**6.4.39 Ranitidine**

*Dose:* PO: 2 mg/kg per dose Q8 hours. IV: 1.5 mg/kg per dose Q8 hours.

*Uses:* Prevention and treatment of stress ulcers and GI hemorrhage aggravated by gastric acid secretion.

*Adverse Effects:* 1/100 Fatigue. Diarrhea, rash, dizziness. 1/1000 Allergic reactions such as swelling of the skin rash, fever, seizures or asthma. Changes in the blood picture and liver function. Jaundice. Depression, hallucinations, disorientation, especially in debilitated and elderly patients. Seeing the fog. Pain in muscles and joints (Young & Mangum, 2010).

#### **6.4.40 Steroids**

Steroids are used as anti-inflammatory, immunosuppressive or in rheumatic diseases in order to increase sensitivity against beta adrenergic, chronic ulcerative colitis, nephrotic syndrome, tuberculosis meningitis and asthma.


The drug can be administered 1-2 times a day by oral route. Hydrocortisone should be administered deeply IM and delta frame should not be performed. Steroids should be administered by SC route as they cause sterile abscess and pseudoatrophy. The duration of therapy may differ from 3-5 days to weeks or months depending on the diagnosis of child. The drug is metabolized in liver and discharged from body via urinary system.

*Side Effects*: Edema, hypertension, headache, convulsion, acne, skin atrophy, hypokalemia, alkalosis, Cushing syndrome, hyperglycemia, peptic ulcer, nausea, vomiting, cataract, glaucoma and muscle weakness are observed side effects (Kavakl et al, 1998).

*The things to be considered by nurse applying the drug:* The recommendation of manufacturer on the route of administration should be taken into consideration. Nurse should administer the drug slowly by IV route. In oral administration it should be administered at meal intervals or after meals to decrease gastric irritation of drug. Salt is limited in foods. If possible diets rich in potassium and protein are prepared. The blood pressure and other vital signs, inputoutput, sleeping condition and daily weight check of child is observed in recorded. Oral and hygienic care is provided at frequent intervals. Steroid can cause hyperkalemia when used with certain diuretics. Phenobarbiturates decrease the effect of steroids. Urinary and blood glucose investigations should be carried out especially in children with diabetics. It may be necessary to increase insulin dose. As it is a drug decreasing hypophyseal stimulation for a long-term it may cause adrenal insufficiency, in which cases such symptoms as loss of appetite, nausea, anorexia, pain, fever and painful urination may appear in children. The drug should be administered carefully in patients with previous psychological problems. The behaviors, emotional status, sleeping order and psychomotor activity changes of child should be monitored and notified to doctor especially on long-term treatments. The treatment should be ceased by gradually decreasing dose. Long-term applications should be avoided in that it has many side effects. Unless otherwise stated by manufacturer nurse should protect drug against light and frost (Kavakl et al, 1998).
