NP Student Resources

• CPT QuickCode Companion
• Fast Facts: Pediatric Antibiotics
• Immunization Station
• OTC Dose Decoder
• ADHD Meds
• Screening & Learning Vault

CPT QuickCode Companion

Procedures

Procedures

• 69210 - Cerumen Impaction (per ear)
• 17250 - Cauterize Umbilical Granuloma
• 69090 - Ear Piercing (per ear)
• 51701 - In and Out Cath
• 17110 - Wart / Molluscum Destruction (<14 lesions)
• 17111 – Wart / Molluscum Destruction (14+ lesions)
• 99213 - Sports Physical (in our system you see a 99999 and the word SPORT, it makes it a $20 visit)
• 99999 - Procedure only visit (use this in addition to Procedure CPT)

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Clinic Administered Medications

Medications

Nebulizer Treatments

• 94640 - bill this for supplies plus med below
  • J7613 - Albuterol
  • J7614 - Xopenex
  • J7620 - DuoNeb

Oral

• Q0163 - Benadryl
• J2405 - Zofran ODT
• A9270 - Motrin
• A9270 - Tylenol

Injections

• 96372 - Injection Fee plus med below
• J0561 - Bicillin
• J0171 - Epinephrine (Epi-Pen)
• J0696 - Rocephin
• J8540 - Decadron

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POC Testing

POC Testing

• 87804 - Flu A/B
• 87426 - COVID 19
• 87807 - RSV
• 87880 - Strep A (Rapid)
• 81002 - UA
• 81025 - Urine Pregnancy Test

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Vaccines

Vaccines

Vaccines

• 90697 - DTaP-IPV/HepB/Hib (Vaxelis)
• 90671 - PCV15 Pneumococcal (Vaxneuvance)
• 90680 - Rotavirus (Rotateq) - 3-dose
• 90686 - Quad Flu, IM (Fluzone)
• 90707 - MMR (M-M-R®II)
• 90716 - Varicella (Varivax)
• 90633 - HepA (Vaqta) - 2 dose
• 90698 - DTaP-IPV/Hib (Pentacel)
• 90710 - MMRV (Proquad)
• 90696 - DTaP-IPV (Quadracel)
• 90619 - Meningococcal Conj ACWY (Menquadfi)
• 90715 - Tdap (Adacel)
• 90651 - HPV (Gardasil)
• 90621 - MenB-FHbp Meningococcal (Trumenba)
• 90732 - PPSV23 Pneumococcal (Pneumovax 23)
• Used if off schedule:
  • 90713 - IPV (Polio)
  • 90670 - PCV13 Pneumococcal (Prevnar 13)
    
  • 90744 - HepB (3-dose)
  • 90647 - Hib (PRP-OMP) (3-dose schedule)

Vaccine Administration Codes

• < 18 years
  • 90460 - vaccine admin, first component
  • 90461 - vaccine admin, each add’l component
• 18 + Years
  • 90471 - vaccine admin, combo
  • 90472 - vaccine admin, each add’l combo vaccine
  • 90473 - vaccine admin, intranasal/oral
  • 90474 - vaccine admin, each add’l intranasal/oral

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Screening

Screening

• 96127 - Anxiety (GAD / SCARED) / Depression (PHQ)
• 96110 - Developmental Screen (SWYC / ASQ / MCHAT)
• 96127 - ADHD Forms (Vanderbilt) - per form
• 92551 - Hearing Eval (Pure Tone Audiometry)
• 99173 - Vision Eval (Snellen Chart)
• 99177 - SPOT Vision Screener

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Problem Visit Billing

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Well Visits

Pediatric

Adolescent

Adult

Fast Facts: Pediatric Antibiotics

• Acute Bacterial Conjunctivitis
• Acute Bacterial Rhinosinusitis (Sinus Infection)
• Acute Lymphadenitis (Swollen Lymph Nodes)
• Acute Otitis Media (AOM)
• Animal Bites
• Atypical Pneumonia (Walking Pneumonia)
• Cellulitis
• Conjunctivitis (Pink Eye)
• Cystitis (Bladder Infection, Uncomplicated UTI)
• Dental Abscess
• Group A Streptococcal Pharyngitis (Strep Throat)
• Human Bites
• Impetigo
• Otitis Externa (Swimmer’s Ear)
• Otorrhea (Ear Discharge)
• Pertussis (Whooping Cough)
• Pneumonia
• Pyelonephritis (Kidney Infection, Febrile UTI)
• Sinus Infection (Acute Bacterial Rhinosinusitis)
• Strep Throat (Group A Streptococcal Pharyngitis)
• Swimmer’s Ear (Otitis Externa)
• Walking Pneumonia (Atypical Pneumonia)
• Whooping Cough (Pertussis)

ACUTE OTITIS MEDIA (AOM)

