Drugs (lecture by Dr.

Zahraa)

1- Adrenalin
Injectable forms (ampule) …1mg/1000 (1mg/ml) given IM (anaphylaxis or status asthmatics)
…1mg/10000 (0.1mg/ml) given IV (Resuscitation)

Does (in resuscitation): 0.1 - 0.3 ml/kg (0.01-0.03mg/kg), can be repeated in (10-15 min) up to 3 shoots if
‫ﯾُﻌْﻠِن‬
no response declares patient death

Adrenalin should always be given with flush of (Normal saline) 5cc or even 10cc immediately after
administration of adrenaline to ensure reaching to the heart in cases of bradycardia or asystole

Indication:
1- cardiac arrest 5. Angioneurotic edema
2- anaphylactic shock 6. Stokes-Adams syndrome
3- status asthmaticus 8. Local bleeding (Epistaxis)
4- resuscitation (3 shoots) 9. Symptomatic bradycardia Not res ponding to ventilation and oxygenation
(HR< 60 + apnea endotracheal intubation with cardiac massage (for 15 sec) …if no response give
first shoot of adrenalin (for 15 min) …if no response give the second then the third shoot)
(because in neonate usual cause of standstill respiratory better prognosis when given adrenaline in
resuscitation than adult in whom the problem is usually cardiac)

Example: 3 kg patient and we need (1/10000) preparation what’s the dose and how to give?
3* (0.1 – 0.3) = (0.3 – 0.9) ml … (if we take 0.3) = 30 units in insulin syringe. Each insulin unit = 0.01ml(cc)
, Hypo kalemia،arrythmia
side effects: hypertension, tachycardia, agitation and irritability

Contraindication : Hypertension, Tachycardia, Diabetesmellitus, congestive heart failure

 2- Atropine
Indications:
3-Sinus Bradycardia
1 organophosphate poising
2 pyloric stenosis (pylorospasm) 4-Compelete heart block
5-Bronchospasm,asystole
Dose: 0.01 – 0.02 (and even 0.06 in organophosphate poising) mg/kg

Side effects: dry mouth, blurry vision, tachycardia, urinary retention, constipation

1. Acute attack of asthma

2. Apnea of prematurity.
3- Aminophylline 3. Drug induced apnea (Diazepam)
Indications:
4. LVF.
1- Apnea of prematurity (it induces respiratory center)

2- asthma

Advantage: CNS stimulation and reduce pulmonary vascular resistance (effective in pulmonary hypertension)

Disadvantage: low therapeutic index

Preparation: 250mg/10cc

Dose: 5 – 8 mg/kg infused during 30 min (loading) and 1- 2 mg/kg/hr. (maintenance) (Caffeine citrate has less side
effects than aminophylline better in (maintenance))

Side effects: liver damage, hypertension ,Tachycardia,Headache,Seizure,irritability

,Nausea,Vomiting,Dysrhythmia
 4- Hydrocortisol
Indication
4-Congenital adrenal hyperplasia
1-status asthmaticus 5-Refractory Hpoglycemia
2-alergy(anaphylaxis)
3-adrenocortical crisis (like in CAH)
Does: 1-2 mg/kg/does (q6h)
Oral: 10 mg/cubic mete
In CAH and 1 year <...can increase to 50 mg and 25 mg regardless of age

5- Dexamethasone (Decadron)
Indication:
1-croup
2-status asthmatics
3-meningitis (to reduce complication)
4-angioedema (lifesaving)

Dose: 0.6mg/kg/dose croup (and can reach in asthma)

0.2- 0.3 anti-inflammatory given by 2, 3 or 4 doses
Maximum dose: 0.6

6- Prednisone
Indications:
1-asthma
2-anaphylaxis
3- autoimmune diseases (nephrotic syndrome, ITP, SLE, hemolytic anemia)

Preparation: syrup ...5mg/5cc and 15mg/5cc

Tab … 5mg, 10mg, and 20mg
Dose: 1-2 mg/kg/day… (can reach to 4mg in ITP)

Tapering (important to avoid relapse especially in nephrotic syndrome) : indicated in any use of
steroid more than 1 week (7-10 days) ..decreasing the dose either by 5mg every 3-5 days or
decreasing by 10mg per week ( the slower the tapering the better the results)

Side effect :- Hypertension,Hyperglycemia,gastric

upset,paresthesia,cushing syndrom,hypokalemic alkalosis,cataract
 7- Immunoglobulins
Indications:
1-ITP first option steroid then Ig 700mg/kg

2-guillain barre drug of choice 700mg - 1g /kg/day (shoot) or by 2,3 doses to reduce side
effects
3-immune deficiency 300 – 400 mg/kg
4-Kawaski disease drug of choice
5-autoimunhemolytic anemia newborn with ABO or RH incompatibility (hyperbilirubinemia
and jaundice in first 24 hrs.) give either albumin or Ig ( Ig thought to saturate FC receptor on RBC
which will reduce hemolysis) ….but Ig costly so they use albumin

Indication for albumin:

1-autoimmune hemolytic anemia
2-nephrotic syndrome albumin + diuretic (Lasix)
(albumin is not given to chronic hypoalbuminemia like kwashiorkor. it can lead to heart failure)
 8- Furosemide (Lasix)

Indication:
1-acute heart failure
2-fluid overload Over rehydration,edema,hypertension,cerebral edema,
3-Pulmonary hypertension
4-Hyperkalemia
Dose: 1 – 2mg /kg/dose (can reach 8 or 10 in chronic renal failure)

9- Glucose water
Indication: hypoglycemia if symptomatic (fits ,etc.) or 30 > in neonate
Preparations: G/W 5% 500cc
G/W 10% 500cc
G/W 25% 10cc (ampule) each cc = 0.25 g
G/W 50% 20cc (vial) each cc = 0.5 g

