**6.4.17 Dobutamine**

322 Complementary Pediatrics

*Dose:* 0.075 mg/kg per dose Q12 hours for 3 days, 0.05 mg/kg per dose Q12 hours for 3 days, 0.025 mg/kg per dose Q12 hours per 2 days, and 0.1 mg/kg per dose Q12 for 2 days IV or PO. *Adverse Effects:* 1/100 Accumulation of fat around the body and face, growth retardation in children, susceptibility to infectious diseases, the activation of diabetes, muscle weakness, abnormal menstruation, body hair in women, akne. Most of these symptoms occurs as a result of long-term glucocorticoid therapy. 1/1000 Disturbances in water management, reducing the level of potassium in the body, accumulation of water in the body, raised blood pressure, heart failure, allergic reactions, accelerated blood clotting, gastrointestinal disorders, increased appetite, weight gain, damage the lining of the digestive tract, sagging skin, mental disorders manifested by extreme changes in mood, insomnia, headache, increased intraocular pressure in the eye lens opacity. If there are troublesome symptoms

It is effective as anxiolytic and muscle- relaxing agent. In treatment of status epilepticus 0.1- 0.5 mg /kg/dose is administered 2 times at 5-15 minutes intervals by IV route in newbornsinfants-children. Its effect by IM route is limited. To decrease anxiety: 4 times 0.2-0.3

Digoxin is an antiarrhythmic and cardiac glycoside drug (Kavakl et al, 1998). It is a highly active cardiac glycoside with a half-life of 48 hours (Dökmeci, 2000; Küçüködük, 1994).

*Uses:* Treatment of heart failure caused by diminished myocardial contractility. Treatment of

*29 < 0.015 mg/kg 0.004 mcg/kg 24 30-36 0.02 mg/kg 0.005 mg/kg 24* 

Total digoxin dose; premature baby: 0.02 mg/kg PO, after birth of newborn; 0.01-0.03 mg/kg IM, IV / 0.04 mg/kg PO, infant; 0.03-0.04 mg/kg IM, IV / 0.05 mg/kg PO, children; 0.010-0.015 mg/kg IM, IV, PO. Higher doses result in fatal arrhythmias (Dökmeci, 2000;

*Adverse Effects:* Toxic Cardiac Effects: PR interval prolongation, sinus bradycardia or SA block, trail or nodal ectopic beats, ventricular arrhythmias. Nontoxic Cardiac Effects: QTc interval shortening, ST segment sagging, T-wave amplitude dampening, heart rate slowing

*The things to be considered by nurse applying the drug:* Before nurse administers Digoxin to a child he or she should very carefully obtain prior Digoxin use history. Serum digoxin, potassium, magnesium and calcium levels should be determined by laboratory investigations before digoxin administration. Nurse should measure radial heart rate for a minute before administrating the drug to child and if any abnormality presents he or she

*>37 0.035 mg/kg 0.006 mg/kg 12 (Young &* 

*Mangum, 2010).* 

*Dose: Old Dose Maintenance Interval* 

SVT, atrial flutter, and atrial fibrillation (Young & Mangum, 2010).

should seek medical attention.

mg/kg/day PO (Eroğlu, 2002).

**6.4.15 Diazepam** 

**6.4.16 Digoxin** 

Küçüködük, 1994).

(Young & Mangum, 2010).

It is used in temporary treatment of heart failures related to the depression caused by cardiac rigidity. 0.0025-0.010 mg/kg/min is administered by IV infusion according to the patient's response (Eroğlu, 2002).

*Dose:* 2 to 20 mg/kg per minute continuous IV infusion. Begin at a low dose and titrate by monitoring effects. Use a large vein for IV (Kanmaz, 2010).

*Side Effects:* Volume replacement should be performed before drug use as it may cause hypotension in hypovolemic patients. Tachycardia may develop at higher doses. Arrhythmia, hypertension and vasodilatation in skin may also develop. If it exudes or passes out of a vessel it causes tissue ischemia (Kanmaz, 2010).

*Administration and Storage Conditions:* Diluted drug can be stored for 6 hours under room temperature and 48 hours in refrigerator. Slight color change does not mean that the drug is spoiled (Kanmaz, 2010).

#### **6.4.18 Dopamine**

It is indicated for all kinds of hypotension, heart failure and circulatory impairments. To increase cardiac output and to improve organ perfusion it is started to be administered by IV infusion at a dose of 0.002-0.005 mg/kg/min (100 mg dopamine in 250 ml 5% dextrose) as 0.400 mg/ml solution. It can be advanced up to 0.020 mg/kg/min (Apak, 1996).

*Uses:* Treatment or hypotension

*Dose:* 2 to 20 mcg/kg per minute continuous IV infusion. Begin at a low dose and titrate by monitoring effects. Use a large vein for IV.