• Watchful waiting (WW) / Safety-Net Antibiotic Prescription (SNAP):
  • Joint decision between provider and caregiver
  • Must have close follow-up (within 48–72 hours) if SNAP not given
  • Must be able to fill antibiotic prescription if signs/symptoms worsen or fail to improve in 48–72 hours from onset
  • Note: If using WW/SNAP, place a comment in prescription instructions: “Fill only upon patient/family request”
• Antibiotic Recommendations
  • Duration:
    • <2 years or severe disease: 10 days
    • 2–5 years: 7 days
    • ≥6 years: 5 days
    • Recent data suggests 5 days may be sufficient for children >2 years with AOM of any severity
      • (Frost et al. J Pediatr. 2020 May; 220:109-115.e1).
  • First-line therapy:
    • Amoxicillin 40–50 mg/kg/dose BID (max 2000 mg/dose)
  • If received amoxicillin within the past 30 days, in daycare, or with concomitant conjunctivitis:
    • Amoxicillin/clavulanate 40–50 mg/kg/dose (amoxicillin component) PO BID (max 2000 mg amoxicillin/dose)
  • Penicillin Allergy:
    • Mild/Moderate—Rashes, including hives:
      • Cefuroxime: 250 mg PO BID (tablets only, not crushable)
      • Cefdinir: 7 mg/kg/dose PO BID (max 300 mg/dose)
      • Cefpodoxime: 5 mg/kg/dose PO BID (max 200 mg/dose)
      • Cefprozil: 15 mg/kg/dose PO BID (max 500 mg/dose)
      • Ceftriaxone: 50 mg/kg/dose IM/IV qDay x 1–3 days (max 1000 mg/dose)
    • Severe—Anaphylaxis:
      • Clindamycin 10 mg/kg/dose PO TID (max 600 mg/dose)
  • Failure to improve after 48–72 hours of initial antibiotic therapy:
    • Treatment failure with amoxicillin:
      • Amoxicillin/clavulanate 40–50 mg/kg/dose (amoxicillin component) PO BID (max 2000 mg amoxicillin/dose)
    • Treatment failure with amoxicillin/clavulanate:
      • Ceftriaxone 50 mg/kg/dose (max 1000 mg/dose) IM or IV daily x 3 days
      • Clindamycin 10 mg/kg/dose PO TID (max 600 mg/dose) PLUS:
        • Cefuroxime 250 mg PO BID
        • Cefpodoxime 5 mg/kg/dose PO BID (max 200 mg/dose)

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OTORRHEA / OTITIS EXTERNA

• Perforated Tympanic Membrane (+ Oral Antibiotics) OR AOM with Tubes:
  • Ciprodex (ciprofloxacin/dexamethasone): 4 drops BID x 7 days for patients >6 months.
  • Alternative (if Ciprodex is unavailable or cost-prohibitive):
    • Ciprofloxacin ophthalmic solution: 2 drops +/- dexamethasone ophthalmic solution: 2 drops BID x 7 days for patients >6 months.
  • Ofloxacin otic solution: 5 drops BID x 10 days for patients >6 months.
• Intact Tympanic Membrane (Non-complicated Otitis Externa):
  • Ciprodex (ciprofloxacin/dexamethasone): 4 drops BID x 7 days.
  • Ofloxacin otic solution: 5 drops BID x 10 days.
  • Cortisporin otic solution: 3 drops TID x 7 days.
• Additional Considerations:
  • Ear wick placement may help deliver medication to the site of infection, especially in cases of significant canal swelling.
  • Pain management (e.g., acetaminophen or ibuprofen) is critical for patient comfort.
• Notes:
  • Ensure proper administration technique to maximize effectiveness (e.g., warming drops before application and keeping the ear tilted for several minutes post-application).
  • If symptoms persist or worsen after 48–72 hours, reassess for alternative diagnoses or complications.

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GROUP A STREPTOCOCCAL PHARYNGITIS

• First-line therapy:
  • Amoxicillin: 50 mg/kg/dose PO BID (max 1000 mg/day) x 10 days
  • Bicillin L-A (Penicillin G benzathine): IM
    • <27 kg: 600,000 U x 1 dose
    • ≥27 kg: 1.2 million U x 1 dose
  • Penicillin VK: PO
    • <27 kg: 250 mg BID-TID x 10 days
    • ≥27 kg: 500 mg BID-TID x 10 days
• Penicillin Allergy:
  • Mild—Rashes, including hives:
    • Cephalexin: 20–25 mg/kg/dose PO BID (max 500 mg/dose) x 10 days
  • Severe—Anaphylaxis:
    • Clindamycin: 7 mg/kg/dose PO TID (max 300 mg/dose) x 10 days
    • Azithromycin: 12 mg/kg/dose PO qDay (max 500 mg/dose) x 5 days
• Notes:
  • Azithromycin is not recommended unless the patient has a severe allergy to both penicillins and cephalosporins. Resistance is well-known, and treatment failure may occur.

