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Pediatric Therapeutics and Medication Calculation

Pediatric Therapeutics and Medication Calculation. Debbie King FNP PNP Summer 2010. What is Therapeutics?. Any substance that is ingested, absorbed, or injected into the body that ultimately alters the body’s function. Includes OTC’s, herbs, illicit substances, and prescription drugs.

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Pediatric Therapeutics and Medication Calculation

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  1. Pediatric Therapeutics and Medication Calculation Debbie King FNP PNP Summer 2010

  2. What is Therapeutics? • Any substance that is ingested, absorbed, or injected into the body that ultimately alters the body’s function. • Includes OTC’s, herbs, illicit substances, and prescription drugs. • Factors in choosing the appropriate therapeutic treatment.

  3. Patient Characteristics • Age- absorption, distribution, and excretion. • PMH/Present medical conditions- choice and route of drug has an impact on the effectiveness and toxicity of the drugs. • Drug allergies. Is it a true allergy? • Use of other medications.

  4. Diagnosis • Choose the most appropriate therapeutic for the diagnosis. • Consider age group and contraindications. • Duration of treatment is different for kids than in adults. • Choose the best man for the job.

  5. Sensitivity and specificity • Sensitivity and specificity are statistical measures of the performance of a binary classificationtest. Sensitivity (also called recall rate in some fields) measures the proportion of actual positives which are correctly identified as such (e.g. the percentage of sick people who are identified as having the condition). Specificity measures the proportion of negatives which are correctly identified (e.g. the percentage of healthy people who are identified as not having the condition). These two measures are closely related to the concepts of type I and type II errors. A theoretical, optimal prediction can achieve 100% sensitivity (i.e. predict all people from the sick group as sick) and 100% specificity (i.e. not predict anyone from the healthy group as sick).

  6. Cost-effectiveness • Best outcome for unit cost. • What is the most effective therapeutic? • Is it in the formulary? • Insurance coverage? • Out of pocket? • Availability? Does it come in generic? • Each case is situational. • Will soon be on a protocol list with your practice for prescriptive authority guidelines. Each office comes up with their own list.

  7. Safety Profile • Therapeutic Index • the difference between the dose that provides a desired effect and the dose that provides an undesired effect. • Food- drug interactions • Drug- drug interactions • Idiosyncratic effects • also known as type B reactions, are drug reactions which occur rarely and unpredictably amongst the population. This is not to be mistaken with idiopathic which implies that the cause is not known.

  8. Patient Compliance • Taste- • to disguise or not to disguise? • Understanding the purpose of the drug. • Storage • Side effects • Understanding the dosage

  9. Overuse of antibiotics spurs vicious cycle • (Reuters) - Patients whose doctors over-prescribe antibiotics may develop drug resistance that lasts up to a year, putting them and the population at risk when more serious treatment is needed, scientists said on Wednesday May 19th, 2010 • Health • The more antibiotics are prescribed for coughs and flu-like illnesses, or urine infections, the more bacteria become resistant in a vicious cycle, said British researchers who analyzed 24 previous studies of antibiotic resistance. • "The effect is greatest in the month immediately after treatment, but may last for up to a year, and this residual effect may be a driver for high levels of resistance in the community," said Alastair Hay, a consultant senior lecturer in primary health care at Bristol University, who led the research. • Medical experts say overuse of antibiotics in Europe, the United States and other wealthy regions is building widespread resistance in and threatening vital medical treatments from hip replacements and cancer therapies, to intensive care. • Hay said his study showed how individual resistance was building up, and how that then translated into community- or population-wide problems

  10. Based on child’s weight or body size. • Adult dose occurs at approximately 40-50 kilograms. • Usually a range is given per unit weight, and the provider must determine the amount of medication based on the concentration of the therapeutic agent. • Change pounds to kilograms. Divide pounds by 2.2 to give you the weight in kilogram and round to the nearest tenth kg.

  11. A child weighs 36 lbs. What is her weight in kilograms? • A child weighs 10 lbs. What is her weight in kilograms? • A child weighs 80 lbs. What is her weight in kilograms?

