Children – Pharmacology across the Lifespan (Nursing)

00:01 Okay, so we talked about neonates and infants, let's move on to children 1 year of age or older.

00:07 This is my favorite age group.

00:09 I love this 1-year plus age when they walk like Frankenstein, they're so fun to be with.

00:15 Now, you're talking about pharmacokinetics.

00:16 You already know that's absorption, distribution, and excretion, but whoa! Wait a minute, we're missing one.

00:23 Well, there's a reason metabolism is at the bottom of the slide.

00:26 See, absorption, distribution, and excretion for children 1 year and older are more like adults than neonates.

00:32 But metabolism of drugs is often faster in children 1 to 12 years of age than adults.

00:38 So make a special note of that.

00:41 3 of the 4 pharmacokinetic processes: absorption, distribution, and excretion, are more like adults than neonates.

00:50 But the metabolism of drugs is often faster in children 1 to 12 years of age than adults are.

00:56 So that's a really key and important point.

01:00 Okay. So let's look at, sadly, some things that happened to pediatrics, their unique pediatric adverse drug reactions.

01:08 There's a reason we do not give aspirin to pediatric patients.

01:11 So aspirin and salicylates can cause something called Reye's syndrome, which can be fatal.

01:17 So we just don't give aspirin to children anymore.

01:21 People that are old enough -- remember, we used to call them baby aspirin and they were kind of orange flavored and little kids would chew them, but they found that following a virus, if you give a child aspirin or a salicylate, it can cause a fatal Reye's syndrome.

01:35 Now glucocorticoids, those are corticosteroids.

01:39 We use them to suppress inflammation, but we try not to use them with pediatric patients because it will suppress their growth.

01:46 So, while we do use glucocorticoids, we try to use the smallest dose for the shortest period of time, and the least invasive route that we can, if possible, because we want to avoid growth suppression.

01:58 Now, antibiotics like chloramphenicol can cause Gray syndrome and that happens in neonates and infants.

02:05 That's a horrible syndrome.

02:07 They're vomiting, they turn this horrible gray color, their blood pressure drops, their breathing gets really irregular, and they cannot maintain their temperature.

02:16 So that is called Gray syndrome, and it happens with chloramphenicol, that's an antibiotic.

02:21 Tetracycline, we don't give to pediatric patients because when you think about tetracyclines, think about teeth, because it turns them brown.

02:31 People of a certain age that were given tetracycline, we just literally started calling it tetracycline teeth because they came really brown and stained.

02:39 And most people have had their teeth replaced with veneers that experienced tetracycline as a child.

02:44 Tetracycline binds to the calcium and that's why it really gives you problems in your teeth.

02:50 And finally, here's a weird one.

02:52 That we're talking about antibiotics, we got chloramphenicol, tetracyclines, and the last group is fluoroquinolones.

02:58 Which we give a ton of fluoroquinolones, by prescription, but in children, it has a rare tendency to cause a tendon rupture.

03:07 So we try to avoid giving the group of fluoroquinolones to children because of the risk for tendon rupture.

03:13 Okay. So we've looked at three groups of medications: aspirin, glucocorticoids, and antibiotics.

03:21 Aspirin is Reye's syndrome; glucocorticoids, growth suppression.

03:26 Then we've got chloramphenicol with Gray syndrome, tetracycline's with your teeth, and fluoroquinolones have a possibility of tendon rupture.

03:36 So, how do you keep these little guys safe? What do we do as nurses to safely give meds to the younger child? Well, another thing you want to keep in mind is they're at risk for choking hazards.

03:48 So you don't ever want to force a crying child to swallow a pill.

03:52 You know, even if it's a liquid, you risk them aspirating it, but if it's a pill, that pill could actually get lodged in their airway.

04:00 That's one of the saddest codes we ever had was a well-intentioned parent had forced a child to take a pill that they had normally taken every day, and ended up blocking their airway, and that was one of the scariest codes I have ever been in.

04:15 Now, you want to use a child's preferred flavors.

04:17 On a happier note, if there's a liquid elixir that you're giving, all the pharmacies have different flavors that you can put in that liquid to help it be more palatable to the child.

04:27 And finally, one really fun idea is you might put a really good taste in their mouth that they like, like a popsicle, before you have to give them an oral medication.

04:36 If it's a flavor they like and it's cold, it'll decrease their sensitivity to a really nasty taste of a medication.

04:44 Now, all kids love stickers and they like positive words.

04:48 So when you can get a child to take a medication, make it a celebration, make it a happy thing, make it a good thing for them by giving them some type of reward.

04:57 Try to identify 1 parent or caregiver in the home as the main medication dispenser.

05:04 One of the risks of overdosing children is if both well-intentioned guardians or parents are giving the child the same medication.

05:12 So an option might be to write down all medications in 1 place.

05:17 That way, if a parent or a guardian is gone, everyone is very clear on how much medication has been given to that child.

05:24 Okay. So we discuss tips for safety with drug administration for the younger child.

05:29 Now let's look at the older child.

05:31 Yeah, stickers don't work with this age group anymore, but the idea of the older child is they're very aware what other people, their peers, and other kids think of them.

05:40 So your job, if you want drug administration to be safe, is you want to simplify the regimen and minimize the child's perception of being too different from other people.

05:50 Remember what Junior High was like? Yeah, you already feel weird and awkward.

05:55 So having to go and take a medication during school, or having to go to the nurse can make things real difficult for that student, and they're less likely to be compliant.

06:04 So try and streamline and simplify the regimen as most as you can, so that student or that child doesn't feel like they stand out too much from their peers.

06:12 Help the older child understand the purpose of the medication and why they really need to take it, how they'll benefit from taking that medication, and give them as much control as possible.

06:24 You want them to have choices so that they can decide when, where, and how, as much as you can within the treatment plan, they're going to take that medication.

06:33 Make sure that you identify 1 parent, just like we talked about with a younger child, you want 1 parent to be the appropriate main medication dispenser.

06:42 You want to make sure that you're meticulous about writing down, every day, the dosages and the times of medication that you're getting, so everyone is communicating and on the same page.

06:51 And if it's a chronic regimen, help the older child find a support group.

06:56 Help them find other kids their age that are struggling with the same time types of concepts and ideas in taking medications and feeling different than others.

07:06 That's one way to help them really buy into the importance of their drug administration plan.

07:11 Okay. Now that we've talked about all that, it's your chance to pause, reflect, and recall.

07:16 So can you name a nursing intervention for safe drug administration that's unique to a younger child, and one that's unique to an older child? Take the time and just write those in your margin of your notes.

07:33 Well, that wraps up our presentation in lifespan pharmacology for the pediatric patient.

07:38 Thank you for watching our video today