Saturday, May 16, 2009
Analgesics/Anesthetic Agents:
-Acetaminophen (Tylenol) 10-20 mg/kg PO/PR q4-6h prn (see page 20 for detailed list of available products).
-Acetaminophen/Codeine [elixir per 5 mL: Acetaminophen 120 mg, Codeine 12 mg; tabs: Tylenol #2: 15 mg codeine/300 mg acetaminophen; #3: 30 mg codeine/300 mg acetaminophen; #4: 60 mg codeine/300 mg acetaminophen] 0.5-1.0 mg codeine/kg/dose PO q4h prn.
-Acetaminophen/Hydrocodone [elixir per 5 mL: hydrocodone 2.5 mg, acetaminophen 167 mg]. Tab: Lortab 2.5/500: Hydrocodone 2.5 mg, acetaminophen 500 mg. Lortab 5/500 and Vicodin: Hydrocodone 5 mg, acetaminophen 500 mg. Lortab 7.5/500: Hydrocodone 7.5 mg, acetaminophen 500 mg. Vicodin ES: Hydrocodone 7.5 mg, acetaminophen 750 mg. Lortab 10/500: Hydrocodone 10 mg, acetaminophen 500 mg. Lortab 10/650: Hydrocodone 10 mg, acetaminophen 650 mg.
Children: 0.6 mg hydrocodone/kg/day PO q6-8h prn. <2>12 years: do not exceed 10 mg/dose.
-ELAMax [lidocaine 4% cream (liposomal): 5, 30 gm]. Apply 10-60 minutes prior toprocedure. Occlusive dressing is optional. Available over the counter.
-EMLA cream (eutectic mixture of local anesthetics) [cream: 2.5% lidocaine and 2.5% prilocaine: 5, 30 gm; transdermal disc]. Apply and cover with occlusive dressing at least 1 hour (max 4 hours) prior to procedure.
-Fentanyl 1-2 mcg/kg IV q1-2h prn or 1-3 mcg/kg/hr continuous IV infusion.
-Hydromorphone (Dilaudid) 0.015 mg/kg IV/IM/SC q34h OR 0.0075 mg/kg/hr continuous IV infusion titrated as necessary for pain relief or 0.03-0.08 mg/kg PO q6h prn.
-Ketamine 4 mg/kg IM or 0.5-1 mg/kg IV. Onset for IV administration is 30 seconds, duration is 5-15 minutes.
-Lidocaine, buffered: Add sodium bicarbonate 1 mEq/mL 1 part to 9 parts lidocaine 1% for local infiltration (eg, add 0.22ml sodium bicarbonate [1mEq/mL concentration] to 2 mL lidocaine 1%) to raise the pH of the lidocaine to neutral and decrease the "sting" of subcutaneous lidocaine.
-Meperidine (Demerol) 1 mg/kg IV/IM q2-3h prn pain.
-Morphine 0.05-0.1 mg/kg IV q2-4h prn or 0.02-0.06 mg/kg/hr continuous IV infusion or 0.1-0.15 mg/kg IM/SC q3-4h or 0.2-0.5 mg/kg PO q4-6h.
-Oxycodone (OxyContin, Roxicodone) Cap: 5 mg Soln: 5 mg/mL, 20 mg/mL Tab: 5, 15, 30 mg Tab: CR: 10, 20, 40, 80, 160 mg
Sedation:Fentanyl and Midazolam Sedation:
-Fentanyl 1 mcg/kg IV slowly, may repeat to total of 3 mcg/kg AND
-Midazolam (Versed) 0.05-0.1 mg/kg slow IV [inj: 1 mg/mL, 5 mg/mL]. Have reversal agents available: naloxone 0.1 mg/kg (usual max 2 mg) IM/IV for fentanyl reversal and flumazenil 0.01 mg/kg (usual max 5 mg) IM/IV for midazolam reversal.