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UNCOMPLICATED PNEUMONIA

• Duration:
  • 5 days
  • Note: Shorter duration of 3–5 days may be sufficient for patients >6 months old (Kuitunen et al. Clin Infect Dis. 2023 Feb 8;76(3):e1123-e1128).
• First-line therapy:
  • Amoxicillin: 40–50 mg/kg/dose PO BID (max 2000 mg/dose)
  • Note: Amoxicillin/clavulanate provides no additional coverage for Streptococcus pneumoniae and is not recommended as a first-line agent.
• Penicillin Allergy:
  • Mild/Moderate—Rashes, including hives:
    • Cefuroxime: 250–500 mg PO BID (for children able to swallow pills; only available in tablets)
    • Cefpodoxime: 5 mg/kg/dose PO BID (max 200 mg/dose)
    • Cefprozil: 15 mg/kg/dose PO BID (max 500 mg/dose)
  • Note: Cefdinir is NOT recommended for empiric treatment of community-acquired pneumonia due to reduced effectiveness against Streptococcus pneumoniae. Clindamycin is preferred if above options are unavailable.
  • Severe—Anaphylaxis ± Cephalosporin Allergy:
    • Clindamycin: 10 mg/kg/dose PO TID (max 600 mg/dose)
  • Severe—Anaphylaxis + Cephalosporin Allergy + Intolerance of Clindamycin:
    • Levofloxacin:
      • Ages 6 months–5 years: 8–10 mg/kg/dose PO BID
      • ≥5 years: 16–20 mg/kg/dose PO QD (max 750 mg/day)

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ATYPICAL PNEUMONIA

• Duration:
  • 5–7 days
• First-line therapy:
  • Azithromycin:
    • Day 1: 10 mg/kg/dose PO (max 500 mg/dose)
    • Days 2–5: 5 mg/kg/dose PO qDay (max 250 mg/dose)
  • Note: Resistance to azithromycin is significant among typical bacterial pathogens, especially Streptococcus pneumoniae.
• Alternatives (without azithromycin):
  • Levofloxacin:
    • Ages 6 months–5 years: 8–10 mg/kg/dose PO BID
    • ≥5 years: 16–20 mg/kg/dose PO QD (max 750 mg/day)
  • Doxycycline (for children ≥8 years):
    • 2 mg/kg/dose PO BID (max 100 mg/dose)
• Notes:
  • Consider atypical pneumonia in adolescents with bilateral or diffuse pulmonary involvement and/or prolonged symptoms such as persistent cough and fever.
  • Levofloxacin and doxycycline provide excellent atypical pathogen coverage and do not require additional macrolides.

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ACUTE BACTERIAL RHINOSINUSITIS (ABRS)

• Criteria for Diagnosis:
  • Presumptive diagnosis of ABRS can be made if a patient with acute upper respiratory tract infection (URI) presents with ONE of the following:
    • Persistent illness (e.g., nasal discharge, daytime cough, or both) lasting >10 days without improvement.
    • Worsening course after initial improvement (e.g., new onset nasal discharge, daytime cough, or fever).
    • Severe onset (e.g., fever ≥102.2°F and purulent nasal discharge) lasting at least 3 consecutive days.
• Duration:
  • 5–7 days
• First-line therapy:
  • Mild-moderate disease (≥2 years, no daycare, no antibiotics in past 30 days):
    • Amoxicillin: 45–50 mg/kg PO BID (max 2000 mg/dose).
  • Severe disease or mild-moderate disease with any of the following: <2 years, daycare attendance, or recent antibiotic use:
    • Amoxicillin-clavulanate: 40–50 mg/kg/dose (amoxicillin component) PO BID (max 2000 mg/dose).
• Penicillin Allergy:
  • Mild/Moderate—Rashes, including hives:
    • Cefpodoxime: 5 mg/kg/dose PO BID (max 200 mg/dose).
    • Cefuroxime: 250 mg PO BID (for children able to swallow tablets; not available in liquid form).
    • Cefixime: 4 mg/kg/dose PO BID (max 200 mg/dose) PLUS Clindamycin: 10 mg/kg/dose PO TID (max 600 mg/dose).
  • Severe—Anaphylaxis ± Cephalosporin Allergy:
    • Levofloxacin:
      • Ages 6 months–5 years: 10 mg/kg/dose PO BID.
      • ≥5 years: 20 mg/kg/dose PO QD (max 500 mg/day).
• Notes:
  • If symptoms worsen or fail to improve after 48–72 hours, reassess for complications or switch to second-line therapy.
  • Consider consulting an infectious diseases physician for complex or recurrent cases.

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CYSTITIS (UNCOMPLICATED UTI)

• Duration:
  • 3–5 days
• First-line therapy:
  • Cephalexin: 50 mg/kg/day PO divided TID (max 1500 mg/day).
  • Cefixime: 8 mg/kg/dose PO qDay (max 400 mg/day).
• Severe Penicillin/Cephalosporin Allergy (e.g., Anaphylaxis):
  • Trimethoprim-Sulfamethoxazole (TMP/SMX):
    • 3–6 mg TMP/kg/dose PO BID (max 160 mg TMP/dose).
  • Nitrofurantoin (for cystitis only):
    • Macrocrystal (Macrodantin or Furadantin): 1.25–1.75 mg/kg/dose PO Q6H x 5–7 days (max 100 mg/dose).
    • Macrocrystal/monohydrate (Macrobid): 100 mg PO BID x 5–7 days (adolescents only).
• Notes:
  • Nitrofurantoin should be used only for lower urinary tract infections and avoided in suspected pyelonephritis or febrile UTIs.
  • Avoid TMP/SMX in infants <2 months due to risk of kernicterus.
  • Consider urine culture and sensitivity for recurrent UTIs or treatment failures.

