Ped medhandbook

For 24-hour referral or pediatric transport, call our Doctors Direct

757-668-9999Outside Hampton Roads: 800-207-2022

Pharmacy: 757-668-7163

Pediatric Clinical Pharmacist On-call: 757-456-6180

Doses provided are initial dose recommendations and guidelines only. Actual doses may vary

depending on the child’s condition.

Pediatric Medication Handbook

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When referring a child, please have the following information available:

•Name,age,weight

•Vitalsignsincludingbloodpressure,heartrate,respiratoryrate,temperature,andoxygensaturations

•Pertinenthistoryandphysicalfindings:generalappearance(e.g.,degreeofdistress),capillaryrefill,qualityofpulses,breathsounds,andlevelofconsciousness

•LabandX-raydata,ifavailable

•IVaccess-siteandtype

•Therapiesadministered

Table of Contents

Emergency and Pediatric Dosing Guide .............2

CHKD Hematology-Oncology Medications Dosing Guide ....................................................26

Nutrition ............................................................32

Pharmacologic Management of Anxiety and/or Violent/Aggressive Behavior of Pediatric Patients..............................................34

CHKD Neonatal Medications and Dosing Guide ....................................................36

Index .................................................................45

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INTUBATION EstimatedETTSIZE=4+(pt’sageinyrs) 4

cuffedETTtube=3.5+(pt’sageinyrs)(forage2orolder) 4 ETTpositionatlip(incm)estimatedas3timesETTdiameter(inmm).Forexample,3.5mmETTshouldbe11.5cmatthelip.

INITIAL VENTILATOR SETTINGS (volumemode;TV=tidalvolume)TV=7-10mL/kg PEEP=5cmH20 Fi02-0.4(Adjusttokeep02sat>90%)IMV=15/minforchild&20-30/minforinfants PIPlessthan35cmH20Inspiratorytime=0.5–0.6secinfant;0.7–0.8secchild; 0.8–1secadolescent

HYPOVOLEMIC/SEPTIC SHOCK:10-20mL/kgasrapidbolusofanisotonic,non-glucosecontainingsolution(i.e.,lactatedringersornormalsaline).RepeatbolusPRNbasedondistalpulses,bloodpressure,andcapillaryrefill.Thereisnomaximum;theamountgivenisdeterminedbytheneedsofthepatient.

Considercolloid(e.g.,5%albuminorplasmanate)after40–60mL/kgofcrystalloidifshockpersists.

MINIMAL BLOOD PRESSURE VALUES0to1month Systolicpressure>60mmHg1monthto1year Systolicpressure>70mmHgGreaterthan1year Systolicpressure>70mmHg+2x(ageinyears)≥10years Systolicpressure>90mmHg

Emergency Guide RESUSCITATION MEDICATIONS

Amiodarone 5mg/kgIV/IO;bolusforVF/pulselessVTorinfuseover20–60minforperfusingtachycardias

Atropine 0.02mg/kgIV;use0.04mg/kgIM/ETMin:0.1mgIV Max:1mgIV

Bicarbonate 1mEq/kgIV

Calcium CaChloride20mg/kg=0.2mL/kgof10%solutionCaGluconate60-100mg/kg=0.6-1mL/kgof10%solutionviaslowIVpush Max:1000mg/doseofCaChlorideor3,000mgCa Gluconate

Dextrose 0.5-1gm/kgIV(2-4mL/kgD25)

Epinephrine 0.01mg/kgIV/IO(0.1mL/kg1:10,000)Max:1mg/dose(10mL1:10,000)Highdose=0.1mg/kg(0.1mL/kg1:1,000) MaxET:2.5mg/dose

Lidocaine 1mg/kgbolusIV/IO

Vasopressin 0.5–1unit/kgbolusIV/IOinepinephrine-refrac-torycardiacarrest(notroutinelyrecommended) Adult(>40kg)40units

CARDIOVERSION/DEFIBRILLATION

(use lower energy dose initially and increase if needed)

Atrial Arrhythmias 0.5-1joules/kg;synchronized

VentricularTachycardiawithPulse 0.5-2joules/kg;synchronized

VentricularFibrillationorPulselessVentricularTachycardia

2-4joules/kg

CARDIOVASCULAR INFUSIONS

Alprostadil (ProstaglandinE1)

0.01–0.1mcg/kg/min

Dopamine and dobutamine

2-20mcg/kg/min

Epinephrine 0.05-1mcg/kg/min

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Methadone Initial:0.1mg/kg/doseIV/POevery6hrs.Iftransitioningtomethadonetoweanoffotheropioids,largerdosesmaybeneeded–discusswithpharmacists. Availableoralsolutionconcentration:2mg/mL

Midazolam(Versed®)

Initial:0.1mg/kg/hr.Mayconsiderloadingdoseof0.05–0.1mg/kg.InAdults (≥50kg)aninitialinfu-sionof0.02-0.05mg/kg/hrisrecommended. Max:0.5mg/kg/hr

Fentanyl Initial:1-2mcg/kg/hr Max:10mcg/kg/hr(ifinthePICUsetting)

Morphine Initial:10-20mcg/kg/hr Max:50mcg/kg/hr

Ketamine Initial:0.3-0.5mg/kg/hr Max:2mg/kg/hr

Propofol Initial:1-3mg/kg/hr.Aloadingdoseof1–2mg/kgmaybeused(consultwithattending) Max:5mg/kg/hr

PARALYTICS

Pancuronium(Pavulon®)

0.1mg/kg/doseIV;lasts30-60min;avoid in renal failure

Rocuronium 0.5-1mg/kg/doseIV;lasts15-45min;fastestonsetofnondepolarizingagents

Vecuronium 0.1-0.2mg/kg/doseIV;lasts20-40min

ANALGESICS

Acetaminophen 15mg/kgPOor20mg/kgPRevery4hrsPRNupto5doses;nottoexceed75mg/kg/dayor4gm/day <13yo:15mg/kg/doseIVQ6H(max:750mg/dose)>13yo+>50kg:1000mgIVQ6H>13yo+<50kg:15mg/kgdoseIVQ6HIV acetaminophen order set available**Consider all sources of acetaminophen to cal-culate total daily dose. AvailableformsatCHKD:Suppositoriesin120,325,650mg;Tabletsin325,500mg;Meltawaytabs80mg,Liquid32mg/mL.

Esmolol Load: 300 – 500 mcg/kg over 15 min; infusion:50–250mcg/kg/min

Labetalol 0.4-1mg/kg/hr;max=3mg/kg/hr

Milrinone Mayloadwith25-50mcg/kgover30-60min(checkwithattending),infusion:0.25-1mcg/kg/min

Nicardipine 0.25–5mcg/kg/min;PreferCVLadministrationto reduce volume administered

Norepinephrine 0.05–2mcg/kg/min

Nitroprusside(Nipride®)

0.5–5mcg/kg/min;Adult (≥40kg)initialinfu-sionat0.1mcg/kg/min

Nitroglycerin 0.25–10mcg/kg/min;Adult (≥40kg)initialinfusiondose:10mcg/min(Notethatdoseisnotweightbasedinadults).Commonlyusedmaximumdoseof200mcg/min

Vasopressin Initial:0.5–2milliunits/kg/min;adjustmentbasedonBPresponse(DOSE FOR SHOCK).InAdult (≥40kg)initialinfusiondose:is20-100mcg/min (Notethatdoseisnotweightbasedinadults)

ANTIARRHYTHMICS

Adenosine 100mcg/kg–(maxfirstdose=6mg)rapidIVP;maydoubledoseupto12mg/doseandrepeatin1-2min***Contraindicated in heart transplant patients

Amiodarone Load:5mg/kgIVover25min,mayrepeatx2,infusion5-15mcg/kg/min

INTUBATED PATIENT SEDATION/PAIN PROTOCOL

Forsedationstartwithlorazepamormidazolam;forpainstartwithmorphineorfentanyl

Dexmedetomidine(Precedex®)

Initial:0.2-0.7mcg/kg/hr Max:1.5mcg/kg/hr

Lorazepam(Ativan®) Initial:0.1mg/kg/doseIV/POevery6hrs.Iftransitioningtolorazepamtoweanoffotherbenzodiazepines,largerdosesmaybeneeded–discusswithpharmacists. Availableoralsolutionconcentration:2mg/mL

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Acetaminophen w/codeinetablet

0.5–1mg/kg/dosecodeinecomponentPOevery4hrsPRN **Because of variability in metabolism, use codeine containing products cautiously in children < 3 years of age**AvailableformsatCHKD:TylenolNo.3:Acetamino-phen300mgandcodeinephosphate30mg TylenolNo2:Acetaminophen300mgandcodeinephosphate 15 mg

Acetaminophen w/codeineliquid

0.2–0.4mL/kg/dosePOevery4hrsPRN (~0.5–1mg/kg/doseofcodeinecomponent) **Because of variability in metabolism, use codeine containing products cautiously in children < 3 years of age** AvailableformatCHKD:12mgcodeine&120mgacetaminophenper5mL

Fentanyl 1–2mcg/kg/doseIVevery1hrPRN

Gabapentin(Neurontin®)

Neuropathicpain:Childrenstartwith5mg/kg/dose.Day2,5mg/kg/dosetwiceaday;day3,givedose3timeseachday.Titratetoeffect;usualrange:3-12mg/kg/dosethreetimeseachday.Adults,initial100mg/dosethreetimeseachday.Increaseby100mg/doseweekly.Usualrange:600-800mg/dosethreetimesdaily.Solution:250mg/5mL.Capsule:100&300mg.

Ibuprofen 10mg/kg/dosePOevery6hrsPRN Max:800mg/dose **Not for routine antipyretic use in patients < 6 months of age**Available oral solution at CHKD: 100 mg/5 mL

Hydrocodone/Acetaminophen (Lortab®)

Dosedonhydrocodonecomponent:0.1-0.2mg/kg/dose(tablet)or0.2-0.4mL/kg/dose(liquid)POq4hrsPRNMax:10mg/dose AvailableformsatCHKD:2.5mghydrocodone& 167mgacetaminophenper5mL(LortabElixir) Hydrocodone5mg&acetaminophen500mgtablet(Lortab5/500)

Hydromorphone (Dilaudid®)

0.015mg/kg/doseIVevery4hrsPRNor 0.03-0.08mg/kg/dosePOevery4hrsPRN Adultdose:0.2–0.6mgIVevery4hrsPRNor 1–2mgPOevery4hrsPRN AvailablePOformatCHKD:4mgtablet (SeeseparateorderformforPCAdosing)

Ketorolac (Toradol®)

0.5mg/kg/doseIVevery6hrs Max:30mgIVevery6hrs,nottoexceed5days **Not for use in patients < 2 months of age** (CHKDstandardizeddoses:1.5,2.5,5,7.5,15, 30mg)

Morphine 0.05-0.1mg/kg/doseIVevery2hrsorevery4hrsPRN(cautioninrenalfailurepatients) Immediatereleasepreparation:0.2-0.5mg/kg/dosePOevery4hrsorevery6hrsPRN AvailableformsatCHKD:10mg/5mLoralsolution,Immediatereleasetablets:15,30mg Extendedreleasetablets:15,30,60mg

Methadone Initial:0.1mg/kg/doseIV/POevery6hrs AvailableformsatCHKD:2mg/mLelixir,5mgtablet.Methadoneconversionishighlyvariabledependingonthepurposeofitsuse(i.e.,chronicvs. acute pain treatment vs. prevention or treat-mentofwithdrawal).PleaseconsultpainserviceorpharmacyMEDserviceformethadonedosingrecommendation.

