paeds meds Flashcards
classification of paediatric age group
premature neonate: <37w
term neonate: 37-41w
neonate: 0-28d post natal
infant: 1m -1y
child : 1-12y
adolescent: 13-18yo
adult: 18yo >
absorption in paeds
children has a slower absorption by oral route and longer gastric emptying time
distribution in paeds
total body water increased in children
decrease in protein binding
larger volume of distribution in neonates and infants
metabolism and elimination in paeds
slow metabolism in newborns
reduced clearance rate and prolonged t1/2
renal excretion is reduced
to measure renal function
schwartz eqn: (k x cm)/ SCr in mg/dl
bedside schwartz: (0.413 x cm)/ SCr in mg/dl
mmol-> mg/dl: divide by 88.4
paracetamol
inhibits cox, no anti-inflammatory property
PO/PR: 10-15mg/kg/dose q4-6h max 75mg/kg or 4g whichever is lower
ibuprofen
inhibits central and peripheral cox
> 6m: PO 5-10mg/kg/dose q6-8h
max 40mg/kg/d or 400mg/single dose
> 12yo/>40kg: PO 200-400mg q6-8h
diclofenac
> 1yo: PO/PR 0.5-2mh/d in 2-3 divided doses max 150mg/d
chlorpheniramine
> 6m: 0.35mg/kg/d TDS dosing
diphenhydramine
used as anti-tussive
2-6yo: 6.25mg q6h (max 37.5mg/d)
6-12yo: 12.5mg q8h (max 75mg/d))
*max 6 doses for both
promethazine
> 2yo: 0.2-0.5mg/kg/dose BD-TDS
ceterizine
2-5yo: 2.5mg OD-BD
> 6yo: 5mg BD -10mg OD
desloratadine
1-2yo (only for urticaria): 1.25mg/d
2-11yo: 1.25mg/d
> 12yo: 5mg/d
fexofenadine
6m-2yo (only for chronic idiopathic urticaria): 15mg BD
2-11yo: 30mg BD
>12yo: 60mg BD
oxymetazoline
alpha adrenergic agonist that vasoconstrict the dilated blood vessels in nasal mucosa
<1yo: 0.01%
2-6yo: 0.025%
>6yo: 0.05%
SE: burning, stinging, dryness, headache, avoid for >5yo
acetylcysteine
2-5yo: 1 sachet TDS
>6yo: 2 sachet TDS
bromhexine
2-5yo: 2mg TDS
6-12yo: 4mg TDS
>12yo: 8mg TDS
ORS
1-2 sachets BD-TDS
adsorbents
absorb toxins and other substances produce by diarrhoea
not recommended for acute diarrhoea
smecta
natural adsorbents: adsorbs viruses, bacteria, bacterial toxins , protects intestinal mucosa
> 2yo 2-3 sachets a day
loperamide
acts on receptors along small inestines to reduce peristalsis
for >6yo: 0.05-0.1mg/kg q8-12h
max 4mg
diphenoxylate
cnt use in <2yo
0.3-0.4mg/kg/d in 4 divided doses max 10mg
SE: tachycardia, resp depression, urinary retention
red flags for diarrhoea
<6m
premature birth, hx of pmh
fever >38 in infant or >39 in children
blood in stools
high output and frequent
persistent vomiting
signs of dehydration
change in mental status
suboptimal response to ORT or unable to tolerate oral
lactulose
semisynthetic disaccharide so not absorbed by gut, metabolised by colonic bacteria to low molecular weights acids increase osmotic pressure
0.5ml/kg/dose q12-24h
forlax (PEG/Macrogol)
osmotic laxatives causing intestinal water secretion and increase stool frequency
> 8yo: 1-2 sachet OM
space 2h from other meds
glycerin
rectal stimulant due to mildly irritant nature of glycerol, increase osmotic pressure
neonate 1/4 supp
infant: 1/2 supp
children: 1 supp
>12yo: 2 supp
bisacodyl
increase intestinal motility by acting on large intestine to produce strong peristaltic movement, stimulate nerve endings to produce parasympathetic reflexes
PR <12m: 2.5mg, 1-5yo: 5mg, >5yo: 10mg
PO: 1-5yo: 5-10mg OD, >5yo: 10-20mg OD
co-trimoxazole
TMP: 6-12mg/kg/d dosed BD
fluoroquinolone
20-30mg/kg/d dosed BD
not recommended <12yo due to erosion of cartilarge, msk
SE: GI, ECG, Photosensitivity
space with iron and calcium
