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Medications in pediatrics


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Medications in pediatrics

  1. 1. Vimala Colaco
  2. 2. Atropine• Treatment of sinus pulseless electrical activity, bradycardia, or asystole.. Neonates and children: 0.02mg/kg intratracheal (max: 0.5mg); may repeat5min later, one timeCardiac pacing is required in neonates with ventricular rates of 50 beats/min or experience heart failure after birth. to increase the heart rate temporarily until pacemaker placement can be arranged Preoperative medication to inhibit secretions and salivation• Antidote to organophosphate poisoning.0.02–0.05 mg/kg every 10–20min until atropine effect is seen then q1–4h for at least 24hr.
  3. 3. Cautions: gastrointestinal obstruction, thyrotoxicosis, and tachycardia.Adverse events: Tachycardia, palpitations, delirium, ataxia, dry hot skin, tremor, urinary retention
  4. 4. EpinephrineIndications: Treatment of cardiac arrest, bronchospasm, anaphylactic reaction For asystole or for failure Epinephrine (0.1– 0.3mL/kg of a 1:10,000 solution, intravenously or intratracheally) is given to respond to 30sec of combined resuscitation. The dose may be repeated every 5 minRoutes- IV, intratracheal, continuous infusion and nebulisation
  5. 5. Adverse events:Tachycardia, hypertension, nervousness, restlessness, irritability, headache, tremor, weakness, nausea, vomiting, acute urinary retention.Peripheral soft tissue damage if they extravasate from peripheral lines into the local tissues
  6. 6. Hydrocortisone• Indications: Status asthmaticus, shock [50mg/kg/dose 4h],Treatment of adrenal insufficiency, congenital adrenal hyperplasia,• Caution: Abrupt withdrawal -acute adrenal insufficiency.• Adverse events: Hypertension, hyperglycemia, hypokalemia, euphoria, insomnia, headache, Cushing syndrome, peptic ulcer, cataracts, immunosuppression, skin and muscle atrophy, acne, edema.
  7. 7. Status asthmaticusOxygen inhalation + adrenaline/terbutaline injinhalation salbutamol+ if not ipratropium and loading dose theophylline hydrocortisone (10mg/kg) improve continue terbutaline inj[20- 30min] hydrocortisone 5mg/kg 6-8 hrly
  8. 8. Anaphylactic shock Consider when compatible history of severe allergic-type reaction with respiratory difficulty and/or hypotension especially if skin changes present Oxygen treatment when available Stridor, wheeze, respiratory distress or clinical signs of shock [1] Adrenaline (epinephrine) [2,3] 1:1000 solution 0.5 mL (500 micrograms) IM Repeat in 5 minutes if no clinical improvement Antihistamine (chlorphenamine) 10-20 mg IM/or slow IV IN ADDITION For all severe or recurrent reactions and If clinical manifestations of shock do not patients with asthma give respond to drug treatment give 1-2 litres IV Hydrocortisone fluid. [4] Rapid infusion or one repeat dose 100-500 mg IM/or slowly IV may be necessary
  9. 9. Dopamine• Indication: hypotension and shock• 1–20μg/kg/min IV• Adverse events: Tachycardia, ectopic beats, ventricular arrhythmias, tissue necrosis with extravasation, vasoconstriction, gangrene of extremities, excess urine output (doses <5μg/kg/min), oliguria (doses 10μg/kg/min).
  10. 10. Dose microgm/kg/minStrengthens throughout dose 1-5contractions rangeIncreases renal blood Low/intermediate 5-15flow dosesVasocontriction High dose 15-25
  11. 11. FurosemideIndications: Pulmonary edema-cardiac failure, SIADH, reduction of ICT in combination with mannitol, broncho-pulmonary dysplasiaAdverse events: Dehydration, electrolyte loss, hyperuricemia, photosensitivity, ischemic hepatitis, hypercalciuria, renal stones, ototoxicity (IV infusion rate >4mL/min), gastrointestinal intolerance
  12. 12. Heart failure. It inhibits the reabsorption of sodium and chloride in the distal tubules and the loop of Henle.Acute diuresis should be given intravenous or intramuscular furosemide at an initial dose of 1– 2mg/kg, which usually results in rapid diuresis.Chronic furosemide therapy is then prescribed at a dose of 1–4mg/kg/24hr given between one and four times a day
  13. 13.  Careful monitoring of electrolytes is necessary with long-term furosemide therapy because of the potential for significant loss of potassium. Potassium chloride supplementation is usually required unless the potassium-sparing diuretic spironolactone is given concomitantly.When furosemide is administered every other day, dietary potassium supplementation may be adequate to maintain normal serum potassium levels
  14. 14. Digoxin• Indications :Treatment of systolic heart failure and supraventricular tachyarrhythmias• Cautions: Contraindicated in AV block, idiopathic hypertrophic subaortic stenosis,or constrictive pericarditis• Adverse events: Anorexia, nausea, vomiting, diarrhea, feeding intolerance,bradycardia, arrhythmias, lethargy, depression, vertigo, blurred vision, diplopia, photophobia, yellow or green vision
  15. 15. The drug crosses the placenta, and therefore a fetus with heart failure(secondary to arrhythmia) can be treated by administering digoxin to the mother.The kidney eliminates digoxin, so dosing must be adjusted according to the patientsrenal function.
