Peds Pharmacology

• Age specific drug dosing:
• Warnings:
• Cautions:
• Contraindications:

Clarks Rule

• Pediatric Dose = child weight(kg)/adult weight of 70kg x adult dose
  
• Pediatric Dose = child weight(pounds)/adult weight of 150lbs x adult dose

Young’s Rule

• Pediatric Dose = adult dose x (child’s age in years/child’s age + 12)

Pediatric Dose by Surface Area

• Formula: SA of child (m2) / 1.7 x adult dose
• The reasoning for using Surface Area to calculate Pediatric Dose:
  • Correlates with physiological variables like cardiac output, liver and renal blood flow, GFR, and body water

Factors influencing absorption

• – Gastric Emptying Time
  
• – Intestinal Motility
  
• – Intestinal blood flow
  
• – Gastric acidity

Pediatric Absorption

• Influencing factors are poorly developed/defined in infancy.
• Enteral absorption is not predictable (generally slower than adults).

Topical Absorption

• Much greater in children than adults, especially high in neonates.
  
• Only the pharmacokinetic parameter will INCREASE in children.

Pediatric Distribution

• Increased total body water (extracellular water) in infants and children results in lower peak levels of water-soluble drugs.
  
• Body fat will increase with age.

Pediatric Metabolism

• Neonatal hepatic function is underdeveloped.
• Results in prolonged half-lives of drugs being oxidized (lidocaine, during undergoing glucuronidation-phase II reactions).

Pediatric Excretion

• Underdeveloped renal function.
• Water-soluble drugs (penicillin, cephalosporins) show prolonged half-life. GFR, renal plasma flow, and tubular function reach adult values 9-12 months of age.

Side effects

Medications

Adenosine

• Dose:
  • 0.1 mg/kg max of 6 mg.
    
  • if no change .2 mg/kg max of 12 mg
• pSVT rates to administer Adenosine:
  • > 220 neonates
    
  • > 180 pediatrics

Albuterol

• Dose:
  • 1.25 – 2.5 mg (packaged in 3ml)
• Common dose for pediatrics < 20 kg:
  • 1.25 mg.
• Common dose for pediatrics > 20 kg:
  • 2.5 mg
• Can be repeated:
  • Once without orders

Amiodarone

• Indication:
  • Refractory V-fib/Pulseless V-tach:
    • Dose: 
      • 5 mg/kg IV,IO bolus.
        
      • May repeat up to a max of 15 mg/kg.
      • Max single dose of 300mg
  • Stable V-tach:
    • Dose:
      • 5 mg/kg in 50mLof D5W infused over 20 – 60 minutes.
        
      • May repeat to a max of 15 mg/kg.
      • Max single dose of 300

Atropine

• Dose: 
  • 0.02 mg/kg IV,IO
• Common max dose:
  • 0.5 mg for child
    
    • May repeat once for a max of 1 mg
      
  • 1 mg for adolescent
    
    • May repeat for a max dose of 3 mg
• Indications:
  • Pre-medication for RSI, unstable bradycardia (2nd line drug)

Benadryl

• Dose range:
  • 1 – 2 mg/kg IV.IO.IM or
    
  • 5mg/kg PO every 24 hrs
    
• Common dose:
  • 1 mg/kgmax of 50 mg

Dexamethasone (Decadron)

• Dose range: 
  • 0.25 – 1 mg/kg
• Common dose:
  • 0.6 mg/kg max of 16 mg

Dextrose

• Dose:
  • 3 ml/kg of D10
• Hypoglycemia:
  • < 40 for neonates
    
  • < 70 for pediatrics

Dilaudid

• Dose: 
  • 0.8 – 2mg IM
    
  • 0.2 – .6mg IV

EPI (1:10,000)

• Common dose:
  • 0.01 mg/kg (0.1 ml/kg) max of 1 mg every 3 – 5 minutes.
• Dose Max: 
  • 0.01 mg/kg IM max of 0.3mg.

Etomidate

• Dose:
  • 0.2-.4 mg/kg Common dose .3
• Max dose:
  • 20 mg/kg
• Min age:
  • 10 years old. Can only be given once.

Glucagon 

• Dose:
  • 0.5 mg less than 20kg
    
  • 1 mg greater than 20kg

Hydroxocobalamin

• (cyano-kit) dose:
  • 70 mg/kg, max of 10 grams.
    
  • may repeat once at the same dose.

Ipratropium (Atrovent)

• Dose range:
  • 250 – 500 mcg (.25 – .5 mg)
• Common Dose:
  • Same as adults. Repeated everything 20 minutes, max of 3 times.

Ketamine

• Dose range:
  • 1 – 2 mg/kg
• Common Dose:
  • 2 mg/kg

Morphine

• Dose: 
  • 0.1 – 0.2 mg/kg.
• Common Dose:
  • 0.1 mg/kg max of 5 mg IV,IO,IM

Narcan

• Dose:
  • 0.1 mg/kg every two minutes as needed.
    
  • IV,IM,IO,SQ max dose of 2 mg.
• Contra-indications:
  • Do not give to neonates born to mothers addicted to narcotics.

Rocuronium

• Long term paralytic.
• Dose:
  • 0.6 – 1.2 Mg/kg
• Common Dose Range:
  • 0.6 mg/kg
• Contraindications:
  • Must be older than 3 months.

Solumedrol 

• Dose range:
  • 1 – 2 mg/kg max of 60 mg.
• Contra-indications:
  • Premature infants.
• Solumedrol considerations:
  • Monitor Blood Sugar.

Succinylcholine

• Who gets it:
  • Neonates, and those unable to intubate/ventilate.
• Dose:
  • 1-2 mg/kg Common Dose of 2 mg/kg
• Too big for broslow tape:
  • Treat with adult dose (1.5 mg/kg)
• Considerations for succinylcholine:
  • Atropine may be needed for vagal response in pediatrics.
     

Versed

• Dose range:
  • 0.05- .5 mg/kg
• Common dose for seizures:
  • 0.1-0.3 mg/kg
• Common dose for RSI for 10 years and younger:
  • 0.1 mg/kg
• Versed considerations:
  • Continuously monitor vital signs

Zofran

• Dose:
  • 0.15 mg/kg max of 4mg.
    
  • IV, IO, IM for ages 6 to 14

Expectorants

Guaifenesin

• Indications:
  • Common cold, pneumonia.
  • Other conditions that require secretion mobilization and expectoration of mucus.
•  MOA:
  • Reduction of the viscosity of thickened secretions by increasing respiratory tract fluid
• Implications:
  • -Encourage deep breathing before coughing in order to mobilize secretions
    
  • -Adequate fluid intake
    
  • -Assess breath sounds

Shock

Defibrillation

• Dose:
  • Initial shock is 2 J/kg
    
  • Subsequent shock is 4 J/kg

Synchronized Cardioversion

• Dose:
  • Initial shock 1 J/kg
    
  • Subsequent shock 2 J/kg