Debbie King

1
Debbie King
Pediatric Therapeutics

• 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
  bodys function.
• Includes OTCs, 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 childs 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
• Zodermcream, 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.

51
Vitamins

• Poly Vi Sol use in 2 6 months babies who
  breast feed only
• Fer-In-Sol
• Flintstones
• Rarely needed for USA children

52
Positive PPD

• INH- Isoniazid
• And of course a chest X-ray
• If positive then to ID and health dept.

53
Pin worms

• Vermox- for 2 and over and non-preg

54
Parasites

• Flagyl

55
Swimmers ear- OE

• Ciprodex-very expensive
• Cortisporin otic
• Floxin Otic
• PO- Aug ES

56
GERD- meds and protocol

• Mylicon
• Zantac
• Prilosec
• Prevacid
• Regland (rarely)
• refer

57
Flu

• Oseltamivir(Tamiflu)- active against both A, B
• 75 mg bid for 5 days for all over 40kg
• lt15kg- 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

58
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

59
Vomiting

• Phenergan (over 2 years)
• IM
• suppository
• Tigan
• Zovaran

60
Diarrhea

• Do not stop
• If long term do stool studies
• May need labs

61
Decongestants

• OTC
• Saline spray

62
Burns

• Silvadine
• Bactroban
• Refer

63
Inpacted cerumen

• Debrox
• Hydrogen peroxide
• Olive oil
• Q tips-not advised

64
Eczema- so common

• Protocal!
• Cutivate
• Elidel (black Label)
• Elocon
• Dermatop
• Demasmoothe
• Claritin
• Zyrtec
• Keflex
• Orapred

65
Warts

• Duct tape is superior to cryotherapy
• 85 vs 60 cure rate
• Plantar warts-
• Process using an OTC