rino drugs ppt

1. Dr. RINO SRIRAM &
Dr. DHARANENDRA PRASAD
POST GRADUATES
DEPARTMENT OF PEDIATRICS.
MGMCRI.

2.  Analgesics and antipyretics
 Anti allergics and anti histaminics
 Nebulisations
 Antifailure medications
 GIT drugs
 Antibiotics
 Antiepileptics
 Sedatives
 Take home message
 References

4.  Analgesic, antipyretic
 Neonate: 10–15 mg/kg/dose Q6–8 hr.
 Pediatric: 10–15 mg/kg/dose Q4–6 hr.
 Maximal dose: 90 mg/kg/24 hr.
 To adjust dose in renal failure.
 Causes hepatotoxicity.

5. Analgesic/antipyretic:
 Dose : 5–10 mg/kg/dose Q6–8 hr PO;
 max. dose 40 mg/kg/24 hr
 Closure of ductus arteriosus:
For <32 wk of gestation and 0.5–1.5 kg
(use birth weight to calculate all doses and infuse all doses over 15 min )
 10 mg/kg/dose IV × 1 dose,
 followed by 2 doses of 5 mg/kg/dose each after 24 and 48 hr.

7.  Antihistamine
 Dose : 0.2-0.3mg/kg/dose in Q8H or Q12H.
 Available as Syrup formulations [5mg/5ml]

8.  Antihistamine
 Available forms :
o Tablet : 5mg, 10mg
o Syrup: 5mg/5ml
DOSE:
 6 mo and <2 yr: 2.5 mg PO once daily.
 2–5 yr: 2.5- 5 mg PO once daily.
 ≥6 yr–adult: 5–10 mg PO once daily.
In hepatic impairment, the following doses have been recommended:
 <6 yr: Use not recommended
 6–11 yr: <2.5 mg PO once daily
 ≥12 yr–adult: 5 mg PO once daily

9.  ANTIHISTAMINE
Available forms :
 Tablet : 2.5mg, 5mg
 Syrup: 2.5mg/5ml
DOSE:
 6 months to 5 yrs: 1.25 mg PO once daily.
 6–11 yr: 2.5 PO once daily.

10. Child < 12 yr: 0.35 mg/kg/24 hr PO ÷ Q4–6 hr or dose based on age as follows:
 2–5 yr: 1 mg/dose PO Q4–6 hr; max. dose 6 mg/24 hr
 6–11 yr: 2 mg/dose PO Q4–6 hr; max. dose 12 mg/24 hr

11.  Anti-allergy leukotriene receptor antagonist
Asthma and seasonal allergic rhinitis:
 Child (6 mo–5 yr): 4 mg (oral granules or chewable tablet) PO QHS; minimum
age for use in asthma (per product label) is 12 months.
 Child (6–14 yr): 5 mg (chewable tablet) PO QHS
 Chewable tablet dosage form is contraindicated in phenylketonuric patients

13.  B2 agonist , Bronchodilator
 Dose : 0.15mg/kg/dose
 Available Preparations: Respules, solutions, syrup[2mg/5ml]

14.  B2 agonist, bronchodilator
 Dose : 0.075 – 0.15mg/kg/dose
 Available formulations : inhaler solutions, respules, yrup[1mg/5ml]

15. Anticholinergic agent
Nebulizer treatment: for Acute use
 <12 yr: 250 mcg/dose Q20 min × 3, then Q2–4 hr PRN
 ≥12 yr: 500 mcg/dose Q30 min × 3, then Q2–4 hr PRN
Nebulized treatment: for Non Acute use
 Infant: 125–250 mcg/dose Q8 hr
 Child ≤ 12 yr: 250 mcg/dose Q6–8 hr
 >12 yr and adult: 250–500 mcg/dose Q6–8 hr

16.  Corticosteroid
Dose : 1-2 mg/kg/day
Available forms :
 Tab-5mg, 10mg, 20mg.
 Syrup-5ml/5mg.
Common uses :
 Acute asthma ,
 Nephrotic syndrome
 Antiinflammatory/ Immunosuppressive
 Dose adjustments needed in Liver disease.

18.  Loop diuretic
 Tabs: 20, 40, 80 mg
 Injection: 10 mg/mL (2, 4, 10 mL)
 Oral solution: 10 mg/ 1ml (60, 120 mL), 40 mg/ 5mL (5, 500 mL)
 Neonate :0.5–1 mg/kg/dose Q8–24 hr. Max. dose 2 mg/kg/dose
 Infant and child: 1–2 mg/kg/dose Q6–12 hr Max. dose: 6 mg/kg/dose
 Contraindicated in anuria and hepatic coma.
 Use with caution in hepatic disease.

