BCPPS cheat sheet

Weight-based dosing (mg/kg) is standard, with every dose capped at the maximum adult dose; body surface area (Mosteller formula) is used for chemotherapy, growth hormone, and narrow-index drugs.

Neonatal gastric pH is higher (less acidic) and gastric emptying is delayed, altering absorption of acid-labile and enteric-coated drugs.

Neonates have lower albumin concentrations and higher unconjugated bilirubin, increasing the free fraction of highly protein-bound drugs; ceftriaxone can displace bilirubin and is avoided in hyperbilirubinemia.

Total body water is about 80-90% of body weight in preterm neonates versus 60% in adults, increasing the volume of distribution of hydrophilic drugs such as aminoglycosides.

CYP3A4 and CYP2D6 activity mature over the first 1-2 years of life, while glucuronidation (UGT) matures over roughly 2-6 months.

GFR is approximately 30-40 mL/min/1.73 m2 at term birth and reaches adult values by 6-12 months, so renally cleared drugs require extended dosing intervals in neonates.

Age definitions: preterm is less than 37 weeks gestation, term is 37-42 weeks, neonate is 28 days or less, and infant is under 12 months.

Dose scaling is not linear above roughly 40-50 kg, so weight-based or BSA-based caps should be applied.

Caffeine citrate for apnea of prematurity: loading dose 20-40 mg/kg IV or orally, then 5-10 mg/kg once daily.

Surfactant for respiratory distress syndrome: beractant 100 mg/kg (4 mL/kg) instilled via the endotracheal tube, repeated every 6 hours as needed.

PDA closure: indomethacin 0.1-0.2 mg/kg/dose every 12-24 hours for up to 3 doses, or ibuprofen 10 mg/kg then 5 mg/kg every 24 hours for 2 doses; avoid with necrotizing enterocolitis, renal failure, or bleeding.

Early-onset neonatal sepsis empiric therapy: ampicillin 100 mg/kg/dose plus gentamicin 4-5 mg/kg every 24-48 hours based on gestational and postnatal age.

Group B streptococcus intrapartum prophylaxis: penicillin G 5 million units IV, then 2.5-3 million units every 4 hours.

Neonatal HSV: acyclovir 20 mg/kg IV every 8 hours for 21 days for CNS or disseminated disease and 14 days for skin-eye-mouth disease.

Vitamin K 0.5-1 mg IM at birth prevents hemorrhagic disease of the newborn.

Necrotizing enterocolitis: withhold feedings, decompress the gut, and give ampicillin plus gentamicin plus metronidazole.

DTaP is given at 2, 4, 6, and 15-18 months and at 4-6 years, with a Tdap booster at 11-12 years.

MMR and varicella require 2 doses, with the first at 12-15 months; live vaccines are contraindicated in pregnancy and severe immunocompromise.

PCV is given at 2, 4, 6, and 12-15 months; Hib primary series at 2, 4, and 6 months with a booster at 12-15 months.

Rotavirus vaccine: first dose by 14 weeks 6 days of age and the series completed by 8 months 0 days.

Acute otitis media first-line therapy: high-dose amoxicillin 80-90 mg/kg/day divided twice daily.

Group A streptococcal pharyngitis: penicillin V or amoxicillin 50 mg/kg once daily (maximum 1 g) for 10 days, with diagnosis confirmed by rapid antigen test or culture.

Vancomycin for serious MRSA infection targets AUC24/MIC of 400-600, with monitoring of renal function.

Aminoglycosides are dosed by extended interval with peak and trough or AUC monitoring because of nephrotoxicity and ototoxicity.

Oseltamivir weight-based dosing: 30 mg twice daily for 15 kg or less, 45 mg for 15-23 kg, 60 mg for 23-40 kg, and 75 mg above 40 kg.

Asthma step therapy: as-needed SABA for all patients, daily low-dose inhaled corticosteroid for persistent asthma, and LABA only in combination with an ICS in children 4 years and older.