The Administration and Dose of Most Frequently Used Drugs in Pediatrics 325

*Dose:* 1 mg/kg IV slow push, IM or PO. May increase to a maximum of 2 mg/kg per dose IV

*Adverse Effects:* > 1 /100 Decreased blood potassium levels, which implies a weakening of the muscles. Decreased levels of magnesium, calcium and sodium. Increasing levels of uric acid in the blood. Reduce the volume of blood in case of longer treatment. 1/1000 Digestive disorders. <1/1000 Phlebitis. Changes in the blood picture. Allergic reactions. If you get a rash you should immediately contact your doctor and stop taking the drug. Dizziness and

It develops hypotension, hyponatremia, hypokalemia, alkalosis and hypercalciuria. It is

*Uses:* It is used in patients with diabetes in decline due to excessively low blood sugar. This

*Adverse Effects*: 1 /100 Nausea and vomiting. 1/1000- <1/1000 Allergic reactions (Young &

*Uses:* Preventing blood clots, the risk of their formation is increased, e.g. after surgical procedures in acute myocardial infarction. Heparin is also used to treat blood clots in the legs and lungs in congestion of the arteries. The use of heparin also gives good results in the treatment of frostbite and burns (Young & Mangum, 2010). Prevention of peripheral and central catheters from congestion. Its use in renal vein thrombosis is still a matter of

For thrombosis treatment 70 Unit/kg bolus in 10 minutes, 28 Unit/kg/hour continuous

*Adverse Effects:* Side effects in the form of bleeding occurs in approximately 10% of patients. >1/100 Bleeding. A decline in platelet count. Changes in the functions of the liver. <1/1000 Allergic reactions, allergic shock. Disturbances in the function of the adrenal cortex.

*Drugs to be confronted at the end point:* Dex/Amino acid mixture, Acyclovir, Amphotericin B, Ampicillin, Calcium gluconate, Cefazolin, Cefepime, Cefotaxime, Ceftazidime, Ceftriaxone,

infusion (Young & Mangum, 2010). 75 units/kg bolus over 19 minutes.

*Administration and Storage Conditions:* The ampoules should be protected against light.

Incompatible: Dopamine, Dobutamine, Erythromycin, Fluconazole, Midazolam.

tinnitus. Increased blood sugar levels (Young & Mangum, 2010).

highly ototoxic especially when administered fast.

condition usually occurs as a result of too much insulin.

Compatible: SF and sterile water.

*Dose:* 200 mcg/kg per dose IV, IM, SC

**6.4.21 Glucagon** 

Mangum, 2010)

**6.4.22 Heparin** 

discussion (Kanmaz, 2010).

*Dose:* IV for each ml of liquid 0.5-1 Unit

Hair loss (Young & Mangum, 2010).

*Miscible Serums:* SF, 5% DX, 10% DX

*Preparation:* Added onto the solution as half of the total.

or 6 mg/kg per dose PO.

*Adverse Effects:* > 1/100 Headache. Additional heartbeat, increased heart rate. Pain in the chest. Nausea and vomiting. Shortness of breath. 1/1000 Heart arhythmia. Changes in the ECG. Lowering blood pressure. Allergic reactions. Pulmonary edema (Young & Mangum, 2010).

*Monitor:* Heart rate and intra-arterial blood pressure should continuously be monitored. Urinary output and peripheral perfusion should be observed. A large vein is recommended to use. Extra care should be shown in terms of extravasation. Pallor may be observed through the subject vein. If it exudes or passes out of a vessel it causes necrosis, in which case 1 mg/ml phentolamine should be injected around lesion (Kanmaz, 2010).

*Administration and Storage Conditions:* The opened ampoule should be stored in refrigerator and consumed within 24 hours. Ampoules with color change should not be used (Kanmaz, 2010).

*Miscible Serums:* 5% DX, 5% DSF, SF, D/AA, fat emulsions (Kanmaz, 2010).

*Incompatible Drugs:* Amphotericin B, Acyclovir, Furosemide, Indomethacin, Insulin, Sodium bicarbonate (Kanmaz, 2010).

#### **6.4.19 Fentanyl**

*Uses:* Anelgesia, sedation, anesthesia.

*Dose:* Sedation and analgesia: 0.5 to 4 mcg/kg per dose IV slow push. Repeat as require (usually Q2 to 4 hours).

Infusion rate: 1 to 5 mcg/kg per hours. Tolerance may develop rapidly following constant infusion.

Anesthesia: 5 to 50 mcg/kg per dose (Young & Mangum, 2010).

*Neonatal dose:* IV slow 0.3-2 mcg/kg/dose IV infusion dose: 0.3-5 mcg/kg/hour (Anand, 2007).

*Adverse Effects:* Respiratory depression, Sometimes nausea, Vomiting, Bradycardia, Hypotension, Extremely bronchospasm. At high doses observed in a small chest muscle stiffness, which may hamper rescue breathing (Young & Mangum, 2010).

