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Debbie King

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

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  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.

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