Drugs and

medications in
children

Moderator : Dr. Deepika Harit

Facilitators: Dr. Pinky Meena
Dr. Enboklang Suting
 Objectives of Today’s Discussion
• Common drugs
• Indications
• Preparations and Dosage
• Routes of administration
• Adverse effects
Routes of Drug Administration
Intravenous Fluids
Intravenous Fluids
 COMPOSITION OF IV FLUIDS
FLUIDS Na+ Cl- K+ Ca2+ HCO3-

Normal saline 154 154 - - -

(0.9%)

1/2 NS 77 77 - - -

Ringer lactate 131 109 4 4 28

Isolyte-P 23 29 - - 20
 Maintenance fluid calculation
HOLIDAY SEGAR FORMULA
100ml/kg for first 10kgs
50ml/kg for next 10kg
i#%
20m/kg for >20kg (after first 20kgs) ...

Example: child of 21kg, calculate maintenance fluid?

Answer is 1000+500+20=1520ml for 24 hrs
 Choice of IV fluids
• Maintenance Fluid = Dextrose Normal Saline
• Diarrheal dehydration=ringer lactate+5% Dx
• Shock = Normal saline
• Hepatic Failure = 10% Dx in 0.45 NS
• Fluid for first 2 days of newborn = electrolyte free fluid for first 48hrs of life
followed by addition of sodium and potassium according to weight (2-3
mEq/kg)

• Fluid in acute kidney injury=insensible loss(400ml per/m2 / day)

replacement by 10%dextrose+losses replaced by N/5
 WHO treatment plan of dehydration
Plan A Plan B
• Home therapy • Admission in Hospital
• Replacement of ongoing losses • Correction of deficits +
9
• Give more fluids than usual :
WHO ORS, Chicken soup with
C replacement of ongoing losses
• WHO ORS : 75 ml/kg over 4

g-
salt hours
• For every loose stool : 10ml/kg • For every loose stool 10 ml/kg
body weight body weight

GE
'
( 2
yr
= 500mL
se
severer -

Hogg logs
in.ggr=
-

, -
> to =
Zl • R Ayr →
30
go
* hrs say Ghz
>
Ayr → Ken Yahr 3h-
 Reduced osmolarity ORS –First line

• 33% reduction in need for IVF.

• 20% reduction in stool output.
W
• 30% lower incidence of vomiting
• Effective in adults and children
i
. (

Gwu

Nq
with cholera also
I
Nam -
2. B
k g
K G
t.gg
-

Cik

⑥
hawse
= 135g
Nau Kate
q g
'
2 -

WHO Drug information Volume . 16, No.2,2002

0
 ORS
LOW OSMOLALITY WHO ORS COMPONENTS:
Sodium chloride 3.5 g/l OSMOLARITY:245 mmol/l
Potassium chloride 2.5 g/l
Trisodium citrate 2.9 g/l
Glucose 13.5 g/l

COMPONENT CONCENTRATION
SODIUM 75
CHLORIDE 65
POTASSIUM 20
CITRATE 10
GLUCOSE 75
Plan C correction for severe dehydration

Fluid (ml/kg) 30 ml/kg 70 ml/kg

< 1 year 1 hour 5 hours

> 1 year 30 mins 2.5 hours

DRUGS USED IN SHOCK
 Epinephrine
Available strength 1 mg/ml 1:1000 A

Side effect Tachyarrhythmia, headache, nausea

s
Route BE
As 1:1000; 1:10000 solution, I/V,I/M,ET, umbilical
←

route in neonatal resuscitation

INDICATION:
1.Asystole/bradyca
-
Ionotropic; 0.01-0.03 mg/kg of 1:10000 (0.1-0.3ml/kg)
rdiaIn solution I/V OR I/O(diluted) q3-5 min iv; ET- 0.1 mg/kg
.
of 1:1000 soln(undiluted); I/V drip- 0.1 – 1 mcg/kg/min
-

2.Croup,
-
Nebulization- 1:1000 Soln. (undiluted) 0.5 ml/kg (max.
bronchiolitis 2.5ml < 5yr; 5 ml/dose for > 5 yr)

