Order Description
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 Bazzano et al. and Mayhew 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.

Post on or before Day 3 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.

Read a selection of your colleagues’ responses.

Respond on or before Day 6 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.

RESOURCES:

Required Resources

Readings
•Arcangelo, V. P., & Peterson, A. M. (Eds.). (2013). Pharmacotherapeutics for advanced practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.
?Review Chapter 4, “Principles of Pharmacotherapy in Pediatrics” (pp. 49–59)

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. 196–216)

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. 671–683)

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. 820–838)

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. 839–854)

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 53, “Travel Medicine” (pp. 855–860)

This chapter provides recommendations on what to include in a traveler’s medical kit and examines health issues travelers may face and how to treat those health issues.
?Chapter 54, “Weight Loss” (pp. 861–871)

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.

•Bazzano, A. T, Mangione-Smith, R., Schonlau, M., Suttorp, M. J., & Brook, R. H. (2009). Off-label prescribing to children in the United States outpatient setting. Academic Pediatrics, 9(2), 81–88.
Retrieved from Walden Library databases.

This study examines the frequency of off-label prescribing to children and explores factors that impact off-label prescribing.
•Mayhew, M. (2009). Off-label prescribing. The Journal for Nurse Practitioners, 5(2), 122–123.
Retrieved from the Walden Library databases.

This article reviews the prevalence of off-label prescribing, including its benefits and risks. It also explores issues regarding the safety of off-label prescribing and when it is unavoidable.

•Drugs.com. (2012). Retrieved from https://www.drugs.com/

This website presents a comprehensive review of prescription and over-the-counter drugs including information on common uses and potential side effects. It also provides updates relating to new drugs on the market, support from health professionals, and a drug-drug interactions checker.

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.