DRUGS
Monday, 17 January 2022
5:17 PM
PEDIATRICS VIVA-VOCE: DRUGS
-Dr.Ashray S Patel
Ph No: 9482141673
E-mail: patel1995ash@gmail.com
ANTIPYRETICS
ANTHELMINTICS
ANTIBIOTICS
ANTICONVULSANTS
ANTIEMETICS
ANTIHISTAMINES
INOTROPES
BRONCHODILATORS
ANTIPYRETICS:
1) PARACETAMOL:
• ACETAMINOPHEN
• MoA: COX-3 inhibitor
• Used to control fever as well as for mild to moderate pain such as myalgia,
headache. Closure of PDA in neonates.
• Dosage:
15mg/kg/dose ORAL
15mg/kg/dose RECTAL
10mg/kg/dose IV
Maximum of 90mg/kg/day or 4g/day oral & 60mg/kg/day IV
• Toxic dose: 200mg/kg or 10g
• Antidote: N-Acetylcysteine
• Formulations available:
Syrup: 125mg/5ml or 250mg/5ml
Tablet: 500mg
Rectal Suppository: 125mg/250mg
• Adverse effects: safe and well tolerated drug. Hepatic damage.
2) MEFENAMIC ACID:
• MoA: Reversible COX inhibitor with PG receptor antagonist action as well.
• Antipyretic, analgesic and good efficacy in dysmenorrhea
• Dosage:
Antipyretic: 5-8mg/kg/dose 8 hourly
Analgesic: 25mg/kg/day 8th hourly
• Formulations available:
Syrup: 100mg/5ml
Tablet: 250/500mg
• Adverse effects: Diarrhea, Skin rashes
3) IBUPROFEN:
• MoA: Reversible COX inhibitor.
• Safest NSAID
• Dosage: 5-10mg/kg/dose 6-8 hourly maximum of 40mg/kg/24hr.
• Formulations:
Syrup: 125mg/5ml or 100mg/5ml
• Adverse effects: much less compared to aspirin
ANTHELMINTICS:
1) ALBENDAZOLE:
• Broad spectrum anthelminthic
• MoA: alters cytoskeletal structure formation
• Due to its broad spectrum activity, indicated for deworming.
• Deworming done twice a year by Indian Government.
• National deworming day is on February 10th. In regions with high
prevalence, 2nd round of deworming is carried out on 10th August.
• Age group included is from 1 to 19 years.
• Dose: 200mg for children under 2 years and 400mg for the rest.
• Formulation: 400mg in 10ml suspension is available.
ANTIBIOTICS:
1) AMIKACIN:
• Aminoglycosides
• MoA: Inhibit peptide synthesis.
• Exhibits concentration dependent killing and post-antibiotic
effect, hence given once daily.
• Main action against gram negative, aerobic bacilli.
• Dose: 15-29mg/kg/day given IV
• Side effects: Nephrotixicity, ototoxicity.
2) AMPICILLIN:
• Extended Spectrum Penicillins
• MoA: Inhibits cell wall synthesis
• Effective against gram positive cocci and bacilli, along with few
gram negative organisms.
• Usually given IV, though oral formulation given.
• Dose: 100-200mg/kg/day 6th hourly, 200-400mg/kg/day for
meningitis.
• Side effects: hypersensitivity reactions
3) AMOXICILLIN:
• Similar to Ampicillin
• Usually given orally
• Cannot be used for meningitis
• Dose: 25-50mg/kg/day given 8 to 12th hourly orally,
50-100mg/kg/day IV
• Formulations: Syp as 125mg/5ml, 250/500mg tablets
• CLAVULINATE: B-latamase inhibitors. Hence combination is
effective against B-lactamase producing organisms.
• Formulation: 156mg/5ml, 228mg/5ml, 457mg/5ml, 375mg tablets,
625mg tablets.
4) CEFTRIAXONE:
• Third generation Cephalosporin
• Resistant to B-lactamase producing organisms .
• Highly effective against Gram negative cocci and bacilli, anaerobes
• Dose: 50-75mg/kg/day q 12-24hourly, meningitis 100mg/kg/day.
• Given IV
• Side effects: Hypersensitivity reactions, pseudomembranous colitis,
diarrhoea
5) CEFIXIME:
• Third generation Cephalosporin
• Given orally
• Dose: 8mg/kg/day once or twice daily. For enteric fever, 20mg/kg/day.
• Formulations: 200/400mg tablets, 50 and 100mg/5ml syp
6) VANCOMYCIN:
• Glycopeptide
• MoA: Inhibiton of cell wall synthesis
• Effective against aerobic as well as anaerobic gram positive species.
• Use is limited to treatment of serious infections caused by MRSA
organisms or PMC not controlled by metronidazole.
• IV
• Dose: 40mg/kg/day 6th hourly & 60mg/kg/day for CNS Infections
• Side Effects: RED MAN SYNDROME due to histamine release
7) AZITHROMYCIN:
• Macrolide
• MoA: Inhibit protein synthesis
• Used to treat mainly Atypical organisms like Mycoplasma,
ureaplasma, chlamydia, Moraxella, H influenza, B pertussis, STD’s
• Given orally
• Dose: 10mg/kg/day on empty stomach on day 1 followed by
5mg/kg/day during next 4 days. Maximum of 500mg
• Side effects: allergic reactions, QT prolongation, cholestatic hepatitis
8) ANTI TUBERCULOSIS TREATMENT:
• First line drugs: ISONIAZID / RIFAMPICIN / PYRAZINAMIDE /
ETHAMBUTOL
• All are bactericidal accept ethambutol which is bacteriostatic.
