Proper Case Presentation for Dengue Fever, Prevention, Treatment and everything else. Prepared by Dr Zain Khan, Doctor at Liaquat College of Medicine and Dentistry
Proper Case Presentation for Dengue Fever, Prevention, Treatment and everything else. Prepared by Dr Zain Khan, Doctor at Liaquat College of Medicine and Dentistry
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
o Information can be used by those who need updated and good quality knowledge about medicine.
o Healthcare providers, such as doctors, pharmacists or nurses and allied health care professionals to help them prescribe ,dispense and administer medicines safely.
o Patients or their care givers, Researchers and general public.
YouTube link: https://youtu.be/gjLi0cwzFz4
Imatinib 100 mg capsules smpc taj pharmaceuticalsTaj Pharma
IMATINIB Taj Pharma : Uses, Side Effects, Interactions, Pictures, Warnings, IMATINIB Dosage & Rx Info | IMATINIB Uses, Side Effects -: Indications, Side Effects, Warnings, IMATINIB - Drug Information - Taj Pharma, IMATINIB dose Taj pharmaceuticals IMATINIB interactions, Taj Pharmaceutical IMATINIB contraindications, IMATINIB price, IMATINIB Taj Pharma Cancer, oncologyImatinib 100 mg capsules. SMPC- Taj Pharma . Stay connected to all updated on IMATINIB Taj Pharmaceuticals Taj pharmaceuticals Hyderabad.
Omeprazole 20mg gastro resistant capsules smpc taj pharmaceuticalsTaj Pharma
Omeprazole - Drug Information - Taj Pharma, Omeprazole dose Taj pharmaceuticals Omeprazole interactions, Taj Pharmaceutical Omeprazole contraindications, Omeprazole price, Omeprazole Taj Pharma Omeprazole 20mg Gastro-resistant Capsules SMPC- Taj Pharma . Stay connected to all updated on Omeprazole Taj Pharmaceuticals Taj pharmaceuticals Hyderabad.
Genetic polymorphisms are variations in gene sequences that occur in at least 1% of the general population, resulting in multiple alleles or variants of a gene sequence.
The most commonly occurring form of genetic variability is the single nucleotide polymorphism (SNP, often called “snip”)
Population pharmacokinetics is the study of the sources and correlates of variability in drug concentrations among individuals who are the target patient population receiving clinically relevant doses of a drug of interest
Clinical pharmacokinetics is the discipline that applies pharmacokinetic concepts and principles in humans in order to design individualized dosage regimens which optimize the therapeutic response of a medication while minimizing the chance of an adverse drug reaction.
Cardiac cycle is defined as the succession of coordinated events taking place in the heart during each beat. Each heart beat consists of two major periods called systole and diastole.
Although some lymphocytes have a lifetime measured in years, most formed elements of the blood last only hours, days, or weeks, and must be replaced continually.
Negative feedback systems regulate the total number of RBCs and platelets in circulation, and their numbers normally remain steady.
The abundance of the different types of WBCs, however, varies in response to challenges by invading pathogens and other foreign antigens.
The heart has four chambers. The two superior receiving chambers are the atria (= entry halls or chambers), and the two inferior pumping chambers are the ventricles (= little bellies).
On the anterior surface of each atrium is a wrinkled pouchlike structure called an auricle
Desmopressin
Lypressin
Terlipressin
Felypressin
Argipressin
ornipressin
Desmopressin: It is a selective V2-receptor agonist and is more potent than vasopressin as an antidiuretic. It has negligible vasoconstrictor action. It is administered by oral, nasal and parenteral routes. Lypressin: It acts on both V1- and V2-receptors. It is less potent but longer acting than vasopressin. It is administered parenterally. Terlipressin: It is a prodrug of vasopressin with selective V1 action. It is administered intravenously. Felypressin: It is a synthetic analogue of vasopressin. It is mainly used for its vasoconstrictor (V1 ) action along with local anaesthetics to prolong the duration of action. Felypressin should be avoided in pregnancy because of its oxytocic (uterine stimulant) activity.
