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Pediatric Medication Handbook

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

757-668-9999

Outside 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 childs condition.

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

Name, age, weight Vital signs including blood pressure, heart rate, respiratory rate, temperature, and oxygen saturations Pertinent history and physical findings: general appearance (e.g., degree of distress), capillary refill, quality of pulses, breath sounds, and level of consciousness Lab and X-ray data, if available IV access - site and type Therapies administered

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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Emergency Guide
INTUBATION Estimated ETT SIZE = 4 + (pts age in yrs) 4 cuffed ETT tube = 3.5 + (pts age in yrs) (for age 2 or older) 4 ETT position at lip (in cm) estimated as 3 times ETT diameter (in mm). For example, 3.5 mm ETT should be 11.5 cm at the lip.

RESUSCITATION MEDICATIONS
Amiodarone Atropine 5 mg/kg IV/IO; bolus for VF/pulseless VT or infuse over 20 60 min for perfusing tachycardias 0.02 mg/kg IV; use 0.04 mg/kg IM/ET Min: 0.1 mg IV Max: 1 mg IV 1 mEq/kg IV Ca Chloride 20 mg/kg = 0.2 mL/kg of 10% solution Ca Gluconate 60 - 100 mg/kg = 0.6 - 1 mL/kg of 10% solution via slow IV push Max: 1000 mg/dose of Ca Chloride or 3,000 mg Ca Gluconate 0.5 - 1 gm/kg IV (2 - 4 mL/kg D25) 0.01 mg/kg IV/IO (0.1 mL/kg 1:10,000) Max: 1 mg/dose (10 mL 1:10,000) High dose = 0.1 mg/kg (0.1 mL/kg 1:1,000) Max ET: 2.5 mg/dose 1 mg/kg bolus IV/IO 0.5 1 unit/kg bolus IV/IO in epinephrine-refractory cardiac arrest (not routinely recommended) Adult (>40 kg) 40 units

Bicarbonate Calcium

INITIAL VENTILATOR SETTINGS (volume mode; TV = tidal volume) TV = 7-10 mL/kg PEEP = 5 cm H20 Fi02 - 0.4 (Adjust to keep 02 sat>90%) IMV = 15/min for child & 20-30/min for infants PIP less than 35 cm H20 Inspiratory time = 0.5 0.6 sec infant; 0.7 0.8 sec child; 0.8 1 sec adolescent

Dextrose Epinephrine

Lidocaine Vasopressin

HYPOVOLEMIC/SEPTIC SHOCK: 10 - 20 mL/kg as rapid bolus of an isotonic, non-glucose containing solution (i.e., lactated ringers or normal saline). Repeat bolus PRN based on distal pulses, blood pressure, and capillary refill. There is no maximum; the amount given is determined by the needs of the patient. Consider colloid (e.g., 5% albumin or plasmanate) after 40 60 mL/kg of crystalloid if shock persists.

CARDIOVERSION/DEFIBRILLATION
(use lower energy dose initially and increase if needed) Atrial Arrhythmias Ventricular Tachycardia with Pulse Ventricular Fibrillation or Pulseless Ventricular Tachycardia 0.5 - 1 joules/kg; synchronized 0.5 - 2 joules/kg; synchronized 2 - 4 joules/kg

MINIMAL BLOOD PRESSURE VALUES 0 to 1 month Systolic pressure > 60 mmHg 1 month to 1 year Systolic pressure > 70 mmHg Greater than 1 year Systolic pressure > 70 mmHg + 2x (age in years) 10 years Systolic pressure > 90 mmHg

CARDIOVASCULAR INFUSIONS
Alprostadil 0.01 0.1 mcg/kg/min (Prostaglandin E1) Dopamine and dobutamine Epinephrine 2 - 20 mcg/kg/min 0.05 - 1 mcg/kg/min

Previous spread Esmolol Labetalol Milrinone Nicardipine Norepinephrine Nitroprusside (Nipride) Nitroglycerin

This handbook is interactive. Topics may be searched alphabetically in the INDEX Load: 300 500 mcg/kg over 15 min; infusion: 50 250 mcg/kg/min 0.4 - 1 mg/kg/hr; max = 3 mg/kg/hr May load with 25 - 50 mcg/kg over 30-60 min (check with attending), infusion: 0.25 - 1 mcg/kg/min 0.25 5 mcg/kg/min; Prefer CVL administration to reduce volume administered 0.05 2 mcg/kg/min 0.5 5 mcg/kg/min; Adult (40 kg) initial infusion at 0.1 mcg/kg/min 0.25 10 mcg/kg/min; Adult (40 kg) initial infusion dose: 10 mcg/min (Note that dose is not weight based in adults). Commonly used maximum dose of 200 mcg/min Initial: 0.5 2 milliunits/kg/min; adjustment based on BP response (DOSE FOR SHOCK). In Adult (40 kg) initial infusion dose: is 20 - 100 mcg/min (Note that dose is not weight based in adults) Fentanyl Morphine Ketamine Propofol Midazolam (Versed) Methadone

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Initial: 0.1 mg/kg/dose IV/PO every 6 hrs. If transitioning to methadone to wean off other opioids, larger doses may be needed discuss with pharmacists. Available oral solution concentration: 2 mg/mL Initial: 0.1 mg/kg/hr. May consider loading dose of 0.05 0.1 mg/kg. In Adults (50 kg) an initial infusion of 0.02 - 0.05 mg/kg/hr is recommended. Max: 0.5 mg/kg/hr Initial: 1 - 2 mcg/kg/hr Max: 10 mcg/kg/hr (if in the PICU setting) Initial: 10 - 20 mcg/kg/hr Max: 50 mcg/kg/hr Initial: 0.3 - 0.5 mg/kg/hr Max: 2 mg/kg/hr Initial: 1 - 3 mg/kg/hr. A loading dose of 1 2 mg/kg may be used (consult with attending) Max: 5 mg/kg/hr

Vasopressin

ANTIARRHYTHMICS
Adenosine 100 mcg/kg (max first dose = 6 mg) rapid IVP; may double dose up to 12 mg/dose and repeat in 1-2 min ***Contraindicated in heart transplant patients Load: 5 mg/kg IV over 25 min, may repeat x 2, infusion 5-15 mcg/kg/min

PARALYTICS
Pancuronium (Pavulon) Rocuronium Vecuronium 0.1 mg/kg/dose IV; lasts 30-60 min; avoid in renal failure 0.5 - 1 mg/kg/dose IV; lasts 15-45 min; fastest onset of nondepolarizing agents 0.1 - 0.2 mg/kg/dose IV; lasts 20-40 min

Amiodarone

INTUBATED PATIENT SEDATION/PAIN PROTOCOL

For sedation start with lorazepam or midazolam; for pain start with morphine or fentanyl Dexmedetomidine (Precedex) Initial: 0.2 - 0.7 mcg/kg/hr Max: 1.5 mcg/kg/hr

ANALGESICS
Acetaminophen 15 mg/kg PO or 20 mg/kg PR every 4 hrs PRN up to 5 doses; not to exceed 75 mg/kg/day or 4 gm/day < 13 yo: 15 mg/kg/dose IV Q6H (max: 750 mg/dose) > 13 yo + > 50 kg: 1000 mg IV Q6H > 13 yo + < 50 kg: 15 mg/kg dose IV Q6H IV acetaminophen order set available **Consider all sources of acetaminophen to calculate total daily dose. Available forms at CHKD: Suppositories in 120, 325, 650 mg; Tablets in 325, 500 mg; Meltaway tabs 80 mg, Liquid 32 mg/mL.

Lorazepam (Ativan) Initial: 0.1 mg/kg/dose IV/PO every 6 hrs. If transitioning to lorazepam to wean off other benzodiazepines, larger doses may be needed discuss with pharmacists. Available oral solution concentration: 2 mg/mL

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Acetaminophen 0.5 1 mg/kg/dose codeine component PO every w/codeine tablet 4 hrs PRN **Because of variability in metabolism, use codeine containing products cautiously in children < 3 years of age** Available forms at CHKD: Tylenol No. 3: Acetaminophen 300 mg and codeine phosphate 30 mg Tylenol No 2: Acetaminophen 300 mg and codeine phosphate 15 mg Acetaminophen 0.2 0.4 mL/kg/dose PO every 4 hrs PRN w/codeine liquid (~0.5 1 mg/kg/dose of codeine component) **Because of variability in metabolism, use codeine containing products cautiously in children < 3 years of age** Available form at CHKD: 12 mg codeine & 120 mg acetaminophen per 5 mL Fentanyl Gabapentin (Neurontin) 1 2 mcg/kg/dose IV every 1 hr PRN Neuropathic pain: Children start with 5 mg/kg/dose. Day 2, 5mg/kg/dose twice a day; day 3, give dose 3 times each day. Titrate to effect; usual range: 3-12 mg/kg/dose three times each day. Adults, initial 100 mg/dose three times each day. Increase by 100 mg/dose weekly. Usual range: 600800 mg/dose three times daily. Solution: 250 mg/5 mL. Capsule: 100 & 300 mg. 10 mg/kg/dose PO every 6 hrs PRN Max: 800 mg/dose **Not for routine antipyretic use in patients < 6 months of age** Available oral solution at CHKD: 100 mg/5 mL

Hydromorphone 0.015 mg/kg/dose IV every 4 hrs PRN or (Dilaudid) 0.03-0.08 mg/kg/dose PO every 4 hrs PRN Adult dose: 0.2 0.6 mg IV every 4 hrs PRN or 1 2 mg PO every 4 hrs PRN Available PO form at CHKD: 4 mg tablet (See separate order form for PCA dosing) Ketorolac (Toradol) 0.5 mg/kg/dose IV every 6 hrs Max: 30 mg IV every 6 hrs, not to exceed 5 days **Not for use in patients < 2 months of age** (CHKD standardized doses: 1.5, 2.5, 5, 7.5, 15, 30 mg) 0.05 - 0.1 mg/kg/dose IV every 2 hrs or every 4 hrs PRN (caution in renal failure patients) Immediate release preparation: 0.2-0.5 mg/kg/dose PO every 4 hrs or every 6 hrs PRN Available forms at CHKD: 10 mg/5 mL oral solution, Immediate release tablets: 15, 30 mg Extended release tablets: 15, 30, 60 mg Initial: 0.1 mg/kg/dose IV/PO every 6 hrs Available forms at CHKD: 2 mg/mL elixir, 5 mg tablet. Methadone conversion is highly variable depending on the purpose of its use (i.e., chronic vs. acute pain treatment vs. prevention or treatment of withdrawal). Please consult pain service or pharmacy MED service for methadone dosing recommendation. Analgesia: 0.1 0.15 mg/kg/dose IM/IV/SQ every 6 hrs PRN Max: 20 mg/dose Pruritus: 0.02 0.05 mg/kg/dose IV/IM/SQ every 3 to 4 hrs PRN Max: 5 mg/dose Used for pruritus from epidural or IV PCA narcotics as IV continuous infusion at 0.25 - 2 mcg/kg/hr **An order set is available at CHKD**

Morphine

Methadone

Ibuprofen

Nalbuphine (Nubain)

