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Each prescribing situation needs to be examined in the light of the chances of accurate execution and some compromises often have to be made between ideal and practicable. G. Avoid Polypharmacy The trend in medicine these days is to give several drugs some of which are to counteract the side effects of others. These in turn tend to give side effects of their own. There are few instances in pediatric psychopharmacology where more than one drug should be given at a time. Polypharmacy is not only costly and unnecessary, but it reduces the prospect of compliance through complexity and increases the chances of drug interactions that reduce or increase the effect of the main drug.

Thus, the pH of the aqueous environment greatly influences the degree of ionization of weak electrolytes, and hence their passage across membranes, since it is the nonionized form of the molecule that is more fat-soluble. This is important since blood, gastrointestinal, and kidney systems have a variable pH depending on the state of digestion, exercise, and respiration. Dissociation of weakly acidic and basic drugs is characterized by a "pKa" value, 26 2. , a low pH) than is the ionization of a weak acid.

A quite indefensible yet common form of polypharmacy is giving different drugs of the same class. There is little evidence that this is indicated even with antipsychotics 7 where in theory it might cancel out side effects (such as to reduce both sedation and extrapyramidal side effects). On the whole, polypharmacy should raise doubts in the minds of parents about the prescribing physician's competence. H. Don't Be a Fiddler Understanding the time frame of drugs and the disorder is essential to therapeutic simplicity, compliance, and success.

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