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Clinical case in community pharmacy :

drugs used in children



1 neonate 1
infant 1 11 children
12-18 adolescent 1


3 ibuprofen syrup,
brompheniramine/phenylephrine syrup carbocysteine syrup

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Clinical case in community pharmacy: drugs used in children

ampicillin cloxacillin
gastric emptying time intestinal
transit
onset of action

3,4

o

Cushings syndrome potenttopical corticosteroids


neurotoxicity gamma-benzene hexachloride5

o
(volume of distribution; Vd)
blood-brain barrier(BBB) 6

o albumin
(free drug bound drug )
free fatty acid bilirubin albumin


(highly
protein binding) (replacement) bilirubin free bilirubin
encephalopathy 7 1

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Clinical case in community pharmacy: drugs used in children

1 : bilirubin
free bilirubin


o metabolism
hepatic enzymatic
metabolism8 chloramphenicol glucuronyl
transferase gray baby syndrome
first-pass metabolism

enzyme
(halflife)
diazepam
24-48 (infant)
10-12 6


o infant
enzyme
6,8

o glomerular filtration rate (GFR)
0.6-0.8
3 6



?





ibuprofen syrup ,
brompheniramine/phenylephrine syrup
9
carbocysteine syrup
10


/
11,12

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Clinical case in community pharmacy: drugs used in children






o (contraindication/ precaution) ibuprofen
NSAIDs
thromboxane A2

Dengue fever

ibuprofen
13
paracetamol
paracetamol
ibuprofen

(excipient)
alcohol sucrose
1 aspartame
phenylketonuria phenylalanine lactose
lactose intolerance
1










28


o (drug dosing)






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Clinical case in community pharmacy: drugs used in children



2



3-4

ibuprofen oral sus
pension drug information handbook
4-10 mg/kg/dose every 6-8 hours

cloxacillin 25-50 mg/
kg/day in divided doses every 6 hours

4 6
cloxacillin

4


2 (double check)


40
1


paracetamol syrup
3

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Clinical case in community pharmacy: drugs used in children


o (drug
duplication)

dextromethorphan paracetamol
- paracetamol

o (medication
adherence)


amoxicillin
3 8 2 12



1,15

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Clinical case in community pharmacy: drugs used in children



14

o

14

o


o




2 (, , )


o


7

azithromycin microspheres suspension
control-release formulation

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Clinical case in community pharmacy: drugs used in children


o 9




o


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Clinical case in community pharmacy: drugs used in children

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10th ed. China: Lippincott Williams & Wilkins; 2013:2265-76.
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3. Silverio J, Poole JW. Serum concentrations of ampicillin in newborn infants after oral administration. Pediatrics
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4. McCracken GH, Jr. Pharmacological basis for antimicrobial therapy in newborn infants. Am J Dis Child
1974;128:407-19.
5. Chosidow O. Clinical practices. Scabies. N Engl J Med 2006;354:1718-27.
6. Morselli PL, Franco-Morselli R, Bossi L. Clinical pharmacokinetics in newborns and infants. Age-related
differences and therapeutic implications. Clinical pharmacokinetics 1980;5:485-527.
7. Odell GB. The dissociation of bilirubin from albumin and its clinical implications. J Pediatr 1959;55:268-79.
8. Triggs EJ, Hooper WD, Dickinson RG. The influence of age on drug metabolism. Implications for drug dosage.
The Medical journal of Australia 1984;141:823-7.
9. Ryan T, Brewer M, Small L. Over-the-counter cough and cold medication use in young children. Pediatric
nursing 2008;34:174-80, 84.
10. Chalumeau M, Duijvestijn YC. Acetylcysteine and carbocysteine for acute upper and lower respiratory
tract infections in paediatric patients without chronic broncho-pulmonary disease. Cochrane Database Syst
Rev 2013;5:CD003124.
11. Chiappini E, Parretti A, Becherucci P, et al. Parental and medical knowledge and management of fever in
Italian pre-school children. BMC pediatrics 2012;12:97.
12. Walsh A, Edwards H. Management of childhood fever by parents: literature review. Journal of advanced
nursing 2006;54:217-27.
13. Sibbald B. Ibuprofen should go behind-the-counter says expert panel. Canadian Medical Association
Journal 2006;175:233.
14. Baber N, Pritchard D. Dose estimation for children. British journal of clinical pharmacology 2003;56:489-93.
15. Dundee FD, Dundee DM, Noday DM. Pediatric counseling and medication management services: opportunities
for community pharmacists. Journal of the American Pharmaceutical Association (Washington,DC : 1996)
2002;42:556-66; quiz 66-7.

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