplete metabolism of some drugs
• liver more probne to hepato toxicity
• Drugs requiring oxidation are more metabolised in
  children

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• Excretion
• decreased due to immature renal system
• decreased excretion in bile
• Half life is therefore increased

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Contraindications Precautions Cautious
assessment and clinical monitoring when drugs are
given to children since clinical trials are not
conducted on children
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Adverse Effects

• Allergic reactions
• Idiosnycratic reactions
• Toxic effects due to immature bodily organs

Interactions

• tetracycline
• Glucocorticosteriods

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Assessment

• Health status
• Developmental level
• Lifestyle / diet / habits
• Environment

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Health Status
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Developmental level

• Birth 12 months
• well developed sucking reflex
• vastus lateralis 3 years

• scalp / foot access for I. V needs

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• Toddlers 1- 3 years
• resistance to drugs needs to be anticipated
• less resistant to suppositories
• todllers have vivid imaginations but little
  knowledge how body works
• intra muscular sites vastus lateralis / rectal
  femoralis
• intravenous sites scalp , avoid foot

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• Preschoolers 3-5 years
• uncooperative
• Need to offer choices
• Fear of punishment
• ventrogluteal site is preferred dorsogluteal if
  necessary
• intravenous peripheral sites only

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• School aged children
• child is very cooperative
• Offer choices
• Avoid rectal suppositories
• Ventrogluteal site preferred , deltoid may be
  used
• Positive reinforcement

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• Adolescents ( 13 16 years)
• cooperation is highly developed
• Offer complete explanations
• Privacy and control are importatn issues
• Route same as adult

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• Lifestyle / diet / habits
• neonate primary intake is milk this affects
  gastric pH
• Adolescents use of substances such as alcohol,
  tobacco and street drugs may affect prescribed
  medications

• Environment / culture
• Children requiring drug therapy at home need a
  responsible guardian
• Religious/cultural beliefs may interfere with
  drug therapy

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• Planning and Intervention
• Oral administration
• Small amounts required use syringe to withdraw
  the exact amount
• Mix with small amounts of food/ apple sauce
• Parenteral asdministration
• Choices offered must be realistic
• EMLA cream may be used

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• Rectal administration
• developmental stage needs to be considered
• Intravenous route
• Extra caution to prevent fluid overload

Calculate doses accurately !!!!!
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• Reducing psychological stress and anxiety
• answer questions simply but truthfully
• parents should be involved
• Ask parents to stroke and comfort child not to
  restrain them
• give positive remarks to child
• play therapy may be used to educate child