Thyra are
, As I
3.Acute severe asthma If β2 agonist N/A: 0.01 mg/kg/dose(undiluted)
S/C every 20 min upto 3 doses

=
4.Hypersensitivity reaction/
anaphylaxis
0.01 mg/kg/dose I/M or S/C(undiluted) max. 0.5
mg /dose

5.Neonatal resuscitation Umbilical

-
route(most preferred) or intra
(given when heart rate is osseous route
-
<60bpm) .01-.03mg/kg per dose
-
Maximum 3 doses to given
Endotracheal route(least preferred) dose not
to be counted-dose-.05 to .1mg/kg/dose.
 Dopamine
Dose 3-5 mcg/kg/min: renal vasodilation and inc
perfusion- inc GFR
> 5 mcg/kg/min: positive ionotropic effect direct
β1 and D1 action

Mech. of action D1 & D2 receptors, acts on α and β1 receptor (no

β2 action)
Side effect Tachyarrhythmia, ectopic beats, hypertension,
vasoconstriction, vomiting, tissue necrosis
Contraindications Pheochromocytoma, tachyarrhythmia,
hypovolemia,
 Dobutamine

Dose 5- 15 mcg/kg/min

Mech. of action Increase force of cardiac contraction, no Significant

change in HR, peripheral resistance and BP, relatively
selective β1 action, less arrhythmogenic than
adrenaline

Side effect Tachyarrhythmia, ectopic beats, hypertension,

vasoconstriction, vomiting, tissue necrosis

contraindication Idiopathic hypertrophic subaortic stenosis

 Norepinephrine
Class Sympathomimetic
Available strength 1 mg/ml
Mech. of action adrenergic
Side effect Arrhythmia, hypertension, headache vomiting,
extravasation into tissue leads to tissue necrosis
(treat locally with phentolamine)
Contraindications Hypovolemia, hypertension
Administration 0.05- 0.1 mcg/kg/min continuous infusion max. 2
mcg/kg/min
INDICATION: Warm shock with low BP
 Human albumin

MOA Increases oncotic pressure

formulation 5%, 20%(100ml=20g), 25%

Indication Hypoalbuminemia, burns, nephrotic syndrome, acute liver

failure, Volume substitution therapy, Severe Dengue refractory
to crystalloids.

Contra CHF, severe anaemia- rapid infusion cause fluid overload

indications
Side effects Anaphylactoid reactions, hypertension, bradycardia,
bronchospasm, pulmonary oedema, headache, vomiting,
urticaria.
STEROIDS
 Hydrocortisone

Ee
INDICATION AND
DOSE
1.
2.
Status asthmaticus
Angioedema/
anaphylaxis
⇐ 10 mg/kg stat I/V f/b 5 mg/kg 6
hrly

3. Thyroid storm
4. Replacement therapy in 10 mg/m2/d
adrenal insufficiency
5. Severe sepsis
6. CAH (classic)
7. Topically : eczema 1 -2 mg/kg/dose max.100 mg
8. Refractory hypoglycemia 15-20 mg/m2/d

Contraindication infection, hypertension .

FORMULATION Tablet and injectable

Tab:5mg/10mg/20mg
Injectable:100mg/vial
Strength
- Dexamethasone
Dose :
1. Airway edema(iv/im) 0.5- 2mg/kg/day in 4 divided doses(begin
- 24 hrs before extubation and continue
for 4-6 doses)
0.6 mg/kg/dose stat
2. Croup(iv/im)
1-1.5mg/kg/day in 4 divided doses

Ig
3. Cerebral edema (iv/im)
0.15 mg/kg/dose – 4 doses for 2 days
4. H. Influenzae Meningitis (iv/im)(3month to
3years of age) 25-30 mic/kg

5. Dexamethasone suppression test 20 mic/kg

6. Prenatal treatment with dexamethasone in

female fetus with 21 hydroxylase CAH
 @
Prednisolone
Formulations Tab 5mg, 10mg, 20mg
Syp 5mg/5ml, 15mg/5 ml
Doses High dose :1-2 mg/kg/day
Low dose : 0.5 mg/kgday
Indications • After acute attack of asthma
• As anti-inflammatory drug in allergy

