Transcript Dosage Calculation Review - Professional Pediatric Home Care

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:
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 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
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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
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Timing:
 Will this interfere with sleep/ feeding schedule/ other medications that have to
be given now?
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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
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RIGHT time
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RIGHT route
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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.
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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
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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
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Conversions
Weight


lb = kg × 2.2
kg = lb ÷ 2.2
Volume
mL = L ×
L = mL ÷
mg = g ×
g = mg ÷
mcg = mg
 mg = mcg
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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)
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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)
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Handout from pharmacy for specific meds