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Casey Hoffman 

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A five-year-old patient and her mother present to the rural health clinic with complaints of a fever of over 101 for the last 2 days. Per the mother, the patient has had difficulty swallowing because of sore throat. The patient’s mother attested that her daughter’s throat appears inflamed and there are white patches located bilaterally on the back of the throat. The patient is diagnosed with strep throat after a rapid strep test comes back positive. The patient is prescribed Amoxicillin 500mg BID q12h by the nurse practitioner. The nurse practitioner failed to remember that the proper dosing for pediatric patients is based on their weight and is not a usual standard dose range like the adult population. Proper pediatric dosing of Amoxicillin is 20-40 mg/kg/day in divided doses q12h (American Academy, 2019).

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In regard to pharmacodynamics, some medications are affected by the stage of development that the patient is in (Stephenson, 2005). The stage of development can alter the action of, and response to, a drug, which truly is an age-dependent difference in pharmacodynamics (Stephenson, 2005). Both a drugs desired action and adverse effects may be affected by the stage of development. An example of medications that are truly age dependent are warfarin and cyclosporin.  According to the authors Lu & Rosenbaum (2014), current research has shown that the use of pharmacokinetic-pharmacodynamic methods in the pediatric population has been widely advocated for by healthcare groups across the nation. Other factors that may impact the pharmacokinetic and pharmacodynamic processes include gastric pH and emptying time, intestinal transit time, immaturity of secretion and activity of bile and pancreatic fluid. These factors determine the oral bioavailability of pediatric and adult populations. According to the authors Fernandez et al. (2011), anatomical, physiological and biochemical characteristics in children also affect the bioavailability of other routes of administration.

In regard to the patient scenario that was presented at the beginning of this post, a course of action was planned and implemented. The pharmacy that the patient’s mother requested the prescription be sent to, was immediately called and informed that the of the dosing error. A new script was then e-prescribed and sent in with the correct pediatric dosing, which was based on the patient’s weight.

 

American Academy of Pediatric Dentistry. (2019). Retrieved August 27, 2019, from

https://www.aapd.org/assets/1/7/rs_commonmeds.pdf

Fernandez, E., Perez, R., Hernandez, A., Tejada, P., Arteta, M., & Ramos, J. T. (2011). Factors and

Mechanisms for Pharmacokinetic Differences between Pediatric Population and Adults.

Pharmaceutics, 3(1), 53-72.

Lu, H., & Rosenbaum, S. (2014). Developmental Pharmacokinetics in Pediatric Populations. The journal

of pediatric pharmacology and therapeutics, 19(4), 262-276. https://doi.org/10.5863/

1551-6776-19.4.262

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