Paediatric - Pharmacology

Question 1

Guidelines

Answer 1

• base doses on accurate patient weight or body surface where possible
• weight should be on medication chart
• check dose using current reputable references (within last 5 years)
• use calculator, re-check units
• know the patients current drug therapy, allergies & potential drug interactions
• drugs quoted in micrograms - word micrograms should be used
• liquid medications should be ordered by the weight of the active ingredients

Question 2

Paracetamol

Answer 2

• neonates, infants, children
• oral / rectal - 15mg/kg/dose 4-6hourly
• total dose maximum - 90mg/kg/day under medical supervision, 60mg/kg/day in community
• stat doses of 30mg/kg can be given for night dosing
• rectal 20-40mg/kg as a once off dose, rounded to appropriate suppository length

Question 3

Codeine

Answer 3

• infants & children
• analgesic - IM / SC - 0.5mg/kg/dose 4-6 hourly, oral - 0.5-1mg/kg/dose 4-6 hourly
• antitussive - oral - 0.25-0.5mg/kg/dose 6-8 hourly

Question 4

Ibuprofen

Answer 4

• infants over 6 months & children
• avoid in infants / children where group A streptococcal infection is suspected / proven
• pain / fever - oral 5-10mg/kg/dose 3-4 times per day
• juvenile chronic arthritis - oral - 10mg/kg/dose 3-4 times per day

Question 5

Antibiotics

Answer 5

• should be changed to narrow spectrum once sensitivities are known
• urinary tract infection
• sick or under 6 months
  
  • benzyl penicillin IV - 50mg/kg (max 3g) 6 hourly & gentamycin IV 7.5mg/kg
• over 6 months or not sick
  
  • trimethoprim oral - 4mg/kg (max 150mg) 12 hourly
• tonsilitis
  
  • penicillin oral 250mg (500mg if >10 years) 12 hourly for 10 days
• otitis media
  
  • amoxycillin oral 15mg/kg (max 500mg) 8 hourly

Question 6

Sedatives, Topical Anesthetics

Answer 6

• midazolam
  
  • neonates - conscious sedation in ventilated babies - 0.3-0.5 micrograms/kg/min initially adjusting as required to max 2 micrograms/kg/min
  • infants / children - induction of anesthesia - 0.15-0.5mg/kg/dose, sedation in ICU - 0.03-0.3mg/kg stat than 0.5-4 micrograms/kg/min
  • seizures - 0.15mg/kg stat then 2 microgram/kg/min increasing by 2 microgram/kg/min until seizures cease
• fentanyl
  
  • use in caution under 6 months
  • analgesia IV
  • ICU / analgesia IV
  • children PCA infusion (PCA needs to be controlled by parent or child with good education, only suitable if parent there frequently or child able to comprehend use of PCA)
• morphine
  
  • doses need filtration depending on condition & response, use in caution under 3 months
  • infusion, IV, SC, IM, PCA

Question 7

Parenteral Fluid Therapy

Answer 7

• indicated when child is unable to ingest sufficient fluid and electrolytes (oral rehydration soultions)
• dehydration is major consern due to high water content
• isotonic solutions usually used for this purpose (as they will not cause fluid shifts into the cell or out of the cell)
• 20ml/kg given as IV bolus over 20 minutes & repeated as required after assessment of child’s initial response
• subsequent therapy is used to replace deficits & meet maintainance water & electrolyte requirements
• water & sodium requirements calculated at 8 hour intervals