Pharmacology in Pediatric Care

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Questions and Answers

Which of the following medications is associated with the risk of Reye's syndrome in children when given with salicylate therapy?

Bismuth Subsalicylate (correct)

Allopurinol

Diphenoxylate with atropine

Colchicine

What is a common sign of salicylate intoxication in children?

Elevated blood pressure

Increased heart rate

Decreased urine output

Tinnitus (correct)

What should be emphasized in patient education regarding opioid use?

Opioids are completely non-addictive.

Long-term use can lead to dependence. (correct)

They should be taken only on an empty stomach.

Opioids should not be mixed with any other medications.

What cultural consideration should be taken into account when administering medications?

Certain cultures may have specific beliefs regarding medication and health. Signup and view all the answers

Which medication is commonly used for managing gout?

Colchicine Signup and view all the answers

What is a significant risk associated with the use of aspirin in children?

Reyes Syndrome Signup and view all the answers

What is the primary concern when using salicylate therapy in children?

Reye's Syndrome Signup and view all the answers

Which of the following is NOT a recommended practice for patient education regarding opioid use?

Encouraging patients to drive if they feel capable Signup and view all the answers

What is a consideration when administering medications to patients from diverse cultural backgrounds?

Cultural beliefs may affect pain assessment and medication adherence Signup and view all the answers

What is the recommended way to manage gout pain according to analgesic treatments?

Using non-opioid analgesics and lifestyle modifications Signup and view all the answers

Which statement about opioid tolerance is true?

Tolerance can result in a need for higher doses to achieve the same effect Signup and view all the answers

Which medication is notably stronger than morphine and used for severe pain relief?

Hydromorphone (Dilaudid) Signup and view all the answers

What is the critical monitoring requirement before administering opioids?

Respiratory rate check Signup and view all the answers

What is a significant risk factor when using salicylates in children?

Potential link to Reye's Syndrome Signup and view all the answers

Which symptom is NOT typically associated with salicylate intoxication in children?

Severe abdominal pain Signup and view all the answers

What is an essential aspect of patient education regarding opioid use?

Advise against sharing medications with family members Signup and view all the answers

What should be considered when providing medication education to patients from different cultural backgrounds?

Involve family members in the educational process when appropriate Signup and view all the answers

Which statement about managing gout is accurate?

Gout can be triggered by excess uric acid accumulation in the body Signup and view all the answers

What is a key point to include when teaching about the long-term use of NSAIDs?

Long-term usage can lead to kidney damage Signup and view all the answers

Which recommendation should be given regarding the use of ibuprofen and other NSAIDs?

Always take with food to prevent GI upset Signup and view all the answers

What factor can influence the decision-making process in some cultural contexts regarding medication?

Family members may be consulted as central decision-makers Signup and view all the answers

What is the primary mechanism of action of H2-receptor antagonists?

Blocking histamine H2 receptors on gastric parietal cells Signup and view all the answers

Which condition is NOT typically treated with H2-receptor antagonists?

Hypertension Signup and view all the answers

Which of the following is a potential consequence of long-term use of H2-receptor antagonists?

Development of tolerance Signup and view all the answers

What factor could impair the absorption of medications when taking H2-receptor antagonists?

Increased gastric pH due to reduced acidity Signup and view all the answers

Which of the following is a common side effect associated with H2-receptor antagonists?

Confusion in elderly patients Signup and view all the answers

Study Notes

Salicylate (Aspirin) Intoxication in Children

Hyperventilation and drowsiness are common symptoms

Acetaminophen (Tylenol)

Do not exceed 4 grams/day to prevent liver damage
Effective for mild pain and fever reduction
Preferred for children for pain and fever relief

Ibuprofen (Advil) and NSAIDs

Reduces inflammation, pain, and fever
Take with food to avoid GI upset or ulcers
Prolonged use can increase bleeding risk, especially in elderly or those on anticoagulants
Avoid alcohol when taking NSAID's
Long-term use can lead to potential kidney damage, risk for bleeding, and gastric ulcers

