Post on 05-Apr-2018
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A PRACTICAL APPROACH IN INITIATING AND
MANAGEMENT OF PHARMACOTHERAPY IN
CHILDREN
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FORMAT OF THE PRESENTATION
INTRODUCTION
GUIDELINES FOR INITIATING AND
MANAGEMENT OF PHARMACOTHERAPY INCHILDREN
CONCLUSION
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Introduction
Optimum individualized drug therapy firstrequire that prescribers understand the
general principles of drug disposition and effect.
Pharmacy profession should choose the mosteffective drug and its correct dosage,formulation, and route of administration, while
aware of its toxicity,contraindications, drug interactions side effectsand cost.
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CONT
Since children can demonstrate age related
pharmacokinetic characteristics that alter drug
disposition,
prescribing medications for pediatric patients
requires an even greater knowledge of the drugs
profile.
It is imperative that prescribers/PharmacyProfessionals keep in mind the pharmacokinetic
differences between adult and children.
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GUIDELINES
In initiating and management of pharmacotherapy in children,
ten main questions need to be answered:
Is Pharmacotherapy Indicated?
Under some conditions drug therapy is
inappropriate, unnecessary, and possibly harmful.
For example,In the management ofuncomplicated viral upper respiratory infections
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Cont..
The professional who views this situations as
an opportunity for education and empowering
parents about the use and misuse of
medications can impact positively and
powerfully on the families in his care.
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What are the criteria to start therapy?
Evaluated the patient,
formulated a differential diagnosis,
selected a probable working diagnosis, and
developed a treatment algorithm based on
the potential risks and benefits of proposed
drug therapy.
the affordability of the drug t affordable
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CONT
After making a probable diagnosis
the clinician then chooses an appropriate drug.
The choice of the preparation and its formulation
will be influenced by: the intended route of administration,
the age of the children
availability of the preparation
concurrent therapy and possible underlyingdisease.
.
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CONT..
This choice requires knowledge of the patient, the
disease entity to be treated, and the drug itself
Patient related factors include
Age: Neonate, infant, child etc
Medication allergies(Drug history)
Presence of chronic medical problem such as
renal or hepatic disease that may impact on
clearance.
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CONT.
Compliance in terms of:
1. Formulation of the preparation
2. Taste of the drug
3. Cost of the drug
Social issues:
1. Complicated Regimen requiring many doses
2. Is Literacy Level of parent marginal3. Drug Compatibility with family moral, ethical,
cultural or religious mindset.
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CONT
Successful drug treatment requires
communication with the patient and family so
that treatment goals, expected duration of
therapy, drug discontinuation procedures and
desired outcomes of treatment are
understood.
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CONT..
Drug factor
Therapeutive index and potential drug toxicity are
critical factors in drug selection.For agent with
narrow therapeutic index,such as cytotoxicagent(methotrexate)must be given every half- life
or more frequently in other to avoid peak level
associated with toxicity. In children less than one year dosages are often
based on weight rather than surface area
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Cont.
For drugs with wide therapeutic index such as
penicillin single dose may be quoted for a
wide age group
It is important to select the safest, most
efficacious drug for each clinical condition
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What is the appropriate dosing
regimen?
Appropriate dosing regimen
dose amount,
dosing interval and
route of administration
is as important as deciding upon the
appropriate drug and incorrect dosing canresult in serious consequences ranging from
suboptimal treatment to toxicity.
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CONT
today, most pediatric patients are dosed
according to body weight with further
adjustments as needed for age difference in
drug clearance.
dosing interval, which may vary with patient
age, is a function of the drugs half life,
which is the time required for theconcentration of the drug in the plasma to
decrease by one half.
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CONT
The half life determine the frequency of dosingand varies both among drugs and patients.
The dosing interval for a drug is not always the
same between a neonate, child and adult. Drugs with short half-life, must be administered
more frequently while drugs with long half-lifemay be administered less frequently.
The average half life of theophylline is 4 5 hrsfor a child, 8hrs for non smoking adult andgreater than 10hours for a neonate.
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Which route of administration is
optimum?
Depends on the specific circumstance of each
individual case.
Is intravenous administration required?
Does the patient have venous access?
Is intramuscular administration a possibility?
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Is therapeutic drug monitoring
required?
Therapeutic drug monitoring (TDM) can be
vital in assessing patients response to
treatment, particularly drugs with narrowtherapeutic index
Serial monitoring of serum drug levels
provides data that are useful in evaluatingboth therapeutic efficacy and adverse effects.
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CONT
Simply obtaining blood samples can be
difficult depending on the age, developmental
maturation and hydration status of the child
Once obtained, drug levels can be evaluated.
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How will drug efficacy be assessed?
Sometimes efficacy is difficult to assess in the
pediatric patient, who may be too young to
answer questions like, Do you feel better. Pharmacy professional should learn to rely on
his patients actions such as going to the
playroom, instead of remaining quietly in bed.
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CONT
It is always important to interview caregivers
about:
the patients activity level,
appetite,
behaviour and
response to drug therapy
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How will adverse effects be evaluated?
Knowing :
the common and severe adverse effects of all
drugs prescribed,
as well as their frequency, severity and
management,
facilitate evaluation of signs and symptoms
hence there possible relation to drug therapy.
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CONT
In general, a practical rule of three approachsuggests that pharmacy professional should
known the three most common and the threemost severe adverse effects of every drugthey prescribe.
This approach helps to reduce polypharmacywhen dealing with adverse effects, rather thanadding a medication
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What drug interaction are possible?
Drug interactions can range from clinicallyirrelevant to fatal, and it only takes two
drug to cause a significant reaction. When prescribing a new medication, it is
essential for the pharmacy professional tobe aware of all other concurrentlyadministered drugs, including over thecounter (OTC) products.
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How will compliance be assessed?
. Evaluating drug compliance in pediatric
patients can be complex and requires
assessment of both parent and patient
behaviours.
. factors affecting compliance :
number of drugs taken,
dosing intervals, adverse effects,
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CONT.
drug cost,
patient or parent educational level,
peer pressure and effectiveness ofcommunication among professional ,parentand patient.
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When and how should a medication
be discontinued?
A plan for discontinuing medication should be
established when therapy is initiated.
At the conclusion of the planned treatment period, itis appropriate to re evaluate the patient and to
decide if the criteria for drug efficacy have been
achieved. Ideally, the patients condition should have
reached a defined end point, such as resolution of
symptoms in acute disease processes, or return to
baseline status in a chromic illness.
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Is the drug licensed
Is the drug licensed?If an unlicensed drug is to
used, the pharmacist should have sufficient
information to support its use.(eg off-label use
medicines)
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CONCLUSION
Pharmacy professionals must ensure that their
knowledge, skills and performance are of high
quality, up to date, evidence based and
relevant to their field of practice, so thatevaluation, diagnosis and treatment of
children can be achieve successfully.
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YOU CAN DO IT
I CAN DO IT
WE CAN DO IT
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THANK YOU