Management of Peripheral Neuropathy and Cardiovascular Effects in Vitamin B1...PARUL UNIVERSITY
Peripheral nerves are susceptible to damage by a wide array of toxins, medications, and vitamin
deficiencies. Vitamin B12 (VB12) deficiency neuropathy is a rare debilitating disease that affects
mostly the elderly. It is important to consider these etiologies when approaching patients with a variety
of neuropathic presentations in this review were have included most relevant and latest information on
mechanisms causing Peripheral neuropathy in VB12 deficiency. We also have included cardiovascular
disorders and their management. Hyperhomocysteinemia has been implicated in endothelial
dysfunction and cardiovascular disease. The association of homocysteine (Hcy) and VB12 with
cardiovascular risk factors in patients with coronary artery disease (CAD) has also been studied
Moyamoya disease (MMD) is a rare and unique cerebrovascular disease. The term “moyamoya” is Japanese and refers to a hazy puff of smoke or cloud. In people with moyamoya disease, this is how the blood vessels appear in the angiogram. MMD is characterized by the progressive stenosis of the distal internal carotid artery (ICA) resulting in a hazy network of basal collaterals called moyamoya vessels. This may be a consequence of Mutations in a few genes. In addition, MMD is also associated with many genetically transmitted disorders, including neurofibromatosis, Down syndrome, Sickle cell anemia, and Collagen vascular disease. It follows bimodal age distribution. Younger populations present with ischaemic symptoms, whereas adults show hemorrhagic symptoms The exact cause remains unknown. Immune, genetic and other factors contribute to this disease. It follows complex pathophysiology resulting in neovascularization as a compensatory mechanism. Diagnosis is based on cerebral angiography using the DSA scale. Treatment involves managing symptoms with medicine or surgery, improving blood flow to the brain, and controlling seizures. Revascularization helps to rebuild the blood supply to the underside of the brain.
A case report on Rheumatoid Arthritis with sickle cell traitPARUL UNIVERSITY
A female patient aged 6 years, a suspected case of sickle cell trait (SCT) having symptoms of Rheumatoid arthritis (RA),
while evaluating joint complaints in adult sickle cell disease (SCD) patients, a number of sickle cell-based entities come
to mind such as avascular necrosis, osteomyelitis, bone infarcts, and septic arthritis. RA is a chronic systemic
inflammatory disease, many reports highlighted the occurrence of RA in SCD presenting as diagnostic challenges for
cases with chronic inflammatory arthritis, SCT also have appeared to persist in some populations at a perplexingly high
rate given the degree of early mortality of homozygosity of SCD, our case report showed that not only SCD but if a patient
has SCT they can develop RA as complication. Our case report concludes that during the evaluation of a SCT patient who
presents with chronic synovitis, one should strongly consider the possibility of coexistence of RA and SCT.
The appendicular skeleton consists of the
shoulder girdle with the upper limbs and the
pelvic girdle with the lower limbs
Shoulder girdle and upper limb:
Each shoulder girdle consists of:
•1 clavicle
•1 scapula.
Each upper limb consists of the following bones:
1 humerus, 1 radius, 1 ulna, 8 carpal bones, 5 metacarpal bones and 14 phalanges.
Histamine is a biogenic amine present in many animal and plant tissues that function as neurotransmitters and are also found in non-neural tissues, have complex physiologic and pathologic effects through multiple receptor subtypes, and are often released locally.
It is also present in venoms and stinging secretions. It is synthesized by decarboxylation of the amino acid, histidine. Histamine is mainly present in storage granules of mast cells in tissues like skin, lungs, liver, gastric mucosa, placenta, etc. It is one of the mediators involved in inflammatory and hypersensitivity reactions.
Anabolic steroids promote protein synthesis and increase muscle mass, resulting in weight gain.
Testosterone is secreted by the testis and is the main androgen in the plasma of men. In women, testosterone (in small amounts) is secreted by the ovary and adrenal glands. Many of the androgens are modified forms of testosterone
Kinetics: Absorbed orally and from of injection site and undergoes rapid first pass metabolism and quick metabolism respectively. In order to retard the rate of absorption, testosterone esters in oil are used which are less polar than the free steroid.
DKA
HHS
CASE DISCUSSION
DIABETES COMPLICATION
Hyperglycaemia is the main cause leading to dehydration due to osmotic diuresis which, if severe, results in hyperosmolarity. In HHS, unlike diabetic ketoacidosis, there is no significant ketone production and therefore no severe acidosis.
Hyperosmolarity may increase blood viscosity and the risk of thromboembolism. Factors precipitating HHS are infection, myocardial infarction, poor adherence with medication regimens or medicines which cause diuresis or impair glucose tolerance, for example, glucocorticoids.
A study on the pharmacological management of mineral bone disease in chronick...PARUL UNIVERSITY
In patients with chronic kidney disease (CKD), along with progression of CKD,
abnormalities of mineral and bone metabolism develop, which result in altered serum levels of minerals
such as calcium and phosphorus, as well as abnormalities in parathyroid hormone (PTH) or vitamin D
metabolism. Chronic Kidney Disease-Mineral Bone Disease (CKD-MBD) is a serious burden because of
increased cardiovascular mortality thus making therapeutic improvements essential in CKD-MBD. The
present study was aimed at evaluation of pharmacological management of CKD-MBD.