£ •

•
•
Immunosuppressant in immunological
diseases(JDM/JIA/SLE)
Nephrotic syndrome
In NCC , before starting albendazole
• Rheumatic carditis
• Induction therapy in Leukemia

Contraindications infection, hypertension, Diabetes mellitus

 Prednisolone in nephrotic
syndrome
• First episode= 6wks(daily)+6wks(alternate day)
-

daily steroid@2mg/kg/day
Alternate day @1.5mg/kg/day

• First relapse= 4wks(daily)+2wks(alternate)

=6weeks(total)
 Adverse Effects of Steroids
• Dermatological
Thin, fragile skin,Mild hirsutism,Bruising,Striae,Acne
• Endocrine and metabolic
Weight gain, cushingoid habitus (moon facies, buffalo hump, central
obesity), Reduced carbohydrate tolerance, increased triglycerides and
cholesterol levels, hypertension, Reduction of protein metabolism
• Growth suppression
Inhibit linear growth and osteoporosis
• Osteonecrosis (previously known as avascular necrosis
• Behavioural changes
• Infections
• Gastrointestinal disease
Peptic ulcer disease and pancreatitis
NUTRITIONAL SUPPLEMENTS
 VITAMIN-A
In national immunization schedule

Age Dose(oral)
9 months of age 1 lakh units
15 months of age 2 lakh units

Then every 6 monthly 2 lakh units

Im doses are half of oral doses

AVAILABLE FORMULATION-Vit A oil formulation syrup
( 100000 U/ml), Capsules (25000/cap) , (100000/cap)
 Indications of vitamin A
• In vit A deficiency - Day 1,2,14
• In neonatal cholestasis 10000-15000 IU/day as Aquasol A
• In severe acute malnutrition
• National immunisation schedule

Age Dose (oral)

<6 months 50000 IU

6-12months or weight < 1 lakh IU
8kg
>12 months of age 2 lakh IU
 Vitamin D
• Available formulations of cholecalciferol:
–Inj Arachitol - 6 lakh/ ml
–Calcirol sachet - 60000U/ sachet
–Syrup vitamin D(800 u/ml)
–Capsules 5000 IU
 Dose of vitamin D in Rickets
Age Daily dose for Single dose Maintenance Calcium
90 days, IU IU Daily dose, IU

< 3 months 2000 N/R 400 500 mg/day

3 – 12 months 2000 50,000 400 500mg/day

12 months – 3000 - 6000 150,000 600 500 mg/day

12 years

> 12 years 6000 300,000 600 500mg/day

 Vitamin D Prophylaxis
• Indicated in infants upto 1 year 400 IU per day
irrespective of mode of feeding
• Cholestatic jaundice
• Renal disease
• Malabsorbtion
 VITAMIN K
• K1 – phylloquinone – plant sources, liver, as medication also

• K2 – menaquinones – intest. bacteria – also in liver, cheese

• K3 (synthetic) : fat soluble : menadione, acetomenapthone

water soluble : menadione sod. bisulfite, menadione
sod. diphosphate.
Preparations:
Phytonadione- vitamin K1- 1 mg/ml for im inj (neonates)
Menadione – 10 mg/ml
Onset of action- 1-2 hrs
Peak effect 12-14 hrs
 Vitamin K
Indications • At birth - 1 mg parenteral. 0.5 mg in < 1
kg ( phylloquinone preferred)
• Infants – 1 mg parenteral, children - 2.5 –
10 mg
• Neonatal cholestasis- 2.5 to 5 mg A/D as
water soluble derivative of menadione
Preparations Phytonadione- vitamin K1- 1 mg/ml for im
inj (neonates)
Menadione – 10 mg/ml
Side effects of vitamin K Vomiting, Porphyrinuria, Albuminuria
Haemolytic anaemia, Haemoglobinuria
Hyperbilirubinemia, Rash, urticaria, pruritis,
anaphylaxis
 Iron Preparations
Oral Parenteral
• Ferrous sulphate • Iron dextran
• Ferrous gluconate • Iron sorbitol citric acid complex
• Ferrous fumarate • Iron sucrose
• Colloidal ferric hydroxide
• Ferrous succinate
• Ferrous ascorbate
 Iron therapy
Oral Parenteral