Nalbuphine (Nubain®)

Analgesia:0.1–0.15mg/kg/doseIM/IV/SQevery6hrsPRN Max:20mg/dose Pruritus:0.02–0.05mg/kg/doseIV/IM/SQevery3to4hrsPRN Max:5mg/dose

Naloxone(Narcan®)

UsedforpruritusfromepiduralorIVPCAnarcoticsasIVcontinuousinfusionat0.25-2mcg/kg/hr **An order set is available at CHKD**

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Oxycodone Immediatereleasepreparation:0.05–0.15mg/kg/dosePOevery4hrsorevery6hrsPRN. Extendedreleaseinadults;startwith10mgevery12 hrs Initialadultdose(>50kg)5mg/doseevery4orevery6hrsPRN AvailableformsatCHKD:Immediatereleasecapsulein5mgandExtendedreleasetabletin10mg

Oxycodone/ Acetaminophen (Percocet®)

Samedosingasoxycodone;Max:10mg/dose;12tablets/day AvailableformsatCHKD:Oxycodone5mg/Acet-aminophen325mg(Percocet®)tablet

Tramadol(Ultram®)

1–2mg/kg/dosePOevery4to6hrsprn Adultdose:50–100mgPOevery4to6hrsprn(maximumdose:400mg)

Approximate Equianalgesic Doses

Narcotic Analgesic Equianalgesic IV Dose Equianalgesic PO DoseMorphine 1 mg 3 mgFentanyl 0.01mg(10mcg) N/AHydromorphone 0.1-0.2mg 0.75mgCodeine N/A 20mgHydrocodone N/A 3-4.5mgOxycodone N/A 1.5-3mg*Methadoneconversionishighlyvariabledependingonthepurposeofitsuse(i.e.chronicvs.acutepaintreatmentvs.withdrawal).PleaseconsultpainserviceorpharmacyMEDserviceformethadonedosingrecommendation. Consider initiating at ½ to ¾ of an equianalgesic dose when switching agents and titrate up as needed.

SEDATIVES

Chloral hydrate 25-50mg/kg/dosePO/PRevery6hrsPRN Max:1gm/dose

Clonidine 1.5-5mcg/kg/dosePOevery8hrsinadditiontoopioidand/orbenzodiazepineAvailablesolution:100mcg/mL.Tablets:0.1mgPatches:0.1,0.2,0.3mg/day

Dexmedetomi-dine(Precedex®)

EDsedationprotocol:aloadingdoseof2mcg/kgIVover10minutes,then2mcg/kg/hour.Mayrepeatloadupto2moretimesifneeded.

Diazepam(Valium®)

0.12-0.8mg/kg/dayPOdivevery6hrs;longhalf-lifewithchronicdosing;maydoseBIDorTID. 0.04-0.3mg/kg/doseIVevery2to6hrs CHKD-oralsoln:1mg/mL;tablets2mg,5mg

Etomidate 0.5mg/kg/doseIVonceforintubation

Ketamine 1-2mg/kg/doseIVevery2hrsPRN 2-4mg/kgIMforproceduralsedation

Lorazepam(Ativan®)

0.05-0.1mg/kg/doseIV/POevery6hrs Max:4mg/dose

Midazolam(Versed®)

0.1mg/kg/doseIVevery1hrPRN Max:5mg/dose 0.25- 0.5mg/kg/dose PO Max:20mg/dose 0.2-0.3mg/kg/doseINTRANASAL Max:10mg/dose

Pentobarbital 2-3mg/kg/doseIV/IM(max:100mg/dose)

ANTIMICROBIALS

(VAMedicaidpreferredagents:cefuroximetab,cefdinircap/susp,cefprozilsusp)

Acyclovir (Neonatesandinfants)20mg/kg/doseIVevery8hrs(Adolescents)10mg/kg/doseevery8hours (VZV)500mg/m2/doseIVevery8hrs (HSV)250mg/m2/doseIVevery8hrs Oraldosing:750mg/m2/dosePOevery12hrsSuspension:200mg/5mL;capsule:200mg; tablet:200mg,400mg

Amoxicillin <3mos:10-15mg/kg/dosePOBID >3mos:15-25mg/kg/dosePOBID AOM:40-45mg/kg/dosePOBID (Max:875mg/dose)Availableoralsolutionconcentrations:125mg/5mL,200mg/5mL,250mg/5mL,400mg/5mL

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Cefuroxime 50mg/kg/doseIVevery8hrsAdultdose:1.5gIVevery8hrs

Clindamycin 10mg/kg/doseIVevery8hrs Adultdose:600mgIVevery8hrsAvailableoralsolutionconcentration:75mg/5mL

Doxycycline 2.1mg/kg/doseIV/POevery12hrsAdultdose:100mgIV/POevery12hrsUse with caution in children < 8 years of ageAvailableoralsolutionconcentration:25mg/5mL

Fluconazole(Diflucan®)

3-12mg/kg/doseIV/POevery24hrs Adultdose:200-800mg/dayAvailableoralsolutionconcentrations:10mg/mL,40mg/mL

Gentamicin NICU or preterm infants see page 37 Terminfants<1mo:2.5mg/kg/doseIVevery8hrs >1mo:5-7.5mg/kg/dayIVevery24hrs Max:500mg/day (except cystic fibrosis patients) Synergydosing:1mg/kg/doseIVevery8hrs CF:10mg/kg/doseIVevery24hrs MED Service to follow and order levels

Meropenem 20mg/kg/doseIVevery8hrs Adultdose:1gm/doseIVevery8hrs

Metronidazole(Flagyl®)

7.5mg/kg/doseIV/POevery6hrs Adultdose:500mg/doseevery6hrs(50mg/mLcompoundedsuspensionavailable)

Oseltamivir(Tamiflu®)

<3mo:12mgPOevery12hrsfor5days 3–5mo:20mgPOevery12hrsfor5days 6–11mo:25mgPOevery12hrsfor5days >12moand<15kg:30mgPOevery12hrsfor5 days 15–23kg:45mgPOevery12hrsfor5days 23–40kg:60mgPOevery12hrsfor5days >40kg:75mgPOevery12hrsfor5days Availableoralsolutionconcentrations:6mg/mL,12mg/mL **ID consult required for patients < 6 months of age**

Amoxicillin/ Clavulanic Acid (Augmentin®)

15-20mg/kg/dose(amoxicillincomponent)POBID MultidrugresistantOM:40–45mg/kg/dose(amoxicillincomponent)POBID (Max:875mg/dose)Availableoralsolutionconcentrations:125mg/5mL,200mg/5mL,250mg/5mL,400mg/5mL,600mg/5mL.Tablet:250mg,500mg,875mg

Ampicillin 50-100mg/kg/doseIVevery6hrs Adultdose:2gmevery6hrs Max:14gm/day

Azithromycin 10mg/kgIV/POonDay1 5mg/kgIV/POevery24hrsonDay2-5 <6mos:10mg/kgIV/POonDay1-5 Adultdose:500mgonDay1,then250mgonDay2-5.Availableoralsolutionconcentration:200mg/5mL.Tablet:250mg,500mg,600mg

Cefazolin 25-30mg/kg/doseIVevery8hrs Adultdose:2gmIVevery8hrs

Cefdinir (Omnicef®)

>6mos:14mg/kg/day once daily or dividedBID >12yo–adults:600mgPOoncedaily Dosageforms:capsule300mg,125mg/5mL, 250mg/5mL

Cefotaxime 50mg/kg/doseIVevery8hrs Meningitis:50mg/kg/doseIVevery6hrs Adultdose:2gmIVevery8hrs

Cefoxitin 30mg/kg/doseIVevery8hrs Adultdose:1gmIVevery8hrsSeriousinfection/peritonitis:30mg/kg/doseIVevery 6 hrsAdultdose:2gmIVevery6hrs

Cefprozil (Cefzil®)

15mg/kg/dosePOevery12hours;max:1gm/day Availableoralsolutionconcentrations:125mg/5mL;250mg/5mL

Ceftazidime* Restricted to ID/HemOnc/CF 50mg/kg/doseIVevery8hrs Adultdose:2gmIVevery8hrs

Ceftriaxone 50mg/kg/doseIVevery24hrs Adultdose:2gmevery24hrs Adultmeningitis:2gIVevery12hrs

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Oxacillin 50mg/kg/doseIVevery6hrs Adultdose:2gmIVevery6hrs

Penicillin 250,000-400,000units/kg/dayIVdivided every 6 hrs Adultdose:12-24millionunits/dayIVdivided every4-6hrs

Piperacillin/ Tazobactam(Zosyn®)

80mg/kg/doseIVevery8hrs Adultdose:3gm/doseIVevery8hrs

Rifampin S.aureussynergy:10mg/kg/doseIV/POevery12 hrs Adultdose:300mgIV/POevery12hrs (60mg/mLcompoundedsuspensionavailable)

Trimethoprim/Sulfamethoxa-zole(TMP/SMX)(Bactrim/Septra®)(Cotrimoxazole)

3-6mgTMP/kg/dosePOevery12hrsformild/moderateinfectionsAdultdose:TMP160mg/SMX800mgPOevery12 hrs PCP/Severeinfections:5mgTMP/kg/doseIVevery6 hrs PCPProphylaxis:2.5mgTMP/kg/dosePOtwicedaily,3timesperweek(Seepage31) **Not for routine use in patients < 2 months of age** Availableoralsolutionconcentration:sulfamethoxa-zole200mg/trimethoprim40mg/5mLTabletsizes:single-strength:TMP80mg/SMX400mg,double-strength:TMP160mg/SMX800mg

Tobramycin SamedosingasGentamicin

Vancomycin 15mg/kg/doseIVevery8hrs Meningitis/Ventriculitis:15mg/kg/doseIVevery6 hrs Adultdose:1000mgIVevery12hrs MED Service to follow and order levels

*restrictedbyIDconsult/MEDSconsult

ELECTROLYTE REPLACEMENTS

Calcium Chloride 10-20mg/kg/doseIVover30-60min Max:2gm/dose(forpatientswithcentralvenouslines)

Calcium Gluconate

60-100mg/kg/doseIVover30-60min Max:4gm/dose-maybegivenviaperipheralIV

MagnesiumSulfate

25-50mg/kg/doseIVover2hoursforelectrolytereplacement Max:2gm/dose

PotassiumChloride

0.5-1mEq/kg/doseIVover1hour(withcardiacmonitoring) Max:20mEq/dose. Usualstartingoralreplacementdose:1mEq/kg/dosePOonetofourtimesaday(1–4meq/kg/day). Potassiumusuallygivenaschloridesaltbutcanuse acetate salt depending on goal.

PotassiumPhosphate

0.2-0.4mmol/kg/doseIVover4-8hours (1mmolKPhos=1.47mEqK+) Max:15mmol/dose

Sodiumchloride3%(Hypertonicsoln=513mEqNa/L)

Infuse4–6ml/kgover15–30mins(delivers~2–3mEq/kgofNa)torapidlytreatsymptomatic hyponatremiaintheICUorEDsettingonly!