Methods:A retrospective study including 180 patients divided into two groups of 90 each (diabetes
mellitus and non-Diabetes) was performed in the Department of Nephrology, SVIMS, Tirupati. Patients
who were on follow up for at least 3 years (2015-2017) were considered, serum parameters were measured at every six months with a total of 6 visits. First visit was taken as baseline and sixth visit as
conclusion.
Results:The disease incidence of CKD-MBD is more common in male patients i.e. 67.8%. Serum calcium
levels were significantly increased and eGFR was significantly decreased in all patients with CKD at
conclusion compared to baseline.Further, Serum calcium levels were significantly increased at conclusion
in CKD patients without DM and eGFR was significantly decreased at conclusion compared to baseline
in CKD patients with DM. The proportion of untreated patients is high for all the drugs except vitamin D
analogues in both subgroups of CKD patients.
Conclusion:Pharmacological intervention in CKD patients helps in the effective management of mineral
bone disease by maintaining serum calcium, phosphate and calcium phosphorous product status.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Evaluation of antidepressant activity of clitoris ternatea in animals
Case presentation on paediatrics
1. CASE PRESENTATION ON
PAEDIATRICS
Presented By
Meraj Fatima, PharmD 4th Year.
Sultan-ul-Uloom College of Pharmacy
Hyderabad, India.
Guided by
Dr. S P Srinivas Nayak, Assistant Professor
Dept. of Pharmacy Practice, SUCP
2. Case:
A 7year old male patient weighting 16kg Presented in the
emergency department with a 2-day history of worsening groin
and hip pain. Could not bear weight. Patient was febrile with a
temperature of 39.2°C, vomiting and dehydrated. There was
no history of injury. There is no previous medical history, No
known drug allergies, no drug history
Differential diagnosis :
Septic arthritis, Osteomyelitis
Dept. of pharmacy practice, SUCP, HYDERABAD 2
3. Test results :
Bone scan revealed right pubic osteomyelitis
CRP = 56mg/L (normal range 0–10mg/L)
ESR = 34mm/h (normal range 1–10mm/h)
Blood culture revealed - Staphylococcus
aureus sensitive to flucloxacillin
Dept. of pharmacy practice, SUCP, HYDERABAD 3
4. Medication prescribed :
■ Flucloxacillin i.v. 800mg four times a day for 2 weeks.
■ To be followed by oral flucloxacillin 800mg four times a
day for 4 weeks.
Progress :
■ Temperature settled and ESR/CRP decreased following
initiation of antibiotic therapy.
Dept. of pharmacy practice, SUCP, HYDERABAD 4
5. On the third day of treatment the patient
developed a raised red rash which was
suspected of being an allergic reaction to
flucloxacillin.
Treatment was changed to i.v. Clindamycin
160mg three times a day (10mg/kg/dose) for 2
weeks followed by oral clindamycin 160mg
three times a day for a further 4 weeks.
Dept. of pharmacy practice, SUCP, HYDERABAD 5
6. Comments on drug therapy and
monitoring required:
•Body weight appears low for age; therefore, need to check if the
weight is correct (expected weight for a 7-year old to be approx. 23kg). If
incorrect, doses of medication will need to be recalculated.
•Recommended i.v. Dose of flucloxacillin of 50mg/kg/dose is correct.
However, usual maximum oral dose of flucloxacillin is 25mg/kg/dose.
This is because of the increased risk of gastric side effects with high
oral doses of flucloxacillin.
• There is a need to consider compliance with oral flucloxacillin therapy
due to poor palatability of the suspension formulation (if the child would
not take capsules) and the frequent dosingregimen.
Dept. of pharmacy practice, SUCP, HYDERABAD 6
7. • Whilst the risk of flucloxacillin-induced hepatotoxicity is low in children, there
is a need to consider measuring baseline and repeat liver function tests
because of the prolonged course (more than 2 weeks) of flucloxacillin therapy.
• Clindamycin has good oral bioavailability, so i.v. Therapy may be
unnecessary.
• The recommended dose of clindamycin by i.v. Infusion is up to 10mg/kg
dose 6 hourly in severe infection. The infusion should be diluted to 6mg/mL
with sodium chloride 0.9% or dextrose 5% (or a combination) and administered
over 30–60min at a maximum rate of 20mg/kg/h. Consider 160mg in 27mL
sodium chloride 0.9% over 30min.
