Medications

Boy taking medicine
When do doctors prescribe medications for children with heart conditions?

Often medications are prescribed to ease discomfort, treat certain symptoms, and improve the heart's functioning as much as possible before surgery, as well as after surgery. Medications are prescribed for any patient so that maximum benefit can be achieved with as few side effects as possible. 

Some conditions can be managed with medication alone. Depending on their condition, some children will need to take medication for life.

In prescribing a medication, the doctor must determine the diagnosis, understand the condition, understand what the medication will do, and determine the right dose for your child. Once your child is taking the medication, the doctor will assess how well it is working. She may change medications or regimens if the side effects are too severe or if the medication is not working well.

Who arranges for your child's medication at home?

Your child will likely need medication to take once he leaves the hospital. In this case, the doctor will write you a prescription. You can have the prescription filled at the hospital's out-patient pharmacy or at your local pharmacy. It is a good idea to check with the nurse or pharmacist whether the medication is easy to get at local pharmacies or whether special arrangements will be needed.

What does medication cost?

There is no charge for medication given in the hospital. In Canada, the cost of most prescription medication outside the hospital is covered through drug plans offered by employers. Some people are eligible for drug coverage through provincial drug plans.

Medication can be quite expensive if you have to pay for it out-of-pocket. If you are not covered by a drug plan, you should be able to get some advice from staff at the hospital. A social worker may work with you to find a solution. For instance, you may be able to qualify for some government drug assistance programs if you have a low income, or no income, and are facing high drug costs.

Questions to ask your pharmacist or doctor

Before your child goes home, you will meet with the pharmacist who will explain what drugs your child needs to take, and why. The pharmacist will be able to answer your questions and serve as a resource if you think of questions when you get home. The pharmacist can share strategies on how to give a drug to your child, as well as help you practise how to use a needle and syringe, if that applies. She may also be able to give you some written material to take home with you to refer to, and will make sure you understand what potential side effects to watch for in your child.

Here are some questions to ask the pharmacist or doctor about the drugs your child is taking:

  • What is the name of the drug and what will it do for my child?
  • Will it interact with anything else my child is taking?
  • How often does the drug need to be taken and for how many days, weeks, months, etc.?
  • When will the drug start working?
  • What do I do if my child misses a dose?
  • Are there side effects? What should I do if my child experiences a side effect?
  • How do I store the medication?

Medication safety tips

The following steps can help you give your child medicine safely.

  • Keep a list of all the medications your child is taking, including prescription drugs, non-prescription drugs, and herbal supplements. Know the generic and brand names of the medication. Know the concentrations of liquid drugs (mg and mL).
  • Ask for information that provides details on the medication.
  • Know when your child should be taking his medication and what dose he should take.
  • Ask about any foods, drinks, or other medicines your child should avoid with the medication he is taking.
  • Report anything unusual, such as an unexpected reaction to a drug.
  • Store all medication out of the reach of children. Make sure all bottle caps are on tight. Call the Poison Centre if your child accidentally takes too much of any medication.
  • Store the medication as directed: for example, at room temperature or in the fridge.
  • Give doses as indicated: for example, with meals or on an empty stomach.
  • Do not give extra doses if your child misses one.
  • Shake liquid formulations well so the drug does not settle in the bottom of the bottle and result in an uneven dosing.
  • If you are doing a "dissolve & dose," carefully follow the instructions to ensure the correct concentration.
  • Order refills on time, so you are not caught short. Some medicines need to be custom-made, so extra time is needed.
  • Watch for any changes in the label when you refill the prescription or get a new prescription.
  • If you are not sure about a medication, say something. If the pharmacist gives you a bottle or pills that a different colour, shape, or size than you were expecting, ask to be sure it is the correct medication.

How do you read a medication label?

On the label, you will see:

  • your child's name
  • the name of the medication
  • the concentration of liquid medication or the amount of medication in each pill
  • the quantity of medication provided
  • instructions for how it should be taken
  • the doctor's name
  • the name and the telephone number of the pharmacy where you got the prescription filled

It might include other special instructions or directions for refilling.

How are medications measured?

Medication that is taken by mouth is measured by weight, usually milligrams (mg), micrograms (mcg), grams (g), or international units (IU).

Many children receive their medications in the form of a liquid. It is important to know the concentration (strength) of any liquid medication. The concentration is how much medication is contained in a measured amount of liquid. For example, a concentration of 5 mg per milliliter (5 mg/mL) means that there is 5 mg of medication in each mL of liquid.

To find out the total dose, multiply the volume by the concentration. For example, if you need to give your child 10 mL of liquid medication with a concentration of 5 mg/mL, the total dose is 50 mg:

10 mL x 5 mg/mL = 50 mg

Do not confuse the volume (mL) and the concentration (mg/mL).

Be sure that you know how much of the liquid to give your child. Some medications are available in different concentrations. When you refill your child's prescription, always check the label to make sure the concentration has not changed.

Your pharmacy will often provide you with a special measuring device to help you measure the amount of drug accurately.

How can you help your child take medications?

If your child is very young, you will be responsible for giving your child the medication he needs, at home and sometimes in the hospital. If your child is older, you can help establish a routine at home to help your child remember when to take the medication. This might include the use of a medication calendar, or simply encouraging your child to take the medication at the same time each day.

If you are giving your child medication at home, make sure you check the label and follow the instructions about when to give the medication, how often, and whether it needs to be taken with or before or after a meal. It is also important that your child keep taking the medication, even if he starts to feel better.

Medication only works properly if it is taken exactly as directed for as long as directed. Sometimes it is tempting to stop taking medication if symptoms seem to disappear. It's important not to do this.

Are any of these medications habit-forming?

Some parents worry that their children will get addicted to narcotics (pain relievers). When taken properly, pain medications are not addicting. It is also very important to make sure that your child is getting adequate pain relief.

What long-term effects can heart medications have?

Some medications can have long-term side effects. Your doctor, pharmacist, or nurse will tell you what to look for.

What about herbal supplements or products from the health food store?

It is important that you discuss herbal supplements with your child's doctor before your child starts using them. For the most part, supplements are less studied than conventional medications. Often there is little evidence to support their use, and some are known to cause dangerous side effects or interact with prescription medication your child may be taking for his heart condition. The same holds true for "specialty teas" or so-called "herbal remedies" that are used topically or come in liquid form. Your pharmacist is also a good person to talk to about these products.

If you decide to use herbals after discussing their use with the doctor, the best bet is to purchase herbals that are identified as pharmaceutical grade, which indicates some degree of quality control when it comes to purity. These are most often available at pharmacies.

How long will your child need to take heart medication?

How long your child needs to take medication depends on the type and severity of heart condition your child has, as well as the type of treatment he is receiving. Some medications need to be taken for a short time, while some need to be taken for life. Your child's cardiologist will discuss this with you.

Beverley Hales, BScPhm, MHSc

Andrew James, MBChB, MBI, FRACP, FRCPC

 

12/14/2009


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