DRUGS VIVA for final md exams maharshtra

DRUGS VIVA for final md exams maharshtra

1. DRUGS VIVA DEPT OF PAEDIATRICS GMKMC,SALEM

2. DOPAMINE Beta 1 agonist- ionotropic effect Improves myocardial efficiency Increases coronary artery blood flow Dose: 5-20 mcg/kg/min Mixed with normal saline/dextrose Given as infusion Side effect: tachycardia (>10 mcg), tissue necrosis if extravasation

3. DOBUTAMINE Ionotrope - acts on beta-1 adrenergic receptors Weak beta 2 and alpha 1 action less tachycardia compared to dopamine Cardiogenic shock Normotensive shock 10-20 mcg/kg/min Side effects- hypertension,tachycardia , arrythmia

4. ADRENALINE/ epinephrine Non selective adrenergic agonist; beta1(predominant), beta 2, alpha 1 actions Increase the myocardial contractility( ionotrope ) Increase the heart rate( positive chronotropic ) Increases the blood pressure Available as 1:1000 ; 1ml=1mg Indications: Cardiopulmonary resuscitation including neonatal resuscitation- 1:10,000 dilution ; 0.1 ml/kg; intravenously every 3-5 minutes ; max 3 doses

5. Drug of choice for Anaphylaxis- 0.01 ml/kg of 1:1000 dilution intra muscular Life threatening asthma- 0.1 ml/kg of 1: 10,000 sub sub - cutaneous Used as intra venous infusion for hypotensive shock of any etiology Use topically for arresting nasal bleed Side effects: tachycardia, arrythmia,headache etc; Should not be used topically in digits

6. NOR ADRENALINE/ norepinephrine Alpha 1& alpha 2 receptor agonist; beta 1 agonist; no action on beta 2 Increases the systolic BP, diastolic BP& MAP Ionotropic effect Indications: Used as intra venous infusion 0.1 -1 mcg/kg/min Mixed with saline or dextrose warm (peripheral vasodilatation)septic shock Hypotensive shock Side effects: reflex bradycardia, arrythmia

7. ATROPINE Muscuranic cholinergic antagonist Uses: OPC poisoning –drug of choice- 0.05 mg/kg/dose Neurotoxic snake bite- 0.02 mg/kg/ dose;prior to neostigmine Side effects: dry mouth, tremor, agitation, confusion,

8. CALCIUM GLUCONATE Each mL contains: Calcium gluconate 94 mg;  Used as slow intravenous infusion only Diluted with dextrose solution Indication: neonatal seizure Hypocalcemia in neonates, children Nutritional rickets Treatment of hyperkalemia ( cardiac membrane stabilisation) Used in Partial parenteral nutrition Side effects: bradycardia, necrosis( extravasation ),

9. PHENOBARBITONE Belongs to barbiturate group of anti convulsant Acts on the GABA A receptors- increases synaptic inhibition Inhibit calcium channels Indication: 20 mg/kg/dose -Diluted with normal saline and infused intravenously over 1 mg/kg/min drug of choice for neonatal seizures Status epilepticus- 3 rd line Can be used in all seizure types Continuous prophylaxis for febrile seizure Side effects: respiratory depression

10. PHENYTOIN Hydantoin derivative Voltage dependant blockage of membrane sodium channels Indication: 20 mg/kg/dose(max 40 mg/kg) -Diluted with normal saline and infused intravenously over 1 mg/kg/min Second line drug in status epilepticus Treatment of all types of seizures Not useful in myoclonic seizure Side effects: arrythmia , hypotension, extravasation causes necrosis of skin; long term- gum hypertrophy, hirsuitism , anemia , ataxia etc

11. fosphenytoin Water soluble pro drug of phenytoin 10 mg =15 mg of fosphenytoin Advantage: faster infusion rate (3 mg/kg/min) Intra muscular route also arrythmia , hypotension is less Expensive; not available in resource limited setting Indication: status epilepticus

12. MIDAZOLAM Benzodiazepine group; fastest acting; short duration of action First line AED; 0.1 mg/kg (max 2 doses) Can be given as I.V./I.M./intra nasal/ buccal Can be given as infusion in refractory status epilepticus Used for procedural sedation, prior to intubation Side effect: hypotension, respiratory depression

13. DIAZEPAM Benzodiazepine group Long acting 0.3 mg/kg/dose ; given as intravenously Can be given per rectal Used as antiepiletic (if lorazepam / midazolam is unavailable) Used to control spasms in Tetanus As muscle relaxant in spastic cerebral palsy Side effects: respiratory depression(more than midazolam )

14. PARACETAMOL Anti pyretic, analgesic, NSAID 15 mg/kg/dose; every 6 hours( max 60mg/kg/day) COX 2 inhibition; inhibits synthesis of prostaglandins Metabolised in liver- glucoronide conjugation and reactive metabolite NAPQI NAPQI- responsible for liver injury Specific antidote- N acetyl cysteine Used for PDA closure in newborn Side effects- acute liver injury in over-dosage