*Preparation:* 1 ml fentanyl from 50 mcg/ml ampoules gets diluted with 4 ml SF.

*Miscible Serums:* 5% DX, 10% DX, SF

*Drugs to be confronted at the end point:* Dex/Amino acid mixture, Dekort, Dobutamine, Dopamine, Furosemide, Heparin, Midazolam, Potassium Chloride.

*Incompatible Drugs:* Phenytoin, Azithromycin.

*Storage Conditions:* It should be protected against light. Diluted ampoules can be stored for 24 hours in refrigerator.

#### **6.4.20 Furosemidum**

*Uses:* Diuretic that may also improve pulmonary function. It is used in pulmonary edema, in heart failures and for increasing urinary discharge

*Dose:* 1 mg/kg IV slow push, IM or PO. May increase to a maximum of 2 mg/kg per dose IV or 6 mg/kg per dose PO.

*Adverse Effects:* > 1 /100 Decreased blood potassium levels, which implies a weakening of the muscles. Decreased levels of magnesium, calcium and sodium. Increasing levels of uric acid in the blood. Reduce the volume of blood in case of longer treatment. 1/1000 Digestive disorders. <1/1000 Phlebitis. Changes in the blood picture. Allergic reactions. If you get a rash you should immediately contact your doctor and stop taking the drug. Dizziness and tinnitus. Increased blood sugar levels (Young & Mangum, 2010).

It develops hypotension, hyponatremia, hypokalemia, alkalosis and hypercalciuria. It is highly ototoxic especially when administered fast.

*Administration and Storage Conditions:* The ampoules should be protected against light.

Compatible: SF and sterile water.

Incompatible: Dopamine, Dobutamine, Erythromycin, Fluconazole, Midazolam.

#### **6.4.21 Glucagon**

324 Complementary Pediatrics

*Adverse Effects:* > 1/100 Headache. Additional heartbeat, increased heart rate. Pain in the chest. Nausea and vomiting. Shortness of breath. 1/1000 Heart arhythmia. Changes in the ECG. Lowering blood pressure. Allergic reactions. Pulmonary edema (Young & Mangum, 2010).

*Monitor:* Heart rate and intra-arterial blood pressure should continuously be monitored. Urinary output and peripheral perfusion should be observed. A large vein is recommended to use. Extra care should be shown in terms of extravasation. Pallor may be observed through the subject vein. If it exudes or passes out of a vessel it causes necrosis, in which

*Administration and Storage Conditions:* The opened ampoule should be stored in refrigerator and consumed within 24 hours. Ampoules with color change should not be used (Kanmaz, 2010).

*Incompatible Drugs:* Amphotericin B, Acyclovir, Furosemide, Indomethacin, Insulin, Sodium

*Dose:* Sedation and analgesia: 0.5 to 4 mcg/kg per dose IV slow push. Repeat as require

Infusion rate: 1 to 5 mcg/kg per hours. Tolerance may develop rapidly following constant

*Adverse Effects:* Respiratory depression, Sometimes nausea, Vomiting, Bradycardia, Hypotension, Extremely bronchospasm. At high doses observed in a small chest muscle

*Drugs to be confronted at the end point:* Dex/Amino acid mixture, Dekort, Dobutamine,

*Storage Conditions:* It should be protected against light. Diluted ampoules can be stored for

*Uses:* Diuretic that may also improve pulmonary function. It is used in pulmonary edema, in

case 1 mg/ml phentolamine should be injected around lesion (Kanmaz, 2010).

*Miscible Serums:* 5% DX, 5% DSF, SF, D/AA, fat emulsions (Kanmaz, 2010).

Anesthesia: 5 to 50 mcg/kg per dose (Young & Mangum, 2010).

IV infusion dose: 0.3-5 mcg/kg/hour (Anand, 2007).

Dopamine, Furosemide, Heparin, Midazolam, Potassium Chloride.

stiffness, which may hamper rescue breathing (Young & Mangum, 2010).

*Preparation:* 1 ml fentanyl from 50 mcg/ml ampoules gets diluted with 4 ml SF.

*Neonatal dose:* IV slow 0.3-2 mcg/kg/dose

bicarbonate (Kanmaz, 2010).

*Uses:* Anelgesia, sedation, anesthesia.

*Miscible Serums:* 5% DX, 10% DX, SF

24 hours in refrigerator.

**6.4.20 Furosemidum** 

*Incompatible Drugs:* Phenytoin, Azithromycin.

heart failures and for increasing urinary discharge

**6.4.19 Fentanyl** 

infusion.

(usually Q2 to 4 hours).

*Uses:* It is used in patients with diabetes in decline due to excessively low blood sugar. This condition usually occurs as a result of too much insulin.

*Dose:* 200 mcg/kg per dose IV, IM, SC

*Adverse Effects*: 1 /100 Nausea and vomiting. 1/1000- <1/1000 Allergic reactions (Young & Mangum, 2010)
