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.
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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®)
50mg/kg/doseIVq8h(adultdose:2gm/dose)
Ceftriaxone(Rocephin®)
50mg/kg/doseIVq24h(adultdose:2gm/dose)
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
Dexamethasone(Decadron®)
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
Famotidine (Pepcid®)
0.5mg/kg/doseIVq12h(adult:20mg/dose)
Ranitidine (Zantac®)
2-3mg/kg/dosePOBID(adult:150mg/dose)
Esomeprazole(Nexium®)
<10kg:0.5-1mg/kg/doseIVdailyorBID; 10-20kg:10mgPO/IVdailyorBID >20-30kg:20mgPO/IVdailyorBID; ≥30kg:40mgPO/IVdailyorBID
Omeprazole(Prilosec®)
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!
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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
CaseinHydrolysate&AminoAcids
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
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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 )
D i p h e n h y d r a m i n e ( B e n a d r y l )
D i p h e n h y d r a m i n e ( B e n a d r y l )
D i p h e n h y d r a m i n e ( B e n a d r y l )
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 )
L o r a z e p a m ( A t i v a n )
L o r a z e p a m ( A t i v a n )
L o r a z e p a m ( A t i v a n )
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 *
RepeatRepeat q 30 min x 2
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
If > 0.3 mg / kg or If > 6 mg in 1 hour
Use Monitored Bed
If > 0.3 mg / kg or If > 6 mg in 1 hour
Use Monitored Bed
* IV Route Associated with Respiratory Depression
* IV Route Associated with Respiratory Depression
* IV Route Associated with Respiratory Depression
* IV Route Associated with Respiratory Depression
* 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
RepeatRepeat q 5 min x 2
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
If > 0.2 mg / kg or If > 10 mg in 1 hour Use Monitored Bed
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
If < 12 y/o & Total Doses > 5mg orIf > 12 y/o & Total Doses >10mg
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**IV Route Increases Risk of QT Prolongation
Use Monitored Bed**IV Route Increases Risk of QT Prolongation
Use Monitored Bed
Caution
If < 12 y/o & Total Doses > 5mg orIf > 12 y/o & Total Doses >10mg
Use Monitored Bed
If < 12 y/o & Total Doses > 5mg orIf > 12 y/o & Total Doses >10mg
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
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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)>2monthsofa*ge: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
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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
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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
Famotidine (Pepcid®)
CHKD’s only IV H2 Blocker <1monthofa*ge: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
Ranitidine (Zantac®)
CHKD’s only PO H2 Blocker 2 mg/kg/dosePOq8hr (notrecommendedin<1500g,incr.sepsisrisk)
Esomeprazole(Nexium®)
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
Omeprazole(Prilosec®)
CHKD’s PO proton pump inhibitor for patients < 10kgfor<10kg:0.5-1mg/kg/dosePOdaily. MayincreasetoBIDifneeded. (notrecommendedin<1500g,incr.sepsisrisk)
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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@2,4and6monthsofa*ge 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.
Dexamethasone(Decadron®)
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
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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
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4746
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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
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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
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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
601Children’sLaneNorfolk,Virginia23507
757-668-7000www.chkd.org