19.  Angiotensin-converting enzyme inhibitor, antihypertensive
 Tabs: 2.5, 5, 10, 20 mg
 Oral suspension: 0.1, 1 mg/ml
 Dose : 0.1mg/kg/day
 Use in caution in B/L renal artery stenosis.
 S/E : cough

20.  Antiarrhythmic agent, inotrope
 Tabs: 125, 250 mcg
 Oral solution: 50 mcg/mL (60 mL)
 Contraindicated in patients with ventricular dysrhythmias
 adjust dose in renal failure

23.  Gastric acid pump inhibitor
 Dose -1mg/kg/day
 Available forms:
 Tab- 20mg, 40mg
 INJ- 40MG VIAL

24.  Gastric acid pump inhibitor
 Dose : 0.5-1mg/kg/day
 Available forms :
 Tab -15mg, 30mg

25. Histamine-2-antagonist
 PO: 2–4 mg/kg/24 hr ÷ Q8–12 hr
 IV: 2 mg/kg/24 hr ÷ Q6–8 hr
 Tabs: 75,150,300 mg
 Oral syrup: 15 mg/ml
 Injection: 25 mg/ml
 Dose adjustment needed in renal failure

26.  Antiemetic agent, 5-HT3 antagonist
 Dose : 0.15 mg/kg/dose at 30 min before food
 Injection: 2 mg/mL
 Tabs: 4, 8 mg
 Syrup: 2mg/5ml

27.  Trace minerals
Dose:
 <6months – 10mg /day
 >6months – 20 mg /day
 Available forms
 Oral solutions :
 Drops [1ml/20mg]
 Syrup [5ml/20mg]

29.  <2 years : 200mg 1 HS stat
 >2 years : 400 mg 1 HS stat
Available forms :
 Tablet 200mg,400mg
 syrup:200mg/5ml

30.  Antihelmintic
 Chewable tabs: 100 mg (may be swallowed whole or chewed)
Child (>2 yr) and adult:
 Pinworms (Enterobius): 100 mg PO × 1, repeat in 2 wk if not cured.
 Hookworms, roundworms (Ascaris), and whipworm (Trichuris): 100 mg PO BID × 3
days.
Repeat in 3–4 wk if not cured.

32.  AMOXICILLIN
 AMOXICILLIN + CLAVULANIC ACID
 AMPICILLIN + CLOXACILLIN
 AZITHROMYCIN
 CEFOTAXIME
 AMIKACIN
 GENTAMYCIN
 CEFIXIME
 CEFTRIAXONE
 VANCOMYCIN
 PIPERACILLIN + TAZOBACTUM
 CEFAPERAZONE + SULBACTUM
 COLISTIN
 METRONIDAZOLE
 ERYTHROMYCIN

34.  Oral suspension: 125, 250 mg/5 mL (80, 100, 150 mL); and 200, 400
mg/5 mL (50, 75, 100 mL)
 Caps: 250, 500 mg
 Tablets: 500,
Child:
 Standard dose: 25–50 mg/kg/24 hr ÷ Q8–12 hr PO
 High dose (resistant Streptococcus pneumoniae): 80–90 mg/kg/24 hr ÷
BID PO
 Max. dose: 2–3 g/24 hr
 Also combined with Beta lactamase inhibitors[CLAVULANIC ACID]
 Available as 4:1[non duo products], 7:1 [Duo ], 16:1[XR].

36. Clavulanic acid extends the activity of amoxicillin to include β-
lactamase–producing strains of
 Haemophilus influenzae,
 Moraxella catarrhalis,
 Neisseria gonorrhoeae,
 Staphylococcus aureus
 Adjust dose in renal failure .
 Contraindicated in patients with a history of cholestatic jaundice/hepatic
dysfunction.

37. Neonate (IM/IV):
<7 days:
 <2 kg: 50–100 mg/kg/24 hr ÷ Q12 hr
 ≥2 kg: 75–150 mg/kg/24 hr ÷ Q8 hr
 Group B streptococcal meningitis:
200–300 mg/kg/24 hr ÷ Q8 hr
≥7 days:
 <1.2 kg: 50–100 mg/kg/24 hr ÷ Q12 hr
 1.2–2 kg: 75–150 mg/kg/24 hr ÷ Q8 hr
 >2 kg: 100–200 mg/kg/24 hr ÷ Q6 hr
 Group B streptococcal meningitis:
300 mg/kg/24 hr ÷ Q4–6 hr
Infant/child:
Mild/moderate infections:
 IM/IV: 100–200 mg/kg/24 hr ÷ Q6 hr
 PO: 50–100 mg/kg/24 hr ÷ Q6 hr; max.
PO dose: 2–3 g/24 hr
Severe infections:
200–400 mg/kg/24 hr ÷ Q4–6 hr
IM/IV
 Adjust dose in renal failure.

