General Principles in Pediatrics 1 PDF

General Principles in Pediatrics I Afnan A. Alsunaidi, PharmD, BCPS Consultant, Pediatric Clinical Pharmacist Director, Clinical Pharmacy Residency Program Co-chair, Pharmacy Practice Counsel K...

General Principles in Pediatrics I Afnan A. Alsunaidi, PharmD, BCPS Consultant, Pediatric Clinical Pharmacist Director, Clinical Pharmacy Residency Program Co-chair, Pharmacy Practice Counsel King Saud University Medical City [email protected] 9/10/2024 King Saud University - College of Pharmacy - PHARM 425 1 Objective Integrate pharmacokinetic and pharmacogenomic principles to determine appropriate dosing in special population Understand the pathophysiologic processes associated with a particular disease state and how it is affected by drug therapy. Recognize the important adverse reactions and interactions with other drugs, and relative and/or absolute contraindications Make therapy recommendations based on dosage calculations, specific uses and indications of drugs and nutritional and support therapy Review the dosing methods in different pediatric age groups Identify the most reliable dosing references to use in pediatric patients 9/10/2024 King Saud University - College of Pharmacy - PHARM 425 2 Outlines Introduction to Pediatrics Developmental Pharmacokinetics Reliable Dosing References in Pediatric Patients Dosing Methods in Different Pediatric Age Groups Appropriate Medication Routes Of Administration And Volumes And Dosage Form Selection Contraindicated Medications and Adverse Drug Reactions in Pediatrics 9/10/2024 King Saud University - College of Pharmacy - PHARM 425 3  Introduction to Pediatrics 9/10/2024 King Saud University - College of Pharmacy - PHARM 425 4 Introduction Percentage of youth and children out of Saudi population according to 2020 report by general authority of statistics 67% less than 34: youth From 0 – 14 years: 30.3 % less than 14: pediatric From 15 – 34 years: 36.7% According to the results from the Global Burden of Disease Study in Saudi Arabia published in 2020 Children maltreatment was among the top 20 Level 2 risk factors for all-cause years lived with disability and percentage changes from 1970 to 2017 32.8% (21.6 to 44.9) 9/10/2024 King Saud University - College of Pharmacy - PHARM 425 5 Pediatric Vulnerability to Medication Error The incidence has been reported 5.7 per 100 orders Medication errors in pediatrics are 3x more likely to cause harm than adults Developmental pharmacokinetics Weight-based dosing Doses are still extrapolated from adult studies (small adults) Off-label use of medications Lack of standardized drug formulations (e.g. extemporaneously prepared oral suspensions and intravenous medications manipulation) Communication barriers 9/10/2024 King Saud University - College of Pharmacy - PHARM 425 6 Role of a Pediatric Pharmacist Pharmacists who care for pediatric patients should be knowledgeable about disease states and medication therapy and have the skills to apply the knowledge to practice. Their responsibilities include, but are not limited to: Medication selection and use Monitoring of effectiveness and toxicity Prevention of medication errors Patient and caregiver education Contributions to knowledge through research Pharmacotherapy: Principles and Practice 2016:19-29 9/10/2024 King Saud University - College of Pharmacy - PHARM 425 7 Pediatric Age Classification and Definitions 9/10/2024 King Saud University - College of Pharmacy - PHARM 425 8  Age Terminology Gestational age (GA): Time from first day of last normal menstrual period to birth Conceptional age: Time elapsed between the day of conception and the day of delivery (more applicable and accurate in pregnancies resulting from assisted reproductive technologies) age since birth Postnatal age (PNA) or chronological age: Time elapsed since birth Postmenstrual age (PMA): GA + PNA Corrected age: Chronological age reduced the number of weeks born before 37 week of gestation (weeks or months) 37: full gestational age (it was written as 40 in the previous slide) Corrected age= PNA – (37 – actual GA) Reported up to 3 year of age if born prematurely Corrected age example: PNA: 3 months (i.e 3x4=12 weeks) actual GA: 32 12-(37-32) =12-7 =5 weeks 9/10/2024 King Saud University - College of Pharmacy - PHARM 425 9  Pediatric Age Classification and Definitions Keep in mind that there is a variation US Department of Health and the Food and Drug Administration (FDA) Infancy: between birth and 2 years of age Childhood: from 2 to 12 years of age Adolescence: from 12 to 21 years of age American academy of pediatrics (AAP) The upper age limit of pediatrics is 21 years Center of Disease Prevention (CDC) The upper age limit of pediatric is 20 years 9/10/2024 King Saud University - College of Pharmacy - PHARM 425 10 Pediatric Age Classification and Definitions According to NICHD (NICHD: Eunice Kennedy Shriver National Institute of Child Health and Human Development in the USA): Stage Definition Preterm neonatal Born before the full gestational period (