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PYELONEPHRITIS (FEBRILE UTI)

• Indications for Admission:
  • Age <2 months.
  • Ill appearance or poor oral intake.
  • Inability to tolerate oral antibiotics.
  • Vomiting, immune compromise, or urinary tract obstruction.
  • Positive culture for bacteria resistant to oral antibiotics.
• Duration:
  • 7–10 days.
  • Note: Shorter duration of 5 days may be sufficient for patients >2 months (Zaoutis et al., JAMA Pediatr. 2023 Aug 1;177(8):782-789).
• First-line therapy:
  • Cephalexin: 25–33 mg/kg/dose PO TID (max 3000 mg/day).
  • Cefixime: 8 mg/kg/day PO qDay (max 400 mg/day).
• Severe Penicillin/Cephalosporin Allergy (e.g., Anaphylaxis):
  • Trimethoprim-Sulfamethoxazole (TMP/SMX):
    • 3–6 mg TMP/kg/dose PO BID (max 160 mg TMP/dose).
  • Ciprofloxacin:
    • 10–20 mg/kg/dose PO BID (max 750 mg/dose).
• Notes:
  • Cefdinir is not recommended for pediatric UTIs due to poor urine concentration in children.
  • Evaluate for potential complications, such as renal scarring or obstruction, especially in recurrent infections.
  • Obtain urine culture and sensitivity to guide therapy.

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IMPETIGO

• Treatment based on severity:
  • Mild (<5 lesions - topical therapy):
    • Mupirocin: Apply TID x 5 days.
  • Extensive (>5 lesions or lesions near the mouth - systemic therapy):
    • Cephalexin: 17 mg/kg/dose PO TID (max 500 mg/dose) x 7 days.
  • If MRSA is suspected or with severe penicillin/cephalosporin allergy:
    • Clindamycin: 7 mg/kg/dose PO TID (max 450 mg/dose) x 7 days.
    • Trimethoprim-Sulfamethoxazole (TMP/SMX):
      • 4–6 mg TMP/kg/dose PO BID (max 160 mg TMP/dose) x 7 days.
• Notes:
  • Systemic antibiotics are preferred if lesions are numerous, involve the mouth or mucosal areas, or in cases with signs of systemic infection.
  • Educate caregivers about proper hygiene to prevent the spread, as impetigo is highly contagious.

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CELLULITIS / ABSCESS

• First-line therapy:
  • Cephalexin: 17 mg/kg/dose PO TID (max 500 mg/dose) x 5 days.
  • Amoxicillin-clavulanate: 22.5 mg/kg/dose (amoxicillin component) PO BID (max 875 mg/dose).
• If MRSA is suspected, abscess is present, or in cases of penicillin/cephalosporin allergy:
  • Clindamycin: 10 mg/kg/dose PO TID (max 450 mg/dose) x 5 days.
  • Trimethoprim-Sulfamethoxazole (TMP/SMX):
    • 4–6 mg TMP/kg/dose PO BID (max 160 mg TMP/dose) x 5 days.
• Notes:
  • For abscesses, incision and drainage (I&D) is the primary treatment; antibiotics may be considered based on the severity or associated cellulitis.
  • Reassess therapy if no improvement is noted after 48–72 hours.
  • Obtain cultures in cases of recurrent abscesses, systemic symptoms, or immunocompromised patients to guide therapy.

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ANIMAL / HUMAN BITES

• First-line therapy:
  • Amoxicillin-clavulanate (Augmentin): 22.5 mg/kg/dose (amoxicillin component) PO BID (max 875 mg amoxicillin/dose).
• Duration:
  • Prophylaxis: 3 days.
  • Treatment: 5–7 days.
• Penicillin Allergy:
  • Clindamycin: 10 mg/kg/dose PO TID (max 450 mg/dose) PLUS one of the following:
    • Trimethoprim-Sulfamethoxazole (TMP/SMX): 5 mg TMP/kg/dose PO BID (max 160 mg TMP/dose).
    • Doxycycline: 2.2 mg/kg/dose PO BID (max 100 mg/dose).
• Additional Considerations:
  • Tetanus booster: Ensure vaccination status is updated.
  • Rabies prophylaxis: Assess need based on the animal and circumstances of the bite.
• Notes:
  • Antibiotic prophylaxis is recommended for high-risk wounds, such as deep punctures, crush injuries, or bites on the hands, face, or genitals.
  • Monitor for signs of infection, including increasing redness, swelling, pain, or systemic symptoms.

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DENTAL ABSCESS

• First-line therapy:
  • Amoxicillin: 17 mg/kg/dose PO TID (max 500 mg/dose) x 10 days.
  • Amoxicillin-clavulanate (Augmentin): 25 mg/kg/dose (amoxicillin component) PO BID (max 875 mg amoxicillin/dose) x 10 days.
• If buccal involvement or penicillin allergy:
  • Clindamycin: 10 mg/kg/dose PO TID (max 450 mg/dose) x 10 days.
• Additional Considerations:
  • Incision and drainage (I&D) is often necessary for definitive management.
  • Dental consultation is recommended to address the underlying cause and prevent recurrence.
• Notes:
  • For systemic symptoms (e.g., fever, swelling extending into facial spaces), hospitalization and IV antibiotics may be required.
  • Encourage dental hygiene and follow-up care to prevent complications or recurrence.

