Pediatric Pharmacology Lecture 10 PDF

ANTIVIRALS 38  § Adenovirus à causes pink eye § Rule of 7 § Upper respiratory tract infections are...

ANTIVIRALS 38  § Adenovirus à causes pink eye § Rule of 7 § Upper respiratory tract infections are common § Palliative treatment § Cool compresses § Artificial tears § Patient education!! § May consider antibiotic if concerned about secondary infection -there’s really no best medication to help it go away faster so use palliative treatment 39  § Signs/Symptoms § (+) PAN § Watery discharge § FBS § Follicular response -clear is viral -watery mucopurulent is allergic -yellow/green is bacterial 40  § Adenovirus serotypes 8, 19, 37 § Begins unilateral, becomes bilateral in up to 70% § Different from run-of-the-mill viral § Stain the cornea!! § Petechial or subconjunctival hemorrhage § Photophobia § Flu-like symptoms (fever, HA, fatigue) § Betadine: povidone iodine -this has corneal involvement so stain the cornea -presents initially unilateral but progresses bilateral so medication has to be applied in both eyes -wear gloves when a pt comes in with urgent red eye 41  § HSV1 § Not typically dendritic like in adults § Primary manifestation: uniliteral vesicular BKC -unilateral and will stay unilateral! -clear discharge bc its viral 42  Blepharoconjunctivitis Consider immune status of patient Topical or oral antivirals May do both oral and topical antiviral in Cornea immunocompromised Epithelial Oral or topical antiviral Oral acyclovir (about one year) long-term Debridement helps decrease the chance of recurrence of Stromal corneal disease (32% vs. 19% with prophylaxis) Topical steroid and antiviral cover (topical or oral) Endotheliitis (disciform keratitis) Topical steroid and oral antiviral Topical antivirals have poor penetration Uveitis Topical steroid and oral antiviral cover -topicals don’t get to the endothelium -if you’re treating a child long term with oral antiviral then you may have to change dosage of the medication bc overtime the child increases in weight hence the change in dosage 43 § Trifluoridine 1% (Viroptic soln) § Oral Acyclovir (Zovirax) § MOA: Inhibits DNA synthesis § MOA: inhibits DNA polymerase § Ages ≥6 years § Ages ≥2 years § Dose: q2h; up to 9x/day § 15 mg/kg/day, 5x/day x7-10 days § More toxic to the cornea, cheaper § Prophylactic dose BID ~1 year § Gancyclovir 0.15% (Zirgan gel) § Kidney and liver function must be monitored § MOA: inhibits DNA replication § Ages ≥2 years § Dosed 5x/day until heals then TID x7 days § Less toxic to the cornea, expensive 44 ANTI-INFLAMMATORIES 45  § Fluoromethalone § 0.1% (FML); 0.25% (FML Forte) § ≥2 years § Ung or soln § Loteprednol etabonate § 0.2% (Alrex); 0.5% (Lotemax) § NE STEROIDS § Prednisolone Acetate 1% (Pred Forte) § NE § Difluprednate 0.05% (Durezol) § NE § Side effects of PSC and elevated IOP are possible! Children are more susceptible and should be monitored closely -for steroids this is the only one that is FDA approved à know this! -however this is not the only one that can be used in kids -the rest of the steroids are off label use 46  § TobraDex (Dexamethasone 0.1% + Tobramycin 0.3%) § ≥2 years § Dose: 1gtt q4-6 hours STEROID + § Maxitrol (Dexamethasone 0.1% + Neomycin0.35% + Polymixin B) ANTIBIOTIC § ≥2 years COMBOS § Dose: 1gtt q4-6 hours § Blephamide (Sulfacetamide 10% + Prednisolone 0.2%) § ≥6 years § Dose: 2 gtts q4 hours -combo drops 47  § Not often prescribed in children § Acular (Ketorolac tromethamine 0.5%) § O n ly one approved; ≥ 2 years NSAIDS § D ose: Q ID § Nepafenac § >10 years 48 § Common Etiologies § Juvenile rheumatoid arthritis, juvenile idiopathic arthritis, traum a (sports), HSV/HZV, adult etiologies m ore rare § Treatment § Same as in adults § Pred Forte QID § Cyclopentolate Q D § Must monitor IOP (steroid responders) § Taper § Steroid Responders: § If IOP increases above 30mmHg: Add timoptic 0.25% § Be aware of contraindications § Co-manage with pediatric rheumatologist 49 -6D of cyl -peached pupils and had cells in AC and PS -bilateral chronic non granulomatous anterior uveitis 50 -can see the PS 51