Dose: 10% ..4 – 6 cc/kg (shoot)

4-12 mg/kg/min (maintenance)
(never delay maintenance or rebound hyperglycemia develop (due to insulin effect)
(if unconscious and persistence hypoglycemia give steroid it could be CAH (this
presentation is common in CAH)
Example: 3kg patient
Shoot 3*4 = 12 cc (G/W 10%)
Maintenance (4- 12)*3 (we choose 8) 8*3*24 hrs.*60 min = 34000mg/day= 34g/day
If we use (G/W 10%) every 100 ml contain 10 g give 300ml = 30g
Then give 8cc (G/W 50%) …each cc= 0.5 g
Or give 16cc (G/W 25%)..each cc= 0.25g

10- calcium
Indication:
1-renal failure
2-Symptomatic hypocalcemia (Hypocalcemic tetany,seizure)
3-exchange transfusion (every 100ml because blood can cause hypocalcemia ..it
contain citrate)
4-Hyperkalemia
Hyperphosphatemia,
,Magnesium intoxication,
Alkalosis,
Calcium channel blocker overdose,
Septic shock and blood transfusion .
 (when give IV calcium we should ensure the cannula is (IN) because it can lead to tissue necrosis and even limb
amputation in neonate!)

Preparation: 10% calcium gluconate 10cc (ampule)

Dose: role of 10 (dose not more than 10cc) ..100- 200 mg/kg

Side Effects : Bradycardia, hypotension,Hypercalcemia,

Extra vasation can lead to cutaneous necrosis.

11-Potassium
(normal range:3.5- 5 mmol/l)

Indications:

1-DKA 10- 20 mmol/kg (must given infusion drips not direct and not exceeding 10mg/kg/hr.)

2- severe dehydration first urine output should be ensured

Preparations: 10,20,30 mmol

Side Effects : Arrhythmia, Respiratory paralysis, Hypotension.

Contraindication :
1. Anuria

2. Hyperkalemia

Hypochloremia
Indications : 1. Acute attack of epilepsy

2. Febrile convulsion

3. Preanesthetic agent for various procedures.

4. Drug withdrawal

5. Sedation

6. Tetanus (in high doses)

7. Muscle relaxant (Spastic CP).

12- diazepam, phenytoin
0.1 – 0.3 mg/kg/dose IV infusion (3 shoots)

Side effects: apnea source of O2 must be present (not given to less than 6 months)

If no IV line give rectally (by insulin syringe after dilution)

No benefit after 3rd shoot phenytoin (luminal) 20mg/kg

Indications :
1. Generalized tonic clonic seizure
2. Partial seizure
3. Migrain phophylaxis
4. Head injury
5. Digitalis toxicity (as an antiarrhythmic)
6-subarchanoid hemorrhage
 13- magnesium
Indications:

1-preedclampsia (gynae)

2-status asthmaticus

3-arrythmeia

Dose: 50mg/kg

14- Vit D
Indication: rickets

Dose: prophylactic first 6 month 400 – 500 IU/day

Next 6 months 600 IU/day

After 1 year 800 – 1000 IU/day

Therapeutic 300000 – 600000 IU single dose

(avoid large amount of vit D without calcium supplement bone resorption and sever bone pain)

15-Zinc
Indications:

1-diarrhea

2-pneumonia

3-any infection (reduce mortality and morbidity)

4-celiac or any severe malnutrition which lead to sever zinc deficiency 1- 2 mg/kg/day

Dose:

10mg/day 0 – 6 months

20mg/day 6 month – 1 year

25mg/day second year

 16- whole blood, packed RBC
Indication:

1-acute blood loss (epistaxis, melena, hemoptysis) whole blood

2-anemia of chronic disease packed RBC

3-acute sever IDA packed RBC (but if IDA is chronic (the body compensate on low Hb) do not give blood until
Hb=5, instead give iron supplemet)

4-anemia of prematurity packed RBC ( not give blood even when Hb= 7 ,but if pnemonia+IDA+congenital
heart disease and Hb=11 give blood)

Dose:

Whole blood 20cc/kg

Packed RBC 7 -10cc/kg

17- plasma
Indications:

1-immuonodefecency

2-clotting disoreders

3-DIC

Dose: 10- 15cc/kg

18- platelets
Indications:

1-aplastic anemia (to treat thromboctopenia)

2-platelets < 50000 with bleeding from vital organ ( intracrinal, GI)

3-pletelets 20000 – 10000

Dose: every 5kg 1 pint

 19- fluids: ORS, NS, RL, D.W., Mannitol
Mannitol: 10% 0.5 – 1mg/kg

20%

Indications: increased ICP (in meningitis for example), cerebral edema

 20- dobutamin, dopamin
Indication: cardiogenic shock

Dose:

5mg/kg renal dose

10mg/kg cardiac dose

15mg/kg systemic dose

21- ceftrixone
Indications:

1-meningitis 50- 70 mg/kg

2-sever infection (sepsis, sever meningitis or arthritis) 100mg/kg/day

(DO NOT mixed with calcium)

(DO NOT give to neonate)

22- vancomycin, lincomycin
vanco exclusive IV with slow infusion (if rapid lead to red man syndrom (not allergic..the dose can be
repeated))

Linco given IV and IM

(prolong use of antibiotic dirrhea (pseudomembrance colitis) we shold stop the medication )

23- Amoxicilin
Oral syrp: 125, 200, 250, 400 mg/5ml
Flagyl

Antipyrol
Plasil

Allermine
Buscopan

Ventolin
Zantac

Pentostam
Digoxin

Sodium bicarbonate
Cyklokapron

Vit K
Insulin
Glucagon