Dosed on hydrocodone component: 0.1 - 0.2 mg/kg/ Hydrocodone/ Acetaminophen dose (tablet) or 0.2 - 0.4 mL/kg/dose (liquid) PO q4 hrs PRN (Lortab) Max: 10 mg/dose Available forms at CHKD: 2.5 mg hydrocodone & 167 mg acetaminophen per 5 mL (Lortab Elixir) Hydrocodone 5 mg & acetaminophen 500 mg tablet (Lortab 5/500)

Naloxone (Narcan)

Previous spread Oxycodone

This handbook is interactive. Topics may be searched alphabetically in the INDEX Immediate release preparation: 0.05 0.15 mg/kg/ dose PO every 4 hrs or every 6 hrs PRN. Extended release in adults; start with 10 mg every 12 hrs Initial adult dose (>50 kg) 5 mg/dose every 4 or every 6 hrs PRN Available forms at CHKD: Immediate release capsule in 5 mg and Extended release tablet in 10 mg

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DexmedetomiED sedation protocol: a loading dose of 2 mcg/ dine (Precedex) kg IV over 10 minutes, then 2 mcg/kg/hour. May repeat load up to 2 more times if needed. Diazepam (Valium) 0.12 - 0.8 mg/kg/day PO div every 6 hrs; long halflife with chronic dosing; may dose BID or TID. 0.04 - 0.3 mg/kg/dose IV every 2 to 6 hrs CHKD - oral soln: 1 mg/mL; tablets 2 mg, 5 mg 0.5 mg/kg/dose IV once for intubation 1 - 2 mg/kg/dose IV every 2 hrs PRN 2 - 4 mg/kg IM for procedural sedation 0.05 - 0.1 mg/kg/dose IV/PO every 6 hrs Max: 4 mg/dose 0.1 mg/kg/dose IV every 1 hr PRN Max: 5 mg/dose 0.25 - 0.5 mg/kg/dose PO Max: 20 mg/dose 0.2 - 0.3 mg/kg/dose INTRANASAL Max: 10 mg/dose 2 - 3 mg/kg/dose IV/IM (max: 100 mg/dose)

Same dosing as oxycodone; Max: 10 mg/dose; 12 Oxycodone/ Acetaminophen tablets/day Available forms at CHKD: Oxycodone 5 mg/Acet(Percocet ) aminophen 325 mg (Percocet) tablet Tramadol (Ultram) 1 2 mg/kg/dose PO every 4 to 6 hrs prn Adult dose: 50 100 mg PO every 4 to 6 hrs prn (maximum dose: 400mg)

Etomidate Ketamine Lorazepam (Ativan) Midazolam (Versed)

Approximate Equianalgesic Doses

Equianalgesic PO Dose 3 mg N/A 0.75 mg 20 mg 3 - 4.5 mg 1.5 - 3 mg *Methadone conversion is highly variable depending on the purpose of its use (i.e. chronic vs. acute pain treatment vs. withdrawal). Please consult pain service or pharmacy MED service for methadone dosing recommendation. Consider initiating at to of an equianalgesic dose when switching agents and titrate up as needed. Narcotic Analgesic Morphine Fentanyl Hydromorphone Codeine Hydrocodone Oxycodone Equianalgesic IV Dose 1 mg 0.01 mg (10 mcg) 0.1- 0.2 mg N/A N/A N/A

Pentobarbital

ANTIMICROBIALS
(VA Medicaid preferred agents: cefuroxime tab, cefdinir cap/susp, cefprozil susp) Acyclovir (Neonates and infants) 20 mg/kg/dose IV every 8 hrs (Adolescents) 10 mg/kg/dose every 8 hours (VZV) 500 mg/m2/dose IV every 8 hrs (HSV) 250 mg/m2/dose IV every 8 hrs Oral dosing: 750 mg/m2/dose PO every 12 hrs Suspension: 200 mg/5 mL; capsule: 200 mg; tablet: 200 mg, 400 mg < 3 mos: 10 - 15 mg/kg/dose PO BID > 3 mos: 15 - 25 mg/kg/dose PO BID AOM: 40 - 45 mg/kg/dose PO BID (Max: 875 mg/dose) Available oral solution concentrations: 125 mg/5mL, 200 mg/5 mL, 250 mg/5 mL, 400 mg/5 mL

SEDATIVES
Chloral hydrate Clonidine 25 - 50 mg/kg/dose PO/PR every 6 hrs PRN Max: 1 gm/dose 1.5 - 5 mcg/kg/dose PO every 8 hrs in addition to opioid and/or benzodiazepine Available solution: 100 mcg/mL. Tablets: 0.1 mg Patches: 0.1, 0.2, 0.3 mg/day Amoxicillin

Previous spread Amoxicillin/ Clavulanic Acid (Augmentin)

This handbook is interactive. Topics may be searched alphabetically in the INDEX 15-20 mg/kg/dose (amoxicillin component) PO BID Multi drug resistant OM: 40 45 mg/kg/dose (amoxicillin component) PO BID (Max: 875 mg/dose) Available oral solution concentrations: 125 mg/5 mL, 200 mg/5 mL, 250 mg/5 mL, 400 mg/5 mL, 600 mg/5 mL. Tablet: 250 mg, 500 mg, 875 mg 50 - 100 mg/kg/dose IV every 6 hrs Adult dose: 2 gm every 6 hrs Max: 14 gm/day 10 mg/kg IV/PO on Day 1 5 mg/kg IV/PO every 24 hrs on Day 2 - 5 < 6 mos: 10 mg/kg IV/PO on Day 1 - 5 Adult dose: 500 mg on Day 1, then 250 mg on Day 2 - 5. Available oral solution concentration: 200 mg/5 mL. Tablet: 250 mg, 500 mg, 600 mg 25 - 30 mg/kg/dose IV every 8 hrs Adult dose: 2 gm IV every 8 hrs > 6 mos: 14 mg/kg/day once daily or divided BID > 12 yo adults: 600 mg PO once daily Dosage forms: capsule 300 mg, 125 mg/5mL, 250 mg/5mL 50 mg/kg/dose IV every 8 hrs Meningitis: 50 mg/kg/dose IV every 6 hrs Adult dose: 2 gm IV every 8 hrs 30 mg/kg/dose IV every 8 hrs Adult dose: 1 gm IV every 8 hrs Serious infection/peritonitis: 30 mg/kg/dose IV every 6 hrs Adult dose: 2 gm IV every 6 hrs 15 mg/kg/dose PO every 12 hours; max: 1 gm/day Available oral solution concentrations: 125 mg/5mL; 250 mg/5mL Restricted to ID/HemOnc/CF 50 mg/kg/dose IV every 8 hrs Adult dose: 2 gm IV every 8 hrs 50 mg/kg/dose IV every 24 hrs Adult dose: 2 gm every 24 hrs Adult meningitis: 2g IV every 12 hrs Meropenem Metronidazole (Flagyl) Oseltamivir (Tamiflu) Cefuroxime Clindamycin 50 mg/kg/dose IV every 8 hrs Adult dose: 1.5g IV every 8 hrs

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10 mg/kg/dose IV every 8 hrs Adult dose: 600 mg IV every 8 hrs Available oral solution concentration: 75 mg/5 mL 2.1 mg/kg/dose IV/PO every 12 hrs Adult dose: 100 mg IV/PO every 12 hrs Use with caution in children < 8 years of age Available oral solution concentration: 25 mg/5 mL 3 -12 mg/kg/dose IV/PO every 24 hrs Adult dose: 200 - 800 mg/day Available oral solution concentrations: 10 mg/mL, 40 mg/mL NICU or preterm infants see page 37 Term infants < 1 mo: 2.5 mg/kg/dose IV every 8 hrs > 1 mo: 5 - 7.5 mg/kg/day IV every 24 hrs Max: 500 mg/day (except cystic brosis patients) Synergy dosing: 1 mg/kg/dose IV every 8 hrs CF: 10 mg/kg/dose IV every 24 hrs MED Service to follow and order levels 20 mg/kg/dose IV every 8 hrs Adult dose: 1 gm/dose IV every 8 hrs 7.5 mg/kg/dose IV/PO every 6 hrs Adult dose: 500 mg/dose every 6 hrs (50 mg/mL compounded suspension available) < 3 mo: 12 mg PO every 12 hrs for 5 days 3 5 mo: 20 mg PO every 12 hrs for 5 days 6 11 mo: 25 mg PO every 12 hrs for 5 days > 12 mo and < 15 kg: 30 mg PO every 12 hrs for 5 days 15 23 kg: 45 mg PO every 12 hrs for 5 days 23 40 kg: 60 mg PO every 12 hrs for 5 days > 40kg: 75 mg PO every 12 hrs for 5 days Available oral solution concentrations: 6 mg/mL, 12 mg/mL **ID consult required for patients < 6 months of age**

Doxycycline

Ampicillin

Azithromycin

Fluconazole (Diucan)

Gentamicin

Cefazolin Cefdinir (Omnicef)

Cefotaxime

Cefoxitin

Cefprozil (Cefzil) Ceftazidime*

Ceftriaxone

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Previous spread Oxacillin Penicillin

This handbook is interactive. Topics may be searched alphabetically in the INDEX 50 mg/kg/dose IV every 6 hrs Adult dose: 2 gm IV every 6 hrs 250,000 - 400,000 units/kg/day IV divided every 6 hrs Adult dose: 12 - 24 million units/day IV divided every 4-6 hrs 80 mg/kg/dose IV every 8 hrs Adult dose: 3 gm/dose IV every 8 hrs S. aureus synergy: 10 mg/kg/dose IV/PO every 12 hrs Adult dose: 300 mg IV/PO every 12 hrs (60 mg/mL compounded suspension available) 3-6 mg TMP/kg/dose PO every 12 hrs for mild/ moderate infections Adult dose: TMP 160 mg/ SMX 800 mg PO every 12 hrs PCP/ Severe infections: 5 mg TMP/kg/dose IV every 6 hrs PCP Prophylaxis: 2.5 mg TMP/kg/dose PO twice daily, 3 times per week (See page 31) **Not for routine use in patients < 2 months of age** Available oral solution concentration: sulfamethoxazole 200 mg/trimethoprim 40 mg/5 mL Tablet sizes: single-strength: TMP 80 mg/SMX 400 mg, double-strength: TMP 160 mg/ SMX 800 mg Same dosing as Gentamicin 15 mg/kg/dose IV every 8 hrs Meningitis/Ventriculitis: 15 mg/kg/dose IV every 6 hrs Adult dose: 1000 mg IV every 12 hrs MED Service to follow and order levels Potassium Phosphate

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PID/CERVICITIS
Inpatients: Cefoxitin Outpatients: Ceftriaxone 2 gm IV every 6 hrs + Doxycycline 100 mg IV/PO every 12 hrs for 14 days 250 mg IM once + Doxycycline 100 mg PO every 12 hrs for 14 days Metronidazole 500 mg PO every 12 hrs for 14 days Azithromycin 1000 mg PO once + Ceftriaxone 250 mg IM once