  16. 16. Digoxin in heart failureRapid digitalization of infants and children in heart failure may be carried out intravenously. The recommended schedule is to give half the total digitalizing dose immediately and the succeeding two one-quarter doses at 12hr intervals later.Maintenance digitalis therapy is started approximately 12hr after full digitalization. The daily dosage is divided in two and given at 12hr .The dosage is one quarter of the total digitalizing doseSlow digitalization –patient not critically ill or initiation of a maintenance digoxin schedule without a previous loading dose .full digitalization in 7–10 days
  17. 17. Monitoring:• Dosing should be guided by measuring serum digoxin concentrations: therapeutic: 0.8–2ng/mL; toxic: >2– 2.5ng/mL.• DLIS - elevate digoxin levels, so pretreatment digoxin levels can be obtained and subtracted from treatment levels or samples can be run through a free-level filter to remove DLIS before assay.• Check post-distribution levels (drawn at least 6–8hr post dose) at steady-state (2–4 wk) or if ECG or clinical signs of toxicity. Check ECG, serum electrolytes, calcium, and magnesium.
  18. 18. Digoxin Immune FabTreatment of digitalis intoxication from digoxin Dose is based on amount of digoxin ingested or estimated total body load based on post-distributive serum concentrationAdverse events: Worsening of heart failure or atrial fibrillation, hypokalemia, facial swelling, and redness.
  19. 19. Naloxone• Indication: opiate excess(overdose, poisoning).• Neonates and children: 0.1mg/kg IV (max dose: 2mg). If no response, repeat q 2–3min until desired effect. May give by continuous IV infusion• Adverse effects May precipitate acute opiate withdrawal. Duration of effect of many opiates may be longer than naloxone requiring individualized naloxone dosing.
  20. 20. Phenytoin• Indications: Anticonvulsant and antiarrhythmic.• Status epilepticus: mg/kg IV Loading dose Maintenance dose Neonates 15-20 5 Children 15-18 .5-6yr 8-10 7-9yr 6-8 10-16yr 6-7
  21. 21. Cautions: Infuse slowly IV; variable oral bioavailability; chewable tablet most consistent. Must shake oral suspension very well before use. Certain disease states (renal failure, acute head trauma) may lead to imbalance between free and protein-bound drug.Fosphenytoin has advantages over the older formulation - it is water soluble, less irritating after IV injection, and well absorbed after intramuscular injection
  22. 22. • Adverse effects: Lethargy, dizziness, nystagmus, hypotension, hirsutism, gingival hyperplasia, rash, Stevens-Johnson syndrome, hepatitis, thrombophlebitis.• Drug interactions: May increase metabolism of certain hepatically cleared drugs; griseofulvin, corticosteroids, cyclosporin; Highly protein boundand may cause displacement interaction.• Monitoring: Phenytoin concentrations: therapeutic 8– 20μg/mL.
  23. 23. PhenobarbitoneIndications: anticonvulsant,sedative, hypnotic, anesthetic, hyperbillubinemiaAnticonvulsant loading dose Children:15 -20mg/kg PO, IV. Maintenance dose Neonates: 3–4mg/kg, Children: 5– 6mg/kg/24hr PO, IV, q12–24h.
  24. 24. • Cautions: Dose titrated to desired effect. Administer IV =30mg/min• Adverse effects: Hypotension, drowsiness, respiratory depression, paradoxical hyperactivity• Drug interactions: May increase metabolism of many hepatically cleared drugs; griseofulvin, corticosteroids. Certain drugs may interfere with phenobarbital metabolism: valproic acid, chloramphenicol, felbamate..
  25. 25. Potassium chlorideIndications: - Hypokalemia < 2.5meq/l, cardiac rhythm disturbances 40mEq/L @ 0.6 mEq/kg/hr under continuous EEG monitoring - Tachyarrhythmias – chronic use of digoxin[max 100m mol)
  26. 26.  Chloride responsive metabolic alkalosis , as a component of mantainance fluids[10/20 meq/l], bronchopulmonary dysplasia ( with hydrochlorothiazide), supplementation (with furosemide in heart failure with digoxin), nonketotic hyperosmolar comaAdverse effects : Hyperkalemia, gastritis
  27. 27. Sodium bicarbonate• Presence of a severe metabolic acidosis(1mEq/kg,) as documented by arterial blood gas analysis and during a prolonged resuscitation when it may be given every 10 min during the arrest• Symptomatic hyperkalemia(>7meq/L), hypermagnesemia, tricyclic antidepressant drug intoxications, or with adverse events due to sodium channel blocking agents• Alkalinization of urine with sodium bicarbonate increases effectiveness of aminoglycosides against in the urinary tract
  28. 28. Alkali therapy may result in hypernatremia, skin slough from infiltration, increased serum osmolarity, hypocalcemia, hypokalemia, Liver injury when oncentrated solutions are administered rapidly through an umbilical vein catheter wedged in the liver
  29. 29. Calcium gluconateHyperkalemia- counteracts the potassium-induced increase in myocardial irritability Calcium gluconate 10% solution, 1.0mL/kg IV, over 3–5 minNeonatal tetany consists of intravenous injections of 5–10mL of a 10% solution of calcium gluconate at the rate of 0.5–1mL/min while the heart rate is monitored.
  30. 30. Symptomatic hypocalcemia in neonates, calcium gluconate is given at a dose of 100–200mg/kg (1– 2mL/kg of a 10% solution).dose may be repeated every 6–8hr until the calcium level stabilizesAlternatively, intravenous infusion can be given Adverse effects :hypercalcemia