P3 Pediatric- Therapeutics
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| Vital signs: Heart rate | age dependent, decreases with age
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| Vital signs: respiratory rate | age dependent, decreases with age
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| Vital signs: blood pressure | age, sex and height dependent, increases with age
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| pediatric temperatures | Normal = 37°C (98.6°F)
Low-grade fever = 37.8°C – 39°C (100°F – 102°F)
High fever = ≥ 40°C (≥ 104°F)
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| Erythromycin in neonates <2 weeks | pyloric stenosis
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| fluoroquinolones in children | risk of cartilage toxicity
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| chloramphenicol in neonates | grey baby syndrome (cyanosis)
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| ceftriaxone in neonates | bliary sludging/kernicerterus
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| sulfonamides in infants <2 months | kernicterus/BMS
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| tetracyclines in children <8 years | dental staining
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| ASA in children <18 years | reye's syndrome
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| CF signs in neonate | meconium ileus, prolonged obstructive juandice
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| CF signs in infants/children | RTI, GI complaints, failure to thrive
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| diagnosis for CF sweat test | >60 mEq/L
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| Most common CF pathogens | S aureus, H influenza, P aeruginosa
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| Less common CF pathogens | Stenotrophomonas maltophilia, Burkholderia cepacia
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| mechanism of Ivacaftor | (Kalydeco) CFTR potentiator
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| what form of CF is Ivacaftor used for | G551D
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| dosage of Ivacaftor | 150 mg BID with fatty food, decrease dose for hepatic dysfunction and co-treatment with CYP3A inhibitors
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| what MVI supplement is used in CF | ADEK
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| how is ADEK dosed | <12 months: 1 ml po QD
1-3 yr: 2 ml po QD
4-10: 1 tab po QD
>10 2 tab po QD
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| When is zinc supplement given in CF | for poor weight gain
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| dosage of pancreatic enzymes in CF | infants: 2000-4000 u/120 ml formula
<4: 1000 u/kg with meals and 1/2 with snacks
>4: 400-500 u/kg with meals and 1/2 with snacks
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| mechanism of dornase alfa | topical mucolytic agent
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| dosage of dornase alfa | 2.5 mg NMT qd to BID
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| Ibuprofen dosage in CF | 20-30 mg/kg BID, adjusted to levels of 50-100 ug/ml
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| Azithromycin maintenance dose in CF | <40 kg: 250 mg po M-W-F
>40 kg: 500 mg po M-W-F
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| prophylatic inhaled abx in CF | TOBI (300 mg NMT BID, 28 on/28 off)
Aztreonam (75 mg inh tid, 28 on/28 off)
Colistin (75 mg NMT BID, save for multi drug resistant)
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| management of CFRD | insulin, po hypoglycemics
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| management of osteopenia/osteoporosis in CF | exercise, vit D, ca, bispohosphonates
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| management of depression in CF | SSRIs, psychotherapy
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| empiric po tx for MSSA | cefuroxime, amox/clav, sulfmethoxazole/trimethoprim
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| empiric po tx for PSA | ciprofloxacin
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| empiric iv tx for MSSA | cefuroxime or oxacillin or cefepime
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| empiric iv tx for MRSA | vanco +/- rifampin
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| empiric iv tx for PSA | double coverage: aminoglycoside (gent, tob, amikacin) +
ceftazidime or cefepime, pip/taz or tic/clav, imipenem/cliastatin or meropenem (2nd line), cipro (last line)
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| tx for CF exacerbation with B cepacia and/or S maltophilia | combination of 2-3 drugs: aminoglycosides, B-lactams (pip/tazo, ceftazidime, carpapenem), cloramhenicol, colistatin, fluoroquinolones, sulfamethoxazole/trimethoprim
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| CF exacerbation w/ history of MSSA/no PSA colonization | cefuroxime or nafcillin or oxacillin
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| CF exacerbation w/ history of MSSA and PSA colonization | double PSA coverage: cefepime + aminoglycoside
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| CF exacerbation w/ history of MRSA/no PSA colonization | vanco +/- rifampin
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| CF exacerbation w/ history of MRSA and PSA colonization | vanco +/- rifampin plus double PSA coverage aminoglycoside + B-lactam (ceftazidime)
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| duration of tx for CF exacerbations | 14-21 days
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| monitoring in abx therapy in CF | FEV1, FVC, SCr, UOP, peak and trough
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| goal peak and trough in CF aminoglycoside dosing | peak: 10-12 mcg/ml
trough: <1.5 mcg/ml
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| exclusions for ped self tx of fever | <6 months w/ rectal temp >38.3 C
>6 months w/ rectal temp >40C
hx of febrile seizures or seizures
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| ped dosing of APAP | 10-15 mg/kg/dose q4-6h
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| ped dosing of ibu | 5-10 mg/kg/dose q6-8h
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| exclusions for ped self tx of cough/cold | high fever, SOB, hx of asthma, immunosuppression therapy
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| ped dosing for PSE | Children < 2 years = 1 mg/kg/dose q6h (not recommended)
Children 2 – 5 years = 15 mg q6h (max = 60 mg/day)
Children 6 – 12 years = 30 mg q6h (max = 120 mg/day)
Children > 12 years = 60 mg q6h (max = 240 mg/day)
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| ped dosing for phenylephrine | Children 4 – 6 years = 2.5 mg PO q4-h (max = 15 mg/day)
Children 7 – 12 years = 5 mg PO q4-6h (max = 30 mg/day)
Children > 12 years = 10 mg PO q4h (max = 60 mg/day)
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| exclusions for ped self tx of allerigic rhinitis | symptoms of AOM, sinusitis, pneumonia, bronchitis
hx of asthma
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| ped dosing of loratidine | Children 2 – 5 years = 5 mg PO daily
Children ≥ 6 years = 10 mg PO daily
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| ped dosing of fexofenadine | Children 6 – 23 months = 15 mg PO q12h
Children 2-11 years = 30 mg PO q12
Children ≥ 12 years = 60 mg PO q12
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| ped dosing of cetirizine | Children 6-12 months = 2.5 mg PO daily
Children 1-5 years 2.5-5 mg per day PO divided q12-24 hours
Children ≥ 6 years = 5-10 mg per day PO divided q12-24 hours
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| pathogens of ped D/V | most common: rotavirus
others: norwalk like viruses and adenovirus
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| exclusions for self tx of acute gastroenteritis | <6 months, severe dehydration, fever (>38.3 in <3 mon, >40 in infants >3 months), blood or mucus in stool, severe abdominal pain/distress
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| ORT of diarrhea w/out dehydration | ORT 10 mL/kg to replace ongoing stool losses
ORT may not be necessary if fluid intake + age appropriate feeding continues
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| ORT for mild dehydration | Correct dehydration: ORT 50 mL/kg over a 4 hour period and reassess q2h
Replace ongoing losses: ORT 10 mL/kg/stool; estimate emesis loss and replace
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| ORT for moderate dehydration | Correct dehydration: ORT 100 mL/kg over a 4 hour period and reassess q1h
Replace ongoing losses: ORT 10 mL/kg/stool; estimate emesis loss and replace
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| self tx of diaper dermatitis | Products containing ≥ 1 of the following:
Allantoin, Cod liver oil, Kaolin, Mineral oil, Zinc oxide, Calamine, Dimethicone, Lanolin, Petrolatum
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