Indication Treatment of iron deficiency Intolerance or non-compliance

anemia, combined deficiency to oral iron, failure to absorb
anemia iron

Dose 3-6mg/kg/day for 3months Z-track technique of im

duration injection
Preterms 1-3 mg/kg/dayTo be
given 30 – 45 min before meals
or 2 hours after meals

Side Effects constipation, abdominal pain, anaphylaxis ,skin rash ,myalgia,

black stools. arthralgia, bleeding, staining of
the skin, formation of sterile
abscesses, tissue necrosis or
atrophy.
 Calcium preparations
Intravenous Oral
Calcium gluconate (9%) Calcium phosphate
Calcium chloride (27%) Calcium lactate
Calcium Acetate (25%) Calcium carbonate
Calcium Glubionate
Calcium Citrate
 Calcium gluconate
INDICATION Hypocalcemia
Part of TPN
Hyperkalemia
Hypoparathyroidism

ROUTE only I/V diluted in 5% dextrose (GIVEN SLOWLY

UNDER CARDIAC MONITORING)

FORMULATION 10%CALIUM GLUCONATE SOLUTION

C/I in ventricular arrythmia, caution in renal
impairment
S/E tissue necrosis if there is extravasation,
hypotension, bradycardia
 Indications of Oral Calcium
1. Rickets- Treatment and prophylaxis
2. Symptomatic hypocalcemia (75-100 mg/kg/day for 3 months)
3. Prophylaxis in preterms (100 mg/kg/day)
 Zinc
Preparations Zinc acetate,Zinc sulphate ,Zinc gluconate
Syrup zinc: 20 mg/5 ml(zinc gluconate)

Indications and • Diarrhoea : < 6mo- 10 mg/day for 14 days

Dose > 6 mo- 20 mg/day for 14 days
• Wilsons disease: 75 mg/kg/day in 3 divided doses
• Severe acute malnutrition(20 mg per day for 14
days)
• Acrodermatitis enthropathica(1-3mg/kg/day)
 Chelation therapy in iron overload
Drugs desferrioxamine deferasirox deferiprone

Route and dose Sc or iv Oral Oral

40-60mg/kg/day 30mg/kg/day 75mg/day
Excretion Urine Stool(80%) Urine(90%)
Stool
Side effects Ocular, auditory, Gastrointestina Gastrointestinal
bone growth l, ,
retardation local increased arthralgia,
reactions, allergy creatinine, agranulocytosis
increased /
hepatic neutropenia
enzymes
ASTHMA DRUGS
 Salbutamol
MOA Beta 2 agonist

Indications Asthma,Bronchiolitis,Hyperkalemia
Strength Syrup : 2mg/5 or 10 ml
MDI: 100 mic/metered dose
Asthalin respirator soln: 5mg/ml
Salsol neb soln: 2.5 mg/ 3 ml
Dose PO:0.1-0.4 mg/kg/dose
MDI: 2 puffs every 4-6 hrs
Nebuliser: 0.15 mg/kg/dose every 20 mins

Side effects: Irritability, tremors, tachycardia, nervousness,

dizziness, hypokalaemia
Ipratropium bromide
MOA Anticholinergic
Strength Respirator solution: 250 mic/ml
MDI: 20 mic/puff

Dose Nebuliser :Infant- 125 mic evey 4 hrs

<12 yrs: 250 mic every 4 hrs
>12 yrs: 500 mic every 4 hrs.
MDI: 1-2 puffs thrice daily

Side effects Anxiety, dizziness, headache, dry

mouth, cough , bronchospasm,
palpitations, nausea, vomiting,
abdomen pain
Budesonide

