DISPENSING 2
LECTURE
PRESCRIPTION ANALYSIS PT. 3
PRESCRIPTION
ANALYSIS FOR
PEDIATRIC PATIENTS
● STAGES
o "NEONATE: Just Born Babies (Up to first 30 days of life)
o PEDIATRIC: Also referred to as Infant (Up to 1 year)
o "EARLY CHILDHOOD: 1-5 years
o "LATE CHILDHOOD: 6-12 Years
NEED FOR VIGILANCE IN PRESCRIBING AND
DISPENSING, WHY?
● Children and particularly neonates, differ from adults in their
response to drug. Special Care is needed and does should be
calculated with Care.
● The Risk of Toxicity is increased at this stage because of:
o Reduced Drug Clearance (the kidney and liver are not yet
fully developed).
o And that the organs have differing target organ sensitivity.
● Wherever possible intramuscular injections (IM) should not be
given as these are painful.
IMPORTANT POINTS TO NOTE ON DISPENSING
PEDIATRIC PRESCRIPTION
● FROM THE LEGAL POINT
o The age of the child must be stated (years or months)
clearly
o The Strength and dosage form must be stated e.g Tablet
Salbutamol 2mg, Syrup Paracetamol 125mg/5mL
● FROM THE LEGAL POINT
o Good to provide body weight in Kg.
o Liquid Preparations are best advised to be used for
children and neonates.
o For long term treatment, choose a sugar free formulation
to avoid dental decay.
● FROM THE COUNSELLING POINT
o Provide syringe for dosage below 5mL.
o Always dispense and give counsel to the caregiver and
not to the neonate, infant or child.
o Label as "Give...." and not "Take..."
o Warn parents to Keep all medicines out of reach of
children.
- Cautionary labels are to be placed on pediatric
dispensed medicines.
o Parents should be advised not to add any medicines to
infant's feed, since the drug may interact with the milk or
liquid; or sometimes the infant does not drink all the
contents of the feed.
PRESCRIPTION ANALYSIS: DOSAGE IN CHILDREN
● CHILDREN’S DOSE IN THE MIMS/BNF ARE STATED IN
THE INDIVIDUAL DRUG ENTRIES, EXCEPT WHERE:
o 1. Pediatric Use is not recommended
o 2. Information is not available
o 3. There are special hazards.
● Dose are generally based on Body - Weight (in Kilograms) or
the following age ranges:
o First month (neonates)
o Infant (Up to 1 year)
o 1-5 years
o 6-12 years
● DOSE CALCULATION:
o 1. Many Children's doses are standardized by weight (and
therefore require multiplying by the body - weight in
Kilograms to determine the Child's Dose).
o 2. Occasionally, the does have been standardized by the
body surface area (in m³).
o NOTE: These methods should be used rather than
attempting to calculate a child's dose on the basis of
doses used in adults.
o 3. Important: Always consult reliable literature such as
MIMS, BNF, etc.
● DOSE CALCULATION:
o For most drugs, the adult maximum dose should not be
exceeded for children.
o Example:
▪ The dose for drug A for Children is stated as 8mg/kg
▪ Max. dose for adult is 300mg
▪ Weight of Child is 40Kg
▪ This Child should receive 300mg and NOT 320mg
o For obese and overweight children, calculation by Body -
Weight may result in higher doses than necessary. In such
cases, calculate using ideal weight use the chart provided.
● DOSE FREQUENCY:
o ANTIBACTERIALS are generally given at regular intervals
throughout the day.
o Some flexibility should be allowed in children to avoid
walking them during the night.
o For example, the night-time dose may be given at the
child's bedtime.
- Where new or potentially toxic drugs are used, the
manufacturer's recommended doses should be
carefully followed.
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PRESCRIPTION
ANALYSIS: FOR
PREGNANT AND
LACTATING WOMAN
PRESCRIPTION ANALYSIS: DRUGS AND
PREGNANCY
● Drugs can have harmful effects on the embryo or fetus at any
time during pregnancy.
● lt is important to note that all women of childbearing age or for
men trying to father a child.
● During the first trimester (the first three months of pregnancy)
drugs can produce congenital malformations (teratogenesis)
and the greatest period of risk is from the 3rd to 11th week of
pregnancy. (RELATING TO THE DNA)
● During the second and third trimesters drugs can affect the
growth or functional development of the fetus or they can
have toxic effects on fetal tissues. (DAMAGE TO THE
DEVELOPMENT AND TISSUE).
● Drugs given shortly before full term or during labor can have
adverse effects on labor or on the neonate (newly born baby)
after delivery. (RELATING TO DELIVERY AND THE
NEONATE).
NOTE:
- Not all the damaging effects of intrauterine exposure e.g.
ADENOCARCINOMA of the vagina after puberty to females
exposed to diethylstilbestrol in her mother's womb.
CLASSIFICATION USED IN BNF
● BNF/MIMS identifies drugs which:
o 1. May have harmful effects in pregnancy and indicates
the trimester of risk
o 2. Are not known to be harmful in pregnancy
NOTE: BNF/MIMS will indicate clearly for the relevant drug
entry the care needed when taking this drug during pregnancy.
NOTE: MIMS uses a more complex classification based on the
FDA classification.
GENERAL GUIDELINES BY BNF/MIMS: FOR
PREGNANT PATIENT
● Drugs should be prescribed in pregnancy only if the expected
benefit to the mother is thought to be greater than the risk to
the fetus, and all drugs should be avoided if possible during
the first trimester.
● Drugs which have been extensively used in pregnancy and
appear to be usually safe should be prescribed in preference
to new or untried drugs.
● The smallest effective dose should be used
● Drugs proven to be teratogenic in human should be avoided.
PRESCRIPTION ANALYSIS: DRUGS AND BREAST
FEEDING
● Breast - Feeding is beneficial:
- The Immunological and nutritional value of breast milk to
the infant is greater than that of formula feeds.
● Although there is concern that drugs taken by the mother
might affect the infant, there is very little information on this.
- However, in the absence of evidence of an effect, the
potential harm can be inferred by drug absorption,
distribution, metabolism studies etc.
● The amount of drug or its metabolites transferred in breast
milk is rarely significant to produce clinical effects on the
infant, especially to poorly absorbed drugs.
CLASSIFICATION USED IN BNF/MIMS
● BNF/MIMS identifies drugs which:
o 1. That should be used with caution or are contraindicated
in breast- feeding.
o 2. That can be given to the mother during breast-feeding
because they are present in milk in amounts which are too
small to be harmful to the infant.
o 3. That might be present in milk in significant amount but
are not known to be harmful.
NOTE: BNF/MIMS states that care is needed in dispensing
drug during breast-feeding, this is indicated under the relevant
drug in the BNF/MIMS.
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