Sodium Phosphate

0.2-0.4mmol/kg/doseIVover4-8hours (1mmolNaPhos=1.33mEqNa+) Max:15mmol/dose

PID/CERVICITIS

Inpatients:Cefoxitin 2gmIVevery6hrs+Doxycycline100mgIV/PO

every12hrsfor14days

Outpatients:Ceftriaxone 250mgIMonce+Doxycycline100mgPOevery

12hrsfor14days±Metronidazole500mgPOevery12hrsfor14days

Cervicitis Azithromycin1000mgPOonce+Ceftriaxone250mgIMonce

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Oral Electrolyte Replacement Chart

Thisservesonlyasareferenceforinitiatingtherapy! Closemonitoringandongoingadjustmentiswarrantedbaseduponpatient’sclinicalstatus,changeinnutritionanddrugtherapy

Electrolyte Starting IV Dose Range (mEq/kg/day)

mEq = mg equivalence

Bioavailability Commonly Used Oral Product(s)

Sodium(Na) 1-2 1mEq=58mg(NaCl)

~100% NaCltabs:*1gm(~17meqNa) (NaCl injection for oral use: *2.5 mEq/ml)

Potassium(K) 1-2 1mEq=75mg(KCl) ~100% KCLsolns:*20mEq/15ml&40mEq/15ml KCLERtabs:8,10,15,20mEq KCLERcaps:8mEq,*10mEq KCLpowder(perpacket):20mEq,25mEq

Calcium(Ca) 0.5 1mEq=20mg(elementalCa)

100mgCaCarbonate=40mgelementalCa=2mEq

25-35% (upto60% ininfants)

CalciumCarbonateChewtabs:400mg,420mg, *500mg [10 mEq],600mg,650mg,750mg,850mg,1000mg, 1250mg,1500mg CalciumCarbonateSoftchew(Rolaids®):1177mg[471mg] CalciumCarbonatetab:364mg,*1250mg[25 mEq],1500mg CalciumCarbonatesusp:*250mg/ml[100mg/ml;5 mEq/ml] Calciumglubionatesyrup:*360mg/ml[23mg/ml;1.15 mEq/ml] Calciumgluconatetab:*500mg[45mg],650mg[58.5mg],975mg[87.75mg]

Magnesium(Mg)

0.25-0.5 1mEq=12mg(elementalMg)

Upto30% MgOxidetabs:*400mg[20 mEq],500mg MgOxidecaps:140mg,600mg MgGluconatetabs:*500mg[2.4 mEq] MgGluconatesoln:*200mg/ml[0.96 mEq/ml]

Phosphate(PO4)

0.5-1.5 mmol/kg/day

1mmol=31mg(elementalPO4)

1-20% *Phos-NaKpowder:250 mg phos [8 mmol]&7.1mEqK/Naeachperpacket *KPhosNeutralorPhospha250Neutraltabs:250 mg phos [8 mmol]&13mEqNa&1.1mEqKpertab *FleetPhospho-soda:128.5 mg phos [4.1 mmol] &1.9mEqNapermL

Bicarbonate(HCO3)

1-3 1mEq=84mg(NaHCO3)

~100% NaBicarbtabs:325mg[3.8 mEq]&*650mg[7.6 mEq] (Na Bicarb injection for oral use: *1 mEq/ml)

ER = Extended release*CHKD Formulary Products [amount in unit] represents the amount of the elemental form of the ionUnderlined items represent the different strengths of Calcium Carbonate available under the Brand name of Tums® Examples: A)MagnesiumOxideOralReplacementina25-kgpatient:0.25mEq/kg/dayelementalMagnesiumx25kg=6.25mEqelementalMg/dayAccountforonly30%oralabsorption:6.25mEq/0.3=20.8mEqelementalMg/dayPO

PatientshouldreceiveMagnesiumOxide400mgtab(=20mEqelementalMg)POdaily

B)PotassiumChlorideOralReplacementina10-kgpatient:2mEq/kg/dayPotassiumx10kg=20mEqPotassium/day(100%bioavailable)PatientshouldreceivePotassiumChloride10mEqcapPObidor10mEq/7.5mlliquidPObid

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ANTICONVULSANTS

Carbamazepine (Tegretol®)

Initial:10-20mg/kg/dayPOdividedevery6-12hrsdependingondosageform;titratetoresponse (trough4-12mcg/mL)(40mg/mLcompoundedsuspensionavailable)

Ethosuximide(Zarontin®)

<6years:Initial:15mg/kg/dayPOdivided every 12hrs(Max:250mg/dose) ≥6years:Initial:250mgPOevery12hrs

Levetiracetam(Keppra®)

Loading:20-30mg/kg/doseIVonce Initial:10mg/kg/doseIV/POevery12hrs Maintenance:10-30mg/kg/doseIV/POevery 12 hrs.Availableoralsolution:100mg/mL

Lorazepam(Ativan®)

0.1mg/kg/doseIV(forseizures>5mins) Max:4mg/dose;Repeatasneededevery10-15min

Midazolam 0.1-0.3mg/kgIMforstatusepilepticuswhennoIVaccess Max:10mg/dose

Oxcarbazepine(Trileptal®)

4-5mg/kg/dosePOevery12hours(initialstartingdose);lowerdosesmaybeusedwhengivenincombinationwithotheranticonvulsants. Adultdose600mgPOtwiceaday. Availableoralsolution:300mg/5mL

Phenobarbital Loadingdose:20mg/kg/doseIV Maintenance:5-10mg/kg/day divided every 12 hrsIV/PO,begin12hourspost-load (trough15–40mcg/mL)Availableoralsolution:20mg/5mL

Phenytoin (FosphenytoinPE)

Loadingdose:20mg/kg/doseIV Maintenance:5-10mg/kg/day divided every 12 hrsIV/PO Fosphenytoin is not available orally(trough10–20mcg/mL,Freephenytointrough1–2mcg/mL)Availableoralphenytoinsuspension:125mg/5mL.Chewabletablet:50mg;extendedreleasecapsule:100mg

Valproicacid Initial:10-15mg/kg/dayPOdividedevery8–24hrs;maintenance:30-60mg/kg/day divided every8–12hrsdependingondosageform. (trough50-100mcg/mL) Availableoralsolution:250mg/5mL

STATUS EPILEPTICUS

Startwithlorazepam0.1mg/kg[maximum:4mg/dose]IV;mayrepeatlorazepamdoseevery5-10minsasneededtostopseizures.IfnoIVaccess,canusemidazolam0.1-0.3mg/kg(Max:10mg/dose)IM

Loadwithphenytoinorfosphenytoin20mg/kgIVover30min(maxof1mg/kg/minupto50mg/minforphenytoin).Checklevel2hoursafterloadingdosetoassuretherapeuticconcentration.(Usualtherapeuticconcentration:10-20mcg/mL)

Beginphenytoin/fosphenytoinmaintenancedose5-10mg/kg/day dividedq12hbeginning6-8hoursafterloadingdose(maxstartingdose=400mg/day).

Ifstillseizingafterphenytoinloadandconcentrationinupperendofrange,considerphenobarbitalload20mg/kgIVover10-15min(max30mg/min).(Usualtherapeuticconcentration:20-40mcg/mL)

Phenytoinandphenobarbitaldosingguidetoincreaseconcentration–Bloodconcentrationwillriseapprox.1mcg/mLforevery1mg/kgmini-loadthatisgiven.

Forrefractorystatusepilepticus,considerloadingwithIVvalproicacid25mg/kgatarateof2to3mg/kg/min.

Midazolaminfusionmayalsobeusedforrefractorystatusepilepticus-loadwith0.15mg/kgIVthenbegininfusionof0.1mg/kg/hr;increaseby0.05mcg/kg/hrevery15minuntilseizuresarecontrolled.

1918


CARDIOVASCULAR/ANTIHYPERTENSIVE

Amlodipine (Norvasc®)

Initial:0.05mg/kg/dosePOoncedaily Adults:2.5-5mg/dosePOonceortwicedailyAvailabletablets:2.5mg,5mg&10mg

Captopril Neonates:0.05–0.1mg/kg/dosePOevery6–12hours Infants&Children:0.2-0.5mg/kg/dosePOevery6-12hrs;First Dose:0.1mg/kg–monitorforhypotension Adults:6.25–25mg/dosePOBID-TID; Max:6mg/kg/dayTablets:12.5 mg,25mg,50 mg

Clonidine 5-25mcg/kg/dayPOdividedevery8hrsforhypertensionTablets:0.1,0.2&0.3mg.Compoundedsolution:0.1mg/mL. Patches:0.1,0.2,0.3mg/day

Digoxin Totaldigitalizingdosevariesbasedonpatient’sage.PleaserefertoLexicompfordosinginforma-tion. Maintenance:5-10mcg/kg/dayPO/IVdividedBIDSolution:50mcg/mLTablet:125,250mcg

Enalapril (Vasotec®)

Initial:0.1mg/kg/dayPOdividedevery12–24hrs;Max0.5mg/kg/dayupto40mg/day Adult:10–40mg/dayPOqdayordivided BIDCompoundedsolution:1mg/mL.Tablets:2.5,5,10&20mg.[Therealsoareextendedreleasecapsulesin30,60&90mg,butnotonCHKDformulary]

Enalaprilat Initial:5-10mcg/kg/doseIVevery6–24hrs Adultdose:0.625-1.25mgIVevery6hrs

Hydralazine 0.1-0.2mg/kg/doseevery1-2hrsIVPRNhypertensive urgency (Renalconsultrequiredinnon-ICUpatients) Max:20mg/doseIV

Labetalol 0.2mg/kg/doseIVevery1–2hrsPRN hypertensive urgency Max:20mg/doseIV

Nifedipine 0.25-0.5mg/kg/dosePOorNG/NDevery4–6hrsPRN Max:10mg/doseCapsule:10mg;extendedreleasetablet:30,60&90mg

Propranolol PO: 0.5-1mg/kg/day dividedevery6-12hrs Max:8mg/kg/day IV:0.01-0.1mg/kg/doseevery6–12hrs Max:Infants-1mg/dose Children-3mg/doseSolution:4mg/mL&8mg/mL.Immediatereleasetablet:10,20,40,60&80mg

ASTHMA/RESPIRATORY

Albuterol Continuousaerosolized:0.5mg/kg/hour;increaseby0.25mg/kg/hrasneeded(max=40mg/hr) Intermittentnebulization:≤20kg:2.5mg, >20kg:5mg

Dexamethasone 0.6mg/kg/doseIV/POfortwodosesgiven24hoursapart(Max:16mg/dose)

Methylprednisolone Loadwith2mg/kgIVthen0.5mg/kg/doseIVevery 6 hrs Max:60mg/doseevery12hours

Prednisone/ Prednisolone

1-2mg/kg/day POdividedevery12–24hrs(Maximumforasthma:60mg/day)Tablets:1,2.5,5,10,&20mgAvailablesolution:15mg/5mL

MagnesiumSulfate 25-75mg/kg/doseIVover20minutes Max:2gm/dose

Ipratroprium(Atrovent®)

0.5mgINHevery6-8hrsx24hrs(0.5mgINHevery20minX3dosesinED)

Racemic epinephrine

0.25mL(infantsandsmallchildren)to0.5mL(olderchildren)of2.25%in2.5mLsalinenebulized(3ml1:1000epinephrine~0.25mlofracemicepi)

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Terbutaline 10mcg/kgslowIVbolus(10min);then0.2mcg/kg/min;maytitrateby0.1mcg/kg/minevery30minto2mcg/kg/min

Theophylline Loadwith5mg/kgIVover30min;thenbegincontinuousinfusion(<1yr=0.6mg/kg/hr;1-9yr=1-1.2mg/kg/hr;9-12yr=0.9mg/kg/hr;>12yr=0.7mg/kg/hr);theophyllinelevel4hrsafterinfusionstarted(target10-18mcg/mL)1mg/kgbolusincreaseslevel~2mcg/mL