MOA Anti inflammatory. Reduces airway

edema
Strength MDI: 200mic/puff
Respules: 0.5, 1 mg /2ml

Side effects Hoarseness of voice, candidiasis

of mouth
 Drugs that can be given by MDI
• Salbutamol
• Budesonide
• Ipratropium
• Beclomethasone dipropionate
• Ciclesonide
• Cromolyn sodium
• Fluticasone propionate
• Triamcinolone acetonide
• Mometasone/formoterol (Dulera)
 Magnesium sulphate
MOA Smooth muscle relaxation sec. to inhibition of calcium
uptake
Indications • Status asthmaticus: 50 mg/kg/dose over 30 min;
and doses continuous infusion- 10-20 mg/kg/hr; can repeat
after 4-6 hr
• Torsades de pointes- I/V 25-50 mg/kg over 20-30
min
• SAM: 0.3ml/kg/d (1mmol= 25 mg) for at least 2 wk
• Hypomagnesemia: 25- 50 mg/kg/dose
• Refractory hypocalcemia

formulation 10 ml vial –(I/M, I/V ); 50% solution ‘w/v’

Side effects hypotension, resp. depression, heart block

 Things to monitor while giving MgSO4 :urine output , respiratory rate,
reflexes
• Dose related toxicity:
>3 mg/dl CNS depression
>5 ; decreased DTR, flushing
>12; respiratory paralysis, heart block
ANTI EPILEPTICS
 PHENYTION
DOSE Loading dose of 20 mg/kg (max 1000 mg) max at rate of
1mg/kg/min to be given in 30ml NS over half hr followed by
5-8mg/kg divided twice a day maintenance dose

INDICATION Tonic clonic seizures, Partial epilepsy, Cardiac

arrhythmias, Trigeminal neuralgia, Migraine prophylaxis,
and Status epilepticus
ADVERSE At high plasma level ( dose related ) : cerebellar
EFFECT & vestibular manifestations, drowsiness,
behavioural alterations, hallucinations, mental
confusion, epigastric pain, fall in BP & cardiac
arrhythmia, respiratory distress ( only on fast iv
inj)
At therapeutic doses, Hypertrophy of gum,
Hirsutism, Hypersensitivity, Hyperglycaemia,
Lymphadenopathy, Megaloblastic anaemia and
Foetal hydantoin syndrome

Remarks Extravasation from iv cannula causes tissue

inflammation and necrosis(high ph of phenytoin
12).
Rapid injection of phenytoin can cause
respiratory depression and hypotension
Drug PHENOBARBITONE
LOADING DOSE 20 mg/kg (max 1000 mg)
MAINTANENCE DOSE 3-5 mg/kg (max 8 mg/kg/day)
INDICATION neonatal seizures: DOC
Status epilepticus
Prophylaxis of febrile seizures
CONTRAINDICATIONS Porphyria ,hepatic and renal disease, and
severe asthma
SIDE EFFECTS Major drawback- sedation ,long term
administration- behavioural abnormalities,
diminution of intelligence,
Impairment of learning and memory,
hyperactivity in children, rashes,
megaloblastic anemia
Drug VALPROIC ACID
DOSE Loading dose-20 mg/kg followed by maintanence
dose of 10 – 60 mg/kg
INDICATION GTCS, partial seizures, myoclonic seizures,
absence seizures
CONTRAIND Active liver disease
ICATION Urea cycle defect
SIDE Alopecia, weight gain, increased bleeding
EFFECTS
tendency , asymptomatic increase In
transaminase, LFT monitoring advised, fulminant
hepatitis rare but serious occurs only in children
(especially <3 yrs of age), long term use in young
girls a/w high incidence of PCOD & menstrual
irregularities.
 Carbamazepine
Dose 10 to 20 mg/kg/day 8 hourly oral

Formulation Tab 100mg, 200mg, 400 mg

Syp 100mg/ 5ml

MOA Binds to voltage-gated sodium channels in their inactive

conformation
Indication Focal seizure, Trigeminal neuralgia, Post herpetic
neuralgia

