Paediatric Principles 3 - 2024 Cases (PDF)

PHM101: PHARMACOTHERAPY MODULE I PEDIATRIC PRINCIPLES: III Pharmaceutical Care Patient Care Process Jas Otal, RPh Clinical Pharmacist, Paediatric & Respiratory Medicine, Surgical Services The Hospital for Sick Children...

PHM101: PHARMACOTHERAPY MODULE I PEDIATRIC PRINCIPLES: III Pharmaceutical Care Patient Care Process Jas Otal, RPh Clinical Pharmacist, Paediatric & Respiratory Medicine, Surgical Services The Hospital for Sick Children with special thanks to Marina Djuka, RPh February 7, 2024 Pediatric Principles: Series I-III Abbreviations ID Intradermal IM Intramuscular SC Subcutaneous OTC Over the counter PO By mouth GERD Gastroesophageal reflux disease ODT Oral dissolving tablet TID Three times daily Q6H Every 6 hours PRN As needed  IMMUNIZATIONS  What are vaccines?  Biological preparations that promote the body’s immune system to make antibodies, T-cells and memory cells against bacterial and viral pathogens  What are they made of?  Killed/inactivated vaccines consist of whole microbes or isolated microbial components  Live (attenuated) vaccines contain altered microorganisms  Both types provide active immunity  Why do we give them?  To provide long term prevention of infection, disease or illness CASES Case 1: Vaccinations 2 month old baby girl comes to the clinic with her mom for scheduled immunizations. Nurse calls to clarify administration of vaccines as well as receive guidance on minimizing pain.  IMMUNIZATION SCHEDULE (ON) DTaP-IVP-Hib: diphtheria, tetanus, acellular pertussis, inactivated polio virus vaccine, H. influenzae type B Var: varicella PneuC-13: pneumococcal conjugate (13 valent) MMRV: measles, mumps, rubella, varicella Men-C-C: meningococcal conjugate (type C) Men-C-ACYW: meningococcal conjugate (A,C,Y,W-135) MMR: measles, mumps, rubella HB: hepatitis B HPV-4: quadrivalent human papilloma virus Tdap: diphtheria, tetanus, acellular pertussis vaccine Inf: influenza Rot-1: rotavirus oral vaccine  Considerations for administration Case 1: Vaccinations 2 month old baby – Number of vaccines: 2 IM, 1 oral girl comes to the (Pediacel, Prevnar-13, RotaTeq) clinic with her mom for scheduled – Age of patient: 2 months immunizations. Nurse calls to clarify administration of – Administration site: vastus vaccines as well as lateralis receive guidance on minimizing pain. – Volume of vaccines: 0.5mL each  Minimizing pain Case 1: Vaccinations 2 month old baby – Swaddling, giving pacifier girl comes to the clinic with her mom – EMLA cream application 30 for scheduled minutes prior to administration immunizations. Nurse calls to clarify – Sucrose prior to administration administration of vaccines as well as receive guidance on – Acetaminophen post immunization minimizing pain. if baby continues to show signs of pain/irritability Case 2: Vaccinations 4 year old boy comes to the same clinic later on in the day. The same nurse calls and asks if there is anything different that they need to do for this patient in terms of vaccine administration and pain management  Considerations for administration Case 2: Vaccinations 4 year old boy – Number of vaccines: 2 IM (DTaP comes to the same Polio, MMRV) clinic later on in the day. The same nurse calls and asks if – Age of patient: 4 years there is anything different that they need to do for this – Administration site: deltoid patient in terms of vaccine – Volume of vaccines: 0.5mL each administration and pain management  Minimizing pain Case 2: Vaccinations 4 year old boy – Distractions: toys, movies, music, comes to the same bubbles clinic later on in the day. The same nurse calls and asks if – EMLA cream application 30 there is anything minutes prior to administration different that they need to do for this patient in terms of – Acetaminophen post vaccine vaccine administration if pain/fever administration and pain management Case 3: Medication History Questions 18 month old boy with a history of reactive airway disease and GERD is Do you have a list of medications your child admitted to the general pediatrics ward. You are Is currently taking? asked to speak to the family in order to obtain a best possible medication history. Do you have your child’s medications with In speaking to the patient’s mother you find out that he you? is using a blue puffer as needed and that he is on 2 medications for GERD. Mom does not remember the At what pharmacy do you fill your child’s names but she knows that medications? one is a tablet she dissolves and another is a liquid of which she gives 1.5mL three times daily.  