Pharmacology

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Pharmacology

• Pediatric Medications

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Objectives

• Identify general rules for administering
  medication to children.
• Identify principles of medication administration
  for children.
• Calculate pediatric medication dosages.

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General Guidelines

• Be honest.
• Be friendly but firm.
• Try to gain cooperation of child.
• May need to restrain the child with help of
  parent or other personnel.
• Talk to the child.

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General Rules

• If the child is old enough, explain that he or
  she will
• taste a medication for a minute or so
• that medication will sting for a minute
• that it is important to be very still
• Keep the needle out of sight until time of the
  injection.

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General Rules

• Keep the knowledge of the injection until the
  last minute, but do let the child know prior to
  the injection.
• Offer praise after medicating even though the
  child may not have cooperated.
• Take opportunities to to explain how the
  treatment will be helpful.

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General Rules

• Crush tablets for children under 5 years old.
• Disguise crushed medications only in nonessential
  foods (the child may remember the bad taste and
  not eat the food again).
• A hug with your praise for cooperation may be
  helpful.

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Donts

• Dont offer bribes
• Do not allow parents to act like they are taking
  the medication first.
• Do not belittle or make fun of the childs fears.

• Do not say be a big boy or girl.
• Do not try to prevent crying.
• Do not offer rewards.
• Do not force oral medications.
• Never lie to a child.

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Oral Administration

• Give liquid instead of solid preparation to young
  children because of the risk of aspiration.
• Guideline is for children under 5 years of age
  (each child will be different).
• The most accurate means of measuring small
  amounts of medication is plastic disposable
  syringes (3-5 ccs).
• If the volume is lt 1 cc, use a tuberculin syringe.

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Oral Medications

• Be careful to avoid aspiration when administering
  oral medications to infants
• Hold in a semi-reclining position
• Place end of syringe along side of tongue
• administer medications in slow, small amounts
• Blow a small puff of air in face of infants up to
  11 months of age /or children with neurological
  impairments to elicit swallow.

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Oral Medications

• Do not add medication to infants formula.
• Do not mix disagreeable tasting medicines to
  essential food items (may be conditioned to taste
  and not eat anymore).

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Intramuscular Medications

• Injections must be placed into muscles large
  enough to accommodate the medication (preferred
  site for infants is the vastus lateralis).
• Dorsogluteal site not recommended until child had
  been walking for at least 1 year. The muscle
  develops with locomotion. Avoid danger of injury
  to sciatic nerve.

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Intramuscular Injections

• Ventrogluteal
• can be used after 7 months of age,
• site is relatively free of major nerves blood
  vessels.
• relatively large muscle with less subcutaneous
  tissue than dorsal site.
• easily accessible less painful than vastus
  lateralis.

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Intramuscular Medications

• Needle length
• must be sufficient to penetrate subcutaneous
  tissue and deposit into the muscle
• usually one inch needle is needed to penetrate
  vastus lateralis in 4 month old.
• Muscles of small infants may not tolerate more
  than 0.5 mL.
• Usually 1 mL is maximum volume in a single site
  to small children and older infants.

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Opthalmic (Eye) Administration

• Child is in a sitting position or with head
  extended
• ask child to look up
• pull lower lid downward
• medication is placed in the conjunctival sac
• may have to place in the nasal corner to let
  drops flow into conjunctival sac if lids have
  been tightly closed

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Otic (Ear) Drops

• Child is placed in a prone position or supine
  position head turned to the appropriate side
  (children younger than 3, gently pull pinna
  downward and straight back).
• After instillation, position on unaffected side
  for a few minutes and gently massage the tragus.

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Nose Drops

• Position with head hyper-extended to prevent
  strangling sensations caused by medicine
  trickling into throat rather than up the nasal
  passages.
• Use edge of bed or a pillow.
• Remain in position for 1 minute.

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Drug Calculations

• Special needs due to smaller size, weight, and
  body surface area.
• Varying capabiliteis for absorption, digestion,
  dsitribution, metabolism, and excretion.
• Check double check SDR (safe dose ranges)
  before medication administration.

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Two Ways to Calculate

• Body weight
• body weight in mg/kg
• or microgram/kg
• most frequently used method
• usually addresses amount in 24 hours
• 1 kg 2.2 lbs
• less accurate than BSA method

• Body surface area
• BSA
• use square meters using a scale called a nomogram
• most accurate

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Solving the Problems

• Step 1 Estimate the childs weight.
• Step 2 Calculate the SDR.
• Step 3 Compare and evaluate the ordered amount
  (is the dose safe?).
• Step 4 Calculate using rate proportion.
• Short cuts Weight in kg, SDR, compare with
  order, calculate dose if safe.

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Rules

• All pediatric medication administration begins
  with an accurate weight and a calculation of the
  SDR.

• To convert infant weight from lbs to kgs, convert
  ounces to pounds by dividing the ounces by 16,
  then divide the total pounds to (to the nearest
  tenth) by 2.2 .

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Working the Problems

• Brown, pg. 225
• Step 1 Estimate weight (2 steps if ounces are
  involved)
• Step 2 SDR (calculate to see if correct)
• Step 3 Evaluate
• Step 4 Decision (give if within SDR), calculate
  and give the correct dose

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Working the Problems

• Brown, practice problems
• Pg. 232 - 233 1 - 3.
• Pg. 230 1 - 5.
• Pg. 240 1 only

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Questions?