PREPARATION FOR PEDIATRIC MEDICATION EXAM All medications and fluid calculations are based on childs weight.

For all IV Medications, the following questions will be asked: 1. What is the safe dose range based on weight of child? To answer this question, you will need the recommended dose range from a Pediatric Drug Handbook [CHLA or Taketomo text] For example, if the recommended dose is 100 to 150 mg/kg for ceftazidime divided every 8 hours, and the childs weight is 26 kg. The answer is: Low: 100mg/kg x 26 kg = 2600 mg / 3 doses = 866.66 mg/dose q 8 hours. High: 150 mg/kg x 26 kg = 3900 mg / 3 doses = 1300 mg/dose q 8 hours. Doctors order: ceftazidime 1000 mg IV q8 Because the prescribed dose is between 866.66 mg to 1300 mg q 8 hours. It is safe to give this dose. 2. What is the amount that will be withdrawn from vial (into a syringe)? To answer this question, you will need the drug concentration from vial. From the drug book or from the pharmacy label, the available concentration is 100 mg/ml Doctors order: ceftazidime 1000 mg IV q8 If there is 100 mg/ml, 1000 mg is how many ml [x] 100mg = 1 ml 1000 mg = x 1000 mg 100 mg x 1 ml = 10 ml

3. How much dilution is required based on dose? From the drug book, final concentration for IV administration is: 40 mg/ml Doctors order: ceftazidime 1000 mg IV q8 40 mg = 1 ml 1000 mg = x 1000 mg x 1 ml = 25 ml 40 mg Therefore, the amount of dilution for this medication will be a total volume of at least 25 ml when being infused into the childs vein [so that it is not irritating the vein].

4. Over how many minutes will the medication be infused? From the drug book, it states administer over 15 to 30 minutes. The answer does not require calculation. This is a given on the test. It will be either 15 or 30 minutes. It will state something like: Time required for administration: 30 min. 5. What is the rate of the pump for medication infusion? To answer this question, you will need the total volume: 25 ml If the Time required for administration: 30 minutes All rates are calculated as x ml/hour [convert the 1 hour = 60 minutes] 25 ml = 30 minutes x ml = 60 minutes 25 ml x 60 minutes = 50 ml/hour 30 minutes If the Time required for administration: 15 minutes 25 ml = 15 minutes x ml = 60 minutes 25 ml x 60 minutes = 100 ml/hour 15 minutes

The following is not needed to know for the test, but may be used in simulations and clinical settings, depending on the administration set: 1. The medication can be given using a volutrol. 10 ml medication 15 ml will be added to it from the primary line, Therefore, 10 ml + 15 ml = 25 ml total medication volume. Rate will be based on 25 ml volume. 2. The medication can be given using a secondary line piggy backed into a primary IV line The medication is 10 ml The secondary line is usually a 25 ml bag Therefore, 10 ml + 25 ml = 35 ml total medication volume. Rate will be based on 35 ml volume. 3. The medication may come premixed from the pharmacy in a 25 ml syringe. Rate will be based on 25 ml, and will be administered using a syringe pump. For all medications other than IV [eg PO, NG, GT], only the safe dose range will be asked and the amount of medicine that will be drawn from the bottle. ***There may be additional questions that may be asked that requires knowledge of implications of medications, and whether medication should be given or held based on the given parameters [VS, drug levels, other relevant values that has safety implications]. Memorize these for the test!! 1 oz = 30 ml 1 tsp = 5 ml 1 kg = 2.2 lb 1 lb = 16 oz 1 L = 1000 ml 1 g = 1000 mg* 1 mg = 1000 mcg* NS = 0.9% NaCL * Know the metric system conversions (i.e. grams to miligrams, etc.) Note: 1 g = 1 ml [urine output on diapers measured in grams, documented in ml] Memorize these for the test!! 1st 10 kg = x 100 ml/kg/day (=1000 ml/day for entire 10 kg) 11 to 20 kg = x 50 ml/kg/day for 11- 20 kg (=500 ml/day maximum for entire 10kg) > 20 kg = x 20* ml/kg/day for >20 kg (=1500 ml +) NOTE: some references say 25ml/kg/day >20kg. For the exam: use 20 ml/kg/day for > 20kg

Know the 7 rights prior to giving medications

PRACTICE PROBLEM 1 Doctors order: Patient weight: Safe dose range: Time required for administration: Available drug concentration: Dilution for IV administration: ceftazidime 1500 mg IV q8 32 kg 100-150 mg/kg/day 30 minutes 100 mg/ml 40 mg/ml

1. What is the safe dose range based on weight of child? Low: _____________________ High: _____________________ 2. What is the amount that will be withdrawn from vial (into a syringe)? 3. How much dilution is required based on dose? 4. Over how many minutes will the medication be infused? 5. What is the rate of the pump for medication infusion? PRACTICE PROBLEM 2 Doctors order: cefuroxime 350 mg IV q8 Patient weight: 8.5 kg Safe dose range: 75-150 mg/kg/day Time required for administration: 15 minutes Available drug concentration: 100 mg/ml Dilution for IV administration: 30 mg/ml 1. What is the safe dose range based on weight of child? Low: _____________________ High: _____________________ 2. What is the amount that will be withdrawn from vial (into a syringe)? 3. How much dilution is required based on dose? 4. Over how many minutes will the medication be infused? 5. What is the rate of the pump for medication infusion?

