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MacLeod J, MacLure K. People with intellectual disabilities and their experience of medication: A narrative literature review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 33:976-991. [PMID: 32100409 DOI: 10.1111/jar.12719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/06/2020] [Accepted: 02/08/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND People with intellectual disabilities are known to have increased medical needs and are prescribed more medication than the general population. Understanding the reality of incorporating medication into their lives would help healthcare professionals provide care in more meaningful and personalised ways. AIM A narrative review of the current literature relating to people with intellectual disabilities and their experience of medication/pharmaceutical care. METHOD Electronic databases were searched for articles relating to intellectual disabilities and medication administration or pharmaceutical care. Other relevant papers identified from included article reference lists were also identified. A narrative literature was undertaken due to the heterogeneity of the identified papers. RESULTS A total of 29 studies from the literature searches were included alongside other relevant papers. CONCLUSIONS The published literature noted some aspects of the medication-related experiences of people with intellectual disabilities. However, a greater understanding of medication-related experiences is still required.
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Affiliation(s)
- Joan MacLeod
- Aberdeen City Health and Social Care Partnership, NHS Grampian and Doctoral Graduate, Robert Gordon University, Aberdeen, UK
| | - Katie MacLure
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK
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Abstract
AIM A transmucosal niosome gel was developed to improve the pharmacokinetics of exogenous melatonin. MATERIALS & METHODS The melatonin niosomes (MN) gel was characterized and melatonin levels were determined in healthy volunteers. RESULTS Micron-sized MN in a gel, mean ex vivo residence time of more than 3 h with maximum adhesiveness at 25 and 37°C showed similar in vitro release but different in vitro permeation to melatonin gel. Oral transmucosal MN gels, at 2.5, 5 and 10 mg, topically applied in 14 healthy volunteers in a randomized double-blinded crossover design with 7-day washout, gave dose-proportional pharmacokinetics, with improved absorption and prolonged systemic circulation. CONCLUSION The transmucosal MN gel provides a topical option for melatonin administration with substantial prolonged systemic delivery.
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Pasini AM, Marjanović J, Roić G, Dukarić N, Batoš AT, Bahtijarević Z, Gagro A. Correction to: Melatonin as an alternative sedation method during magnetic resonance imaging in preschool children with musculoskeletal problems. Eur J Pediatr 2018; 177:1363-1366. [PMID: 29872931 DOI: 10.1007/s00431-018-3184-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AbstractMagnetic resonance imaging (MRI) in preschool children is often challenging due to excessive motion artifacts. Sedation or general anesthesia (GA) are commonly used to prevent children from moving in the MRI scanner, with increased risk for cardiopulmonary complications and requirement for skilled personnel. Herein we investigated whether oral melatonin, a natural hormone implicated in circadian rhythm regulation, could be used as an alternative sedation method prior to the MRI in preschool children with musculoskeletal problems. Fifteen children with suspected juvenile idiopathic arthritis underwent a total of 16 MRI examinations following administration of 10 mg of oral melatonin; satisfactory images were obtained in all but one case, with no adverse events.Conclusion: The use of melatonin before the musculoskeletal MRI in preschool children is an effective, safe and inexpensive alternative to standard sedation and general anesthesia in preventing motion artifacts. What is known: • Magnetic resonance imaging (MRI) is a well-recognized diagnostic method to visualize synovial inflammation and changes of cartilage and bone in juvenile idiopathic arthritis.• MRI examination requires sedation or general anesthesia to ensure immobility in children who are uncooperative. What is new: • Additional to previous published studies we were able to show that melatonin for sedation for an MRI of joints, even without sleep deprivation, in the studied population may provide an alternative in children without behavioral problems, in order to avoid sedation/GA.
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Affiliation(s)
- Agneza Marija Pasini
- Children's Hospital Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Josip Marjanović
- Faculty of Medicine, Josip Juraj Strossmayer, University of Osijek, Osijek, Croatia
| | - Goran Roić
- Children's Hospital Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Nikola Dukarić
- Children's Hospital Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ana Tripalo Batoš
- Children's Hospital Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Zoran Bahtijarević
- Children's Hospital Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Alenka Gagro
- Children's Hospital Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia. .,Department of Radiology, Royal Belfast Hospital for Sick Children, Belfast, UK. .,Department of Pulmonology, Allergology, Immunology and Rheumatology, Department of Pediatrics, Children's Hospital Zagreb, Zagreb, Croatia.
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Thabet Y, Walsh J, Breitkreutz J. Flexible and precise dosing of enalapril maleate for all paediatric age groups utilizing orodispersible minitablets. Int J Pharm 2018; 541:136-142. [DOI: 10.1016/j.ijpharm.2018.02.037] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 02/19/2018] [Accepted: 02/19/2018] [Indexed: 11/16/2022]
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Influence of Food on Paediatric Gastrointestinal Drug Absorption Following Oral Administration: A Review. CHILDREN-BASEL 2015; 2:244-71. [PMID: 27417362 PMCID: PMC4928757 DOI: 10.3390/children2020244] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 05/15/2015] [Accepted: 05/18/2015] [Indexed: 12/26/2022]
Abstract
The objective of this paper was to review existing information regarding food effects on drug absorption within paediatric populations. Mechanisms that underpin food-drug interactions were examined to consider potential differences between adult and paediatric populations, to provide insights into how this may alter the pharmacokinetic profile in a child. Relevant literature was searched to retrieve information on food-drug interaction studies undertaken on: (i) paediatric oral drug formulations; and (ii) within paediatric populations. The applicability of existing methodology to predict food effects in adult populations was evaluated with respect to paediatric populations where clinical data was available. Several differences in physiology, anatomy and the composition of food consumed within a paediatric population are likely to lead to food-drug interactions that cannot be predicted based on adult studies. Existing methods to predict food effects cannot be directly extrapolated to allow predictions within paediatric populations. Development of systematic methods and guidelines is needed to address the general lack of information on examining food-drug interactions within paediatric populations.