Contraindication Juvenile myoclonic epilepsy, Absence epilepsy

Side effects Bone marrow suppression

 Midazolam
Dose (iv) 0.05 – 0.1 mg/kg/dose
ROUTE OF ADMINISTRATION Iv/oral/intranasal spray/buccal
MOA Enhances effect of
neurotransmitter GABA on
GABA A receptors
INDICATION Procedural sedation, sedation
during mechanical ventilation,
aborting acute seizures,
status epilepticus.
CONTRAINDICATION Shock, renal impairment
SIDE EFFECT Respiratory depression/
hypotension, bradycardia
 DIAZEPAM
DOSE 0.1 – 0.2 mg/kg/dose IV,IM Oral

MECHANISM Act through GABA receptors

INDICATIONS Febrile seizures, procedural

sedation, ventilation, aborting acute
seizures, status epilepticus
CONTRAINDICATIONS Myasthenia gravis
Acute narrow angle glaucoma
Paralytic ileus
SIDE EFFECTS Hypotension
Respiratory depression
Ataxia
Miscellaneous
 Amoxycillin+clavulanate
Dosages: 25-50mg/kg/day q 8-12 hourly oral
100mg/kg/day iv
Formulations Syrup – 125mg/5ml, tab: 250, 500 mg
Less shelf life after reconstitution (Discard when it turns
brown)
MOA: binds to penicillin binding proteins, inhibiting final
step of peptidoglycan synthesis. Clavulanate
inhibits beta lactam producing bacteria causing
extended spectrum
Indications: LRTI, sinusitis, otitis media, CAP, skin abscesses,
enteric fever
Contraindicatio Penicillin allergy
ns
Side effects: diarrhea, nausea, vomiting
 Azithromycin
Dose 10mg/kg/day po/iv OD
enteric fever: 20mg/kg/day po/iv OD
Formulary 100mh/5ml, 200mg/5ml, 250mg, 500mg

MOA RNA dependent protein synthesis inhibition

Indication acute otitis media, community acquired pneumonia,

sinusitis, pharyngitis, MAC infection, chlamydia,
enteric fever, Enteric fever, Cholera

Side effects diarrhea, nausea, abdomen pain, vomiting

 Ceftriaxone
Dosage Septic dose : 50 – 75 mg/kg/day IV or IM
Anti meningitic dose : 100mg/kg/day IV or
IM
Formulation 125mg , 250 mg, 500 mg, 1 gram vials

MOA 3rd generation cephalosporin

Inhibit bacterial cell wall synthesis by
inhibiting the crosslinking of
peptidoglycan
Indication LRTI, UTI, Bacterial sepsis, Meningitis,
Enteric Fever

Side Effects Precipitate in bile leading to gallstones,

Elevation in liver enzymes, Diarrhea
 Cefixime
Dosage 8 mg/kg/day
Enteric fever 20mg/kg/day

Formulation Tab 100mg, 200 mg

Syp 50mg/5 ml, 100 mg/5 ml

MOA 3rd generation cephalosporin

Inhibit bacterial cell wall synthesis by
inhibiting the crosslinking of
peptidoglycan
Indication LRTI, UTI, Enteric Fever

Side Effects Hypersensitivity reactions,

 Amikacin
Dosage 15-20 mg/kg/day iv or im

Formulations 100 mg, 250 mg, 500 mg vials

MOA Irreversibly binds to the 16S rRNA of the

30 s subunit of prokaryotic ribosomes and
inhibit protein synthesis
Indications UTI, Meningitis, Intraabdominal
infections, 2nd line drug for tuberculosis

Contraindications Sensitivity to any aminiglycosides, Dose

adjustment in renal failure

Side Effects Ototoxicity, Nephrotoxicity,

Neuromuscular blockage
 Promethazine/Phenargan
MOA Antihistamine H1 blocker

Indication motion sickness, sedation, allergic

conditions, nausea

Administration iv/im/po

Route syrup: 6.2mg/5ml, 12.5 mg tab, 25mg/ml iv

Dose 0.2-.5 mg/kg (antihistamine dose)
0.5-1.5mg/kg(sedative)

Side effects sedation, confusion, blurred

vision,tachycardia
 BENZATHINE PENICILLIN
MOA interferes with cell wall mucopeptide synthesis –
bactericidal activity

