School of Pharmacy, University of Otago

PHCY 473: Quality Use of Medicine C, 2018

Module 4: Special Populations
Workshop 7: Therapeutics
Paediatric Conditions
STUDENT Notes 2018

Workshop Objectives:

After studying bacterial meningitis, and asthma, students will be able to:

• Recommend treatment suited to a patient’s health goals

• Present a case to another healthcare professional.
• Use information about the patient to make a decision on:
• characteristics, aetiology, clinical presentation and diagnosis
• aims of treatment
• medicine therapy, including; consideration of mechanism of action, choice
of agent, dosage, formulation, adverse effects, interactions, counselling
and other relevant aspects.

Recommended Reading
 Chisholm-Burns MA et al (eds) (2010). Pharmacotherapy Principles and Practice.
McGraw-Hill Companies Inc, USA, (or later). Chapter on Paediatrics.

Useful websites
 New Zealand Formulary http://nzformulary.org/
 Medsafe datasheets http://www.medsafe.govt.nz/profs/datasheet/DSForm.asp

Case 1
 Meningitis Research Foundation
http://www.mrfpaediatricguide.info/intro.php.html
 Starship guidelines for meningococcaemia https://www.starship.org.nz/for-health-
professionals/starship-clinical-guidelines/m/meningococcaemia/
 Ministry of Health Meningococcal Disease https://www.health.govt.nz/your-
health/conditions-and-treatments/diseases-and-illnesses/meningococcal-disease-
including-meningitis

Case 2
 Asthma Foundation https://www.asthma.org.nz/pages/download-brochures
 BPAC Diagnosing and Managing Asthma in Children
http://www.bpac.org.nz/BPJ/2012/february/asthma.aspx

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Disease Template

To prepare for the workshop

Answer the following questions (where appropriate) in relation to the treatment of:

1. Bacterial Meningitis

1. Definition of the disease/condition.

2. The incidence, pathophysiology, and signs and symptoms (including warning
signs) of the disease/condition.
3. What is the prognosis, long-term risks if not treated and overall treatment goal?
4. What are the main pharmacological treatment options of the disease/condition?
5. Outline the choice of dosage frequency/dosage forms suitable for these patients.
6. Outline the mode of action, common side effects, drug interactions, precautions
and monitoring requirements of each pharmacological treatment option.
7. For each pharmacological treatment option discussed above, what points would
you raise during patient counseling?
8. Discuss the non-pharmacological treatment options of the disease/condition?

2. Paediatric Asthma

1. Definition of the disease/condition.

2. The incidence, pathophysiology, and signs and symptoms (including warning
signs) of the disease/condition.
3. What is the prognosis, long-term risks if not treated and overall treatment goal?
4. What are the main pharmacological treatment options of the disease/condition?
5. Outline the choice of dosage frequency/dosage forms suitable for these patients.
6. Outline the mode of action, common side effects, drug interactions, precautions
and monitoring requirements of each pharmacological treatment option.
7. For each pharmacological treatment option discussed above, what points would
you raise during patient counseling?
8. Discuss the non-pharmacological treatment options of the disease/condition?

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Student Instructions
Overview

Activity Time
Introduction 5 min
Activating prior knowledge; What is 20 min
bacterial meningitis and asthma?

Case 2: bacterial meningitis 60 min

Case 3: asthma 60 min
Reflection and feedback 5 min
Total 150 min

Activating prior knowledge; Kahoot!

In class Kahoot to test general knowledge about meningitis and asthma in children.

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Case 1: Bacterial Meningitis

Hayley Hill. 2 years old. 11kg.

Hayley and her family had been at a 4 year old’s birthday party at Chipmunks in the
weekend. When the family returned home, Hayley was feeling tired, was a little bit
grumpy with a ‘sore body’. That night, Hayley did not want to eat her dinner, and then
vomited just before she went to bed. During the evening, Laura (Hayley’s Mum) checked
on Hayley, and she felt very hot and had developed a rash on her leg.
Laura took Hayley to the After Hours Doctor for assessment. The GP took Hayley’s
temperature which recorded 38.7 °C. The GP noticed a rash, placed a glass tumbler
against the rash and saw that it was non-blanching. An ambulance was called and Hayley
and Laura were taken to Auckland Hospital for assessment.
The Paediatric Consultant assessed Hayley and diagnosed uncomplicated bacterial
meningitis.

http://www.mrfpaediatricguide.info/diagnosis.php.html

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GP medical history
Date of Medical Condition
Diagnosis
From 6 weeks Fully vaccinated

Family History
Family Medical Condition
Member
Father n/a
Mother n/a
Older Brother n/a

Community Pharmacy Dispensing History

Start Date Medication
1 year ago Amoxicillin 100mg tds for 5/7

Laboratory and other

Test Date Result Reference range

Sodium 138 135- 145 mmol/L

Potassium 4.5 3.5 – 5.0 mmol/L

WBC 35 4.0 – 11.0 x109/L

Neutrophils today 15 1.9 – 7.5 x109/L

CSF Normal

Neisseria meningitides
Bacterial screen
present
Temperature 38.7°C 36°C

Patient/caregiver goal(s): To have a full recovery with minimal long term consequences
associated with bacterial meningitis.

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Case 1 task:
You are the PICU ward pharmacist and have been asked to do a presentation to your
fellow colleagues on the PICU ward (nurses, physiotherapists, house surgeons). During
your presentation, ensure that you discuss what medications are needed to treat
meningitis in THIS patient, and what prophylactic treatments are required for close
contacts.
Create a powerpoint presentation using the following slide headings:
 Pathophysiology of Neisseria meningitides
 Hayley’s signs and symptoms of Neisseria meningitides
 Complications associated with meningococcal infection
 Acute treatment for bacterial meningitis
 Ongoing treatment for bacterial meningitis
 Medicines and vaccine to prevent bacterial meningitis

You have 20 min to prepare the presentation. You then will have 5 minutes to present this
case and 2 minutes for questions.

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Case 2: Asthma
Emma Jones. 8 years old. 25kg.
Emma has had asthma since she was 5 years old. Because Emma and her Mum know
you well, they have come into your community pharmacy to ask for some advice
regarding Emma’s shortness of breath. You notice during the consultation, that you can
hear a slight high pitched whistling sound coming from Emma’s chest, which Emma
describes as a wheeze. To help Emma with her symptoms you give her a spacer and
salbutamol. Within a few minutes, Emma is able to breathe a lot easier and you continue
with the consultation.
During the consultation, Emma starts to open up and shares that has not been wanting to
use her in haler at school as she has been getting teased by other school children for
having asthma. Because of this she doesn’t want to do any exercise because she
sometimes gets short of breath finds it difficult to talk after exercise.
Your community pharmacy is next door to Emma’s GP practice and you refer Emma for
further assessment by the pharmacist prescriber.
Current medicines:
 Fluticasone 50mcg, twice daily regularly.
 Salbutamol 100mcg, one to two puffs up to QID when required.

Patient goal: To not be wheezy.

Case 2 tasks:

In the care plan template below, write your pharmacological and non-pharmacological
treatments to address both Emma’s and your goals to help improve Emma’s asthma.
Once this is completed, the care plan will be discussed as a group.

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Writing a Care Plan: Identifying Issues, Clinical Reasoning and Judgement

Issues (Problems) Clinical Reasoning Clinical Judgement (Plans)

Medicine Treatment Patient
Treatment/ Monitoring/
Priority‡ related problem Options Recommendation Counselling
(actual or potential) Therapy Goals Follow-up
Considered Points

Non-compliance
with reliever
1 inhaler. Children
can die from
asthma attacks.

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 Issues (Problems) Clinical Reasoning Clinical Judgement (Plans)
Medicine Treatment Patient
‡ Treatment/ Monitoring/
Priority related problem Options Recommendation Counselling
(actual or potential) Therapy Goals Follow-up
Considered Points

‡ Once all drug therapy problems are identified prioritise them in order of importance / severity, where 1 = the most urgent / important.

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