Commonly used drugs in children By Dr Sachin Rathod

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Commonly used drugs in children

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Commonly used drugs in children By Dr Sachin Rathod

  1. 1. Dr Sachin Rathod Email:- drsachin.rathod@yahoo.com
  2. 2. Analgesics in Pediatric Dentistry  Concepts About Pain in Children. 1. Children have higher tolerance to pain. 2. Pain perception is low because of biologic immaturity. 3. Little or no memory of a painful experience. 4. More sensitive to side-effect of analgesics. 5. Special risk for addiction to narcotics.
  3. 3. Classification of Analgesics  Centrally acting (narcotic)  Peripherally acting (non-narcotic)
  4. 4. Centrally Acting Analgesics  These are more effective against acute pain. But have a greater incidence of adverse effect.  They usually are administered parenterally and are devoid of anti-inflammatory and antipyretic effect.  Recent Opioid Analgesics 1. Alfentanil 2. Remifentanil 3. Tramadol
  5. 5. Alfentanil & Remifentanil Mechanism of action • Rapid onset (within 1-1.5 min) • Metabolized in liver • Half-life is 1-2 hours Uses • Short , pain full procedures requiring intense analgesia and blunting of stress responses. • Remifentanil for longer neurosurgical procedures where rapid emergence from anesthesia is important. Commercial forms • ALFENTA (Alfentanil) • ULTIVA (Remifentanil)
  6. 6. Tramadol Mechanism of action • Weak agonist at all type of opioid receptors with some selectivity for µ receptors. Uses • Mild to moderate pre-and postoperative pain. • Severe acute or chronic pain, cancer pain Commercial forms • CONTRAMAL • CONTRAAL DT • DOLOMED • DOLOTRAM • TRAMOL
  7. 7. Peripherally acting Analgesics  These are less effective against severe pain. But have a lower incidence of adverse effects.  They usually are administered orally and are used for chronic low grade pain.  Some possess anti-inflammatory and antipyretic effect. • Ibuprofen • Diclofenac • Nimesulide • Paracetamol.
  8. 8. Combination therapy for pain  Ibuprofen & Paracetamol.  Diclofenac sodium & Paracetamol.  Nimesulide & Paracetamol.  Mefenamic & Paracetamol.
  9. 9. Dose Calculation for Children 1. Clark’s rule child’s weight in Ib X adult dose = child’s dose 150 2. Young’s rule Age of child X adult dose = child’s dose Age + 12
  10. 10. Commonly used Antibiotics in children
  11. 11.  AMOXICILLIN  Action: interferes with cell wall replication of susceptible organisms, the cell wall rendered osmatically instable, swells & bursts from osmatic pressure .  Dose: 20-40 mg/kg/day 3 divided doses  Adverse reaction: increased thirst, nausea, vomiting, diarrhea, pruritus urticaria, angione- urotic edema, bronchospasm, anaphylaxis.  Contra- indication: Hypersensitivity to penicillin, neonates.
  12. 12.  AMOXICILLIN + CLAVUNATE POTASSIUM  Action: interferes with cell wall replication of susceptible organisms, the cell wall rendered osmatically instable, swells & bursts from osmatic pressure .  Dose: 20-40 mg/kg/day 3 divided doses  Adverse reaction: Discolored tongue,glossititis,increased thirst, nausea, vomiting, diarrhea, pruritus,urticaria, bronchospasm, anaphylaxis.  Contra- indication: Hypersensitivity to penicillin, neonates.
  13. 13.  AMOXICILLIN + CLOXACILLIN  Action: interferes with cell wall replication of susceptible organisms, the cell wall rendered osmatically instable, swells & bursts from osmatic pressure .  Dose: 50-100 mg/kg/day 3 divided doses  Adverse reaction: increased thirst, nausea, vomiting, hyperkalemia, pruritus,urticaria, bronchospasm, anaphylaxis.  Contra- indication: Hypersensitivity to penicillin.