DOSE < 6 yrs 0.6 mega units IM weekly

> 6 yrs 1.2 mega units IM q3 weekly

FORMULATION Penidura LA 6,12,24

INDICATIONS rheumatic fever prophylaxis, syphilis, yaws

Adverse effects Anaphylaxis (test dose given), thrombophlebitis,

Jarisch herxheimer reaction, serum sickness

* Give after sensitivity testing every time

 Albendazole
Dose < 2yrs- 200mg,
2yrs: 400mgper oral single dose, Repeat dose
after 2 weeks for pinworm , roundworm
Neurocysticercosis 15mg/kg/day for 14 to 21
days
MOA degeneration of cytoplasmic microtubule of
intestinal helminths
Indication pinworm, roundworm, hookworm, NCC,
whipworm, tapeworm, giardia
Contraindication ocular, intraventricular cysticercosis

Side effects headache, abdominal pain, nausea, vomiting

 Mannitol
Indications • To reduce Intracranial pressure(Should
be administered iv rapidly over period of
30-60 minutes for relief of brain oedema)
• Water intoxication

Dose 5 ml/kg initially , then 2ml/kg every 6 hrs for

2 days
Formulation Available as mannitol 20% - 100ml solution

Contraindication severe renal disease, active IC bleed,

dehydration, pulmonary oedema
 Paracetamol
MOA weak inhibition of PG synthesis, inhibits
COX 2
Dose Oral :15mg/kg q 4-6 hourly, Rectal:
15mg/kg/dose, IV: 10 mg/kg/dose
Route 125mg/5ml, 20mg/5ml, 250,h, 500mg

Indication antipyretic, analgesic

Contraindication Hepatic damage, nephropathy

 Potassium chloride
Indication • In hypokalemia with ECG changes or severe
hypokalemia: 0.5 mEq /kg/hr as infusion for
1-2 hrs
• Severe acute malnutrition
• Diabetic Ketoacidosis
Dose and Inj.Kcl – 2 mEq/ml
Formulation
Oral potklor (20 mEq/15 ml)

Oral dose: 1-4 mEq/kg/day in 2-4 divided doses

Route Iv ,oral
Contra indication Renal failure
 Sodium bicarbonate
Indication Severe metabolic acidosis
Cyanotic spell in Fallots Tetralogy

Route iv
Formulation 7.5 % (0.9 meq/ml) W/v 10 ml vial

Contraindication respiratory alkalosis, hypochloremia,

bicarbonate is not given in patient till
ventilation of patient is stabilized

Side effects hypernatremia, hypokalemia, tissue

necrosis, hypomagnesemia
 Hepatitis immunoglobulin
MOA pooled immunoglobulins from donors that contains
immunoglobulin G specific to hepatitis B surface
antigen

Dose 1) Newborn born to HBsAg positive mother: 0.5 ml im

< 12 hrs after birth in newborn at anterolateral thigh/
deltoid region

2) post exposure prophylaxis:

<12mnths: 0.05ml/kg im
>12mnths:0.06ml/kg im once and hep B vaccine

Side effects erythema, pain, vomiting, myalgia, headache

 IVIG
Formulation 5%, 10%

Indication and dosage Kawasaki disease ( 2g/kg over 12 hours)

Gullain Barre syndrome (1 g/kg/day for 2
days)
ITP (
Rh isoimmunisation (1gm/kg/dose)
Immunodeficiency states
SLE
Side effects Hypertension, Renal impairment,
Anaphylaxis, Neutropenia, Transfusion
related infections, Transfusion related
reactions, Poor response to vaccines
 Methylprednisolone
• Regulate gene expression
• Prep: I/V succinate, I/V acetate (preferred in those who have
vomiting with former preparation)
• Strength: 40 mg/ml, 80 mg/ml
• INDICATION
1. Anti-inflammatory/ immunosuppressant
2. Lupus nephritis
3. Gullain Barre Syndrome
4. Transverse myelitis
5. steroid resistant nephrotic syndrome
6. Acute Demyelinating Encephalomyelitis
THANK YOU ALL