Benzodiazepines:
-Diazepam (Valium) 0.2-0.5 mg/kg/dose PO/PR or 0.05-0.2 mg/kg/dose IM/IV, max 10 mg. -Lorazepam (Ativan) 0.05-0.1 mg/kg/dose IM/IV/PO, max 4 mg.
-Midazolam (Versed) 0.08-0.2 mg/kg/dose IM/IV over 10-20 min, max 5 mg; or 0.2-0.4 mg/kg/dose PO x 1, max 15 mg, 30-45 min prior to procedure; or 0.2 mg/kg intranasal (using 5 mg/mL injectable solution, insert into nares with needleless tuberculin syringe.)
Phenothiazines:
-Promethazine (Phenergan) 0.5-1 mg/kg/dose IM or slow IV over 20 min, max 50 mg/dose. -Chlorpromazine (Thorazine) 0.5-1 mg/kg/dose IM or slow IV over 20 min, max 50 mg/dose.
Antihistamines:
-Diphenhydramine (Benadryl) 1 mg/kg/dose IV/IM/PO,max 50 mg.-Hydroxyzine (Vistaril) 0.5-1 mg/kg/dose IM/PO, max50 mg.
Barbiturates:
-Methohexital (Brevital) IM: 5-10 mg/kg.
IV: 1-2 mg/kg.PR: 25 mg/kg (max 500 mg/dose).
-Thiopental (Pentothal): Sedation, rectal: 5-10 mg/kg; seizures, IV: 2-3 mg/kg
Other Sedatives:
-Chloral hydrate 25-100 mg/kg/dose PO/PR (max 1.5 gm/dose); allow 30 min for absorption.
Nonsteroidal Anti-Inflammatory Drugs:
-Ibuprofen (Motrin, Advil,Nuprin,Medipren, Children’s
Motrin) Anti-inflammatory: 30-50 mg/kg/day PO q6h, max 2400 mg/day. [cap: 200 mg; caplet: 100, 200 mg; oral drops: 40 mg/mL; susp: 100 mg/5 mL; tabs: 200, 400, 600, 800 mg; tabs, chewable: 50, 100 mg]
-Ketorolac (Toradol) Single dose: >2 years : 0.4-1 mg/kg IV/IM (max 30 mg/dose IV, 60 mg/dose IM). Multiple doses: >2 years: 0.4 mg/kg IV/IM q6h prn (max 30 mg/dose). >16 years: 10 mg PO qid. [inj: 15 mg/mL, 30 mg/mL]. Do not use for more than three days because of risk of GI bleed.
-Naproxen (Naprosyn) Analgesia: 5-7 mg/kg/dose PO q8-12h Inflammatory disease: 10-15 mg/kg/day PO q12h Max 1000 mg/day [susp: 125 mg/5mL; tab: 250, 375, 500 mg; tab, DR: 375, 500 mg
-Naproxen sodium (Aleve, Anaprox, Naprelan) Analgesia: 5-7 mg/kg/dose PO q8-12h. Inflammatorydisease: 10-15 mg/kg/day POq12h, Max 1000 mg/day [tab: 220, 275, 550 mg; tab, ER: 412.5, 550 mg]. Naproxen sodium 220 mg = 200 mg base.
Antiemetics
-Chlorpromazine (Thorazine) 0.25-1 mg/kg/dose slow IV over 20 min/IM/PO q4-8h prn, max 50 mg/dose [inj: 25 mg/mL; oral concentrate30 mg/mL;supp: 25,100 mg; syrup: 10 mg/5 mL; tabs: 10, 25, 50, 100, 200 mg].
-Dimenhydrinate (Dramamine) >12 years: 5 mg/kg/day 50-100 mg PO q4-6h prn, max 400 mg/day Not recommended in <12 years due to high incidence of extrapyramidal side effects. [ liquid 12.5 mg/4 mL, 15.62 mg/5mL; tab: 50 mg; tab, chew: 50mg].
