The Past, Present, and Future of Oral Dosage Forms for Children.

The administration of medications to children has been a challenge for parents and caregivers for generations. Pharmaceutical companies have often overcome the difficulties of weight-based dosing and the -inability of most young children to swallow solid dosage forms by creating oral liquids. While oral liquids -offer advantages in terms of dose flexibility, swallowability, and ease of administration for young children and patients with enteral tubes, they have been plagued by issues such as taste, volume, and texture, to name a few. While the recommendations for broader use of oral syringes can help with the issue of measuring accuracy and incremental dosing, the issues of poor taste and frequently unacceptable volumes for doses remain a problem. New oral dosage forms which have begun to enter the United States marketplace have the potential to improve adherence and acceptability of oral medications for children, but come with their own unique challenges.

Key Potentially Inappropriate Drugs in Pediatrics: The KIDs List.

OBJECTIVES: The safe use of medications in pediatric patients requires practitioners to consider the unique pharmacokinetics and pharmacodynamics of drugs prescribed in this age group. In an effort to create a standard of care for the safe use of medications in this population, a list of drugs that are potentially inappropriate for use in pediatric patients has been developed and titled the "KIDs List." METHODS: A panel of 7 pediatric pharmacists from the Pediatric Pharmacy Association were recruited to evaluate primary, secondary, and tertiary literature; FDA Pediatric Safety Communications; the Lexicomp electronic database; and product information for drugs that should be considered potentially inappropriate for use in pediatric patients. Information was rated using predefined criteria. A PubMed search was conducted using the following terms: adverse drug events OR adverse drug reactions. The search was limited to humans; age <18 years; case reports, observational studies, or clinical trials; and English language. No date range was used. Results were used to create an evidence-based list of candidate drugs that was then peer-reviewed and subjected to a 30-day public comment period prior to being finalized. RESULTS: A PubMed search yielded 4049 unique titles, of which 210 were deemed relevant for full review. Practitioner recommendations highlighted an additional 77 drugs. FDA Pediatric Safety Communications and the Lexicomp database yielded 22 and 619 drugs, respectively. After critical analysis, peer review, and public review the final KIDs List contains 67 drugs and/or drug classes and 10 excipients. CONCLUSIONS: This extensive effort led to compilation of the first list of drugs that are potentially inappropriate for prescribing in all or in a select subgroup of pediatric patients. If avoidance is not clinically possible, the drug should be used with caution and accompanied by appropriate monitoring.

Caring for and assessing pediatric patients: Aspects to consider as a pharmacy practitioner.

PURPOSE: Pharmacists care for patients of all ages. Pediatric patients are not smaller versions of adults; thus, they provide a unique challenge to pharmacists. Basic components of patient assessment and considerations for medication dosing and administration for pediatric patients are reviewed here. SUMMARY: Each pediatric patient is different, and physiological changes occur as a patient ages. Growth, vital signs, and laboratory tests are common assessments for all patients. However, there are unique factors to consider within the pediatric population, and a pharmacist must understand how to assess and interpret these data for pediatric patients of all ages. Additionally, individualized medication dosing is based on patient factors such as age, weight, or body surface area in this population. Key information about the administration of medications and understanding of dosage formulations for this patient population is an area where pharmacists can make recommendations to prescribers and counsel patients and caregivers in order to improve patient outcomes and increase adherence. CONCLUSION: Patient assessment by the pharmacist is a key step in developing a patient treatment plan. Assessment factors in the pediatric population can differ from those in the adult population. A working knowledge of differences within the pediatric population and understanding how to assess them is essential for providing optimal patient care to this population.

Pharmacotherapy review of chronic pediatric hypertension.

BACKGROUND: The number of antihypertensive agents on the market has increased dramatically over the past 20 years. Many of these agents are used to treat children and adolescents with hypertension despite there being relatively limited data available supporting such use. Recent legislation has helped to increase the number of studies conducted in children, but many clinical questions remain unanswered. OBJECTIVE: The goals of this article were to review the currently available antihypertensive agents used in the treatment of pediatric hypertension and to assist clinicians in selecting the most appropriate treatment. METHODS: Searches of MEDLINE and International Pharmaceutical Abstracts through July 2011 were conducted. Search terms used included child, pediatric, hypertension, and the following drugs: captopril, enalapril, lisinopril, fosinopril, losartan, valsartan, irbesartan, candesartan, olmesartan, amlodipine, nifedipine, isradipine, felodipine, propranolol, metoprolol, labetalol, minoxidil, furosemide, spironolactone, chlorothiazide, hydrochlorothiazide, hydralazine, and prazosin. Clinical trial data were reviewed and evaluated and were limited to English-language articles. RESULTS: A total of 45 observational and randomized controlled trials were identified and summarized in this review. The angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and calcium channel antagonists (CCAs) had the strongest data to support their use in pediatric patients. ACE inhibitors and ARBs are preferred agents for children with renal disease and have a favorable safety profile. Many trials, including 2 comparative trials, supported the use of CCAs, particularly amlodipine, in children. CONCLUSIONS: Trials in all 3 classes suggested their efficacy as well as a tolerable adverse-effect profile. More trials in children are needed, particularly with newer antihypertensive agents. Comparative trials of different agents are the most lacking.

Implementing a pediatric pharmacy educational program for health-system pharmacists.

OBJECTIVE: To implement an educational program to improve pediatric content knowledge and confidence in providing pediatric care among health-system pharmacists. DESIGN: Pharmacists were asked to voluntarily participate in this prospective, observational education program. A demographic assessment, pre- and post-intervention confidence assessments, and pre- and post-lecture competency assessments were conducted to evaluate the program. ASSESSMENT: Five of the 6 confidence scores improved from the preintervention to the postintervention stage. Test scores for 2 of the 8 postlecture tests improved significantly, and the average test scores for all postlecture tests combined were significantly higher than those for the prelecture tests. CONCLUSION: This study demonstrated significant improvements in both confidence and competence in pediatric pharmacotherapy among health-system pharmacists following implementation of a pediatric pharmacy education program.

Pediatric fluid and electrolyte therapy.

Managing fluids and electrolytes in children is an important skill for pharmacists, who can play an important role in monitoring therapy. Fluid therapy is divided into maintenance, deficit, and replacement requirements. The Holliday-Segar equation remains the standard method for calculating maintenance fluid requirements. Accounting for deficits when determining the fluid infusion rate is an important factor in treating dehydrated patients; deficit fluid is generally administered over the first 24 hours of hospitalization. Maintenance electrolyte requirements must be taken into account, with particular attention paid to sodium requirements, as recent evidence suggests that sodium needs in hospitalized children are higher than originally thought. Fluid therapy can also have an impact on drug therapy. Hydration status can affect the dose needed to achieve therapeutic concentrations, and dehydrated patients may be at risk for toxicity if standard doses of drugs with high volumes of distribution are used. Monitoring fluid and electrolyte therapy is an important role of the pediatric pharmacist.