53 terms

how are all pediatric meds dispensed

All Rx are to be dispensed in milliliter (mL)

-Discontinue the term "tsp"

-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

-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

Allergies

Sensitivities

Compliance

Know the family

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)**

Interaction between medication and cow's milk

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

-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

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

-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!!!

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)

*

(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

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)

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

- 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

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)

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

A child should not receive higher doses than those recommended for an adult, ever

in general how are Pediatric doses rounded

-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

(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

(15 mg /1 kg) X (x mg/ 10 kg)= 150 mg/ dose

(what you have X what you need)

(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

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)

( 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)

(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

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:

-Acute otitis media:

indications for Augmentin (amoxicillin/clavulanate)

-Bacterial infections:

-Acute otitis media

-Acute otitis media

indications for Omnicef (cefdinir)

Acute otitis media

indications for

Bacterial infections

Severe bacterial infections

Otitis media

Severe bacterial infections

Otitis media

indications for Keflex(cephalexin)

Bacterial infections

-otitis media

-otitis media

indications for Rocephin (ceftriaxone)

(IV) bacterial infx

indications for Zithromax (azithromycin)

otitis media

pneumonia

strep pharyngitis

pneumonia

strep pharyngitis

indications for Pulmicort (budesonide inhaled)

(one of the most common asthma meds)

Prior bronchodilator alone

Prior inhaled steroid

Prior oral steroid

Prior bronchodilator alone

Prior inhaled steroid

Prior oral steroid

indications for albuterol

(one of the most common asthma meds)

-bronchospasm

-bronchospasm

indications for prednisone

(one of the most common asthma meds)

-Asthma exacerbation (ER/ hospital)

-Asthma exacerbation (outpatient "burst")

-Asthma, severe persistent

-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

-given not by wt but by age

most common gi meds

-Zofran (odansetron): Nausea/Vomiting

-Prevacid (lansoprazole): GERD

-Zantac (ranitidine): GERD

-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

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

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)

-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

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

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

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)

-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

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

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