Acute asthma: nebulized albuterol 0.15 mg/kg (minimum 2.5 mg) every 20 minutes for 3 doses, plus ipratropium 0.5 mg for moderate-severe exacerbations, and prednisolone 1-2 mg/kg/day (maximum 60 mg) for 3-5 days.

Dexamethasone 0.6 mg/kg (maximum 16 mg) as a single dose is an alternative to a short prednisolone course for mild-moderate asthma.

Montelukast dosing: 4 mg for ages 2-5 years, 5 mg for 6-14 years, and 10 mg for 15 years and older.

Croup: single dose of dexamethasone 0.15-0.6 mg/kg; nebulized epinephrine 0.5 mL of 2.25% or 5 mL of 1:1000 for stridor at rest.

Cystic fibrosis: dornase alfa 2.5 mg inhaled daily, hypertonic saline 7% twice daily, azithromycin 3 days per week for anti-inflammatory effect, and pancreatic enzymes 500-1000 lipase units/kg/meal.

RSV immunoprophylaxis: palivizumab 15 mg/kg monthly during RSV season, or a single dose of nirsevimab for eligible infants.

Theophylline therapeutic range is approximately 5-15 mcg/mL, and clearance is reduced by CYP1A2 inhibitors such as ciprofloxacin.

PALS cardiac arrest: epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,000) IV/IO every 3-5 minutes, maximum 1 mg.

Defibrillation energy: 2 J/kg for the first shock, then 4 J/kg for subsequent shocks, maximum 10 J/kg.

SVT: adenosine 0.1 mg/kg rapid IV push (maximum 6 mg), then 0.2 mg/kg (maximum 12 mg) if needed.

Amiodarone 5 mg/kg IV/IO (maximum 300 mg) for VF or pulseless VT, and for perfusing tachycardia.

Symptomatic bradycardia: atropine 0.02 mg/kg (minimum 0.1 mg; maximum 0.5 mg in a child, 1 mg in an adolescent).

Ductal-dependent congenital heart lesions: prostaglandin E1 infusion 0.01-0.1 mcg/kg/min; apnea is a common adverse effect.

Digoxin therapeutic concentration is 0.5-2 ng/mL; toxicity risk rises with hypokalemia, hypercalcemia, and renal impairment, and Fab fragments are the antidote.

Endocarditis prophylaxis for high-risk lesions: amoxicillin 50 mg/kg (maximum 2 g) 30-60 minutes before the procedure.

Infant gastroesophageal reflux is managed primarily with nonpharmacologic measures; H2RA or PPI therapy is reserved for diagnosed GERD, with omeprazole about 1 mg/kg/day.

Ondansetron 0.15 mg/kg IV (maximum 4 mg) reduces vomiting in acute gastroenteritis, but QT prolongation should be monitored.

Constipation: PEG 3350 maintenance 0.4-0.8 g/kg/day, with disimpaction using 1-1.5 g/kg/day for up to 6 days.

Helicobacter pylori eradication: PPI plus amoxicillin plus clarithromycin for 14 days.

Inflammatory bowel disease: exclusive enteral nutrition for Crohn disease induction, mesalamine for mild ulcerative colitis, and infliximab for moderate-severe disease.

Biliary atresia: ursodeoxycholic acid 10-20 mg/kg/day; Kasai portoenterostomy outcomes depend on early timing.

Celiac disease is managed with a lifelong gluten-free diet; no pharmacotherapy is available.

Chemotherapy-induced nausea: ondansetron plus dexamethasone, with an NK1 antagonist such as aprepitant added for highly emetogenic regimens.

Holliday-Segar maintenance: 100 mL/kg/day for the first 10 kg, 50 mL/kg/day for the next 10 kg, and 20 mL/kg/day for each kg above 20.

Hourly 4-2-1 rule: 4 mL/kg/hour for the first 10 kg, 2 mL/kg/hour for the next 10 kg, and 1 mL/kg/hour for each kg above 20.