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ACUTE LYMPHADENITIS

• First-line therapy:
  • Cephalexin: 17–25 mg/kg/dose PO TID (max 1000 mg/dose) x 7–10 days.
  • Amoxicillin-clavulanate (Augmentin): 22.5 mg/kg/dose (amoxicillin component) PO BID (max 875 mg amoxicillin/dose) x 7–10 days.
• If MRSA is suspected or with severe penicillin/cephalosporin allergy:
  • Clindamycin: 10 mg/kg/dose PO TID (max 450 mg/dose) x 7–10 days.
• If Bartonella henselae (cat-scratch disease) is suspected:
  • Azithromycin: 10 mg/kg/dose PO qDay (max 500 mg/dose) x 5 days.
• Additional Considerations:
  • Obtain cultures or imaging (e.g., ultrasound) if abscess formation is suspected.
  • Monitor closely for systemic symptoms such as fever, weight loss, or night sweats, which may warrant further investigation for atypical infections or malignancy.
• Notes:
  • Typical bacterial causes include Staphylococcus aureus and Streptococcus pyogenes.
  • For children with recurrent or persistent lymphadenitis, consider consultation with an infectious diseases specialist.

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ACUTE BACTERIAL CONJUNCTIVITIS

• Infants (especially <2 months):
  • Erythromycin ointment (5 mg/g): Apply 1 cm to the affected eye QID for 5 days.
  • Polymyxin B ointment: Apply 1.25 cm to the affected eye QID for 5 days.
• Children and adolescents:
  • Polymyxin B solution: 1 drop in the affected eye QID for 7 days.
• Alternative topical therapies:
  • Tobramycin (0.3%) ophthalmic solution: Instill 1–2 drops into the affected eye every 4 hours.
  • Azithromycin (1%) ophthalmic solution:
    • Instill 1 drop into the affected eye BID (8–12 hours apart) on days 1–2.
    • Then, instill 1 drop daily into the affected eye on days 3–7.
    • Note: More expensive and harder to find than other alternatives.
• If corneal involvement or patient wears contact lenses:
  • Consider alternatives with broader gram-negative coverage:
    • Ciprofloxacin (0.3%) ophthalmic drops: Instill 1–2 drops in the affected eye 4 times daily.
    • Ofloxacin (0.3%) ophthalmic drops: Instill 1–2 drops in the affected eye 4 times daily.
• Notes:
  • Avoid ophthalmic solutions containing neomycin due to a high incidence of allergic reactions.
  • For severe cases or if no improvement after 48 hours, consider bacterial resistance or alternative diagnoses such as viral conjunctivitis.

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PERTUSSIS

Reportable - Must Notify Louisiana Department of Health; Must stay home until completed antibiotics

• Indications for Treatment:
  • Confirmed or suspected pertussis cases.
  • Prophylaxis for close contacts of pertussis cases, especially high-risk individuals (e.g., infants, pregnant women, or those with immunocompromised household members).
• Duration:
  • 5–7 days depending on the selected antibiotic.
• First-line therapy (macrolides):
  • Azithromycin:
    • Infants <6 months: 10 mg/kg/dose PO qDay x 5 days
    • ≥6 months:
      • Day 1: 10 mg/kg/dose PO (max 500 mg/dose)
      • Days 2–5: 5 mg/kg/dose PO qDay (max 250 mg/dose)
  • Clarithromycin:
    • 7.5 mg/kg/dose PO BID (max 500 mg/dose) x 7 days
• Alternative therapy (if macrolides are contraindicated):
  • Trimethoprim-Sulfamethoxazole (TMP/SMX):
    • 4–6 mg TMP/kg/dose PO BID (max 160 mg TMP/dose) x 14 days
• Notes:
  • Azithromycin is preferred for infants <1 month due to safety concerns with erythromycin (risk of hypertrophic pyloric stenosis).
  • TMP/SMX should be avoided in infants <2 months due to the risk of kernicterus.
  • Early treatment is critical to limit transmission, but treatment after the paroxysmal stage may not alter the course of symptoms.

Immunization Station

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Adacel (Tdap)

• Number of doses: 1 dose (booster) at 11–12 years old, then every 10 years.
• Spacing:
  • Administer at least 5 years after the last tetanus-containing vaccine.
• Major teaching:
  • Protects against tetanus, diphtheria, and pertussis.
  • Critical for adolescents and adults to prevent pertussis transmission to infants.
  • May cause mild pain or swelling at the injection site.

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Gardasil (HPV)

• Number of doses:
  • 2 doses (6–12 months apart) for individuals starting at age 11–12 and under 15 years.
  • 3 doses (0, 1–2, and 6 months) for individuals ≥15 years or immunocompromised.
• Spacing:
  • Ensure a minimum interval of 5 months between the first and last doses.
• Major teaching:
  • Protects against HPV-related cancers and genital warts.
  • Most effective when given before exposure to HPV.
  • May cause fainting; observe adolescents for 15 minutes post-vaccination.

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M-M-R II (Measles, Mumps, Rubella)

• Number of doses: 2 doses (at 12–15 months and 4–6 years).
• Spacing:
  • Minimum interval: 4 weeks between doses.
• Major teaching:
  • Live vaccine; avoid in immunocompromised individuals or during pregnancy.
  • May cause mild fever or rash 1–2 weeks after vaccination.
  • Critical for preventing measles outbreaks.