Piperacillin/ Tazobactam (Zosyn) Rifampin

Cervicitis

ELECTROLYTE REPLACEMENTS
Calcium Chloride 10 - 20 mg/kg/dose IV over 30 - 60 min Max: 2 gm/dose (for patients with central venous lines) Calcium Gluconate Magnesium Sulfate Potassium Chloride 60 - 100 mg/kg/dose IV over 30 - 60 min Max: 4 gm/dose - may be given via peripheral IV 25 - 50 mg/kg/dose IV over 2 hours for electrolyte replacement Max: 2 gm/dose 0.5 - 1 mEq/kg/dose IV over 1 hour (with cardiac monitoring) Max: 20 mEq/dose. Usual starting oral replacement dose: 1 mEq/kg/ dose PO one to four times a day (1 4 meq/kg/day). Potassium usually given as chloride salt but can use acetate salt depending on goal. 0.2 - 0.4 mmol/kg/dose IV over 4-8 hours (1 mmol KPhos = 1.47 mEq K+) Max: 15 mmol/dose

Trimethoprim/ Sulfamethoxazole (TMP/SMX) (Bactrim/Septra) (Cotrimoxazole)

Tobramycin Vancomycin

*restricted by ID consult/MEDS consult

Sodium chloride Infuse 4 6 ml/kg over 15 30 mins (delivers 3% (Hypertonic ~2 3 mEq/kg of Na) to rapidly treat symptomatic soln = 513 mEq hyponatremia in the ICU or ED setting only! Na/L) Sodium Phosphate 0.2 - 0.4 mmol/kg/dose IV over 4-8 hours (1 mmol NaPhos = 1.33 mEq Na+) Max: 15 mmol/dose 13

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Oral Electrolyte Replacement Chart

This serves only as a reference for initiating therapy! Close monitoring and ongoing adjustment is warranted based upon patients clinical status, change in nutrition and drug therapy
Electrolyte Starting IV Dose mEq = mg Range (mEq/kg/day) equivalence Bioavailability Commonly Used Oral Product(s)

Sodium (Na) Potassium (K)

1-2 1-2

1 mEq = 58 mg (NaCl)

~100%

NaCl tabs: *1 gm (~17 meq Na) (NaCl injection for oral use: *2.5 mEq/ml) KCL solns: *20 mEq/15 ml & 40 mEq/15 ml KCL ER tabs: 8, 10, 15, 20 mEq KCL ER caps: 8 mEq,*10 mEq KCL powder (per packet): 20 mEq, 25 mEq Calcium Carbonate Chewtabs: 400 mg, 420 mg, *500 mg [10 mEq], 600 mg, 650 mg, 750 mg, 850 mg, 1000 mg, 1250 mg, 1500 mg Calcium Carbonate Softchew(Rolaids): 1177 mg [471 mg] Calcium Carbonate tab: 364 mg, *1250 mg [25 mEq], 1500 mg Calcium Carbonate susp: *250 mg/ml [100 mg/ml; 5 mEq/ml] Calcium glubionate syrup: *360 mg/ml [23 mg/ml; 1.15 mEq/ml] Calcium gluconate tab: *500 mg [45 mg], 650 mg [58.5 mg], 975 mg [87.75 mg] Mg Oxide tabs: *400 mg [20 mEq], 500 mg Mg Oxide caps: 140 mg, 600 mg Mg Gluconate tabs: *500 mg [2.4 mEq] Mg Gluconate soln: *200 mg/ml [0.96 mEq/ml] *Phos-Na K powder: 250 mg phos [8 mmol] & 7.1 mEq K/Na each per packet *KPhos Neutral or Phospha 250 Neutral tabs: 250 mg phos [8 mmol] & 13 mEq Na & 1.1 mEq K per tab *Fleet Phospho-soda: 128.5 mg phos [4.1 mmol] & 1.9 mEq Na per mL Na Bicarb tabs: 325 mg [3.8 mEq] & *650 mg [7.6 mEq] (Na Bicarb injection for oral use: *1 mEq/ml)

1 mEq = 75 mg (KCl) ~100%

Calcium (Ca)

0.5

1 mEq = 20 mg (elemental Ca) 100 mg Ca Carbonate = 40 mg elemental Ca = 2 mEq

25-35% (up to 60% in infants)

Magnesium (Mg)

0.25-0.5

1 mEq=12 mg (elemental Mg)

Up to 30%

Phosphate (PO4)

0.5-1.5 mmol/kg/day

1 mmol = 31 mg (elemental PO4)

1-20%

Bicarbonate (HCO3)

1-3

1 mEq = 84 mg (NaHCO3)

~100%

ER = Extended release *CHKD Formulary Products [amount in unit] represents the amount of the elemental form of the ion Underlined items represent the different strengths of Calcium Carbonate available under the Brand name of Tums Examples: A) Magnesium Oxide Oral Replacement in a 25-kg patient: 0.25 mEq/kg/day elemental Magnesium x 25 kg = 6.25 mEq elemental Mg/day Account for only 30% oral absorption: 6.25 mEq/0.3 = 20.8 mEq elemental Mg/day PO 14

Patient should receive Magnesium Oxide 400 mg tab (=20 mEq elemental Mg) PO daily B) Potassium Chloride Oral Replacement in a 10-kg patient: 2 mEq/kg/day Potassium x 10 kg = 20 mEq Potassium/day (100% bioavailable) Patient should receive Potassium Chloride 10 mEq cap PO bid or 10 mEq/7.5 ml liquid PO bid 15

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ANTICONVULSANTS
Carbamazepine (Tegretol) Initial: 10 - 20 mg/kg/day PO divided every 6 -12 hrs depending on dosage form; titrate to response (trough 4 - 12 mcg/mL) (40 mg/mL compounded suspension available) < 6 years: Initial: 15 mg/kg/day PO divided every 12 hrs (Max: 250 mg/dose) 6 years: Initial: 250 mg PO every 12 hrs Loading: 20 - 30 mg/kg/dose IV once Initial: 10 mg/kg/dose IV/PO every 12 hrs Maintenance: 10 - 30 mg/kg/dose IV/PO every 12 hrs. Available oral solution: 100 mg/mL 0.1 mg/kg/dose IV (for seizures > 5 mins) Max: 4 mg/dose; Repeat as needed every 10 - 15 min 0.1 - 0.3 mg/kg IM for status epilepticus when no IV access Max: 10 mg/dose 4-5 mg/kg/dose PO every 12 hours (initial starting dose); lower doses may be used when given in combination with other anticonvulsants. Adult dose 600 mg PO twice a day. Available oral solution: 300 mg/5 mL Loading dose: 20 mg/kg/dose IV Maintenance: 5 - 10 mg/kg/day divided every 12 hrs IV/PO, begin 12 hours post-load (trough 15 40 mcg/mL) Available oral solution: 20 mg/5 mL

Initial: 10 - 15 mg/kg/day PO divided every 8 24 hrs; maintenance: 30 - 60 mg/kg/day divided every 8 12 hrs depending on dosage form. (trough 50 - 100 mcg/mL) Available oral solution: 250 mg/5 mL

Ethosuximide (Zarontin) Levetiracetam (Keppra)

STATUS EPILEPTICUS
Start with lorazepam 0.1 mg/kg [maximum: 4 mg/dose] IV; may repeat lorazepam dose every 5-10 mins as needed to stop seizures. If no IV access, can use midazolam 0.1 - 0.3 mg/kg (Max: 10 mg/dose) IM Load with phenytoin or fosphenytoin 20 mg/kg IV over 30 min (max of 1 mg/kg/min up to 50 mg/min for phenytoin). Check level 2 hours after loading dose to assure therapeutic concentration. (Usual therapeutic concentration: 10 - 20 mcg/mL) Begin phenytoin/fosphenytoin maintenance dose 5 -10 mg/kg/day divided q12h beginning 6 - 8 hours after loading dose (max starting dose = 400 mg/day). If still seizing after phenytoin load and concentration in upper end of range, consider phenobarbital load 20 mg/kg IV over 10 - 15 min (max 30 mg/min). (Usual therapeutic concentration: 20 - 40 mcg/mL) Phenytoin and phenobarbital dosing guide to increase concentration Blood concentration will rise approx. 1 mcg/mL for every 1 mg/kg mini-load that is given. For refractory status epilepticus, consider loading with IV valproic acid 25 mg/kg at a rate of 2 to 3 mg/kg/min. Midazolam infusion may also be used for refractory status epilepticus - load with 0.15 mg/kg IV then begin infusion of 0.1 mg/kg/hr; increase by 0.05 mcg/kg/hr every 15 min until seizures are controlled.

Lorazepam (Ativan) Midazolam

Oxcarbazepine (Trileptal)

Phenobarbital

Phenytoin Loading dose: 20 mg/kg/dose IV (Fosphenytoin PE) Maintenance: 5 - 10 mg/kg/day divided every 12 hrs IV/PO Fosphenytoin is not available orally (trough 10 20 mcg/mL, Free phenytoin trough 1 2 mcg/mL) Available oral phenytoin suspension: 125 mg/5 mL. Chewable tablet: 50 mg; extended release capsule: 100 mg

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CARDIOVASCULAR/ANTIHYPERTENSIVE
Amlodipine (Norvasc) Captopril Initial: 0.05 mg/kg/dose PO once daily Adults: 2.5 - 5 mg/dose PO once or twice daily Available tablets: 2.5 mg, 5 mg & 10 mg Neonates: 0.05 0.1 mg/kg/dose PO every 6 12 hours Infants & Children: 0.2 - 0.5 mg/kg/dose PO every 6 - 12 hrs; First Dose: 0.1 mg/kg monitor for hypotension Adults: 6.25 25 mg/dose PO BID-TID; Max: 6 mg/kg/day Tablets: 12.5 mg, 25 mg, 50 mg 5 - 25 mcg/kg/day PO divided every 8 hrs for hypertension Tablets: 0.1, 0.2 & 0.3 mg. Compounded solution: 0.1 mg/mL. Patches: 0.1, 0.2, 0.3 mg/day Total digitalizing dose varies based on patients age. Please refer to Lexicomp for dosing information. Maintenance: 5 -10 mcg/kg/day PO/IV divided BID Solution: 50 mcg/mL Tablet: 125, 250 mcg Initial: 0.1 mg/kg/day PO divided every 12 24 hrs; Max 0.5 mg/kg/day up to 40 mg/day Adult: 10 40 mg/day PO q day or divided BID Compounded solution: 1 mg/mL. Tablets: 2.5, 5, 10 & 20 mg. [There also are extended release capsules in 30, 60 & 90 mg, but not on CHKD formulary] Initial: 5 -10 mcg/kg/dose IV every 6 24 hrs Adult dose: 0.625 - 1.25 mg IV every 6 hrs 0.1 - 0.2 mg/kg/dose every 1 - 2 hrs IV PRN hypertensive urgency (Renal consult required in non-ICU patients) Max: 20 mg/dose IV 0.2 mg/kg/dose IV every 1 2 hrs PRN hypertensive urgency Max: 20 mg/dose IV

0.25 - 0.5 mg/kg/dose PO or NG/ND every 4 6 hrs PRN Max: 10 mg/dose Capsule: 10 mg; extended release tablet: 30, 60 & 90 mg PO: 0.5 - 1 mg/kg/day divided every 6 -12 hrs Max: 8 mg/kg/day IV: 0.01 - 0.1 mg/kg/dose every 6 12 hrs Max: Infants - 1 mg/dose Children- 3 mg/dose Solution: 4 mg/mL & 8 mg/mL. Immediate release tablet: 10, 20, 40, 60 & 80 mg

