Drug Benefits and Risks - 2

7/31/2019 Drug Benefits and Risks - 2

1/31

A PRACTICAL APPROACH IN INITIATING AND

MANAGEMENT OF PHARMACOTHERAPY IN

CHILDREN


2/31

FORMAT OF THE PRESENTATION

INTRODUCTION

GUIDELINES FOR INITIATING AND

MANAGEMENT OF PHARMACOTHERAPY INCHILDREN

CONCLUSION


3/31

Introduction

Optimum individualized drug therapy firstrequire that prescribers understand the

general principles of drug disposition and effect.

Pharmacy profession should choose the mosteffective drug and its correct dosage,formulation, and route of administration, while

aware of its toxicity,contraindications, drug interactions side effectsand cost.


4/31

CONT

Since children can demonstrate age related

pharmacokinetic characteristics that alter drug

disposition,

prescribing medications for pediatric patients

requires an even greater knowledge of the drugs

profile.

It is imperative that prescribers/PharmacyProfessionals keep in mind the pharmacokinetic

differences between adult and children.


5/31

GUIDELINES

In initiating and management of pharmacotherapy in children,

ten main questions need to be answered:

Is Pharmacotherapy Indicated?

Under some conditions drug therapy is

inappropriate, unnecessary, and possibly harmful.

For example,In the management ofuncomplicated viral upper respiratory infections


6/31

Cont..

The professional who views this situations as

an opportunity for education and empowering

parents about the use and misuse of

medications can impact positively and

powerfully on the families in his care.


7/31

What are the criteria to start therapy?

Evaluated the patient,

formulated a differential diagnosis,

selected a probable working diagnosis, and

developed a treatment algorithm based on

the potential risks and benefits of proposed

drug therapy.

the affordability of the drug t affordable


8/31

CONT

After making a probable diagnosis

the clinician then chooses an appropriate drug.

The choice of the preparation and its formulation

will be influenced by: the intended route of administration,

the age of the children

availability of the preparation

concurrent therapy and possible underlyingdisease.

.


9/31

CONT..

This choice requires knowledge of the patient, the

disease entity to be treated, and the drug itself

Patient related factors include

Age: Neonate, infant, child etc

Medication allergies(Drug history)

Presence of chronic medical problem such as

renal or hepatic disease that may impact on

clearance.


10/31

CONT.

Compliance in terms of:

1. Formulation of the preparation

2. Taste of the drug

3. Cost of the drug

Social issues:

1. Complicated Regimen requiring many doses

2. Is Literacy Level of parent marginal3. Drug Compatibility with family moral, ethical,

cultural or religious mindset.


11/31

CONT

Successful drug treatment requires

communication with the patient and family so

that treatment goals, expected duration of

therapy, drug discontinuation procedures and

desired outcomes of treatment are

understood.


12/31

CONT..

Drug factor

Therapeutive index and potential drug toxicity are

critical factors in drug selection.For agent with

narrow therapeutic index,such as cytotoxicagent(methotrexate)must be given every half- life

or more frequently in other to avoid peak level

associated with toxicity. In children less than one year dosages are often

based on weight rather than surface area


13/31

Cont.

For drugs with wide therapeutic index such as

penicillin single dose may be quoted for a

wide age group

It is important to select the safest, most

efficacious drug for each clinical condition


14/31

What is the appropriate dosing

regimen?

Appropriate dosing regimen

dose amount,

dosing interval and

route of administration

is as important as deciding upon the

appropriate drug and incorrect dosing canresult in serious consequences ranging from

suboptimal treatment to toxicity.


15/31

CONT

today, most pediatric patients are dosed

according to body weight with further

adjustments as needed for age difference in

drug clearance.

dosing interval, which may vary with patient

age, is a function of the drugs half life,

which is the time required for theconcentration of the drug in the plasma to

decrease by one half.


16/31

CONT

The half life determine the frequency of dosingand varies both among drugs and patients.

The dosing interval for a drug is not always the

same between a neonate, child and adult. Drugs with short half-life, must be administered

more frequently while drugs with long half-lifemay be administered less frequently.

The average half life of theophylline is 4 5 hrsfor a child, 8hrs for non smoking adult andgreater than 10hours for a neonate.


17/31

Which route of administration is

optimum?

Depends on the specific circumstance of each

individual case.

Is intravenous administration required?

Does the patient have venous access?

Is intramuscular administration a possibility?


18/31

Is therapeutic drug monitoring

required?

Therapeutic drug monitoring (TDM) can be

vital in assessing patients response to

treatment, particularly drugs with narrowtherapeutic index

Serial monitoring of serum drug levels

provides data that are useful in evaluatingboth therapeutic efficacy and adverse effects.


19/31

CONT

Simply obtaining blood samples can be

difficult depending on the age, developmental

maturation and hydration status of the child

Once obtained, drug levels can be evaluated.


20/31

How will drug efficacy be assessed?

Sometimes efficacy is difficult to assess in the

pediatric patient, who may be too young to

answer questions like, Do you feel better. Pharmacy professional should learn to rely on

his patients actions such as going to the

playroom, instead of remaining quietly in bed.


21/31

CONT

It is always important to interview caregivers

about:

the patients activity level,

appetite,

behaviour and

response to drug therapy


22/31

How will adverse effects be evaluated?

Knowing :

the common and severe adverse effects of all

drugs prescribed,

as well as their frequency, severity and

management,

facilitate evaluation of signs and symptoms

hence there possible relation to drug therapy.


23/31

CONT

In general, a practical rule of three approachsuggests that pharmacy professional should

known the three most common and the threemost severe adverse effects of every drugthey prescribe.

This approach helps to reduce polypharmacywhen dealing with adverse effects, rather thanadding a medication


24/31

What drug interaction are possible?

Drug interactions can range from clinicallyirrelevant to fatal, and it only takes two

drug to cause a significant reaction. When prescribing a new medication, it is

essential for the pharmacy professional tobe aware of all other concurrentlyadministered drugs, including over thecounter (OTC) products.


25/31

How will compliance be assessed?

. Evaluating drug compliance in pediatric

patients can be complex and requires

assessment of both parent and patient

behaviours.

. factors affecting compliance :

number of drugs taken,

dosing intervals, adverse effects,


26/31

CONT.

drug cost,

patient or parent educational level,

peer pressure and effectiveness ofcommunication among professional ,parentand patient.


27/31

When and how should a medication

be discontinued?

A plan for discontinuing medication should be

established when therapy is initiated.

At the conclusion of the planned treatment period, itis appropriate to re evaluate the patient and to

decide if the criteria for drug efficacy have been

achieved. Ideally, the patients condition should have

reached a defined end point, such as resolution of

symptoms in acute disease processes, or return to

baseline status in a chromic illness.


28/31

Is the drug licensed

Is the drug licensed?If an unlicensed drug is to

used, the pharmacist should have sufficient

information to support its use.(eg off-label use

medicines)


29/31

CONCLUSION

Pharmacy professionals must ensure that their

knowledge, skills and performance are of high

quality, up to date, evidence based and

relevant to their field of practice, so thatevaluation, diagnosis and treatment of

children can be achieve successfully.


30/31

YOU CAN DO IT

I CAN DO IT

WE CAN DO IT


31/31

THANK YOU

Documents

Drug Benefits and Risks - 2