Journal of Pediatric Pharmacology and Therapeutics最新文献

Dexmedetomidine is a centrally acting selective α₂-adrenergic agonist that initially received US Food and Drug Administration approval in 1999 for the sedation of intubated and mechanically ventilated adult patients for up to 24 hours. Since then, it has seen widespread use in clinical practice in various clinical scenarios including sedation during mechanical ventilation, provision of adjunctive analgesia, procedural sedation, treatment of withdrawal, and sedation during end-of-life care. Although traditionally administered intravenously, animal investigations and anecdotal clinical experience has reported efficacy with subcutaneous (SC) administration. Clinical applications of SC dexmedetomidine have included procedural sedation; outpatient and home care where IV administration may not be feasible or interfere with patient comfort; the management or prevention of drug withdrawal symptoms; and during end-of-life care. This educational review outlines the basic physiology of dexmedetomidine, and details reports of its SC administration in laboratory animals as well as various clinical scenarios with a specific focus on its applications in pediatric-aged patients. Techniques for SC administration and dosing schemes are presented.

Cannabis edible products pose significant health risks to children due to a wide variety of reasons. Currently, there is inconsistent governmental regulation and oversight for the manufacturing, packaging, and labeling of these products. Additionally, consumer education and harm reduction strategies are lacking, leading to an increase in the incidence of unintentional cannabis edible ingestions by the pediatric population. The variation of the components and potencies of cannabis products causes a wide range of dose-dependent adverse events within this patient population. This poses a significant challenge for clinicians treating pediatric patients who present with signs and symptoms consistent with cannabis intoxication. This article provides medical and pharmacological context on the current state of cannabis edibles in the United States, with further recommendations for the initial screening, management, and prevention of cannabis ingestions by pediatric patients.

Immunizations are among the most effective public health measures, significantly reducing the prevalence of serious infectious diseases across the population. Their success is so profound that many in the United States have never witnessed the devastating effects of illnesses, such as measles, polio, or diphtheria. Despite this progress, the Centers for Disease Control and Prevention reports a decrease in childhood vaccination rates. These decreases are likely related to the increasing rates of misinformation and disinformation surrounding immunizations. The impact of declining immunization rates is already being felt, as evidenced by the highest number of measles cases reported in more than 30 years. Pharmacists are in a key position to provide evidence-based recommendations and information to the public. As such, the Pediatric Pharmacy Association believes in the importance of ensuring pharmacists' continued access to reliable, evidence-based resources for professional reference and patient education, enabling effective communication and promoting informed decision-making about immunizations and the diseases they prevent.

Neonates are at an increased risk for seizures and are treated based on separate clinical practice guidelines compared with the pediatric patient population. Most seizures in the neonatal population are provoked, with the most common cause being intraventricular hemorrhage in preterm neonates and hypoxic ischemic encephalopathy in term neonates. Prompt recognition and treatment are considered cornerstones of therapy to help optimize long-term neurodevelopmental outcomes. This article focuses on considerations for pharmacological interventions in the treatment of neonatal seizures.

Objective: Pediatric diabetic ketoacidosis (DKA) results in dehydration and electrolyte losses, but there is no standardized potassium salt form for repletion. The objective of this research was to assess time to resolution of ketoacidosis in DKA patients comparing different potassium salts in the 2-bag system during an electrolyte shortage.

Methods: A retrospective cohort study was performed to review pediatric cases that met the institution's criteria for DKA and were started on the 2-bag system. Patients were identified from use of a DKA order set within the electronic health record. Cases were excluded if a patient received both potassium acetate and chloride, deviated from the active protocol product or were transferred to/from another institution. Data collected included patient demographics, and laboratory values including blood glucose, beta-hydroxybutyrate, venous pH, serum bicarbonate, and serum potassium collected at presentation and then per protocol until resolution of DKA. Initial laboratory values were utilized to determine DKA severity. Statistical analysis included descriptive statistics, Kaplan-Meier analysis for time to resolution of DKA, Wilcoxon rank sum test for continuous non-parametric data, and χ² or Fisher exact test for nominal data.

Results: A total of 124 cases were included: 62 in each cohort. There was a similar number of patients presenting with severe DKA in the potassium acetate group compared with the potassium chloride group (48.4% vs 51.6%). Cases in the potassium acetate group showed a median 48-minute faster time to DKA resolution than the potassium chloride group; this was not a statistically significant difference (p = 0.54). There was a statistically significant difference amongst the median length of stay between the potassium acetate and potassium chloride groups (43.7 hours vs 48.6 hours; p = 0.037). There was no noted mortality in either group.

Conclusions: There were no clinically significant differences in outcomes in pediatric DKA patients when comparing potassium acetate and potassium chloride in the 2-bag system.

Objective: Evidence on South African pharmacists' pediatric knowledge is limited. This study explored the knowledge, attitudes, and self-reported practices of South African pharmacists regarding pediatric pharmaceutical care.

Methods: A descriptive cross-sectional online survey was conducted among registered South African pharmacists. The survey, which was developed by the researcher based on previous studies, consisted of 4 sections: demographics, knowledge, attitudes, and self-reported practices. Contact information of pharmacists was obtained from The South African Pharmacy Council. Pharmacists were invited to participate via email, and a reminder email was sent after 2 weeks. The study was closed 3 days thereafter. Quantitative data were analyzed using descriptive and inferential statistics (significance set at p < 0.05), and qualitative responses underwent thematic analysis.

Results: A total of 436 surveys were fully completed (response rate of 2.4%). The median knowledge score of pharmacists was 9 out of 12 (IQR, 8-10). Participants performed well (90% correct) in questions on basic pediatric medicine, but more poorly in questions on pediatric dose calculations (66% correct), formulation challenges (67% correct), and pharmacokinetics (55% correct). There was no significant correlation between knowledge scores and years of practice, sector of practice, highest qualification, or training in pediatrics. There was a statistically significant correlation between participant knowledge and attitude scores (p = 0.003).

Conclusion: The study sample possesses knowledge of basic pediatric principles; however, gaps in knowledge remain. Participants expressed a lack of perceived preparedness for pediatric care following undergraduate training, underscoring the need for further research and educational reform.

Tacrolimus is a core medication of anti-rejection regimens for pediatric kidney transplant recipients. It is well known to have a narrow therapeutic window, affected by multiple factors, including absorption differences that influence drug concentrations in the body. Genetic polymorphisms of metabolizing enzymes, drug interactions, and intercurrent illnesses can impact drug clearance. This case report discusses a unique situation where a 12-year-old kidney transplant recipient experienced undetectable concentrations of tacrolimus in whole blood that were initially thought to result from excessive clearance due to severe diarrhea. Our nurse case manager investigated potential pharmacy errors by recommending that we test the home medication bottle, which revealed the absence of tacrolimus. Instead, the patient was given hydroxyurea, an anti-metabolite commonly used for oncologic and hematologic indications and can cause diarrhea, thrombocytopenia, and neutropenia. The patient experienced borderline rejection. The cause of this pharmacy error was multifactorial. However, confusion and complexities in the compounding process of liquid formulations likely played a role. This report underscores the importance of considering pharmacy errors as a potential cause of variations in tacrolimus drug concentrations. It emphasizes the role of nurses and interdisciplinary collaboration in identifying and addressing medication errors. It also underscores the need for standardization in the pharmaceutical compounding process and advocates for pharmaceutical industries to produce pediatric-appropriate formulations to reduce such errors.