**6.4.13 Iron**

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

*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 absorbed when taken with food.

*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 patients receiving EPO treatment: 6 mg/kg/day

*Iron dextran:* For ones who cannot take by oral route 0.4-1 mg/kg/day is administered as continuous infusion in D/AA.

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

#### **6.4.14 Dexamethasone**

*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 certain cancers.

The Administration and Dose of Most Frequently Used Drugs in Pediatrics 323

should check apical pulse and its rate, rhythm and properties and notify doctor. The drug can be administered by IV route either directly or via a solution including 5% dextrose or 9% sodium chloride. Absorption may delay if the drug is administered by oral route after meals. And absorption may also delay when administered with antacids. IM administration of drug is not advised especially for children with diabetics or mild tissue perfusion as it causes pain. When IM route is used the drug should be administered deep into a large muscle mass and then the area should be massaged after injection. No more than 5 mL should be administered in one area. In case that digoxin is administered with such drugs as diuretics which decrease potassium level and some antibiotics toxicity may develop. Besides, calcium should not be administered to digitalized children. It may have fatal consequences. If the drug is used for atrial fibrillation treatment purposes nurse should check heart rate and if it is below 60 or above 100 beats per minute then he or she should notify doctor. The drug should be administered with precaution and at fewer doses in children with hyperkalemia having kidney and hepatic impairment. The inputs/outputs of child should be followed, edema should be monitored and daily weight check should be ensured. Cardiac arrhythmia and anorexia in children are early symptoms of toxicity. Nurse should pay attention to those symptoms. If it is suspected of toxicity blood digoxin level should be measured and EGK should be performed. Nurse should store the drug in tightclosed and light-proof bottles. If any color change is observed the drug should not be used

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

*Dose:* 2 to 20 mg/kg per minute continuous IV infusion. Begin at a low dose and titrate by

*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

*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

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)

*Dose:* 2 to 20 mcg/kg per minute continuous IV infusion. Begin at a low dose and titrate by

as 0.400 mg/ml solution. It can be advanced up to 0.020 mg/kg/min (Apak, 1996).

(Kavakl et al, 1998).

**6.4.17 Dobutamine** 

spoiled (Kanmaz, 2010).

*Uses:* Treatment or hypotension

monitoring effects. Use a large vein for IV.

**6.4.18 Dopamine** 

patient's response (Eroğlu, 2002).

monitoring effects. Use a large vein for IV (Kanmaz, 2010).

passes out of a vessel it causes tissue ischemia (Kanmaz, 2010).

*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 should seek medical attention.

#### **6.4.15 Diazepam**

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 mg/kg/day PO (Eroğlu, 2002).