ACUTE ALLERGIC REACTIONS

Epinephrine (1:1000)0.01mg/kg/doseIM(Max:0.5mg/dose)

Diphenhydramine 1mg/kg/doseIV(Max:50mg/dose)

Methylprednisolone 2mg/kg/doseIV(Max:60mg/dose)

DIURETICS

Acetazolamide(Diamox®)

5mg/kg/doseIV/POevery6-12hrsx24hrsCompoundedsolution:50mg/mL Tablets:125&250mg

Chlorothiazide(Diuril®)

<6mo:10-20mg/kg/dosePOevery12hrs>6mo:10mg/kg/dosePOevery12hrsSuspension:250mg/5mL Tablets:250&500mg

Bumetanide (Bumex®)

0.01-0.05mg/kg/doseIV/PO(0.025mg/kgequivto1mg/kgLasix);continuousinfusion:0.05mg/kg/hrtitratedtoeffect

Furosemide (Lasix®)

1mg/kg/dose(InitialAdultdose:20mg) (PObioavailability~60%ofIV) Continuousinfusion:0.05-0.4mg/kg/hrtitratedtoeffectSolution:10mg/mLTablet:20,40&80mg

Metolazone(Zaroxyln®)

0.1–0.2mg/kg/dosePOq12hrsAdults(>40kg)5-10mg/dayTablets:2.5,5&10mg

Spironolactone(Aldactone®)

1-3mg/kg/dayPOdivided every 12 hrs

Lasix/DiurilInfusion Lasix1mg/mLandDiuril5mg/mL;begincontinuousinfusionat0.1mg/kg/hrofLasixcomponentandtitratetoeffect; max0.4mg/kg/hrofLasix

GI/METABOLIC

Docusate (Colace®)

5mg/kg/dayPOdividedevery12–24hrsSolution:10mg/mLCapsule:50&100mg

Erythromycin (forGImotility)

15-20mg/kg/dayPOdividedevery6–8hrsethylsuccinate:200mg/5mLor400mg/5mL;estolate:250mg/5mL

Esomeprazole(Nexium®)

<10kg:0.5–1mg/kg/dayIV/PO,mayincreasedosingtotwiceaday 10-20kg:10mg,mayincreasedosingtotwiceadayupto10mg/dose >20kg:1mg/kg/dayIV/PO Max:80mgdividedBIDSuspension:10&20mgpacketsCapsule:20,40mg

Famotidine (Pepcid®)

0.5mg/kg/doseIVevery12hrs Adultdose:20mg/doseIVBIDSolution:10mg/mLTablet:20mg (UseRanitidineasoralagentatCHKD)

Gastrografin/NormalSaline/Mineraloil (PoleyBomb)

15mL/kgrectally Max:1000mL Mustorderasfollows: Gastrografin/NS/Mineraloil1:1:1#ofmL

Lactulose Forconstipation,1-3mL/kg/day divided every 8-12hrs. Max60mL/day Solution:10g/15mL

Metoclopramide(Reglan®)

0.1mg/kg/doseIV/POevery6hrs Max:10mg/doseSolution:5mg/mL;Syrup:5mg/5mL Tablets:5&10mg

Omeprazole(Prilosec®)

Restricted to kids < 10 kg at CHKD 0.5–1mg/kg/dosePO,dailyorevery12hrs Pre-terminfants:0.7mg/kg/daySolution:2mg/mL

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Ondansetron(Zofran®)

0.15mg/kg/doseIV/POevery8hrsPRN Max:8mg/doseLiquid:0.8mg/mL;Solution:2mg/mLTablet:4,8mgDisintegratingtablet:4mg

Polyethyleneglycolwithelectrolytes (Miralax®)

1gm/kg/dayPO,mayincreasetotwiceaday (CHKDstandardizeddoses:2.12,4.25,8.5,17gm)

Promethazine(Phenergan®)

0.25-0.5mg/kg/doseIV/IM/POevery6hrsPRN(donotexceed6.25mg/doseIVifgivenperipherally) Contraindicated in children <2 yoElixir:6.25mg/5mLTablet:25mgSupposi-tory:12.5or25mg

Ranitidine (Zantac®)

4-10mg/kg/dayPOdividedevery8-12hrs Adultdose:150mgBIDSolution:25mg/mLSyrup:15mg/mL Tablet:150mg

Senna+Docusate(Peri-colace®)

Children2to<6yrs:0.5tabletPOdailyatbedtimeChildren6to<12yrs:1tabletdailyatbedtime>12yrs:2tabletsdailyatbedtimeMax<12yr:1tablettwiceadayMax>12yr:2tabletstwiceaday

Ursodiol (Actigall®)

30mg/kg/dayPOdividedevery8-12hrs Adultdose:300mgPOBIDSolution:60mg/mLCapsule:300mg

STEROIDS (Standard Doses)

Dexamethasone(Decadron®)

0.6mg/kg/doseIV/POx1doseforcroup 0.25-0.5mg/kg/doseIVevery6hrsforextubation(nottoexceed24hoursunlessperattending)max:15mg/dose IncreasedICP:0.5-1mg/kg/doseIVq6h–Adultdose4-10mg/doseq6hSolution:10mg/mLor1mg/mLTablet:0.5,0.75,1&4mg

Hydrocortisone Stressdose:50mg/m2/dayIVdivided every 6 hrsor1mg/kg/doseIVevery6hrs Mayalsouse2–4timeshomedoseforstressdosing.Adultstressdose:100mg

Methylprednisolone 2mg/kg/dayIVdividedevery6-12hrs; usual max60mg/doseevery12hours Spinalcordinjury:30mg/kgIVover15minfol-lowedby5.4mg/kg/hrinfusionx23hours

Prednisone/ Prednisolone

1-2mg/kg/dayPOdividedevery12-24hrs Usualadultmax60mg/day Tablets:1,2.5,5,10,20mg Availablesolution:15mg/5mL

TOXICOLOGY/REVERSAL AGENTS

Acetylcysteine Acetaminophen poisoning–useinconjunctionwithRumack-Matthewnomogram NG dosing:140mg/kgloadingdosefollowedby70mg/kgevery4hrsx17doses IV dosing (Acetadote®):Loadingdose=150mg/kgover15min,maintenancedose=50mg/kgover4hoursthen100mg/kgover16hoursascontinuousinfusion

Activated Charcoal 1-2gm/kgNG/PO(avoidrepeatdosesofcharcoalwithsorbitol)

Albuterol Hyperkalemia: albuterol5mgnebulized

Flumazenil Benzodiazepine reversal (contraindicatedwithhistoryofseizures) 0.01mg/kg/doseIV;lastsless<1hr Max:0.2mg/dose,mayrepeatevery1min,upto1mgPRN

Glucagon Hypoglycemia secondary to insulin excess 0.02mg/kgIV/IM/SQ Max:1mg;mayrepeatevery20min Beta-blocker overdose Child:0.025-0.05mg/kgIVbolusfollowedby0.07mg/kg/hrinfusion Adolescent:2-3mgIVfollowedby5mg/hrinfusion

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Insulin,Regular+glucose

Hyperkalemia:0.5gm/kgglucose+0.1unit/kginsulin;infuseover30-60min

Kayexalate 1gm/kg/dosePO;1.5-2gm/kg/dosePRmixedwith20%Sorbitol

Naloxone (Narcan®)

Respiratorydepression:0.001-0.01mg/kg/doseIV(1-10mcg/kg/dose),mayrepeatevery2-3minPRN Max:0.4mg/dose.Titrationofsmall(1-2mcg/kg)doseslimitsriskofacutepain/stress Rapid,fullreversalofnarcoticoverdose:0.1mg/kg/doseIV,mayrepeatevery2–3minPRN Max:2mg/dose

MISCELLANEOUS MEDICATIONS

Albumin 4mL/kg(1gm/kg)of25%solution;roundto50mLincrementsifpossible

Aspirin 5mg/kg/dosePO/PRq24h(CHKDstandardizeddoses:20.25,40.5,81mg)

Glycopryrrolate 4-10mcg/kg/doseIVq6h 40-100mcg/kg/dosePOq6hSolution:2mg/4mL

Haloperidol 0.05-0.15mg/kg/dayIV/IM/POdividedq6-8hr (seealgorithmforacutebehaviormanagement,page 34-35)

Hydroxyzine 0.5-1mg/kg/dosePO/IM*q4-6hrprn(adultdose:50mg/dose)*Has been administered slow IV push* Syrup10mg/5mL;Tablet10mg,25mg

Iron Supplementation

3-6mg/kg/dayPOelemental iron divided q8-24h

Insulin(regular) 0.05-0.1unit/kgSQ;beginIVinfusionat 0.1unit/kg/h

THAM 3-4mL/kg/doseIV(~1mmol/kg/dose)3mL=0.9mmolTHAM;requiresrenalfunction

Vasopressin(for DI): Begininfusionat0.5milliU/kg/hr–increaseby0.5milliU/kg/hrevery5-10minuntilUOP <2mL/kg/hr

BLOOD PRODUCTS **Blood Bank phone number: (757) 668-7255**

Cyroprecipitate 1unit=15mL

Dose=(desiredincreaseinfibrinogenlevel(mg/dL)xpatient’splasmavolume)/250mg/unitforfibrinogen

FFP 1PediFFPunit=50mL

10mL/kg(donotinfuserapidly–maydecreaseionizedcalciumconcentra-tion)

PRBCs 1PediSplitunit=80mL

10-15mL/kg(ininfants&children10mL/kgraiseshgbby~3g%andhctby~9%)

Platelets <10kgone-halfpheresisunit>10kgonepheresisunit Onepheresisunit~ 6-10singledonorunits

Patientslessthan2yo:10mL/kgbodyweight Patientsgreaterthan2yo:1unit/10kgbodyweight(1randomdonorunit/5kgraisesplateletsby~50,000/mm3)

CONVERTING WEIGHT (POUNDS) TO BODY SURFACE AREA (M2)[assumesnormalproportionoflengthtoweight]

Weight (pounds) BSA (m2)

3 0.1 6 0.2 12 0.3 18 0.4 24 0.5 30 0.6 36 0.7 42 0.8 48 0.9 60 1.0 70 1.1 80 1.2 90 1.3 100 1.4

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CHKD Hematology-Oncology Medications Dosing GuideCHKDHem/OncClinicalPharmacist:Ciscophone8-8058,Simon2861

Anti-infectives

Acyclovir 250mg/m2/doseIVq8h (HSVinimmunocompromisedhost) 500mg/m2/doseIVq8h (VZVinimmunocompromisedhost) 250mg/m2/doseIVq12hforprophylaxispost-BMTSuspension:200mg/5mLCapsule:200mg Tablet:400&800mg

LiposomalAmphotericin B (Ambisome®)

3mg/kg/doseIVq24h(empirictherapy) 5mg/kg/doseIVq24h(documentedinfection) round to nearest 50 mg vial size

Azithromycin(Zithromax®)

10mg/kg/dosePO/IVx1onday1then 5mg/kg/dosePO/IVdailyonday2-5 (adultdose:500mgPOx1onday1then250mgPOdailyonday2-5)

Trimethoprim/Sulfamethoxa-zole(TMP/SMX)(Bactrim/Septra®)(Cotrimoxazole)

PCPprophylaxis-->Refertopage31 Infections-->Refertopage12

Caspofungin (Cancidas®)

70mg/m2/doseIVonday1,then50mg/m2/doseIVdaily(adultdose:70mgIVx1onday1,then50mgIVdaily)

Cefepime(Maxipime®)

50mg/kg/doseIVq8h(adultdose:2gm/dose)

