A Scoping Review of Medications Studied in Pediatric Polypharmacy Research.

PURPOSE: The purpose of this study is to describe medications most commonly studied in pediatric polypharmacy research by pharmacologic classes and disease using a scoping review methodology. METHODS: A search of electronic databases was conducted in July 2019 that included Ovid Medline, PubMed, Elsevier Embase, and EBSCO CINAHL. Primary observational studies were selected if they evaluated polypharmacy as an aim, outcome, predictor, or covariate in children 0-21 years of age. Studies not differentiating between adults and children or those not written in English were excluded. Study characteristics, pharmacologic categories, medication classes, and medications were extracted from the included studies. RESULTS: The search identified 8790 titles and after de-duplicating and full-text screening, 414 studies were extracted for the primary data. Regarding global pharmacologic categories, central nervous system (CNS) agents were most studied (n = 185, 44.9%). The most reported pharmacologic category was the anticonvulsants (n = 250, 60.4%), with valproic acid (n = 129), carbamazepine (n = 123), phenobarbital (n = 87), and phenytoin (n = 83) being the medications most commonly studied. In studies that reported medication classes (n = 105), serotonin reuptake inhibitors (n = 32, 30.5%), CNS stimulants (n = 30, 28.6%), and mood stabilizers (n = 27, 25.7%) were the most studied medication classes. CONCLUSION: While characterizing the literature on pediatric polypharmacy in terms of the types of medication studied, we further identified substantive gaps within this literature outside of epilepsy and psychiatric disorders. Medications frequently identified in use of polypharmacy for treatment of epilepsy and psychiatric disorders reveal opportunities for enhanced medication management in pediatric patients.

Polypharmacy in pediatric patients and opportunities for pharmacists' involvement.

Rates of chronic conditions among pediatrics have been steadily increasing and medications used to treat these conditions have also shown a proportional increase. Most clinical trials focus on the safety of solitary medications in adult patients. However, data from these trials are often times extrapolated for use in pediatric patients who have different pharmacokinetic processes and physical profiles. As research increases and more drugs become available for pediatric use, the issue of polypharmacy becomes more of a concern. Polypharmacy is defined as the practice of administering or using multiple medications concurrently for the treatment of one to several medical disorders. With the increased rates of diagnosed complex disease states as prescribed mediations in pediatric patients, the prevalence and effect of polypharmacy in this patient population is largely a mystery. Polypharmacy falls within the realm of expertise of specialized pharmacists who can undertake medication therapy management services, medical chart reviews, and other services in pediatrics. Pharmacists have the time and knowledge to undertake pertinent interventions when managing polypharmacy and can play a major positive role in preventing adverse events. The aim of this paper is to review the literature on pediatric polypharmacy and provide insight into opportunities for pharmacists to help with management of polypharmacy. Information on adverse events, efficacy, and long-term outcomes with regard to growth and development of children subject to polypharmacy has yet to be published, leaving this realm of patient safety ripe for research.

Disguising the taste of antiretrovirals for pediatric patients infected with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome: creative flavor compounding and techniques, part 1.

The question of how to disguise the taste of antiretrovirals for pediatric patients infected with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome is common for physicians, pharmacists, and parents/caregivers. Adherence to antiretroviral therapy is essential for living a long life and is imperative for the successful treatment of pediatric patients. The taste of these medications has been shown to affect adherence in this patient population. Parents/caregivers are not only tasked with remembering refills, dosages, and strengths of antiretrovirals, they have to become persuasive diplomats for the daily administration of these medications to their children. Provided in this first part of a two-part article is background information on this topic and a discussion on palatability concerns.

Disguising the taste of antiretrovirals for pediatric patients infected with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome: creative flavor compounding and techniques, part 2.

Adherence to antiretrovirals for pediatric patients is challenging for a variety of reasons, many of which are quite obvious. The medication's taste and texture may contribute to a child's resistance to following their regimen. To make the problem of compliance even more complex, there are fewer pediatric-friendly formulations available and fewer alternative options for antiretrovirals when compared to formulations and alternatives available to adults. For the sake of compliance, it is vital that parents and/or caregivers be offered innovative ways to disguise the taste of antiretrovirals for pediatric patients infected with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome. Compounding pharmacists can play an important role in finding answers to this situation. This article provides an in-depth discussion on some of the specific flavoring and taste-masking options that are available in the effort to increase adherence in the pediatric patient population.

Pharmacists' Research Contributions in the Fight against HIV/AIDs.

Pharmacists have made many contributions to HIV/AIDs research and are still showing their significance as members of the healthcare team through innovative clinical trials. Pharmacists are showing advances in several healthcare settings including inpatient, outpatient, and community pharmacies. Because of the complex regimens of highly active antiretroviral therapy (HAART), the increased life span of patients living with HIV, and other concomitant medications taken for comorbid disease states, there is a high risk for health-related complications and the development of adverse events. These adverse events may lead to decreased adherence to HAART, which may cause the development of HIV drug resistance. Pharmacists are providing examples through growing research on how they help combat medication-related errors and also continue to contribute as healthcare providers as a part of a holistic healthcare team.