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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

Pediatric Therapeutics

Debbie King

BSN, RN, MSN

CFNP, CPNP, CS


What is therapeutics
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.


Patient characteristics
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.


Diagnosis
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.


Cost effectiveness
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


Safety profile
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


Patient compliance
Patient Compliance

  • Taste- to disguise or not to disguise?

  • Understanding the purpose of the drug.

  • Storage

  • Side effects

  • Understanding the dosage


Pediatric dosing
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.


Example 1
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?


Example 2
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


Example 3
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.


Answer for example 3
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)


Example 4
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?


Example 5
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?


Common pediatric illness and treatments
Common Pediatric Illness and Treatments

  • Carry Peds drug book

  • Know protocols

  • Learn dosage for yourself

  • Favorites

  • Routines

  • Drug reps


Acne

  • Topical benzoyl peroxide

    • Brevoxyl: gel, cleansing lotion, creamy wash

    • Triaz: gel, cleanser, pad

    • Zoderm:cream, gel, cleanser

    • Clinac BPO

    • Benzashave


Acne

  • Topical antibiotic

    • clindamycin

      • Clindagel: gel

      • Cleocin T: solution, gel lotion

      • Evoclin: foam- my favorite

    • Erythromycin

      • 2% ery pads

      • ATS

      • Erygel, Erymax


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


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


Acne

  • Oral Contraceptive

    • Orho Tri-Cuclen

    • Estrostep

    • Yasmin-28 best tolerated

  • Oral Isotretinoin- only by a Dermatologist!!

    • Accutane

    • Amnesten

    • Claravis

    • Sotret


Asthma rad exercise
Asthma/RAD/Exercise

  • Albuteral

    • MBI

    • PO

    • nebulizer solution

  • Xopenex

    • Nebulizer solution

    • MDI

  • Pulmicort Respules

    • Nebulizer solution

    • Inhaler


Asthma rad excercise
Asthma/RAD/Excercise

  • Flovent

    • MDI

    • DPI

  • Advair age 4 and older

    • Corticosteriod

    • Long acting- bronchodilator

  • Singulair

    • Granules

    • tabs


Bronciolitis rsv
BRONCIOLITIS (RSV)

  • Albuteral

  • Xopenex

  • Chest PT

  • Orapred-rarely helpful

  • Severe- ER


Croup
Croup

  • Orapred- with stidor or less that two

  • Protocol- includes warm to cool

  • ER with persistant stidor at rest


Conjunctivitis
Conjunctivitis

  • Allergic (vernal-chronic allergic)

    • Zaditor

    • Patenol

  • Bacterial

    • Garamycin

    • Ocuflox

    • Ciloxan

    • Viagamox!

    • Polytrim


Conjunctivitis1
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


Conjuctivitis
Conjuctivitis

  • Viral

  • Aritificial tears

  • Topical steroids-ONLY by ophthalmologist!

  • If herpes virus to ophthalmologist today!!


Cellulitis situational
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


Constipation so common
Constipation- so common

  • Increase fiber

  • Increase water

  • Decrease milk products

  • Milk of Magnesia

  • Mineral Oil- always mixed in something

  • Benefiber

  • Mirolax


Cough
Cough

  • Rarely suppress- new research

  • Delsym

  • Phenergan DM

  • Too many to list

  • Assess for the cause!!


Allergies
Allergies

  • Benadryl

  • Claritin-OTC

  • Alavert

  • Zyrtec

  • Dytan

  • Allegra-OTC

  • Singulair

  • Steroid nasal sprays

    • Flonase

    • Nasonex


Dental infections prophylaxis
Dental infections/ prophylaxis

  • PCN

  • Keflex

  • Z-max

  • Augmentin


Om know protocol
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


Sinusitis
Sinusitis

  • Same as OM

  • Length of may be treatment maybe longer, yet do not over use antibiotics!