Patient Teaching and Discharge Instructions: Opioids

Educate on the risks of dependence and tolerance
Teach signs of respiratory depression (e.g., slowed breathing, confusion)
Discuss safe storage and proper disposal of unused medications to prevent misuse

Patient Teaching and Discharge Instructions: NSAIDs

Educate on GI risks: Always take with food and report any signs of stomach pain or black stools
Clarify daily maximums and potential risks with exceeding them
Contraindicated for patients with renal disease

Cultural Considerations in Medication Administration

Tailor education to accommodate different cultural preferences (e.g., use interpreters if necessary, provide written instructions in preferred language)
Understand Health Beliefs: Some cultures may use alternative therapies; respectfully inquire about these practices and provide guidance that incorporates their beliefs
Family Involvement: In some cultures, family may play a central role in decision-making — include them in patient education when appropriate.

Anti-Gout

Gout is caused by a buildup of uric acid crystals in the joints, leading to sudden and severe pain, swelling, redness, and tenderness, often in the big toe
It occurs when the body either produces too much uric acid or cannot remove enough of it.
Common medications include allopurinol (Zyloprim) and Colchicine

Gastrointestinal Drugs & Bowel Disorder Drugs: Diphenoxylate with atropine (Lomotil)

OPIOID prescription laxative - Slows intestinal motility to increase fluid absorption, reducing diarrhea

Gastrointestinal Drugs & Bowel Disorder Drugs: Bismuth Subsalicylate (Pepto-Bismol)

May cause dark-colored stool, dark tongue, and constipation

Gastrointestinal Drugs & Bowel Disorder Drugs: Simethicone (Mylicon)

Administered for excessive and painful intestinal gas
Safe for children/babies and adults

Gastrointestinal Drugs & Bowel Disorder Drugs: Calcium Antacids

Not commonly used due to potential

Gastrointestinal Drugs & Bowel Disorder Drugs: Magnesium-Containing Antacids

Use cautiously in patients with renal failure due to possible complications

Gastrointestinal Drugs & Bowel Disorder Drugs: H.pylori Infection Treatment

(e.g., Omeprazole & Antibiotics): Often used to treat H.pylori infections causing peptic ulcers

Gastrointestinal Drugs & Bowel Disorder Drugs: Antacid and Medication Administration

Administer medications at least 1 hour apart from antacids to avoid interaction

Gastrointestinal Drugs & Bowel Disorder Drugs: Cimetidine Side Effects

May cause confusion and disorientation in elderly patients

Gastrointestinal Drugs & Bowel Disorder Drugs: PPIs and ICU patients

Often given to prevent stress ulcers in patients with nasogastric tubes and ventilation

Gastrointestinal Drugs & Bowel Disorder Drugs: PPIs and Osteoporosis

Long-term use can increase the risk of osteoporosis

Gastrointestinal Drugs & Bowel Disorder Drugs: Overuse of Sodium Bicarbonate

May cause metabolic alkalosis

Long-Term Laxative Use

May result in dependency and decreased bowel tone

Histamine (H2)-Receptor Antagonists

When assessing patients always START with ABCs - considering airway, breathing, and circulation as the PRIORITY and then move on to pain and other findings after ABCs are managed.

Pain Assessment Scales

Verbal Pain Intensity Scale: No Pain, Mild Pain, Moderate Pain, Severe Pain, Very Severe Pain, Worst Possible Pain
0-10 Numeric Pain Intensity Scale: 0 - No Pain, 10- Moderate Pain
Visual Analogue Scale: Worst Possible Pain, No Pain
Wong-Baker FACES® Pain Rating Scale:
- 0: No Pain
- 2: Hurts Little Bit
- 4: Hurts Little More
- 6: Hurts Even More
- 8: Hurts Whole Lot
- 10: Hurts Worst

Terms to Review:

Opioid Naïve: A person who has not taken opioids on a regular basis or has not taken opioid analgesics in at least 30 days
Opioid Tolerance: A state of adaptation in which exposure to a drug induces a decrease in the drug's effect over time
Partial Agonist: A drug that binds to and activates a receptor, but produces less of an effect than a full agonist in other words it's not as potent
Opioid Dependence: A state of adaptation that occurs when there is a chronic exposure to opioids, leading to a need for a continued intake of the opioid to avoid the development of withdrawal symptoms, and to avoid experiencing unpleasant withdrawal symptoms such as discomfort, anxiety, and muscle aches

Opioid Analgesics: Usage, Management, and Monitoring: Hydromorphone (Dilaudid) vs.Morphine

Hydromorphone is 7x stronger than Morphine - administer in much smaller doses
Used for severe pain relief, especially when Morphine is ineffective

Opioid Analgesics: Usage, Management, and Monitoring: Respiratory Depression

Critical Monitoring: Assess respiratory rate before administering opioids (must be ≥ 12/min). Opioids depress the CNS and can cause fatal respiratory failure
Older Adult Caution: Post-op patients, especially older adults, are at higher risk

Opioid Analgesics: Usage, Management, and Monitoring: Naloxone (Narcan)

Commonly used for overdose or with surgical anesthesia
Opioid Antagonist: Keep available for reversing opioid-induced respiratory depression
Emergency Use: Administer if respirations drop significantly or patient is unresponsive

Opioid Analgesics: Usage, Management, and Monitoring: Discharge Teaching for Patients on Opioids

Constipation Management: Encourage fluids, fiber intake, and regular use of stool softeners
Opioid Safety: Discuss the risk of tolerance (higher doses needed over time) and potential addiction
Side Effects: Warn about common side effects (drowsiness, dizziness) and advise against driving

Non-Opioid Analgesics and NSAIDs: Aspirin

NOT FOR CHILDREN:
- Risk for Reyes Syndrome: Acute and potentially life-threatening condition involving progressive neurologic deficits that can lead to coma and may also involve liver damage. Triggered by viral illnesses such as influenza as well as by salicylate therapy itself in the presence of a viral illness.

Mechanism of Action

H2-receptor antagonists work by blocking histamine H2 receptors on stomach cells responsible for acid production.
This blocking action decreases the amount of acid secreted by the stomach, leading to a higher pH in the stomach.
This higher pH helps heal ulcers and reduces the symptoms of GERD.

Clinical Applications

H2-receptor antagonists are commonly used to treat ulcers in the stomach and duodenum.
They are also used to manage GERD.
H2-receptor antagonists can help prevent ulcers in hospitalized patients who are at risk of stress-induced mucosal damage.
They can also help with indigestion symptoms.
In rare cases, H2-receptor antagonists are used for Zollinger-Ellison syndrome, a condition that causes excessive stomach acid production.

Drug Interactions

H2-receptor antagonists can interfere with the absorption of some medications that require an acidic environment.
This includes ketoconazole, a type of antifungal medication, and some protease inhibitors, which are used to treat HIV infection.
H2-receptor antagonists can also increase the effects of medications that are broken down by certain liver enzymes.
Antacids can decrease the absorption of H2-receptor antagonists, so it is recommended to take them separately, with some time in between.

Pharmacokinetics

H2-receptor antagonists are available in oral, intravenous, and topical formulations.
The extent of absorption varies between different agents, but most are well-absorbed from the intestines.
They are mainly broken down in the liver and their byproducts are excreted in the urine.
The half-life of H2-receptor antagonists typically ranges from one to four hours, which means multiple doses per day or extended-release formulations may be required.

Side Effects

Common side effects include headache, dizziness, fatigue, and constipation or diarrhea.
While rare, serious side effects can occur, including confusion, especially in elderly patients, and liver damage.
H2-receptor antagonist use can increase the risk of gastrointestinal infections because of reduced stomach acidity.
Long-term use of H2-receptor antagonists could lead to tolerance, meaning they may become less effective over time.

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Description

This quiz focuses on critical aspects of common medications used in pediatric care, including salicylate intoxication, acetaminophen safety, and NSAID usage. Learn how to educate patients and ensure safe medication management to prevent complications and promote effective treatment options.