Pediatric Dosing

Question 1

What is most accurate measuring device for oral liquid meds?

Answer 1

oral syringe

Question 2

What are the three dosing guidelines in ped dosing?

Answer 2

1. Age-based dosing
2. Bodyweight-based dosing
3. Body surface area-based dosing

Question 3

Age based dosing

• advantage
• disadvantage

Answer 3

Advantage:
- easy
Disadvantage:
- assume ADME principles are same in all pts

*good choice for drug with wide margin of safety

Question 4

Body weight based dosing

• advantages
• disadvantages

Answer 4

Advantages:

• most common
• takes into account higher medication clearance compared to adults (Must have accurate weight)

Disadvantage:

• No established cut off for weight-based dosing
• Can result in doses that exceed adult recommendations (don’t exceed adult max dose)

*Best for drugs with small margin of safety

Question 5

Body surface area-based dosing

• advantages
• disadvantages

Answer 5

Advantages

• Most precise
• Limits potential for OD based on actual weight

Disadvantages

• Difficult calculation
• Requires patient’s height
• Not a well-studied approach
• Potential for unaccounted differences between pediatric and adult patients

Question 6

Amoxicillin/clavulanic acid

- dosing recommendations (standard and high dose)

Answer 6

• Standard dose (UTI): 45 mg/kg/day

* High Dose (Otitis media, community acquired pneumonia): 90 mg/kg/day

Question 7

Sulfamethoxazole/trimethoprim

• dosing recommendation
• max single dose

Answer 7

• 6-12 mg trimethoprim/kg/day in divided doses every 12 hours
• Max trimethoprim single dose 160 mg

*based on trimethoprim not sulfamethoxazole

Question 8

Cefdinir

- dosing recommendation

Answer 8

14 mg/kg/day in divided dose 1-2 times/day

Question 9

Cephalexin

- dosing recommendation

Answer 9

25-50 mg/kg/day in divided doses every 6 hours

Question 10

Clarithromycin

• dosing recommendation
• max single dose

Answer 10

• 15 mg/kg/day divided dose every 12 hours

* Max single dose 500 mg

Question 11

Clindamycin

• max daily dose
• max single dose

Answer 11

• Max daily dose 1800 mg/day

* Max single dose 450 mg

Question 12

Doxycycline

- max daily dose

Answer 12

200 mg/day

Question 13

Ciprofloxacin

• max dose mild-mod infection
• max dose serious infection

Answer 13

• Max dose mild-moderate infections: 500 mg/dose

* Max dose for serious infections: 750 mg/dose

Question 14

Nystatin

- Dosing recommendation for infants ≥ 30 days

Answer 14

Nystatin suspension 100,000 units to each cheek (200,000 total units per dose) four times daily for 7-14 days

Question 15

Nystatin

- Dosing recommendation for children

Answer 15

Nystatin suspension 400,000 to 600,000 units “swish and swallow” four times per day for 7-14 days

Question 16

Ibuprofen

• dosing recommendation
• max daily dose

Answer 16

• 4-10 mg/kg q 6-8 hours

* Max dose 40 mg/kg/day

Question 17

Acetaminophen

• dosing recommendation
• max daily dose

Answer 17

• 10-15 mg/kg q 4-6 hours

* Max 5 doses in 24 hours

Question 18

Albuterol inhaler

- dosing recommendation

Answer 18

90 mcg/puff

- 2 puffs q 4-6 hours

Question 19

Albuterol nebulization

- dosing recommendation (include min and max dose)

Answer 19

• 0.15 mg/kg (min dose 2.5 mg) every 20 minutes for 3 doses

* Then 0.15 to 0.3 mg/kg (not to exceed 10 mg) every 1-4 hours

Question 20

Fluticasone inhaler 5-11 yo

- low dose recommendation

Answer 20

88-176 mcg

• 44 mcg/puff inhaler: 1-2 puffs BID

Question 21

Fluticasone inhaler 5-11 yo

- medium dose recommendation

Answer 21

177-352 mcg
• 44 mcg/puff inhaler: 3-4 puffs BID
• 110 mcg/puff inhaler: 1 puff BID

Question 22

Fluticasone inhaler 5-11 yo

- high dose recommendation

Answer 22

> 352 mcg

• 110 mcg/puff inhaler: ≥ 2 puffs BID

Question 23

Budesonide nebulization 5-11 yo

- low dose recommendation

Answer 23

0.5 mg
• 0.25 mg nebules: 1 neb BID
• 0.5 mg nebules: 1 neb daily

Question 24

Budesonide nebulization 5-11 yo

- medium dose recommendation

Answer 24

1.0 mg
• 0.5 mg nebules: 1 neb BID
• 1.0 mg nebules: 1 neb daily

Question 25

Budesonide nebulization 5-11 yo

- high dose recommendation

Answer 25

2.0 mg

• 1.0 mg nebules: 1 neb BID

Question 26

Steroid short burst for children <12 yo

Answer 26

• 2 mg/kg on first day
• 1-2 mg/kg in divided doses once or twice daily after day one
• Max daily dose 60 mg
• Dose for 3-10 total days
** am dosing

Question 27

Montelukast

- dosing recommendation

Answer 27

**Age based dosing
• 6 months to 5 years: one 4 mg oral granule package
• 2-5 years: one 4 mg chewable tablet
• 6-14 years: one 5 mg chewable tablet
• ≥ 15 years: one 10 mg tablet

Question 28

Ondansetron

• dosing recommendation
• max daily dose

Answer 28

• Single oral dose of 0.15 mg/kg

* Max dose 8 mg

Question 29

Miralax

- dosing recommendation

Answer 29

**Age-based dosing
• <18 months: 0.5 to 1 teaspoon daily
• 18-36 months: 2-3 teaspoons daily
• >36 months: 2-4 teaspoons daily

Question 30

Ranitidine

• dosing recommendation
• max daily dose

Answer 30

• 4-8 mg/kg/day divided twice daily

* Max dose: 300 mg/day

Question 31

Griseofulvin microsize

• dosing recommendation
• max daily dose

Answer 31

• 20-25 mg/kg/day in 1-2 doses

* Max: 1,000 mg/day

Question 32

Griseofulvin ultramicrosize

• dosing recommendation
• max daily dose

Answer 32

• 10-15 mg/kg/day in 1-2 doses

* Max: 750 mg/day

Question 33

Be able to …

Answer 33

calculate dose based on pt weight and medication dose recommendations :)