Roadrunner peds 02-12.pub

P R E S C R I P T I O N C O M P O U N D I N G P R E S C R I P T I O N C O M P O U N D I N G F O R Omeprazole is an effective treatment for GERD in children, how- The following study found that omeprazole 1 mg/kg per day is an ever as the following study notes, dosings on a milligram-per- effective therapy for the majority of children with severe erosive kilogram basis are recommended -“Pharmacokinetics of omepra- oesophagitis due to abnormal isolated bile reflux or combined zole in healthy adults and in children with gastroesophageal re- acid and bile reflux -“Treatment of oesophageal bile reflux in chil- flux disease” (Ther Drug Monit. 2004 Feb;26(1):3-8). dren: the results of a prospective study with omeprazole” (J Pedi-atr Gastroenterol Nutr. 2006 Apr;42(4):376-83). OBJECTIVES: Reflux of duodenal juice into the oesophagus ABSTRACT: “Studies of the pharmacokinetics of omeprazole in has a role in the pathogenesis of both oesophageal and laryngo- children with gastroesophageal reflux disease (GERD) remain pharyngeal inflammatory and neoplastic lesions. As little is known scarce despite the vast number of reports on its efficacy. The ob- about effective therapy, we studied the effect of proton pump in- jectives of this study were to assess the pharmacokinetics of ome- hibitor therapy on oesophageal bile reflux in children. prazole in healthy adults and in children with GERD. Omeprazole (Losec, delayed-release capsules) was administered orally to 18 METHODS: Twenty-nine children with moderate to severe ero- healthy adults (mean age 36.8 years) and 12 children with GERD sive oesophagitis and abnormal oesophageal bile reflux were stud- (mean age 6.1 years). Blood samples were collected over 5 hours, ied before and after treatment with omeprazole 1 mg/kg per day. and plasma concentrations were assessed using liquid chromatog- Outcomes included a clinical symptom score, oesophageal acid raphy. Population pharmacokinetic parameters were calculated and bile reflux (simultaneous 24-hour pH and Bilitec 2000 moni- using NONMEM. A 1-compartment model with zero-order absorp- tion and a lag time was used. The population approach was well suited to the limited number of samples available, and residual RESULTS: After 8 weeks of therapy, 17 (59%) of the patients variability was low. Oral clearance (CL/F) and apparent volume of were symptom-free, and 5 (17%) had minimal symptoms. Mucosal distribution (V(ss)/F) in healthy adults (Mean +/- SD: 0.62 +/- 0.27 healing or reduction to low-grade oesophagitis was achieved in 25 L/h/kg and 0.76 +/- 0.26 L/kg, respectively) were not significantly children (86%; P < 0.0005). Mean percentages of total, upright, different than those in children with GERD (0.51 +/- 0.34 L/h/kg and supine time with oesophageal pH less than 4 were reduced and 0.66 +/- 0.25 L/kg, respectively). Healthy adults displayed a from 17.0%, 16.8%, and 19.2% before treatment, to 2.83%, statistically significantly longer delay in drug absorption (Lag time: 3.17%, and 2.07%, respectively, after treatment (all P < 0.00001). 0.62 +/- 0.15 hours) as compared with that observed in children Similarly, mean percentages of total, upright, and supine time with with GERD (0.12 +/- 0.03 hours, P < 0.05). On the basis of these bile reflux were reduced from 16.96%, 12.67%, and 22.0%, to findings, omeprazole dosings on a milligram-per-kilogram basis are 2.27%, 1.91%, and 2.23%, respectively (P < 0.000001, P < recommended with no further adjustments for the treatment of 0.0001, and P < 0.000001, respectively). CONCLUSIONS: Omeprazole 1 mg/kg per day is an effective therapy for the majority of children with severe erosive oesophagi-tis due to abnormal isolated bile reflux or combined acid and bile reflux. It remains unclear how patients with treatment-resistant An example of how you might prescribe follows: bile reflux should be managed. PMID: 16641575 With our state of the art compounding lab and pharmaceutical knowledge and experience, we can compound omeprazole as an oral liquid that will Ibuprofen is one of the standard treatments for children with fever -“Efficacy of ibuprofen in pediatric patients with fever” (Int J Clin Phar-macol Ther Toxicol. 