Formulary




INTRODUCTION



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  • In addition to medications in this formulary chapter, the following categories of medications can be found in the identified chapters:




    • Intubation Medications – see chapter 6



    • Code Medications – see chapter 7



    • Cardiovascular Medications – see chapter 14



    • Sedation/Analgesia/Neuromuscular Blockade – see chapter 15



    • Anti-infective Medications – see chapter 16






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Respiratory
Medication Dose Mechanism Comment
Albuterol Intermittent 2.5 mg nebulization or ß2-agonist: bronchodilation via airway smooth muscle relaxation Frequent re-evaluation needed, especially if tachycardic
Continuous nebulization from 5–20 mg/hr Side effects: tremor, tachycardia, agitation, hypokalemia
Acetylcysteine Infants: 1–2 mL of 20% solution or 2–4 mL of 10% solution (undiluted); three to four times daily Exerts mucolytic action through its free sulfhydryl group, which opens up the disulfide bonds in the mucoproteins, thus lowering mucous viscosity
Children and adolescents: 3–5 mL of 20% solution or 6–10 mL of 10% solution (undiluted); administer three to four times daily
Ipratropium 125–500 mcg nebulization q6–8 hr Inhaled anticholinergic (inhibit cGMP) bronchodilator Systemic SEs rare due to poor absorption from lung
Saline nebulization 0.9%, 3%, 7% 3% solution: 4 mL inhaled every 2 hr Pretreatment with a bronchodilator is recommended to prevent potential bronchospasm
≥6 years and adolescents: inhalation: 7% solution: 4 mL inhaled twice daily
Terbutaline Load: 2–10 mcg/kg IV Systemic ß2-agonist SEs same as albuterol
Infusion: 0.08–1 mcg/kg/min Stop infusion and obtain ECG for chest pain or ST changes



SE: Side Effects




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Neurologic
Medication Route Dose Mechanism
Midazolam IV bolus Loading dose: 0.15–0.2 mg/kg Enhances GABA activity
IV infusion 0.06–0.5 mg/kg/hr
Intramuscular 0.2 mg/kg/dose, may repeat every 10–15 min, maximum dose: 6 mg
Buccal 0.2–0.5 mg/kg once; maximum dose: 10 mg
Intranasal 0.2 mg/kg once; maximum dose: 10 mg
Lorazepam IV bolus 0.1 mg/kg maximum: 4 mg, slow IV over 2–5 min; may repeat in 5–15 min
Diazepam IV bolus 0.1–0.3 mg/kg/dose given over 3–5 min, every 5–10 min; maximum dose: 10 mg/dose
Rectal 2–5 years: 0.5 mg/kg
6–11 years: 0.3 mg/kg
≥12 years and adolescents: 0.2 mg/kg
Fosphenytoin IV bolus 15–20 mg PE/kg; maximum dose: 1500 mg PE Stabilizes voltage-gated sodium channels
Administer at 1–3 mg PE/kg/min up to a maximum of 150 mg PE/min
Levetiracetam IV bolus 20–60 mg/kg; dose should not exceed adult initial range: 1000–3000 mg Thought to have multiple sites of action, including calcium channels, glutamate receptors, and GABA modulation
Pentobarbital IV bolus Loading dose: 5 mg/kg Enhances GABA activity
IV infusion Initial: 0.5–1 mg/kg/hr
Phenobarbital IV bolus 15–20 mg/kg; maximum dose: 1000 mg



PE: Phenytoin equivalent; GABA: gamma-aminobutyric acid.




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Miscellaneous
Medication Dose Mechanism Comment
Albumin 0.5–1 g/kg/dose IV Provides increase in intravascular oncotic pressure Administration rate:
Use 5% in hypovolemic or intravascularly depleted patients 5% = 2–4 mL/min
Use 25% in fluid/Na restricted patients 25% = 1 mL/min (after initial volume replacement)
Diphenhydramine 0.5 mg/kg/dose IV/PO Maximum dose: 50 mg Antihistamine
Haloperidol Limited data available Nonselectively blocks postsynaptic dopaminergic receptors in the brain Use has been associated with adverse effects, including cardiac effects, circulatory and respiratory insufficiency, extrapyramidal symptoms, and neuroleptic malignant syndrome
≥3 months, children, and adolescents: IV (lactate, immediate release): loading dose: 0.15–0.25 mg/dose infused slowly over 30–45 min
Mannitol IV bolus 0.25–1 g/kg/dose infused over 20–30 min Osmotic diuresis, decrease in ICP through osmosis and reduction in blood viscosity
Metoclopramide 0.1 mg/kg/dose IV/PO Enhances motility and accelerates gastric emptying
Naloxone Full reversal: Opioid antagonist
0.1 mg/kg/dose IV (2 mg max)
For respiratory depression: 0.001–0.005 mg/kg/dose
Octreotide Load: 1–2 mcg/kg bolus IV over 2–5 min Mimics natural somatostatin Consider tapering dose for discontinuation
Maintenance: IV: 1–10 mcg/kg/hr continuous infusion
Ondansetron 0.1 mg/kg/dose IV/PO Selective 5-HT3-receptor antagonist



ICP: Intracranial pressure.




