小兒科藥物劑量培訓(xùn)課件

1、小兒科藥物劑量Fulid supplement010Kg (4 MD/kg)：100ml/kg/day 1020kg(2 MD/kg)：1000( BW10 ) 50/day20kg (1 MD/kg)：1500( BW20 ) 20/dayExample 1: BW=25 kg,Keep IV route with 0.33%G/S _MD/minAns: (10 4) + (10 2) + (5 1) = 65 MD/minExample 2: BW=30 kg,Keep IV route with 0.33%G/S _MD/min _c.c. qdAns: (10 4) + (10 2)

2、 + (10 1) = 70 MD/min (10 100) + (10 50) + (10 20) = 1700 c.c./day2小兒科藥物劑量Management of DehydrationAccess fluid deficit: 10%(severe): Lethargy or Coma, Sunken anterior frontanelle and eyes, Cold extremities, Weak or impalpable pulse, Hypotension 3小兒科藥物劑量Management of Dehydration Rehydration: First 8

3、 hr Later 16 hr Deficit 1/2 1/2 Maintenance 1/3 2/3 e.g.: 10kg, 10% loss, 3 days Deficit : 10% x 10 (kg) x 0.6(deficit% from ECF ) X 1000 = 600 mlMaintenance: 10 x 100 = 1000 ml First 8 hr later 16 hr Deficit 300ml 300ml Maintenance 333ml 660ml 4小兒科藥物劑量Management of DehydrationShock: 20ml/kg N/S or

4、Lactate Ringersor 10ml/kg 5% albumin, blood, plasma Loading speed: 10ml/kg/hr, ( 2ml/kg/hr in CHF ) 5小兒科藥物劑量Electrolyte supplementNa：34 mEq/kg/day3%NaCl 1ml = 0.5 mEq 0.9% NaCl 500ml = 77mEq K： 23 mEq/kg/day15%KCl 1ml2 mEqCa：2001000 mg/kg/day q8h-qd10% Ca gluconate(100mg/1ml,1Amp10ml)NaHCO3：1 mEq/kg

5、 ( if PH7.2 )17 mEq/20cc/amp 6小兒科藥物劑量Correct Metabolic AcidosisTachypnea (BE=PCO2 1.5 x HCO3 + 8 2 ) BE HCO3 Mild 17 Observation Moderate 10-20 17-8 Slow correction Severe 20 7 7% NaHCO3 ( 17 mEq/20ml ) supply half in 2-8 hours:2-4 mEq/kg/doseBE x 0.3 x BW( 15-HCO3 ) x 0.6 x BW7小兒科藥物劑量Common Dose一般劑

6、量20kg：錠劑磨粉40Kg：1 # po qid 30Kg：1 # po tid 若可吞,不用磨20Kg：1/2# po qid10Kg：1/4# po qid 20kg：糖漿一般咳嗽流鼻水糖漿多為BW/4 c.c.退燒抗生素糖漿多為BW/2 c.c.例外：止瀉藥水氣管擴(kuò)張劑糖漿紅黴素類糖漿8小兒科藥物劑量Antipyretics 退燒藥Scanol (500mg/1#) ：1015mg/kg/dose q4hq6h (50 mg/kg/day)Antiphen (Acetaminophen syrup)： BW/2 q4h prn if BT 38.5(120mg/kg/dose)Macs

7、afe(Ibuprofen syrup)：NSAIDs 38.5 : BW/4 cc q6h； 39.5 : BW/2 cc q6hDiclofen (supp)( 12.5mg )：6kg 1/3# supp q6h prn if BT 39.5610kg 1/2# supp q6h prn if BT 39.510kg 1# supp q6h prn if BT 39.5 9小兒科藥物劑量Antitussives and expectorants止咳化痰藥Medicon-A ( 20mg/cap ): Common doseMedicon syrup (Dextromethorphan)(

8、2.5mg/ml)：BW/4 cc po qid ,1-2mg/kg/day q6-8hMucosolven (Ambroxol liq.)(3mg/ml) (化痰):BW/4 cc qid ;止咳):BW/4 cc qid ; 26y/o:2.55 cc qid ; 612y/o 510cc qid 10小兒科藥物劑量Antihistamines & Decongestants 流鼻水,鼻塞抗過敏藥Cyproh syrup (Cyproheptadine 0.4 mg/ml)： BW/4 cc po qidCyproh tablet (嗜睡,增加食慾)：Common doseDemin (C