1992 Mar;30(3):94-6). ABSTRACT: “We studied the efficacy of ibuprofen in 56 infants significantly lower in group I vs III (ibuprofen 5 mg/kg vs placebo) and children (age 0.5-12 years) with rectal temperature greater (p less than 0.0005), and group II vs III (ibuprofen 10 mg/kg vs than or equal to 38.3 degrees C, using a double-blind randomized placebo) (p less than 0.0001). The temperature was also markedly placebo-controlled design. Ibuprofen liquid was given as a single different for patients in group I vs II (ibuprofen 5 mg/kg vs ibupro- dose, 5 mg/kg to 18 patients (group I) and 10 mg/kg to 18 pa- fen 10 mg/kg) between 4 and 8 hours after the dose (p less than tients (group II); placebo was administered to 20 patients (group 0.01). The duration of action was longer for ibuprofen 10 mg/kg III). Temperature and vital signs were measured every 0.5-1.0 than 5 mg/kg. The mean maximum decrease from baseline tem- hours for 8 hours. Multiple blood samples were also collected over perature was 1.3 degrees C, 1.8 degrees C and 0.8 degrees C for this period; ibuprofen plasma concentrations were measured by group I, II and III, respectively. The maximum reduction in tempera- HPLC. The mean temperature was 38.3 degrees C in group I, 38.1 ture occurred at 3-4 hours in the ibuprofen groups, and at 7 hours degrees C in group II, and 38.9 degrees C in group III during 8 hours after drug or placebo administration. The temperature was With our state of the art compounding lab and pharmaceutical experience, we have the ability to compound and custom dose ibuprofen, based on body weight, into a suppository or transdermal gel for those patients who have Examples of how you might prescribe follow: Apply 1ml to neck or inner wrist Q6-8H PRN The following posting states that topical promethazine can be compounded for patients suffering from various causes of nau- Promethazine (Phenergan) belongs to the class of antiemetics called phenothiazines. Phenothiazines are effective in the preven- From Medscape Pharmacists > Pharmacy Practice tion and control of mild-to-moderate nausea and vomiting. Pro- Topical Phenergan -Virna Ignacio Almuete, RPh methazine is available as a tablet, oral liquid, rectal suppository, and intravenous solution. Phenergan cream 2% is a product that is commercially available outside the United States. The only similar topical product available in the United States for the control of nausea and vomiting is the scopolamine patch, which is primarily “I have received requests from local physicians to compound Phenergan cream for topical treatment of nausea. Does this prod-uct demonstrate an effective therapy for nausea and by what con- centration and compounding methodology?” A recipe for compounding promethazine gel with a final concentra-tion of 12.5 mg/mL is available at the Pharmacy Times Com-pounding Hotline Web site (see "Suggested Reading"). Topical application of medication is an effective method for drug delivery. However, the amount of medication absorbed through the skin is influenced by skin type, thickness of skin, and the area of applica-tion. Absorption can also be influenced by temperature and the addition of occlusive dressing to the area of application. With our state of the art compounding lab and Cases of intoxication have been reported with topical administra- pharmaceutical experience, we have the ability to tion of promethazine. With topical administration, medication is absorbed through the skin and then slowly released from the skin into the general circulation. In the case of overdosage, drug expo-sure can be prolonged. The benefits of topical administration of promethazine should be weighed against the variability of drug absorption through this route.” An example of how you might prescribe follows: Prescriber Name____________________________________________________________________________________ Prescriber Address__________________________________________________________________________________ City _________________________________________________ State_______________ Zip_____________________ Phone____________________________________________ Fax____________________________________________ Date _________________ Patient Name____________________________________________ DOB_______________ Address________________________________ City/State/Zip__________________________ Phone_______________ □ Patient will pick up at pharmacy □ Please ship to patient All topical compound %s are per 1 ml or 1 gm unless otherwise noted Directions: Insert 1 suppository rectally Q6-8H PRN Directions: Apply 1ml to neck or inner wrist Q6-8H PRN _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ Prescriber’s Signature____________________________________ Refills: 1 2 3 4 5 6 7 8 9 10 11 12 NR

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