Pediatrics Must Know Drug Exam Study Guide

Lidocaine/Prilocaine

Topical Anesthetic for minor procedures; venipuncture, IV cannulation, superficial minor surgeries.

Dosage

1-2.5 grams covered with occlusive dressing for at least 60 min prior to procedure.

Dexamethasone (Decadron)

Corticosteroid; Anti-inflammatory agent, immunosuppressant. Used in variety of allergic, hematologic, dermatologic, neoplastic, rheumatic, autoimmune, nervous system, renal, and respiratory origin (FDA approved in pediatric patients).

Dexamethasone Administration

PO with food or milk to prevent GI upset or IM or IV (slow push over 1-4 min or intermittent infusion over 15-30 min).

Dexamethasone Side Effects

May affect growth velocity, cause osteoporosis or impair bone growth; growth should be routinely monitored in pediatric patients, increased risk of fractures in prolonged use.

Dexamethasone Monitoring

Monitor for hyperglycemia; may alter glucose production/regulation leading to hyperglycemia.

Cefotaxime (Claforan)

Antibiotic: Third generation cephalosporin. Broad-spectrum. Treatment of susceptible lower respiratory tract, skin and skin structure, bone and joint, intra-abdominal, genitourinary tract, septicemia, meningitis.

Cefotaxime Side Effects

Pruritis, skin rash, diarrhea, inflammation at injection/pain/tenderness at injection site.

Cefotaxime Administration

IV intermittent infusion (30 minutes) or IM. Large doses should be divided and administered in 2 sites.

Cefotaxime Caution

Use with caution in patients with anaphylaxis response to Penicillin. Avoid rapid IV administration, can cause arrhythmias.

Cefotaxime Monitoring

Educate patient and parents about c.difficile-associated diarrhea-signs/symptoms to look for.

Important Dosing Note

Important: look up and verify patient dosing before administering, every time for every patient. You must understand why your patient is ordered the drug and have an accurate weight in kilograms.

Dexamethasone Side Effects (Continued)

Upset stomach, peptic ulcer, gastritis, increased appetite, headaches, dizziness, excitatory psychiatric disturbances (restlessness, mood changes, difficulty sleeping, etc), hyperglycemia, acne/facial rash, adrenal suppression, Cushingoid appearance, infection, increased intraocular pressure.

Cefotaxime Dosing Note

Dosing based off of weight and indication!!!

Dexamethasone Growth Monitoring

Growth should be routinely monitored in pediatric patients.

Dexamethasone Risk

Increased risk of fractures in prolonged use.

Cefotaxime Hypersensitivity

Hypersensitivity-anaphylaxis.

Cefotaxime GI Effects

GI-diarrhea, nausea, vomiting, oral candidiasis.

Cefotaxime Administration Routes

PO on empty stomach or IM or IV (slow push over 3-5 min or intermittent infusion over 10-15 min).

Cefotaxime Dosing Variability

Varies: Dosing based off of age (neonate ≤28 days vs.

Ampicillin

Antibiotic: Penicillins used for treatment of susceptible respiratory, gastrointestinal, and urinary tract infections; bacterial meningitis, septicemia, neonatal sepsis, and endocarditis (FDA approved in pediatric patients).

Ampicillin Rash

Generalized maculopapular and pruritic rash appears 7-10 days after initiation and usually resolves within a week of discontinuation; not recommended in patients with infectious mononucleosis.

Amoxicillin/Clavulanate (Augmentin)

Antibiotic: Penicillin and beta-lactamase inhibitor used for infections caused by susceptible organisms involving the lower respiratory tract, otitis media, sinusitis, skin and skin structure, and urinary tract.

Amoxicillin/Clavulanate Dosing

Dosing based off of amoxicillin component; verify ordered amoxicillin to clavulanate ratio.

C.Difficile Associated Diarrhea

Antibiotic associated diarrhea may occur; monitor for signs and educate patient and parents.

Amoxicillin Administration

Administer at the start of a meal to decrease the frequency or severity of GI side effects; reconstituted suspensions should be kept in the refrigerator and discarded after 10 days.

Hypersensitivity Reactions

Can occur as early as 1 hour after administration; maculopapular rash may appear as late as day 14.

Albuterol Sulfate (Proventil)

Beta2-Adrenergic Agonist; Bronchodilator; antiasthmatic used to treat asthma and bronchospasm; considered a rescue drug, not for maintenance.

Albuterol Dosage

0.63-2.5mg (age and weight dependent) every 4-6 hours.

