**6.4.9 Calcium gluconate 10%**

*Uses:* Treatment and prevention of hypocalcaemia, usually defined as a serum ionized calcium concentration less than approximately 4 mg/dL. Treatment of asymptotic infants is controversial.

*Dose:* Symptomatic hypocalcaemia – acute treatment: 100 to 200 mg/kg per dose. Maintenance treatment: 200 to 800 mg/kg per day (Young & Mangum, 2010).

*The things to be considered by nurse applying the drug:* The drug should be administered by IV route in a way not to exceed 0.5 ml per minute. Besides, 1000 ml serum, prepared in physiologic, can be administered every 12-24 hours. The temperature of solution should be close to the body temperature. The fast delivery of calcium to heart at higher concentrations may result in fatal cardiac arrest. So the drug should be administered very slowly when parenteral route is used. The heart rate should be checked and monitored. When the drug is administered by non-diluted IV route paresthesias, peripheral vasodilatation and hypotension can be observed. If the child is observed with any symptom drug administration should be ceased and the child should be ensured to rest for half an hour or one hour. It can cause extravasation (the process of exuding or passing out of a vessel into surrounding tissues) tissue irritation and necrosis. Nurse should closely monitor the injection area.

The Administration and Dose of Most Frequently Used Drugs in Pediatrics 321

*Adverse Effects:* Not recommended for use in neonatal with hyperbilirubinemia! Displaces bilirubin from albumin binding sites, resulting in higher free bilirubin serum concentration. Concurrent administration of ceftriaxone and calcium-containing solutions or products in neonates is contraindicated. Eosinophilia, Thrombocytosis, leukopenia. Increase in AST and ALT. Skin rash. Transient gallbladder precipitations occasionally associated with colicky

*Uses:* Sedative/hypnotic for short-term use only. Chloral hydrate has no analgesic after a

*Dose:* 25 to 75 mg/kg per dose PO. Oral preparation should be diluted or administered after

*Adverse Effects:* Chloral hydrate may lead to unpleasant side effects, including: drowsiness, nausea, vomiting, and diarrhea. Toxic doses (overdoses) can cause a marked drop in blood pressure and severely compromised respiration (breathing). Signs of an overdose of chloral hydrate can include: confusion, seizures, difficulty breathing, slurred speech, slow or irregular heartbeat, vomiting, weakness, and a lowered body temperature. Chronic use of chloral hydrate is also associated with a severe withdrawal syndrome and may induce liver

*Pharmacology:* Ferrous salts are preferred as they are absorbed 2-3 times better than ferric salts when administered by oral route. Ferrous sulfate, ferrous fumarate, ferrous gluconate can also be used. Absorption is better on an empty stomach. Half or one-third of it is

*Dose:* Premature infants: Elemental iron 2 mg/kg/dose PO, started after 4 weeks in doses divided into 2-3. For babies lighter than 1000 gr 4 mg/kg/day may be administered. For

*Iron dextran:* For ones who cannot take by oral route 0.4-1 mg/kg/day is administered as

*Side effects:* Iron treatment should not be launched as long as premature infants do not get adequate vitamin E. Hemolysis may increase in that case. Diarrhea and constipation, lethargy, hypotension, black-colored stool and erosion in gastric mucosa can be observed. It

*Uses:* Dexamethasone is used primarily in the intensive and short-term treatment of severe allergic conditions such as asthma, also in rheumatic diseases, skin diseases, eye, blood and

may be required to seek for occult blood in stool in suspicious cases (Kanmaz, 2010).

*Indication:* The prevention and treatment of iron-deficiency induced anemia.

abdominal pain, nausea, and vomiting (Young & Mangum, 2010).

**6.4.12 Chloral hydrate** 

feeding to reduce gastric irritation.

feeding to reduce gastric irritation.

damage (Young & Mangum, 2010).

absorbed when taken with food.

continuous infusion in D/AA.

**6.4.14 Dexamethasone** 

certain cancers.

patients receiving EPO treatment: 6 mg/kg/day

**6.4.13 Iron** 

In order to ensure well absorption by oral route the drug should be administered 1-1.5 hours after meals. In order to promote intestinal absorption the use of milk and milk products should be decreased. As calcium gluconate increases the digital toxicity it should be attentively administered in patients receiving digital.

The effect of drug on tetany treatment is evaluated by neuromuscular recovery (Kavakl et al, 1998).

*Administration:* It can be either slowly administered by IV route in 10-30 minutes or used as continuous infusion.

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

*Drugs to be confronted at the end point:* Dex/Amino acid, Lipid solution, Aminophylline, Ampicillin, Amicasin, Dobutamine, Furosemide, Heparin, Midazolom, Meropenem, Potassium chloride, Vancomycin

*Incompatibility:* Amphotericin B, Fluconazole, Sodium bicarbonate

*Side effects:* Bradycardia, cardiac arrest, tissue necrosis, intestinal bleeding, diarrhea, gastric irritation. It should be used carefully in patients who receive digital treatment and has bradypnea.

#### **6.4.10 Captopril**

*Uses:* Treatment of moderate to severe hypertension. Afterload reduction in patients with congestive heart failure.

*Dose:* 0.01 to 0.05 mg/kg per dose PO Q8 to 12 hours. Adjust dose and interval based on response. Administer 1 hour before feeding.

*Adverse Effects:* Captopril produces the following side effects: Angioedema with involvement of the face, mouth, larynx, tongue, and glossitis, neutropenia, anemia and thrombocytopenia, proteinuria, acidosis, tachycardia, cardiac arrest, arrhythmias, rash and erythema multiform, exfoliate dermatitis, photosensitivity, elevated liver enzymes in serum, liver cell injury, cholestasis jaundice, gastric irritation, hepatitis, drowsiness, nervousness, depression, paresthesias of hands, confusion, ataxia, bronchitis, bronchospasm, pneumonia eosinophil, rhinitis (Young & Mangum, 2010).

#### **6.4.11 Ceftriaxone**

*Uses:* Treatment of neonatal sepsis and meningitis caused by susceptible gram-negative organisms (e.g. E coli, Pseudomonas, Klebsiella, H influenzae). Treatment of gonococcal infections.

*Dose:* Septis and disseminated gonococcal infection: 50mg/kg Q24 hours. Meningitis: 100 mg/kg loading dose, then 80 mg/kg Q24 hours. Uncomplicated gonococcal ophthalmia: 50 mg/kg (maximum 125 mg) single dose. (note: topical antibiotic therapy alone is inadequate and is unnecessary if systemic treatment is administered). IV administration: infusion by syringe pump over 30 minutes. Avoid administration of calcium-containing solution or products within 48 hours of the last administration. IM administration: to reduce pain at the injection site, reconstitute with 1% lidocaine without epinephrine.

*Adverse Effects:* Not recommended for use in neonatal with hyperbilirubinemia! Displaces bilirubin from albumin binding sites, resulting in higher free bilirubin serum concentration. Concurrent administration of ceftriaxone and calcium-containing solutions or products in neonates is contraindicated. Eosinophilia, Thrombocytosis, leukopenia. Increase in AST and ALT. Skin rash. Transient gallbladder precipitations occasionally associated with colicky abdominal pain, nausea, and vomiting (Young & Mangum, 2010).
