Journal Article Introduction to pediatric pharmacy practice: Reflections of pediatrics practitioners Get access Kimberly A. Pesaturo, Pharm.D., Kimberly A. Pesaturo, Pharm.D. Assistant Professor Department of Pharmacy Practice Massachusetts College of Pharmacy and Health Sciences 19 Foster Street Worcester, MA 01608 kimberly.pesaturo@mcphs.edu Search for other works by this author on: Oxford Academic Google Scholar E. Zachary Ramsey, Pharm.D., E. Zachary Ramsey, Pharm.D. Clinical Specialist, Pediatric Cardiology Department of Pharmacy Services The Children’s Hospital of Philadelphia Search for other works by this author on: Oxford Academic Google Scholar Peter N. Johnson, Pharm.D., BCPS, Peter N. Johnson, Pharm.D., BCPS Assistant Professor Department of Pharmacy, Clinical and Administrative Sciences The University of Oklahoma College of Pharmacy Search for other works by this author on: Oxford Academic Google Scholar Lisa M. Taylor, Pharm.D., BCPS Lisa M. Taylor, Pharm.D., BCPS Clinical Specialist, Pediatrics Department of Pharmacy Services Shands Hospital at the University of Florida Search for other works by this author on: Oxford Academic Google Scholar American Journal of Health-System Pharmacy, Volume 65, Issue 14, 15 July 2008, Pages 1314–1319, https://doi.org/10.2146/ajhp080009 Published: 15 July 2008

Study Objective. To describe the dose‐concentration relationship of a continuous intravenous infusion of valproic acid (VPA) in pediatric patients when a dosing protocol is used.Design. Retrospective and concurrent chart review.Setting. Tertiary care, 473‐bed, academic medical center with a 120‐bed, dedicated children's hospital.Patients. Twenty‐six pediatric patients (< 18 yrs old) who received VPA according to the protocol for continuous intravenous infusions between January 1, 2004, and March 31, 2006, identified by using a pharmacy order‐entry system.Measurements and Main Results. Patient demographics, VPA treatment regimens, clinical responses, and safety data were recorded and analyzed. Median patient age was 8.5 years (range 1.4–16 yrs). Approximately two thirds received VPA for seizures, and one third for migraines. Patients were given a mean ± SD VPA loading dose of 28.5 ± 5.2 mg/kg followed by a continuous infusion rate of 1 ± 0.2 mg/kg/hour. Mean ± SD serum concentration measured 4.5 ± 1.6 hours after the loading dose was 83.3 ± 22.8 μg/ml. Steady‐state concentration at 23.3 ± 3.0 hours after the start of the continuous infusion was 80.0 ± 26.0 μg/ml. Postload and steady‐state serum concentrations were within the target concentration of 50–100 μg/ml in 77% and 69% of patients, respectively. On further analysis, when the target range was expanded to 50–125 μg/ml (125 μg/ml was deemed acceptable if no adverse effects were noted), 89% and 92% of patients, respectively, had postload and steady‐state VPA serum concentrations within this range. The response rate was excellent, with nearly 85% of patients achieving a complete or partial response to therapy. Adverse effects were generally mild and uncommon.Conclusions. The continuous‐infusion protocol permitted rapid intravenous loading of VPA in pediatric patients while minimizing adverse events and achieving concentrations in the upper region of the therapeutic range.

Objective: To review the literature concerning the use of hypertonic saline (HS) in patients with cystic fibrosis and explain the rationale for its use. Data Sources: A MEDLINE search was conducted through February 2007. Search terms included hypertonic saline, mucociliary clearance, cystic fibrosis, and human DNASE 1 protein. Additional data were identified through subsequent bibliographic reviews. Study Selection And Data Extraction: All articles in English identified from the data sources were evaluated. Pertinent studies using HS in patients with cystic fibrosis were included in the analysis. Data Synthesis: Cystic fibrosis is caused by a deficiency in the cystic fibrosis transmembrane regulator gene, resulting in reduced chloride secretion and excessive sodium absorption. The most significant changes are seen in the airway lumen of the lungs. HS has been shown to improve mucociliary clearance versus placebo. A short-term efficacy trial showed a modest and variable increase in forced expiratory volume in 1 second (FEV 1 ) over a 2 week period (15.0 ± 16.0% from baseline vs 2.8 ± 13.1% with HS 6% and NaCI 0.9%, respectively; p = 0.004). A long-term efficacy trial of either HS 7% or NaCI 0.9% twice daily for 48 weeks has shown a modest sustained improvement in FEV 1 and a significantly increased exacerbation-free survival rato (76% vs 62% for HS 7% and NaCI 0.9%, respectively; p = 0.03). Conclusions: HS preceded by a bronchodilator is an inexpensive, safe, effective additional therapy in cystic fibrosis patients with stable lung function. Its use has been associated with a modest improvement in lung function and reduced frequency of pulmonary exacerbations.

In patients with a history of heparin-induced thrombocytopenia, alternative anticoagulant agents must be considered.

The potential risk for heparin-induced thrombocytopenia should be suspected in postoperative patients who develop thrombocytopenia in the presence of heparin and low-molecular weight heparin agents.