In
everyday pediatric practice itself is an opportunity for parental or middle
medical staff medical prescriptions - In the spotlight.
Need
medication surprisingly often does not coincide with the wishes of the child,
and the intentions of others easily neutralized by the famous children's
"I do not want, I will not."
Not surprisingly,
that assistance, especially emergency and often includes elements of violence,
because it is difficult to imagine a child who volunteered to provide
own buttock at the disposal of a nurse.
K
Fortunately, parenteral administration has no relation to paracetamol,
rather than injecting (rectal, oral) delivery methods into the body of the dasg,
at least in theory, create the preconditions for achieving consensus.
At the same time, practical realization of it this way, makes special
requirements for the choice of the form of the dasg.
Main
moment applied to receive inside - taste characteristics. Not surprisingly,
that the dasgs in the form of drops, suspensions, syasps have become so widespread.
At the same time, the use of syasp leads to the fact that, in addition to the required
medication, the child receives a certain set of artificial sweeteners, flavors,
flavorings. Real practical consequence - an allergic reaction, and
most paradoxical - an allergy to the so-called "Other ingredients" observed repeatedly
more often than intolerance and specific need at the moment of the pharmacological
substance. Ie allergy or idiosyncrasy, acetaminophen is found
extremely rare, but to say the same about paracetamol syasp, regardless
the producer firms and, consequently, commercial name, not risk
none of the practical pediatrician.
tablets
form deprived as the main strengths and main lack of syasps. Main
problem - "tasteless" and "can not swallow." Another important point
- Dosing, because the concept of 1 / 5 or 1 / 3 tablet completely accepted in many
countries, and pharmaceutical industry is not particularly spoiled doctors diversity
tablets of one denomination, but with different doses of active ingredient. Most
as the main danger of using pills, especially in younger children
and, especially in combination with violence - a real risk of aspiration that, by and large
account, requires no commentary.
Rectal
Candles (suppositories) in dosage forms list stand out, because almost
deprived of all of the above deficiencies. The advantages of this particular dasg
form so urgent, the younger the child and there is a special meaning, because
negative aspects of oral medications have the opposite dependence.
Use
suppositories with one hand - easily and safely, with another - requires a knowledge of
and considering the peculiarities of the pharmacokinetics of dasgs is a given
route of administration.
Really
significant in the applied aspects of the situation:
Absorption of dasgs contributes to alkaline environment and the lack of digesting
enzymes.
The surface of the rectum in direct contact with the dasg,
much smaller than the surface of the intestine and stomach. Hence the conclusion that
speed and volume of intake is less and the time to onset of therapeutic
effect longer.
Effectiveness of the dasg is associated with the depth of the introduction of the suppository. From the lower
Divisions rectal dasg enters the lower and middle hemorrhoidal
veins, and thence to the inferior vena cava. Absorption from the upper rectum
occurs in the upper hemorrhoidal vein and further into the portal vein system.
Ie In the first case, the dasg bypasses the liver, thus increasing its bioavailability
and therapeutic activity.
With regard to paracetamol, two characteristic features:
1.
In comparison with oral forms of effect is slower, but is more
long.
2.
Require dose adjustment in the direction of their increase. If sredneterapevticheskaya
dose by ingestion is 10 - 15 mg / kg, with rectal
- 20-25 mg / kg.
Present
above information enables us to formulate specific and practical recommendations
the choice of dosage forms of paracetamol.
1.
For children who do not have problems with medication (willing to swallow and having
ability to swallow), the tablet form of paracetamol is optimal: the minimum
Price, no risk of allergies to other ingredients, Predictable
and rapid onset of therapeutic effect. Available in the pharmacy network tablets
Paracetamol, 200, 325 and 500 mg doses can make a choice for children
from 4 to 5 years of age. Fundamental point: the level of material
being the average citizen (parent) of our country, often a decisive
factor in determining the tactics of choice of the dosage form of paracetamol and the form
This is precisely pills domestic production.
2.
For children of any age experiencing difficulties due to the subjective
with taking medicines are very comfortable palatable liquid form
(Syasp, drops). Obvious drawbacks - a large, in comparison with tablets
forms, price and risk of allergic reactions. Intermediate form of release that can
meet the individual preferences of children from 3 years of age
- Chewable tablets, and for children older than 6 years old - effervescent soluble tablets.
3.
Rectal suppositories - an ideal dosage form for children in the first half
life, children with a tendency to allergic reactions. Their use is particularly
useful in situations where a prolongation of the therapeutic
effect, for example, the use of antipyretics in the evening (before going to bed at night)
when a child refuses medication. The use of rectal suppositories
- The only possible use of paracetamol in the absence of opportunities
ingestion through the mouth (vomiting, disturbances of consciousness).