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Systemic Steroids
Medication Dose Mechanism Comment
Prednisolone (PO) Load: 2 mg/kg Decrease inflammation, mucus production, and mediator release


  • Stress dosing may be needed for patients on long-term steroids



  • Max effect 6–12 hr



  • No Δ PO/IV dose

Max: usually 60 mg
Maintenance:
0.5–1 mg/kg q6 hr
Max: usually 60 mg/dose
Methylprednisolone (IV) Load: 2 mg/kg
Max: usually 60 mg
Maintenance:
0.5–1mg/kg q6 hr
max: usually 60 mg/dose
Hydrocortisone Shock: IV 50–100 mg/m2/day divided every 6 hr Decreases inflammation and reverses increased capillary permeability


  • No Δ PO/IV dose

Physiologic replacement: IV/PO 8–10 mg/m2/day divided every 8 hr
Dexamethasone Croup: 0.6 mg/kg/dose IV/PO once Decreases inflammation and mediator release


  • No Δ PO/IV dose




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Glucorticoid Equivalency Table
Glucocorticoid Equivalent Dose (mg) Routes Relative Anti-inflammatory Potency Relative Mineralo-corticoid Potency Elimination Half-Life (hr)
Cortisone 25 PO, IM 0.8 0.8 ∼0.5
Hydrocortisone 20 IM, IV 1 1 ∼2
MethylPREDNISolone 4 PO, IM, IV 5 0 1–2
PrednisoLONE 5 PO 4 0.8 2–4
PredniSONE 5 PO 4 0.8 2–3
Dexamethasone 0.75 PO, IM, IV 25–30 0 ∼4
Fludrocortisone — PO 10 125 ∼3.5



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Electrolytes
Medication Dose Max Dose Max Rate



  • 3% Sodium chloride


  • Increased intracranial pressure: 2–5 mL/kg/dose



  • Na def = [desired sodium (mEq/L) − actual sodium (mEq/L)] × [0.6 × wt (kg)]



  • 3% has 513 mEq Na/L


  • 1 mEq/kg/hr



  • 10 mEq/kg/hour when treating acute, life-threatening ICP elevation




  • Arginine chloride


  • To correct hypochloremia:



  • (mEq) = 0.2 × kg × [103 − Cl−]



  • give 1/2 to 2/3 of calculated dose and reevaluate


  • Supplements chloride ions




  • Potassium chloride and sodium chloride supplementation should be considered



  • Calcium chloride


  • 10–20 mg/kg/dose IV/IO; slow IV push



  • Calcium chloride is three times more potent than calcium gluconate


  • 1 gm/dose



  • [2 gm/dose: CV arrest]


  • IVP = 50–100 mg/min



  • Infusion = 45–90 mg/kg over 1hr




  • Calcium gluconate


  • 100 mg/kg/dose IV/IO over 15–20 min



  • 1 gm Ca gluc = 90 mg elemental Ca = 4.5 mEq Ca


  • 2–3 gm/dose


  • IVP = 50–100 mg/min



  • Infusion = 200 mg/min




  • Magnesium sulfate


  • 25–50 mg/kg/dose IV/IO/IM


  • 2 gm


  • Pediatric: 125 mg/kg/hr



  • Adult: 2 gm/hr; can give over 15–20 min in emergent situations




  • Potassium chloride

 0.5–1 mEq/kg/dose IV over 2–3 hr


  • 40 mEq


  • Infuse at 0.5 mEq/kg/hour or 10 mEq/hour (whichever is slower)




  • Potassium phosphate


  • 0.16–0.36 mmol/kg/dose IV over 6 hr



  • 3 mmol phos + 4.4 mEq potassium per mL


  • Dose limit: 27 mmol Phos = 40 mEq K


  • 0.06 mmol/kg/hr




  • Sodium bicarbonate 4.2%



  • (0.5 mEq/ml)



  • (for <2 yr old)


  • 1 mEq/kg/dose IV/IO; do not administer through UAC


  • 50 mEq


  • IVP: 10 mEq/min



  • Infusion: 0.33 mEq/kg/hr




  • Sodium bicarbonate 8.4%



  • (1 mEq/ml)



  • (For >2 yr old)


  • 1 mEq/kg/dose IV/IO; do not administer through UAC


  • 50 mEq


  • IVP: 10 mEq/min



  • Infusion: 0.33 mEq/kg/hr




  • Sodium phosphate


  • 0.16–0.36 mmol/kg/dose IV over 6 hr



  • 3 mmol phos + 4 mEq Na/ml


  • 0.06 mmol/kg/hr

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Related posts:

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  3. Hypertension
  4. Mechanical Ventilation

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Jan 14, 2019 | Posted by in PEDIATRICS | Comments Off on Formulary

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