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Albertini B, Di Sabatino M, Melegari C, Passerini N. Formulating SLMs as oral pulsatile system for potential delivery of melatonin to pediatric population. Int J Pharm 2014; 469:67-79. [PMID: 24768728 DOI: 10.1016/j.ijpharm.2014.04.055] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 04/19/2014] [Accepted: 04/22/2014] [Indexed: 12/21/2022]
Abstract
The formulation development of melatonin (MLT) for infants and children with neurodevelopmental difficulties was fully investigated. This population have a higher prevalence of sleep disorders and present special challenges for drug administration and swallowing. To solve these issues, solid lipid microparticles (SLMs) were designed to obtain an oral flexible dosage form constituted by GRAS excipients and a free flow pulsatile delivery system for MLT, able to maintain its release through 8h. Three groups of SLMs were produced by spray congealing and characterized as regards particle size, morphology, flowability, solid state, drug content and release behavior. The SLMs manipulation with milk and yogurt and the MLT stability in these foods were also investigated. Microparticles with different excipient composition were selected to obtain a pulsatile release pattern over 8h. The final delivery platform displayed a prompt release from group I SLMs together with a lag phase of groups II and III SLMs, followed by a repeated MLT release from group II and a prolonged MLT release related to the last group. Finally, MLT was compatible and stable in milk and yogurt suggesting that microparticles sprinkled into food is acceptable for MLT administration to children unable to swallow capsules or tablets.
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Affiliation(s)
- Beatrice Albertini
- Department of Pharmacy and Biotechnology, University of Bologna, Via San Donato 19/2, Bologna 40127, Italy.
| | - Marcello Di Sabatino
- Department of Pharmacy and Biotechnology, University of Bologna, Via San Donato 19/2, Bologna 40127, Italy
| | - Cecilia Melegari
- Department of Pharmacy and Biotechnology, University of Bologna, Via San Donato 19/2, Bologna 40127, Italy
| | - Nadia Passerini
- Department of Pharmacy and Biotechnology, University of Bologna, Via San Donato 19/2, Bologna 40127, Italy
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Akram G, Mullen AB. Mixing medication into foodstuffs: Identifying the issues for paediatric nurses. Int J Nurs Pract 2013; 21:125-31. [DOI: 10.1111/ijn.12222] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Gazala Akram
- Strathclyde Institute of Pharmacy and Biomedical Sciences; University of Strathclyde; Glasgow UK
| | - Alex B Mullen
- Strathclyde Institute of Pharmacy and Biomedical Sciences; University of Strathclyde; Glasgow UK
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Akram G, Mullen AB. Paediatric nurses' knowledge and practice of mixing medication into foodstuff. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2011; 20:191-8. [DOI: 10.1111/j.2042-7174.2011.00179.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Abstract
Objective
To investigate paediatric nurses' knowledge and understanding of potential drug stability issues caused by mixing medication into foodstuff.
Methods
Self completion of semi-structured questionnaires and face-to-face interviews.
Key findings
Fourteen paediatric mental health and 16 paediatric general nurses (response rate, 71%) were investigated. With the exception of one nurse, all others reported they had modified oral dosage forms, or had mixed medication with food, prior to administration. The most common foodstuffs were fruit yoghurts, diluting juice and (concentrated) fruit juices. More than half of both cohorts felt sufficiently trained in carrying out the procedure, but 27% did not feel sufficiently knowledgeable about drug stability issues. The in-depth interviews highlighted a knowledge deficit as to the nature of clinical problems that could result from performing the procedures and the associated professional liabilities. Some interviewees expressed reservations about the effectiveness of the dose when administered in this way. Co-mixing was perceived as a time-consuming process and preference was expressed for mixing the powdered dosage form into juice or a liquid rather than into solid foods. Several training issues were identified from this study, including more information about drug/food compatibilities and the need for standardised documentation around the procedures which could be implemented at the ward level.
Conclusions
Co-mixing of medication into foodstuff is a common practice. The majority of nurses are unaware of potential drug stability/degradation issues and/or the clinical impact of these practices.
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Affiliation(s)
- Gazal Akram
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, UK
- Department of Child Psychiatry, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Alexander B Mullen
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, UK
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Johnson CE, Cober MP, Thome T, Rouse E. Stability of an extemporaneous alcohol-free melatonin suspension. Am J Health Syst Pharm 2011; 68:420-3. [DOI: 10.2146/ajhp100274] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Cary E. Johnson
- Department of Clinical Sciences, College of Pharmacy, University of Michigan (UM), Ann Arbor, and Clinical Pharmacist— Pediatrics, Department of Pharmacy, University of Michigan Hospitals and Health Centers (UMHHC), Ann Arbor
| | - Mary Petrea Cober
- Akron Children’s Hospital, Akron, Ohio, and Clinical Assistant Professor of Pharmacy Practice, Northeastern Ohio Universities College of Pharmacy, Rootstown; at the time of the study she was Clinical Assistant Professor—Pediatric Pharmacotherapy, Department of Clinical Sciences, College of Pharmacy, UM, and Clinical Pharmacist—Pediatric Surgery, Department of Pharmacy, UMHCC
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