-Diphenhydramine (Benadryl) 1 mg/kg/dose IM/IV/PO q6h prn, max 50 mg/dose. [caps: 25, 50 mg; caplet: 25, 50 mg; inj: 50 mg/mL; liquid: 12.5 mg/5 mL; tabs: 25, 50 mg; tab, chew: 12.5 mg].
-Prochlorperazine (Compazine) 0.1-0.15 mg/kg/dose IM 0.4 mg/kg/day PO/PR q6-8h prn (10-14kg: max 7.5mg/day, 15-18kg: max 10 mg/day, 19-39kg: max 15mg/day). Not recommended in <12 years due to high incidence of extrapyramidal side effects. [caps, SR: 10, 15, 30 mg; inj: 5 mg/mL; supp: 2.5, 5, 25 mg; syrup: 5 mg/5 mL; tabs: 5, 10, 25 mg].
-Promethazine (Phenergan) 0.25-1 mg/kg/dose PO/IM/IV over 20 min or PR q46h prn, max 50 mg/dose [inj: 25mg/ml,50 mg/mL; supp: 12.5, 25, 50 mg; syrup 6.25 mg/5 mL; tabs: 12.5, 25, 50 mg].
-Trimethobenzamide (Tigan) 15 mg/kg/day IM/PO/PR q6-8h, max 100 mg/dose if <13.6 kg or 200 mg/dose if 13.6 kg. [caps: 100, 250 mg; inj: 100 mg/mL; supp: 100, 200 mg].
Post-Operative Nausea and Vomiting:
-Ondansetron (Zofran) >2 years and <40kg:>40kg: 4mg IV x 1
-Dolasetron (Anzemet) >2 years: 1.2 mg/kg PO (max 100mg) or 0.35 mg/kg IV x 1 (max 12.5mg) [inj: 20mg/mL; tabs: 50, 100 mg].
-Droperidol (Inapsine) 0.01-0.03 mg/kg IV/IM q4-6h prn, max 5 mg [inj: 2.5 mg/mL].
Chemotherapy-Induced Nausea:
-Dexamethasone 10 mg/m2/dose (max 20 mg) IV x 1, then 5 mg/m2/dose (max 10 mg) IV q6h prn [inj: 4 mg/mL, 10 mg/mL]
-Dolasetron (Anzemet) >2 years:1.8 mcg/kg (max 100mg) IV/PO 30 minutes before chemo [inj: 20mg/mL; tabs: 50, 100 mg].
-Dronabinol (Marinol) 5 mg/m2/dose PO 1-3 hrs prior to chemotherapy, then q4h prn afterwards. May titrate up in 2.5 mg/m2/dose increments to max of 15 mg/m2/dose. [cap: 2.5, 5, 10 mg]
-Granisetron (Kytril) >2 years: 10-20 mcg/kg IV given just prior to chemotherapy (single dose), max 1 mg Adolescents: 1 mg PO bid or 2 mg PO qd
[inj: 1 mg/mL; oral soln: 1mg/5mL; tab: 1mg]
-Metoclopramide (Reglan) 0.5-1 mg/kg/dose IV q6h prn. Pretreatment with diphenhydramine 1 mg/kg IV is recommended to decrease the risk of extrapyramidal reactions. [inj: 5 mg/mL]
-Ondansetron (Zofran) 0.15 mg/kg/dose IV 30 minutes before chemotherapy and repeated 4 hr and 8 hr later (total of 3 doses)
OR
0.3 mg/kg/dose IV x 1 30 minutes beforechemotherapy OR0.15mg/kg IV loading dose followed by 0.45
mg/kg/day as a continuous IV infusion OR 4-11 years: 4 mg PO 30 min prior to chemotherapy; may repeat 4h and 8 h later >11 years: 8 mg PO 30 min prior to chemotherapy; may repeat 4h and 8h later [inj: 2 mg/mL; oral soln: 4mg/5 mL; tab: 4, 8, 24 mg; tab, orally disintegrating: 4, 8 mg]
-Acetaminophen (Tylenol) 10-20 mg/kg PO/PR q4-6h prn (see page 20 for detailed list of available products).
