Journal of Pediatric Pharmacology and Therapeutics最新文献

Cannabis is a highly discussed topic in medicine today. From therapeutic applications in conditions such as chronic pain, multiple sclerosis, epilepsy, chemotherapy-induced nausea and vomiting, and inflammatory bowel disease to the growing prevalence of recreational use, cannabis remains at the forefront of medical and societal conversations. In this review, we will explore the history of marijuana use in medicine, examine the current evidence supporting its pharmacological benefits, and delve into its impact on the developing brain. Additionally, we will highlight the pivotal role pharmacists play in this evolving landscape and guide you through the latest research findings.

Objective: Variations in pharmacokinetics necessitate monitoring anti-Xa concentrations for optimal anticoagulation in pediatric patients receiving enoxaparin for the prophylaxis or treatment of venous thromboembolism. Pharmacists play an essential role through pharmacist-to-dose (PTD) protocols. This study aims to assess the impact of pharmacist involvement by comparing rates of achieving target anti-Xa concentrations before and after implementation of the PTD protocol in a pediatric population.

Methods: Medical records were queried for patients 18 years old and younger who received enoxaparin as an inpatient at West Virginia University Medicine Children's Hospital from January 2016 to September 2023. Indication, dosing, and administration of enoxaparin were assessed. Anti-Xa concentrations were evaluated for appropriate timing and goal range. Secondary outcomes included the number of anti-Xa concentrations drawn, the number of enoxaparin dose adjustments, the rate of accurately drawn anti-Xa concentrations, the rate of following guideline recommended enoxaparin dosing on initiation, and the time to goal anti-Xa concentration.

Results: There was no difference in the rate of anti-Xa concentrations that were in goal before and after the implementation of a pharmacist-led enoxaparin dosing protocol. The frequency of concentrations drawn appropriately was higher, and the time to goal was shorter after the implementation of the PTD protocol, although this difference was not statistically significant.

Conclusions: There was no difference in the rate of anti-Xa concentrations that were in goal between groups. This likely stemmed from the use of the same dose adjustment guideline among both groups. This underscores the equal quality of care provided by pharmacists in achieving optimal anticoagulation and positive outcomes.

Objective: The purpose of this survey was to evaluate knowledge and perception of naloxone among patients with sickle cell disease and their caregivers.

Methods: A 13-question survey about naloxone and the subject's perception of naloxone was developed by the research team and reviewed by 5 advocates for pediatric patients with sickle cell disease. The survey was offered to patient-caregivers and patients ≥12 years old with sickle cell disease and a prescription for home opioid medication. The survey was conducted during a clinic visit or inpatient admission with a convenience sampling strategy.

Results: A total of 23 surveys were completed (9 patients and 14 caregivers). Nine of 23 subjects (40%) said they had heard of naloxone. Three subjects had naloxone at home. Only 3 caregivers said having naloxone at home would change their opioid use behavior.

Conclusion: There is a lack of awareness about naloxone in the pediatric sickle cell disease population. Those who were aware of naloxone did feel it was an important medication and appeared to have a positive view of it.

Objective: This study aimed to investigate the chemical stability of diphenhydramine in a pediatric "Magic Mouthwash" preparation, specifically a 1:1 mixture of aluminum hydroxide/magnesium hydroxide/simethicone (Mylanta comparable product) and liquid diphenhydramine over 90 days under different storage conditions.

Methods: A high-performance liquid chromatography-ultraviolet method was developed for quantifying diphenhydramine in the mouthwash. A total of 10 bottles of mouthwash were prepared, with half stored in the refrigerator and half kept at room temperature. The method was applied to analyze the stability of diphenhydramine in the mouthwash preparations, with 5-mL aliquots removed from each bottle at 0, 1, 7, 14, 30, 60, and 90 days. Stability was defined as maintaining 90-110% of the initial concentration.

Results: Both storage conditions (room temperature: 19.3 ± 0.8°C; refrigeration: 3.01 ± 0.3°C) maintained stable temperatures. The pH remained stable (room temperature: 8.34 ± 0.4; refrigeration: 8.38 ± 0.4). Diphenhydramine concentrations stayed within the 90-110% range for the entire study duration under both conditions. No statistically significant differences in diphenhydramine concentration were observed between storage conditions or over time.

Conclusion: The pediatric "Magic Mouthwash" demonstrated stable pH and diphenhydramine potency over 90 days, regardless of whether it was stored at room temperature or refrigerated. This supports the feasibility of bulk preparation and extended storage of this formulation, providing a safe and effective alternative to lidocaine-containing mouthwash for pediatric patients.

Objective: Medication workflows are important to improve patient safety and provide timely lifesaving medical care. When operating efficiently, they can also decrease medication and labor waste. The objective of this quality improvement project is to compare missing dose request rates before and after improvements in medication workflows, specifically, decreases in medication and labor waste and the financial implications of these improvements.