38.  Penicillinase resistant
 Caps: 250, 500 mg.
Child (<40 kg)
 Mild/moderate infections: 12.5–50 mg/kg/24 hr PO ÷ Q6 hr
 Severe infections: 50–100 mg/kg/24 hr PO ÷ Q6 hr
 Max. dose: 2 g/24 hr.
Child (≥40 kg) and adult:
 125–500 mg/dose PO Q6 hr.
 Max. dose 2 g/24 hr.

39.  8:1 ratio of piperacillin to tazobactam
 Injection powder:
2 g piperacillin and 0.25 g tazobactam; 3 g piperacillin and 0.375 g
tazobactam, 4 g piperacillin and 0.5 g tazobactam, 36 g piperacillin and 4.5
g tazobactam.
 All dose calculation based on piperacillin.

40. Neonate:
100 mg/kg/dose IV at the following intervals,
<1 kg:
 ≤14 days old: Q12 hr
 15–28 days old: Q8 hr
≥1 kg:
 ≤7 days old: Q12 hr
 8–28 days old: Q8 hr
Severe infections
 <2 months: 300–400 mg/kg/24 hr ÷ Q6 hr
 2–9 mo: 240 mg/kg/24 hr ÷ Q8 hr
 >9 mo: 300 mg/kg/24 hr ÷ Q8 hr; max. dose: 16 g/24 hr

41. Appendicitis or peritonitis :
 2–9 months: 240 mg/kg/24 hr ÷ Q8 hr
 >9 months–adolescent and ≤40 kg: 300 mg/kg/24 hr ÷ Q8 hr
 >9 months–adolescent and >40 kg: 3 g Q6 hr; max. dose: 16 g/24 hr

43. Neonate:
Postnatal age ≤ 7 days:
 <2000 g: 100 mg/kg/24 hr ÷ Q12 hr
 ≥2000 g: 100–150 mg/kg/24 hr ÷ Q8–12 hr
Postnatal age > 7 days:
 <1200 g: 100 mg/kg/24 hr ÷ Q12 hr
 1200–2000 g: 150 mg/kg/24 hr ÷ Q8 hr
 >2000 g: 150–200 mg/kg/24 hr ÷ Q6–8 hr
Infant and child (1 mo–12 yr and <50 kg):
 100–200 mg/kg/24 hr ÷ Q6–8 hr IV/IM.

44. Meningitis:
 200 mg/kg/24 hr ÷ Q6 hr IV/IM.
 Higher doses of 225–300 mg/kg/24 hr ÷ Q6–8 hr, in combination with vancomycin
(dosed at CNS target levels), have been recommended for meningitis due to penicillin-
resistant pneumococci.
 Max. dose: 12 g/24 hr
 Child (>12 yr or ≥50 kg) and adult: 1–2 g/dose Q6–8 hr IV/IM
 Severe infection: 2 g/dose Q4–6 hr IV/IM
 Max. dose: 12 g/24 hr
 Uncomplicated gonorrhea: 0.5–1 g × 1 IM

45. Neonate:
 Gonococcal ophthalmia or prophylaxis: 25–50 mg/kg/dose IM/IV ,max. dose: 125 mg/dose
Infant (>1 mo) and child:
 Mild/moderate infections: 50–75 mg/kg/24 hr ÷ Q12–24 hr IM/IV; max. dose 2 g/24 hr
 Meningitis (including penicillin-resistant pneumococci):
100 mg/kg/24 hr IM/IV ÷ Q12 hr; max. dose 2 g/dose and 4 g/24 hr
 Penicillin-resistant pneumococci outside of CSF:
80–100 mg/kg/24 hr ÷ Q12–24 hr; max. dose 2 g/dose and 4 g/24 hr
 Acute otitis media: 50 mg/kg IM × 1; max. dose 1 g
 Adult: 1–2 g/dose Q12–24 hr IV/IM; max. dose 2 g/dose and 4 g/24 hr
 Bacterial endocarditis prophylaxis for dental and upper respiratory procedures:
Infant and child: 50 mg/kg IV/IM (max. dose 1 g) 30 min before procedure
Adult: 1 g IV/IM 30 min before procedure