-Acetaminophen/Codeine [elixir per 5 mL: Acetaminophen 120 mg, Codeine 12 mg; tabs: Tylenol #2: 15 mg codeine/300 mg acetaminophen; #3: 30 mg codeine/300 mg acetaminophen; #4: 60 mg codeine/300 mg acetaminophen] 0.5-1.0 mg codeine/kg/dose PO q4h prn.
-Acetaminophen/Hydrocodone [elixir per 5 mL: hydrocodone 2.5 mg, acetaminophen 167 mg]. Tab: Lortab 2.5/500: Hydrocodone 2.5 mg, acetaminophen 500 mg. Lortab 5/500 and Vicodin: Hydrocodone 5 mg, acetaminophen 500 mg. Lortab 7.5/500: Hydrocodone 7.5 mg, acetaminophen 500 mg. Vicodin ES: Hydrocodone 7.5 mg, acetaminophen 750 mg. Lortab 10/500: Hydrocodone 10 mg, acetaminophen 500 mg. Lortab 10/650: Hydrocodone 10 mg, acetaminophen 650 mg.
Children: 0.6 mg hydrocodone/kg/day PO q6-8h prn. <2>12 years: do not exceed 10 mg/dose.
-ELAMax [lidocaine 4% cream (liposomal): 5, 30 gm]. Apply 10-60 minutes prior toprocedure. Occlusive dressing is optional. Available over the counter.
-EMLA cream (eutectic mixture of local anesthetics) [cream: 2.5% lidocaine and 2.5% prilocaine: 5, 30 gm; transdermal disc]. Apply and cover with occlusive dressing at least 1 hour (max 4 hours) prior to procedure.
-Fentanyl 1-2 mcg/kg IV q1-2h prn or 1-3 mcg/kg/hr continuous IV infusion.
-Hydromorphone (Dilaudid) 0.015 mg/kg IV/IM/SC q34h OR 0.0075 mg/kg/hr continuous IV infusion titrated as necessary for pain relief or 0.03-0.08 mg/kg PO q6h prn.
-Ketamine 4 mg/kg IM or 0.5-1 mg/kg IV. Onset for IV administration is 30 seconds, duration is 5-15 minutes.
-Lidocaine, buffered: Add sodium bicarbonate 1 mEq/mL 1 part to 9 parts lidocaine 1% for local infiltration (eg, add 0.22ml sodium bicarbonate [1mEq/mL concentration] to 2 mL lidocaine 1%) to raise the pH of the lidocaine to neutral and decrease the "sting" of subcutaneous lidocaine.
-Meperidine (Demerol) 1 mg/kg IV/IM q2-3h prn pain.
-Morphine 0.05-0.1 mg/kg IV q2-4h prn or 0.02-0.06 mg/kg/hr continuous IV infusion or 0.1-0.15 mg/kg IM/SC q3-4h or 0.2-0.5 mg/kg PO q4-6h.
-Oxycodone (OxyContin, Roxicodone) Cap: 5 mg Soln: 5 mg/mL, 20 mg/mL Tab: 5, 15, 30 mg Tab: CR: 10, 20, 40, 80, 160 mg
Sedation:Fentanyl and Midazolam Sedation:
-Fentanyl 1 mcg/kg IV slowly, may repeat to total of 3 mcg/kg AND
-Midazolam (Versed) 0.05-0.1 mg/kg slow IV [inj: 1 mg/mL, 5 mg/mL]. Have reversal agents available: naloxone 0.1 mg/kg (usual max 2 mg) IM/IV for fentanyl reversal and flumazenil 0.01 mg/kg (usual max 5 mg) IM/IV for midazolam reversal.