  12. The prescribed reference dose for Ceftin is 30mg/kg. If your client weighs 24 lbs, what dose should you administer? • Divide 24 lbs by 2.2= 10.9 kg • 30 mg multiplied by 10.9= 327 mg • Ceftin is given BID; 327mg divided by 2 • Comes in 250mg/5ml and 125/5

  13. Cefixime (Suprax) is prescribed for a 14 lb infant. The reference dose for Suprax is 8mg/kg/QD. You have 100mg/5ml. Calculate the number of ml/dose for the infant • 14 divided by 2.2= 6.3kg • 6.3 X 8mg/kg= 50.9mg • Multiply 50.9mg X 5ml= 254 • Divide 254 by 100mg= 2.5ml(1/2 tsp)

  14. Otitis Media • 5 year old girl with no history of OM, who has had ear pain for four days and now has a fever of 102. She has no allergies and no history of recent antibiotic use. She weighs 32 pounds • What is first line • What is the dose • How does it come • How expensive is it

  15. OM • Amoxil • 80-90 mg per kg per day • 46 divided by 2.2 is what? • How many times a day will you give it? • How many days will you give it? • How much is her dose? • Write the RX

  16. OM • Comes in many strengths • 125/5 • 200/4 • 400/5 • 400mg chew • 875 tabs • Can be given bid or tid • Why would you do tid??

  17. OM • For this patient your Kg is 14.55 • Multiply by 90 • Is 1,300 • Divide this by time per day • BID • 650 mg per dose (round this down) • Using 400/5 • Give 1 ½ tsp BID for 10 days

  18. OM • Same patient is allergic to Amoxil • What is second line • What dose do you use • How does it come • How often do you give • For how long do you give it • How expensive is it

  19. OM • Can use a cephalosporin • If cost is not an issue use Omnicef • If cost is an issue use Ceftin • If taste is an issue use Omnicef

  20. OM • Omnicef • Comes in • 125/5 • 250/5 • 300mg tabs • Ceftin • Comes in • 125/5 • 250/5 • 250 mg tabs

  21. OM • Omnicef is • 14 mg/kg/per day • Can be QD or BID for 7-10 days (14) • Ceftin is • 30 mg/kg/per day • Is given BID for 10 days

  22. OM • For 32 pounds • Give Omnicef • 250/5 • ¾ tsp QD for 10 days • Ceftin • 250/5 • ¾ tsp BID for 10 days

  23. OM • 6 year old with same symptoms but recently took Amoxil for a previous OM. This patient weighs 44 pounds • What is second line • What dose do you give • How does come • Often is it given • How long do you give it • Is it expensive

  24. OM • 44 divided by 2.2 is 20 • 20 times 90 is 18,000 • 18,000 divided by 2 is 900 • Augmentin comes in • 400/5 • Extra Strength is 600/5 • It contains a higher dose of Amoxil • What dose will you give

  25. OM • Augmentin ES 600/5 • 1 ½ tsp BID for 10 days • Give every 12 hours with food.

  26. Strep throat with a positive SA • 10 year old is in with sore throat and scarlatina rash. He is 67 pounds and is allergic to PCN • What drugs could you use • How do they come • How often do you give them • How long do you give them

  27. Strep • Keflex • 40-50mg/kg/day for strep can be BID • Only for strep other wise use tid for other DX • Comes in 125/5, 250/5, 250 mg tabs, 500 mg tabs, new dose 750mg tabs • For 67 pounds • 2 ½ tsp BID for 10 days • 500mg tabs 1 ½ tab bid for 10 days • 750 mg bid ECT

  28. Strep • Same patient who is allergic is allergic to PCN and Cephalosporins; or wants a once a day med • Zithromax • 100/5 • 200/5 • 250 mg tabs • Also the three day pac and the one day dose

  29. Strep • Zithromax for 67 pound child who does not swallow pills • Give for 5 days at 10- 12mg/kg/QD • 8 cc QD for 5 days • Always use the high does the whole 5 days for strep

  30. Asthma • Child with severe wheezing needs a steroid. He weighs 25 pounds • Give steroids for wheezing at 2mg/kg/day/divided BID (can be QD) • 25 divided by 2.2 is 11.36 • 11 times 2 is 22 • Needs 11mg BID for five days

  31. Asthma • Orapred • Comes in 15mg/5 • ODT tabs at 10mg and 15 mg and 30 mg • Prelone • Comes in 15/5 • Comes in 5/5 • Prednisone tabs- same as adults

  32. Asthma • Could give ¾ tsp of Orapred 15/5 bid • Could give one ODT 10 mg bid • Could give two tsp of Prelone 5/5 • ECT…

  33. Atypical pneumonia • Same child 3 years later who is in with cough, rales, rhonchi, wheezes and slight fever, diagnosed with atypical pneumonia. He now weighs 69 pounds • What do you want to give • How does it come • How often is it given • How long is it given • How expensive is it

