Download Pediatric Acetaminophen

Pediatric Acetaminophen
• Infants’ Tylenol®
– Grape Flavor
– New Formulation
• 160 mg/5 mL
– Old Formulation
• 80 mg/ 0.8 mL
– Source: www.tylenol.com
Pediatric Acetaminophen
• Current directions for use:
– Repeat dose every 4 hours
– Max 5 times/24 hours
Weight (lb)
Age (yr)
Dose (mL)
Under 24
Under 2 years
Ask a doctor
24-35
2-3 years
5 mL
– 10-15 mg/kg
Tylenol® Products
• Infants’ Tylenol® Oral Suspension
– 160 mg/5 mL (grape)
• Children’s Tylenol® Oral Suspension
– 160 mg/5 mL (grape, cherry blast)
• Children’s Tylenol® Meltaways® Chewable
Tablets
– 80 mg/Tablet (bubble gum burst, grape punch)
• Jr. Tylenol® Meltaways® Chewable Tablets
– 160 mg/Tablet (bubble gum burst, grape punch)
Acetaminophen Case Study
• How much acetaminophen would you
recommend for a child weighing 44 pounds?
Acetaminophen Case Study
• How much acetaminophen would you
recommend for a child weighing 44 pounds?
• 44 pounds = 20 kg
• Dose = 10 mg/kg x 20 kg = 200 mg
Acetaminophen Case Study
• How much liquid acetaminophen would the
parent measure?
• Dose = 200 mg
• Volume = 5 mL/160 mg x 200 mg = 6.25 mL
• Note – same volume whether infant drops or
children’s liquid
Pediatric Ibuprofen
• 5-10 mg/kg
• Infants’ Advil®
– Ibuprofen 50 mg/1.25 mL
– Every 6-8 hours
– Max 4 times/24 hours
Weight (lb)
Age (mos)
Dose (mL)
Under 6 mos
Ask a Doctor
12-17 lb
6-11 mos
1.25 mL
18-23 lb
12-23 mos
1.875 mLInI
• Source: childrens.advil.com
Pediatric Ibuprofen
• Children’s Advil®
– 100 mg/5 mL
– Every 6-8 hours
– Max 4 times/24 hours
– Source: childrens.advil.com
Advil® Products
• Infants’ Advil® Drops
– 50 mg/1.25 mL
• Children’s Advil® Suspension
– 100 mg/5 mL
• Junior Strength Advil® Chewables
– 100 mg/Tablet
• Junior Strength Advil® Tablets
– 100 mg/Tablet
Ibuprofen Case Study
• How much ibuprofen would you recommend
for a child weighing 44 pounds?
Ibuprofen Case Study
• How much ibuprofen would you recommend
for a child weighing 44 pounds?
• Per the Children’s Advil® label:
Weight (lb)
Age (yr)
Dose (tsp)
Under 24 lb
Under 2 yr
Ask a doctor
24-35 lb
2-3 yr
1 tsp
36-47 lb
4-5 yr
1 ½ tsp
48-59 lb
6-8 yr
2 tsp
60-71 lb
9-10 yr
2 ½ tsp
72-95 lb
11 yr
3 tsp
Ibuprofen Case Study
• How much ibuprofen would you recommend
for a child weighing 44 pounds?
• Per the Children’s Advil® label:
– 1 ½ tsp
– 150 mg
• Based on weight:
– 5 mg/kg x 20 kg = 100 mg
– 10 mg/kg x 20 kg = 200 mg
New Labeling Cough and Cold
• FDA has advised that cough and cold
medications not be used in children under 2
years of age
• Manufacturers have voluntarily updated
cough and cold product labels, and they
current state “do not use” in children under 4
years of age
Decongestants
• Sinus and nasal congestion
• Adrenergic agonists (sympathomimetics)
• Adverse reactions:
– CNS stimulation
– Cardiovascular stimulation
Decongestants
• Phenylephrine (q 4 hours)
– 4-5 years old: 2.5 mg
– 6-11 years old: 5 mg
– Adults: 10 mg
• Pseudoephedrine (q 4-6 hours)
– 4-5 years old: 15 mg
– 6-11 years old: 30 mg
– Adults: 60 mg
Antihistamines
• Allergic rhinitis
• Two classifications:
– First-generation
• Sedating
• Nonselective
– Second-generation
• Nonsedating
• Selective
Antihistamines
• First-generation
– Highly Sedating (> 6 years old)
• Clemastine
• Diphenhydramine
• Doxylamine
Antihistamines
• First-generation
– Moderately Sedating (>6 years old)
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Brompheniramine
Chlorpheniramine
Dexbrompheniramine
Dexchlorpheniramine
Pheniramine
Antihistamines
• First-generation
– Weak CNS effects; increased GI effects (>6 years
old)
• Pyrilamine
Antihistamines
• Second-generation
– Minimally to moderately sedating
• Cetirizine (>2 years old)
• Hydroxyzine (Rx)
• Levocetirizine (Rx)
Antihistamines
• Second-generation
– Nonsedating (> 2 years old)
• Fexofenadine
• Loratadine
Nonpharmacologic Therapy
• All patients:
– Fluid intake
– Rest
– Nutritious diet
– Humidifier, vaporizer or steamy shower
• Infants:
– Saline drops or spray
– Upright position
• Adults:
– Neti-pot
Case Study Cold and Allergy (Child)
• Patient with a runny nose, sneezing, nasal
congestion, itchy watery eyes
• Symptoms have been present for 2 days
• No medications
• NKDA
• Patient:
– What if patient is 8 years old?
– What if patient is 3 years old?
Case Study Cold and Allergy (Adult)
• Patient with a runny nose, mild congestion,
headache and itchy eyes
• Symptoms have been present for 2 days when
arrived at friend’s house for a visit
• 42 year old female
• Medications:
– Multivitamin daily
– Oral contraceptive
• NKDA
Case Study Cold and Allergy (Adult)
• Runny nose and itchy eyes: antihistamine
• Mild congestion: decongestant
• Headache: analgesic
• Questions:
– What at her friend’s house is causing the
symptoms?
– What adverse reactions should we avoid?
Cough
• Antitussives
– Dextromethorphan (>4 years old)
– Diphenhydramine (>6 years old)
• Expectorant
– Guaifenesin (>4 years old)
Nonpharmacologic Therapy
• Lozenges
• Humidifier or vaporizer
• Hydration
Case Study Nonproductive Cough
(Child)
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•
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Chesty cough without mucus
Wakes her up at night
No other symptoms.
6 years old
NKDA
No medications
Case Study Nonproductive Cough
(Adult)
• Dry hacking cough
• Wakes her up at night and interrupts work.
• Cold last week, but most of symptoms have
resolved. Still has nasal congestion with a
sensation of something tickling her throat.
• 25 years old
• NKDA
• Oral contraceptive
Case Study Productive Cough (Child)
• Productive cough with some clear mucus for 3
days.
• Cough wakes her up at night and interrupts work.
• Symptoms started 3 days ago with nasal
congestion, headache, cough and sore throat.
• 25 years old
• NKDA
• Oral contraceptive
Case Study Productive Cough (Adult)
• Productive cough with some clear mucus for 3
days.
• Cough wakes her up at night and interrupts work.
• Symptoms started 3 days ago with nasal
congestion, headache, cough and sore throat.
• 25 years old
• NKDA
• Oral contraceptive