Propranolol

Clonidine

ASTHMA/RESPIRATORY
Albuterol Continuous aerosolized: 0.5 mg/kg/hour; increase by 0.25 mg/kg/hr as needed (max = 40 mg/hr) Intermittent nebulization: 20 kg: 2.5 mg, >20 kg: 5 mg 0.6 mg/kg/dose IV/PO for two doses given 24 hours apart (Max: 16 mg/dose)

Digoxin

Dexamethasone

Enalapril (Vasotec)

Methylprednisolone Load with 2 mg/kg IV then 0.5 mg/kg/dose IV every 6 hrs Max: 60 mg/dose every 12 hours Prednisone/ Prednisolone 1-2 mg/kg/day PO divided every 12 24 hrs (Maximum for asthma: 60 mg/day) Tablets: 1, 2.5, 5, 10, & 20 mg Available solution: 15 mg/5 mL

Enalaprilat Hydralazine

Magnesium Sulfate 25 - 75 mg/kg/dose IV over 20 minutes Max: 2 gm/dose Ipratroprium (Atrovent) Racemic epinephrine 0.5 mg INH every 6 - 8hrs x 24hrs (0.5 mg INH every 20 min X 3 doses in ED) 0.25 mL (infants and small children) to 0.5 mL (older children) of 2.25% in 2.5 mL saline nebulized (3 ml 1:1000 epinephrine ~ 0.25 ml of racemic epi)

Labetalol

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This handbook is interactive. Topics may be searched alphabetically in the INDEX 10 mcg/kg slow IV bolus (10 min); then 0.2 mcg/kg/min; may titrate by 0.1 mcg/kg/min every 30 min to 2 mcg/kg/min Load with 5 mg/kg IV over 30 min; then begin continuous infusion (< 1 yr = 0.6 mg/kg/hr; 1 - 9 yr = 1 - 1.2 mg/kg/hr; 9 - 12 yr = 0.9 mg/kg/hr; >12 yr = 0.7 mg/kg/hr); theophylline level 4 hrs after infusion started (target 10 - 18 mcg/mL) 1 mg/kg bolus increases level ~2 mcg/mL

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Theophylline

Lasix/Diuril Infusion Lasix 1 mg/mL and Diuril 5 mg/mL; begin continuous infusion at 0.1 mg/kg/hr of Lasix component and titrate to effect; max 0.4 mg/kg/hr of Lasix

GI/METABOLIC
Docusate (Colace) Erythromycin (for GI motility) Esomeprazole (Nexium) 5 mg/kg/day PO divided every 12 24 hrs Solution: 10 mg/mL Capsule: 50 & 100 mg 15 - 20 mg/kg/day PO divided every 6 8 hrs ethylsuccinate: 200 mg/5 mL or 400 mg/5 mL; estolate: 250 mg/5 mL <10 kg: 0.5 1 mg/kg/day IV/PO, may increase dosing to twice a day 10 - 20 kg: 10 mg, may increase dosing to twice a day up to 10 mg/dose > 20 kg: 1 mg/kg/day IV/PO Max: 80 mg divided BID Suspension: 10 & 20 mg packets Capsule: 20, 40 mg 0.5 mg/kg/dose IV every 12 hrs Adult dose: 20 mg/dose IV BID Solution: 10 mg/mL Tablet: 20 mg (Use Ranitidine as oral agent at CHKD) 15 mL/kg rectally Max: 1000 mL Must order as follows: Gastrografin/NS/Mineral oil 1:1:1 # of mL For constipation, 1 -3 mL/kg/day divided every 8-12 hrs. Max 60 mL/day Solution: 10 g/15 mL 0.1 mg/kg/dose IV/PO every 6 hrs Max: 10 mg/dose Solution: 5 mg/mL; Syrup: 5 mg/5 mL Tablets: 5 & 10 mg Restricted to kids < 10 kg at CHKD 0.5 1 mg/kg/dose PO, daily or every 12 hrs Pre-term infants: 0.7 mg/kg/day Solution: 2 mg/mL 21

ACUTE ALLERGIC REACTIONS

Epinephrine Diphenhydramine (1:1000) 0.01 mg/kg/dose IM (Max: 0.5 mg/ dose) 1 mg/kg/dose IV (Max: 50 mg/dose)

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

DIURETICS
Acetazolamide (Diamox) Chlorothiazide (Diuril) 5 mg/kg/dose IV/PO every 6 -12 hrs x 24 hrs Compounded solution: 50 mg/mL Tablets: 125 & 250 mg < 6 mo: 10 - 20 mg/kg/dose PO every 12 hrs > 6 mo: 10 mg/kg/dose PO every 12 hrs Suspension: 250 mg/5 mL Tablets: 250 & 500 mg 0.01 - 0.05 mg/kg/dose IV/PO (0.025 mg/kg equiv to 1 mg/kg Lasix); continuous infusion: 0.05 mg/kg/hr titrated to effect 1 mg/kg/dose (Initial Adult dose: 20 mg) (PO bioavailability ~60% of IV) Continuous infusion: 0.05-0.4 mg/kg/hr titrated to effect Solution: 10 mg/mL Tablet: 20, 40 & 80 mg 0.1 0.2 mg/kg/dose PO q12 hrs Adults (>40 kg) 5-10 mg/day Tablets: 2.5, 5 & 10 mg 1 - 3 mg/kg/day PO divided every 12 hrs Famotidine (Pepcid)

Bumetanide (Bumex) Furosemide (Lasix)

Gastrografin/ Normal Saline/ Mineral oil (PoleyBomb) Lactulose

Metolazone (Zaroxyln) Spironolactone (Aldactone)

Metoclopramide (Reglan)

Omeprazole (Prilosec)

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Previous spread Ondansetron (Zofran)

This handbook is interactive. Topics may be searched alphabetically in the INDEX 0.15 mg/kg/dose IV/PO every 8 hrs PRN Max: 8 mg/dose Liquid: 0.8 mg/mL; Solution: 2 mg/mL Tablet: 4, 8 mg Disintegrating tablet: 4 mg Hydrocortisone

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Polyethylene glycol 1 gm/kg/day PO, may increase to twice a day (CHKD standardized doses: 2.12, 4.25, 8.5, with electrolytes 17gm) (Miralax) Promethazine (Phenergan) 0.25 - 0.5 mg/kg/dose IV/IM/PO every 6 hrs PRN (do not exceed 6.25 mg/dose IV if given peripherally) Contraindicated in children <2 yo Elixir: 6.25 mg/5 mL Tablet: 25 mg Suppository: 12.5 or 25 mg 4 - 10 mg/kg/day PO divided every 8-12 hrs Adult dose: 150 mg BID Solution: 25 mg/mL Syrup: 15 mg/mL Tablet: 150 mg Children 2 to <6 yrs: 0.5 tablet PO daily at bedtime Children 6 to <12 yrs: 1 tablet daily at bedtime >12 yrs: 2 tablets daily at bedtime Max <12 yr: 1 tablet twice a day Max >12 yr: 2 tablets twice a day 30 mg/kg/day PO divided every 8-12 hrs Adult dose: 300 mg PO BID Solution: 60 mg/mL Capsule: 300 mg

Stress dose: 50 mg/m2/day IV divided every 6 hrs or 1 mg/kg/dose IV every 6 hrs May also use 2 4 times home dose for stress dosing. Adult stress dose: 100 mg

Methylprednisolone 2 mg/kg/day IV divided every 6-12 hrs; usual max 60 mg/dose every 12 hours Spinal cord injury: 30 mg/kg IV over 15 min followed by 5.4 mg/kg/hr infusion x 23 hours Prednisone/ Prednisolone 1-2 mg/kg/day PO divided every 12-24 hrs Usual adult max 60 mg/day Tablets: 1, 2.5, 5, 10, 20 mg Available solution: 15 mg/5 mL

Ranitidine (Zantac)

TOXICOLOGY/REVERSAL AGENTS
Acetylcysteine Acetaminophen poisoning use in conjunction with Rumack-Matthew nomogram NG dosing: 140 mg/kg loading dose followed by 70 mg/kg every 4 hrs x 17 doses IV dosing (Acetadote): Loading dose = 150 mg/kg over 15 min, maintenance dose = 50 mg/ kg over 4 hours then 100 mg/kg over 16 hours as continuous infusion 1 - 2 gm/kg NG/PO (avoid repeat doses of charcoal with sorbitol) Hyperkalemia: albuterol 5 mg nebulized Benzodiazepine reversal (contraindicated with history of seizures) 0.01 mg/kg/dose IV; lasts less < 1 hr Max: 0.2 mg/dose, may repeat every 1 min, up to 1 mg PRN Hypoglycemia secondary to insulin excess 0.02 mg/kg IV/IM/SQ Max: 1 mg; may repeat every 20 min Beta-blocker overdose Child: 0.025 - 0.05 mg/kg IV bolus followed by 0.07 mg/kg/hr infusion Adolescent: 2 - 3 mg IV followed by 5 mg/hr infusion 23

Senna+Docusate (Peri-colace)

Ursodiol (Actigall)

Activated Charcoal Albuterol Flumazenil

STEROIDS (Standard Doses)

Dexamethasone (Decadron) 0.6 mg/kg/dose IV/PO x1 dose for croup 0.25 - 0.5 mg/kg/dose IV every 6 hrs for extubation (not to exceed 24 hours unless per attending) max: 15 mg/dose Increased ICP: 0.5 -1 mg/kg/dose IV q6h Adult dose 4 - 10 mg/dose q6h Solution: 10 mg/mL or 1 mg/mL Tablet: 0.5, 0.75, 1 & 4 mg

Glucagon

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Previous spread Insulin, Regular + glucose Kayexalate Naloxone (Narcan)

This handbook is interactive. Topics may be searched alphabetically in the INDEX Hyperkalemia: 0.5 gm/kg glucose + 0.1 unit/kg insulin; infuse over 30 - 60 min 1 gm/kg/dose PO; 1.5 - 2 gm/kg/dose PR mixed with 20% Sorbitol Respiratory depression: 0.001 - 0.01 mg/kg/ dose IV (1-10 mcg/kg/dose), may repeat every 2 - 3 min PRN Max: 0.4 mg/dose. Titration of small (1-2 mcg/ kg) doses limits risk of acute pain/stress Rapid, full reversal of narcotic overdose: 0.1 mg/kg/dose IV, may repeat every 2 3 min PRN Max: 2 mg/dose

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

Cyroprecipitate 1 unit = 15 mL FFP 1 PediFFP unit = 50 mL PRBCs 1 PediSplit unit = 80 mL Platelets <10 kg one-half pheresis unit >10 kg one pheresis unit One pheresis unit ~ 6-10 single donor units Dose = (desired increase in fibrinogen level (mg/dL) x patients plasma volume)/250 mg/unit for fibrinogen 10 mL/kg (do not infuse rapidly may decrease ionized calcium concentration) 10 -15 mL/kg (in infants & children 10 mL/kg raises hgb by ~3 g% and hct by ~9%) Patients less than 2 yo: 10 mL/ kg body weight Patients greater than 2 yo: 1 unit / 10 kg body weight (1 random donor unit/5 kg raises platelets by ~50,000/ mm3)

