Debbie King

1. Pediatric Therapeutics Debbie King BSN, RN, MSN CFNP, CPNP, CS

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. 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

6. 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

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

8. Pediatric Dosing • 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.

9. Example #1 • 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?

10. Example #2 • 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

11. Example #3 • Cefixime (Suprax) is prescribed for a 14 lb infant. The reference dose for Suprax is 8mg/kg. You have 110mg/5ml. Calculate the number of ml/dose for the infant.

12. Answer for example #3 • 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)

13. Example #4 • 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?

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

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

16. Acne • Topical benzoyl peroxide • Brevoxyl: gel, cleansing lotion, creamy wash • Triaz: gel, cleanser, pad • Zoderm:cream, gel, cleanser • Clinac BPO • Benzashave

17. Acne • Topical antibiotic • clindamycin • Clindagel: gel • Cleocin T: solution, gel lotion • Evoclin: foam- my favorite • Erythromycin • 2% ery pads • ATS • Erygel, Erymax

18. Acne • Topical combinations- always a good choice • Benzaclin –clindamycin and BP • Duac- clindamycin and BP • Benzamycin-erythromycin and BP • Topical retinoids • Retin A, retin A micro • Differin • Tazorac

19. Acne • PO Antibiotics • Doxycycline • Minocycline- use 100 mg bid x 2 wks, then Q day • Tetracyline not under 18 years • Erythromycin • Azithromycin • Septra – be careful

20. Acne • Oral Contraceptive • Orho Tri-Cuclen • Estrostep • Yasmin-28 best tolerated • Oral Isotretinoin- only by a Dermatologist!! • Accutane • Amnesten • Claravis • Sotret

21. Asthma/RAD/Exercise • Albuteral • MBI • PO • nebulizer solution • Xopenex • Nebulizer solution • MDI • Pulmicort Respules • Nebulizer solution • Inhaler

22. Asthma/RAD/Excercise • Flovent • MDI • DPI • Advair age 4 and older • Corticosteriod • Long acting- bronchodilator • Singulair • Granules • tabs

23. BRONCIOLITIS (RSV) • Albuteral • Xopenex • Chest PT • Orapred-rarely helpful • Severe- ER

24. Croup • Orapred- with stidor or less that two • Protocol- includes warm to cool • ER with persistant stidor at rest

25. Conjunctivitis • Allergic (vernal-chronic allergic) • Zaditor • Patenol • Bacterial • Garamycin • Ocuflox • Ciloxan • Viagamox! • Polytrim

26. Conjunctivitis • Corneal abrasion • Confirm with fluorescein • May or may not use antibiotic gtts or ointment- Vigamox, Ilytocin • May or may not patch • Recheck one day- refer if no improvement

27. Conjuctivitis • Viral • Aritificial tears • Topical steroids-ONLY by ophthalmologist! • If herpes virus to ophthalmologist today!!

28. Cellulitis- situational • Treatments are based on location and systemic symptoms, as well as cause • Augmentin ES • Keflex • Rocephin • Ceftin • Rarely Bactrim or Clindamycin- used with positive culture or pretty sure is MRSA

29. Constipation- so common • Increase fiber • Increase water • Decrease milk products • Milk of Magnesia • Mineral Oil- always mixed in something • Benefiber • Mirolax

30. Cough • Rarely suppress- new research • Delsym • Phenergan DM • Too many to list • Assess for the cause!!

31. Allergies • Benadryl • Claritin-OTC • Alavert • Zyrtec • Dytan • Allegra-OTC • Singulair • Steroid nasal sprays • Flonase • Nasonex

32. Dental infections/ prophylaxis • PCN • Keflex • Z-max • Augmentin

33. OM- know protocol • Amoxil- high dose • Augmentin ES • Omnicef • Ceftin • Rocephin • Vantin is dosed by the dose not the day • Z-max- not that helpful here • Cefzil – rarely used now

34. Sinusitis • Same as OM • Length of may be treatment maybe longer, yet do not over use antibiotics!

35. Atypical pneumonia • Zmax • Biaxin • If also wheezing • Albuteral or xopenex • steroids

36. Pneumonia –out patient tx • Rocephin • Augmentin ES • Ceftin

37. UTI- know protocol- for children • Septra • Suprax • Augmentin • Depends on ID and sensitivities – always culture!!

38. Impetigo • Keflex • Augmentin ES • Ominicef • Duracef • Antibacterial soap- protocol

39. MRSA (seen more in the community now) • Bactrim • Clinadamyain

40. Rhus dermatitis • Steroids- topical • Benadryl • Claritin • Prednisone- severe only and always taper dose • May need antibiotic with 2nd infections

41. GABHS • Pen VK- no longer the first choice • Bicillin-IM • Amoxil is now first choice • Keflex- some seasons is better choice • Z-max- at the high dose all 5 days • Omincef

42. Thrush • Nystatin- must be swabbed, not swallowed • Diflucan

43. Vaginal and Diaper Yeast Infections • Lotrimin AF • Diflucan

44. Tinea capitis • Griseofulvin-still the preferred

45. Tinea corporis/pedis • Spectazole • Tinactin

46. Allergic RX- potential • Epi-pen JR with practice pen • Benadryl • Epi-pen • Twin-jet pak- new • refer for testing – even babies with possible food reactions

47. OCP • Yasmin 28 day • Ortho tri cycline

48. Pain • Tylenol • Motrin • Tylenol with codeine

49. Bed wetting • Desmopressin (DDAVP)-many side effects-nasal spray and tablets • Now also in a generic by Teva pharm

50. Well H20 • Fluoride- HL for dosage- use only in 6 months and older, who receive no city water.