Cefotaxime(Claforan®)


Ceftriaxone(Rocephin®)


Clindamycin (Cleocin®)

10mg/kg/doseIVq8h(adultdose:600mg/dose)

Fluconazole(Diflucan®)

5mg/kg/dose(max:200mg/dose)PO/IVqdayforprophylaxis;6-12mg/kg/doseIV/POqdayforsystemic candidiasis

Gentamicin/Tobramycin

10mg/kg/doseIVq24h(Dosebasedondosingbodyweightifpatientisobese) MED Service to follow and order levels

Levofloxacin(Levaquin®)

6mos-5years10mg/kg/doseIV/POq12h;>5years10mg/kg/doseIV/POevery24hours

Linezolid(Zyvox®)

10mg/kg/doseIV/POq8h(pt≥12yo:600mgIV/POq12h)

Meropenem(Merrem®)

20mg/kg/doseIVq8h(adult1gIVq8h;severeinfection:2gIVq8h)

Metronidazole(Flagyl®)

7.5mg/kg/doseIV/POq6h(adultdose:500mg/dose)

Oxacillin 50mg/kg/doseIVq6h(adultdose:2gm/dose)

PenicillinVK Forpneumococcalprophylaxis<2mos:62.5mgPOBID;2mos-3yo:125mgPOBID;>3yo:250mgPOBID;pt>50kg:500mgPOBID Suspension: 125 mg/5 mL, 250 mg/5 mL; Tablet: 250 mg, 500 mg

Vancomycin 15mg/kg/doseIVq8h(pt≥45kg:1gmIVq12h)MED Service to follow and order levels

Voriconazole(Vfend®)

8mg/kg/dose(adultdose200 mg)IV/POq12h.Avoid IV formulation in patients with renal insufficiency.

Oral antibiotics

(VAMedicaidpreferredagents:cefuroximetab,cefdinircap/susp,cefprozilsusp)

Cefuroxime(Ceftin®)

15mg/kg/dosePOq12h(adultdose:250-500mgPOq12h) Suspension: 125 mg/5 mL, 250 mg/5 mL; Oral tablet: 250 mg, 500 mg

Cefdinir (Omnicef®)

14mg/kg/dosePOdailyor7mg/kg/dosePOq12h(max:600mg/day) Suspension: 125 mg/5 mL, 250 mg/5 mL; Oral capsule: 300 mg

Cefixime(Suprax®)

8mg/kg/dosePOdailyor4mg/kg/dosePOq12h(max:400mg/day) Suspension: 100 mg/5 mL, 200 mg/5 mL; Oral tablet: 400 mg

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Cefprozil(Cefzil®)

15mg/kg/dosePOq12h(adultdose:250-500mgPOq12h) Oralsusp:125mg/5mL,250 mg/5 mL;Oraltablet:250mg,500mg

Anti-emetics

Aprepitant (Emend®)

125mgPO1hrpriortochemoonday1,80mgPOoncepriortochemoondays2and3combinedw/scheduled5HT-3antagonist(eg,ondansetron)&steroid in pts ≥12yo&≥40kg


10mg/m2/doseIV/POpriortochemo (max:10mg/dose) Delayedemesis:8mgIV/POq12hx2daysthen4mgIV/POq12hx2daysincombinationw/scheduled5HT-3antagonist(eg,ondansetron)inadult-sizepatients

Diphenhydramine (Benadryl®)

1mg/kg/dosePO/IVq6hprn(max:50mg/dose)

Dronabinol (Marinol®)

5mg/m2/dosePOq4horq6hprn (dosein2.5mgincrements)

Granisetron (Kytril®)

10-20mcg/kg/doseIVBID(adultdose:1mgIVBID)

Lorazepam (Ativan®)

0.02-0.04mg/kg/doseIVq6hprnfornausea/vom-iting(max:2mg/dose)

Ondansetron(Zofran®)

0.15mg/kg/doseIVq8hscheduled/prn (max:8mg/dose)or0.45mg/kg/doseIVq24hpriortochemotherapy(max=24mg/dose)

Prochlorperazine(Compazine®)

0.1-0.15mg/kg/doseIVq8hprn (max:10mg/dose;40mg/day)

Promethazine(Phenergan®)

0.25-1mg/kg/doseIV/PR/POq4horq6hprn (max:25mg/dose) (avoidinchildren<2yo;maxdose:6.25mgifgivenviaperipheralIV)

GI Agents

Bisacodyl (Dulcolax®)

3-12yo:5mgPOBID;>12yo:10mgPOBID

Docusate (Colace®)

2.5mg/kg/dosePOBID(max:400mg/day);roundtonearest50-mgcapsizeoruseliquid

Lactulose (Chronulac®)

Forconstipation,1-3mL/kg/day divided every 8-12hrs. Max60mL/day Solution:10g/15mL

MagnesiumCitrate <6yo:2-4mL/kg;6-12yo:100-150mL;>12yo:150-300mLPOq6huntilstooling

Polyethyleneglycol(Miralax®)

8.5-17gmPOdailyorBID

Senna/Docusate(Peri-Colace®)

<6yo:0.5tabPOBID;6-12yo:1tabPOBID;>12yo:2tabsPOBID

Senna <2yo:1.25mLPOBID;2-6yo:2.5mLBID;6-12yo:5mLPOBID;>12yo:10mLBID


0.5mg/kg/doseIVq12h(adult:20mg/dose)


2-3mg/kg/dosePOBID(adult:150mg/dose)


<10kg:0.5-1mg/kg/doseIVdailyorBID; 10-20kg:10mgPO/IVdailyorBID >20-30kg:20mgPO/IVdailyorBID; ≥30kg:40mgPO/IVdailyorBID


Restricted to kids < 10 kg at CHKD: 0.5-1mg/kg/dosePOdailyorBID

Pain Management

Acetaminophen 10-15mg/kg/dosePOq4horq6hprn (adult:650mg/dose;Max:4g/day)

Acetaminophen/Codeine

0.5-1mg/kg/dosecodeineor0.2-0.4mL/kg/dosePOq4horq6hprn/scheduled Oral liquid: 12 mg codeine/120 mg acetamino-phen per 5 mL Oral tablet: 30 mg codeine/300 mg acetamino-phen (Tylenol No. 3 tab) 15 mg codeine/300 mg acetaminophen (Tylenol No. 2 tab)

Fentanyl 0.5-1mcg/kg/doseIVq1hprn

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Hydrocodone/Acetaminophen (Lortab®)

0.2mg/kg/dosehydrocodonePOq4hprn (max:10mg/dose) Oral elixir: 2.5 mg hydrocodone/167 mg acetaminophen per 5 mL Oral tablet: 5 mg hydrocodone/500 mg acetaminophen (Lortab 5/500)

Hydromorphone(Dilaudid®)

0.015mg/kg/doseIVq4hprn (adult:0.2-0.6mgIVq4hprn) 0.03-0.08mg/kg/dosePOq4hprn

Ibuprofen (Motrin®/Advil®)

10mg/kg/dosePOq6hscheduled/prn (max:800mg/dose;3200mg/day)

Ketorolac (Toradol®)

0.5mg/kg/doseIVq6hscheduled/prn (max:30mg/dose);donotexceed5days

Morphine 0.05-0.1mg/kg/doseIVq2horq4hprn (adult:2.5-10mg/dose)

Morphine ImmediateRelease

0.2-0.5mg/kg/dosePOq4hprn (adult:10-30mgPOq4hprn)

MSContin ControlledRelease

24-hPCAtotalmorphinex3dividedin2-3doses scheduled(dosein15-mgincrements)

Nalbuphine(Nubain®)

Analgesia: 0.1-0.15mg/kg/doseIV/SQ/IMq6hprn(max:20mg/dose) Pruritus:0.05mg/kg/doseIV/IM/SQq4hprn(max:5mg/dose)

Naloxone (Narcan®)

Pruritus from PCA:0.25-2mcg/kg/hrIVas continuousinfusion

Oxycodone/APAP(Percocet®)

0.05-0.15mg/kg/doseoxycodonePOq4horq6hprn/scheduled(max:10mg/dose) Oral tablet: 5 mg oxycodone/325 mg acetaminophen (Percocet 5/325)

Miscellaneous

Allopurinol (Zyloprim®)

≤10yo:10mg/kg/dayor200-300mg/m2/day POin2-3divideddoses >10yo:600-800mg/day POin2-3divideddoses(max:800mg/day)

Folic Acid 1mgPOdaily

MagicMouthwash (Benadryl:Maalox:Viscouslidocaine1:1:1) 3-5mLswish/spitorswallowq6hprn

Peridex® Mouthwash

10-15mLswish/spittid

Caphosol Mixblueandwhiteampulestogether.Give15mL(1/2dose)swishx1minutethenspit.Repeatwithremaining15mL

Rasburicase(Elitek®)

0.15mg/kgIVonce(max:6mg/dose)mayrepeatafter12hoursifnecessary

Electrolyte Supplements

Magnesiumdosing:[IVdailyrequirement(mEq)x3.3]/20mEq=#MagnesiumOxidetabsperday(in2-3divideddoses)

3 Mg Oxide tablet: 20mEqMg/400mgtab3 Mg Gluconate solution:0.96mEqMg/mL

Phosphorousdosing:[IVdailyrequirement(mmol)x5]/8mmol=#Phos-NaKpowderpacketsperday(in2-3divideddoses)

3 Phos-Na K powder:250mgPhos(8mmol),7.1mEqK,7.1mEqNaperpacket3 KPhos Neutral or Phospha 250 Neutral tablet:250mgPhos(8mmol),1.1mEqK,13mEqNapertablet

Bactrim® Dosing Chart for PCP Prophylaxis

(DosetobegivenBIDonFriday,SaturdayandSundayeachweek)

Weight (kg) Dosing range (mg/kg/dose)

Dose (mg) Liquid (mL) SS Tabs

DS Tabs

<8 > 2.5 20 2.5 – –

8–11 2.5–3.5 28 3.5 – –

12–17 2.4–3.3 40 5 0.5 –

18–24 2.5–3.3 60 7.5 – –

25–34 2.4–3.2 80 10 1 0.5

35–50 2.4–3.4 120 15 1.5 –

>50 < 3.2 160 20 2* 1

*BactrimDS®tabletsareoblong-shaped,largeandcanbedifficulttoswallowforsomepatients.ConsiderusingBactrimSS®x2inplaceofDS®tabinthesepatientstoimprovecompliance!