MISCELLANEOUS MEDICATIONS
Albumin Aspirin Glycopryrrolate 4 mL/kg (1 gm/kg) of 25% solution; round to 50 mL increments if possible 5 mg/kg/dose PO/PR q24h (CHKD standardized doses: 20.25, 40.5, 81 mg) 4 - 10 mcg/kg/dose IV q6h 40 - 100 mcg/kg/dose PO q6h Solution: 2 mg/4 mL 0.05 - 0.15 mg/kg/day IV/IM/PO divided q6 - 8 hr (see algorithm for acute behavior management, page 34-35) 0.5- 1 mg/kg/dose PO/IM* q4-6 hr prn (adult dose: 50mg/dose) *Has been administered slow IV push* Syrup 10 mg/5 mL; Tablet 10 mg, 25 mg 3 - 6 mg/kg/day PO elemental iron divided q8 - 24h 0.05 - 0.1 unit/kg SQ; begin IV infusion at 0.1 unit/kg/h 3 - 4 mL/kg/dose IV (~1 mmol/kg/dose) 3 mL = 0.9 mmol THAM; requires renal function

Haloperidol

CONVERTING WEIGHT (POUNDS) TO BODY SURFACE AREA (M2)

[assumes normal proportion of length to weight]

Weight (pounds) BSA (m2)

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

Hydroxyzine

Iron Supplementation Insulin (regular) THAM

Vasopressin (for DI): Begin infusion at 0.5 milliU/kg/hr increase by 0.5 milliU/kg/hr every 5-10 min until UOP < 2 mL/kg/hr

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This handbook is interactive. Topics may be searched alphabetically in the INDEX Gentamicin/ Tobramycin Levofloxacin (Levaquin) Linezolid (Zyvox) Meropenem (Merrem) Metronidazole (Flagyl) Oxacillin PenicillinVK

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CHKD Hematology-Oncology Medications Dosing Guide

Anti-infectives
Acyclovir

CHKD Hem/Onc Clinical Pharmacist: Cisco phone 8-8058, Simon 2861 250 mg/m2/dose IV q8h (HSV in immunocompromised host) 500 mg/m2/dose IV q8h (VZV in immunocompromised host) 250 mg/m2/dose IV q12h for prophylaxis post-BMT Suspension: 200 mg/5 mL Capsule: 200 mg Tablet: 400 & 800 mg

10 mg/kg/dose IV q24h (Dose based on dosing body weight if patient is obese) MED Service to follow and order levels 6 mos-5 years 10 mg/kg/dose IV/PO q12h; >5 years 10 mg/kg/dose IV/PO every 24 hours 10 mg/kg/dose IV/PO q8h (pt 12yo: 600 mg IV/PO q12h) 20 mg/kg/dose IV q8h (adult 1 g IV q8h; severe infection: 2 g IV q8h) 7.5 mg/kg/dose IV/PO q6h (adult dose: 500 mg/ dose) 50 mg/kg/dose IV q6h (adult dose: 2 gm/dose) For pneumococcal prophylaxis <2 mos: 62.5 mg PO BID; 2 mos-3 yo: 125 mg PO BID; >3 yo: 250 mg PO BID; pt>50 kg: 500 mg PO BID Suspension: 125 mg/5 mL, 250 mg/5 mL; Tablet: 250 mg, 500 mg 15 mg/kg/dose IV q8h (pt 45 kg: 1 gm IV q12h) MED Service to follow and order levels 8 mg/kg/dose (adult dose 200 mg) IV/PO q12h. Avoid IV formulation in patients with renal insufciency.

3 mg/kg/dose IV q24h (empiric therapy) Liposomal Amphotericin B 5 mg/kg/dose IV q24h (documented infection) (Ambisome ) round to nearest 50 mg vial size Azithromycin (Zithromax) 10 mg/kg/dose PO/IV x1 on day 1 then 5 mg/kg/dose PO/IV daily on day 2-5 (adult dose: 500 mg PO x 1 on day 1 then 250 mg PO daily on day 2-5)

Trimethoprim/ PCP prophylaxis -->Refer to page 31 Sulfamethoxa- Infections -->Refer to page 12 zole (TMP/ SMX) (Bactrim/ Septra) (Cotrimoxazole) Caspofungin (Cancidas) Cefepime (Maxipime) Cefotaxime (Claforan) Ceftriaxone (Rocephin) Clindamycin (Cleocin) Fluconazole (Diucan) 70 mg/m2/dose IV on day 1, then 50 mg/m2/dose IV daily (adult dose: 70 mg IV x 1 on day 1, then 50 mg IV daily) 50 mg/kg/dose IV q8h (adult dose: 2 gm/dose) 50 mg/kg/dose IV q8h (adult dose: 2 gm/dose) 50 mg/kg/dose IV q24h (adult dose: 2 gm/dose) 10 mg/kg/dose IV q8h (adult dose: 600 mg/dose) 5 mg/kg/dose (max: 200 mg/dose) PO/IV qday for prophylaxis; 6-12 mg/kg/dose IV/PO qday for systemic candidiasis

Vancomycin Voriconazole (Vfend)

Oral antibiotics
(VA Medicaid preferred agents: cefuroxime tab, cefdinir cap/susp, cefprozil susp) Cefuroxime (Ceftin) 15 mg/kg/dose PO q12h (adult dose: 250-500 mg PO q12h) Suspension: 125 mg/5 mL, 250 mg/5 mL; Oral tablet: 250 mg, 500 mg 14 mg/kg/dose PO daily or 7 mg/kg/dose PO q12h (max: 600 mg/day) Suspension: 125 mg/5 mL, 250 mg/5 mL; Oral capsule: 300 mg 8 mg/kg/dose PO daily or 4 mg/kg/dose PO q12h (max: 400 mg/day) Suspension: 100 mg/5 mL, 200 mg/5 mL; Oral tablet: 400 mg

Cefdinir (Omnicef)

Cefixime (Suprax)

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This handbook is interactive. Topics may be searched alphabetically in the INDEX 15 mg/kg/dose PO q12h (adult dose: 250-500 mg PO q12h) Oral susp: 125 mg/5 mL, 250 mg/5 mL; Oral tablet: 250 mg, 500 mg Docusate (Colace) Lactulose (Chronulac)

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2.5 mg/kg/dose PO BID (max: 400 mg/day); round to nearest 50-mg cap size or use liquid For constipation, 1-3 mL/kg/day divided every 8-12 hrs. Max 60 mL/day Solution: 10 g/15 mL <6yo: 2-4 mL/kg; 6-12 yo: 100-150 mL; >12yo: 150-300 mL PO q6h until stooling 8.5-17 gm PO daily or BID <6yo: 0.5 tab PO BID; 6-12 yo: 1 tab PO BID; >12yo: 2 tabs PO BID <2yo: 1.25 mL PO BID; 2-6yo: 2.5 mL BID; 6-12yo: 5 mL PO BID; >12yo: 10 mL BID 0.5 mg/kg/dose IV q12h (adult: 20 mg/dose) 2-3 mg/kg/dose PO BID (adult: 150 mg/dose) <10 kg: 0.5-1 mg/kg/dose IV daily or BID; 10-20 kg: 10 mg PO/IV daily or BID >20-30 kg: 20 mg PO/IV daily or BID; 30 kg: 40 mg PO/IV daily or BID Restricted to kids < 10 kg at CHKD: 0.5-1 mg/kg/dose PO daily or BID

Anti-emetics
Aprepitant (Emend) 125 mg PO 1 hr prior to chemo on day 1, 80 mg PO once prior to chemo on days 2 and 3 combined w/scheduled 5HT-3 antagonist (eg, ondansetron) & steroid in pts 12 yo & 40 kg 10 mg/m /dose IV/PO prior to chemo (max: 10 mg/dose) Delayed emesis: 8 mg IV/PO q12h x 2 days then 4 mg IV/PO q12h x 2 days in combination w/ scheduled 5HT-3 antagonist (eg, ondansetron) in adult-size patients
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Magnesium Citrate Polyethylene glycol (Miralax) Senna/Docusate (Peri-Colace) Senna Famotidine (Pepcid) Ranitidine (Zantac) Esomeprazole (Nexium)

Dexamethasone (Decadron)

Diphenhydramine 1 mg/kg/dose PO/IV q6h prn (max: 50 mg/dose) (Benadryl) Dronabinol (Marinol) Granisetron (Kytril) Lorazepam (Ativan) Ondansetron (Zofran) 5 mg/m2/dose PO q4h or q6h prn (dose in 2.5 mg increments) 10 - 20 mcg/kg/dose IV BID (adult dose: 1 mg IV BID) 0.02-0.04 mg/kg/dose IV q6h prn for nausea/vomiting (max: 2 mg/dose) 0.15 mg/kg/dose IV q8h scheduled/prn (max: 8 mg/dose) or 0.45 mg/kg/dose IV q24h prior to chemotherapy (max = 24 mg/dose)

Omeprazole (Prilosec)

Pain Management
Acetaminophen Acetaminophen/ Codeine 10-15 mg/kg/dose PO q4h or q6h prn (adult: 650 mg/dose; Max: 4 g/day) 0.5-1 mg/kg/dose codeine or 0.2-0.4 mL/kg/ dose PO q4h or q6h prn/scheduled Oral liquid: 12 mg codeine/120 mg acetaminophen per 5 mL Oral tablet: 30 mg codeine/300 mg acetaminophen (Tylenol No. 3 tab) 15 mg codeine/300 mg acetaminophen (Tylenol No. 2 tab) 0.5-1 mcg/kg/dose IV q1h prn

Prochlorperazine 0.1-0.15 mg/kg/dose IV q8h prn (max: 10 mg/dose; 40 mg/day) (Compazine) Promethazine (Phenergan) 0.25-1 mg/kg/dose IV/PR/PO q4h or q6h prn (max: 25 mg/dose) (avoid in children<2 yo; max dose: 6.25 mg if given via peripheral IV)

GI Agents
Bisacodyl (Dulcolax) 3-12 yo: 5 mg PO BID; >12yo: 10 mg PO BID Fentanyl

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Previous spread Hydrocodone/ Acetaminophen (Lortab)

This handbook is interactive. Topics may be searched alphabetically in the INDEX 0.2 mg/kg/dose hydrocodone PO q4h prn (max: 10 mg/dose) Oral elixir: 2.5 mg hydrocodone/167 mg acetaminophen per 5 mL Oral tablet: 5 mg hydrocodone/500 mg acetaminophen (Lortab 5/500) 0.015 mg/kg/dose IV q4h prn (adult: 0.2-0.6 mg IV q4h prn) 0.03-0.08 mg/kg/dose PO q4h prn 10 mg/kg/dose PO q6h scheduled/prn (max: 800 mg/dose; 3200 mg/day) 0.5 mg/kg/dose IV q6h scheduled/prn (max: 30 mg/dose); do not exceed 5 days 0.05-0.1 mg/kg/dose IV q2h or q4h prn (adult: 2.5-10 mg/dose) 0.2-0.5 mg/kg/dose PO q4h prn (adult: 10-30 mg PO q4h prn) 24-h PCA total morphine x 3 divided in 2-3 doses scheduled (dose in 15-mg increments) Analgesia: 0.1-0.15 mg/kg/dose IV/SQ/IM q6h prn (max: 20 mg/dose) Pruritus: 0.05 mg/kg/dose IV/IM/SQ q4h prn (max: 5 mg/dose) Pruritus from PCA: 0.25-2 mcg/kg/hr IV as continuous infusion 0.05-0.15 mg/kg/dose oxycodone PO q4h or q6h prn/scheduled (max: 10 mg/dose) Oral tablet: 5 mg oxycodone/325 mg acetaminophen (Percocet 5/325) Peridex Mouthwash Caphosol 10-15 mL swish/spit tid

