Grugs: Simplifying Drug Dosages for Doctors with a Progressive Web App

Within the medical profession, practitioners face a recurrent challenge concerning memorizing intricate drug dosage formulas, particularly in pediatric care. The complexity and precision required in dosage calculations often divert the physician's cognitive resources from critical diagnostic and treatment considerations.

Grugs emerges as a pragmatic solution to the aforementioned issue. This Progressive Web App facilitates a simplified approach to drug dosage calculations, allowing medical professionals to direct their focus toward diagnostic and therapeutic imperatives. By providing a user-friendly drug dosage calculator, Grugs streamlines the dosage determination process, optimizing the physician's cognitive bandwidth for more critical aspects of patient care.

Grugs distinguishes itself by its ease of use and absence of installation requirements. As a Progressive Web App, it offers an accessible platform for doctors to access the dosage calculator expediently. Noteworthy is the cost-free nature of Grugs, contributing to its practicality and broader adoption within the medical community.

However, it is imperative to acknowledge the current limitation of Grugs—namely, its constrained drugs database. The app presently encompasses a finite array of medications, necessitating an augmentation of its database to encompass a broader spectrum of pharmaceuticals. This enhancement would fortify Grugs' utility and relevance across diverse medical scenarios.

Utilizing Grugs involves a straightforward process. Medical practitioners gain direct access to the Web App by clicking the link provided using a smartphone. This expeditious method ensures that doctors can seamlessly incorporate Grugs into their practice, optimizing the efficiency of drug dosage calculations.

In summary, Grugs is a pragmatic response to a persistent issue medical professionals encounter. Its nuanced approach to drug dosage calculations, coupled with user-friendly attributes, positions Grugs as a tool with significant potential for aiding healthcare practitioners in their pursuit of precision and efficacy in patient care. Acknowledging its strengths and recognizing areas for improvement, Grugs embodies an evolving contribution to the intersection of technology and healthcare.

Essentially, there are three approaches to determining the dosage for children. If the patient's weight and height are unknown, the dosage can be calculated based on their age. If the weight is known, the dosage can be derived from that parameter. If both weight and height are available, the body surface area method can be employed. It is essential to ascertain the recommended adult dosage as a prerequisite initially. If uncertain about the adult dose, you can refer to the Search tab for information. Each method involves distinct rules and formulas. In this application, we employ Young's rule for the age-based method, Clark's rule for the weight-based method, and the standard body surface area (BSA) formula. (This introductory information is accessible on the Welcome! tab.)

Young's Rule 

Introduction
Young's Rule is an equation used to calculate pediatric medication dosage based on the age of the patient, as well as the known recommended adult dose. The definition of Young's Rule is the age of the patient, divided by the age added to twelve, all multiplied by the recommended adult dose. Young's Rule can be applied to quickly approach a situation in which the patient's weight is unknown. Other approaches to pediatric dosing that also use age include Webster's Rule and Fried's Rule. If the weight of the patient is known, Clark's Rule or the Body Surface Area rule can be implemented. 

Issues of Concern
Pediatric dosing based on one's age has the potential for suboptimal therapeutic levels due to the broad range of potential weight, especially with increasing childhood obesity. 

Clinical Significance
In situations where the pediatric patient's weight is unknown, for instance, at the point of injury, then Young's Rule can be safely implemented if their age and the recommended adult dosing are known. Additionally, certain classes of medications require weight-based dosing, such as antibiotics and antiepileptics. Ultimately, age-based dosing has demonstrated to be a safe and effective approach. However, caution should be used depending on the class of the drug. 

Clark's Rule

Introduction
Clark's rule is an equation used to calculate pediatric medication dosage based on the known weight of a patient and a known adult dose of medication to be used. Clark's rule equation is defined as the weight of the patient in pounds divided by the average standard weight of one hundred fifty pounds multiplied by the adult dose of a drug equals the pediatric medication dose. Clark's rule is one of the known pediatric medication dosing rules described in the medical literature that utilizes the patient's weight to calculate medication dosage. 

Issues of Concern
Pediatric Obesity and Medication Dosing
Data from 2011 to 2014 showed the prevalence of obesity among children and adolescents of the ages 2 to 19-year-old of age to be 17% in the United States and continues to increase. In addition to the known numerous health complications and the development of comorbidities associated with pediatric obesity, this epidemic has created challenges to weight-based medication dosing because of the pharmacokinetic changes associated with obesity. For medication distribution, excess adipose tissue in obese pediatric patients has been described to affect a medication's volume distribution (the amount of medication in the body compared to plasma concentration). Lipophilic medications are more likely to have higher volume distribution into adipose tissue when compared to normal weight pediatric patients, while hydrophilic medications may have either increased or decreased volume distributions, therefore altering the medication loading dose.Due to the alterations in medication loading doses, obese pediatric patients may be at risk for either medication toxicity or sub-therapeutic medication therapy. Studies have described the use of ideal body weight for the calculation of hydrophilic medication loading dose, total body weight for lipophilic medications loading dose, and adjusted body weight for a partially lipophilic medication loading dose.Pediatric obesity effects on pharmacokinetic changes in medication absorption, metabolism, and excretion remain an area in need of further research. 

Clinical Significance
Medication dosing for pediatric patients is described to use either the following methods for medication dosing: age-based dosing, allometric scaling, body surface area based dosing, and weight-based dosing; neither method is to be more superior to the other and varies based on a medications chemical properties and age of the patient. Weight-based dosing is the most commonly used method for calculating recommended medication doses in the pediatric clinical practice. Some have thought that adult medication dosages are universally applied to pediatric patients when in fact this is a misconception. Pediatric patient pharmacokinetics and pharmacodynamics varies among age, body weight, body surface area, and developmental growth and function of various organ systems when compared to adults. The absence of deliberate practice in correct pediatric medication dosing can have potential effects such as exposing the patient to suboptimal medication dosages, severe systemic toxicity, and may even result in fatalities. 

Body Surface Area (BSA)

Introduction
Body surface area was developed as a metric to use in the modulation of various pharmacological therapies, as well as a standard tool by which to index various physiologic measurements such as glomerular filtration rate and cardiac output. 

Issues of Concern
A predominant area of concern in calculating body surface area is that many different equations are used in the calculation. As such, some of the equations may yield vastly different results from others. In the clinical context, this presents a significant challenge. For example, body surface area is used to calculate the dosing regimen for many medications to ensure the medication’s therapeutic window is maintained, and adverse effects avoided. Significant variances in body surface area calculations potentially result in over- or under-dosing of drugs and failure to obtain the targeted effects of the drug. 

Clinical Significance
The body surface area metric holds a significant place in both pharmacology and physiologic data measurement. Body surface area is most commonly used to guide the dosing of chemotherapeutic drugs. Early chemotherapy research found that the effects of these cancer treatments were much more consistent among individuals when dosed according to body surface area as opposed to bodyweight alone. 

1. Wade CI, Martinez T. Young's Rule. [Updated 2023 Apr 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554603/

2. Delgado BJ, Safadi AO, Bajaj T. Clark's Rule. [Updated 2023 Jul 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541104/

3. Flint B, Hall CA. Body Surface Area. [Updated 2023 Mar 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559005/