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Chapter 8 : Pediatric Pharmacology

DrugAdenosine
Indications
  • SVT
Side Effects
  • Facial flushing
  • Shortness of breath
  • Lightheadedness
  • Nausea
  • Hypotension
  • Dyspnea
  • Palpitations
  • Angina
  • Headache
Dosage
  • First dose: 0.1 mg/kg IV/IO rapid push (max 6 mg)
  • Second dose: 0.2 mg/kg IV/IO rapid push (max 12 mg)
DrugAlbuterol
Indications
  • Asthma
  • Anaphylaxis
  • Hyperkalemia
Side Effects
  • Anxiety
  • Headache
  • Cough
  • Dyspnea
  • Palpitations
  • Tachycardia
  • Hypertension
  • Heartburn
  • Nausea
  • Diarrhea
  • Flushing
  • Hypotension
Dosage
  • 4 to 8 puffs repeat 20 minutes PRN
  • 2.5 mg/dose every 20 minutes for children <20 kg
  • 5 mg/dose every 20 minutes for children >20 kg
DrugAmiodarone
Indications
  • SVT
  • VT
  • Pulseless arrest
Side Effects
  • Headache
  • Dizziness
  • Pulmonary fibrosis
  • ARDS
  • Bradycardia
  • Nausea
  • Vomiting
  • Rash
  • Hyper or hypothyroidism
  • CHF
  • Abdominal pain
Dosage
  • SVT, VT: 5 mg/kg IV/IO load over 20 to 60 minutes max dose of 300 mg
  • Pulseless arrest: 5 mg/kg IV/IO bolus max dose of 300 mg
Drug Atropine
Indications
  • Symptomatic Bradycardia
  • Toxins  or overdose
  • Rapid sequence intubation
Side Effects
  • Headache
  • Dizziness
  • Blurred vision
  • Tachycardia
  • Hypotension
  • Nausea
  • Vomiting
  • Urinary retention
  • Rash
  • Dry skin
Dosage
  • .02mg/kg. May repeat once. Minimum dose is 0.1 mg and max single dose is 0.5 mg.
  • Bradycardia: 0.02 mg/kg IV/IO and can repeat one dose. Or 0.04 to 0.05 mg/kg ET
  • Toxins or overdose: 0.02 to 0.05 mg/kg IV/IO initially and repeat every 20 to 30 minutes for children <12 years of age. Or 0.05 mg/kg IV/IO initially and then 1 to 2 mg repeat every 20 to 30 minutes for children >12 years of age
  • RSI: 0.01 or 0.02 mg/kg IV/IO or 0.02 mg/kg IM
Drug Epinephrine
Indications
  • Anaphylaxis
  • Asthma
  • Bradycardia
  • Croup
  • Pulseless arrest
  • Shock –hypotensive
  • Toxins/overdose
Side Effects
  • Tremors
  • Anxiety
  • Dyspnea
  • Arrhythmias
  • Palpitations
  • Tachycardia
  • Hypertension
  • Nausea
  • Vomiting
  • Renal vascular ischemia
  • Hyperglycemia
Dosage
  • Anaphylaxis: 0.01 mg/kg in thigh every 15 mins or 0.01 mg/kg every 3 to 5 minutes IV/IO
  • Asthma: 0.01 mg/kg every 15 minutes
  • Bradycardia: 0.01 mg/kg every 3 to 5 minutes IV/IO
  • Croup: 0.25 mL racemic solution with 3 mL NS by inhaled nebulizer or 3 ml by inhaled nebulizer
  • Pulseless Arrest: 0.01 mg/kg every 3 to 5 minutes IV/IO
  • Hypotensive shock: 0.1 to 1 µg/kg per minute IV/IO infusion
  • Toxins/overdose: 0.01 mg/kg IV/IO
  • 0.3mg autoinjector
DrugIpratropium Bromide
Indications
  • Asthma
Side Effects
  • Anxiety
  • Dizziness
  • Blurred vision
  • Cough
  • Palpitations
  • Nausea
  • Vomiting
  • Rash
Dosage
  • 250 to 500 µg inhaled every 20 minutes x 3 doeses

 

DrugLidocaine
Indications
  • VF/pulseless VT
  • Wide-complex tachycardia
  • RSI
Side Effects
  • Seizures
  • Headache
  • Dizziness
  • Tinnitus
  • Blurred vision
  • Hypotension
  • Cardiac arrest
  • Dyspnea
  • Nausea
  • Vomiting
  • Rash
  • Edema
Dosage
  • Pulseless VT/VF and complex Tachy: 1 mg/kg IV/IO loading bolus initial and 20 to 50 µg/kg per minute IV/IO infusion for maintenance
  • RSI: 1 to 2 mg/kg IV/IO

 

DrugMagnesium Sulfate
Indications
  • Torsades de pointes
  • Asthma
  • Hypomagnesemia
Side Effects
  • Confusion
  • Sedation
  • Respiratory depression
  • Hypotension
  • Bradycardia
  • Nausea
  • Vomiting
  • Cramps
  • Flushing
  • Sweating
Dosage
  • Asthma: 25 to 50 mg/kg IV/IO slower infusion 15 to 30 minutes
  • Torsades: 25 to 50 mg/kg IV/IO bolus
  • Hypomagnesemia: 25 to 50 mg/kg IV/IO over 10 to 20 minutes

 

Drug Methylprednisolone
Indications
  • Asthma
  • Anaphylactic shock
Side Effects
  • Depression
  • Headache
  • Hypertension
  • Embolism
  • Hemorrhage
  • Diarrhea
  • Nausea
  • Fractures
  • Hyperglycemia
  • Ulcers
Dosage
  • Load 2mg/kg (max 60 mg)and maintenance of 0.5 mg/kg for 6 hours (max of 120 mg/d)
DrugNitroglycerine
Indications
  • Congestive heart failure
  • Cardiogenic shock
Side Effects
  • Headache
  • Dizziness
  • Hypoxemia
  • Tachycardia
  • Cardiac arrest
  • Syncope
  • Flushing
  • Pallor
  • Sweating
Dosage
  • 0.25 to 0.5 µg/kg per minute IV/IO infusion and can increase to 0.5 to 1 µg/kg per minute every 3 to 5 minutes PRN for max dose of 10 µg/kg per minute
Drug Norepinephrine
Indications
  • Hypotensive shock
Side Effects
  • Headache
  • Anxiety
  • Respiratory distress
  • Hypertension
  • Tachycardia
  • Renal failure
  • Arrhythmias
Dosage
  • 0.05 to 2mcg/kg/min
DrugOxygen
Indications
  • Hypoxia
  • Respiratory distress/failure
  • Shock
  • Trauma
  • Cardiopulmonary failure
  • Cardiac arrest
Side Effects
  • Headache
  • Dry mucous membranes
  • Airway obstruction
  • Gastric distention
Dosage
  • 100% O2 initially via high flow O2 system

 

Drug Sodium Nitroprusside
Indications
  • Cardiogenic shock
  • Hypertension
Side Effects
  • Seizures
  • Headache
  • Nausea
  • Hypothyroidism
  • Cyanide toxicity
Dosage
  • 0.3 to 2 mcg/kg/min (with max 8 mcg/kg/min prn)

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