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Menquadfi (Meningococcal ACWY)

• Number of doses: 2 doses (at 11–12 years and 16 years).
• Spacing:
  • At least 8 weeks between doses if additional doses are required for high-risk individuals.
• Major teaching:
  • Protects against meningococcal disease (ACWY serogroups).
  • Recommended for college students living in dormitories.
  • May cause mild soreness at the injection site.

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Pentacel (DTaP-IPV/Hib)

• Number of doses: 4 doses (at 2, 4, 6, and 15–18 months).

• Spacing:

  • Minimum interval of 4 weeks between doses in the primary series (2, 4, and 6 months).
  • Booster dose at 15–18 months, spaced at least 6 months after the third dose.

• Major teaching:

  • Combines protection against 5 diseases: diphtheria, tetanus, pertussis, polio, and Haemophilus influenzae type b (Hib).
  • Reduces the number of injections needed at each visit.
  • Common side effects include mild fever, irritability, and injection site redness/swelling.
  • Ensure parents are aware of the importance of completing the series for full protection against these diseases.

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ProQuad (MMR & Varicella)

• Number of doses: 2 doses (at 4–6 years and earlier if needed).
• Spacing:
  • Minimum interval of 3 months between doses.
• Major teaching:
  • Combines MMR and Varicella for convenience.
  • Live vaccine; avoid in pregnancy or severe immunosuppression.
  • Mild rash or fever may occur.

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Quadracel (DTaP-IPV)

• Number of doses: 1 dose at 4–6 years.
• Spacing:
  • Must be spaced at least 6 months after the previous DTaP-IPV dose.
• Major teaching:
  • Protects against diphtheria, tetanus, pertussis, and polio.
  • Booster dose completes the series before entering school.

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RotaTeq (RV5)

• Number of doses: 3 doses (at 2, 4, and 6 months).
• Spacing:
  • Minimum interval of 4 weeks between doses.
  • Final dose must be administered before 8 months of age.
• Major teaching:
  • Protects against severe rotavirus gastroenteritis.
  • Oral vaccine; no injection required.
  • Common side effects include mild diarrhea or fussiness.

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Trumenba (Meningococcal B)

• Number of doses: 2 doses (0 and 6 months apart).
• Spacing:
  • A 3-dose schedule (0, 1–2, and 6 months) may be recommended for certain high-risk groups.
• Major teaching:
  • Protects against meningococcal B disease, which can cause rapid and severe infections.
  • Recommended for individuals 16–23 years old, especially those in high-risk settings (e.g., college campuses).

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Vaqta (Hep A)

• Number of doses: 2 doses (at 12 months and 18 months).
• Spacing:
  • At least 6 months between doses.
• Major teaching:
  • Protects against hepatitis A, a liver infection spread by contaminated food/water.
  • Common side effects include mild injection site soreness.

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Varivax (Varicella)

• Number of doses: 2 doses (at 12–15 months and 4–6 years).
• Spacing:
  • Minimum interval of 3 months between doses.
• Major teaching:
  • Live vaccine; avoid in pregnancy or severe immunosuppression.
  • Mild rash or fever may occur 1–2 weeks after vaccination.

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Vaxelis (DTaP-IPV/HepB/Hib)

• Number of doses: 3 doses (at 2, 4, and 6 months).
• Spacing:
  • Minimum interval of 4 weeks between doses.
• Major teaching:
  • Protects against six diseases (diphtheria, tetanus, pertussis, polio, hepatitis B, and Haemophilus influenzae type b).
  • May cause mild fever, soreness, or swelling at the injection site.

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Vaxneuvance (PCV15)

• Number of doses: 4 doses (at 2, 4, 6, and 15 months).
• Spacing:
  • Minimum interval of 4 weeks between primary doses.
  • Booster dose recommended at least 8 weeks after the 3rd dose.
• Major teaching:
  • Protects against 15 serotypes of Streptococcus pneumoniae, which can cause pneumonia, meningitis, and bacteremia.
  • May cause mild fever or irritability post-vaccination.

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Flu Vaccine

FluMist (Live Attenuated Influenza Vaccine - LAIV4)

• Type: Live attenuated vaccine administered intranasally.
• Age indications: Approved for healthy individuals aged 2–49 years.
• Effectiveness: Comparable to the flu shot in most years but may vary depending on the season and strains.
• Contraindications:
  • Children <2 years or adults ≥50 years.
  • Pregnant individuals.
  • Immunocompromised individuals or close contacts of severely immunocompromised individuals (e.g., bone marrow transplant patients in protective isolation).
  • Children 2–4 years with asthma or wheezing in the past 12 months.
  • Severe allergy to any FluMist component.
• Major teaching:
  • Avoid in individuals taking aspirin or salicylate-containing medications due to the risk of Reye's syndrome.
  • Mild side effects include runny nose, sore throat, or headache.

Flu Shot (Inactivated Influenza Vaccine - IIV4)

• Type: Inactivated vaccine administered via intramuscular injection.
• Age indications: Approved for individuals 6 months and older, including pregnant individuals and those with chronic health conditions.
• Effectiveness: Provides broad protection against circulating influenza strains; updated yearly to match predicted strains.
• Contraindications:
  • Severe allergy to any flu shot component, including egg protein (though egg-free formulations are available).
• Major teaching:
  • Common side effects include mild soreness or swelling at the injection site, low-grade fever, or fatigue.
  • Safe for individuals with chronic medical conditions or weakened immune systems.
  • For children <9 years receiving the flu vaccine for the first time, 2 doses are required at least 4 weeks apart.