Benzodiazepines:
-Diazepam (Valium) 0.2-0.5 mg/kg/dose PO/PR or 0.05-0.2 mg/kg/dose IM/IV, max 10 mg. -Lorazepam (Ativan) 0.05-0.1 mg/kg/dose IM/IV/PO, max 4 mg.
-Midazolam (Versed) 0.08-0.2 mg/kg/dose IM/IV over 10-20 min, max 5 mg; or 0.2-0.4 mg/kg/dose PO x 1, max 15 mg, 30-45 min prior to procedure; or 0.2 mg/kg intranasal (using 5 mg/mL injectable solution, insert into nares with needleless tuberculin syringe.)
Phenothiazines:
-Promethazine (Phenergan) 0.5-1 mg/kg/dose IM or slow IV over 20 min, max 50 mg/dose. -Chlorpromazine (Thorazine) 0.5-1 mg/kg/dose IM or slow IV over 20 min, max 50 mg/dose.
Antihistamines:
-Diphenhydramine (Benadryl) 1 mg/kg/dose IV/IM/PO,max 50 mg.-Hydroxyzine (Vistaril) 0.5-1 mg/kg/dose IM/PO, max50 mg.
Barbiturates:
-Methohexital (Brevital) IM: 5-10 mg/kg.
IV: 1-2 mg/kg.PR: 25 mg/kg (max 500 mg/dose).
-Thiopental (Pentothal): Sedation, rectal: 5-10 mg/kg; seizures, IV: 2-3 mg/kg
Other Sedatives:
-Chloral hydrate 25-100 mg/kg/dose PO/PR (max 1.5 gm/dose); allow 30 min for absorption.
Nonsteroidal Anti-Inflammatory Drugs:
-Ibuprofen (Motrin, Advil,Nuprin,Medipren, Children’s
Motrin) Anti-inflammatory: 30-50 mg/kg/day PO q6h, max 2400 mg/day. [cap: 200 mg; caplet: 100, 200 mg; oral drops: 40 mg/mL; susp: 100 mg/5 mL; tabs: 200, 400, 600, 800 mg; tabs, chewable: 50, 100 mg]
-Ketorolac (Toradol) Single dose: >2 years : 0.4-1 mg/kg IV/IM (max 30 mg/dose IV, 60 mg/dose IM). Multiple doses: >2 years: 0.4 mg/kg IV/IM q6h prn (max 30 mg/dose). >16 years: 10 mg PO qid. [inj: 15 mg/mL, 30 mg/mL]. Do not use for more than three days because of risk of GI bleed.
-Naproxen (Naprosyn) Analgesia: 5-7 mg/kg/dose PO q8-12h Inflammatory disease: 10-15 mg/kg/day PO q12h Max 1000 mg/day [susp: 125 mg/5mL; tab: 250, 375, 500 mg; tab, DR: 375, 500 mg
-Naproxen sodium (Aleve, Anaprox, Naprelan) Analgesia: 5-7 mg/kg/dose PO q8-12h. Inflammatorydisease: 10-15 mg/kg/day POq12h, Max 1000 mg/day [tab: 220, 275, 550 mg; tab, ER: 412.5, 550 mg]. Naproxen sodium 220 mg = 200 mg base.
Antiemetics
-Chlorpromazine (Thorazine) 0.25-1 mg/kg/dose slow IV over 20 min/IM/PO q4-8h prn, max 50 mg/dose [inj: 25 mg/mL; oral concentrate30 mg/mL;supp: 25,100 mg; syrup: 10 mg/5 mL; tabs: 10, 25, 50, 100, 200 mg].
-Dimenhydrinate (Dramamine) >12 years: 5 mg/kg/day 50-100 mg PO q4-6h prn, max 400 mg/day Not recommended in <12 years due to high incidence of extrapyramidal side effects. [ liquid 12.5 mg/4 mL, 15.62 mg/5mL; tab: 50 mg; tab, chew: 50mg].