46.  Oral suspension: 100 mg/5 mL (50, 75 mL)
 Tabs: 400 mg
 Infant (>6 mo) and child:
8 mg/kg/24 hr ÷ Q12–24 hr PO; max. dose 400 mg/24 hr
 Acute UTI:
16 mg/kg/24 hr ÷ Q12 hr on day 1, followed by 8 mg/kg/24 hr Q24 hr PO ×13
days. Max. dose 400 mg/24 hr.
 Adjust dose in renal failure

48.  Infant and child:
15–22.5 mg/kg/24 hr ÷ Q8 hr IV/IM;
 Infants and patients requiring higher
doses (e.g., cystic fibrosis) may receive
initial doses of 30 mg/kg/24 hr ÷ Q8 hr
IV/IM
 Dose adjustment required in case of renal
failure.
 May cause ototoxicity, nephrotoxicity,
neuromuscular blockade, and rash

49. AVAILABLE FORMS:
 Injection: 10 mg/mL (2 mL), 40 mg/mL (2, 20 mL)
 Premixed injection in NS: 40 mg (50 mL), 60 mg (50 mL), 70 mg (50 mL), 80 mg (50, 100 mL),
90 mg (100 mL), 100 mg (50, 100 mL), 120 mg (50, 100 mL)
 Ophthalmic ointment: 0.3% (3.5 g)
 Ophthalmic drops: 0.3% (5, 15 mL)
 Topical ointment: 0.1% (15, 30 g)
 Topical cream: 0.1% (15, 30 g)

50.  Child: 7.5 mg/kg/24 hr ÷ Q8 hr
 Adult: 3–6 mg/kg/24 hr ÷ Q8 hr
 Cystic Fibrosis: 7.5–10.5 mg/kg/24 hr ÷ Q8
hr
 Intrathecal/intraventricular :
 Newborn: 1 mg once daily
 >3 mo: 1–2 mg once daily
 Adult: 4–8 mg once daily
 Ophthalmic ointment: Apply Q8–12 hr
 Ophthalmic drops: 1–2 drops Q2–4 hr
 Dose adjustment required in renal failure.

52.  Tabs: 250, 500 mg
 Delayed-release tabs: 250, 333, 500 mg
 Delayed-release caps: 250 mg
 Topical ointment: 2% (25 g)
 Topical gel: 2% (30, 60 g); contains alcohol 92%
 Topical solution: 2% (60 mL); may contain 44%–66% alcohol
 Topical pad/swab: 2% (60s)
 Ophthalmic ointment: 0.5% (1, 3.5 g)

53.  Chlamydial conjunctivitis and pneumonia:
50 mg/kg/24 hr ÷ Q6 hr PO × 14 days; max. dose 2 g/24 hr
 Child :
30–50 mg/kg/24 hr ÷ Q6–8 hr; max.
 Pertussis:
40–50 mg/kg/24 hr ÷ Q6 hr PO × 14 days
 Parenteral:
Child: 20–50 mg/kg/24 hr ÷ Q6 hr IV
Adult: 15–20 mg/kg/24 hr ÷ Q6 hr IV
Max. dose: 4 g/24 hr
 Rheumatic fever prophylaxis:
500 mg/24 hr ÷ Q12 hr PO

54.  Tablets: 250, 500, 600 mg
 Oral suspension: 100 mg/5 mL, 200 mg/5 mL
 Oral Powder (Sachet): 1 g
 Injection: 500 mg
 Ophthalmic solution (Azasite): 1% (2.5 mL)

55. Infant and child:
Otitis media (≥6 mo):
 5-day regimen: 10 mg/kg PO on day 1 (max. dose: 500 mg), followed by 5 mg/kg/24 hr PO once
daily (max. dose: 250 mg/24 hr) on days 2–5
 3-day regimen: 10 mg/kg/24 hr PO once daily × 3 days (max. dose: 500 mg/24 hr)
 1-day regimen: 30 mg/kg/24 hr PO × 1 (max. dose: 1500 mg/24 hr)
Community-acquired pneumonia (≥6 mo):
 Tablet or oral suspension: Use otitis media 5-day regimen.
 Extended-release oral suspension (Zmax): 60 mg/kg (max. dose: 1500 mg) PO × 1.