Exercise-Induced Bronchospasm Prevention

Use albuterol 15 to 30 minutes before physical activity.

Albuterol Side Effects

Excitement, nervousness, tremors, tachycardia, palpitations, increased serum glucose, increased appetite, decreased hematocrit/hemoglobin, hyperactive behavior, dizziness, upper respiratory infection symptoms, muscle spasm, mydriasis, hypertension, ST segment depression, hypokalemia.

Albuterol Administration in Children

In infants and children <4 years, a face mask with either the metered-dose inhaler or nebulizer is recommended.

Inhaler Use in Children

May use an inhaler for community use once the child is developmentally mature enough to understand direction and proper use.

CNS Stimulation in Children

CNS stimulation, hyperactivity, and insomnia occur more frequently in younger children than in adults.

Albuterol Oral Therapy Risks

Erythema multiforme/Stevens-Johnson syndrome have been reported (rare) in children receiving oral albuterol therapy.

Albuterol Contamination Risks

Lower respiratory tract colonization/infection have been attributed to contaminated multidose albuterol bottle.

Proper Use of Nebulizer/MDI

Teach about proper use, cleaning, and storage of nebulizer/MDI spacer/inhaler.

Pediatric Dosing Considerations

In pediatrics, dosing is determined with consideration of age, weight, and indication.

Ampicillin FDA Approval

FDA approved in pediatric patients.

Amoxicillin/Clavulanate FDA Approval

FDA approved in all ages.

Albuterol Usage

Not intended for maintenance therapy.

Albuterol Administration Frequency

Administer every 4-6 hours as needed.

Digoxin

Antiarrhythmic Agent, Cardiac Glycoside. Improves myocardial contractility. Treatment of mild to moderate heart failure, fetal tachycardia, slow ventricular rate in supraventricular tachyarrhythmias such as supraventricular tachycardias (SVT).

Digoxin Immune Fab

Antidote for toxicity.

Digoxin Dosage

Dose should be based on lean body weight and renal function taken into consideration.

Digoxin Administration

Administered every 12 hours. PO may be IV.

Digoxin Oral Administration

Direct oral elixir toward side and back of mouth.

Digoxin Tooth Care

Give water to prevent tooth decay if child has teeth.

Digoxin Vomiting Protocol

If child vomits, do not re-administer dose.

Ferrous Sulfate

Prevention and treatment of iron deficiency anemias.

Ferrous Sulfate Side Effects

GI upset is common at start of therapy (diarrhea, constipation, nausea, abdominal pain). Darkening stool (tarry green).

Ferrous Sulfate Administration

If tolerated, administer on an empty stomach, 1 hour before or 2 hours after milk/antacids. Give with Vitamin C to increase absorption.

Ibuprofen

Analgesic, NSAID, antipyretic. Also used in Juvenile Idiopathic Arthritis (JIA), closure of patent ductus arteriosus (PDA).

Ibuprofen Administration Age

Should only be administered to infants and children 6 months and older.

Ibuprofen Dosing

Weight-directed dosing: Infants, Children and Adolescents: Oral: 5 to 10 mg/kg/dose every 6 to 8 hours; maximum dose: 600 mg/dose; maximum daily dose: 2,400 mg/day.

Ibuprofen Liquid Concentrations

Oral liquid products are available in 2 concentrations (concentrated infant drops: 50 mg/1.25 mL [40 mg/mL] and suspension: 100 mg/5 mL [20 mg/mL]).

Acetaminophen

Analgesic/antipyretic. Common uses in pediatrics; teething pain, fever, mild to moderate pain.

Acetaminophen Dosing

Weight-directed dosing: Infants, Children, and Adolescents: 10 to 15 mg/kg/dose every 4 to 6 hours as needed.

Acetaminophen Concentration

Most pediatric concentrations are 160mg/5mL.

Acetaminophen Prophylactic Use

Prophylactic use of acetaminophen to reduce fever and discomfort associated with vaccination is not recommended.

Atomoxetine

Selective norepinephrine reuptake inhibitor. Non-stimulant drug. Used in Attention-deficit/hyperactivity disorder.

Atomoxetine Age Approval

FDA approved in ages ≥6 years.

Atomoxetine Black Box Warning

Monitor for suicidal ideation. Aggressive behavior and hostility, particularly with initiation. Irritability. Increased HR and BP.

Atomoxetine Administration

May be administered without regard to food. Do not crush, chew, or open capsule; swallow whole with water or other liquids.