Key Differences:

Aspect	FluMist (Nasal Spray)	Flu Shot (Injection)
Type of Vaccine	Live attenuated	Inactivated
Route of Administration	Nasal spray	Intramuscular injection
Age Range	2–49 years	6 months and older
Pregnancy Safe?	No	Yes
Immunocompromised Use?	No	Yes
Common Side Effects	Runny nose, sore throat, headache	Soreness, redness, low-grade fever

OTC Dose Decoder

• Tylenol
• Motrin or Advil

• Antihistamines (Allergies):

  • Benadryl
  • Zyrtec

• Decongestants:

  • Sudafed
  • Mucinex Stuffy Nose & Chest Congestion Liquid

• Cough Suppressants and Expectorants:

  • Robitussin-DM
  • Mucinex Children's Cough Liquid

• Combination Medications for Colds:

  • Robitussin
  • Children's Dimetapp
    

Tylenol 

(Acetaminophen)

Use for: Fever, pain relief, teething

Not to be given if under 2 months (unless cleared with pediatrician)
Can be repeated every 4 hours as needed
Do not give more than 5 doses in 24 hours

Weight (lbs)	Dose (mgs)	Infant Oral Suspension (160 mg/5 ml)	Child Oral Suspension (160 mg/5 ml)	Chewable (80 mg tab)	Jr. Strength (160 mg tab)	Adult Tab (325 mg)
6 - 11	40	1.25 ml = 1/4 tsp	-	-	-	-
12 - 17	80	2.5 ml = 1/2 tsp	2.5 ml = 1/2 tsp	-	-	-
18 - 22	120	3.75 ml = 3/4 tsp	3.75 ml = 3/4 tsp	1 1/2 tabs	-	-
23 - 35	160	5 ml = 1 tsp	5 ml = 1 tsp	2 tabs	1 tab	-
36 - 47	240	7.5 ml = 1 1/2 tsp	7.5 ml = 1 1/2 tsp	3 tabs	1 1/2 tabs	-
48 - 59	320	10 ml = 2 tsp	10 ml = 2 tsp	4 tabs	2 tabs	1 tab
60 - 71	400	12.5 ml = 2 1/2 tsp	12.5 ml = 2 1/2 tsp	5 tabs	2 1/2 tabs	1 tab
72 - 95	480	15 ml = 3 tsp	15 ml = 3 tsp	6 tabs	3 tabs	1 1/2 tabs
96+	640	20 ml = 4 tsp	20 ml = 4 tsp	8 tabs	4 tabs	2 tabs

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Motrin or Advil

(Ibuprofen)

Use for: Fever, pain relief, teething

Not to be given if under 12 pounds or 6 months
Best if not given on an empty stomach
Can be repeated every 6 hours as needed

Weight (lbs)	Dose (mgs)	Infant Oral Drops (50 mg/1.25 ml)	Child Oral Suspension (100 mg/5 ml)	Chewable (100 mg tab)	Jr. Strength (100 mg tab)	Adult Tab (200 mg)
12 - 17	50	1.25 ml = 1 dropper	2.5 ml = 1/2 tsp	--	--	--
18 - 23	75	1.875 ml = 1 1/2 dropper	3.75 ml = 3/4 tsp	--	--	--
24 - 35	100	2.5 ml = 2 droppers	5 ml = 1 tsp	1 tab	1 tab	--
36 - 47	150	--	7.5 ml = 1 1/2 tsp	1 1/2 tabs	1 1/2 tabs	--
48 - 59	200	--	10 ml = 2 tsp	2 tabs	2 tabs	1 tab
60 - 71	250	--	12.5 ml = 2 1/2 tsp	2 1/2 tabs	2 1/2 tabs	1 tab
72 - 95	300	--	15 ml = 3 tsp	3 tabs	3 tabs	1 1/2 tabs
96+	400	--	20 ml = 4 tsp	4 tabs	4 tabs	2 tabs

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Benadryl

(Diphenhydramine)

Use for: Allergic reactions, itchy hives, seasonal allergies

Not to be given if under 6 months of age
Can be repeated every 6 hours as needed
Maximum of 4 doses in 24 hours
Caution: May cause drowsiness

Weight (lbs)	Suspension (12.5 mg/5 ml)	Chewable (12.5 mg tab)	FastMelts (12.5 mg tab)	Tab/Cap (25 mg)
12 - 19	2.5 ml = 1/2 tsp	-	-	-
20 - 26	3.75 ml = 3/4 tsp	-	-	-
27 - 39	5 ml = 1 tsp	1 tab	1 tab	-
40 - 52	7.5 ml = 1 1/2 tsp	1 tab	1 tab	-
53 - 67	10 ml = 2 tsp	2 tabs	2 tabs	1 tab/cap
68 - 79	12.5 ml = 2 1/2 tsp	2 tabs	2 tabs	1 tab/cap
80 - 95	15 ml = 3 tsp	3 tabs	3 tabs	1 tab/cap
96+	20 ml = 4 tsp	4 tabs	4 tabs	2 tabs/caps