Dehydration bolus: 20 mL/kg isotonic crystalloid, reduced to 10 mL/kg in neonates, cardiac disease, or diabetic ketoacidosis.

Hyponatremia: 3% sodium chloride 2-4 mL/kg raises serum sodium by roughly 2-4 mEq/L; the rise should not exceed 8-10 mEq/L per day.

Hyperkalemia: 10% calcium gluconate 100 mg/kg IV, insulin 0.1 unit/kg with dextrose 0.5 g/kg, and nebulized albuterol.

Neonatal hypoglycemia: 10% dextrose 2 mL/kg IV bolus followed by an infusion of 6-8 mg/kg/min.

Breast milk and standard term formula provide 20 kcal/oz (0.67 kcal/mL); preterm infants require about 120-150 kcal/kg/day.

Maintenance electrolytes: sodium 2-4 mEq/kg/day and potassium 2-3 mEq/kg/day; monitor phosphate, magnesium, and potassium during refeeding.

Status epilepticus: lorazepam 0.1 mg/kg IV (maximum 4 mg), then fosphenytoin 20 mg PE/kg, levetiracetam 60 mg/kg, or valproate 40 mg/kg.

Fosphenytoin infusion maximum 3 mg PE/kg/min (maximum 150 mg PE/min); phenytoin maximum 1 mg/kg/min with cardiac monitoring.

Valproate is contraindicated in urea cycle disorders and suspected mitochondrial disease; hepatotoxicity risk is highest in children under 2 years.

Carbamazepine: HLA-B*1502 screening in patients of Asian ancestry identifies elevated risk of Stevens-Johnson syndrome and toxic epidermal necrolysis.

Neonatal seizures: phenobarbital loading dose 20 mg/kg IV.

ADHD stimulants such as methylphenidate 0.3-1 mg/kg/day require monitoring of growth, blood pressure, and heart rate.

Fluoxetine is FDA-approved for depression in children 8 years and older; all antidepressants carry a boxed warning for suicidality.

Neonatal opioid withdrawal: morphine 0.05-0.1 mg/kg every 3-4 hours or methadone, titrated using Finnegan scores.

Diabetic ketoacidosis: isotonic fluid bolus 10-20 mL/kg, then regular insulin 0.05-0.1 unit/kg/hour without a bolus; add dextrose when glucose falls below 250-300 mg/dL.

DKA cerebral edema: mannitol 0.5-1 g/kg IV or 3% sodium chloride 5-10 mL/kg, with slowing of fluid and insulin administration.

Congenital hypothyroidism: levothyroxine 10-15 mcg/kg/day started within the first 2 weeks of life.

Adrenal crisis: hydrocortisone 1-2 mg/kg IV (or 50-100 mg/m2) followed by stress-dose corticosteroids.

Congenital adrenal hyperplasia: hydrocortisone 10-15 mg/m2/day divided three times daily plus fludrocortisone 0.1 mg daily.

Growth hormone deficiency: somatropin about 0.3 mg/kg/week divided into daily subcutaneous doses.

Precocious puberty: GnRH agonist such as leuprolide depot to suppress pubertal progression.

Type 2 diabetes: metformin is approved for children 10 years and older, with lifestyle modification as first-line therapy.

Febrile infant under 2 months: obtain cultures and start ampicillin plus gentamicin (or cefotaxime) empirically.

Urinary tract infection: cephalexin or trimethoprim-sulfamethoxazole based on susceptibilities; nitrofurantoin is not used for febrile pyelonephritis.

Vesicoureteral reflux prophylaxis: trimethoprim-sulfamethoxazole 2 mg/kg (trimethoprim component) nightly or nitrofurantoin 1-2 mg/kg nightly.

Nocturnal enuresis in children 6 years and older: oral desmopressin 0.2-0.6 mg at bedtime with fluid restriction to avoid hyponatremia.

Idiopathic nephrotic syndrome: prednisone 60 mg/m2/day (maximum 60 mg) for 6 weeks, then 40 mg/m2 every other day for 6 weeks.