56.  Pharyngitis/tonsillitis (2–15 yr):
12 mg/kg/24 hr PO once daily × 5 days (max. dose: 500 mg/24 hr)
 Acute sinusitis (≥6 mo):
10 mg/kg/dose (max. dose: 500 mg) PO once daily × 3 days
 Pertussis:
Infant < 6 mo: 10 mg/kg/dose PO once daily × 5 days
≥6 months: 10 mg/kg/dose (max. dose: 500 mg) PO × 1, followed by 5 mg/kg/day
(max. dose: 250 mg) PO once daily on days 2–5
 Scrub typhus: 10mg/kg/day x 5 days

57.  Antibiotic, antiprotozoal
 Tabs: 250, 500 mg
 Caps: 375 mg
 Oral suspension: 10 mg/mL or 50 mg/ml
 Injection: 500 mg;

58. Amebiasis:
 Child: 35–50 mg/kg/24 hr PO ÷ TID × 10 days
 Adult: 500–750 mg/dose PO TID × 10 days
Anaerobic infection:
 Neonate, PO/IV:
 Infant/child/adult:
IV/PO: 30 mg/kg/24 hr ÷ Q6 hr; max. dose: 4 g/24 hr
<7 days: ≥7 days:
<1.2 kg: 7.5 mg/kg/dose Q48 hr
1.2–2 kg: 7.5 mg/kg/dose Q24 hr
≥2 kg: 15 mg/kg/24 hr ÷ Q12 hr
<1.2 kg: 7.5 mg/kg Q24 hr
1.2–2 kg: 15 mg/kg/24 hr ÷ Q12 hr
≥2 kg: 30 mg/kg/24 hr ÷ Q12 hr

59. CNS - ANTIEPILEPTICS

60.  Benzodiazepine, anticonvulsant
 Dose : 0.75mg/kg/day.
 Adjust dose in hepatic impairment.

61.  Benzodiazepine
 0.05–0.1 mg/kg IV/IM, max dose 4 mg
 DOC in status epilepticus
 Long duration of action
 May be repeated Q10-15min for 3 doses

62.  Benzodiazepines
 Short onset of action[1.5-5 mins],
 Short duration of action[1-5 hours]
 Dose : 0.05- 0.1 mg/kg Q10min for 3 doses
 IM Dose: 0.2 mg/kg

63.  Benzodiazepine, anxiolytic, anticonvulsant.
 Sedative/muscle relaxant:
Child:
 IM or IV: 0.04–0.2 mg/kg/dose Q2–4 hr; max. dose 0.6 mg/kg within an 8-hr period
 PO: 0.12–0.8 mg/kg/24 hr ÷ Q6–8 hr
Adult:
 IM or IV: 2–10 mg/dose Q3–4 hr PRN
 PO: 2–10 mg/dose Q6–12 hr PRN
 Status epilepticus:
 Neonate: 0.3–0.75 mg/kg/dose IV Q15–30 min × 2–3 doses; max. total dose: 2 mg.
 Child > 1 mo: 0.2–0.5 mg/kg/dose IV Q15–30 min; max. total dose <5 yr, 5 mg; ≥5 yr, 10 mg
 Contraindicated in myasthenia gravis, severe respiratory insufficiency, severe hepatic failure,
and sleep apnea syndrome.

64.  Barbiturate
Available forms:
 Tabs: 15, 16.2, 30, 32.4, 60, 64.8, 97.2, 100 mg
 Oral solution: 20 mg/5 mL.
 Injection: 65, 130 mg/mL.
Status epilepticus:
Loading dose, IV:
 Neonate, infant, and child: 15–20 mg/kg/dose (max. loading dose: 1000
mg)
 May give additional 5-mg/kg doses Q15–30 min to a max. total of 40
mg/kg

65. Maintenance dose, PO/IV:.
 Neonate: 3–5 mg/kg/24 hr ÷ once daily–BID
 Infant: 5–6 mg/kg/24 hr ÷ once daily–BID
 Child 1–5 yr: 6–8 mg/kg/24 hr ÷ once daily–BID
 Child 6–12 yr: 4–6 mg/kg/24 hr ÷ once daily–BID
 >12 yr: 1–3 mg/kg/24 hr ÷ once daily–BID
 Hyperbilirubinemia
(<12 yr): 3–8 mg/kg/24 hr PO ÷ BID–TID. Doses up to 12 mg/kg/24 hr have been used.
 Preoperative sedation (child):
1–3 mg/kg/dose IM/IV/PO . Give 60–90 min before procedure.
Contraindicated in porphyria, severe respiratory disease with dyspnea, or obstruction