• The recommended standard oral dose of clindamycin is 3–6mg/ kg/dose
four times a day. This may contribute to problems with adherence to long-term
therapy. A three times daily dosing regimen is to be preferred, particularly as
this child may return to school, and four times daily dosing would require a
dose to be administered at school which may be problematic.
Dept. of pharmacy practice, SUCP, HYDERABAD 7
8. • Consideration should be given to how to administer clindamycin. Clindamycin
palmitate suspension, which was palatable, is no longer available as a licensed
preparation in the UK. Whilstextemporaneous formulations are available that
use clindamycin - hydrochloride capsules, the palatability of the resultan
suspension is a major concern, particularly given the prolonged course of
therapy. A 75mg/5mL suspension, licensed in Belgium, can be imported. From
a safety and efficacy perspective it is preferable to use such a product, which
has been through a regulatory process similar to that of the UK, than to
compound an extemporaneous preparation, which has not undergone
appropriate pharmaceutical/pharmacokinetic evaluation.
Dept. of pharmacy practice, SUCP, HYDERABAD 8
9. •Consideration could be given to decreasing the
dose of clindamycin to 150mg three times a day to
accommodate capsules, although the child may
have difficulty taking these.
•The most serious adverse effect of clindamycin is
antibiotic associated colitis. Therefore, it is
important to monitor for diarrhoea. If this arises
treatment should be discontinued.
Dept. of pharmacy practice, SUCP, HYDERABAD 9
10. 18 months old female patient, weighting 10 kg is
presented with Severe right-sided abdominal pain,
Vomiting and loss of appetite, Increased temperature
38.2°C
No previous medical history, no known drug allergies.
Test : ultrasound
Provisional diagnosis : Appendicitis
■ Appendicectomy was performed.
■ The appendix was noted to be perforated.
Dept. of pharmacy practice, SUCP, HYDERABAD 10
11. Medications :
Morphine 50mg in 50mL to run at 1–4mL/h (10–40mcg/kg/h)
Paracetamol 200mg four times a day as required orally or per rectum
Diclofenac 12.5mg twice a day as required per rectum.
or
Ibuprofen 100mg four times a day as required orally when tolerating milk
Five days of i.v. Antibiotic therapy with:
Gentamicin 70mg daily
Ampicillin 250mg four times a day
Metronidazole 75mg three times a day
Dept. of pharmacy practice, SUCP, HYDERABAD 11
12. Comments on the patient’s drug
therapy :
• The morphine dose is incorrect. If the infusion is prepared as directed, 1mL/h will
actually provide 100μcg/kg/h. This is a 10-fold overdose which is a medication error
frequently seen in children.
• There is a need to consider how to administer the appropriate rectal dose of
paracetamol to this child. Often post appendicectomy patients will need to be nil by
mouth for several days. Rectal bioavailability is lower than oral bioavailability and
there may be a need to consider giving a larger rather than smaller paracetamol dose,
that is, possibly 250mg/rectum 8 hourly rather than 125mg 6 hourly, for up to 48h,
but not exceeding 90mg/kg/day.
Dept. of pharmacy practice, SUCP, HYDERABAD 12
13. • Suggest that paracetamol and NSAID are administered regularly in addition to the morphine
for at least the first few days post-surgery. Multimodal analgesic therapy is recommended.
• There will be a need to monitor CS for side effects. Nausea, vomiting and pruritus all occur
frequently with morphine but can be treated/prevented.
• Young children are particularly susceptible to developing myoclonic jerks with morphine.
These are often worrying for parents but resolve on withdrawal of the morphine.
Dept. of pharmacy practice, SUCP, HYDERABAD 13
14. • NSAIDs are well tolerated by children and the risk of adverse
events is much lower in children than the adult population.
However, it is important to ensure adequate hydration status
postoperatively, particularly when using NSAIDs. Acute renal failure
has been reported in children who have been treated with NSAIDs
and not adequately hydrated.
• The choice of antibiotics for CS is appropriate. High-dose (7
mg/kg) once-daily aminoglycoside (gentamicin/tobramycin)
therapy is now routinely used in children. It is administered by short
infusion over 20 min. Plasma drug levels should be monitored to
achieve a 18–24 h trough level of <1 mg/L. Monitor urea and
electrolytes and serum creatinine. Ampicillin can be given as a
bolus injection over 3–5 min. Metronidazole should be given as a
short infusion over 20 min.
Dept. of pharmacy practice, SUCP, HYDERABAD 14