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Zyrtec

(Cetirizine)

Use for: Allergic reactions, itchy hives, seasonal allergies, sinus drip, nasal congestion

Not to be given if under 6 months of age
Best if given before bedtime. Only given once a day
Caution:May cause drowsiness

Age	Dose (mL)
6-12 months	2.5 mL
1-2 years	2.5-3.75 mL
2-3 years	3.75 mL
3-4 years	5 mL
4-5 years	5-7.5 mL
6 years & older	7.5-10 mL

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Robitussin-DM

(Dextromethorphan, Guaifenesin)

Use for: Nonproductive (dry) cough, to suppress the cough reflex and reduce the urge to cough, providing relief from persistent or irritating coughing.

Not to be given if under 2 years of age
Can be repeated every 4 hours as needed
Maximum of 6 doses in 24 hours

Age	Dose (mL)
2-4 years	2.5 mL
4-6 years	3.75 mL
6-9 years	5 mL
9-12 years	7.5 mL
12 & older	10 mL

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Robitussin

(Guaifenesin)

Use for: Productive (wet) cough, chest congestion, thick nasal congestion with mucus or phlegm present, to thin and loosen mucus, making it easier to cough up and clear from the airways.

Not to be given if under 2 years of age
Can be repeated every 4 hours as needed
Maximum of 6 doses in 24 hours

Age	Dose (mL)
2-4 years	2.5-3.75 mL
4-6 years	3.75-5 mL
6-9 years	5-7.5 mL
12 & over	10-20 mL

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Children's Dimetapp

Cold & Allergy

Brompheniramine maleate (antihistamine)

• Use Cold & Allergy for: Nasal congestion, Runny nose, Itchy eyes, Watery eyes, Sneezing, & Itchy throat

Cold & Cough

Brompheniramine maleate (antihistamine) & Dextromethorphan HBr (cough suppressant)

•  Use Cold & Cough for: Runny nose, Itchy eyes, Watery eyes, Sneezing, & nonproductive (dry) cough

Not to be given if under 2 years of age
Can be repeated every 4 hours as needed
Maximum of 4 doses in 24 hours

Age	Dose (mL)
2-4 years	5 mL
4-6 years	7.5 mL
6-9 years	10 mL
9-12 years	15 mL
12 & older	20 mL

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Mucinex Children's Cough Liquid

(Guaifenesin 100 mg/5 mL, Dextromethorphan HBr 5 mg/5 mL)

Use for: Cough relief, chest congestion, thinning and loosening mucus

Not to be given if under 2 years of age
Can be repeated every 4 hours as needed
Maximum of 6 doses in 24 hours
Stop use and consult a doctor if cough persists for more than 7 days or is accompanied by fever, rash, or persistent headache

Age	Dose (mL)
2-4 years	2.5-3.75 mL
4-6 years	3.75-5 mL
6-9 years	5-7.5 mL
9-12 years	7.5-10 mL
12 & over	10-15 mL

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Mucinex - Children's Stuffy Nose & Chest Congestion Liquid

Use for: Productive (wet) cough, chest congestion, thick nasal congestion with mucus or phlegm present, to thin and loosen mucus, making it easier to cough up and clear from the airways.

Not to be given if under 9 months of age
Can be repeated every 4 hours as needed
Maximum of 6 doses in 24 hours

Age	Dose (mL)
9-12 months	1 mL
12-15 months	1.25 mL
15-18 months	1.6 mL
18-24 months	2 mL
2-4 years	2.5-3.75 mL
4-6 years	3.75-5 mL
6-9 years	5-7.5 mL
9-12 years	7.5-10 mL
12 & over	10-15 mL

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Sudafed

(Pseudoephedrine HCl)

Use for: Nasal congestion, sinus pressure, stuffy nose due to colds or allergies

Not to be given to children under 4 years of age
Do not use with MAOIs or within 14 days of stopping MAOI treatment
Consult a doctor before use if you have heart disease, high blood pressure, diabetes, or other medical conditions
Follow recommended dosages and do not exceed the maximum daily dose

Age	Children's Sudafed Liquid (15 mg/5 mL)	Sudafed Sinus Congestion (30 mg tabs)	Sudafed PE Sinus Congestion (10 mg tabs)
4–5 years	5 mL every 4–6 hours (Max: 4 doses in 24 hours)	-	-
6–11 years	10 mL every 4–6 hours (Max: 4 doses in 24 hours)	1 tablet every 4–6 hours (Max: 4 tablets in 24 hours)	-
12+ years	20 mL every 4–6 hours (Max: 4 doses in 24 hours)	2 tablets every 4–6 hours (Max: 8 tablets in 24 hours)	1 tablet every 4 hours (Max: 6 tablets in 24 hours)

ADHD Meds

Meds by Form	Meds by Duration
Meds (Alphabetical)	Co-Occuring Conditions

Screening & Learning Vault

Periodicity Schedule

Periodicity Schedule

Screening Tools

ASQ (Development)

MACHAT (Autism)

PHQ/GAD (Anxiety/Depression)

SCARED (Anxiety)

SWYC (Development)

Vanderbilt (ADHD)

Reference Material