15. N ACETYL CYSTEINE Specific antidote for paracetamol poisoining Used in non paracetamol induced fulminant hepatic failure, Mucolytic - in cystic fibrosis, bronchiectasis , ventilated patients Used as intra venous infusion, nebulisation, oral capsules

16. HYDROCORTISONE Short acting low potent glucocorticoid Rapid onset of action Indications: Anaphylaxis, allergic disorders Acute severe asthma Adrenocortical insufficiency (Congenital Adrenal Hyperplasia , Addisons disease Juvenile idiopathic arthritis Catecholamine resistant septic shock

17. Hydrocortisone contd., Contraindictions : Immunocompromised children Neonatal fungal infections Dosage : anaphylaxis : < 2 years – 25 mg 2-5 years - 50mg > 5 years – 100mg

18. DEXAMETHASONE Long acting Potent glucocorticoid Indications: Acute Laryngo Tracheo Bronchitis Meningitis and encephalitis(prior to giving antibiotics)-to prevent inflammation Cerebral edema Moderate to severe covid pneumonia

19. dexamethasone contd., 0.2 mg/kg/ dose intravenously 8 th hourly ALTB- 0.6 mg/kg single dose

20. ONDANSETRON 5 HT3 antagonist. Indications: vomiting Dose : 0.1 mg/kg /dose iv/ im /oral as needed

21. RANITIDINE H2 receptor blocker Dosage : 1-2 mg/kg /dose i.v . Bd (before food) 2-4 mg /kg /dose oral Bd (before food) Indications : Acute gastritis Stress ulcer Allergic disorder GI bleed Rapid infusion –myocardial depression

22. VITAMIN K Vitamin K1 ( Phytomenadione ) Helps in blood clotting of 2,7,9,10 Dosage : 1 mg intra muscular- at birth Indications: to all newborns to Prevent hemorrhagic disease of newborn (HDN) For treatment of HDN in newborn (2mg i.v . Single dose) In older children: Bleeding disorders DIVC Hepatic failure

23. MANNITOL Osmotic diuretic Dosage: 0.25 to 0.5 g/kg intravenously every 6 th hourly Indications : cerebral edema Adverse effects: Pulmonary congestion, acidosis, electrolyte imbalance

24. ZINC Naturally occuring element Dosage: 2-6 month- 10 mg OD for 14 days >6 months- 20 mg OD for 14 days Indication: acute diarrhoea , antibiotic induced diarrhoea , wilsons disease , acrodermatitis enteropathica

25. ZINC Mechanism of action: Inhibits fluid secretion in the intestine- improves the consistency of stools Improves the absorption of water & electrolytes- reduces the frequency of stools Regeneration of intestinal epithelium-reduces the duration of diarrhea Local intestinal immuno modulator-prevent the future episode of diarrhea in 3 months

26. ORAL REHYDRATION SOLUTION(ORS) Osmolarity - 245 Composition( mmol /lit): sodium- 75;glucose -75 potassium-20; chloride-65; citrate-10; Mechanism: ability of glucose to stimulate sodium and fluid absorption in the small intestine via cyclic AMP independent process Advantage of RO-ORS: Reduces stool output or volume by 25% Reduces vomiting by 30% Reduces the need for unscheduled IV therapy by 30%

27. Dosage: as much as the child takes (10 ml/kg/dose)-plan A 75 ml/kg in 4 hours+ ongoing losses(plan B) Used with caution: altered sensorium , severe electrolyte imbalance, ileus , persistent vomiting

28. AMPICILLIN Semi synthetic penicillin Effective against Gram positive & some gram negative bacteria Dosage: 100-300 mg/kg/day; 2 -3 divided doses; intravenously Indication: listeria infection Community acquired pneumonia – hospitaslised Menigitis Infective endocarditis Septicemia Urinary tract infection Contraindication: penicillin anaphylaxis/ hypersenstivity

29. CLOXACILLIN Penicillin derivative Effective against Gram positive- staphylococcus aureus (MSSA) Dosage: 50-100 mg/kg/day in 2-3 divided doses; intravenously Adverse effect: skin rash; skin necrosis if extra vasation , thrombophlebitis

30. CEFOTAXIM Third generation cephalosporin Broad spectrum antibiotic 100-300 mg/kg/day in 2-3 divided doses Intravenous/intra muscular Pneumonia, meningitis, urinary tract infection. septicemia ,soft tissue infection, epiglottitis , Contraindication: known hypersensitivity Side effects: hypersensitivity- rash, fever, urticaria , anaphylaxis

31. NORMAL SALINE 0.9% Isotonic Crystalloid 0.9 gm in 100 ml Contains sodium and chloride 154 mmol /l Osmolarity -286 Dehydration correction Used in correction of shock of any etiology Correction of hyponatremia Reconstitution of drugs

32. RINGER LACTATE/Hartmann fluid Isotonic crystalloid fluid balanced or buffered solution used for fluid replacement Osmolarity-273; pH of about 6.5 Sodium -130 mM ; chloride-110 mM ; potassium-4 mM;calcium-0.67 mM ; sodium bicarbonate Dehydration correction in diarrhoea Mild Metabolic acidosis