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Mix blue and white ampules together. Give 15mL (1/2 dose) swish x 1 minute then spit. Repeat with remaining 15mL 0.15 mg/kg IV once (max: 6 mg/dose) may repeat after 12 hours if necessary

Hydromorphone (Dilaudid) Ibuprofen (Motrin/Advil) Ketorolac (Toradol) Morphine Morphine Immediate Release MS Contin Controlled Release Nalbuphine (Nubain)

Rasburicase (Elitek)

Electrolyte Supplements
Magnesium dosing: [IV daily requirement (mEq) x 3.3] / 20 mEq = # Magnesium Oxide tabs per day (in 2-3 divided doses) 3 Mg Oxide tablet: 20 mEq Mg/400 mg tab 3 Mg Gluconate solution: 0.96 mEq Mg/mL Phosphorous dosing:[IV daily requirement (mmol) x 5]/ 8 mmol = # Phos-Na K powder packets per day (in 2-3 divided doses) 3 Phos-Na K powder: 250 mg Phos (8 mmol), 7.1 mEq K, 7.1 mEq Na per packet 3 KPhos Neutral or Phospha 250 Neutral tablet: 250 mg Phos (8 mmol), 1.1 mEq K, 13 mEq Na per tablet

Bactrim Dosing Chart for PCP Prophylaxis

(Dose to be given BID on Friday, Saturday and Sunday each week)
Weight (kg) Dosing range Dose (mg) Liquid (mL) (mg/kg/dose) SS Tabs DS Tabs

Naloxone (Narcan) Oxycodone/APAP (Percocet)

<8 8 11 12 17 18 24 25 34 35 50 > 50

> 2.5 2.5 3.5 2.4 3.3 2.5 3.3 2.4 3.2 2.4 3.4 < 3.2

20 28 40 60 80 120 160

2.5 3.5 5 7.5 10 15 20

0.5 1 1.5 2*

0.5 1

Miscellaneous
Allopurinol (Zyloprim) 10 yo: 10 mg/kg/day or 200-300 mg/m2/day PO in 2-3 divided doses >10 yo: 600-800 mg/day PO in 2-3 divided doses (max: 800 mg/day) 1 mg PO daily (Benadryl: Maalox: Viscous lidocaine 1:1:1) 3-5 mL swish/spit or swallow q6h prn

Folic Acid Magic Mouthwash

*Bactrim DS tablets are oblong-shaped, large and can be difficult to swallow for some patients. Consider using Bactrim SS x 2 in place of DS tab in these patients to improve compliance!

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

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INFANT FORMULAS
Term Formulas Milk-Protein Based Soy-Based Protein Hydrolysate & Amino Acid Enfamil Lipil Similac Advance Similac Isomil Enfamil Pregestimil Alimentum Nutramigen Neocate w/ Iron Early Shield w/ Iron Advance ProSobee Availbility Ready to Feed (RTF), Powder(Pwd), & concentrate(C) RTF and pwd Pwd Calorie/oz 20 20 20 20 20 20 20 20 Kcal/cc 0.67 0.67 0.67 0.67 0.67 0.67 0.67 0.67 Protein g/dl 1.42 1.4 1.7 1.7 1.9 1.9 1.9 2 Soy Protein Source Whey & Nonfat Nonfat Milk & Whey Soy Casein Hydrolysate Casein Hydrolysate Casein Hydrolysate L-Amino Acids Protein Concentrate Milk Protein w/ w/ L-methionine & Amino Acids & Amino Acids & Amino Acids L-methionine CHO (g/dl) 7.4 7.6 7 7.2 6.9 6.9 7.4 7.8 Source Lactose Lactose Corn Syrup & Corn Syrup Corn Syrup Solids Sucrose & Modified Corn Syrup Solids Corn Syrup Solids GOS (Prebiotic) Sucrose Solids & Corn Starch Tapioca Starch & Corn Starch Fat (g/dL) 3.65 3.65 3.7 3.6 3.8 3.7 3.4 3 Source Palm, Olein, High-Oleic SafHigh Oleic Palm Olein, MCT (55%), Soy, MCT (33%), Palm, Olein, Soy, Hybrid Safflower, Soy, Coconut, flower, Coconut Safflower, Soy, Coconut, Corn, High Oleic Safflower & Coconut, High Oleic Refined Vegetable Oil High Oleic & Soy Oils Coconut & High-Oleic Oils Soy Oils Sunflower Oils (Coconut, Soy) Sunflower Oils Soy Oils Sunflower Oils mOsm/Kg H2O 300 300 200 200 280-340 370 320 375 Uses/ Features Standard infant formula. Lipil and Milk-free, lactose-free infant Hypoallergenic formula with MCT Oil Hypoallergenic formulas Elemental infant Similac Advance contain added DHA formula for infants sensitive to formula with 100% and ARA. intact proteins of milk. free amino acids Also available: Enfamil LactoFree Lipil, Similac Sensitive w/ Iron, Portagen, Monogen, Similac PM 60/40 (renal)

PEDIATRIC/ADOLESCENT FORMULAS
Standard Formula 1-10 yrs Standard Formula > 10 yrs Protein Hydrolysates Elemental Formula > 10 yrs Oral Supplements > 10 yrs Pediasure Jevity Nutren 1.5 Pediasure Peptide Peptamen Jr. EleCare Jr. Vivonex RTF Carnation Resource (w/ & w/out 1 cal (Nutren 2.0) Inst. Breakfast Fruit Fiber) (1.2 cal) Beverage Availbility 8 oz can 8 oz can 250mL can 8 oz can 250mL can Powder 250mL can 250mL can 8 oz carton Calorie/oz 30 / 45 30 (36) 45 (60) 30 / 45 30 30 30 30 32 Kcal/cc 1 / 1.5 1 (1.2) 1.5 (2) 1 / 1.5 1 1 1 1 1.06 Protein g/L 30 / 59 44.3 (55.5) 60 (80) 30 / 45.1 40 30 50 35 38 Sodium and Ca & K Whey Protein Whey Protein Free Amino Free Amino Acids Calcium Whey Protein Source Whey Protein Calcium Caseinate Caseinate Acids Caseinate Protein CHO Source Maltodextrin, Maltodextrin Maltodextrin, Corn Maltodextrin, Maltodextrin Corn syrup Maltodextrin Corn Syrup Sugar, Corn sucrose Corn Syrup Sucrose Syrup Soybean Oil, Safflower Oil, Soybean Oil, 40% Canola Oil, None added Fat Source Safflower Safflower & Canola Oil, 50% Structured Lipids 70% MCT Oil 33% MCT Oil MCT Oil Corn Oil & Soy Oil, Canola Oil, MCT (75% MCT (Interesterified Canola and MCT) 50% MCT 15% MCT oil 19% MCT oil for Nutren 2.0) mOsm/Kg H2O 480 300 (450) 430-510 (745) 390 270 596 630 480-490 700 Like fruit juice Uses/Features For children 1 For children Semi-elemental Elemental for GI Elemental for GI Very low fat elemental tube feed formula dewith added to 10 yrs 10 yrs-adult for 1-13 yr old impaired children impaired chilsigned for GI impaired protein and with malabsorption 10 yrs -adult dren 1-10 yrs children 10 y/o-adult vitamins.

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Also available: Perative, Suplena (renal), Nepro (renal), Portagen

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

Agitated or Hostile Behavior

Pharmacological Management of 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

1 2
Dose Route

Behavioral Interventions
Poor Response

Poor Response AND Extreme Physical Aggression

Antihistamine

Poor Response

3
Dose Route Repeat Max

Benzodiazepine
Lorazepam (Ativan)
0.05 to 0.1 mg / kg / dose PO q 30 min x2 IM q 15 min x2 2 mg / dose If > 0.3 mg / kg or If > 6 mg in 1 hour Use Monitored Bed IV * q 5 min x2

Poor Response

4
Dose Route Repeat Max

Neuroleptic
(Choose One)

Diphenhydramine (Benadryl)
1 mg / kg / dose PO IM IV

Haloperidol (Haldol)
0.025 to 0.075 mg / kg / dose PO IM q 5 min x2 5 mg / dose If > 0.2 mg / kg or If > 10 mg in 1 hour U s e Mo n ito re d B e d IV **

OR
Dose Route Repeat Max

Olanzapine (Zyprexa)
For < 12 y/o: 5 mg / dose For > 12 y/o: 10 mg / dose PO q 30 min x2 IM q 15 min x2

q 30 min q 30 min q 10 min Repeat x2 x2 x2 Max Caution 50 mg / dose Avoid Antihistamine if Delirium Suspected

20 mg / dose If < 12 y/o & Total Doses > 5mg or If > 12 y/o & Total Doses >10mg U s e Mo n ito re d B e d

Caution

Caution

Caution

* IV Route Associated with Respiratory Depression

**IV Route Increases Risk of QT Prolongation U s e Mo n ito re d B e d

Poor Response
References: 1 Use of Chemical & Physical Restraints in the Pediatric Emergency Dept, Pediatric Emergency Care, Vol 16(5), 2000 2 Chemical Restraints for the Agitated, Violent or Psychotic Patient in the Pediatric Emergency Dept, Pediatric Emergency Care, Vol16 (2), 2004 3 Review of Benzodiazepine Use in Children and Adolescents, Psychiatric Quarterly, Vol 76(3), 2005 4 Prehospital Evaluation and Management of Violent or Agitated Children, Clinical Pediatric Emergency Medicine, Vol 8, 2007 5 Harriet Lane Handbook, 17th Ed, 2005 6 Agitation Treatment for Pediatric Emergency Patients, J Am Academy Child & Adolescent Psychiatry Vol 47(2), 2008

5
Dose Route Max

Benzodiazepine AND
0.05 mg / kg Lorazepam

Combination of

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

(Can Administer Lorazepam & Haloperidol in Same Syringe)

IM

Neuroleptic
0.05 mg / kg Haloperidol

IM

2 mg / dose

5 mg / dose
Version 06.01.12

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CHKD Neonatal Medications and Dosing Guidelines