9、hlorpheniramine 0.5mg/ml )： BW/4 cc po qidCTM tablet (嗜睡,使痰更濃)：Common doseVenalin (Diphenhydramine 30mg/amp): 10-50mg IV or IM q2-3h, max 400mg/day (1mg/kg/dose)Urticaria, angioedema or EPS時可用11小兒科藥物劑量Antihistamines & Decongestants 流鼻水,鼻塞抗過敏藥Clarityne(10mg/tab)：30kg 1/2# po qd；30kg 1# po qdClarityne

10、 syrup (Loratadine 1mg/ml 60ml )30kg 5ml po qd；30kg 10ml po qdAllegra (60mg tab) ：1# bid -1# qd12小兒科藥物劑量Bronchodilator 氣管擴(kuò)張劑Bricanyl (Terbutaline 2ml/5mg ) : 20Kg:1 # in N/S 3ml for neubrilization q6hVentolin (Salbutamol neubule 2.5ml/5mg) :The same with Bricanyl; Tab(2mg): 0.1 mg/kg/dose up to 2 mg

11、 PO tidBerotec(Fenoterol HBr) syrup(0.5mg/ml) :BW/4BW/5 cc tid ;1 y/o:2.5 cc bid; 16y/o:2.55 cc tid ; 614y/o 5cc tidMeptin(Procaterol) syrup(mg/ml) :6y/o:5 cc po q12h 13小兒科藥物劑量Bronchodilator 氣管擴(kuò)張劑Xidanef (Ketotifen)100 ml syrup:2.5-5ml bidAtrovent (Ipratropium UDV 0.5mg/2ml):1 vial q6h prnEpinephrin

12、e(1:1000) ：0.01ml/kg/dose(Max 0.5ml) q15minSC 14小兒科藥物劑量Xanthines茶鹼類AminophyllineS.E：nausea, vomiting, insomnia, tachycardiaLoading dose：5(26)mg/kg/dose iv drip for 2030 min;Maintain：1mg/ kg/hr Infants= 0.20.9mg/kg/hr, 1-9y/o=11.2mg/kg/hr; 9-16y/o=0.81mg/kg/hr; youngsmoker:0.81mg/kg/hr, nonsmoker:0.5

13、0.7mg/kg/hrApnea of prematurity：46mg/kg iv 30 min ,then maintaince : 1.53 mg/kg/dose iv q8-12h 15小兒科藥物劑量Xanthines茶鹼類Ventol:3ml/kg/day qidAminophylline tab.：200mg/tab po qid ; dose = iv form 16小兒科藥物劑量Steriods 類固醇Decadron：0.1 mg/kg/dose im q8h.Rinderon (4mg/ml): 0.1 mg/kg/dose im,iv q8hPrednisolone(5m

14、g/tab):12mg/kg/day po qdqid ; max:4#8#(2040) mg/day for 35 day.40kg給Pulmicort (steroid ,200mcg/dose) ：12 puff bid for 3 month for prevent asthma(可有效預(yù)防氣喘再發(fā))17小兒科藥物劑量Antidiarrheals, digestives and antiflatulents止瀉、消化、消氣劑Kaopectin：6 mons：3 po qid（嚴(yán)重再給）6 mons6 Y/O：5 po qid6 Y/O：10 po qid.Biofermin tab：普

15、通劑量2 po qid.Simethicone tab：普通劑量 po qid.Bismuth: 普通劑量po qid.19小兒科藥物劑量Antiemetics止吐劑Motilium(10 mg/tab) ：普通劑量 po qid.Prepulsid：0.10.2mg/kg/dose po qidNovamine or Priperam may cause EPSEPS：Akineton=Biperidine(1#=2mg;5mg/1cc/amp) Adult：2mg per 30 min.max 4 vial(20mg) 20小兒科藥物劑量Laxatives 輕瀉劑Glycerine bal

16、l enema：0.51# qdMgO tab：普通劑量 po qid.Ducolax (Bisacodyl 5mg tab) ： 612 yo 1# po st.Cascara (Cascara sagrada) ：12# po qhs21小兒科藥物劑量Anticonvulsants 抗痙攣劑Valium(Diazepam)(10mg/2/amp):5y/o: the same as above except (max 10 mg)adolescents: 5-10 mg/dose; max: 30mg. Neuropam(Lorazepan)(2mg/ml/amp) ;中效(10-15 h

17、rs)：0.03-0.1mg/kg/dose q1520min 2 dose max: 4mg/dose22小兒科藥物劑量Anticonvulsants 抗痙攣劑Dilantin(phenytoin) (250mg/5cc/amp)：Loading 1020mg/kg iv with rate1mg/kg/min,max50mg/min ,Maintain 5mg/kg/day iv q12h, (不可加於Glucose solution)Luminal(Phennobarbital) (100mg/cc/amp;32mg/1#)Loading 20mg/kg iv with rate30mg

