2. Introduction – Drugs and Children
• This presentation identifies some of the drugs
children are given in nursing. We look at the drugs
uses, how it is given, and who can and can’t be given
it.
• Medication dosing errors occur in up to 17.8% of
hospitalized children.
• Pirmohamed et al (2004) research suggested that
ADR’s in children were a large burden on the NHS
relating to morbidity, mortality and extra costs.
• Rashed et al (2012) also suggested that the
importance of identifying the reasons behind ADR’s
is to create prevention strategies for the future.
3. Paracetamol
(Acetaminophen)
The Most Commonly used medication both in
hospitals and in the community
• Uses - To relieve pain and lower raised
temperature.
• Who can have it – From neonates (28 weeks)
onwards.
• How is it given – most commonly by mouth, also
given rectally and by IV
• Who can’t have it - alcohol dependents
4. Paracetamol - Is It All Good??
• Pre-emptive administration before
vaccinations is thought to reduce antibody
response.
• Mounting evidence linking use of paracetamol
to the increases in prevalence of childhood
asthma.
• Should only be used for comfort not to
reduce fever – no evidence to show that it
reduces risk of febrile convulsions.
5. Ibuprofen
• Uses – To relieve pain, lower raised
temperature and reduce inflammation of
soft tissue injuries, also in NICU to close
patent ductus arteriosus
• Who can have it – From one month
• How is it given – By mouth or IV
• Who can’t have it – Not to asthmatics,
those with renal failure, gastrointestinal
problems, lupus, liver problems, low platelets
(oncology) also caution with cardiac
impairment.
6. Ibuprofen – Is It
All Good?
• It is now recommended it be used with
caution to close ductus arteriosus –
moderate sized duct usually doesn’t need to
be closed until the age of 1 or 2 years.
• Significant hypothermia has been
documented after therapeutic use or an
overdose.
• Renal toxicity – many febrile children will be
mildly dehydrated which is difficult to
detect.
7. Ibuprofen and/or Paracetamol?
• No evidence that reducing fever reduces mortality – in fact
current evidence suggests may actually adversely affect
outcome.
• Little is known about long term effects.
• NICE 2007
– antipyretic agents do not stop febrile convulsions and should not be
used specifically to reduce temperature.
– Not to administer the 2 drugs at the same time, but to consider the
alternative if child does not respond to first drug.
• Little evidence of any benefit or harm (either with fever or
comfort) of using both together.
• Combination of both can have summative effect and lead to
hypothermia.
• Complacent use in hospitals directly affects the
administration of these medicines in the home – age related
dosage at home may lead to under or over dosing.
8. Midazolam /benzodiazapine
• Uses – Given to children with convulsions
lasting > 5mins also a sedative for
procedures, pre med and anti epilepsy
medication
• Who can have it – From neonate
• How is it given – By I.V and buccal cavity
• Side Effects – respiratory depression
• Warning in a few patients can cause opposite
affect to sedation
9. Salbutamol
(Albuterol)
• Uses – To manage brochoconstriction and
asthma
• Who can have it –from 1 month
• How is it given – By I.V, aerosol (inhaler),
nebulised inhalation or dry powder
• Side effects - tremor (very common),
headache, sweats and tachycardia (fast heart
rate)
• Advise caution in diabetics due to potassium
regulation however remember ABC
10. Salbutamol
• The use of intravenous salbutamol in
patients with acute respiratory distress
syndrome is unlikely to be beneficial and
could worsen outcome - 34% of patients in
the salbutamol group died compared with
23% in the placebo group.
• Use of inhalers with spacers and
nebulisers have same outcome as long as
staff are properly trained in use of spacer.
11. Gaviscon Infant
• Uses – To relieve gastro oesophageal
reflux and dysphagia
• Who can have it – From neonate
• How is it given – Given by mouth, mixed
with feeds or water for breast fed babies
• Who can’t have it - Not where water loss
is likely or if there is an intestinal
obstruction.
12. Cefotaxime (pronounced with a K)
• Uses – An antibiotic usually first line on
most wards (broad spectrum antibiotic
covers anaerobes and aerobes).
• Who can have it – neonate - based on
weight
• How is it given – By I.M, I.V
13. Caffeine base/citrate
• Uses – respiratory stimulant – reduces the
frequency of neonatal apnoea and need for
mechanical ventilation during the first seven days
of treatment. Used in management of preterm
infants up to 44 weeks (or as long as required)
• Any babies born and started on ventilation will have
caffeine.
• How is it given – Given PO or IV
• Caution - with those with gastro oesophageal
reflux, cardiovascular but ABC comes first so
caffeine would be used to help respiratory
• Lots of research on caffeine and babies and used
in Canadian NICU as matter of course (according to
the QA neonatal consultant)
14. Morphine
• Uses – For pain or sedation
• Who can have it – From neonates
• How is it given – Given PO, IV or IM. If given by
injection diamorphine is preferable due to it being
more soluble can be given in smaller volume (The
equivalent subcutaneous dose is approximately a
third of the oral dose of morphine)
• Caution – respiratory depression, hypotensions,
shock
• Side effects – nausea, vomiting, hallucinations
(especially in the elderly)
15. Flucloxacillin (penicillin)
• Uses – Bacterial infections such as skin infections,
umbilical flare in NICU
• Who can have it – From neonates
• How is it given – Given by PO, I.M, I.V
• Who can’t have it - Contraindications – liver or
kidney problems
• Caution - Check allergy to penicillin -
hypersensitivity which causes rashes and
anaphylaxis and can be fatal. Allergic reactions to
penicillin’s occur in 1–10% of exposed individuals;
anaphylactic reactions occur in fewer than 0.05%
of treated patients. May cause diarrhoea
16. References
• NICE 2007
• BNF children 2012
• Pirmohamed, M., James, S., Meakin, S., Green C. (2004). Adverse drug reactions as
cause of admission to hospital: prospective analysis of 18 820 patients. BMJ, 2004.
• Rashed, A., Wong, I., Cranswick, N., Tomlin, S., Rascher, W., & Neubert, A. (2012).
Risk factors associated with adverse drug reactions in hospitalised children:
international multicentre study. European journal of clinical pharmacology, 68 (5).
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