53 terms

pediatric pharmacology

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how are all pediatric meds dispensed
All Rx are to be dispensed in milliliter (mL)
-Discontinue the term "tsp"
what should we recommend parents to use when giving meds
-Recommend oral syringe to dispense to get as specific as possible
-Offer to demonstrate to parents how to use an oral syringe
why are children more sensitive to medications
because their weight, their height , their physical condition, immature immune system and their metabolism
when prescribing meds what should you know
Know your patients:
Allergies
Sensitivities
Compliance
Know the family

Know your drugs:
Ease of delivery
Fewest side effects
Polypharmacy
How to combat/prevent certain side effects
is it good to mix medicines into feedings
-Discourage from adding drugs to feeds
Interaction between medication and cow's milk

If feed not taken completely, drug amount is variable (so you don't know how much they get in)
what are Elixir dosage forms
alcoholic solutions in which the drug is dissolved and evenly distributed
-First dose and last dose should contain the same amounts of drug
do you have to shake Elixir dosage forms?
NO!!
what are suspension forms
contains undissolved particles of drug that must be distributed by shaking (if you dont shake well then the first dose might contain less than the last dose )
chewable dosage forms
Bypasses disintegration

Better bioavailability
Dissolvable/ Absorbable dosage forms
rapid onset of action
inhalable dosage forms
Liquid or powder forms inhaled in fine droplets
How should we NEVER give meds to kids
with tablespoon or teaspoon (huge variability in dosing)
-Ex: Measured volume of teaspoon
Varies from 2.5- 7.8 mL
when writing for meds where should we avoid writing zeros
avoid writing zeros after the decimal point
how are doses for children usually written
in mg/kg/day
Then divided into number of daily doses
If weight is in pounds, you need to convert to kilograms!!!
how many pounds are in 1 kilogram?
*1 kilogram = 2.2 pounds *
*Always round kilogram weight to nearest tenth*
(divide the the pounds given by 2.2 to get kilograms)
how many kg s a pt who is 108 lbs
108 ilbs/2.2 ilbs = 49.1 kg
what is a more simple way of converting pounds to kilograms
, subtract the first digit of the patient's weight from the total number of pounds and divide by two
For example, if a child weighs 46 lb : Subtract 4 (the first digit) from 46 (the child's weight in pounds).
This gives you 42. Divide by two to get 21 kg. It works every time!
how many ounces are in 1 pound
16 oz= 1 pound
so if 4 lb, 5 oz then in order to calculate kilograms (5/16=.3 then 4+.3 =4.3 pounds so do 4.3/2.2 =1.94 kilograms)
what does it mean when prescription says 250mg/5mL
Means that for every 5 ml of liquid, you are giving 250 mg of medication
- If a patient takes 2 teaspoons of the Omnicef twice a day:
Each dose is (250 x 2)= 500 mg
500 mg x 2 (twice a day) = 1000 mg total daily dose
how to convert teaspoon to ml
one teaspoon is 5 ml
so if someone is taking 3 teaspoon of a med (5 ml x 3= 15 ml per dose)
what is the formula you use when youre trying to figure out how many ml to give
(mg/ml) X (mg/mL)
Ex: You want to give a patient in the office Benadryl 12.5 mg PO q 4-6 h. You only have Benadryl 25/5mL in the drug cabinet. How many milliliters would be needed to give the patient 12.5 mg?
(25/5) X (12.5/x ml) = 2.5 ml
(so basically what you have X what you need)
when can a child receive adult dosages
A child > 50 kg may receive adult dosages
what if the calculated dose is greater than recommended adult dose
do not prescribe!!!!
A child should not receive higher doses than those recommended for an adult, ever
in general how are Pediatric doses rounded
to the nearest 10th !
-Infants and young children, may round dose to nearest hundredth (digoxin, some anti seizure medications, some opiates, and if the child is very tiny you can round to nearest hundeth for more specific doses)
how to convert kg to pounds
kg x 2.2 = pounds
in order to determine whether a drug is safe or not whar formula do you use
- first convert to kg then calculate the minimum and maximum dose
(mg/kg) X (mg/ kg) > do this for minimum and maximum
A child weighs 22 lb. He needs acetaminophen for fever. What is the safe and therapeutic dose range for this patient , if the recommended dose is 10-15mg/kg/dose q 4-6 h?
(10 mg / 1 kg) X (xmg/ 10 kg) = 100 mg /dose
(15 mg /1 kg) X (x mg/ 10 kg)= 150 mg/ dose
(what you have X what you need)
Now calculate the dose in milliliters for the dose range using 100mg/5mL strength:
(100 mg/ 5 ml) X (82 mg/ml)=4.1 ml minimum
(100 mg/ 5 ml) X (164 mg/ x ml)= 8.2 ml maximum
how do we determine if what we prescribed is safe and therapeutic for the child
-Divide the ordered dose by child's weight to get the mg/kg/ dose
OR
-Calculate the minimum and maximum dose and see where the ordered dose falls
what type of med is calculated for 24 hour dose range
Very common for antibiotics
( calculated based on recommended dose for 24 hours and then divided into single doses; so mg/kg/day)
What makes a dose safe
As long as the dose does not exceed the maximum dose established in 24 hours and does not exceed adult dose, then it can be given safely
if you take a pill every 6 hrs how many dses do you have to take in one day
4 doses
(so when determinin the safe dosage for a day make sure you divide that number by 4 to get the safe dose for just one dose)
Ben needs amoxicillin. He weighs 52lbs. You use the standard 40mg/kg/day range, divided. Amoxil comes in liquid doses: 125, 200, 250, 400/5mL. How would you write out his prescription?
Ben is 24 kg
40mg x 24 kg = 960 mg/day
960mg / 2 doses = 480 mg/ dose
480 mg / 400 mg = 1.2
5mL x 1.2 doses = 6mL/ dose
Rx: Amoxicillin 400/5mL; take 6 mL q 12 hours
For Ben, how much amoxicillin would you DISPENSE if you wanted to treat him for 5 days?
If he is taking 6 mL per dose (2 doses per day, then 6 x 2 = 12 mL daily)
-12 mL daily x 5 days = 60 mL for 5 days of therapy
indications of amoxicillin
-Bacterial infections:

-Acute otitis media:
indications for Augmentin (amoxicillin/clavulanate)
-Bacterial infections:
-Acute otitis media
indications for Omnicef (cefdinir)
Acute otitis media
indications for
Bacterial infections
Severe bacterial infections
Otitis media
indications for Keflex(cephalexin)
Bacterial infections
-otitis media
indications for Rocephin (ceftriaxone)
(IV) bacterial infx
indications for Zithromax (azithromycin)
otitis media
pneumonia
strep pharyngitis
indications for Pulmicort (budesonide inhaled)
(one of the most common asthma meds)
Prior bronchodilator alone
Prior inhaled steroid
Prior oral steroid
indications for albuterol
(one of the most common asthma meds)
-bronchospasm
indications for prednisone
(one of the most common asthma meds)
-Asthma exacerbation (ER/ hospital)
-Asthma exacerbation (outpatient "burst")
-Asthma, severe persistent
Singulair (montelukast)-
(one of the most common asthma meds)
-given not by wt but by age
most common gi meds
-Zofran (odansetron): Nausea/Vomiting
-Prevacid (lansoprazole): GERD
-Zantac (ranitidine): GERD
Most Common Topical Meds
-vigamox (moxifloxacin ophthalmic)
Bacterial conjunctivitis
-Polytrim (polymyxin B/ trimethoprim ophthalmic): Bacterial ocular infections, superficial
-Cortisporin otic (neomycin/ polymyxin B/ hydrocortisone)
Otitis externa
Most Common OTC Meds
Tylenol (acetaminophen)
Pain, fever (cant take more than 4 grams a day > liver toxicity
-Motrin (ibuprofen): Pain, fever
most common allergises med
age based dosing for allergies
-Allergies, motion sickness
- Allergic reaction (age and wt based dosing)
why are Maintenance IV fluids are used in children
Maintenance IV fluids are used in children who cannot be fed enterally to MAINTAIN their volume status
Ex: a child awaiting surgery, or has gastroenteritis
when do we use fluid therapy
When do we use them?
A healthy adolescent can tolerate being NPO for 12- 18 hours

A 6 month old will require fluids after 8 hours NPO

A child with high urine output from nephrogenic diabetes will need fluids soon after being made NPO
Goals of Maintenance Therapy
Prevent dehydration
Prevent Electrolyte disorders
Prevent Ketoacidosis
Prevent protein degradation
composition of fluid therapy
-Water: Provide enough so that the kidneys do not need to significantly dilute or concentrate urine
-Glucose :vPrevent onset of starvation ketoacidosis and decreases protein degradation
-Potassium
-Sodium
(Does not provide adequate calories, calcium, phosphorous, magnesium or bicarbonate which is usually not a problem if youre just using it for a few days)
100/50/20 rule of maintenance therapy
For the first 10 kg of body weight, provide 100mL/kg of water

For the next 10 kg of body weight, provide 50mL/kg of water

For each additional kilogram above 20kg, provide 20mL/kg of water
Calculate maintenance therapy on an afebrile 25kg child
-For the first 10 kg of body weight, provide 100mL/kg of water
10kg x 100 mL = 1000 mL
-For the next 10 kg of body weight, provide 50mL/kg of water
10 kg x 50 mL = 500 mL
-For each additional kilogram above 20kg, provide 20mL/kg of water
5 kg x 20 mL = 100 mL
Now add them all up
1000mL+500mL+100mL = 1600 mL water for maintenance