18、/min ; Maintain 5-10mg/kg/day to achieve serum level 40 ug/mlChloral hydrate enema(10% 30ml)：Neonates: 25-50 mg/kg/dose, Children: 25-100mg/kg/dose 1/23/4 BW cc enema 23小兒科藥物劑量Antibiotics 抗生素Penicillin :Bctereimia:2.5-5 ;Meningitis 7.5-10 ; infection 10-25(單位：萬u/kg/dose q4-6h)Ampicillin : IV 100mg/k

19、g/day, q6h. Amoxicillin Cap(500mg) : (Ac. tonsillitis, AOM)Hiconcil Cap(250mg)= 50 mg/kg/day q8h.Amoxicillin syrup = BW/2 po q8h. Augmentin (amoxicillin + clavulanic acid, 375mg/1#,600mg/vial) : BW/2 po q8h.24小兒科藥物劑量Antibiotics 抗生素-Cephalosporins頭芽孢素Cephazolin(Veterin) : IV 100mg/kg/day, q6h.Keflex(

20、250mg/1#,Cephalexin 1,Ceflexin 500mg/1#):25-50 mg/kg/day poq6h for G(+).Keflor (2 Cefaclor,250 mg/1#,125mg/5cc/60cc/susp) 50 mg/kg/day q8h.; BW/2 q8h.(AOM)Zinacef (2 Cefuroxime, 250mg,750mg): 2mg:250mg/dose po bidZinnat (2 Cefuroxime, 25mg/ml) AOM : 2 y/o 10ml q12h Common infection: 5ml q12h Rocephi

21、n,Syntrix(3Ceftriaxone 500mg/5cc/vial): 50-100mg/kg/day iv q12h-qd; Meningitis:100mg/kg/day q12h (max:4g/day)Prostaphlin (Oxacillin) :IV 100mg/kg/day, q6h. (Cellulitis)25小兒科藥物劑量Antibiotics 抗生素- MacrolidesErythromycin(Mycoplasma,Chlamydia,Legionella)Erythrocin syrup (40mg/cc)：BW/4 cc po q6h Ilosone (

22、250/1#):30-50 mg/kg/day q6h.(20kg 1# qid, 40kg 2# qid)Zithromax(Azithromycin,250mg/1#,200mg/5cc/susp) child :1# qd * 3day (40kg:2#)Zithromax syrup ： BW/4 cc po qd * 3 days Klaricid(Clarithromycin ,250/tab): Adult 12# po bid; Child:7.5mg/kg bid26小兒科藥物劑量Antibiotics 抗生素-UTINitrofurantoin(Ninru,100mg/1#

23、)：57mg/kg/day, po qid (UTI),Adult:1#po qid.Prophylactic dose: 1/31/4 therapeutic doseAzactam(Aztreonam 1 g/inj):90-120mg/kg/day iv q6-8h for G(-) and PseudomonasMycostatin( 50萬u/1#):for Candida(Oral thrush): Infant: 2/5# (20萬u)/dose q6h Child: 1# (40-60u)/dose q6hBaktar(TMP-80 + SMX-400):6-12 mg/kg/

24、day po q12h (Contraindication 1y/o; 0.075-0.15 mg/kg,slow IV, repeat twice q15m28小兒科藥物劑量其他特殊用藥Aspirin(500mg/13): Analgesic:10-15 mg/kg/dose po q6-8h Anti-rheumatic:65-100mg /kg/day po q6-8h Kawasaki disease: 100mg/kg/day po q6hIndocin: Dose : No.1 No.2 No.3 7 days - 0.2 0.1 0.2529小兒科藥物劑量其他特殊用藥Lasix(

25、40mg/1#,20mg/2cc/inj):1-2mg/kg/dose q6-12hMannitol(60mg/20%/300cc):0.5-1.0g/kg/dose iv for 30min Insulin: DKA:0.05-0.1u/kg/hr iv drip , maintain： 0.5-1u/kg/day/SC Glucose intolerance in prematurity: 0.01-0.1u/kg/hr.Difflam Anti-Inflammatory Spray（得伏寧 消炎噴液劑） 成份：每mL含Benzydamine Hydrochloride 15 mg 作用：Benzydamine為一抗炎止痛劑，可舒解口腔及咽喉疼痛。 用法：直接噴5-10次於