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Unformatted text preview: nistration. 27 Dosage Determination Dosing is most commonly based on weight.
Initial pediatric dosing is, at best, an approximation.
Subsequent doses need to be adjusted. 28 Dosage Determination
Approximate dosage for a child =
Body surface area of the child × adult dose
1.73 m² 29 Body Surface Area
BSA is indicated where
the straight line that
connects height (on the
left) and weight (on the
right) intersects the BSA
column or, if client is
above average size, from
weight alone (enclosed
area). 30 Drug Therapy in
Geriatric Patients 31 Geriatric Patients A disproportionately high prescription drug use exists
in the elderly.
in • Only 12% of Americans are 65 years of age or older – yet this
12% consumes 31% of prescribed drugs.
12% Experience more adverse drug reactions and drugdrug interactions than younger patients do. Are admitted to the hospital for adverse drug
reactions (ADRs) three times more frequently than
younger adults. Represent 51% of the deaths and 39% of
hospitalizations from ADRs (persons over 60 years). Experience more drug-related incidents than the older
adult population (25% of all admissions from a
nursing home setting to a hospital are drug-related). 32 Geriatric Patients Altered pharmacokinetics • More sensitive to drugs than younger adults and have wider
variation Multiple and severe illnesses • Severity of illness, multiple pathologies Multiple-drug therapy • Excessive prescribing Poor adherence 33 34 Adverse Drug Reactions Seven times more likely in the elderly
Account for 16% of hospital admissions
Account for 50% of all medication-related deaths
Majority are dose related, not idiosyncratic
Symptoms in elderly often nonspecific
• Dizziness, cognitive impairment 35 Goals of Therapy
• Maintain health status using the fewest drugs
• Start slow go slow---start on smallest effective
dose and titrate up.
• Do not use drug if the adverse effects...
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- Spring '14