Chronic kidney disease: erythropoiesis-stimulating agents for anemia, calcitriol for mineral bone disease, phosphate binders, and sodium bicarbonate for acidosis.

Acute kidney injury: avoid nephrotoxins and adjust renally cleared drugs using estimated creatinine clearance from the Schwartz equation.

Hemodialysis removes vancomycin and aminoglycosides, so supplemental post-dialysis doses are required.

Iron deficiency anemia: elemental iron 3-6 mg/kg/day divided; ferrous sulfate contains about 20% elemental iron.

Sickle cell disease: penicillin V prophylaxis until age 5 years, hydroxyurea about 20 mg/kg/day, and complete pneumococcal vaccination.

Immune thrombocytopenia: treat only for significant bleeding, using IVIG 1 g/kg or a short corticosteroid course.

Febrile neutropenia: empiric antipseudomonal beta-lactam such as cefepime or piperacillin-tazobactam; add vancomycin for line infection or MRSA risk.

Tumor lysis syndrome: aggressive hydration plus allopurinol or rasburicase; rasburicase is contraindicated in G6PD deficiency.

Vincristine is fatal if administered intrathecally and must be given only by the intravenous route.

Anaphylaxis: epinephrine 0.01 mg/kg IM of 1:1000 (maximum 0.3-0.5 mg), repeated every 5-15 minutes as needed.

Primary humoral immunodeficiency: IVIG 400-600 mg/kg every 3-4 weeks.

Acetaminophen overdose: N-acetylcysteine regimen of 150 mg/kg over 1 hour, 50 mg/kg over 4 hours, then 100 mg/kg over 16 hours, guided by the Rumack-Matthew nomogram at 4 hours.

Salicylate toxicity: sodium bicarbonate to alkalinize the urine and enhance elimination; hemodialysis for severe poisoning.

Iron poisoning: deferoxamine 15 mg/kg/hour for severe toxicity with metabolic acidosis or shock.

Lead poisoning: succimer (DMSA) 10 mg/kg every 8 hours for 5 days then every 12 hours for 14 days; severe encephalopathy uses dimercaprol plus CaNa2EDTA.

Opioid overdose: naloxone 0.1 mg/kg IV/IM (maximum 2 mg), repeated every 2-3 minutes because its duration is shorter than many opioids.

Organophosphate poisoning: atropine 0.02-0.05 mg/kg IV plus pralidoxime.

Methanol or ethylene glycol ingestion: fomepizole to block alcohol dehydrogenase, with hemodialysis for severe cases.

Activated charcoal 1 g/kg within 1 hour of ingestion for most poisonings; contraindicated with an unprotected airway or caustic ingestion.

Button battery lodged in the esophagus requires emergent endoscopic removal.

Septic shock: isotonic crystalloid boluses of 20 mL/kg up to 40-60 mL/kg, with epinephrine for cold shock and norepinephrine for warm shock.

Anaphylaxis: epinephrine 0.01 mg/kg IM of 1:1000 (maximum 0.5 mg) into the lateral thigh, repeated every 5-15 minutes, plus 20 mL/kg fluid boluses.

Status asthmaticus: continuous albuterol, ipratropium, systemic corticosteroids, and magnesium sulfate 25-50 mg/kg IV (maximum 2 g).

Rapid sequence intubation: ketamine 1-2 mg/kg or etomidate 0.3 mg/kg for induction, with rocuronium 1 mg/kg for paralysis.

DKA cerebral edema: mannitol 0.5-1 g/kg IV or 3% sodium chloride 5-10 mL/kg.

Hypoglycemia: 10% dextrose 2-4 mL/kg IV.

ARDS: lung-protective ventilation with tidal volume about 6 mL/kg predicted body weight and adequate PEEP.

Sedation infusions: dexmedetomidine 0.2-1 mcg/kg/hour and fentanyl 1-2 mcg/kg boluses.