A PRACTICAL APPROACH IN INITIATING AND MANAGEMENT OF PHARMACOTHERAPY IN CHILDREN

FORMAT OF THE PRESENTATION

INTRODUCTION
GUIDELINES FOR INITIATING AND MANAGEMENT OF PHARMACOTHERAPY IN CHILDREN CONCLUSION

Introduction
Optimum individualized drug therapy first require that prescribers understand the

general principles of drug disposition and effect.

Pharmacy profession should choose the most effective drug and its correct dosage, formulation, and route of administration, while aware of its toxicity, contraindications, drug interactions side effects and cost.

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/Pharmacy Professionals keep in mind the pharmacokinetic differences between adult and children.

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 of uncomplicated viral upper respiratory infections

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.

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

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 underlying disease. .

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.

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 marginal 3. Drug Compatibility with family moral, ethical, cultural or religious mindset.

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.

CONT..
Drug factor Therapeutive index and potential drug toxicity are critical factors in drug selection.For agent with narrow therapeutic index,such as cytotoxic agent(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

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

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 can result in serious consequences ranging from suboptimal treatment to toxicity.

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 the concentration of the drug in the plasma to decrease by one half.

CONT
The half life determine the frequency of dosing and 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-life may be administered less frequently. The average half life of theophylline is 4 5 hrs for a child, 8hrs for non smoking adult and greater than 10hours for a neonate.

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?

Is therapeutic drug monitoring required?

Therapeutic drug monitoring (TDM) can be vital in assessing patients response to treatment, particularly drugs with narrow therapeutic index Serial monitoring of serum drug levels provides data that are useful in evaluating both therapeutic efficacy and adverse effects.

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.

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.

CONT
It is always important to interview caregivers about: the patients activity level, appetite, behaviour and response to drug therapy

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.

CONT
In general, a practical rule of three approach suggests that pharmacy professional should known the three most common and the three most severe adverse effects of every drug they prescribe. This approach helps to reduce polypharmacy when dealing with adverse effects, rather than adding a medication

What drug interaction are possible?

Drug interactions can range from clinically irrelevant 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 to be aware of all other concurrently administered drugs, including over the counter (OTC) products.

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,

CONT.
drug cost, patient or parent educational level, peer pressure and effectiveness of communication among professional ,parent and patient.

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, it is 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.

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)

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 that evaluation, diagnosis and treatment of children can be achieve successfully.

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