3332


TermFormulasMilk-ProteinBasedSoy-BasedProteinHydrolysate&AminoAcidEnfamilLipilw/Iron

SimilacAdvanceEarlyShieldw/Iron

SimilacIsomilAdvance

Enfamil ProSobee

Pregestimil Alimentum Nutramigen Neocate

AvailbilityReadytoFeed(RTF),Powder(Pwd),&concentrate(C)RTFandpwdPwdCalorie/oz 20 20 20 20 20 20 20 20Kcal/cc 0.67 0.67 0.67 0.67 0.67 0.67 0.67 0.67Proteing/dl 1.42 1.4 1.7 1.7 1.9 1.9 1.9 2Source Whey&Nonfat

MilkNonfatMilk&WheyProteinConcentrate

SoyProteinw/L-methionine

SoyProtein w/L-methionine

CaseinHydrolysate&AminoAcids



L-AminoAcids

CHO(g/dl) 7.4 7.6 7 7.2 6.9 6.9 7.4 7.8Source Lactose Lactose

GOS(Prebiotic)CornSyrup&Sucrose

CornSyrup Solids

CornSyrupSolids&CornStarch

Sucrose&ModifiedTapiocaStarch

CornSyrupSolids&CornStarch

CornSyrupSolids

Fat(g/dL) 3.65 3.65 3.7 3.6 3.8 3.7 3.4 3Source Palm,Olein,

Soy,Coconut,HighOleic

SunflowerOils

High-OleicSaf-flower,Coconut &SoyOils

HighOleicSafflower,Coconut&SoyOils

PalmOlein, Soy,Coconut,High-OleicSunflowerOils

MCT(55%),Soy,Corn,HighOleic

Oils

MCT(33%), Safflower& SoyOils

Palm,Olein,Soy,Coconut,HighOleicSunflowerOils

HybridSafflower,RefinedVegetableOil(Coconut,Soy)

mOsm/KgH2O 300 300 200 200 280-340 370 320 375Uses/FeaturesStandardinfantformula.LipilandMilk-free,lactose-freeinfantHypoallergenicformulawithMCTOilHypoallergenicformulasElementalinfant SimilacAdvancecontainaddedDHAformulaforinfantssensitivetoformulawith100% andARA.intactproteinsofmilk.freeaminoacids

INFANT FORMULAS

Alsoavailable:EnfamilLactoFreeLipil,SimilacSensitivew/Iron,Portagen,Monogen,SimilacPM60/40(renal)

StandardFormula1-10yrsStandardFormula>10yrsProteinHydrolysatesElementalFormula>10yrsOralSupplements>10yrsPediasure(w/&w/outFiber)

Jevity® 1 cal

(1.2cal)

Nutren1.5(Nutren2.0)

PediasurePeptide Peptamen Jr. EleCare Jr. VivonexRTF Carnation Inst.Breakfast

ResourceFruit

BeverageAvailbility 8ozcan 8ozcan 250mLcan 8ozcan 250mLcan Powder 250mLcan 250mLcan 8ozcartonCalorie/oz 30/45 30(36) 45(60) 30/45 30 30 30 30 32Kcal/cc 1/1.5 1(1.2) 1.5(2) 1/1.5 1 1 1 1 1.06Proteing/L 30/59 44.3(55.5) 60(80) 30/45.1 40 30 50 35 38ProteinSource WheyProtein Sodiumand

Calcium CaseinateCa&K

CaseinateWheyProtein WheyProtein Free Amino

AcidsFree Amino Acids Calcium

CaseinateWhey Protein

CHOSource Maltodextrin,sucrose

Maltodextrin Maltodextrin,CornSyrup

CornMaltodextrin, Sucrose

Maltodextrin Corn syrup Maltodextrin CornSyrup Sugar,CornSyrup

FatSource Safflower&SoyOil,15%MCToil

Safflower&CanolaOil,19%MCToil

CanolaOil,50%MCT(75%MCTforNutren2.0)

StructuredLipids (InteresterifiedCanola andMCT)50%MCT

SoybeanOil,70%MCTOil

SafflowerOil,33%MCTOil

SoybeanOil,40%MCTOil

CanolaOil,CornOil

Noneadded

mOsm/KgH2O 480 300(450) 430-510(745) 390 270 596 630 480-490 700Uses/Features For children 1

to10yrsFor children 10yrs-adult

Semi-elemental for1-13yrold withmalabsorption

ElementalforGIimpaired children 10yrs-adult

ElementalforGIimpaired chil-dren1-10yrs

Verylowfatelementaltubefeedformulade-signedforGIimpairedchildren10y/o-adult

Likefruitjuicewithaddedprotein and vitamins.

Alsoavailable:Perative,Suplena(renal),Nepro(renal),Portagen

PEDIATRIC/ADOLESCENT FORMULAS

3534


P h a r m a c o l o g i c a l M a n a ge m e n t o f Ag i ta t e d o r H o s t i l e B e h av i o r

i n P e d i a t r i c Pa t i e n t s

A g i t a t e d o r H o s t i l e B e h a v i o r

Poor

Response2 A n t i h i s t a m i n eA n t i h i s t a m i n eA n t i h i s t a m i n eA n t i h i s t a m i n e

D i p h e n h y d r a m i n e ( B e n a d r y l )





DoseDose 1 mg / kg / dose1 mg / kg / dose1 mg / kg / dose

RouteRoute PO IM IV

RepeatRepeat q 30 min x 2

q 30 min x 2

q 10 min x 2

MaxMax 50 mg / dose50 mg / dose50 mg / dose

CautionCaution Avoid Antihistamine if Delirium Suspected

Avoid Antihistamine if Delirium Suspected

Avoid Antihistamine if Delirium Suspected

3 B e n z o d i a z e p i n eB e n z o d i a z e p i n eB e n z o d i a z e p i n eB e n z o d i a z e p i n e

L o r a z e p a m ( A t i v a n )





DoseDose 0.05 to 0.1 mg / kg / dose0.05 to 0.1 mg / kg / dose0.05 to 0.1 mg / kg / dose

RouteRoute PO IM IV *


q 15 min x 2

q 5 min x 2

MaxMax 2 mg / dose2 mg / dose2 mg / dose

CautionCaution

If > 0.3 mg / kg or If > 6 mg in 1 hour

Use Monitored Bed


Use Monitored Bed


Use Monitored Bed

* IV Route Associated with Respiratory Depression





4 N e u r o l e p t i c ( C h o o s e O n e ) N e u r o l e p t i c ( C h o o s e O n e ) N e u r o l e p t i c ( C h o o s e O n e ) N e u r o l e p t i c ( C h o o s e O n e ) N e u r o l e p t i c ( C h o o s e O n e ) N e u r o l e p t i c ( C h o o s e O n e ) N e u r o l e p t i c ( C h o o s e O n e )

H a l o p e r i d o l O l a n z a p i n e H a l o p e r i d o l O l a n z a p i n e H a l o p e r i d o l O l a n z a p i n e H a l o p e r i d o l O l a n z a p i n e H a l o p e r i d o l O l a n z a p i n e H a l o p e r i d o l O l a n z a p i n e H a l o p e r i d o l O l a n z a p i n e H a l o p e r i d o l O l a n z a p i n e ( H a l d o l )( H a l d o l )( H a l d o l )( H a l d o l )( H a l d o l ) ( Z y p r e x a ) ( Z y p r e x a ) ( Z y p r e x a )

DoseDose 0.025 to 0.075 mg / kg / dose0.025 to 0.075 mg / kg / dose0.025 to 0.075 mg / kg / dose Dose For < 12 y/o: 5 mg / dose For > 12 y/o: 10 mg / doseFor < 12 y/o: 5 mg / dose For > 12 y/o: 10 mg / dose

RouteRoute PO IM IV ** Route PO IM


q 5 min x 2

q 5 min x 2 Repeat q 30 min

x 2q 15 min

x 2

MaxMax 5 mg / dose5 mg / dose5 mg / dose Max 20 mg / dose20 mg / dose

CautionCaution

If > 0.2 mg / kg or If > 10 mg in 1 hour Use Monitored Bed



Caution

If < 12 y/o & Total Doses > 5mg orIf > 12 y/o & Total Doses >10mg

Use Monitored Bed


Use Monitored Bed**IV Route Increases Risk of QT Prolongation Use Monitored Bed**IV Route Increases Risk of QT Prolongation

Use Monitored Bed**IV Route Increases Risk of QT Prolongation



Use Monitored Bed

Caution


Use Monitored Bed


Use Monitored Bed

Mike Chicella, Pharm. D. Peter Dozier, M.D.Bryan Fine, M.D.Jon Mason, M.D. Dana Ramirez, M.D.Arno Zaritsky, M.D.

References:1 Use of Chemical & Physical Restraints in the Pediatric Emergency Dept,

Pediatric Emergency Care, Vol 16(5), 20002 Chemical Restraints for the Agitated, Violent or Psychotic Patient in the

Pediatric Emergency Dept, Pediatric Emergency Care, Vol16 (2), 20043 Review of Benzodiazepine Use in Children and Adolescents,

Psychiatric Quarterly, Vol 76(3), 20054 Prehospital Evaluation and Management of Violent or Agitated Children,

Clinical Pediatric Emergency Medicine, Vol 8, 20075 Harriet Lane Handbook, 17th Ed, 20056 Agitation Treatment for Pediatric Emergency Patients, J Am Academy

Child & Adolescent Psychiatry Vol 47(2), 2008

Version 06.01.12

5 C o m b i n a t i o n o f B e n z o d i a z e p i n e A N D N e u r o l e p t i c

C o m b i n a t i o n o f B e n z o d i a z e p i n e A N D N e u r o l e p t i c

C o m b i n a t i o n o f B e n z o d i a z e p i n e A N D N e u r o l e p t i c

DoseDose 0 . 0 5 m g / k g L o r a z e p a m

0 . 0 5 m g / k g H a l o p e r i d o l

RouteRoute IM IMRouteRoute (Can Administer Lorazepam & Haloperidol in Same Syringe) (Can Administer Lorazepam & Haloperidol in Same Syringe)

MaxMax 2 mg / dose 5 mg / dose

+

O R

Poor Response

Poor Response

Poor Response AND

Extreme Physical Aggression

Poor

Response

1 B e h a v i o r a lI n t e r v e n t i o n s

Pharmacologic Management of Anxiety and/or Violent/Aggressive Behavior of Pediatric Patients

3736


CHKD Neonatal Medications and Dosing GuidelinesCHKDNICUClinicalPharmacist:Ciscophone RedTeam:8-8002,BlueTeam:8-5491

Antibiotics/Antivirals/Antifungals/Immune Globulin

Acyclovir IVPreterm Neonate < 33 weeks: 20 mg/kg/doseIVq12hrNeonate > 34 weeks: 20 mg/kg/doseIVq8hrDosing Adjustment in Renal Impairment: SCr=0.8–1.1 20 mg/kg/doseIVq12hr SCr=1.2-1.5 20 mg/kg/doseIVq24hr SCr>1.5orurineoutput<1ml/kg/hr(oliguria):10 mg/kg/doseIVq24hr

Amikacin IV:Infuseover30mins. (Base dose on actualweightinneonates)0-4 weeks, <1200gm: 7.5 mg/kg/doseq24hrPostnatal age < 7 days: 1200-2000gm: 7.5 mg/kg/doseq12hr >2000 gm: 10 mg/kg/doseq12hr Postnatal age > 7 days: 1200-2000gm: 7.5 mg/kg/doseq12hr >2000gm: 10 mg/kg/doseq8hr

Amoxicillin (for UTI prophylaxis)POonly10-15mg/kg/doseq24hr IfNPO,useAmpicillin50mg/kg/doseIVqPM

Amphotericin B (over 4 hr per NICU protocol) 1 mg/kgIVq24hrExtendintervaltoq48hrwithrenaldysfunction.Needsaseparateline/portifinfusingw/TPN&fats.With1line:RunTPNover20hrs,checkbloodsugarswhileoffTPNduringAmphoinfusion.