PRACTICE PROBLEM 3 Doctors order: cefotaxime 500 mg IV q8 Patient weight: 14 kg Safe dose range: 100-200 mg/kg/day Time required for administration: 20 minutes Available drug concentration: 100 mg/ml Dilution for IV administration: 25 mg/ml 1. What is the safe dose range based on weight of child? Low: _____________________ High: _____________________ 2. What is the amount that will be withdrawn from vial (into a syringe)? 3. How much dilution is required based on dose? 4. Over how many minutes will the medication be infused? 5. What is the rate of the pump for medication infusion? PRACTICE PROBLEM 4 Doctors order: acetaminophen 500 mg PO q 4 6 hours prn Patient weight: 18.2 lbs Safe dose range: 10 - 15 mg/kg/dose Available drug concentration: 160 mg/tsp 1. What is the safe dose range based on weight of child? Low: _____________________ High: _____________________ 2. How many ml will the patient receive _______ PRACTICE PROBLEM 5 Doctors order: 500 mg penicillin po bid Patients weight: 16.5 lbs Available Syrup: 250 mg/5 ml Safe dose range: 25 to 50 mg/kg/day What is the safe dose range? Low: _____________________ High: _____________________ How many teaspoons will you tell the parent to give per dose?

For all fluid maintenance calculations, the following will be asked: 1. Calculate the 24 hour fluid requirement at 1X maintenance a. 24 hour total = _________________________________ b. Anticipated hourly IV rate = ______________________ 2. If this Child is fluid restricted at 2/3 X maintenance c. 24 hour total = _________________________________ d. Anticipated hourly IV rate = ______________________ 3. If this Child requires increase of fluids to 1.5 X maintenance d. 24 hour total = _________________________________ d. Anticipated hourly IV rate = ______________________ Example: Child weighs 36 kg 100 ml x 10 kg for 1st 10 kg of body weight = 1000 ml 50 ml x 10 kg for 2nd 10 kg of body weight = 500 ml 20 ml x 16 kg for remaining body weight = 320 ml 1820 ml/day 1. Calculate the 24 hour fluid requirement at 1X maintenance 24 hour total = 1820 ml/day Anticipated hourly IV rate = 1820 ml / 24 hours = 75.83 ml/hr 2. If this Child is fluid restricted at 2/3 X maintenance 24 hour total = 1820 x 2 = 1213.33/day 3 Anticipated hourly IV rate = 1213.33 ml / 24 hours = 50.56 ml/hr 3. If this Child requires increase of fluids to 1.5 X maintenance 24 hour total = 1820 ml x 1.5 = 2730 ml/day Anticipated hourly IV rate = 113.75 ml/hr

PRACTICE PROBLEMS Calculate fluid requirements for the patients below: Patient 1 32 kg 1. Calculate the 24 hour fluid requirement at 1X maintenance e. 24 hour total = _________________________________ f. Anticipated hourly IV rate = ______________________ 2. If this Child is fluid restricted at 2/3 X maintenance g. 24 hour total = _________________________________ d. Anticipated hourly IV rate = ______________________ 3. If this Child requires increase of fluids to 1.5 X maintenance h. 24 hour total = _________________________________ d. Anticipated hourly IV rate = ______________________ Patient 2 18.5 kg 1. Calculate the 24 hour fluid requirement at 1X maintenance i. j. 24 hour total = _________________________________ Anticipated hourly IV rate = ______________________

2. If this Child is fluid restricted at 2/3 X maintenance k. 24 hour total = _________________________________ d. Anticipated hourly IV rate = ______________________ 3. If this Child requires increase of fluids to 1.5 X maintenance l. 24 hour total = _________________________________ d. Anticipated hourly IV rate = ______________________ Patient 3 14 kg 1. Calculate the 24 hour fluid requirement at 1X maintenance m. 24 hour total = _________________________________ n. Anticipated hourly IV rate = ______________________ 2. If this Child is fluid restricted at 2/3 X maintenance o. 24 hour total = _________________________________ d. Anticipated hourly IV rate = ______________________ 3. If this Child requires increase of fluids to 1.5 X maintenance p. 24 hour total = _________________________________ d. Anticipated hourly IV rate = ______________________

Patient 4 18.2 lbs 1. Calculate the 24 hour fluid requirement at 1X maintenance q. 24 hour total = _________________________________ r. Anticipated hourly IV rate = ______________________ 2. If this Child is fluid restricted at 2/3 X maintenance s. 24 hour total = _________________________________ d. Anticipated hourly IV rate = ______________________ 3. If this Child requires increase of fluids to 1.5 X maintenance t. 24 hour total = _________________________________ d. Anticipated hourly IV rate = ______________________ Patient 5 16.5 lbs 1. Calculate the 24 hour fluid requirement at 1X maintenance u. 24 hour total = _________________________________ v. Anticipated hourly IV rate = ______________________ 2. If this Child is fluid restricted at 2/3 X maintenance w. 24 hour total = _________________________________ d. Anticipated hourly IV rate = ______________________ 3. If this Child requires increase of fluids to 1.5 X maintenance x. 24 hour total = _________________________________ d. Anticipated hourly IV rate = ______________________ Conversions: 15 gm = ______ ml 3 oz = ______ ml 5 tsp = ______ ml ______ lb = 23 kg ______ lb= 8 oz. ______ L = 1375 ml 1/3 NS = _____ % NaCL _______ gm = 250 ml _______ oz = 150 ml _______ tsp = 30 ml 33 lbs = ______ kg _______ lb = 48 oz. 1.75 L = ______ ml _____ NS = 0.225 % NaCL