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Drug Dosing: Infants and Children01:29

Drug Dosing: Infants and Children

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Pediatric patient dosages diverge from adults due to disparities in body surface area, total body water, and extracellular fluid per kilogram of body weight. The dosing regimen considers the variations in pharmacokinetics and pharmacology across distinct age groups, encompassing preterm newborns, infants, young children, older children, and adolescents. Calculation of pediatric patient doses is predicated on determining body surface area, which exhibits a superior correlation with the child's...
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Dosage Regimens: Designs and Approaches01:28

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Designing a dosage regimen, which refers to the manner of drug administration, is a complex process involving the selection of drug dose, route, and frequency. This process is underpinned by pharmacokinetic parameters derived from tests and population averages. These parameters are then tailored to patient-specific variables such as diagnosis, demographics, and allergy status. Once therapy commences, therapeutic response monitoring is critical and achieved through clinical and physical...
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Pharmacokinetics in Pediatric Patients: Drug Excretion01:26

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In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
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It is not uncommon for complete drug pharmacokinetic profiles to remain elusive in pharmacokinetics. This necessitates certain educated assumptions by pharmacokineticists to determine appropriate dosage regimens without comprehensive pharmacokinetic data from animal or human studies. One prevalent assumption is setting the bioavailability factor, denoted as F, to 1 or 100%. This assumption caters to the scenario where a drug doesn't achieve full systemic absorption, resulting in the patient...
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In pediatric care, understanding the nuances of hepatic drug metabolism is crucial, as it significantly differs from that of adults. This divergence is primarily due to the developmental stage of drug-metabolizing enzymes, which affects how medications are processed in the body. In neonates, for instance, the activity of Phase I enzymes—critical for the initial breakdown of drugs—is markedly reduced, functioning at just 20–40% of the levels seen in adults. This reduction poses...
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Nomograms and tabulations are vital tools used by clinicians to design accurate and individualized dosage regimens. These instruments provide a straightforward method for adjusting dosages based on individual patient characteristics, including age, weight, and physiological condition. The foundation of a drug's nomogram is population pharmacokinetic data collected and analyzed using specific models. This data simplifies complex equations, presenting them diagrammatically or tabularly for easy...
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A Standardized Formulary to Reduce Pediatric Medication Dosing Errors: A Mixed Methods Study.

Nichole Bosson1, Amy H Kaji1, Marianne Gausche-Hill1

  • 1Received June 9, 2021 from Los Angeles County Emergency Medical Services Agency, Santa Fe Springs, California (NM, MG-H); Department of Emergency Medicine, Harbor-UCLA Medical Center and, the Lundquist Institute, Torrance, California (NM, AHM); David Geffen School of Medicine at UCLA, Los Angeles, California (NM, AHM, MG-H). Revision received July 6, 2021; accepted for publication July 6, 2021.

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Summary

Implementing a Medical Control Guideline (MCG) with a standardized formulary reduced pediatric medication dosing errors for seizures. Paramedic anxiety decreased while confidence increased after the guideline

Keywords:
emergency medical servicesmedical errorpediatrics

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Area of Science:

  • Emergency medicine
  • Pediatric critical care
  • Medical quality improvement

Background:

  • Pediatric medication dosing errors are a significant concern in emergency medical services (EMS).
  • Midazolam is frequently administered by EMS for pediatric seizures, a time-sensitive condition.
  • Existing dosing protocols may contribute to errors and paramedic anxiety.

Purpose of the Study:

  • To evaluate the impact of a Medical Control Guideline (MCG) with a standardized formulary on pediatric midazolam dosing errors.
  • To assess changes in paramedic anxiety and confidence in administering midazolam for pediatric seizures post-MCG implementation.

Main Methods:

  • A mixed-methods study analyzing data from the Los Angeles County EMS data registry.
  • Comparison of midazolam dosing errors in pediatric patients (≤14 years) before and after MCG implementation (February 2017).
  • Paramedic surveys and semi-structured interviews to assess anxiety and confidence levels.

Main Results:

  • A reduction in dosing errors from 18.5% pre-MCG to 14.1% post-MCG (risk difference -4.5%, p=0.049).
  • Significant decrease in paramedic anxiety (p<0.001) and increase in confidence (p<0.001) regarding midazolam dosing.
  • Paramedics reported benefits including simplified tasks, increased self-efficacy, and improved communication.

Conclusions:

  • Implementation of an MCG with a standardized formulary effectively reduced pediatric medication dosing errors.
  • The guideline enhanced paramedic confidence and potentially improved patient care through task simplification and better communication.