Ampicillin IV,IMPostnatal age: < 7 days OR < 1200gm 100 mg/kg/doseq12hr > 7 days & 1200-2000gm 100 mg/kg/doseq8hr > 7 days & > 2000gm 100 mg/kg/doseq6hr UTI Prophylaxis while NPO: 50 mg/kg/doseqPM

Cefazolin (Ancef®) IV,IM Postnatal age: < 7days OR < 2000gm 20 mg/kg/doseq12hr > 7 days & > 2000gm 20 mg/kg/doseq8hr

Cefotaxime (Claforan®)IV,IMPostnatal age: < 7 days OR < 1200gm 50 mg/kg/doseq12hr > 7 days & > 1200gm 50 mg/kg/doseq8hrMeningitis dose after 28 days of life 50 mg/kg/doseq6hr

Cefoxitin (Mefoxin®) IV,IM 30 mg/kg/doseevery8hrs

Cefuroxime InfuseIVover30mins. All neonates <7daysOR<2000gm: 50mg/kg/doseq12hr >7daysAND>2000gm: 50mg/kg/doseq8hr

Clindamycin IV,IM–InfuseIVover30mins.All neonates < 1200gm: 5 mg/kg/doseq12hrPostnatal age: < 7 days & < 2000gm 5 mg/kg/doseq12hr < 7 days & > 2000gm 5 mg/kg/doseq8hr > 7 days & < 1200gm 5 mg/kg/doseq12hr > 7 days & 1200-2000gm 5 mg/kg/doseq8hr > 7 days & > 2000gm 5 mg/kg/doseq6hrTerm infant: > 30 days & > 2.5kg 10mg/kg/doseIVq8hr

Cotrimoxazole (BactrimTM) PO(UTIprophylaxis)(Sulfamethoxazole/Trimethoprim(TMP)>2monthsofage:BasedonTMPcomponent 2mgTMP/kg/dayor5mgTMP/kg/dosetwiceweekly

Fluconazole IV/PO—InfuseIVover60mins.< 29 weeks Postmenstrual Age: 0-14days:6mg/kg/doseq72hr >14days:6mg/kg/doseq48hr 30-36 weeks Postmenstrual Age: 0-14days:6mg/kg/doseq48hr >14days:6mg/kg/doseq24hr 37-44 weeks Postmenstrual Age:0-7days: 6mg/kg/doseq48hr >7days: 6mg/kg/doseq24hr> 45 weeks Postmenstrual Age: ALL: 6mg/kg/doseq24hrThrush:6mg/kgPOx1then3mg/kg/doseq24hr

Gentamicin/ Tobramycin IV,IMInfuseIVover30mins.Preterm Infants (ALL 0-4 weeks of age) 3 mg/kg/doseq24hrPreterm Infants > 4 weeks old: < 1200gm 3 mg/kg/doseq24hr 1200-2000gm 2.5 mg/kg/doseq12hr > 2000gm 2.5 mg/kg/doseq8hrTERM Infants Postnatal age: < 7 days 4 mg/kg/doseq24hr Postnatal age: > 7 days &< 1200 gm 3 mg/kg/doseq24hr > 7 days & 1200-2000gm 2.5 mg/kg/doseq12hr > 7 days & > 2000gm 2.5 mg/kg/doseq8hr

3938


Hepatitis B Vaccine and Hep B Immune Globulin IMHepatitis B Vaccine:0.5mlIMx1Hepatitis B Immune Globulin:(HBIG)0.5 mlIMx1

• HbsAg-positivemother:GiveHepBvaccineandHBIGw/in12hrofbirth.

• Preterminfant<2kg&HbsAg-unknownmother:GiveHepBvaccine.GiveHBIGifmomtestspositiveorifresultsareunknownwithin12hrsofbirth.

• Infant> 2kg & HbsAg-unknown mother: GiveHepBvaccineandobtainHbsAgonmother.GiveHBIGwithin7daysofbirth, onlyifmother tests positive.

Immune Globulin (IVIG): IVonlyDAT positive hemolytic anemia: 1,000mg/kg/doseIVover2hours Sepsis/Neutropenia: 750 mg/kg/doseIVover4hr

Meropenem (Merrem®) IV –Infuseover30mins.< 7 days OR < 2000gm: 20 mg/kg/doseIVq12hr> 7 days & > 2000gm: 20 mg/kg/doseIVq8hrMeningitis (Pseudomonas):40 mg/kg/doseIVq8hr

Metronidazole (Flagyl®) IV/PO-InfuseIVover30mins.All neonates < 1200gm 7.5 mg/kg/doseq48hrPostnatal age: < 7 days & 1200 - 2000gm 7.5 mg/kg/doseq24hr < 7 days & > 2000gm 7.5 mg/kg/doseq12hr > 7 days & 1200-2000gm 7.5 mg/kg/doseq12hr > 7 days & > 2000gm 15 mg/kg/doseq12hrPostmenstrual age > 45 weeks (all) 7.5 mg/kg/doseq6hrTerm Infant > 30 days & > 2.5kg 10mg/kg/doseIVq6hr

Nystatin PO={100,000units/ml}suspensionPreterm Infant: 0.5 mltoeachsideofmouthq6hrTerm Infant: 1 mltoeachsideofmouthq6hrCream/Ointment: applytoareatopicallyBID-QID

Oxacillin IV,IM:InfuseIVover30mins.Postnatal age: < 7 days OR < 1200gm 50 mg/kg/doseq12hr < 7 days & > 2000gm 50 mg/kg/doseq8hr > 7 days & 1200-2000gm 50 mg/kg/doseq8hr > 7days & > 2000gm 50 mg/kg/doseq6hr

Penicillin G IV,IM–InfuseIVover30mins.Postnatal age: < 7 days OR < 1200gm 50,000 units/kg/doseq12hr < 7 days & > 2000gm 50,000 units/kg/doseq8hr > 7 days & 1200-2000gm 50,000 units/kg/doseq8hr > 7 days & > 2000gm 50,000 units/kg/doseq6hrGBS Meningitis: 100,000 units/kg/doseq6hr

Penicillin G Benzathine IMOnlyAsymptomaticcongenitalsyphilis>1200g:50,000units/kgx1doseIM

Rifampin IVorPO–InfuseIVover30mins.10 mg/kg/doseIV/POq12hrSynergy for MRSA in combination w/other ABX:5-10mg/kg/doseIV/POq12hr

Piperacillin-Tazobactam (Zosyn®) Infuseover30mins.< 29 weeks (GA): 0to28days 80 mg/kg/doseq12hr >28days 80 mg/kg/doseq8hr30-36 weeks (GA):0to14days 80 mg/kg/doseq12hr >14days 80 mg/kg/doseq8hr37-44 weeks (GA):0to7days 80 mg/kg/doseq12hr >7days 80 mg/kg/doseq8hr> 45 weeks (GA): ALL 80 mg/kg/doseq8hr

Vancomycin IV–Infuseover60mins.Postnatal age All neonates < 1200gm: 15 mg/kg/doseq24hr < 7 days & > 1200gm: 15 mg/kg/doseq12hr > 7 days & 1200 – 2000gm: 15 mg/kg/doseq12hr > 7 days & > 2000gm: 15 mg/kg/doseq8hr

Zidovudine (Retrovir®/AZT™) IVorPOGA < 29 weeks, 0-28 days:IV:1.5 mg/kg/doseq12hr;PO:2 mg/kg/doseq12hrGA < 29 weeks, > 28 days:IV:1.5 mg/kg/doseq8hr;PO:2 mg/kg/doseq8hrGA 30-34 weeks, 0-14 days:IV:1.5 mg/kg/doseq12hr;PO:2 mg/kg/doseq12hrGA 30-34 weeks, > 14 days:IV:1.5 mg/kg/doseq8hr;PO:2 mg/kg/doseq8hrGA > 35 weeks, ALL:IV:1.5 mg/kg/doseq6hr;PO:4mg/kg/doseq12hr

Anticonvulsants

Fosphenytoin (Cerebyx®)

IVonly Load: 15-20 mgPE/kgIVoveratleast10mins Maintenance:2.5-4mg/kg/doseevery12hours (Fosphenytoin1mgPE=Phenytoinsodium1mg)

Phenobarbital IVorPOLoad:20 mg/kgx1 Maintenance:3-5 mg/kg/dayIV/POq24hr

4140


Phenytoin (Dilantin®)

IVorPOLoad:15-20 mg/kgx1(IVover30min) Maintenance:2.5-4mg/kg/doseevery12hours

Cardiac

Alprostadil (ProstaglandinE1)

Standardized Drip Concentration ContinuousIVinfusion:0.01to0.1mcg/kg/min

Bosentan (Tracleer®)

POonly(forPAH);limitedpedsdata.AvoidifimpairedliverfunctionandmonitorLFTduringtherapy. Initialdose:1-2 mg/kg/dosePOBID Titratetomaintenancedoseof2-4 mg/kg/doseBID

Dobutamine Standardized Drip Concentration ContinuousIVinfusion:2to20mcg/kg/min

Dopamine Standardized Drip Concentration ContinuousIVinfusion:2to20mcg/kg/min

Epinephrine Standardized Drip Concentration ContinuousIVinfusion:0.1to1 mcg/kg/min

Hydralazine IVorPO(specifyBPparameters) (POisapproximately2timestheIVdose) IV:0.25-0.5 mg/kg/doseq6-8hrprn(max.2 mg/kg/dose) PO:0.25-1 mg/kg/doseq6-8hrprn

Hydrocortisone IVorPOStress Dosing: 1.5 mg/kg/doseIV/POq6hrTaperdose:Stress—>½stress—> Maintenance Maintenance Dose for Adrenal Insufficiency: Forpt<1kg,0.3mgIV/POq6hr(lowestmainte-nancedoserecommended) 1 – 1.5kg,Hydrocortisone0.4 mgIV/POQ6hr Oncept>1.5kg:1 mgqAMand0.5 mgqPMIV/PO ACTHstimtestonce1800 gm or >32weeks

Ibuprofen (NeoProfen®)

IVforPDAclosure PDATx:Load10 mg/kgx1dosethen5 mg/kg/doseQ24hx2dosesstarting24hrafterload(max.2courses)

Indomethacin(Indocin®)

IVPDA Prophylaxis:0.1 mg/kg/doseIVq24hrx3 doses PDA Tx:0.2 mg/kg/doseIVq24hrx3dosespercourse(maximum2courses)

Propranolol(Inderal®)

IVorPO(perCardiology) IV:0.01 mg/kg/doseIVQ6hrorQ8hr PO:0.25 mg/kg/dosePOQ6hrorQ8hr

Sildenafil (Revatio®)(Viagra®)

POonly(forPPHN) Initialdose:0.5-1 mg/kg/dosePOevery6-12hrs.(Max:3mg/kg/doseinterminfant)

Gastrointestinal

Erythromycin (forGImotility)

IVorPO3-5 mg/kg/doseq6hr(POpreferred) Salts:PO=EES/IV=ErythromycinLactobionate


CHKD’s only IV H2 Blocker <1monthofage:0.5 mg/kg/dayIVQday >1month(correctedterm):0.5 mg/kg/doseIVBID ***UseTotalDailydoseinTPN*** Dosing Adjustment in Renal Impairment: CrCl10-50ml/min/m2:0.5 mg/kg/doseq24hr CrCl<10ml/min/m2:0.5 mg/kg/doseq48hr


CHKD’s only PO H2 Blocker 2 mg/kg/dosePOq8hr (notrecommendedin<1500g,incr.sepsisrisk)


CHKD’s only IV proton pump inhibitor 0.5-1 mg/kg/day.MayincreasetoBIDifneeded. (notrecommendedin<1500g,incr.sepsisrisk)

Hyoscyamine(Levsin® drops)

SLorPO <2kg1to2dropsevery4-6hr 2-3.4kg3dropsevery4-6hr >3.4kg4dropsevery4-6hr


CHKD’s PO proton pump inhibitor for patients < 10kgfor<10kg:0.5-1mg/kg/dosePOdaily. MayincreasetoBIDifneeded. (notrecommendedin<1500g,incr.sepsisrisk)

4342


Simethicone(Mylicon® )drops

POonly 20 mg/doseq6hrPRN

Ursodiol (Actigall™)

POonly 10-15 mg/kg/doseq12hr

Miscellaneous

3%Saline (HypertonicSolution)

IV:5-6mL/kgx1over2hr. To be used only after Attending’s approval

Calcium Supplementation

Ca Gluconate (IV):100-200 mg/kg/doseq6hr over 1 hour Ca Glubionate (PO):90-315 mg/kg/doseq6hr

Cholecalciferol,vitD3,400IU/mL (D-Vi-Sol®)

POonly200-400InternationalUnitsPOdaily

Granulocyte Colony StimulatingFactor(GCSF)/filgrastim

Neutropenia/Sepsis:10 mcg/kgIVq24hruntilANC>1000(order1doseatatime)IVover15-30mins

Hyaluronidase (Amphadase®)

SubQ:onlyupto24hoursafterextravasationinjury.Drawup0.1 ml(150units/mlconc.)andmixw/0.9 mlNStomake15units/mlconc.Administer0.2 mlSubQinacircularpatternaroundinjuredsite.