CHKD NICU Clinical Pharmacist: Cisco phone Red Team: 8-8002, Blue Team: 8-5491

Cefuroxime Infuse IV over 30 mins. All neonates < 7 days OR < 2000gm: 50 mg/kg/dose q12hr > 7 days AND > 2000gm: 50 mg/kg/dose q8hr Clindamycin IV, IM Infuse IV over 30 mins. All neonates < 1200gm: 5 mg/kg/dose q12hr Postnatal age: < 7 days & < 2000gm 5 mg/kg/dose q12hr < 7 days & > 2000gm 5 mg/kg/dose q8hr > 7 days & < 1200gm 5 mg/kg/dose q12hr > 7 days & 1200-2000gm 5 mg/kg/dose q8hr > 7 days & > 2000gm 5 mg/kg/dose q6hr Term infant: > 30 days & > 2.5kg 10 mg/kg/dose IV q8hr Cotrimoxazole (BactrimTM) PO (UTI prophylaxis) (Sulfamethoxazole/Trimethoprim (TMP) >2 months of age: Based on TMP component 2 mg TMP/kg/day or 5 mg TMP/kg/dose twice weekly Fluconazole IV/ POInfuse IV over 60 mins. < 29 weeks Postmenstrual Age: 0-14 days: 6 mg/kg/dose q72hr >14 days: 6 mg/kg/dose q48hr 30-36 weeks Postmenstrual Age: 0-14 days: 6 mg/kg/dose q48hr >14 days: 6 mg/kg/dose q24hr 37-44 weeks Postmenstrual Age: 0-7 days: 6 mg/kg/dose q48hr >7 days: 6 mg/kg/dose q24hr > 45 weeks Postmenstrual Age: ALL: 6 mg/kg/dose q24hr Thrush: 6 mg/kg PO x1 then 3 mg/kg/dose q24hr Gentamicin/ Tobramycin IV, IM Infuse IV over 30 mins. Preterm Infants (ALL 0-4 weeks of age) 3 mg/kg/dose q24hr Preterm Infants > 4 weeks old: < 1200gm 3 mg/kg/dose q24hr 1200-2000gm 2.5 mg/kg/dose q12hr > 2000gm 2.5 mg/kg/dose q8hr TERM Infants Postnatal age: < 7 days 4 mg/kg/dose q24hr Postnatal age: > 7 days &< 1200 gm 3 mg/kg/dose q24hr > 7 days & 1200-2000gm 2.5 mg/kg/dose q12hr > 7 days & > 2000gm 2.5 mg/kg/dose q8hr

Antibiotics/Antivirals/Antifungals/Immune Globulin
Acyclovir IV Preterm Neonate < 33 weeks: 20 mg/kg/dose IV q12hr Neonate > 34 weeks: 20 mg/kg/dose IV q8hr Dosing Adjustment in Renal Impairment: SCr = 0.8 1.1 20 mg/kg/dose IV q12hr SCr = 1.2 - 1.5 20 mg/kg/dose IV q24hr SCr> 1.5 or urine output < 1ml/kg/hr (oliguria): 10 mg/kg/dose IV q24hr Amikacin IV: Infuse over 30 mins. (Base dose on actual weight in neonates) 0-4 weeks, <1200gm: 7.5 mg/kg/dose q24hr Postnatal age < 7 days: 1200-2000gm: 7.5 mg/kg/dose q12hr >2000 gm: 10 mg/kg/dose q12hr Postnatal age > 7 days: 1200-2000gm: 7.5 mg/kg/dose q12hr >2000gm: 10 mg/kg/dose q8hr Amoxicillin (for UTI prophylaxis) PO only 10-15 mg/kg/dose q24hr If NPO, use Ampicillin 50 mg/kg/dose IV qPM Amphotericin B (over 4 hr per NICU protocol) 1 mg/kg IV q24hr Extend interval to q48hr with renal dysfunction. Needs a separate line/ port if infusing w/ TPN & fats. With 1 line: Run TPN over 20hrs, check blood sugars while off TPN during Ampho infusion. Ampicillin IV, IM Postnatal age: < 7 days OR < 1200gm 100 mg/kg/dose q12hr > 7 days & 1200-2000gm 100 mg/kg/dose q8hr > 7 days & > 2000gm 100 mg/kg/dose q6hr UTI Prophylaxis while NPO: 50 mg/kg/dose qPM Cefazolin (Ancef) IV, IM Postnatal age: < 7days OR < 2000gm > 7 days & > 2000gm 20 mg/kg/dose q12hr 20 mg/kg/dose q8hr

Cefotaxime (Claforan) IV, IM Postnatal age: < 7 days OR < 1200gm 50 mg/kg/dose q12hr > 7 days & > 1200gm 50 mg/kg/dose q8hr Meningitis dose after 28 days of life 50 mg/kg/dose q6hr Cefoxitin (Mefoxin) IV, IM 30 mg/kg/dose every 8hrs

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This handbook is interactive. Topics may be searched alphabetically in the INDEX Penicillin G Benzathine IM Only Asymptomatic congenital syphilis >1200g: 50,000 units/kg x 1 dose IM Rifampin IV or PO Infuse IV over 30 mins. 10 mg/kg/dose IV/PO q12hr Synergy for MRSA in combination w/other ABX: 5-10 mg/kg/dose IV/PO q12hr Piperacillin-Tazobactam (Zosyn) Infuse over 30 mins. < 29 weeks (GA): 0 to 28 days 80 mg/kg/dose q12hr >28 days 80 mg/kg/dose q8hr 30-36 weeks (GA): 0 to 14 days 80 mg/kg/dose q12hr >14 days 80 mg/kg/dose q8hr 37-44 weeks (GA): 0 to 7 days 80 mg/kg/dose q12hr >7 days 80 mg/kg/dose q8hr > 45 weeks (GA): ALL 80 mg/kg/dose q8hr

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Hepatitis B Vaccine and Hep B Immune Globulin IM Hepatitis B Vaccine: 0.5 ml IM x 1 Hepatitis B Immune Globulin: (HBIG) 0.5 ml IM x 1 HbsAg-positive mother: Give Hep B vaccine and HBIG w/in 12hr of birth. Preterm infant < 2kg & HbsAg-unknown mother: Give Hep B vaccine. Give HBIG if mom tests positive or if results are unknown within 12hrs of birth. Infant > 2kg & HbsAg-unknown mother: Give Hep B vaccine and obtain HbsAg on mother. Give HBIG within 7 days of birth, only if mother tests positive. Immune Globulin (IVIG): IV only DAT positive hemolytic anemia: 1,000 mg/kg/dose IV over 2 hours Sepsis/Neutropenia: 750 mg/kg/dose IV over 4hr Meropenem (Merrem) IV Infuse over 30 mins. < 7 days OR < 2000gm: 20 mg/kg/dose IV q12hr > 7 days & > 2000gm: 20 mg/kg/dose IV q8hr Meningitis (Pseudomonas): 40 mg/kg/dose IV q8hr Metronidazole (Flagyl) IV/PO - Infuse IV over 30 mins. All neonates < 1200gm 7.5 mg/kg/dose q48hr Postnatal age: < 7 days & 1200 - 2000gm 7.5 mg/kg/dose q24hr < 7 days & > 2000gm 7.5 mg/kg/dose q12hr > 7 days & 1200-2000gm 7.5 mg/kg/dose q12hr > 7 days & > 2000gm 15 mg/kg/dose q12hr Postmenstrual age > 45 weeks (all) 7.5 mg/kg/dose q6hr Term Infant > 30 days & > 2.5kg 10 mg/kg/dose IV q6hr Nystatin PO = {100,000 units/ml} suspension Preterm Infant: 0.5 ml to each side of mouth q6hr Term Infant: 1 ml to each side of mouth q6hr Cream/Ointment: apply to area topically BID - QID Oxacillin IV, IM: Infuse IV over 30 mins. Postnatal age: < 7 days OR < 1200gm 50 mg/kg/dose q12hr < 7 days & > 2000gm 50 mg/kg/dose q8hr > 7 days & 1200-2000gm 50 mg/kg/dose q8hr > 7days & > 2000gm 50 mg/kg/dose q6hr Penicillin G IV, IM Infuse IV over 30 mins. Postnatal age: < 7 days OR < 1200gm 50,000 units/kg/dose q12hr < 7 days & > 2000gm 50,000 units/kg/dose q8hr > 7 days & 1200-2000gm 50,000 units/kg/dose q8hr > 7 days & > 2000gm 50,000 units/kg/dose q6hr GBS Meningitis: 100,000 units/kg/dose q6hr 38

Vancomycin IV Infuse over 60 mins. Postnatal age All neonates < 1200gm: 15 mg/kg/dose q24hr < 7 days & > 1200gm: 15 mg/kg/dose q12hr > 7 days & 1200 2000gm: 15 mg/kg/dose q12hr > 7 days & > 2000gm: 15 mg/kg/dose q8hr Zidovudine (Retrovir/AZT) IV or PO GA < 29 weeks, 0-28 days: IV: 1.5 mg/kg/dose q12hr; PO: 2 mg/kg/dose q12hr GA < 29 weeks, > 28 days: IV: 1.5 mg/kg/dose q8hr; PO: 2 mg/kg/dose q8hr GA 30-34 weeks, 0-14 days: IV: 1.5 mg/kg/dose q12hr; PO: 2 mg/kg/dose q12hr GA 30-34 weeks, > 14 days: IV: 1.5 mg/kg/dose q8hr; PO: 2 mg/kg/dose q8hr GA > 35 weeks, ALL: IV: 1.5 mg/kg/dose q6hr; PO: 4 mg/kg/dose q12hr

Anticonvulsants
Fosphenytoin (Cerebyx) IV only Load: 15-20 mg PE/kg IV over at least 10 mins Maintenance: 2.5-4 mg/kg/dose every 12 hours (Fosphenytoin 1 mg PE= Phenytoin sodium 1 mg) IV or PO Load: 20 mg/kg x 1 Maintenance: 3 - 5 mg/kg/day IV/PO q24hr

Phenobarbital

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Cardiac
Alprostadil Standardized Drip Concentration (Prostaglandin E1) Continuous IV infusion: 0.01 to 0.1 mcg/kg/min Bosentan (Tracleer) PO only (for PAH); limited peds data. Avoid if impaired liver function and monitor LFT during therapy. Initial dose: 1-2 mg/kg/dose PO BID Titrate to maintenance dose of 2-4 mg/kg/dose BID Standardized Drip Concentration Continuous IV infusion: 2 to 20 mcg/kg/min Standardized Drip Concentration Continuous IV infusion: 2 to 20 mcg/kg/min Standardized Drip Concentration Continuous IV infusion: 0.1 to 1 mcg/kg/min IV or PO (specify BP parameters) (PO is approximately 2 times the IV dose) IV: 0.25 - 0.5 mg/kg/dose q6-8hr prn (max. 2 mg/ kg/dose) PO: 0.25 - 1 mg/kg/dose q6-8hr prn IV or PO Stress Dosing: 1.5 mg/kg/dose IV/ > stress > PO q6hr Taper dose: Stress Maintenance Maintenance Dose for Adrenal Insufciency: For pt < 1 kg, 0.3 mg IV/PO q6hr (lowest maintenance dose recommended) 1 1.5kg, Hydrocortisone 0.4 mg IV/PO Q6hr Once pt > 1.5kg: 1 mg qAM and 0.5 mg qPM IV/ PO ACTH stim test once 1800 gm or > 32 weeks IV for PDA closure PDA Tx: Load 10 mg/kg x 1 dose then 5 mg/kg/ dose Q24h x 2 doses starting 24hr after load (max. 2 courses) Propranolol (Inderal) Sildenafil (Revatio) (Viagra)

IV PDA Prophylaxis: 0.1 mg/kg/dose IV q24hr x 3 doses PDA Tx: 0.2 mg/kg/dose IV q24hr x 3 doses per course (maximum 2 courses) IV or PO (per Cardiology) IV: 0.01 mg/kg/dose IV Q6hr or Q8hr PO: 0.25 mg/kg/dose PO Q6hr or Q8hr PO only (for PPHN) Initial dose: 0.5-1 mg/kg/dose PO every 6-12 hrs. (Max: 3 mg/kg/dose in term infant)

