1. Pediatric Pharmacotherapy Clinical Pearls
Caitlin Lozorak, PharmD
PGY2 Pediatric Pharmacy Resident
Palmetto Health Children’s Hospital
March 13, 2016

2. Disclosure
I have no disclosures or conflicts of interest at this time regarding the subject matter of this presentation.

3. Please note that this Power Point presentation is an educational tool that is general in nature. It is not intended to be an exhaustive review of the subject matter or the opinion of Palmetto Health. Materials presented in this presentation should not be considered a substitute for actual statutory or regulatory language. Always refer to your legal counsel and the current edition of a referenced statute, code and/or regulation for precise language.

4. Objectives
Upon completion of this program, the participant should be able to:
Explain principles of basic pediatric pharmacology including:
Weight-based dosing
Developmental pharmacology
Drugs in Pregnancy/Breastfeeding
Pediatric pharmacotherapy references

5. Weight-based Dosing Primary dosing method for pediatrics
unit (mcg,mg,gram) / kg (weight) / DOSE
unit (mcg,mg,gram) / kg (weight) / DAY
Be mindful of MAXIMUM doses
Do not exceed adult maximum doses
Patients >12 years old and/or > 50 kg
Similar to adult dosing
/ = PER
Always need to be mindful if per dose or per day and then splitting total into divided doses.
ALWAYS use a calculator

6. Developmental Pharmacology
“Pediatrics does not deal with miniature men and women, with reduced doses and the same class of disease in smaller bodies, but… has its own independent range and horizon.”
- Dr. Abraham Jacobi, the father of American Pediatrics
N Engl J Med 2003;349:

7. Absorption Enteral Absorption Intramuscular Absorption Changes in pH
Elevated in neonates
Immature biliary function
Delayed gastric emptying
Delayed intestinal motility
Decreased rate of absorption
Intramuscular Absorption
Reduced skeletal-muscle blood flow
Decreased muscle movement for drug dispersion
N Engl J Med 2003;349:

8. Absorption Rectal Absorption Topical Intrapulmonary
Contractions may cause expulsion of drug
Good blood flow and absorption
Topical
Increased absorption
Use with caution
Intrapulmonary
Systemic exposure may occur
N Engl J Med 2003;349:

9. Distribution  volume of distribution for hydrophilic medications
Especially neonates and young infants
 protein binding
Increased free drug
 distribution across blood brain barrier
Immature blood brain barrier in neonates and young infants
N Engl J Med 2003;349:

10. Metabolism Delayed maturation of drug-metabolizing enzymes Phase I
Cytochrome P-450’s
Change remarkedly during development
Phase II
Conjugation and glucuronidation decreased
Increases with age
Blood esterases
Decreased in neonates
N Engl J Med 2003;349:

11. Elimination Renal Decreased GFR
Renal maturation  GFR increases with age
Adult values at 8-12 months of age
Neonates – record urine output as a more accurate portrayal of renal function.
N Engl J Med 2003;349:

12. Drugs in Pregnancy/Breastfeeding
Recent change to “Pregnancy and Lactation Labeling Rule”
Effective June 2015
No longer A,B,C,D,X
Based off of human vs.
animal data
Instead of lettering
system narrative risk
summary
Allows patients and physicians to decide risk vs. benefit on their own
Image:

13. Pediatric Drug References
Comprehensive drug references
Lexicomp / Pediatric and Neonatal Lexi-Drugs
Micromedex / Neofax
Pediatric and Neonatal Dosage Handbook / Drug Information Handbook
Harriet Lane Handbook
Pediatric Pharmacotherapy Textbook (ACCP)
Intravenous Resources
Pediatric Injectable Drugs (Teddy Bear book)
Handbook of Injectable Drugs (Trissel’s)
Gahart’s Intravenous Medications

14. Pediatric Drug References
Infectious Disease
Red Book
Guidelines (IDSA, AAP, etc.)
Nelson’s Pediatric Antimicrobial Therapy
Harriet Lane Handbook on Antimicrobial Therapy
Drugs in Pregnancy & Lactation
Brigg’s
Miscellaneous
Guidelines on specific disease states
Journal Articles

15. Questions??