Atypical pneumonia
Atypical pneumonia

  • Zmax

  • Biaxin

  • If also wheezing

    • Albuteral or xopenex

    • steroids


Pneumonia out patient tx
Pneumonia –out patient tx

  • Rocephin

  • Augmentin ES

  • Ceftin


Uti know protocol for children
UTI- know protocol- for children

  • Septra

  • Suprax

  • Augmentin

  • Depends on ID and sensitivities – always culture!!


Impetigo
Impetigo

  • Keflex

  • Augmentin ES

  • Ominicef

  • Duracef

  • Antibacterial soap- protocol



Rhus dermatitis
Rhus dermatitis

  • Steroids- topical

  • Benadryl

  • Claritin

  • Prednisone- severe only and always taper dose

  • May need antibiotic with 2nd infections


Gabhs
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


Thrush
Thrush

  • Nystatin- must be swabbed, not swallowed

  • Diflucan



Tinea capitis
Tinea capitis

  • Griseofulvin-still the preferred


Tinea corporis pedis
Tinea corporis/pedis

  • Spectazole

  • Tinactin


Allergic rx potential
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


OCP

  • Yasmin 28 day

  • Ortho tri cycline


Pain

  • Tylenol

  • Motrin

  • Tylenol with codeine


Bed wetting
Bed wetting

  • Desmopressin (DDAVP)-many side effects-nasal spray and tablets

    • Now also in a generic by Teva pharm


Well h20
Well H20

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


Vitamins
Vitamins

  • Poly Vi Sol – use in 2 –6 months babies who breast feed only

  • Fer-In-Sol

  • Flintstones

    • Rarely needed for USA children


Positive ppd
Positive PPD

  • INH- Isoniazid

  • And of course a chest X-ray

    • If positive then to ID and health dept.


Pin worms
Pin worms

  • Vermox- for 2 and over and non-preg


Parasites
Parasites

  • Flagyl


Swimmers ear oe
Swimmers ear- OE

  • Ciprodex-very expensive

  • Cortisporin otic

  • Floxin Otic

  • PO- Aug ES


Gerd meds and protocol
GERD- meds and protocol

  • Mylicon

  • Zantac

  • Prilosec

  • Prevacid

  • Regland (rarely)

  • refer


Flu

  • Oseltamivir(Tamiflu)- active against both A, B

    • 75 mg bid for 5 days for all over 40kg

    • <15kg- 30mg bid

    • 15-23kg- 45 mg bid

    • 23-40kg- 60mg bid

  • Zanamivir(Relenza) for 7years old and up, active against A,B

    • Not for those with underlying airways disease!!

  • Rimantadin(Flumadin) for over 40kg, active only against A

    • Not used in pregnancy

    • Resistance many be developing in US and asia

  • Amatadine(Symmetrel) is cheapest, 100mg bid, If less than 40kg 5mg/kg/day, active only against A

    • Not used pregnancy

    • May affect central nervous system

    • Resistance may be developing in US and asia


Premature infants
Premature infants

  • Synagis IM- is providers job to identify those at risk and who qualify for this med and then schedule with a pulminologist

    • Is expensive, and must be given every month of rsv season oct-march


Vomiting
Vomiting

  • Phenergan (over 2 years)

    • IM

      • suppository

        Tigan

        Zovaran


Diarrhea
Diarrhea

  • Do not stop

  • If long term do stool studies

  • May need labs


Decongestants
Decongestants

  • OTC

  • Saline spray


Burns
Burns

  • Silvadine

  • Bactroban

  • Refer


Inpacted cerumen
Inpacted cerumen

  • Debrox

  • Hydrogen peroxide

  • Olive oil

  • Q tips-not advised


Eczema so common
Eczema- so common

  • Protocal!

  • Cutivate

  • Elidel (black Label)

  • Elocon

  • Dermatop

  • Demasmoothe

  • Claritin

  • Zyrtec

  • Keflex

  • Orapred


Warts
Warts

  • Duct tape is superior to cryotherapy

    • 85% vs 60% cure rate

  • Plantar warts-

    • Process using an OTC


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