Gastrointestinal
Erythromycin (for GI motility) Famotidine (Pepcid) IV or PO 3-5 mg/kg/dose q6hr (PO preferred) Salts: PO = EES / IV= Erythromycin Lactobionate CHKDs only IV H2 Blocker < 1 month of age: 0.5 mg/kg/day IV Qday > 1 month (corrected term): 0.5 mg/kg/dose IV BID *** Use Total Daily dose in TPN*** Dosing Adjustment in Renal Impairment: CrCl 10-50 ml/min/m2: 0.5 mg/kg/dose q24hr CrCl <10 ml/min/m2: 0.5 mg/kg/dose q48hr CHKDs only PO H2 Blocker 2 mg/kg/dose PO q8hr (not recommended in <1500g, incr. sepsis risk) CHKDs only IV proton pump inhibitor 0.5 - 1 mg/kg/day. May increase to BID if needed. (not recommended in <1500g, incr. sepsis risk) SL or PO < 2kg 1 to 2 drops every 4 - 6hr 2 - 3.4kg 3 drops every 4 - 6hr > 3.4kg 4 drops every 4 - 6hr CHKDs PO proton pump inhibitor for patients < 10kg for < 10kg: 0.5 - 1 mg/kg/dose PO daily. May increase to BID if needed. (not recommended in <1500g, incr. sepsis risk)

Dobutamine Dopamine Epinephrine Hydralazine

Hydrocortisone

Ranitidine (Zantac) Esomeprazole (Nexium) Hyoscyamine (Levsin drops)

Ibuprofen (NeoProfen)

Omeprazole (Prilosec)

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Simethicone PO only (Mylicon ) drops 20 mg/dose q6hr PRN Ursodiol (Actigall) PO only 10-15 mg/kg/dose q12hr

Respiratory
Albuterol (HHN) 1.25 mg - 2.5 mg nebulized Q4 - 6hr PRN Aldactazide PO only (Spironolactone/HCTZ) 1 mg/kg/dose (each component) BID Budesonide (Pulmicort (HHN) ) Bumetanide (Bumex) Caffeine Citrate 0.25 mg nebulized Qday - BID IV or PO: 0.05 mg/kg/dose Q8-Q12 hr, titrate based on diuresis IV or PO IV: Infuse Load over 30mins, daily IV dose over 10 mins Loading dose: 40 mg/kg x 1 Initial Maintenance dose: 8 mg/kg/day Via ETT only (divided into 2 aliquots) Max. total dose 5 ml/kg. Load: 2.5 ml/kg/dose. Subsequent doses: 1.25 ml/kg/dose q12hr up to 2 additional doses. IV or PO Day 1-3 0.25 mg/kg/dose q12hr Day 4-6 0.15 mg/kg/dose q12hr 1 mg/kg/dose IV or 2 mg/kg/dose PO Frequency from Qday Q12hr, (max q6hr) 0.25 mg INH q8hr 0.125 mL of 2.25% solution diluted in 3ml NS IV only: 2 mEq/kg/dose. Mix 1:1 w/sterile H20. Infuse over 30 mins. HCO3 (mEq) = 0.3 x weight (kg) x base deficit

Miscellaneous
3% Saline IV: 5-6 mL/kg x 1 over 2hr. (Hypertonic Solution) To be used only after Attendings approval Calcium Supplementation Cholecalciferol, vit D3, 400 IU/mL (D-Vi-Sol) Granulocyte Colony Stimulating Factor (GCSF)/filgrastim Hyaluronidase (Amphadase) Ca Gluconate (IV): 100 - 200 mg/kg/dose q6hr over 1 hour Ca Glubionate (PO): 90 - 315 mg/kg/dose q6hr PO only 200 - 400 International Units PO daily Neutropenia/Sepsis: 10 mcg/kg IV q24hr until ANC >1000 (order 1 dose at a time) IV over 15-30 mins SubQ: only up to 24 hours after extravasation injury. Draw up 0.1 ml (150 units/ml conc.) and mix w/0.9 ml NS to make 15 units/ml conc. Administer 0.2 ml SubQ in a circular pattern around injured site. Standard Drip Conc. Continuous IV infusion: 0.01 to 0.1 units/kg/hr; titrated to blood glucose (IV=75% of oral dose) IV: 7-12 mcg/kg/day q24hr PO: 10-15 mcg/kg/day q24hr Magnesium Sulfate (IV): 25 mg/kg/dose x 1 Mag. Gluconate (PO): 185-370 mg/kg/day PO q6hr (Inactivated Polio, dTaP & HIB) 0.5 ml IM @ 2, 4 and 6 months of age Order Prevnar & Hepatitis B separately. PO only 0.5 - 1 mL daily

Curosurf (Poractant Alfa)

Dexamethasone (Decadron) Furosemide (Lasix) Ipratropium (Atrovent ) (HHN) Racemic Epinephrine (HHN) Sodium Bicarbonate

Insulin (Regular only) Levothyroxine (Synthroid) Magnesium Supplementation Pentacel

Poly-Vi-Sol Plain or with Iron

Potassium Chloride PO: 1 mEq/kg/dose; frequency dependent (Chloride Supplement) upon level of deficiency, start @ q12hr 42 43

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Sedation/Analgesia/Paralytics
Acetaminophen (Tylenol) Diazepam (Valium) PO or PR 10 - 15 mg/kg/dose q6hr PRN IV or PO *reserved for older/TERM infants due to decreased metabolism*; very long half-life with chronic dosing and often only need to dose two to three times per day. Consult your NICU Pharmacist for dosing. Standard Drip Concentration Continuous IV infusion: 1 to 5 mcg/kg/hr: titrate IV bolus: 1 - 2 mcg/kg/dose IV q2hr - q4hr PRN IV or PO: 0.05 to 0.1 mg/kg/dose q4-6hr PRN titrate to effect IV or PO (=analgesic to Morphine, but > sedating) 0.05 - 0.1 mg/kg/dose q6hr-q12hr, titrate to effect Neontl Narcotic w/d: 0.05-0.1 mg/kg/dose q6hr After 24-48hr, extend interval to q12-q24hr. To taper, wean by 0.05 mg/kg/day. IV or PO Standard Drip Concentration continuous IV infusion: 0.05 to 0.2 mg/kg/hr IV bolus: 0.05 - 0.15 mg/kg/dose IV q2hr- q4hr PRN IV or PO Standard Drip Concentration Continuous IV infusion: 10 to 20 mcg/kg/hr: titrate IV bolus: 0.05-0.2 mg/kg/dose IV q4hr - q6hr PRN PO: 0.1-0.2 mg/kg/dose PO q4hr - q6hr PRN IV only; prolonged duration with poor renal function 0.1 mg/kg/dose IV Q1hr PRN movement NO analgesic effect-use with sedation/analgesia For multiple doses/day, also order Lacri-lube OU PRN Standardized Drip Concentration Continuous IV infusion: 0.05 to 0.15 mg/kg/hr Recommend ordering Lacri-lube OU PRN while on drip

INDEX
Click on page numbers to go to destination 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/clavulanic acid: 10 Amphotericin B: 36 Amphotericin B, 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 Caffeine citrate: 43 Calcium chloride: 3, 13 Calcium glubionate: 42 Calcium gluconate: 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 Chloral hydrate: 8 Chlorothiazide: 20, 21 Cholecalciferol: 42 Clindamycin: 11, 26, 37 Clonidine: 8,18 Codeine: 8 Cotrimoxazole (TMP/SMX): 12, 26, 31, 37 45

Fentanyl

Lorazepam (Ativan) Methadone

Midazolam (Versed)

Morphine

Pancuronium (Pavulon)

Vecuronium

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Previous spread 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

This handbook is interactive. Topics may be searched alphabetically in the INDEX G Gabapentin: 6 Gastrografin/normal saline/ mineral oil: 21 Gentamicin: 11, 27, 37 Glucagon: 23 Glycopyrrolate: 24 Granisetron: 28 H Haloperidol: 24 Hepatitis B Vaccine: 38 Hepatitis B Immune Globulin (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 M Magic Mouthwash: 30 Magnesium citrate: 29 Magnesium gluconate: 31, 42 Magnesium oxide: 31 Magnesium sulfate: 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 Ibuprofen: 6, 30, 40 Indomethacin: 41 Insulin: 24, 42 Ipratropium: 19, 43 Iron: 24 IVIG: 38 P Pancuronium: 5, 44 Penicillin: 12, 27, 38 L Labetalol: 18 Lactulose: 21, 28 Levetiracetam: 16 Levofloxacin: 27 Levothyroxine: 42 Lidocaine: 3 Linezolid: 27 Lorazepam: 4, 8, 16, 17, 28, 44 K Kayexalate: 24 Ketamine: 5, 9 Ketorolac: 7, 30 N Nalbuphine: 7, 30 Naloxone: 7, 24, 30 Nicardipine: 4 Nifedipine: 19 Norepinephrine: 4 Nitroprusside: 4 Nitroglycerin: 4 Nystatin: 38

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Omeprazole: 21, 29, 41 Ondansetron: 22, 28 Oseltamivir: 11 Oxacillin: 12, 27, 38 Oxcarbazepine: 16 Oxycodone: 8 Oxycodone/acetaminophen: 7, 30

Penicillin, Benzathine: 39 Pentacel: 42 Pentobarbital: 9 Peridex: 31 Phenobarbital: 16, 17, 39 Phenytoin: 16, 17, 40 Piperacillin/tazobactam: 12, 39 Polyethylene glycol: 22 Poly-vi-sol: 42 Poractant alpha (Curosurf): 43 Potassium chloride: 13, 42 Potassium phosphate: 13, 31 Prednisone: 19, 23 Prednisolone: 19, 23 47

F Famotidine: 21, 29, 41 Fentanyl: 5, 6, 8, 29, 44 Filgrastim (GCSF): 42 Fluconazole: 11, 26, 37 Flumazenil: 23 Folic acid: 30 Fosphenytoin: 16, 17, 39 Furosemide: 20, 21, 43 46

Previous spread 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 Sodium bicarbonate: 3, 43 Sodium chloride 3%: 13, 42 Sodium phosphate: 13 Spironolactone: 20 Spironolactone/HCTZ: 43

This handbook is interactive. Topics may be searched alphabetically in the INDEX T Terbutaline: 20 THAM: 24 Theophylline: 20 Tobramycin: 12, 26, 37 Tramadol: 8 Trimethoprim/Sulfamethoxazole: 12, 26, 31, 37 U Ursodiol: 22, 42 Valproic acid: 17 Vancomycin: 12, 27, 39 V Vasopressin: 3, 4, 25 Vecuronium: 5, 44 Vitamin D: 42 Voriconazole: 27 Z Zidovudine: 39

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This handbook is interactive. Topics may

Contributors: Michael Chicella, PharmD Jennifer Chow, PharmD Casey Cottrill, MD James Dice, PharmD Kathleen Noorbakhsh, MD Jessica Price, PharmD Jennifer Walker, MD Sara Wittenberg, RD, CSP, CNSC Eloise Woodruff, PharmD Arno Zaritsky, MD

601 Childrens Lane Norfolk, Virginia 23507 757-668-7000 www.chkd.org 50

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