-Diphenhydramine (Benadryl) 1 mg/kg/dose IM/IV/PO q6h prn, max 50 mg/dose. [caps: 25, 50 mg; caplet: 25, 50 mg; inj: 50 mg/mL; liquid: 12.5 mg/5 mL; tabs: 25, 50 mg; tab, chew: 12.5 mg].
-Prochlorperazine (Compazine) 0.1-0.15 mg/kg/dose IM 0.4 mg/kg/day PO/PR q6-8h prn (10-14kg: max 7.5mg/day, 15-18kg: max 10 mg/day, 19-39kg: max 15mg/day). Not recommended in <12 years due to high incidence of extrapyramidal side effects. [caps, SR: 10, 15, 30 mg; inj: 5 mg/mL; supp: 2.5, 5, 25 mg; syrup: 5 mg/5 mL; tabs: 5, 10, 25 mg].
-Promethazine (Phenergan) 0.25-1 mg/kg/dose PO/IM/IV over 20 min or PR q46h prn, max 50 mg/dose [inj: 25mg/ml,50 mg/mL; supp: 12.5, 25, 50 mg; syrup 6.25 mg/5 mL; tabs: 12.5, 25, 50 mg].
-Trimethobenzamide (Tigan) 15 mg/kg/day IM/PO/PR q6-8h, max 100 mg/dose if <13.6 kg or 200 mg/dose if 13.6 kg. [caps: 100, 250 mg; inj: 100 mg/mL; supp: 100, 200 mg].
Post-Operative Nausea and Vomiting:
-Ondansetron (Zofran) >2 years and <40kg:>40kg: 4mg IV x 1
-Dolasetron (Anzemet) >2 years: 1.2 mg/kg PO (max 100mg) or 0.35 mg/kg IV x 1 (max 12.5mg) [inj: 20mg/mL; tabs: 50, 100 mg].
-Droperidol (Inapsine) 0.01-0.03 mg/kg IV/IM q4-6h prn, max 5 mg [inj: 2.5 mg/mL].
Chemotherapy-Induced Nausea:
-Dexamethasone 10 mg/m2/dose (max 20 mg) IV x 1, then 5 mg/m2/dose (max 10 mg) IV q6h prn [inj: 4 mg/mL, 10 mg/mL]
-Dolasetron (Anzemet) >2 years:1.8 mcg/kg (max 100mg) IV/PO 30 minutes before chemo [inj: 20mg/mL; tabs: 50, 100 mg].
-Dronabinol (Marinol) 5 mg/m2/dose PO 1-3 hrs prior to chemotherapy, then q4h prn afterwards. May titrate up in 2.5 mg/m2/dose increments to max of 15 mg/m2/dose. [cap: 2.5, 5, 10 mg]
-Granisetron (Kytril) >2 years: 10-20 mcg/kg IV given just prior to chemotherapy (single dose), max 1 mg Adolescents: 1 mg PO bid or 2 mg PO qd
[inj: 1 mg/mL; oral soln: 1mg/5mL; tab: 1mg]
-Metoclopramide (Reglan) 0.5-1 mg/kg/dose IV q6h prn. Pretreatment with diphenhydramine 1 mg/kg IV is recommended to decrease the risk of extrapyramidal reactions. [inj: 5 mg/mL]
-Ondansetron (Zofran) 0.15 mg/kg/dose IV 30 minutes before chemotherapy and repeated 4 hr and 8 hr later (total of 3 doses)
OR
0.3 mg/kg/dose IV x 1 30 minutes beforechemotherapy OR0.15mg/kg IV loading dose followed by 0.45
mg/kg/day as a continuous IV infusion OR 4-11 years: 4 mg PO 30 min prior to chemotherapy; may repeat 4h and 8 h later >11 years: 8 mg PO 30 min prior to chemotherapy; may repeat 4h and 8h later [inj: 2 mg/mL; oral soln: 4mg/5 mL; tab: 4, 8, 24 mg; tab, orally disintegrating: 4, 8 mg]
Label: Doctor Pedeatric
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