Methods: The study evaluated the rate of medication missing dose requests on a 24-bed medical surgical unit in a standalone pediatric hospital from May 2022 to October 2022. Medication workflows were evaluated by pharmacy and nursing team members, and interventions were identified and implemented with the Model for Improvement methodology. Outcomes of missing dose requests per 100 medication doses dispensed were tracked weekly, as were staff time and costs of medications.

Results: The missing dose requests per 100 medication doses dispensed decreased from 3.8 to 1.03 during the 6-month initiative. This improvement estimated that 988 missing medication doses were prevented, leading to an estimated $61,038.64 in waste savings. The average cost of the medication and materials (excluding labor) to replace a single missing dose of medication was $61.78. The median cost was $54.71 (IQR, 11.91-4,213.11). Pharmacist, pharmacy technician, and nurse time saved per missing dose were estimated to be 6, 14, and 17 minutes, respectively.

Conclusion: Multimodal improvements in inpatient medication workflow reduce missed medication errors and improve cost and labor efficiencies.

Objective: The objective was to update the KIDs List, a list of drugs and excipients that are potentially inappropriate for use in pediatric patients, accounting for emerging pharmacologic agents and published evidence.

Methods: A panel of 12 pediatric pharmacists from the Pediatric Pharmacy Association (PPA) evaluated primary, secondary, and tertiary literature; FDA Pediatric Safety Communications; the UpToDate Lexidrug database; and product information for drugs that may be considered potentially inappropriate for use in pediatric patients. A PubMed search identified new publications from October 1, 2017, to November 1, 2023. All agents included in the previous publication and those anecdotally identified as candidates for the list by the authors or PPA members were evaluated. Evidence was reviewed by all authors. The draft list underwent a 30-day public comment period prior to being finalized.

Results: A PubMed search yielded 917 unique titles of which 17 were deemed relevant for full review. Sixty-seven drugs and/or drug classes and 10 excipients from the original publication were also reviewed. Author and PPA member recommendations highlighted an additional 25 drugs or drug classes. The UpToDate Lexidrug database extraction yielded 1470 drugs, which were filtered to 145 agents for author review. After critical analysis and reorganization, the second edition of the KIDs List contains 39 drugs and/or drug classes and 10 excipients.

Conclusions: This article updates the initial list of drugs and excipients that are potentially inappropriate for prescribing in all or a select subgroup of pediatric patients. The second edition should stimulate novel research to inform future updates.

Objectives: Intrapleural alteplase is used in children with parapneumonic effusion (PPE) with variable dosing strategies. We compared the outcomes of a lower (≤2 mg) and a higher (>2 mg) alteplase dose in children with PPE.

Methods: A retrospective study was conducted among admitted patients younger than 18 years who received at least 1 intrapleural alteplase dose from July 2014 to May 2023. The primary outcome was the treatment failure rate. Secondary outcomes included chest tube output and duration of placement and hospital and pediatric intensive care unit (PICU) length of stays.

Results: Seventy-two patients were included (lower dose: 62.5% vs higher dose: 37.5%) with a median age of 5 years (IQR, 1-8 years). The median alteplase dose was 2 mg (IQR, 2-4 mg). Treatment failure occurred in 10 (14%) patients. The lower dose group had a similar failure rate compared with the higher dose group (lower dose: 9% vs higher dose: 22%; p = 0.161), despite a statistically significant higher median chest tube output in the higher dose group (346 [IQR, 256-466] vs 175 [IQR, 70-358] mL/24h; p = 0.002). However, after adjusting for weight, both groups had a similar output (12 mL/kg/24h). Alteplase instillation after primary video-assisted thoracoscopic surgery (VATS) was associated with a significant reduction in the duration of chest tube placement and hospital and PICU stays.

Conclusions: Lower alteplase doses (≤2 mg) were effective for most children with PPE. Alteplase combined with primary VATS might be associated with better outcomes.

The Pediatric Pharmacy Association (PPA) understands the dilemma and varying factors that many institutions face concerning the routine participation of pharmacists in emergency resuscitation. Acknowledging these challenges, the PPA encourages all institutions to strongly consider creating, adopting, and upholding policies to address pharmacists' participation in cardiopulmonary resuscitation (CPR) events. The PPA advocates that pharmacists be actively involved in the institution's medical emergency team committees and the preparation of emergency drug kits and resuscitation trays. The PPA advocates that all institutions requiring a pharmacist's participation in CPR events consider adopting preparatory training programs. The PPA recommends that pharmacists obtain emergency response credentialling with basic life support and pediatric advanced life support and may consider advanced cardiac life support and neonatal resuscitation program certification dependent on practice area. Additionally, the PPA recommends that pharmacists are educated on the pharmacotherapy of drugs used in the CPR process, including, but not limited to, medication preparation and administration guidelines, medication compatibility, recommended dosing for emergency medications, and familiarity with the institutional emergency cart.