NURS 6521: Week 11: Pediatrics Essay Assignment Paper

Children deal with variety of health issues similar to adults, but they also have issues that are more prevalent within their population. One issue that significantly impacts children is the prescription of drugs for off-label use. Consider the case of Rebecca Riley. When she was two years old, Riley was diagnosed with ADHD, and by age three, she was diagnosed with bipolar disorder. In the span of two years, Riley’s doctor prescribed four drugs off-label: Clonidine, Depakote, Zyprexa, and Seroquel. Riley’s doctor also approved 13 increases in drug dosages. Then, at age four, Riley died from pneumonia combined with a toxic level of prescription drugs (Lambert, 2010). Cases such as this have brought attention to the off-label use of drugs in pediatric patients, as well as the importance of monitoring patient reactions to prescribed drugs and evaluating the effects of drug-drug interactions. As an advanced practice nurse, how do you determine the appropriate use of off-label drugs in pediatrics? Are there certain drugs that should be avoided with pediatric patients?

This week you examine the practice of prescribing off-label drugs to children. You also explore strategies for making off-label drug use safer for children from infancy to adolescence as it is essential that you are prepared to make drug–related decisions for pediatric patients in clinical settings.

Learning Objectives

By the end of this week, students will:

• Evaluate the practice of prescribing off-label drugs to children
• Analyze strategies to make the off-label use of drugs safer for children
• Understand and apply key terms, concepts, and principles related to prescribing drugs to treat pediatric patients

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

This page contains the Learning Resources for this week. Be sure to scroll down the page to see all of this week’s assigned Learning Resources. To access select media resources, please use the media player below.

Required Readings

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.

• • Review Chapter 4, “Principles of Pharmacotherapy in Pediatrics” (pp. 53-63)
    This chapter explores concepts relating to drug selection, administration, and interaction for pediatric patients. It also compares age-related pharmacokinetic differences in children and adults.

• • Chapter 17, “Ophthalmic Disorders” (pp. 221-243)
    This chapter examines the causes, pathophysiology, diagnostic criteria, and drug treatment for four ophthalmic disorders: blepharitis, conjunctivitis, keratoconjunctivitis sicca, and glaucoma. It also explores methods of monitoring patient response to treatment.

• • Chapter 43, “Attention-Deficit/Hyperactivity Disorder” (pp. 743-756)
    This chapter explains the process of diagnosing Attention-Deficit/Hyperactivity Disorder (ADHD). It also identifies drugs for treating patients with ADHD, including proper dosages, selected adverse events, and special considerations for each drug.

• • Chapter 51, “Immunizations” (pp. 906-926)
    This chapter explores vaccines that are licensed for use in the United States and provides a recommended vaccination schedule for pediatric patients and adults.

• • Chapter 52, “Smoking Cessation” (pp. 927-943)
    This chapter examines clinical implications of smoking. It also covers various approaches for aiding patients who are dependent on nicotine but want to stop smoking.

• Chapter 54, “Weight Loss” (pp. 945-956)
  This chapter begins by reviewing patient factors that contribute to obesity. It also examines drug therapy for initiating weight loss in patients, as well as alternative non-drug treatments.

Panther, S. G., Knotts, A. M., Odom-Maryon, T., Daratha, K., Woo, T., & Klein, T. A. (2017). Off-label prescribing trends for ADHD medications in very young children. The Journal of Pediatric Pharmacology and Therapeutics, 22(6), 423-429. DOI: 10.5863/1551-6776-22.6.423

This study examines the frequency of off-label prescribing to children and explores factors that impact off-label prescribing.This study examines off-label prescribing to children with ADHD.

Corny, J., Lebel, D., Bailey, B., & Bussieres, J. (2015). Unlicensed and off-label drug use in children before and after pediatric governmental initiatives. The Journal of Pediatric Pharmacology and Therapeutics, 20(4), 316–328. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4557722/

Required Media

Laureate Education, Inc. (Executive Producer). (2012). Advanced pharmacology – Final course review. Baltimore, MD: Author.

This media is an interactive final review covering course content.

Note: Although this media piece references Week 12, the content associated with Week 12 is a review of Week 1.

Optional Resources

Refer to the Optional Resources listed in Week 1.

Discussion: Off-Label Drug Use in Pediatrics

The unapproved use of approved drugs, also called off-label use, with children is quite common. This is because pediatric dosage guidelines are typically unavailable since very few drugs have been specifically researched and tested with children.

When treating children, prescribers often adjust dosages approved for adults to accommodate a child’s weight. However, children are not just “smaller” adults. Adults and children process and respond to drugs differently in their absorption, distribution, metabolism, and excretion. Children even respond differently during stages from infancy to adolescence. This poses potential safety concerns when prescribing drugs to pediatric patients. As an advanced practice nurse, you have to be aware of safety implications of the off-label use of drugs with this patient group.

To prepare:

• Review the Panther et al (2017) and Corney, Lebel, Bailey, and Bussieres (2015) articles in the Learning Resources. Reflect on situations in which children should be prescribed drugs for off-label use.
• Think about strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Consider specific off-label drugs that you think require extra care and attention when used in pediatrics.

With these thoughts in mind:

By Day 3

Post an explanation of circumstances under which children should be prescribed drugs for off-label use. Then, describe strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Include descriptions and names of off-label drugs that require extra care and attention when used in pediatrics.

By Day 6

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who provided a different rationale than you did, in one or more of the following ways:

• Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.
• Validate an idea with your own experience and additional research.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

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