66.  Anticonvulsant, class Ib antiarrhythmic
Status epilepticus:
 Loading dose (all ages): 15–20 mg/kg IV [Max. dose: 1500 mg/24 hr]
 Maintenance for seizure disorders (initiate 12 hr after administration of loading
dose):
Neonate:
Start with 5 mg/kg/24 hr PO/IV ÷ Q12 hr.
Infant/child:
Start with 5 mg/kg/24 hr ÷ BID–TID PO/IV.
Usual dose ranges are (doses divided BID–TID):
 6 mo–3 yr: 8–10 mg/kg/24 hr
 4–6 years: 7.5–9 mg/kg/24 hr
 7–9 years: 7–8 mg/kg/24 hr
 10–16 years: 6–7 mg/kg/24 hr

67. Antiarrhythmic (secondary to digitalis intoxication):
 Loading dose (all ages): 1.25 mg/kg IV Q5 min up to a total of 15 mg/kg
 Maintenance:
Child (IV/PO): 5–10 mg/kg/24 hr ÷ Q8–12 hr
Contraindicated in patients with heart block or sinus bradycardia,

68.  Caps: 250 mg
 Delayed-release caps: 125, 250, 500 mg
 Syrup: 250 mg/5 mL (473 mL),
 Injection: 100 mg/mL (5mL)
DOSE:
 Initial: 10–15 mg/kg/24 hr ÷ once daily–TID
 Maintenance: 30–60 mg/kg/24 hr ÷ BID–TID.
 Contraindicated in hepatic disease, pregnancy, mitochondrial disorders with
mutations in DNA polymerase gamma.

69.  Acting via non-GABAergic mechanism.
 Available forms :
 Tabs: 250, 500, 750, 1000 mg
 Oral solution: 100 mg/mL
 Injection: 100 mg/mL (5 mL)
IV DOSE :
STATUS EPILEPTICUS :
 20-30mg/kg/ loading followed by 10mg/kg/dose Q6-12H,
can increase upto 10-20mg/kg Q6H to a maximum of 80mg/kg/day, not exceeding 3grams/day.
 Dose adjustment required in Renal failure.

70. Partial seizures:
 Infant (1–5 mo):
Start at 7 mg/kg/dose PO BID; increase by 7 mg/kg/dose BID every
2 wk as tolerated to the recommended dose of 21 mg/kg/dose BID.
An average daily dose of 35 mg/kg/24 hr was reported in clinical trials.
 Infant ≥ 6 mo–child 3 yr (>20 kg):
Start at 10 mg/kg/dose PO BID; increase by 10 mg/kg/dose BID
every 2 wk as tolerated to the recommended dose of 25 mg/kg/dose BID.
An average daily dose of 47mg/kg/24 hr was reported in clinical trials.
 Child 4–15 yr:
Start at 10 mg/kg/dose PO BID; increase by 10 mg/kg/dose BID every 2 wk as
tolerated up to a max. dose of 30 mg/kg/dose BID or 3000 mg/24 hr.
An average daily dose of 44 mg/kg/24 hr was reported in clinical trials.

72.  Available as syrup [5ml/500mg].
 Dose [20-30mg/kg ].

73.  Melatonin is a natural hormone produced by the pineal gland in the body.
 Synthetic compound, which plays equivalent role of natural hormone,
helps in sedation
 Melatonin is available in 1 mg, 3 mg, 5 mg and 10 mg strengths

74. Maintenance Dose:
In patients with renal insufficiency, the dose may be adjusted by ,
1. Interval extension (I):
Lengthen intervals between individual doses, keeping dose size normal.
2. Dose reduction (D):
Reduce amount of individual doses, keeping interval between doses normal,
recommended when a relatively constant blood level of drug is desired.
3. Interval extension and dose reduction (DI):
Both lengthen interval and reduce dose.
4. Interval extension or dose reduction (D, I):
In some instances, either dose or interval can be changed.

75.  Dose is calculated according to schwartz formula,
 CREATININE CLEARANCE = HEIGHT[cm] x K
sr.Creatinine [mg/dl]
K is constant
 Preterm = 0.33
 Term = 0.45
 Children and adolescent girls = 0.55
 Adolescent boys = 0.70

76.  HARRIET LANE – HANDBOOK
 FRANK SHANN – DRUG DOSAGES
 SUCHITRA RANJITH – PEDIATRIC EMERGENCY TEXT BOOK
 GOODMAN & GILMAN'S THE PHARMACOLOGICAL BASIS OF
THERAPEUTICS,