Insulin (Regularonly)

Standard Drip Conc.ContinuousIVinfusion:0.01to0.1 units/kg/hr;titratedtobloodglucose

Levothyroxine (Synthroid®)

(IV=75%oforaldose) IV:7-12 mcg/kg/dayq24hr PO:10-15 mcg/kg/dayq24hr

Magnesium Supplementation

MagnesiumSulfate(IV):25 mg/kg/dosex1 Mag.Gluconate(PO):185-370 mg/kg/dayPOq6hr

Pentacel® (InactivatedPolio,dTaP&HIB) 0.5 mlIM@2,4and6monthsofage OrderPrevnar&HepatitisBseparately.

Poly-Vi-SolPlainorwithIron

POonly 0.5-1mLdaily

PotassiumChloride(ChlorideSupplement)

PO:1mEq/kg/dose;frequencydependentuponlevelofdeficiency,start@q12hr

Respiratory

Albuterol(HHN) 1.25 mg-2.5 mgnebulizedQ4-6hrPRN

Aldactazide(Spironolactone/HCTZ)

POonly 1 mg/kg/dose(eachcomponent)BID

Budesonide (Pulmicort® (HHN))

0.25mgnebulizedQday-BID

Bumetanide (Bumex®)

IVorPO:0.05 mg/kg/doseQ8-Q12hr,titratebasedondiuresis

CaffeineCitrate IVorPO IV:InfuseLoadover30mins,dailyIVdoseover10mins Loadingdose:40 mg/kgx1 InitialMaintenancedose:8mg/kg/day

Curosurf® (PoractantAlfa)

ViaETTonly(dividedinto2aliquots)Max.totaldose5ml/kg.Load: 2.5ml/kg/dose.Subsequent doses:1.25ml/kg/doseq12hr–up to 2 additional doses.


IVorPODay1-30.25 mg/kg/doseq12hr Day4-60.15mg/kg/doseq12hr

Furosemide (Lasix®)

1mg/kg/doseIVor2mg/kg/dosePO FrequencyfromQday–Q12hr,(maxq6hr)

Ipratropium (Atrovent® )(HHN)

0.25mgINHq8hr

RacemicEpinephrine(HHN)

0.125mLof2.25%solutiondilutedin3mlNS

SodiumBicarbonate IVonly:2mEq/kg/dose.Mix1:1w/sterileH20.Infuseover30mins. HCO3(mEq)=0.3xweight(kg)xbasedeficit

4544


Sedation/Analgesia/Paralytics

Acetaminophen (Tylenol®)

POorPR 10-15 mg/kg/doseq6hrPRN

Diazepam (Valium®)

IVorPO*reservedforolder/TERMinfantsduetodecreasedmetabolism*;verylonghalf-lifewithchronicdosingandoftenonlyneedtodosetwotothree times per day. Consult your NICU Pharmacist for dosing.

Fentanyl Standard Drip Concentration ContinuousIVinfusion:1to5mcg/kg/hr:titrate IVbolus:1-2mcg/kg/doseIVq2hr-q4hrPRN

Lorazepam(Ativan®)

IVorPO:0.05to0.1 mg/kg/doseq4-6hrPRNtitratetoeffect

Methadone IVorPO(=analgesictoMorphine,but>sedating) 0.05-0.1 mg/kg/doseq6hr-q12hr,titratetoeffect Neont’l Narcotic w/d:0.05-0.1 mg/kg/doseq6hr After24-48hr,extendintervaltoq12-q24hr. Totaper,weanby0.05 mg/kg/day.

Midazolam(Versed®)

IVorPOStandard Drip Concentration continuousIVinfusion:0.05to0.2mg/kg/hr IVbolus:0.05-0.15 mg/kg/doseIVq2hr-q4hrPRN

Morphine IVorPOStandard Drip Concentration ContinuousIVinfusion:10to20mcg/kg/hr:titrate IVbolus:0.05-0.2 mg/kg/doseIVq4hr-q6hrPRN PO:0.1-0.2 mg/kg/dosePOq4hr-q6hrPRN

Pancuronium(Pavulon®)

IVonly;prolongeddurationwithpoorrenalfunction 0.1 mg/kg/doseIVQ1hrPRNmovement NOanalgesiceffect-usewithsedation/analgesia Formultipledoses/day,alsoorderLacri-lubeOUPRN

Vecuronium Standardized Drip Concentration ContinuousIVinfusion:0.05to0.15 mg/kg/hr RecommendorderingLacri-lubeOUPRNwhileon drip

A

Acetaminophen:5,29,44

Acetaminophen/codeine:6, 29

Acetazolamide:20

Acyclovir:9,26,36

Adenosine:4

Acetylcysteine:23

Albumin:24

Albuterol:19,23,43

Allopurinol:30

Alprostadil:3,40

Amikacin:36

Amiodarone:3,4

Amlodipine:18

Amoxicillin:9,36

Amoxicillin/clavulanicacid:10

AmphotericinB:36

AmphotericinB,liposomal:26

Ampicillin:10,36

Aprepitant:28

Aspirin:24

Azithromycin:10,13,26

Atropine:3

B

Bisacodyl:28

Bosentan:40

Budesonide:43

Bumetanide:20,43

C

Caffeinecitrate:43

Calciumchloride:3,13

Calciumglubionate:42

Calciumgluconate:3,13,42

Caphosol:30

Captopril:18

Carbamazepine:16

Cardioversion/Defibrillation:16

Caspofungin:26

Cefazolin:10,36

Cefdinir:10,27

Cefepime:26

Cefixime:27

Cefotaxime:10,26,36

Cefoxitin:10,13,36

Cefprozil:10,28

Ceftazidime:10

Ceftriaxone:10,13,26

Cefuroxime:11,27,37

Charcoal,activated:23

Chloralhydrate:8

Chlorothiazide:20,21

Cholecalciferol:42

Clindamycin:11,26,37

Clonidine:8,18

Codeine:8

Cotrimoxazole(TMP/SMX):12,

26,31,37

INDEX

Click on page numbers to go to destination

4746


D

Dexamethasone:19,22,28,43

Dexmedetomidine:4,9

Dextrose:3

Diazepam:9,44

Digoxin:18

Diphenhydramine:20,28

Dobutamine:3,40

Docusate:21,22,29

Dopamine:3,40

Doxycycline:11,13

Dronabinol:28

E

Enalapril:18

Enalaprilat:18

Epinephrine:3,20,40

Epinephrine,racemic:19,43

Erythromycin:21,41

Ethosuximide:16

Esmolol:4

Esomeprazole:21,29,41

Etomidate:9

F

Famotidine:21,29,41

Fentanyl:5,6,8,29,44

Filgrastim(GCSF):42

Fluconazole:11,26,37

Flumazenil:23

Folicacid:30

Fosphenytoin:16,17,39

Furosemide:20,21,43

G

Gabapentin:6

Gastrografin/normalsaline/

mineraloil:21

Gentamicin:11,27,37

Glucagon:23

Glycopyrrolate:24

Granisetron:28

H

Haloperidol:24

HepatitisBVaccine:38

HepatitisBImmuneGlobulin

(HBIG):38

Hyaluronidase:42

Hydralazine:18,40

Hydrocodone:8

Hydrocodone/acetaminophen:6,30

Hydrocortisone:23,40

Hydromorphone:7,8,30

Hydroxyzine:24

Hyoscyamine:41

I

Ibuprofen:6,30,40

Indomethacin:41

Insulin:24,42

Ipratropium:19,43

Iron:24

IVIG:38

K

Kayexalate:24

Ketamine:5,9

Ketorolac:7,30

L

Labetalol:18

Lactulose:21,28

Levetiracetam:16

Levofloxacin:27

Levothyroxine:42

Lidocaine:3

Linezolid:27

Lorazepam:4,8,16,17,28,44

M

MagicMouthwash:30

Magnesiumcitrate:29

Magnesiumgluconate:31,42

Magnesiumoxide: 31

Magnesiumsulfate:13,19,42

Meropenem:11,27,38

Methadone:5,7,44

Methylprednisolone:19,20,23

Metoclopramide:21

Metolazone:20

Metronidazole:11,13,27,38

Midazolam:5,9,16,17,44

Milrinone:4

Morphine:5,7,8,30,44

N

Nalbuphine:7,30

Naloxone:7,24,30

Nicardipine:4

Nifedipine:19

Norepinephrine:4

Nitroprusside:4

Nitroglycerin: 4

Nystatin:38

Omeprazole:21,29,41

Ondansetron:22,28

Oseltamivir:11

Oxacillin:12,27,38

Oxcarbazepine:16

Oxycodone:8

Oxycodone/acetaminophen:7,30

P

Pancuronium:5,44

Penicillin:12,27,38

Penicillin,Benzathine:39

Pentacel:42

Pentobarbital:9

Peridex:31

Phenobarbital:16,17,39

Phenytoin:16,17,40

Piperacillin/tazobactam:12,39

Polyethyleneglycol:22

Poly-vi-sol:42

Poractantalpha(Curosurf):43

Potassiumchloride:13,42

Potassiumphosphate:13,31

Prednisone:19,23

Prednisolone:19,23

4948


Prochlorperazine:28

Promethazine:22,28

Propofol:5

Propranolol:19,41

R

Rasburicase:31

Ranitidine:22,29,41

Rifampin:12,39

Rocuronium:5

S

Senna:22,29

Sildenafil:41

Simethicone:42

Sodiumbicarbonate:3,43

Sodiumchloride3%:13,42

Sodiumphosphate:13

Spironolactone:20

Spironolactone/HCTZ:43

T

Terbutaline:20

THAM:24

Theophylline:20

Tobramycin:12,26,37

Tramadol:8

Trimethoprim/Sulfamethoxazole:

12,26,31,37

U

Ursodiol:22,42

Valproicacid:17

Vancomycin:12,27,39

V

Vasopressin:3,4,25

Vecuronium:5,44

VitaminD:42

Voriconazole:27

Z

Zidovudine:39

50

This handbook is interactive. Topics may be searched alphabetically in the INDEXPrevious spread

Contributors:

MichaelChicella,PharmD

JenniferChow,PharmD

CaseyCottrill,MD

JamesDice,PharmD

KathleenNoorbakhsh,MD

JessicaPrice,PharmD

JenniferWalker,MD

SaraWittenberg,RD,CSP,CNSC

EloiseWoodruff,PharmD

ArnoZaritsky,MD

0612.5000

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