What is the safest method of calculating a medication dose for the pediatric patient?

What is the Beer Criteria, and what is its’ significance in prescribing?
Beers Criteria is widely used by clinicians, educators, researchers, healthcare administrators and regulators since 2011 as a guide for Potentially Inappropriate Medication (PIM) in older adults aged 65 years and older (“American Geriatrics Society 2019 Updated AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults”, 2019). Beers Criteria is updated on a 3-year cycle (“American Geriatrics Society 2019 Updated AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults”, 2019). The Beers Criteria is a list of potentially inappropriate medications that healthcare providers should avoid prescribing in specific circumstances, diseases, or conditions (“American Geriatrics Society 2019 Updated AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults”, 2019). The AGS Beers Criteria is an important tool to guide providers in prescribing drugs that should generally be avoided for adults 65 years and above, except when the benefits outweigh the risks (Rosenthal & Burcham, 2021).
What is the safest method of calculating a medication dose for the pediatric patient?
Dosage determination for pediatric patients can be challenging because of pharmacokinetic factors that are highly variable in this population (Rosenthal & Burcham, 2021). Only a few drugs have established pediatric doses. Drugs without established doses are estimated from adult doses using the body surface area (BSA) conversion method (Rosenthal & Burcham, 2021). Subsequent doses should be monitored for safety by evaluating clinical outcomes, therapeutic response, plasma drug concentrations, and adverse reactions (Rosental & Burcham, 2021).
At what time period in a pregnancy can medication potentially have the greatest risk of causing malformations?
Providers must be aware of possible fetal risks such as teratogenesis when prescribing drug therapy during pregnancy. Teratogenesis is congenital anomalies resulting in gross fetal malformations such as hydrocephalus, cleft palate, club foot and other abnormalities (Rosenthal & Burcham, 2021). Teratogens are agents that can alter the growth or structure of the embryo or fetus during the developmental period, leading to birth defects (Alwan & Chambers, 2015). Providers must be aware of how teratogens can affect fetal development before drug therapy because the effects change during fetal development (Rosenthal & Burcham, 2021). Fetal development has three major stages. The first stage is the preimplantation period which occurs from conception to the second week of pregnancy (Rosenthal & Burcham, 2021). The next stage is the embryonic period between weeks three to eight (Rosenthal & Burcham, 2021). The third period is the fetal period from week 9 through the term (Rosenthal & Burcham, 2021). The embryonic period is when teratogens have the most significant risk of causing gross malformations in the first trimester because it is when the internal organs and other structures are developing (Rosenthal & Burcham, 2021).
If your patient sometimes forgets to take her medication, what type of medication half-life would be beneficial?
Medication half-life determines the medication’s dosing intervals (Rosenthal & Burcham, 2021). Medicines with a short half-life will require more frequent dosing intervals than medications with a long half-life (Rosenthal & Burcham, 2021). Therefore, a patient who sometimes forgets to take her medication will benefit from drugs with a long half-life.
Your patient is on the highest daily dose of his medication and it is not giving him the desired effect. What type of metabolizer is he with this medication?
Therapeutic drug levels can be impacted by metabolic tolerance. According to Rosenthal & Burcham (2021), metabolic tolerance is a drug tolerance that happens due to accelerated drug metabolism. A patient who develops metabolic tolerance may require an increased dosage to maintain therapeutic drug levels (Rosenthal & Burcham, 2021). A patient already taking the highest daily dose of his medication without any desired effect is more likely a rapid metabolizer. Rapid metabolizers often require a higher dose to prevent treatment failure, while slow metabolizers require a lower dose to avoid toxicity (Rosenthal & Burcham, 2021).
What food item interacts with many medications and should be asked about its ingestion, especially in the elderly?
Drug and food interactions can impact drug efficacy and safety by altering drug absorption and metabolism (Rosenthal & Burcham, 2021). For example, grapefruit may interact with medications such as felodipine, nifedipine, verapamil, statins, amiodarone, carbamazepine, buspirone, triazolam, midazolam, cyclosporine, saquinavir, SSRIs, praziquantel, dextromethorphan and sildenafil (Rosenthal & Burcham, 2021). Therefore, providers must evaluate the patient’s grapefruit or grapefruit juice intake and educate the patient for possible drug interactions, especially in the elderly.
References:
Alwan, S., & Chambers, C. D. (2015). Identifying Human Teratogens: An Update. Journal of
pediatric genetics, 4(2), 39– 41. https://doi.org/10.1055/s-0035-1556745
American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate
Medication Use in Older Adults. (2019), 67(4), 674-694.
Rosenthal, L.D., & Burchman, J.R. (2021). Lehne’s pharmacotherapeutics for Advanced Practice
Nurses and Physician Assistants (2nd ed.). St. Louis, MO: Elsevier

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