  14. 14.  AMPICILLIN  Action: interferes with cell wall replication of susceptible organisms, the cell wall rendered osmatically instable, swells & bursts from osmatic pressure .  Dose: 50-100 mg/kg/day 3 divided doses  Adverse reaction: Discolored tongue, glossititis, rush, increased thirst, nausea, vomiting, diarrhea, pruritus,urticaria, glomerulonephritis, angioneurotic edema, bronchospasm, anaphylaxis.  Contra- indication: Hypersensitivity to penicillin,
  15. 15.  CEPHALEXIN  Action: inhibits bacterial cell wall synthesis, rendering cell wall osmotically unstable.  Doses: 50-100 mg/kg/day  Adverse reaction: candidiasis, glossitis, nausea, vomiting , diarrhea, anorexia, pseudomembranous colitis, nephrotoxicity, urticaria, rash, anaphylaxis.  Contraindications: hypersensitivity to penicillin, pregnancy, infants < 1 month.
  16. 16.  COTRIMOXAZOLE (sulfamethoxazole + trimethoprim )  Action: sulfamethoxazole interferes with bacterial biosynthesis of proteins by competitive antagonism of PABA, trimethoprim blocks synthesis of tetrahydrofolic acid, this combination blocks 2 consecutive synthesis of essential nucleic acids, proteins  Doses: 8mg/kg/day  Adverse reaction; candidiasis, stevens- johnson syndrome, anaphylaxis, SLE, nausea, vomiting, diarrhea, hepatitis, enterocolitis, leukopenia, agranulocytosis, renal failure.  Contraindication : hypersensitivity to trimethoprim or sulfame-thoxazole megaloblastic anemia, infants < 2 months,
  17. 17.  ERYTHROMYCIN  Action: binds to SDS ribosomal susceptible bacteria and suppresses protein synthesis.  Doses: 30-50 mg/kg/day  Adverse reaction: candidiasis, rash, pruritus, hypersensitivity, nausea, vomiting, diarrhea, hepatotoxicity, abdominal pain, pseudomembranous tinnitus.  Contraindications: hypersensitivity to pre- existing hepatic disease.
  18. 18.  METRONIDAZOLE  Action: in anaerobic microorganisms metronidazole is converted to active form by reduction of its nitro group. This gets bound to DNA and prevents nucleic acid formation.  Doses : 5 mg/ kg  Adverse reaction ; dry mouth, furry tongue,, bitter taste, metallic taste, leukopenia, bone-marrow aplasia, rash, urticaria, nausea, vomiting, diarrhea, abdominal pain, nephrotoxicity.  Contraindication: hypersensitivity to this drug, renal disease, pregnancy, lactation, hepatic disease, alcoholic patients.
  19. 19. Recent advanced in Antibiotics Fourth generation Cephalosporins  Cefepime  Developed in 1990s  Antibacterial spectrum similar to 3rd generation  Resistance to β-lactamases  Cefepirome  Recently marketed in India.  Used for treatment of serious hospital-based infection  Better penetration through gram-negative bacteria  More potent than 3rd generation
  20. 20. Newer Macrolides
  21. 21.  ROXITHROMYCIN  Semi-synthetic, long acting, acid–stable with anti microbial spectrum resembling erythromycin. Indication  Respiratory infections  ENT infections  Skin & soft tissue infection  Genital track infections Dosage  Adult 150 mg BD  Children 2.5 -5 mg / kg BD Commercial forms  ROXID  ROXEM  ROXIBID  150 mg & 50 mg kid tab.
  22. 22.  CLARITHROMYCIN  Antimicrobial spectrum resembling erythromycin Indication  First line drug in Mycobacterium avium complex in AIDS patients. Dosage  250 mg BD for 7 days  Severe cases 500 mg BD for 14 days Commercial forms  CLARIBID  CELEX  CLARIMAC
  23. 23.  AZITHROMYCIN  Antimicrobial spectrum expanded as compared to erythromycin.  Active against H.influenzae.  High activity on respiratory pathogens  Good activity against Mycobacterium avium complex in AIDS patients. Indication  Pharyngitis  Tonsillitis  Sinusitis  Staphylococcal & streptococcal skin & soft tissue infection  MAC in AIDS patients Dosage  500 mg OD  Children above 6 months 10 mg / kg of 3 days Commercial forms  ZITHROMAC  AZITHRAL  AZIWOK
  24. 24. Dr Sachin Rathod Email:- drsachin.rathod@yahoo.com

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