SAMPLE QUESTIONS 1. Do you have a list of medications you are currently taking? 2. Do you have your medications with you? 3. What does your medication look like? (dosage form, shape, colour) 4. Are the pills in the bottle same as what is on the label? 5. Did the doctor change the dose or stop any of your medication recently? 6. Have you changed the dose or stopped any of your medications recently? 7. Have any of the medications been causing side effects? 8. When you feel better, do you sometimes stop taking your medicine? 9. Sometimes if you feel worse when you take your medicine, do you stop taking it? Case 3: Case 3: Medication History Medication History After calling the community 18 month old boy with a pharmacy… history of reactive airway disease and GERD is admitted to the general pediatrics ward. You are Lansoprazole ODT 7.5mg po daily asked to speak to the family in order to obtain a best (15mg/tablet) possible medication history. In speaking to the patient’s mother you find out that he is using a blue puffer as Domperidone 7.5mg po TID needed and that he is on 2 (5mg/mL) medications for GERD. Mom does not remember the names but she knows that one is a tablet she dissolves Salbutamol MDI 2puffs inhaled Q6H PRN and another is a liquid of which she gives 1.5mL three (100mcg/puff) times daily. Case 4: Case 3: Medication History counseling Discharge Dose on admission 18 month old boy with reactive airway disease and GERD is about to be Lansoprazole ODT 7.5mg po daily discharged home. You notice that his measured weight of (15mg/tablet) 12.5 kg is higher than the estimated weight on admission. You suggest Domperidone 7.5mg po TID optimizing the dose of his current reflux medications. (5mg/mL) The medical team would like to start him on an inhaled corticosteroid (fluticasone) given worsening respiratory symptoms and requested that you do some teaching with the family. RESOURCE: SickKids e-formulary Dose on admission Lansoprazole ODT 7.5mg po daily (15mg/tablet) Dose on discharge Lansoprazole ODT 15mg po daily RESOURCE: SickKids e-formulary Dose on admission Domperidone 7.5mg po TID 7.5mg/12.5kg = 0.6mg/kg/dose Volume per dose = 1.5mL Dose on discharge Domperidone 10mg po TID 0.8mg/kg/dose x 12.5kg = 10mg Volume per dose = 2mL Case 4: Case 3: Medication History counseling Discharge Discharge counseling 18 month old boy with reactive airway disease and GERD is about to be discharged home. You notice Fluticasone that his measured weight of 12.5 kg is higher then the Indication estimated weight on admission. You suggest Administration – dosage form optimizing the dose of his current reflux medications. Side effects The medical team would like to start him on an Storage inhaled corticosteroid (fluticasone) given worsening respiratory symptoms and requested that you do some teaching with the family. DISCHARGE COUNSELING  Pediatric Principles: Series I-III Basics & Paediatric Talking to Development Prescriptions Patients Pharmacokinetic/ Drug Products Medication history, Pharmacodynamic Dosage Forms Patient Counselling Pharmaceutical Care Patient Care Process ASSESSMENT  Meet the patient  Elicit relevant information from the patient  Pharmacotherapy work up CARE PLAN  Establish goals of therapy  Select appropriate interventions for resolution of DTPs  Schedule follow-up EVALUATION/FOLLOW-UP  Elicit clinical/lab evidence of patient outcomes and compare to goals of therapy (determine effectiveness)  Elicit clinical and lab evidence of adverse effects (determine safety)  Document clinical status & any required changes to pharamcotherapy  Assess patient for any new DTPs  Schedule next follow-up evaluation Thank You