The largest difference between pediatric dosing and adult dosing is weight based calculations for peds. Weight dosing is done based on KILOGRAMS (not pounds). Example: 45 mg/kg of Amoxicillin BID Adult: 500mg Amoxicillin given daily Kg= pounds / 2.2 *Kg is a smaller number than pounds Home care differs from hospital care in that parents do occasionally give the medications. No electronic charting/ med scanning. Pharmacy is not in-house. Still have to ONLY work off of orders like in hospital: Nurses CAN NOT give OTC meds in the home without an order Can not stop parents from giving these meds if they want to : but needs to be documented Safety of ordered dose: Is the dose within the SAFE parameters ▪ Ie. Anti-epileptics are dosed based on weight/ severity/ type of seizure. You are not responsible to say “this is the best size dose for my patient”, rather : with my patient’s weight he could be prescribed between 50-150 mg daily. Is this dose between those numbers? ▪ Is this patient on other medications (may be prescribed by different doctors) that will interact with this medication? ▪ SAME side effects ▪ SAME place of metabolism ▪ SAME ingredients: ie. Tylenol and Percocet Timing: Will this interfere with sleep/ feeding schedule/ other medications that have to be given now? PRN Meds: Is it appropriate to give this medication? **Look at indication for reason to give: ie. Tylenol can be ordered for pain OR fever OR both. Cannot give for pain if only ordered for fever, etc. RIGHT medication RIGHT patient RIGHT time RIGHT route RIGHT dose RIGHT documentation Do I really need to go through this since I only have one patient and I am working in their home?? YES. Tylenol safe dosing is 10-12 mg/kg/ dose every 4 hours **Do NOT exceed 4 doses in 24 hours! Ibuprofen 10 mg/kg/ dose every 6-8 hours Pain Medications Antispasmotics, anti-epileptics Mostly given PO/ G-Tube routes G-tube / “GB” = G button- meds given through this route go directly into stomach.. So they are the same concentrations and formulas as oral meds) Some common Abbreviations Liters= L Mililiters= mL Kilgram=Kg Miligram= mg Microgram= mcg Ounces= oz Pounds= lbs PO PR GT PRN OTC BID TID QID q1h AC P.M A.M A.U GTT Supp QHS* By Mouth Per Rectum Per Gastrostomy tube As needed Over the counter 2 times daily 3 Times Daily 4 times daily Every 1 hour (can substitute any number) before meals afternoon/ evening morning (before noon) both ears drops suppository hour of sleep (at bedtime) * Means not a recommended abbreviation, but you still may see it UNACCEPTED Abbreviations Abbreviation: DC or D/C HS QD QOD MSO4 U or IU IV SQ or SC TIW cc Ug or g OD Confused between: “discontinue” or “discharge” “half-strength” or “at bedtime” “every day” or “right eye” “every other day” or “daily “magnesium sulfate” or “morphine sulfate” “unit” or “zero” or “0” “intravenous” or “international units” “subcutaneous” or “5Q” (“5 every”)? use Subq, subcut. “twice a week” or “three times a week” “cubic centimeter” or “milliliter”? “microgram” or “Ugh”? “once daily” or “right eye”? *LEAD with zeros, do not follow or “trail” with zeros. ie.: 0.02= correct. 0.020=WRONG *Rounding liquids= round to nearest tenth of milliliter Conversions Weight lb = kg × 2.2 kg = lb ÷ 2.2 Volume mL = L × L = mL ÷ mg = g × g = mg ÷ mcg = mg mg = mcg 1,000 1,000 1,000 1,000 × 1,000 ÷ 1,000 1ml = 1 cc 1 ounce = 30 ml 1 tablespoon (T or tbsp) = 15 ml 1 teaspoon (t or tsp) = 5 ml Grains (gr.) 15 = 1 Gram (g) or 1000 milligrams (mg) 1 Grain (gr.) = 60 Milligrams (mg) Example A 12 kg child is ordered 10 mg/kg of Tylenol PRN pain q4hours. Tylenol is available in chewable 80 mg tabs, or 160 mg /5 ml . His pain is currently a 7-10 on the FLACC scale. Route= Orally (PO) Time= PRN Pain- The child is in pain and has NOT exceeded the 4 dose/day limit. So appropriate to give NOW Dose= how much of the medication will be given Example: 10mg x 12 kg = 120 mg kg Concentration= how much MEDICATION is in the solution/ pill. Example: 160mg/ 5 ml 80 mg/ 1 tab Conversion= based on the concentration and dose Dose (120 mg ) x Concentration ( 5 mL ) = 3.75 mL 160 mg Example A 12 kg child is ordered 10 mg/kg of Tylenol PRN pain q4hours. Tylenol is available in chewable 80 mg tabs, or 160 mg /5 ml . His pain is currently a 7-10 on the FLACC scale. Dimensional analysis: Desired units x conversion formula (ie. Concentration) x Original Factors to convert DOSE: mg= 12 kg x 10mg = 120 mg 1 kg ml= 120 mg x 5 ml = 3.75 ml 160 mg Lexicomp Dosing book Lexicomp phone app- 75$ but has pediatric specific reference! Epocrates – FREE app for phone Online (make sure your sources are reliable) Handout from pharmacy for specific meds