  34. AP • Zithromax for 69 pounds • 10-12mg/kg day one • 5-6 mg/kg days 4-5 • 9ml QD for one day • 4.5 ml OD for 4 more days

  35. Thrush • Nystatin first line • Oral, but rub on • 2cc QID for 10-14 days • Treat mom as well if breast feeding • Diflucan second line • Comes in several strengths of liquid but 10mg/ml is easiest to dose • 6 mg/kg day one • 3mg/kg days 2-13mg/kg days 2-13 • 12 pound baby • Divide by 2.2 • 5.45 times 6 • Give 3ml day one • Give 1.5 ml days two to fourteen

  36. Impetigo • Best choice is Keflex • Must give TID or QID for skin infection • Same dose as strep (and moderate OE) • Bullis impetigo • Give Augmentin ES or tabs • Same dose as OM (and for severe OE)

  37. Periorbital cellulitis • Three year old female unimmunized with redness and swelling around the left eye at the lids and just beyond. Is pretty tender. Her CBC is normal so far and you elect to treat outpatient. She weighs 35 pounds • What is the best out patient treatment to start with? • How is it dosed?

  38. Periorbital Cellulitis • Rocephin IM • 50mg/kg • Given QD up to three days • For 36 pounds or 16.36 mg • How much would you give • 800 mg IM • See what strength is on hand and help the nurses calculate

  39. Child weighs 50lbs. Acetaminophen (Tylenol) dosing range is 10-15 per kilogram. The dosage of the Tylenol Suspension is 160mg/5ml. How much Tylenol can this child have?

  40. 10 year old Joe weighs 80lbs. Motrin dosing is 10mg/kg. The Motrin Suspension is 100mg/5ml. How much Motrin can Joe have?

  41. Vantin good for resistant OM • Vantin comes in 100mg/5ml or 50/5 • It is dosed at 5mg/kg/dose give BID • If Sam weighs 45 pounds • How many mg does he need? • What dose do you tell the parent to give

  42. OM • Vantin 100/5 • 1 tsp BID for 10 days • For 22 pounds give • 100/5 (I never use the 50/5) • ½ tsp BID (less is best)

  43. GER • Prevacid for infants • 2mg/kg/day divided BID • Comes in 3mg/ml • Baby weighs 10 pounds • How much do you give?

  44. GER • Prevacid for 10 pound • 4.5 kg • Times 2 is 9mg • Divide by 2 is 4.5 mg each dose • For 3mg/ml • Give 1 ½ ML BID

  45. GER • Prevacid solutabs 15mg and 30 mg • For 2 mo to 1 year give ½ of 15mg tab QD • For young children over 1 year give 15 mg tab QD • For older children give 30 mg tab QD • Potential drug interactions • Clarithromycin or voriconazole because they may increase the risk of Prevacid SoluTab Orally Disintegrating Tablets's side effects • Anticoagulants (eg, warfarin) or digoxin because the risk of their side effects may be increased by Prevacid SoluTab Orally Disintegrating Tablets • Azole antifungals (eg, ketoconazole), clopidogrel, HIV protease inhibitors (eg, atazanavir), iron, or theophylline because their effectiveness may be decreased by Prevacid SoluTab Orally Disintegrating Tablets

  46. GER- first line • Zantac for infants • Also 2 mg/kg/day • Comes in 15mg/ml • Be very careful with this one its easy to over dose! • 9 pounds or 4 kg • Times two is 8 kg divided by two is 4 mg/dose • Give 1/3 ml bid (close enough)

  47. MRSA or UTI • Septra or Bactrim (same drug) • Suspension • Simple trick to dose • Give ½ tsp for every 10 pounds each dose and give BID • Tabs-double strength • Use for 90 pounds and over

  48. MRSA or UTI • 32 pound child with a positive UTI • Give 1 ½ tsp of Septra Suspension bid for 10 days • 90 pound teen with MRSA • Give Septra DS tabs -1 tab bid for 10 days

  49. Common Pediatric Illness and Treatments • Carry Pediatric drug book • Know protocols • Learn dosage for yourself • Favorites • Routines • Drug reps

  50. Acne—update this slide!!!!!!!!! • Topical benzoyl peroxide • Brevoxyl: gel, cleansing lotion, creamy wash • Triaz: gel, cleanser, pad • ZoDerm:cream, gel, cleanser • Clinac BPO • Benzashave • Topical antibiotic • clindamycin • Clindagel: gel • Cleocin T: solution, gel lotion • Evoclin: foam- my favorite • Erythromycin • 2% Ery pads Erygel, Erymax

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