• Drug Regimen:
• Drug Dosage and Fixed Drug Combination:
• Pyridoxine & Role of Steroids:
• Side Effects:
9. COTRIMOXAZOLE:
• Sulphonamides
• MoA: inhibition of Bacterial Folic Acid Synthesis
• Active against gram negative organisms, anti-malarial,
Toxoplasmosis
• Clinical Uses: UTI/Prevention of UTI, Respiratory Tract Infections /
Prevention, Typhoid, STD, Dysentry
• Dose: 5-8mg/kg of TMP, 25-50mg/kg of Sulfamethoxazole. Typhoid
its 10mg/kg & Pneumocystis 20mg/kg. Prophylaxis against UTI is
1-3mg/kg and PCP 5mg/kg.
• Formulation: 40mg/200mg per 5 ml Syp, 80mg/400mg tablet
• Side Effects: Kerinecterus in newborn, hypersensitivity, crystalluria
ANTICONVULSANTS:
1. LORAZEPAM / MIDAZOLAM:
• Benzodiazepines
• MoA: Enhance the frequency of GABA mediated Cl channel opening
• Clinical use: First line agent in Status Epilepticus
• Dose: 0.2mg/kg IM or Intranasal spray 0.3mg/kg Midazolam or
0.1mg/kg/dose IV Lorazepam
• Side effects: Pronounced sedative effects, development of tolerance
to their anticonvulsant effects.
2. Levetiracetam
• Newer Anti-epileptic drugs
• MoA: by inhibiting the synaptic vesicles containing Glutamine to fuse
• Broad Spectrum Anti Seizure Medication
• Dose: 20-60mg/kg/day
• Formulation: 100mg/mL syrup, 250/500mg tablet
• Side effects: dizziness, weakness, suicidal tendencies
3. Phenytoin:
• MoA: decreasing Glutamate release
• Mainly used to treat GTCS type convulsions. First line drugs in status
epilepticus.
• Should not be used for Absence seizures or myoclonic seizures
• Also used to treat Trigeminal neuralgia and ventricular arrhythmia
• Dose: 5-8 mg/kg/day
• Formulation: 30mg/5ml syrup, 100mg tablet
• Side effects: gingival hyperplasia, megaloblastic anemia, vitamin k
deficiency, hirsutism, congenital malformations
4. Valproate:
• MoA: decreasing release of glutamate and increase GABA activity
• Broad spectrum activity: GTCS, absence seizures, myoclonic jerks,
infantile spasms, first line drugs in status epilepticus.
• Dose: 20-60 mg/kg/day
• Formulation: 200mg/5ml syrup, 200/400/500mg tablet
• Side effects: hepatotoxic, pancreatitis, thrombocytopenia, GIT,
alopecia, tremors.
5. Phenobarbitone:
• Barbiturates class of drugs
• MoA: enhances GABA mediated inhibitory effects and also inhibits
glutamate mediated excitatory effects
• Used for GTCS type and neonatal seizures
• Dose: 3-5 mg/kg/day 12 hourly
• Formulation: Syp available as 20mg/5ml.
• Side effects: sedative, drug interaction p, irritability, hyper excitability
Newer Anti-epileptics: Vigabatrine, Lamotrigine, Levitiracetam,
Tigabaine, Topiramate, Zonisamide, etc
ANTIEMETICS:
1. Ondansetron:
• Selective 5-HT3 receptor antagonists
• MoA: blocking 5-HT3 receptors peripherally on vagal nerve terminals
& centrally on NTS & CTZ.
• Dose: IV: 0.15mg/kg/ dose maximum 8mg/dose, can be given 4th
hourly. Oral, <4yr: 2mg q4hr, 4-11yrs: 4mg q4hr, >12yrs: 8mg q4hr.
• Formulation: 2mg/5ml syrup, 4mg & 8mg tablets
• Side effects: very good safety profile. Headache, constipation, rashes.
ANTIHISTAMINES:
1. Cetirizine:
• Second generation antihistamine
• MoA: H1 receptor blocker
• Allergic rhinitis, urticaria
• Dose: 6mo-2yr: 2.5mg OD, 2-6yrs: 2.5mg bd or 5mg od, >6yrs:
5-10mg od/bd. Avoid in children less than 6months
• Formulation: 5mg/5ml Syp
• Side effects: sedation, antimuscarinic side effects.
2. Chlorpheniramine maleate:
• First generation antihistamine
• MoA: H1 receptor blocker
• Common cold
• Dose: 0.35mg/kg/day q6hr
• Formulation: Sinarest-AF drops(2.5mg/1ml), Sinarest AF
Syp(5mg/5ml)
3. Pheniramine maleate:
• First generation antihistamine
• Dose: 0.5mg/kg/day q8hr
• Formulation: Avil 22.75mg as 2mg ampoule
INOTROPES:
BRONCHODILATORS: