libro neonatologia

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libro en inglés de neonatología

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libro neonatologia

  1. 1. NNeeoonnaattoollooggiissttss’’ PPoocckkeett DDrruugg RReeffeerreennccee Fifth edition 2012 For suggestions and inquries
  2. 2. New in this edition Revised drug dosage: reflecting recent changes in Neofax 2011, British National Formulary for Children 2011-2012 and Manual ofNeonatal Care 2012. Addition of New drugs: EMLA cream, Famotidine, Hyalase, Lanzor, Noradrenaline and Vfend. Neonatologists’ Pocket Drug Reference
  3. 3. Acetylcistein® Acetylcysteine 200 mg effervescent sachets Dose: 200 - 400 mg PO up to 3 times daily if necessary. BNFC2011-12 ‫صضتايين‬ ‫اصتيل‬‫فوار‬(‫كِظ‬٢٠٠‫مجم‬/٤‫ضم‬‫مقطز‬‫ماء‬)...‫ضم‬‫بالفم‬/٢٢‫ضاعت‬ Solution concentration 50 mg/mL. USES Meconium ileus. Mucolytic; lowers mucous viscosity and facilitates its removal by the mucociliary action. It improves the phagocytic capacity of alveolar macrophages. ADVERSEEFFECTS / PRECAUTIONS Hypersensitivity-like reactions including rashes and anaphylaxis. Mild increase in INR and PT. Avoid with peptic ulceration. TREATMENTOF ACETAMINOPHEN TOXICITY N-acetylcysteine (use concentration of 40 mg/mL) LD: 150 mg/kg in D5W IVI over 60 minutes. MD: 50 mg/kg IVI over 4h then 100 mg/kg over 16h until clinical and biochemical markers of hepatic injury improve (e.g. INR normaliz es). In acetaminophen poisoning, giving acetylcysteine by mouth [unlicensed route] is an alternative if intravenous access is not possible. BNFC2011-12
  4. 4. Acyclovir (Zovirax®) 250 mg / 5 mL Vial or 200 mg / 5 mL Susp. Dose: 20 mg/kg/8h IVI over 1h, for 14 days ((iinn llooccaalliizzeedd HHSSVV iinnffeeccttiioonnss)) or 21 days ((iinn ddiisssseemmiinnaatteedd oorr CCNNSS iinnffeeccttiioonnss)). Neofax2011 In Chickenpox and Herpes Zoster Infection: 10-20 mg/kg/8h IVI over 1h for at least 7days. B NFC2011-12 In Prophylaxis of Chickenpox After Delivery: 10 mg/kg/8h IVI over 1h; continued until serological tests confirm absence of virus. BNFC2011-12 Prolong dosing interval to Q12h in PT <34 wk PMA, in RF or LCF. ‫يراكط‬‫زوف‬(٢٥٠‫مجم‬/٥‫م‬‫ض‬()٢‫ضم‬+٩‫ضم‬)...‫ضم‬/۸‫ضاعاث‬‫د‬‫وري‬‫ــت‬‫ع‬‫ضا‬ ‫ـدى‬‫م‬ ‫على‬ Infusion solution concentration 5 mg/mL. Maximum Infusion solution concentration 7 mg/mL. Dilution should be used within 24h. Don’t refrigerate. Compatible with D5W and NS. For Chronic Suppression: 75 mg/kg/dose Q12h PO. Neofax2011 ‫شراب‬ ‫زوفيراكط‬(٢٠٠‫مجم‬/٥‫ضم‬)...‫ضم‬‫بال‬‫فم‬/٢٢‫ضاعت‬ Store oral suspension at room temperature. RENAL IMPAIRMENT BNFC2011-12 Cr Cl 25-50 mL/min/1.73 m 2  IV dose Q12h. Cr Cl 10-25 mL/min/1.73 m 2  IV dose Q24h. Cr Cl 10-25 mL/min/1.73 m 2  For HZV PO Q8h. Cr Cl < 10 mL/min/1.73 m 2  For HZV or HSV PO Q12h. USES Neonatal HSV,VZV infections with CNS and pulmonary involvement. MONITOR Periodic CBC. SSeerruumm ccoonncceennttrraattiioonn 2h after dose is ~2 μg/mL. Renal and hepatic function. IV site for phlebitis  use more diluted infusion. ADVERSE EFFECTS / PRECAUTIONS Neutropenia (20%)   dose or use Neupogen® if ANC remains < 500/mm 3 . Phlebitis at IV site (due to alkaline pH of 10). Transient renal dysfunction and crystalluria  slow infusion rate, good hydration. USE IN PREGANANCY Not known to be harmful—manufacturers advise use only when potential benefit outweighs risk.
  5. 5. Addamel N® Trace Elements Contents Per mL - Chromic Cl 5.33 mcg - Copper Cl 0.34 mg - Xylitol 300 mg - FeCl3 0.54 mg - K iodide 16.6 mcg - Manganese Cl 99 mcg - Na fluoride 0.21 mg - Na molybdate 4.85 mcg - Na selenite 10.5 mcg - ZnCl2 1.36 mg
  6. 6. Adenocor® Adenosine 3 mg / mL vial Starting Dose: 50 µg/kg rapid IV push (1-2 sec) Increase dose in 50 µg/kg increments Q2min until return of sinus rhythm. Usual maximum dose: 250 µg/kg. Neofax2011 150 μg/kg; repeat injection Q1-2min increasing dose by 50–100 μg/kg until tachycardia terminated or max. single dose of 300 μg/kg given. BNFC2011-12 ‫وكور‬‫اديى‬(٣‫جم‬‫م‬/‫ضم‬)(½‫ضم‬+٥.٤‫ضم‬‫م‬ ‫م‬)...‫اوطولين‬ ‫بطزهجت‬ ‫زطت‬ ‫غ‬٢٠٠‫د‬‫وري‬‫آلان‬ (‫الاضخجابت‬ ‫حطب‬ ‫دقُقخين‬ ‫كل‬ ‫وجكزارها‬ ‫الجزعت‬ ‫سٍادة‬ ‫وٍخم‬) Solution concentration 300 µg/mL. The injection should be administered by rapid IV injection into a central or large peripheralvein. Flush IV with saline immediately. Don’t refrigerate; crystallization will occur. Compatible with: D5W and NS USES Acute treatment of ssuussttaaiinneedd ppaarrooxxyyssmmaall SSVVTT (adenosine  sinus node automaticity and AV node conduction with no negative inotropic effects; can be used safely with impaired cardiac function or postoperative arrhythmias). ADVERSE EFFECTS / PRECAUTIONS FFlluusshhiinngg,, ddyyssppnneeaa aanndd iirrrriittaabbiilliittyy (frequent but resolve within 1min). TTrraannssiieenntt (duration < 1 min) aarrrrhhyytthhmmiiaass may occur between termination of SVT and onset of normal sinus rhythm (discontinue if asystole or severe bradycardia occur). HHyyppootteennssiioonn (discontinue if severe). AAppnneeaa (in preterms). RReeccuurrrreennccee in 30% of treated patients. Aminophylline/Theophylline and caffeine  adenosine’s effect by competitive antagonism. Contraindications 2 nd or 3 rd degree AV block (unless pacemaker fitted); long QT syndrome; severe hypotension; decompensated HF; asthma. In SVT, adenosine is given by rapid IV. IV amiodarone, flecainide or a beta- blocker can be tried. The use of d.c. shock and vagal stimulation also have a role in the treatment of SVT. Atenolol, sotalol and flecainide are used for the prophylaxis of paroxysmal SVT. USE IN PREGANANCY Large doses may produce fetal toxicity; manufacturer advises use only if essential.
  7. 7. Adrenaline 1 mg / mL 1 Severe bradycardia, hypotension: 0.1 - 0.3 mL/kg of 1:10,000 concentration (equal to 0.01-0.03 mg/kg), IV push or IC. Given via ETT in high doses up 0.05-0.1 mg/kg, followed immediately by 1 mL NS. Neofax2011 ً‫ـ‬‫ي‬‫ـال‬‫ى‬‫ادري‬(٢‫مجم‬/٢‫ضم‬()٢‫ضم‬+٩‫ضم‬)٢٠–٣٠‫ين‬‫وطول‬‫أ‬ ‫بطزهجت‬ ‫غزطت‬٢٠٠/‫م‬‫كج‬ ‫ورٍد‬(‫القلب‬ ‫اوعاع‬ ‫ثىاء‬‫أ‬) ً‫ـ‬‫ي‬‫ـال‬‫ى‬‫ادري‬(٢‫مجم‬/٢‫ضم‬)٢٠‫ين‬‫وطول‬‫أ‬ ‫بطزهجت‬ ‫غزطت‬٢٠٠/‫كجم‬‫حىجزٍت‬‫ال‬ ‫ألاهبوبت‬ ‫في‬ ‫ثم‬٢‫لح‬‫م‬ ‫م‬ ‫ضم‬٩.٠٪(‫ب‬‫القل‬ ‫اوعاع‬ ‫ثىاء‬‫أ‬) IVI: Start 0 .1 μg/kg/min, max. of 1 μg/kg/min. Adjust to desired response. Neofax2011 ً‫ـ‬‫ي‬‫ـال‬‫ى‬‫ادري‬(٢‫مجم‬/٢‫م‬‫ض‬( )٢‫ضم‬+٤٩‫ضم‬)‫مدى‬ ‫على‬ ‫ورٍد‬٢٤‫بمعدل‬ ‫ضاعت‬٣.٠‫ضم‬/‫كجم‬/ ‫الط‬‫اع‬‫ت‬‫الى‬ ‫بت‬‫الاضخجا‬ ‫حطب‬ ‫وجشٍد‬ ‫لبداًت‬‫ا‬ ‫في‬٣‫ضم‬/‫كجم‬/‫عت‬‫لطا‬‫ا‬ Infusion solution concentration 20 μg/mL. Incompatible with NaHCO3 . Protect from light. Compatible with dobutamine, dopamine, Lasix ® , fentanyl, heparin, midazolam and KCl. Maximum infusion concentration 60 μg/mL. Aerosol Therapy: 0.05-0.15 mL of 1:1000 concentration diluted with NS to 3 mL, Q½h, maximum 4 doses. Gome lla2009 ٥-٢٥‫وطولين‬‫أ‬ ‫بطزهجت‬ ‫غزطت‬٢٠٠‫ـ‬‫ى‬‫ادري‬‫ـ‬‫ـ‬‫ـ‬ً‫ـ‬‫ي‬‫ال‬(٢‫مجم‬/٢‫م‬‫ض‬)+٣‫م‬ ‫م‬ ‫ضم‬‫ـسر‬‫ـ‬‫ـ‬‫ـ‬‫ـ‬‫الي‬‫و‬‫ــ‬‫ـ‬‫ـ‬‫ـ‬‫ي‬‫هب‬ a 1:100 (1%) solution contains 10 mg in 1 ml a 1:1000 (1‰) solution contains 1 mg in 1 ml a 1:10,000 solution contains 0.1 mg in 1 ml USES AAccuuttee ccaarrddiioovvaassccuullaarr ccoollllaappssee; when adequate ventilation and chest compression have failed to increase the HR > 60 bpm. Short-term use for ssyysstteemmiicc hhyyppootteennssiioonn. In older infants, may be used SC to relief of bbrroonncchhoossppaassmm.
  8. 8. Adrenaline 1 mg / mL 2 MONITOR Heart rate, blood pressure and IV site for signs of infiltration. ADVERSEEFFECTS / PRECAUTIONS If possible correct acidosis before administration of epinephrine to enhance the effectiveness of the drug. Hypokalemia and  s erum lactate. Hyperglycemia. Cardiac arrhythmias (premature ventricular complexes and VT). Renal vascular ischemia (add low dose of dopamine with IVI). Bolus  Severe hypertension with intracranial hemorrhage.  Myocardial oxygen requirement. IV infiltration caus es tissue ischemia and necrosis.
  9. 9. Amikin® Amikacin 500 mg / 2 mL 1 Dose: as table IVI over 30 min. Ne ofax2011 ‫كي‬‫أمي‬‫ـ‬‫ـ‬‫ـ‬ً(٥٠٠‫مجم‬/٢‫ضم‬( )½‫ضم‬+٥.٢٤‫ضم‬)...‫حتى‬ ‫ًكمل‬ ‫م‬‫ض‬٢٠‫م‬‫ض‬‫وري‬‫ـ‬‫ـ‬‫د‬‫ى‬‫مد‬ ‫على‬ ‫عت‬‫ضا‬ ‫هصف‬/...‫ــت‬‫ع‬‫ضا‬ ‫كي‬‫أمي‬‫ـ‬‫ـ‬‫ـ‬ً(٥٠٠‫جم‬‫م‬/٢‫م‬‫ض‬)...‫اوطولين‬ ‫بطزهجت‬ ‫غزطت‬٢٠٠‫ل‬ ‫ـض‬‫ع‬/٢٤‫ـت‬‫ـ‬‫ضاع‬ Infusion solution concentration 5 mg/mL. Also available in 100 mg per 2 mL vials IM injection is associated with variable absorption especially in the very small infants. Compatible with: D5W, D10W, D20W and NS. PMA (wk) Postnatal (d) Dose (mg/kg) Interval (h) ≤ 29 * 0-7 8-28 ≥ 29 18 (3.6 mL) 15 (3 mL) 15 48 36 24 30-34 0-7 ≥ 8 18 15 36 24 ≥ 35 All 15 24 * or significant asphyxia, PDA or ttt with indomethacin. USES G-ve Bacilli - resistant to other aminoglycosides - usually combined with a β-lactam antibiotic (in separate infusion). ADVERSEEFFECTS Patients with impaired renal function, dehydration and those who receive high dosage or prolonged therapy are at  risk of toxicity. Transient and reversible renal tubular dysfunction   urinary loss of Na, Ca, and Mg. Vestibular and auditory ototoxicity (irreversible).  Neuromuscular blockade when used with pancuronium and in patients with hypermagnesemia. DC or adjust dose when there’s an evidence of oto- or nephrotoxicity.
  10. 10. Amikin® Amikacin 500 mg / 2 mL 2 PRECAUTIONS The use of other oto- and nephrotoxic drugs (lasix / vancomycin) may  thes e side effects. SERUM LEVEL Measure when treating for > 48h. Obtain peak concentration 30 minutes after end of infusion or 1 hour after IM injection and trough level just prior to the next dose, refrigerate blood sample soon. Peak: 20-30 µg/mL Trough: 2-5 µg/mL INTERACTIONS WITH Analgesics: plasma concentration of amikacin and gentamicin possibly  by indometacin. Antibacterials:  risk of nephrotoxicity and ototoxicity when given with teicoplanin or vancomycin; possible  risk of nephrotoxicity when given with cephalosporins. Amphotericin:  risk of nephrotoxicity. Digoxin: gentamicin possibly  plasma concentration of digoxin. Loop Diuretics:  risk of otoxicity.
  11. 11. Amiodarone Cordarone® 150 mg / 3 mL amp. 1 LD: 5 mg/kg IVI over 30-60 min, preferably in a central vein. MD: 7-15 µg/kg/min (10-20 mg/kg/day). Begin at 7 µg/kg/min and titrate by monitoring effects. Consider switching to oral therapy within 24-48h. PO: 5-10 mg/kg Q12h. Ne ofax2011 ‫كوردارون‬(٢٥٠‫مجم‬/٣‫ضم‬)...‫لين‬‫و‬‫اوط‬ ‫هجت‬‫ز‬‫بط‬ ‫غزطت‬٢٠٠‫حتى‬ ‫حطخكمل‬‫و‬٢٤‫ضم‬ ‫ج‬٥٪‫وريد‬‫مدى‬ ‫على‬٢٤‫بمعدل‬ ‫ضاعت‬٢‫ت‬‫الطاع‬ ‫في‬ ‫ضم‬ Infusion Solution concentration should be < 2 mg/mL (unless using a central line). Dose: 5 mg/kg over at least 3 min (for VF or pulseless ventricular tachycardia refractory to defibrillation) BNFC2011-12 Compatible with D5W, NS at concentrations of 1-6 mg/mL, heparin and NaHCO3 . Protect from light. Avoid benzyl alcohol containing injections in neonates. PO: initially 5-10 mg/kg Q12h for 7-10 days, then reduced to MD of 5–10 mg/kg Q24h. BNFC2011-12 ‫كوردارون‬(‫قزص‬٢٠٠‫مجم‬)(½‫قزص‬+٢٠‫ضم‬‫م‬ ‫م‬)...‫ضم‬‫ايل‬‫ر‬‫بال‬/٢٢‫ضاعت‬ USES Class III antiarrhythmic used for life-threatening or drug-resistant refractory SVT, VT and postoperative junctional ectopic tachycardia (JET). ADVERSEEFFECTS / PRECAUTIONS Short term toxicity: 1. Bradycardia and hypotension (possibly associated with rapid rates of infusion). 2. AV block (unless pacemaker fitted). 3. Polymorphic ventricular tachycardia. 4. Irritation to peripheral vessels (concentrations > 2 mg/mL). 5. May exacerbate an exciting arrhythmia.
  12. 12. Amiodarone Cordarone® 150 mg / 3 mL amp. 2 ADVERSEEFFECTS / PRECAUTIONS Long term toxicity: 1. Hyperthyroidis m (due to inhibition of T4 and T3). 2. Hypothyroidism (due to high concentrations of inorganic iodine). Amiodarone contains iodine and can cause both hypothyroidism or hyperthyroidism can. Laboratory tests (T3, T4 and TSH) should be performedbefore treatment and every 6 months. The thyrotoxicosis may be very refractory, and amiodarone should usually be withdrawn at least temporarily to help achieve control; treatment with carbimazole may be required. Hypothyroidism can be treated with replacement therapy without withdrawing amiodarone if it is essential. BNFC2011-12 3. Hepatitis and cholestatic jaundice (rare). 4. Photosensitivity (10%), nausea and vomiting (10%), optic neuritis (4-9%) and pulmonary fibrosis (4-9%) have been reported with prolonged oral use in adults. MONITOR HR and blood pressure. ECG monitor and resuscitation facilities must be available during IVI. Liver-function and thyroid-function tests required before treatment and then every 6 months. Measure serum K + concentration before treatment. Pulmonary function tests and CXR required before treatment. Acute porphyria.
  13. 13. Amiodarone Cordarone® 150 mg / 3 mL amp. 3 INTERACTIONS WITH AAmmiiooddaarroonnee hhaass aa lloonngg hhaallff--lliiffee;; tthheerree iiss aa ppootteennttiiaall ffoorr ddrruugg iinntteerraaccttiioonnss ttoo ooccccuurr ffoorr sseevveerraall wweeeekkss ((oorr eevveenn mmoonntthhss)) aafftteerr ttrreeaattmmeenntt wwiitthh iitt hhaass bbeeeenn ssttooppppeedd.. Anti-arrhythmics:  myocardial depression. Antibacterials (parenteral erythromycin, co-trimoxazole):  risk of ventricular arrhythmias - avoid concomitant use. Anticoagulants : amiodarone inhibits metabolism of coumarins and phenindione ( anticoagulant effect). Antiepileptics: amiodarone inhibits metabolism of pphheennyyttooiinn ( plasma concentration). Beta-blockers :  risk of bradycardia, AV block and myocardial depression;  risk of ventricular arrhythmias when amiodarone given with sotalol - avoid concomitant use. Cardiac Glycosides: amiodarone  plas ma concentration of ddiiggooxxiinn (hhaallvvee ddoossee ooff ddiiggooxxiinn). Diuretics:  cardiac toxicity with amiodarone if hypokalemia occurs. Grapefruit Juice: plasma concentration of amiodarone is .
  14. 14. Human Albumin 20% Dose 1 gm (5 mL)/kg/dose IVI over 2 hour. Indications As a volume expander (1:3 D5W) For hypoalbuminemia (1:1 D5W) Use vial within 4h of opening. Indication IV Dosage Administration Hypovolemia 0.5 g/kg/dose Infuse 5% albumin over >60 min, may be infused more rapidly (10- 20 min) in hypovolemic shock, repeat as needed Hypoalbuminemia 0.5-1 g/kg/dose Infuse 5% albumin over >2h, repeat q1-2d. Dilutions may be made with NS or D5W in cases of Na restriction MNC2012 USES Severe hypoalbuminemia associated with low plasma volume and generalized edema where s alt and water. Adjunct in treatment of hyperbilirubinemia by exchange transfusion. Paracentesis of large volume ascites associated with portal hypertension. CONTRAINDICATIONS Cardiac failure. Severe anemia. ADVERSEEFFECTS / PRECAUTIONS Hypersensitivity reactions (anaphylaxis and urticaria). Nausea and vomiting. Fever, tachycardia and chills.
  15. 15. Atropine 1 mg / mL IV (over 1 min) or IM: 0.01-0.03 mg/kg/dose Q10-15min to achieve desired effect with a maximum total dose of 0.04 mg/kg. ET: 0.01-0.03 mg/kg/dose immediately followed by 1 mL NS. PO: begin with 0.02 mg/kg/dose Q4-6h, may  gradually to 0.09 mg/kg/dose. Ne ofax2011 ‫أث‬‫ـ‬‫ـ‬‫روب‬‫ـ‬‫ي‬‫ـ‬‫ـ‬ً(٢‫مجم‬/٢‫ضم‬( )½‫ضم‬+٥.٩‫م‬ ‫ضم‬‫اء‬‫م‬‫قطز‬)...‫عضل‬ ‫أو‬ ‫ورٍد‬ ‫ضم‬‫م‬‫بالف‬‫أو‬... Infusion solution concentration 0.05 mg/mL Compatible with D5 W and NS. Give IV dosage form PO. USES Reversal of severe sinus bradycardia, particularly when parasympathetic influences on heart (digoxin, beta-blockers, hyperactive carotid sinus reflex) p redominate.  The muscarinic effects of neostigmine when reversing neuromuscular blockade. Duration of action is 6 hours. MONITOR Heart rate. ADVERSEEFFECTS / PRECAUTIONS Cardiac arrhythmias particularly during the first 2 minutes following IV use. Fever, especially in brain-damaged infants. Abdominal distension with decreas ed bowel activity. Esophageal reflux ( esophageal sphincter tone). Mydriasis and cycloplegia.
  16. 16. Atrovent® Ipratropium Bromide 250-500 μg / 2 mL Dose: 75-175 μg viajet nebulizer Q6-8h Neofax2011 Dose: 25 μg/kg/dose vianebulizer Q8h Gomella2009 ‫اث‬‫ـ‬‫روفىت‬(٢٥٠‫مُكزوجزام‬/٢‫ضم‬)(٦.٠‫ضم‬+٢‫م‬ ‫م‬ ‫ضم‬)‫الًشر‬‫و‬ُ‫هب‬/٦-۸‫ـاث‬‫ـ‬‫ضاع‬ ‫اث‬‫ـ‬‫روفىت‬(٥٠٠‫مُكزوجزام‬/٢‫ضم‬)(٣.٠‫ضم‬+٢‫م‬ ‫م‬ ‫ضم‬)‫الًشر‬‫و‬ُ‫هب‬/٦-۸‫ضا‬‫ـاث‬‫ـ‬‫ع‬ USES Anti-cholinergic bronchodilator for primary treatment of COPD and adjunctive treatment of acute bronchospasm (peak effect within 1- 2h, duration of effect 4-6h). Not useful for bronchiolitis. Bronchodilatoreffect may be potentiated when given with ß-2 agonist i.e. albuterol. Both drugsare compatible when admixed ifgiven within 1 h. ADVERSEEFFECTS Temporary blurring of vision. Precipitation of narrow-angle glaucoma or eye pain (if solution comes into direct contact with the eyes).
  17. 17. Augmentin® Amoxycillin/Clavulanic acid 600 mg / 60 mL IV Dose: 30 mg/kg Q12h. BNFC2011-12 Amoxycillin Dose for Listerial Meningitis: Neonate < 7 days: 50 mg/kg Q12h; dose may be doubled in meningitis. Neonate 7–28 days: 50 mg/kg Q8h; dose may be doubled in meningitis. BNFC2011-12 ‫أوجمىتين‬(٦٠٠‫مجم‬/٦٠‫م‬‫ض‬)...‫ببطء‬ ‫ورٍد‬ ‫ضم‬... /‫عت‬‫ـا‬‫ض‬ Infusion solution concentration 10 mg/mL. PO Dose: 0.25 mL/kg of the 156 mg/ 5 mL susp. Q8h. BNFC2011-12 ‫أوجمىتين‬‫شراب‬(٢٥٦‫مجم‬/٥‫ضم‬)...‫ضم‬‫لفم‬‫با‬/۸‫ث‬ ‫ـاعا‬‫ض‬ ‫هقط‬ ‫أوجمىتين‬(٥.٦٢‫مجم‬/‫ضم‬)‫لوسن‬‫ا‬ ‫المت‬ ‫ع‬ ‫عىد‬ ‫بالقطارة‬/۸‫عاث‬‫ـا‬‫ض‬ USES Infections due to beta-lactamase-producing strains (where amoxicillin alone not appropriate) including respiratory-tract infections, bone and joint infections, genito-urinary and abdominal infections, cellulitis, animal bites. ADVERSEEFFECTS / PRECAUTIONS Diarrhea, vomiting Hypersensitivity reactions, jaundice, fever. Pseudomembranous colitis HEPATIC IMPAIRMENT Monitor hepatic function Cholestatic jaundice may occur either during orshortly after the use of co-amoxiclav, usually self limiting. The duration of therapy should not usually exceed 14 days. RENAL IMPAIRMENT)IV ROUTE( Cr Cl 10-30 mL/min/1.73m 2  use normal initial IV dose then half dose Q12h Cr Cl <10 mL/min/1.73m 2  use normal initial IV dose then half dose Q24h RENAL IMPAIRMENT)POROUTE( GFR 10-30 mL/min/1.73m 2  use normal dose Q12h GFR<10 mL/min/1.73m 2  use half normal dose Q12h
  18. 18. Azactam® Aztreonam 1 g / 50 mL Dose: 30 mg/kg/dose IVI over 5-10 min or IM. Ne ofax2011 ‫ـ‬‫ت‬‫ازك‬‫ـ‬‫ـ‬‫ام‬(٢‫جم‬/٥٠‫ضم‬)...‫ورٍد‬ ‫ضم‬‫غدًد‬ ‫ببطء‬/۸‫ضاعاث‬ Infusion solution concentration 20 mg/mL. Compatible with D5 W, D10W and NS. PMA (weeks) Postnatal (days) Interval (hours) ≤ 29 0-28 >28 12 8 30-36 0-14 >14 12 8 37-44 0-7 >7 12 8 ≥ 45 All 6 USES Bactericidal against aerobic G-ve organisms (e.g. E. coli, H. influenza, Pseudomonas, and Serratia). Usually used with ampicillin (empirical) or aminoglycosides (synergistic against Pseudomonas and Enterobacteriaceae). MONITOR Serum glucose 1h after administration. Periodic CBC, AST, ALT. ADVERSEEFFECTS / PRECAUTIONS Provide adequate amounts of glucose to avoid hypoglycemia; contains 780 mg L-arginine / g (23.4 mg/kg/dose). Eosinophilia.  Serum ALT, AST. Phlebitis at the injection site. RENAL IMPAIRMENT Cr Cl 10-30 mL/min/1.73m 2  use normal initial dose then ½ dose Cr Cl <10 mL/min/1.73m 2  use normal initial dose then ¼ dose
  19. 19. Bebe-vit® Drops Vitamin Per 1 mL A 1.500 IU D 400 IU E 5 mg C 40 mg Thiamine (B1) 0.5 mg Riboflavin (B2) 0.6 mg Nicotinamide (B3) 8 mg Pyridoxine(B6) 0.6 mg ‫بي‬‫ـ‬‫ـ‬‫ـ‬‫بي‬‫في‬‫ـ‬‫ـ‬‫ـ‬‫ـ‬‫ت‬٢‫ضم‬‫بالف‬‫ـ‬‫ـ‬‫ـ‬‫ـ‬‫ـ‬‫ـ‬ً‫ا‬‫ز‬‫بال‬‫أو‬ ‫م‬‫ـ‬‫ـ‬‫ـ‬‫ل‬/٢٤‫ضاع‬‫ـ‬‫ـ‬‫ـ‬‫ـ‬‫ـ‬‫ت‬
  20. 20. Sodium Bicarbonate 8.4 % 1 mEq NaHCO3 / mL (2 mOsmol / mL) Usual dose: 1-2 mEq/kg IVI over at least 30 min. Dose (in mEq) based on Base Deficit = 0.3 X Base deficit (mEq/L) X weight (kg). Give ½ dose then assess need for remainder. Neofax2011 Dose (in mEq) based on HCO3 level = 0.5 X [24 - serum HCO3 - (mEq/L) X weight (kg)]. Give ½ dose then assess need. Dose in RTA: 2-3 mEq/kg/day in divided doses for type I and IV. Proximal RTA (type II) requires larger doses, as high as 10 mEq/kg/day. MNC2012 Can be administrated also by IVI or PO. ‫بيكربوهات‬ ‫صوديوم‬(٤.۸٪)...‫ضم‬...+‫ج‬ ‫ضم‬٥٪‫ت‬‫ضاع‬ ‫هصف‬ ‫مدى‬‫على‬ ‫ورٍد‬ Maximum Concentration 0.5 mEq/mL. Recommended Concentration 0.25 mEq/mL. Na Content is 1 mEq/mL. Also available as Sodium Bicarbonate 5 % (0.6 mEq/mL). Compatible with D5W, D10W, NS,furosemide, heparin, insulin and KCl. Incompatible with dobutamine, dopamine, epinephrine, MgSO4, midazolam and norepinephrine. USES To correct nnoorrmmaall aanniioonn ggaapp mmeettaabboolliicc aacciiddoossiiss caused by renal or GI losses. NaHCO3 is not a recommended therapy in NRP. Administration during prolonged resuscitation remains controversial – use only after adequate ventilation is established and there is no response to other therapies: -  Pulmonary vascular resistance. - Improves myocardial function. -  Response of myocardium to sympathomimetics. MONITOR ABG. Serum calcium, sodium and potassium. ADVERSE EFFECTS IVH (with rapid infusion).  PCO2   pH (if given during inadequate ventilation). Local tissue necrosis. Hypocalcemia. Hypernatremia and hypokalemia.
  21. 21. Brufen® Ibuprofen 100 mg / 5 mL Syrup First dose 10 mg/kg Second and third doses 5 mg/kg. Administer at 24 h intervals. Ne ofax2011 Course may be repeated after 48 hours if necessary. BNFC2011-12 ‫بروفين‬‫شراب‬(٢٠٠‫مجم‬/٥‫ضم‬)...‫اًل‬‫ز‬‫بال‬/٢٤‫ـت‬‫ع‬‫ضا‬‫الزضاعت‬ ‫بعد‬ USES Closure of PDA. Not indicated for IVH prophylaxis. MONITOR Urine output. Assess for ductal closure. Signs of bleeding. ADVERSEEFFECTS Less severe decrease in UOP than indo methacin. Inhibit platelet aggregation. Contraindicated in preterms with infection, active bleeding, thrombocytopenia or coagulation defects, NEC, significant renal dysfunction and CHD with duct-dependent systemic blood flow. INTERACTIONS WITH Antifungals: plas ma concentration is  by voriconazole. INTERACTIONS WITH
  22. 22. Caffeinospire® Caffeine Citrate 20 mg / mL LD: 20-25 mg/kg IV over 30 min or PO. MD: 5-10 mg/kg/dose Q24h IV slowly or PO. May consider an additional LD and higher MD if able to monitor serum concentrations. Ne ofax2011 ‫شراب‬‫ير‬‫ب‬‫كافيىوص‬(٢٠‫م‬‫جم‬/‫ضم‬)...‫الزضاعت‬ ‫بعد‬‫بالفم‬‫ضم‬/٢٤‫ـت‬‫ـ‬‫ع‬‫ـا‬‫ض‬ ‫كافيىوصبير‬‫وريد‬(٢٠‫م‬‫جم‬/‫ضم‬)...‫ضم‬‫ضاعت‬ ‫هصف‬‫مدى‬‫على‬ ‫ورٍد‬/٢٤‫ـت‬‫ـ‬‫ع‬‫ـا‬‫ض‬ Compatible with D5W and D50W. USES Neonatal Apnea, including post-extubation and post anesthesia (antagoniz es adenosine   Respiratory center output, chemoreceptor sensitivity to CO2, smooth muscle relaxation and COP).  The rate of BPD from 47% to 36% if started during the 1 st 10 days of life in infants with B W of 500-1250 g. Also, improves the rate of survival without neurodevelopmental disability at 18-21 months corrected age. MONITOR Therapeutic serum trough le vel on D5 of therapy 5-25 μg/mL. Monitor HR; withhold dose if > 180 bpm. Agitation. ADVERSEEFFECTS Restlessness. Vomiting. Functional cardiac symptoms. May be associated with NEC (not proved).
  23. 23. Calcium Chloride 10% Acute ttt of symptomatic hypocalcemia: 0.35-0.7 mL/kg/dose IV. Dilute, then infuse over 10-30 min while monitoring for bradycardia. Stop if HR < 100 bpm. Maintenance ttt: 0.75-3 mL/kg/day IVI for 3-5 days. In exchange transfusion: 0.33 mL/100 mL blood exchanged, IVI over 10-30 min. Ne ofax2011 ‫كلورايد‬‫كالضيوم‬٠١٪...‫ضم‬+...‫ج‬ ‫ضم‬٥٪‫غدًد‬ ‫ببطء‬‫ورٍد‬/٦‫ضاعاث‬ Each 100 mg = 1 mL = 27 mg ele mental Ca Don’t give intra-arterially. Compatible with D5W, D10W, NS, amikacin, amiodarone, dobutamine, dopamine, epinephrine, hydrocortisone, milrinone, morphine and prostaglandin E1. Incompatible with amphotericin B, NaHCO3 and Mg salts. USES Treatment and prevention of hypocalcemia (ionized calcium < 4 mg/dL and total calcium < 8 mg/dL). Ne ofax2011 MONITOR Serum Ca level; measure ionized calcium directly. Check IV site for extravasation Correct  Mg if pres ent. Bradycardia (IV). GI tolerance (PO). ADVERSEEFFECTS More likely than calcium gluconate to caus e metabolic acidosis. Bradycardia or cardiac standstill with rapid infusion. Cutaneous necrosis or calcium deposition occurs with extravasation. Bolus infusion by UAC is associated with intestinal bleeding and lower-extremity tissue necrosis. Infusion by UVC may result in hepatic necrosis if it is lodged in a branch of the portal vein.
  24. 24. Calcium Gluconate 10% Acute ttt of symptomatic hypocalcemia: 1-2 mL/kg/dose IV. Dilute, then infuse over 10-30 min while monitoring for bradycardia. Stop if HR < 100 bpm. Maintenance ttt: 2-8 mL/kg/day IVI for 3-5 days. In exchange transfusion: 1 mL/100 mL blood exchanged IVI over 10 min. Ne ofax2011 ‫كالضيوم‬‫هات‬‫و‬‫جلوك‬٠١٪...‫ضم‬+...‫ج‬ ‫ضم‬٥٪‫غدًد‬ ‫ببطء‬‫ورٍد‬/٦‫ضاعاث‬ Each 100 mg = 1 mL = 9.3 mg elemental Ca Don’t give intra-arterially. Administration by continuous infusion is more efficacious than intermittent bolus dosing due to less renal calcium loss. Compatible with D5W, D10W, NS, amikacin, amiodarone, dobutamine, dopamine, heparin, epinephrine, hydrocortisone, milrinone, morphine and prostaglandin E1. Incompatible with amphotericin B, NaHCO3 and Mg salts. USES Treatment and prevention of hypocalcemia (ionized calcium < 4 mg/dL and total calcium < 8 mg/dL) Ne ofax2011 MONITOR Serum ionized Ca level. Correct hypomagnesemia if pres ent. Check IV site for extravasation. Bradycardia (IV). GI tolerance (PO). Early hypocalcemia is common in asphyxiated infants, PT and IDM. It may occur also with alkalosis or following exchange transfusion. Signs of hypocalce mia include muscle twitching, jitteriness, generalized seizures, QTc above 0.4 sec.
  25. 25. Capoten® Captopril 25 mg tab. 1 Initial Dose: 0.01 - 0.05 mg/kg/dose PO Q8-12h. Adjust dose and interval basedon response. Administer1 hbefore feeding. Neofax2011 Initial Dose: PT infants: 0.01 -0.05 mg/kg/dose PO Q8-12h. FT infants : 0.05 - 0.1 mg/kg/dosePO Q8-24h. Max. recommendeddose:0.5 mg/kg/dose PO q6-24h. MNC2012 ‫ـ‬‫ب‬‫كا‬‫ـــ‬‫وثي‬‫ن‬(½‫قزص‬٢٥‫مجم‬/٥.٢٢‫مقطز‬ ‫ماء‬ ‫م‬‫ض‬)...‫ين‬‫ـول‬‫ط‬‫و‬‫ا‬ ‫بطزهجـت‬ ‫زطت‬ ‫ـ‬‫غ‬٢٠٠‫م‬‫ـ‬‫ف‬‫بال‬ ‫بطاعت‬ ‫عت‬‫الزضا‬ ‫قبل‬/٢٢‫ض‬‫ـ‬‫ـ‬‫ع‬‫ا‬‫ـ‬‫ت‬ Solution concentration 1 mg/mL. Onset of action is 15 min after a dose, with peak effects seen in 30-90 minutes. Duration of action is usually 2-6 hours, but may be significantly longer (>24 hours). USES Moderate tosevere hypertension. Afterload reduction inpatients with CHF. MONITOR Blood pressure, particularly after the firstdose. Renal function and serumK+ . ADVERSE EFFECTS/ PRECAUTIONS Hypotension, rash, fever. Eosinophilia, neutropenia. GI disturbances. Jaundice or elevated liver enzymes is a reason for immediate drug withdrawal. MNC2012  Cerebral blood flow(seizures, apnea, and lethargy).  Renal blood flow (oliguria).  K+ (if receivingK-sparingdiuretics orK supplements). Contraindicated in patients with bilateral renovascular disease or with unilateral renal artery stenosis in asolitary kidney.
  26. 26. Capoten® Captopril 25 mg tab. 2 INTERACTIONS WITH General Anesthetics:  hypotensive effect. NSAIDs:  riskof renal impairment, antagonize hypotensive effect. Antacids: absorptionof ACE inhibitors possibly. Heparins:  riskofhyperkalemia. Beta-blockers:  hypotensive effect. Calcium-channel Blockers: hypotensive effect. Digoxin: captoprilpossibly  plasma concentrationofdigoxin. Corticosteroids:hypotensive effect of ACE-i is antagonized. Diazoxide:  hypotensive effect. Diuretics:  hypotensive effect; K+ with K+ -paring diuretics and aldosterone antagonists (monitor K+ concentration). Potassium Salts:  riskofsevere hyperkalemia. Prostaglandins:  hypotensive effect.
  27. 27. Ceclor® Cefaclor susp. 125 mg / 5 mL For children 1 m - 12 y: 20 mg/kg/day in 3 divided doses, doubled for severe infection (usual max. 1 g daily). BNFC2011-12 ‫شراب‬ ‫صيكلور‬(٢٢٥‫مجم‬/٥‫ضم‬)...‫ضم‬/۸‫ـاعـاث‬‫ض‬. USES Acute Otitis Media Infection, H. Influenzae Pneumonia, Lower Respiratory Infections, Pharyngitis, Pneumonia, Skin Infection, Strept. Pneumonia, Tonsillitis, URT Infection, UTI Infections. RENAL IMPAIRMENT BNFC2011-2012 No dosage adjustment required. ADVERSEEFFECTS Most Frequent: Serum Sickness, Vulvovaginal Candidiasis. Less Frequent: Abdominal Pain with Cramps, Diarrhea, Nausea, Oral Candidiasis, Vomiting. Rare: Allergic Reactions, Anaphylaxis, Angioedema, Drug Fever, Erythema, Erythema Multiforme, Hemolytic Anemia, Hypoprothrombinemia, Pruritus of Skin, Pseudomembranous Enterocolitis, Renal Diseas e, Seizure Disorder, Skin Rash, Stevens- Johnson Syndrome.
  28. 28. Cefazolin® Cefazolin 1 g / 10 mL Dose: 25 mg/kg/dose IV slow push or IM. Neofax2011 ‫صيفازولين‬(٢‫جم‬/٢٠‫ضم‬( )٢‫ضم‬+٩‫ضم‬)...‫ورٍد‬ ‫ضم‬/۸‫ضاع‬‫ـ‬‫ـ‬‫اث‬ ‫صيفازولين‬(٢‫جم‬/٤‫ضم‬)...‫عضل‬ ‫ضم‬/۸‫ضاعاث‬ Brands include Totacef® and Zinol® 500 mg and 1 g vials. Compatible with D5 W, D10W and NS. PMA Weeks Postnatal days Interval hours ≤ 29 0-28 >28 12 8 30-36 0-14 >14 12 8 37-44 0-7 >7 12 8 ≥ 45 All 6 USES It’s a bactericidal 1 st generation cephalosporin, mainly G+ve with poor CNS penetration. Peri-operative infection prophylaxis. UTI and soft tissue infections caus ed by e.g. penicillin r esistant Staph. aureus, Klebsiella and Proteus. ADVERSEEFFECTS (RARE) Phlebitis Eosinophilia
  29. 29. Cefdin® Cefdinir 125 mg / 5 mL susp. Dose: 14 mg/kg/day PO. Once-daily dosing is as effective as twice daily dosing. ‫ص‬‫ي‬‫ـف‬‫اب‬‫ر‬‫ش‬ ً‫دي‬(٢٢٥‫مجم‬/٥‫ضم‬)...‫ـم‬‫ف‬‫بال‬ ‫ضم‬/٢٢‫ـاعت‬‫ـ‬‫ض‬ USES A 3 rd generation cephalosporin that is active against G-ve organisms including H. influenza, Enterobacteriaceae, Citrobacter sp., E. coli, Klebsiella and Proteus. Active against G+ve organisms such as Staph. aureus, Staph. epidermidis, strept. pneumonia and Strept. pyogenes. ADVERSEEFFECTS (RARE) Diarrhea, loos e stools Nausea, vomiting, abdominal pain Abnormal liver tests. Allergic reactions. Storage Keep suspension in the fridge for up to 10 days after reconstitution.
  30. 30. Cetal® Acetaminophen 250 mg / 5 mL syrup Oral Dose: LD 20-25 mg/kg MD 12-15 mg/kg/dos e. Ne ofax2011 Rectal Dose: LD 30 mg/kg MD 12-18 mg/kg/dose. Ne ofax2011 IV Dose: 7.5 mg/kg Q4-6h; max. 30 mg/kg/day. BNFC2010-11 Gestational Age Interval FT Q6h PT ≥ 32 wk PMA Q8h PT < 32 wk PMA Q12h ‫شراب‬ ‫ـال‬‫ـ‬‫ـ‬‫ت‬‫صي‬(٠٥١‫مجم‬/٥‫صم‬)...‫ضم‬... /‫عت‬‫ضا‬ ‫قطارة‬ ‫ـال‬‫ـ‬‫ـ‬‫ت‬‫صي‬(٠١١‫مجم‬/٠‫صم‬)...‫بالفم‬ ‫طت‬‫هق‬... /‫عت‬‫ضا‬ ‫لبوش‬ ‫ـال‬‫ـ‬‫ـ‬‫ت‬‫صي‬‫أطفال‬(٠٠٥‫مجم‬)...‫غز‬ ‫لبوص‬‫جي‬... /‫عت‬‫ضا‬ ‫ــان‬‫ج‬‫برفال‬(٠١‫مجم‬/‫صم‬)...‫ضاعت‬ ‫ربع‬ ‫مدى‬ ‫على‬ ‫ورٍد‬ ‫ضم‬ Use Perfalgan® either undiluted or dilute to a concentration of 1 mg/mL in D5W orNS; use within1hof dilution. Brands include: Paracetamol® 120 mg / 5 mL Rectal suppositories associated with erratic release. USES Fever reduction. Mild to moderate pain. MONITOR Signs of pain, Temperature. Liver function. ADVERSE EFFECTS Liver toxicity (if prolonged administration > 48h or excessive dosing) Rash, fever. Thrombocytopenia, leucopenia and neutropenia Routine prophylactic use of acetaminophen at the time of vaccination is not recommended because of a potentional reduction in antibody response. TREATMENT OF TOXICITY N-acetylcysteine (use conc. of 40 mg/mL) LD: 150 mg/kg in D5W IVI over 60minutes. MD: 50 mg/kg IVI over 4h then 100 mg/kg over 16h until clinical and biochemical markers of hepatic injury improve (e.g. INR normalizes).
  31. 31. Chloral Hydrate 500 mg / 5 mL Dose: 25-50 mg/kg/dose POor PR. MNC2012 Onset within 10-15 min. ‫كل‬‫ـ‬‫ـ‬‫ـ‬‫ـ‬‫ـ‬‫ـ‬‫ـ‬‫ـ‬‫ـ‬‫هيدرات‬ ‫ورال‬...‫بالف‬ ‫ضم‬‫ـ‬‫ـ‬‫ـ‬‫ـ‬‫م‬‫ـشوم‬‫ـ‬‫ـ‬‫ـ‬‫ـ‬‫ل‬‫ال‬ ‫ـد‬‫ـ‬‫ـ‬‫ـ‬‫ى‬‫ع‬(‫الوسن‬ ‫هصف‬) The preparation islight sensitive. USES Sedative-Hypnotic for short term use only. No analgesic properties. MONITOR Level ofsedation. ADVERSE EFFECTS / PRECAUTIONS Oral preparation should be diluted oradministrated after a feeding to reduce gastric irritation. Paradoxical excitation ininfants with pain. Allergic manifestations. Acute overdose: CNS, respiratory and myocardial depression, cardiacarrhythmias, ileus and bladder atony. Indirect hyperbilirubinemia. Contraindicated withsignificant hepatic or renal disease.
  32. 32. Ciprofloxacin Rancif® 200 mg / 100 mL Dose: 6-10 mg/kg/dose Q12h IVI over 60 min for complicated UTI or severe respiratory and GI tracts infections. BNFC2011-12 Dose for Pseudomonal lower respiratory-tract infection in cystic fibrosis in infants > 1 mo: 10 mg/kg IV Q8h. BNFC2011-12 ‫ص‬‫ـ‬‫ـ‬‫برو‬(٢٠٠‫جم‬/٢٠٠‫ضم‬)...‫مدى‬ ‫على‬ ‫ورٍد‬ ‫ضم‬‫ضاعت‬/٢٢‫ضاعت‬ Infusion solution concentration 2 mg/mL. USES Mainly G-ve; salmonella, shigella, campylobacter, neisseria and pseudomonas. Moderate activity against G+ve; Strept. pneumoniae (not used for pneumococcal pneumonia) and Entercoccus faecalis. Chlamydia and some mycobacteria. Most anaerobes are not susceptible. Avoid use with MRSA (resistant). MONITOR Liver function ADVERSEEFFECTS / PRECAUTIONS Nausea, vomiting, and diarrhea Skin rash, or abnormal liver function. Quinolones caus e arthropathy in the weight-bearing joints of immature animals and are therefore generally not recommended in children and growing adolescents. However, the significance of this effect in humans is uncertain and in some specific circumstances short term use of a quinolone in children is justified. BNFC2011-12 RENAL IMPAIRMENT Cr Cl <20 mL/min/1.73m 2  use half normal dose
  33. 33. Claforan® Cefotaxime 500 mg / 5 mL Dose: 50 mg/kg/dose IVI over 30 min, or IM. Neofax2011 Dose may be doubled in severe infection and meningitis. Disseminated Gonococcal Infections: 25 mg/kg/dos e IVI over 30 min, or IM Q12h for 7 days, with a duration of 10-14 days if meningitis is documented. Ne ofax2011 ‫كالف‬‫ـ‬‫ـ‬‫ـ‬‫ـ‬‫وران‬(٥٠٠‫مجم‬/٥‫ضم‬)...‫ضم‬‫ورٍد‬‫ضاعت‬ ‫هصف‬‫مدى‬‫على‬/...‫ض‬‫ـ‬‫ـ‬‫ـ‬‫ـ‬‫ـ‬‫اعت‬ Infusion solution concentration 100 mg/ml. Compatible with D5 W, D10W and NS. ‫كالف‬‫ـ‬‫ـ‬‫ـ‬‫ـ‬‫وران‬(٥٠٠‫مجم‬/٢‫ضم‬)...‫لين‬‫و‬‫اوط‬ ‫هجت‬‫ز‬‫بط‬‫غزطت‬٢٠٠‫عضل‬/...‫ض‬‫ـ‬‫ـ‬‫ـ‬‫ـ‬‫ـ‬‫اعت‬ PMA (wks) Postnatal (D) Interval (h) ≤ 29 0-28 >28 12 8 30-36 0-14 >14 12 8 37-44 0-7 >7 12 8 ≥ 45 All 6 USES Neonatal meningitis and sepsis by G-ve organisms (e.g. E. coli, H. influenza and Klebsiella). Disseminated gonococcal infections. MONITOR Periodic CBC. RENAL IMPAIRMENT Cr Cl <5 mL/min/1.73m 2  use usual initial IV dos e then half dose ADVERSEEFFECTS (RARE) Rash, Phlebitis and Diarrhea Leucopenia, granulocytopenia, and eosinophilia.
  34. 34. Clexane® Enoxaparin sodium (LMWH) 100 mg / mL Initial Treatment ofThrombosis: Neofax2011 FT infants 1.7 mg/kg/dose Q12h SC. PT infants 2 mg/kg/dose Q12h SC. Infants > 3 mo of age 1 mg/kg/dose Q12h SC. Adjust dose to maintain anti-factor Xa level between0.5-1 units/mL. Low Risk Prophylaxis: Neofax2011 Dose 0.75 mg/kg/dose Q12h SC. Infants > 3 mo of age 0.5 mg/kg/dose Q12h SC. Adjust dose to maintain anti-factor Xa level 0 .1-0.4 units/mL. ‫كلكضان‬(٢٠٠‫مجم‬/‫ضم‬)...‫الجل‬ ‫جحت‬‫غزطت‬‫د‬/٢٢‫ـت‬‫ع‬‫ضا‬ Compatible with NS and sterile water. USES Anticoagulation. MONITOR Anti-factor Xa 4h after a dose. After attaining target level, dose adjustment is needed 1-2 times/month. Signs of bleeding and thrombosis. ADVERSEEFFECTS Bleeding (even in therapeutic range) 4 %. Hematoma at administration site. Compartment syndrome. IC and GI hemorrhage.
  35. 35. Colimex® Colistin Sulphate 50.000 unit / mL Dose: 0.75 mL/kg/dose POQ8h. ‫اب‬‫ر‬‫ش‬ ‫كوليمكط‬(٥٠٠٠٠‫وحدة‬/‫ضم‬)...‫ـم‬‫ف‬‫بال‬ ‫ضم‬/۸‫ـاث‬‫ع‬‫ضا‬ USES Not used for GI infections by oral route but used for gut sterilization.
  36. 36. Cymevene® Ganciclovir 500 mg / 10 mL Dose: 6 mg/kg/dose Q12h IVI over 1h for a minimum of 6 weeks. Chronic oral suppression: 30-40 mg/kg/dose Q8h PO ‫صيميفين‬(٥٠٠‫مجم‬/٢٠‫ضم‬()٢‫ضم‬+٩‫ضم‬)...‫ـت‬‫ع‬‫ضا‬ ‫ـدى‬‫م‬ ‫على‬ ‫ـد‬ٍ‫ور‬ ‫ضم‬/ ٢٢‫ـت‬‫ع‬‫ضا‬ Infusion solution concentration 10 mg/ml. USES Prevention of progressive hearing loss and lessening of developmental delays in babies with symptomatic congenital CMV infection involving the CNS. MONITOR CBC every 2-3 days during 1 st 3 weeks, then weekly if stable. ADVERSEEFFECTS Significant neutropenia in majority of patients. Reduce the dos e by half if < 500 cells/mm 3 . Stop if not resolved. Anemia and thrombocytopenia.
  37. 37. Dalacin-C® Clindamycin 600 mg / 4 mL Dose: 5-7.5 mg/kg/dose IVI over 30 minutes, or PO. Neofax2011 ‫دالاصين‬-‫ي‬ ‫س‬(٦٠٠‫مجم‬/٤‫ضم‬( )٥.٠‫ضم‬+٥.٢٤‫ضم‬)…‫ضم‬‫مدى‬ ‫على‬ ‫ورٍد‬ ‫ضاعت‬ ‫هصف‬/۸‫ضاعاث‬ Infusion solution concentration 5 mg / mL. Compatible with D5 W, D10W and NS. PMA weeks Postnatal days Interval hours ≤ 29 0-28 >28 12 8 30-36 0-14 >14 12 8 37-44 0-7 >7 12 8 ≥ 45 All 6 USES Bacteriostatic for bacteremia, pulmonary and deep tissue infections by anerobic bacteria and some G+ve cocci. Should NOT be used in ttt of meningitis (poor CSF penetration). MONITOR Liver function, GI status. Therapeutic serum level ranges from 2-10 µg/mL. HEPATIC IMPAIREMENT Increase dosing interval. ADVERSEEFFECTS Pseudomembranous colitis (Bloody diarrhea, abdominal pain, and fever)  discontinue, bowel rest, TPN and consider oral metronidazole.
  38. 38. Decadron® 8 mg/2 mL amp. Orazone®0.5 mg/5 mL syrup Dexamethasone 1 DART (Dexamethasone: A Randomized Trial) Protocol Ne ofax2011 0.075 mg/kg/dose Q12h for 3 days 0.05 mg/kg/dos e Q12h for 3 days 0.025 mg/kg/dose Q12h for 2 days 0.01 mg/kg/dos e Q12h for 2 days Given IV slow push or PO Total of 10 days. Extubation/airway edema: 0.25-0.5 mg/kg once. May repeat Q8h for a total of 4 doses starting 4h before extubation. MNC2012 ‫ديكادرون‬(۸‫مجم‬/٢‫ضم‬()٢‫ضم‬+٣‫م‬ ‫م‬ ‫ضم‬)...‫ورٍد‬‫ببطء‬/٢٢‫عت‬‫ضا‬ Infusion solution concentration 1 mg/mL. ‫ازون‬‫أور‬‫غزاب‬(٥.٠‫مجم‬/٥‫ضم‬)...‫ــم‬‫ف‬‫ل‬‫با‬ ‫ـم‬‫ض‬/٢٢‫عت‬‫ضا‬ Phenadone® Syrup contains 0.5 mg Dexamethasone and 2 mg Chlorpheniramine maleate per 5 mL Courses For Severe BPD MNC2008 Begin tre atment after D7 but before D14 of life. Short Course D1 0.1 mg/kg Q12h D2 0.075 mg/kg Q12h D3 0.05 mg/kg Q12h May repeat weekly if necessary Long Course D1 0.1 mg/kg Q12h D2 0.1 mg/kg Q12h If no response after 48-72h, Stop. If respond, Continue D3 0.075 mg/kg Q12h D4 0.075 mg/kg Q12h D5 0.05 mg/kg Q12h D6 0.05 mg/kg Q12h D7 0.05 mg/kg Q12h D8 Off D9 0.05 mg/kg Q12h D10 End
  39. 39. Decadron® 8 mg/2 mL amp. Orazone®0.5 mg/5 mL syrup Dexamethasone 2 USES Anti-inflammatory us ed to facilitate extubation and improve lung function in infants at higher risk for developing CLD. 1. Treat only those at high risk. 2. Use lower doses. 3. BBeeggiinn ttrreeaattmmeenntt aafftteerr DD77 bbuutt bbeeffoorree DD1144 ooff lliiffee. 4. Don’t give with indomethacin. ADVERSEEFFECTS  Risk of CP. No  in risk of ROP. GI perforation and hemorrhage occur more in patients treated beginning in D1 and in those treated concurrently with indomethacin. Hyperglycemia and glycosuria. DKA? Hypertension, Na + and water retention. Cardiac effects on D14 of therapy include  LV wall thickness with outflow tract obstruction, transient impairment of LV filling and ST s egment depression. Hypokalemia, hypocalcemia, Hypertriglyceridemia.  Risk of sepsis. Renal stones (in patients receiving Lasix ® ). Osteopenia and inhibition of growth Adrenal insuffieciency due to pituitary suppression. MONITOR Blood pressure and hyperglycemia during acute illness. Lipid profile (hyperlipidemia). Guaiac gastric aspirate. EEcchhooccaarrddiiooggrraapphhyy iiff ttrreeaattiinngg lloonnggeerr tthhaann 77 ddaayyss..
  40. 40. Decadron® 8 mg/2 mL amp. Orazone®0.5 mg/5 mL syrup Dexamethasone 3 INTERACTIONS ACE Inhibitors: corticosteroids antagoniz e hypotensive effect. Analgesics:  risk of GI bleeding and ulceration when given with NSAIDs. Antibacterials: metabolis m is possibly inhibited by erythromycin. Antiepileptics: metabolism is  by phenytoin ( effect)  Risk of hypokalemia when given with amphotericin - avoid concomitant use unless corticosteroids needed to control reactions. Barbiturates: metabolism is  by barbiturates ( effect). Beta-blockers : corticosteroids antagonise hypotensive effect. Calcium Salts : corticosteroids  absorption. Cardiac Glycosides:  risk of hypokalemia. Diazoxide: corticosteroids antagonise hypotensive effect. Diuretics: corticosteroids antagoniz e effect;  risk of hypokalemia when given with acetazolamide, loop diuretics or thiazides and related diuretics. Sodium Benzoate: corticosteroids possibly  effects. Theophylline:  risk of hypokalemia. Vaccines: high doses impair immune response to vaccines; avoid concomitant use with live vaccines. Hydralazine: corticosteroids antagonize its hypotensive effect.
  41. 41. Diamox® or Cidamex® Acetazolamide 250 mg tab. Diuretic: 5 mg/kg/dose Q24h IV or PO. Anticonvulsant: 4-16 mg/kg/day PO divided every 6-8h (not to exceed 30 mg/kg/day or 1 g/day). To alkalinize urine: 5 mg/kg/dose PO 2-3 times over 24h. To  CSF production: 5 mg/kg/dose IV or PO Q6h increased by 25 mg/kg/day to a maximum of 100 mg/kg/day. Lasix® may be used in combination. ‫دياموكط‬(٢٥٠‫قزص‬ ‫مجم‬/٢٠‫ضم‬)...‫اًل‬‫ز‬‫بال‬‫الزضاعت‬ ‫بعد‬/٦‫ـ‬‫ع‬‫ـا‬‫ض‬‫ث‬‫ا‬ USES Mild diuretic. Anticonvulsant in refractory neonatal seizures (retards abnormal discharge from CNS neurons). Decrease CSF production in PHH. Renal tubular acidosis. MONITOR Serum electrolytes (contraindicated in K + and Na + ). Plasma pH and Chloride. ADVERSEEFFECTS / PRECAUTIONS GI irritation. Anorexia. Transient hypokalemia. Hyperchloremic metabolic acidosis. Growth retardation. Bone marrow suppression, thrombocytopenia, hemolytic anemia, pancytopenia and leucopenia. Drowsiness, paresthesias.
  42. 42. Diflucan® Fluconazole 2mg / mL IV or 5 mg/ mL PO 1 Invasive Candidiasis LD12-25 mg/kg MD6-12 mg/kg/dose IVI over 30 min or PO Neofax2011 Consider higher doses for treatingsevere infections. 2 mg/mL ‫ديفلوكان‬(٢‫مج‬‫م‬/٢‫ضم‬)...(‫ضم‬...+‫ج‬ ‫ضم‬٥٪)‫ضـاعت‬ ‫ى‬‫مد‬ ‫على‬ ‫ورٍد‬‫آلان‬‫م‬‫ث‬ ...(‫ضم‬... +‫ج‬ ‫ضم‬٥٪)‫عت‬‫ـا‬‫ض‬ ‫مدى‬ ‫على‬ ‫ورٍد‬/…‫ضاع‬‫ـ‬‫ت‬ Compatible withD5W andD10W. Prophylactic in VLBW infants at high risk for invasive fungal disease 3-6 mg/kg/dose twice weekly. IVI over 30 min or PO Neofax2011 2 mg/mL ‫ديفلوكان‬(٢‫مج‬‫م‬/٢‫ضم‬)...(‫ضم‬...+‫ج‬ ‫ضم‬٥٪)‫ـاعت‬‫ض‬ ‫مدى‬ ‫على‬ ‫ورٍد‬‫ـين‬‫ـ‬‫ـ‬‫ـ‬‫ـ‬‫مزج‬ ‫ا‬‫ـ‬‫ـ‬‫ـ‬‫ـ‬‫ـ‬ُ‫أضبوع‬ Thrush LD6 mg/kg on D1 MD3 mg/kg/dose/24h PO Neofax2011 5 mg/mL ‫ـوكان‬‫ل‬‫ديف‬(٥‫مجم‬/‫م‬‫ض‬)‫شراب‬...‫ثم‬ ‫ل‬‫الاو‬ ‫لُوم‬‫ا‬ ‫في‬ ‫ـم‬‫ف‬‫ل‬‫با‬ ‫ضم‬...‫م‬‫ـ‬‫ف‬‫ل‬‫با‬ ‫ضم‬ /٢٤‫ض‬‫ـ‬‫ـ‬‫ع‬‫ا‬‫ـ‬‫ـ‬‫ت‬ GA (wk) Postnatal (d) Interval (h) ≤ 29 0-14 >14 48 24 30 and older 0-7 >7 48 24 USES Systemic infections, meningitis and s evere superficial mycoses caused by Candida species. MONITOR Renal function. AST, ALT and direct bilirubin especially in patients on the higher doses. Periodic CBC for eosinophilia.
  43. 43. Diflucan® Fluconazole 2mg / mL IV or 5 mg/ mL PO 2 ADVERSEEFFECTS / PRECAUTIONS Reversible  AST, ALT (in 12 %). Interfere with metabolism of barbiturates and phenytoin, aminophylline, caffeine, theophylline and midazolam. Adjust dosage for impaired renal function. RENAL IMPAIRMENT Use extended dosing intervals when s erum creatinine > 1.3 mg/dL. Cr Cl < 50 mL/min/1.73m 2  usual initial dose then halve subsequent doses. INTERACTIONS WITH Analgesics: fluconazole possibly  plasma concentration of fentanyl. Antibacterials: metabolism of fluconazole accelerated by rifampicin ( plasma concentration). Antiepileptics: fluconazole  plasma concentration of phenytoin (consider  dose of phenytoin). Antifungals: triazoles possibly antagonise effects of amphotericin. Anxiolytics and Hypnotics: fluconazole  plasma concentration of midazolam (risk of prolonged s edation). Cisapride: precipitates life-threatening arrhythmias (contraindicated). Theophylline:  plasma concentration of theophylline.
  44. 44. Digibind® Digoxin immune Fab (38 mg per vial) Dose (number of vials) = Each vial contains 38 mg and will bind 0.5 mg digoxin. Once administered, digoxin serum concentrations can no longer be determined accurately. USES Life threatening digoxin toxicity. ADMINISTRATION The contents in each vial to be us ed should be dissolved with 4 mL of Sterile Water for Injection, by gentle mixing, to give a clear, colorless, approximately isosmotic solution with a protein concentration of 9.5 mg/mL. Reconstituted product should be used promptly. If it is not used immediately, it may be stored under refrigeration at 2-8°C for up to 4 hours. Digibind® is administered by IVI over 30 minutes. If cardiac arrest is imminent, it can be given as a bolus injection. STORAGE Refrigerate at 2° to 8°C. Unreconstituted vials can be stored at up to 30°C for a total of 30 days.
  45. 45. Dobutamine Dobuject® 250 mg / 5 mL Dose: 2-25 μg/kg/min IVI. Begin low and titrate by monitoring effect. Neofax2011 Volume of drug needed per day = (if using Dobuject®) or = (if using Dobutrex®) is added to 24 mL D5W, D10W, NS or LR, given as IVI at a rate of 1 mL/h. ‫بي‬‫و‬‫د‬‫وجيكت‬(٢٥٠‫مجم‬/٥‫ضم‬)...‫لين‬‫و‬‫ـ‬‫ط‬‫او‬ ‫ـت‬‫ج‬‫ه‬‫ز‬‫بط‬‫ـزطت‬‫غ‬٢٠٠+٢٤‫ج‬ ‫ضم‬ ٥٪‫مدى‬ ‫على‬ ‫ورٍد‬٢٤‫بمعدل‬‫ـت‬‫ع‬‫ضا‬٢‫ضم‬/‫ـت‬‫ع‬‫الطا‬ Brands include: Dobutrex® 250mg/20mL. 10 μg/kg/min dose is equal to 0.29 mL/kg/24h of Dobuject® 250 mg / 5 mL 10 μg/kg/min dose is equal to 1.15 mL/kg/24h of Dobutrex® 250 mg / 20 mL Incompatible with NaHCO3 and Lasix ® . Compatible with Alprostadil, dopamine, epinephrine, fentanyl, heparin, insulin, MgSO4, midazolam, KCl, D5W, D10W, LR and NS. USES Hypoperfusion and hypotension, especially if related to myocardial dysfunction. Onset of action is 1-2 min after IVI with peak effect in 10 min. serum half-life is several minutes. MONITOR Heart rate and Blood pressure. IV sites for extravas ation. ADVERSEEFFECTS / PRECAUTIONS Hypotension if patient is hypovolemic. Volume loading is recommended before starting therapy. Tachycardia at high dosage. Arrhythmias, hypertension and cutaneous vasodilatation. Increases myocardial oxygen consumption. Tissue ischemia occurs with infiltration. Contraindicated in idiopathic hypertrophic subaortic stenosis.
  46. 46. Dopamine Intropin® 200 mg / 5 mL Dose: 2-20 μg/kg/min IVI. Begin low and titrate by monitoring effect. Neofax2011 Volume of drug needed per day = then added to 24 mL D5W and given as IVI at a rate of 1 mL/h. ‫ـامين‬‫ب‬‫و‬‫د‬(٢٠٠‫مجم‬/٥‫ضم‬)...‫ـزط‬‫غ‬‫لين‬‫و‬‫ـ‬‫ط‬‫او‬ ‫ـت‬‫ج‬‫ه‬‫ز‬‫بط‬‫ت‬٢٠٠+٢٤‫ج‬ ‫ضم‬٥٪ ‫مدى‬ ‫على‬ ‫ورٍد‬٢٤‫بمعدل‬‫ـت‬‫ع‬‫ضا‬٢‫ضم‬/‫ـت‬‫ع‬‫الطا‬ 5 μg/kg/min is equal to0.18 mL/kg/24h of Intropin® 200 mg/5 mL Incompatible with NaHCO3 , Insulin and Lasix ® . Compatible with Dobutamine, epinephrine, fentanyl, heparin, MgSO4, midazolam, KCl, PGE1 , D5W, D10W, LR and NS. Diluted solutions are stable for 24h. Admixtures exhibiting a color change should not be used. USES Hypotension. MONITOR Heart rate Blood pressure Urine output and peripheral perfusion. IV sites for blanching and infiltration. ADVERSEEFFECTS / PRECAUTIONS Tachycardia and arrhythmias. May increase pulmonary artery pressure. Reversible suppression of prolactin and thyrotropin secretion. Tissue sloughing may occur with IV infiltration. Use higher doses with caution in patients with PPHN. Contraindicated in Pheochromocytoma, tachyarrythmias or hypovolemia. Us e with caution in pulmonary hypertension.
  47. 47. Dormicum® or Midathetic® Midazolam 15 mg / 3 mL 1 SEDATIVE DOSE: Neofax2011 IV (or IM): 0.05-0.15 mg/kg over at least 5 minutes, repeat as required, usually Q2-4h. IVI: 0.01-0.06 mg/kg/h ( after several days of therapy due to tolerance or  clearance). Intranas al: 0.2-0.3 mg/kg/dose using injectable form. Sublingual: 0.2 mg/kg/dose using injectable form mixed with a small amount of flavored syrup. ANTICONVULSANT DOSE: Ne ofax2011 LD: 0.15 mg/kg IV over at least 5 min, followed by Maintenance IVI: 0.06-0.4 mg/kg/h (1-7 µg/kg/min). ‫دورميكم‬(٢٥‫م‬‫جم‬/٣‫ضم‬()٢٠‫وطولين‬‫ا‬ ‫جت‬‫بطزه‬ ‫غزطت‬٢٠٠‫الى‬ ‫وجكمل‬ ‫مزكش‬٢٠٠‫ج‬ ‫غزطت‬ ٥٪)...‫وطولين‬‫ا‬ ‫بطزهجت‬ ‫زطت‬ ‫غ‬٢٠٠‫وريد‬‫مدى‬ ‫على‬٥‫دقائق‬/٢-٤‫ضاعاث‬ Infusion solution concentration 1 mg/mL. Incompatible with Albumin, Lasix ® and NaHCO3. Compatible with D5W, NS, sterile water for injection, dopamine, dobutamine, epinephrine, fentanyl, heparin, insulin, milrinone, morphine and KCl. USES Sedative, hypnotic (duration of action is 2-6h, and quite variable, up to 22h, in premature babies and those with impaired hepatic function). Anesthesia induction. Treatment of refractory s eizures.
  48. 48. Dormicum® or Midathetic® Midazolam 15 mg / 3 mL 2 MONITOR Respiratory status and Blood pressure. Hepatic function. Signs of withdrawal after prolonged therapy. ADVERSEEFFECTS Respiratory depression and respiratory arrest especially when used for sedation in non-critical care settings. Severe hypotension and seizures with bolus infusion. Burning sensation with nasal administration. Seizure-like myoclonus (8% of PT infants receiving continuous infusion).
  49. 49. Edemex® Bumetanide 0.5 mg / 2 mL Dose: 0.005-0.1 mg /kg/dose IV slow push, IM, or PO. Neofax2011 Given Q24h in the 1 st 2 months of life then Q12h afterwards. Infants with lung diseas e and normal kidneys should be started on a low dos e. Infants with CHF or RF will need a higher dose. ‫إ‬‫ديمكط‬)٥.٠‫مجم‬/٢‫ضم‬)...‫لين‬‫و‬‫اوط‬ ‫هجت‬‫ز‬‫بط‬‫غزطت‬٢٠٠‫وريد‬/٢٢‫ضاعت‬ Compatible with D5 W, NS, lasix ® , milrinone and morphine. Incompatibe with dobutamine and midazolam. USES Potent loop diuretic used in RF, CHF or significant edema that is refractory to Lasix ® . MONITOR Serum electrolytes and UOP. Serum K + level (esp. if receiving digoxin concurrently). Weight changes. ADVERSEEFFECTS Water and electrolytes imbalances; hyponatremia, hypokalemia and hypochloremic alkalosis. Potentially ototoxic (less than Lasix®). May displace bilirubin from albumin binding sites when given in high doses or for prolonged periods.
  50. 50. Eltroxen® Levothyroxine T4 50 μg tab. Initial Oral Dose: 10-14 μg/kg/dose PO Q24h (37.5-50 μg/ dose for an average term infant). Dosage is adjusted in 12.5 μg increments. Initial IV Dose: 5-8 μg/kg/dose Q24h. Neofax2011 ‫ين‬‫ض‬‫التروك‬(‫قزص‬٥٠‫في‬ ‫ًذاب‬ ‫ام‬‫ز‬‫مُكزوج‬٥‫ضم‬‫مقطز‬ ‫ماء‬)...‫كل‬ ‫بالفم‬ ‫ضم‬ ٢٤‫ـت‬‫ع‬‫ضا‬ Use immediately. USES Hypothyroidism MONITOR After 2 weeks of treatment Serum TT44 level should be in the high normal range (10-16 μg/dL) and should be maintained in this range for the first year of life. TT33 level should be normal (70-220 ng/dL) and TTSSHH should have declined from initial value. After 12 weeks of treatment Serum TTSSHH should be in the normal range (< 15 mU/L). Measure TT44 and TTSSHH at 2 weeks of age, then every 1-2 months or 2 weeks after any change in dosage. Signs of hypothyroidism: lethargy, poor feeding, prolonged neonatal jaundice, constipation, intermittent cyanosis. Signs of thyrotoxicosis: hyperactivity, altered sleep pattern, tachycardia, tachypnea, fever, exophthalmos and goiter. Growth, development and bone-age advancement. ADVERSEEFFECTS Prolonged overtreatment can produce premature craniosynostosis and acceleration of bone age.
  51. 51. EMLA® cream Lidocaine 2.5% and Prilocaine 2.5% Apply 1-2 gm to distal half of penis then wrap with the occlusive dressing. Allow dressing to remain intact for 60-90 min, remove and clean treated area completely prior to circumcision to avoid systemic absorption. Ne ofax2011 USES Topical analgesia for circumcision (applied 60-90 min before the procedure) . Not effective for heel lancing. MONITOR Blood methemoglobin conentration. ADVERSEEFFECTS Blanching and redness resolve without treatment. Methemoglobinemia (with application of > 3 gm) Contraindicated with congenital or idiopathic methemoglobinemia, with other drugs causing methemoglobinemia: sulfonamides, acetaminophen, nitrates, nitroglycerin, nitroprusside, phenobarbital and phenytoin.
  52. 52. Epanutin® or Ipanten® Phenytoin LD: 15-20 mg/kg IVI over at least 30 min. Neofax2011 MD: 4-8 mg/kg Q24h IV slowpushor PO. Up to: 8 mg/kg/dose Q8-12h after 1 week of age. Flush IV with saline before and after administration. Avoid use incentral lines; mayprecipitate. Not to be given IM. ‫ـوثين‬‫ه‬‫ـا‬‫ب‬‫إي‬(٢٥٠‫مجم‬/٥‫ـم‬‫ض‬()٢‫ـم‬‫ض‬+٩‫ضم‬‫م‬ ‫م‬‫لح‬٩.١٪)...‫ضم‬‫يد‬‫ور‬‫ف‬‫هص‬ ‫مدى‬ ‫على‬ ‫ثم‬ ‫ضاعت‬...‫ضم‬‫وريد‬‫ببطء‬/٢٢‫ضاعت‬ ‫ـا‬‫ب‬‫إي‬‫هت‬‫ن‬‫شراب‬(٣٠‫مجم‬/٥‫ـم‬‫ض‬)...‫ضم‬‫ـم‬‫ف‬ ‫بال‬/٢٢‫ضاعت‬ Maximum rate of infusion 0.5 mg/kg/min Infusion solutionconcentration 5 mg / mL Incompatible withD5W, D10W. USES Anticonvulsantforseizures refractorytophenobarbital. HEPATIC IMPAIRMENT Reduce dose. MONITOR Bradycardia, arrhythmias andhypotensionduring infusion. IV site for extravasation. Serum therapeutic level is 6-15 μg/mL in the 1st weeks, then 10-20 μg/mL due to change in protein binding. Obtain initial trough level after 48h of IV LD. Bilirubin displaces phenytoin from protein-binding sites, resulting in increased free drug. ADVERSE EFFECTS Extravasation  inflammation andnecrosis. Hypersensitivity reactions. Highserum concentration is associated withseizures. With long term therapy: Arrhythmias, hypotension, gingivitis, nystagmus, rickets, hyperglycemia, and hypoinsulinemia.
  53. 53. Epoetin alpha Eprex® 2000 iu / 0.5 mL Dose: 200-400 iu/kg/dose, 3-5 times per week for 2-6 weeks. Total dose per week is 600-1400iu/kg. Short course: 300 iu/kg/dose daily for10 days. Administer SC or IVI (over ≥4h or continuously in TPN). Supplemental iron, adequate proteins and Vit-E should be initiated concurrently. ‫ايب‬‫ـ‬‫ركط‬(٢٠٠٠‫وحدة‬/٥.٠‫ضم‬)...‫ًوم‬‫بعد‬‫ًوم‬‫الجلد‬ ‫جحت‬‫غزطت‬ For IVI: Dilute in 2 mL of solutions containing at least 0.05% protein and infuse over 4 hours. Stable for 24h. USE Stimulate erythropoiesis and  the need for PRBCs transfusion in high risk preterms (the most likely to benefit are ELBW < 800 gm with phlebotomy losses > 30 ml/kg). MONITOR Weekly CBC to check for neutropenia and RBC response. ADVERSEEFFECTS / PRECAUTIONS Neutropenia (rare, resolves with discontinuation of the drug). STORAGE Store between 2-8 ◦ c. Don’t shake or freeze. Undiluted epoetin is stable plastic syringes for 2 weeks.
  54. 54. Erythromycin Erythrocin® 200 mg/ 5 mL In Chlamydia trachomatis Conjunctivitis and Pneumonitis: 12.5 mg/kg/dose PO Q6h for 14 days. For other infections and prophylaxis : 10 mg/kg/dose PO Q6h. In treatment and prophylaxis of Pertussis: 12.5 mg/kg/dose PO Q6h for 14 days (Azithromycin is the drug of choice in neonates). Ne ofax2011 Dose for feeding intolerance due to dysmotility: 10 mg/kg/dose PO Q6h for 2 days followed by 4 mg/kg/dose PO Q6h for 5 days. Neofax2011 ‫شراب‬‫ين‬‫ص‬‫يثرو‬‫ر‬‫ا‬(٢٠٠‫مجم‬/٥‫ضم‬)...‫ـم‬‫ف‬‫ـ‬‫ل‬‫با‬‫الزضاعت‬ ‫مع‬/٦‫ـ‬‫ع‬‫ضا‬‫ث‬‫ا‬ For prophylaxis of ophthalmia neonatorum: ribbon of 0.5 % ointment instilled in each conjunctival sac. Neofax2011 USES Infections by Chlamydia, Mycoplasma, and Ureaplasma. Treatment and prophylaxis for Bordetella pertussis. Substitute for penicillin in allergic intolerance. Prokinetic agent (motilin-receptor agonist) in feeding intolerance. MONITOR Diarrhea and abdominal discomfort. CBC for eosinophilia. ADVERSEEFFECTS / PRECAUTIONS Loose stools. Intrahepatic cholestasis. x10  risk of hypertrophic pyloric stenosis in neonates under 2 wks of age.  Plasma clearance of midazolam (Dormicum®) by 50%  Serum concentration of digoxin, midazolam, theophylline and carbamazepine.
  55. 55. Famotidine Antodine® 20 mg / 2 mL amp. IV, slow push: 0.25-0.5 mg/kg/dose Q24h. Ne ofax2011 Continuous IVI of the daily dose in adult provides better gastric suppression than intermittent dosing. PO: 0.5-1 mg/kg/dose Q24h. Ne ofax2011 ً‫أهتودي‬(٢٠‫مجم‬/٢‫ضم‬)(٢‫ضم‬+٩‫ضم‬)...‫ببطء‬‫ورٍد‬/٢٤‫ضاعت‬ Infusion Solution Conentration 1 mg / mL. Compatible with D5W, D10W, NS, calcium gluconate, dobutamine, dopamine, epinephrine, hepain, insulin, MgSO4, midazolam, morphine, KCl and NaHCO3. ‫ا‬ً‫هتودي‬‫اص‬‫ز‬‫أق‬(٢٠‫مجم‬/٢٠‫ضم‬)...‫ـم‬‫ف‬‫ـ‬‫ل‬‫با‬/٢٤‫ضاع‬‫ت‬ Solution Conentration 2 mg / mL. USES Prevention and treatment of stress ulcers and GI hemorrhage aggrevated by gastric acid secretion. MONITOR Gastric pH (> 4) ADVERSEEFFECTS Increased risk of late-onset bacterial and fungal s epsis. Routine gastric acid suppression in neonates should be avoided. In adults (<5%): headache, dizziness, constipation and diarrhea.
  56. 56. Fentanyl Fentanyl-Janssen® 50 μg / mL Sedation and Analgesia: 0.5-4 μg/kg/dose IV slow push, repeatas required, usually Q2-4h. Infusion rate:1-5 μg/kg/h (quickly develop tolerance). Anesthesia: 5-50 μg/kg/dose. Neofax2011 ‫ـل‬‫ي‬‫ـاه‬‫ت‬‫فى‬(٥٠‫ام‬‫ز‬‫مُكزوج‬/‫ضم‬( )½‫ضم‬+٢٢‫ضم‬)...‫ضم‬‫ببطء‬‫ورٍد‬/٤‫ث‬‫ضاعا‬ ‫الطبِب‬‫بأمز‬ Infusion solution concentration 2 μg / mL. For a dose of 2 µg/kg, give 1 mL/kg Stable for 24h refrigerated after dilution. Protect from light. Compatible with D5 W, D10W and NS. USES Analgesia, sedation. Anesthesia. MONITOR Respiratory and cardiovascular status. Abdominal distension, loss of bowel sounds. Muscle rigidity. ADVERSEEFFECTS / PRECAUTIONS Respiratory depression with anesthetic dose (> 5 μg/kg). Chest wall rigidity (in 4% of neonates who received 2.2-6.5 μg/kg/dos e) with laryngospasm, reversible with naloxone ® . Urinary retention with continuous infusion. Tolerance to analgesic doses with prolonged use. Withdrawal symptoms after IVI for 5 days or longer.
  57. 57. Flagyl® Metronidazole 500 mg / 100 mL Vial LD: 15 mg/kg PO or IVI over 1h MD: 7.5 mg/kg/dos e PO or IVI over 1h Neofax2011 ‫ـل‬‫ي‬‫فالج‬(٥٠٠‫مجم‬/٢٠٠‫ضم‬(...‫ضم‬+…‫ج‬ ‫ضم‬٥٪‫ثم‬‫ضاعت‬ ‫مدى‬ ‫على‬ ‫ورٍد‬ ‫بعد‬...‫ضاعت‬…‫ضم‬+…‫ج‬ ‫ضم‬٥٪‫ورٍد‬... /‫ـت‬‫ع‬‫ضا‬ ‫مدى‬ ‫على‬ ‫ضاعت‬ ‫ـل‬‫ي‬‫فالج‬‫شراب‬(٢٢٥‫م‬‫جم‬/٥‫ضم‬)...‫ضم‬‫بالفم‬/...‫ضاعت‬ Na content is 14 mEq per 100 mL. Infusion solution concentration 5 mg/ml. Compatible with D5 W and NS. PMA (wk) Postnatal (d) Interval (h) ≤ 29 0-28 >28 48 24 30-36 0-14 >14 24 12 37-44 0-7 >7 24 12 ≥ 45 All 8 HEPATIC IMPAIRMENT Reduce total daily dose to one third and give once daily Use with caution in hepatic encephalopathy USES Meningitis, ventriculitis and endocarditis caused by Bacteroides fragilis and other anaerobes resistant to penicillin. Serious intra-abdominal infections and C. difficile colitis. Trichomonas vaginalis infections. ADVERSEEFFECTS / PRECAUTIONS Carcinogenic?!! Seizures, sensory polyneuropathy (in adults receiving high doses over a prolonged period). Brownish discoloration of urine.
  58. 58. Fludrocortisone Astonin-H® or Cortilon® 0.1 mg tab. Dose: initially 0.05 mg PO once daily, adjusted according to response; usual range 0.05–0.2 mg/day; higher doses may be required. BNFC2011-12 ‫هين‬‫و‬‫اصت‬-ٌ‫اص‬‫ز‬‫أق‬(٢.٠‫مج‬‫م‬)...‫في‬ ‫ًذاب‬‫قزص‬٥‫َعطى‬‫و‬‫مقطز‬ ‫ماء‬ ‫ضم‬‫بالفم‬ /٢٤‫ضاع‬‫ت‬ USES Mineralocorticoid replacement in adrenocortical insufficiency. MONITOR Blood pressure Serum electrolytes; Na+ , K+ and Ca++ . Body weight ADVERSE EFFECTS / PRECAUTIONS Hypertension Na+ and water retention K+ and Ca++ loss
  59. 59. Folic Acid Folicap® 500 μgcap. Dose: 15 μg/kg/dose or up to maximum 50 μg/day PO, deep IM, IV or SC. Neofax2011 ‫أصيد‬‫فوليك‬(½‫مجم‬/٢٠٠‫ضم‬)٢‫بالفم‬‫ضم‬/٢٤‫ضاعت‬ Prevention of megaloblastic anemia associated with ppyyrriimmeetthhaammiinnee and ssuullffaaddiiaazziinnee treatment of congenital toxoplas mosis: Neonate: 5 mg 3 times a week (increased up to 20 mg 3 times a week if neutropenic). Child 1 month-1 year: 10 mg 3 times a week. BNFC2010-11 USES Megaloblastic and macrocytic anemia as a result of folate deficiency. MONITOR Hematocrit Hemoglobin Reticulocyte ADVERSEEFFECTS / PRECAUTIONS May mask hematological defects of Vit B12 deficiency, but it will not prevent the progression of irreversible neurologic abnormalities. GI upset Slight flushing May decrease phenytoin serum concentration. Contraindicated in pernicious, aplastic and normocytic anemia
  60. 60. Fortum® Ceftazidime 1 g / 40 mL Dose: 30 mg/kg/dose IVI over 30 min, or IM. Neofax2011 PMA (wks) Postnatal (days) Interval (hrs) ≤ 29 0-28 >28 12 8 30-36 0-14 >14 12 8 37-44 0-7 >7 12 8 ≥ 45 All 8 Another Dose Regimen MNC2012 Age Weight Dosage (IV/IM) All neonates < 1,200 g 50 mg/kg/dose Q12h Postnatal age ≤ 7d 1,200-2,000 g 50 mg/kg/dose Q12h Postnatal age ≤ 7d > 2,000 g 50 mg/kg/dose Q8h Postnatal age > 7d > 1,200 g 50 mg/kg/dose Q8h ‫ثام‬‫فور‬(٢‫جم‬/٤٠‫م‬ ‫م‬ ‫ضم‬)...‫م‬‫ض‬‫ي‬‫ور‬‫ـ‬‫ـ‬‫د‬‫عت‬‫ضا‬ ‫هصف‬ ‫مدى‬ ‫على‬... /‫ث‬ ‫ضاعا‬ Infusion solution concentration 25 mg/ml. Compatible with D5 W, D10W and NS. ‫ثام‬‫فور‬(٥٠٠‫مجم‬/٢‫ضم‬)...‫ضم‬‫ـل‬‫ـ‬‫عض‬... /‫ث‬ ‫ضاعا‬ Also available as 250 mg and 1 g vials USES Neonatal meningitis and sepsis by G-ve organisms (e.g. E. coli, H. influenza, Neisseria, Klebsiella, and Proteus species), esp. Pseudomonas aeruginosa. Synergisticwith aminoglycosides. ADVERSE EFFECTS (UNCOMMON) Rash, Eosinophilia Diarrhea,  Hepatic ALT,AST. False positive direct Coombs’ test.
  61. 61. Fungizone® Amphotericin-B 50 mg / 10 mL 1 Dose: 1-1.5 mg/kg IVI over 2-6h Q24h Ne ofax 2011 Dose: Gome lla 2 009 - Initial dose: 0.25-0.5 mg/kg IVI over 4-6h. - MD: 0.5-1 mg/kg IVI over 2-6h Q24-48h for 2-6 wks or longer. ‫يزون‬‫ـىج‬‫ف‬(٥٠‫مجم‬/٢٠‫ضم‬( )½‫ضم‬+٥.٢٤‫ج‬ ‫ضم‬٥٪)...‫ين‬‫ـاعخ‬‫ض‬ ‫ـدي‬‫م‬ ‫على‬ ‫ـد‬ٍ‫ور‬ ‫ضم‬ ‫ـدل‬‫ع‬‫بم‬...‫ضم‬/‫كل‬ ‫ـاعـت‬‫ط‬‫ال‬٢٤‫ـاعـت‬‫ض‬ Infusion solution concentration 0.1 mg/mL. Compatible with D5 W, D10W, D15W and D20W. Don’t mix with NS. Protect from light. Stable for 24h at room temperature or 7 days in refrigerator. USES Systemic fungal infections. Severe superficial mycoses. ADVERSEEFFECTS / PRECAUTIONS Hypokalemia (K + < 3 mmol/L) and transient  in serum creatinine in ~16% of treated patients.  RBF and GFR by 20-60%.  K + and Mg loss due to tubular injury,  reabsorption of Na and renal tubular acidosis. Na intake > 4 mEq/kg/day may prevent or  nephrotoxicity. Concurrent use with other nephrotoxic drugs may lead to additive nephrotoxicity. Anemia, thrombocytopenia. Consider analgesia before infusion. Fever, chills, nausea or vomiting. Cardiac arrest has occurred in patients who received 10 times the recommended dose.
  62. 62. Fungizone® Amphotericin-B 50 mg / 10 mL 2 MONITOR CBC, electrolytes, UOP, BUN and serum creatinine aatt lleeaasstt eevveerryy ootthheerr ddaayy.. IV sites for irritation (phlebitis). RENAL IMPAIRMENT If creatinine increases > 0.4 mg/dL from baseline during therapy, hold dose for 2-5 days. Neofax 2011 Alternate-day dosing is recommended over decreasing daily dose in patients experiencing renal toxicity. Ne ofax 2011 Discontinue if BUN > 40 mg/dL, s erum creatinine is > 3 mg/dL, or liver function tests are abnormal. INTERACTIONS WITH Antibacterials:  risk of nephrotoxicity when given with aminoglycosides; possible  risk of nephrotoxicity when amphotericin given with vancomycin. Cardiac Glycosides: hypokalemia caused by amphotericin  cardiac toxicity with cardiac glycosides. Corticosteroids:  risk of hypokalemia when amphotericin given with corticosteroids - avoid concomitant use unless needed to control reactions. Diuretics:  risk of hypokalemia when given with loop diuretics or thiazides.
  63. 63. Garamycin® Gentamicin 40 mg / 4 mL Dose: as chart IVI over 30 minutes. Ne ofax2011 ‫جاراميضين‬)٤٠‫مجم‬/٤‫ضم‬((٢‫ضم‬+٤‫ج‬ ‫ضم‬٥٪)...‫مدى‬ ‫على‬ ‫ورٍد‬ ‫ضم‬ ‫ضاعت‬ ‫هصف‬/٢٤‫ـت‬‫ع‬‫ضا‬ Infusion solution concentration 2 mg/mL. Compatible with D5 W, D10W and NS IM injection is associated with variable absorption, especially in the very small infant. PMA (wks) Postnatal (d) Dose (mg/kg) Interval (h) ≤ 29 * 0-7 8-28 ≥ 29 5 4 4 48 36 24 30-34 0-7 ≥ 8 4.5 4 36 24 ≥ 35 All 4 24 * or significant asphyxia, PDA or ttt with indomethacin. USES Aerobic G-ve Bacilli (e.g. Ps eudomonas, Klebsiella, E. coli). Usually used in combination with a β-lactam antibiotic. ADVERSEEFFECTS Transient and reversible renal tubular dysfunction ( urinary loss of Na, Ca, and Mg). Vestibular and auditory ototoxicity. Increased neuromuscular blockade when us ed with pancuronium and in patients with hypermagnes emia. The use of gentamicin ointment for newborn ocular prophylaxis has been associated with periocular ulcerative dermatitis. SERUM LEVEL Obtain ppeeaakk concentration 30 minutes after end of infusion and ttrroouugghh level just prior tothe nextdose, refrigerate bloodsamplesoon Peak: 5-12 µg/mL Trough: 0.5-1 µg/mL
  64. 64. Gastrazole® Omeprazole 20 mg cap. Losec® Omeprazole 40 mg vial Dose: 0.5 - 1.5 mg/kg/dose POQ24h. Neofax2011 ‫ـرازول‬‫ت‬‫ـ‬‫ص‬‫جا‬(٢٠‫مجم‬/٢٠‫ث‬‫ها‬‫و‬‫ب‬‫ز‬‫بُك‬‫صودًوم‬‫ضم‬٤.۸٪)...‫ـم‬‫ف‬‫بال‬‫ضم‬/٢٤ ‫ـت‬‫ع‬‫ـا‬‫ض‬ Solution concentration 2 mg/mL. ‫لوصيك‬(٤٠‫مجم‬/٢٠‫ضم‬( )٢‫ضم‬+٩‫ضم‬)...‫لين‬‫و‬‫أوط‬ ‫هجت‬‫ز‬‫بط‬ ‫غزطت‬٢٠٠ ‫ـد‬‫ـ‬ٍ‫ور‬‫غدًد‬ ‫ببطء‬/٢٤‫ـت‬‫ع‬‫ـا‬‫ض‬ Infusion solutionconcentration 4 mg/mL. Dilute with D5W or NS. BNFC2011-12 USES Short-term (< 8 weeks) treatment of documented reflux esophagitis or duodenal ulcer refractory to conventional therapy. OOnnsseett ooffaaccttiioonn within 1h with dduurraattiioonn ooffaaccttiioonn of72h. MONITOR Symptomatic improvement within 3 days. Intra-esophageal pH monitor to assess efficacy (pH >4.0). ALT, ASTifduration oftherapy >8 wks. ADVERSE EFFECTS Hypergastrinemia. Mild ALT, ASTelevation.
  65. 65. Geveskon® Na Alginate / Na Bicarbonate Dose: 1-2 mL after feeding PO Q8h. ‫اب‬‫ر‬‫ـ‬‫ش‬‫ن‬‫جيفيضكو‬٢-٢‫بالفم‬‫ضم‬/۸‫الزضاعت‬ ‫بعد‬‫ضاعاث‬ Each 5 mL contains 5 g sodium alginate + 2.5 gm NaHCO3 USES NaHCO3 may, by acting as an antacid, control some of the symptoms of gastro-oesophageal reflux. Alginate reacts with gastric acid to form a viscous gel or ‘raft’ that then floats tothe top of the stomach, acting as a mechanical barrier to oesophageal reflux. ADVERSE EFFECTS / PRECAUTIONS Metabolic alkalosis Hypernatremia Gaviscon® Infant Sachets Powder for oral suspension Each dose of Gaviscon® infant Sachets contains 225 mg of sodium alginate and 87.5 mg magnesium alginate. Prepare immediately before use as directed below: For breast-fed infants: < 4.5 kg, one dose and 2 doses if > 4.5 kg Add 5 mL of cooled boiled water to the powder in a glass. Mix to a smoothpaste and add another 10 mL water and mix. Give after each feed using a spoon or feeding bottle. For bottle-fed infants: < 4.5 kg, one dose to be mixed into not less than 115 mL of each feed in thebottle and shaken well. > 4.5 kg, 2 doses to be mized into not less than 225 mL of each feed in thebottle and shaken well. Young children: 2 doses, prepared as breast-fed infsnts. To be taken after each meal.
  66. 66. Glucagon® Glucagon 1 mg vial Dose: 0.2mg/kg/dose IV push, IM or SC. Maximum dose:1 mg. IVI: begin with 0.01-0.02 mg/kg/h. Rise in bloog glucose should occur within 1h ofstartinginfusion. Neofax2011 ‫ج‬‫ن‬‫لوكاجو‬(٢‫مجم‬)‫آلان‬ ‫احدة‬‫و‬ ‫مزة‬ ‫الجلد‬ ‫جحت‬‫ًحقن‬ USES Hypoglycemia: - Refractory to IV dextroseinfusions - When dextrose infusionis unavailable - Documented glucagon deficiency. Glucagonstimulates gluconeogenesis, inhibits small-bowel motility and gastric acid secretion. In high doses, it has a cardiac inotropiceffect. MONITOR Blood glucose concentration; rise in blood glucose will last ~2h. Rebound hypoglycemia ADVERSE EFFECTS Nausea and vomiting. Tachycardia. Ileus. Hyponatremia. Thrombocytopenia.
  67. 67. Heparin 5000 i.u. / mL To maintain patency of peripheral and central vascular catheters: 0.5-1 units/mL of fluids to be infused. Neofax2011 Heparin lock for central lines: 1-2 mL of 10 units/mL solution Q4- 6h and as needed. MNC2012 Treatment of Thro mbosis: 75 units/kg bolus over 10 minutes, followed by 28 units/kg/h IVI - Measure aPTT 44hh after initiating therapy - Adjust dose to achieve aPTT of 60-85 seconds (corresponds to an anti-factor Xa level of 0.35-0.7). - Limit treatment to 10-14 days. Ne ofax2011 ً‫هيباري‬(٥٠٠٠‫وحدة‬/‫ضم‬()٢‫ضم‬+٩‫ضم‬)٥‫وطولين‬‫ا‬ ‫بطزهجت‬ ‫غزطاث‬٢٠٠‫لكل‬٥٠‫م‬‫ض‬ ‫محالُل‬ Compatible with D5 W, D10W and NS. USES To maintain patency of peripheral and central vascular catheters (continuous infusions rather than intermittent flushes). Treatment of thrombosis. MONITOR Platelet count every 2-3 days. aPTT (achieve aPTT of 60-85 seconds). Signs of bleeding and thrombosis. ADVERSEEFFECTS / PRECAUTIONS Heparin-induced thrombocytopenia (HIT) 1%. Osteoporosis (with long-term use) Fatal hemorrhage with incorrect concentration used. Contraindicated in infants with evidence of intracranial or GI bleeding or thrombocytopenia (<50.000/mm 3 ).
  68. 68. Hepatitis B Immune Globulin Hepabig® 200 iu / mL Vial Dose: 0.5 mL given in th e anterolateral thigh IM. Ne ofax2011 Don’t administer IV. FT and PT with HBsAg +ve mother Given within 12h of birth. FT and PT ≥ 2 kg with unknown status of mother’s HBsAg Given as soon as it is determined that the mother is HBsAg +ve, within 7 days of birth. PT < 2 kg with unknown status of mother’s HBsAg Given within 12h of birth. Uses Passive immuniz ation of newborns whos e mothers have active hepatitis B infection at the time of delivery, or who are HBsAg +ve. Infants born to mothers who are HBeAg +ve have the highest risk. PRECAUTION FOR HBIG When given at the same time as the first dose of H epB vaccine  Use a separate syringe and a different site. Draw back on the plunger of the syringe before injection to be certain the needle is not in a blood vessel. ADVERSEEFFECTS / PRECAUTIONS Local pain and tenderness. Systemic reactions if given IV. Use univers al precautions with neonates born to HBsAg +ve mothers until they have been bathed carefully.
  69. 69. Hepatitis B Recombinant Vaccine Euvax B® Dose: 0.5 mL given in the anterolateral thigh IM. Ne ofax2011 Store refrigerated at 2 ◦ C to 8 ◦ C. Don’t freeze-destroys potency. Maternal HBs Ag +ve Give 1 st dose before 12h of birth (regardless of birth weight). If < 2 kg, give 3 additional doses beginning at 1-2 months of age. Maternal HBs Ag unknown Give 1 st dose before 12h of birth (regardless of birth weight). IIff << 22 kkgg,, give HBIG within 12h of age. IIff ≥≥ 22 kkgg,, give HBIG within 7 days of birth if mother tests HBsAg +ve. Maternal HBs Ag -ve Give 1 st dose shortly after birth, before hospital discharge. IIff << 22 kkgg aanndd mmeeddiiccaallllyy ssttaabbllee,, give 1 st dose at 30d of chronologic age or at time of hospital discharge if before 30d of chronologic age. USES Immunoprophylaxis against hepatitis B. Safe for us e in infants born to HIV-positive mothers, although it may be less effective. USES Immunoprophylaxis against hepatitis B. ADVERSEEFFECTS / PRECAUTIONS Soreness at injection site. Fever > 37.7 ◦ C (in 1-6%).
  70. 70. Hyaluronidase Hyalase® 1500 iu amp. Inject 1 mL (150 units) as 5 separate 0.2 mL SC injections around the periphery of the extravasationsite. Use 25-or 26- gauge needle and change after each injection. Neofax2011 ‫هياالز‬(٢٥٠٠‫وحدة‬/٢٠‫ضم‬‫م‬‫م‬)٢‫الجلد‬ ‫جحت‬‫ضم‬.. Solution Concentration 150 units / mL Compatible withD5W, D10W and NS. USES Prevention of tissue injury caus e by IV extravasation of drugs with hyperosmolarity or extreme pH (e.g. aminophylline, amphotericin B, calciu m, oxacillin, phenytoin, KCl, rifampicin, NaHCO3, vancomycin, TPN and concentrated IV solutions). Not indicated for treatment of extravas ations of vasoconstrictive agents (e.g. dopamine, epinephrine and norepinephrine). ADVERSEEFFECTS / PRECAUTIONS Not recommended for IV use.
  71. 71. Hydralazine Slowapresoline® 50 mg tab Apresoline® 20 mg vial IV: begin with 0.1 - 0.5 mg/kg/dose Q6-8h. Increase gradually as required to a maximum of 2 mg/kg/dose Q6h. PO: 0.25-1 mg/kg/dose Q6-8h, or approximately twice the required IV dose. Administer with foodto enhance absorption. Neofax2011 ً‫ي‬‫ز‬‫ـدرالا‬‫ي‬‫ه‬(٢٠‫مجم‬/٢٠‫م‬‫م‬‫ضم‬)...‫ضم‬‫وريد‬/٦-۸‫ضاعاث‬ Infusion solution concentration 1 mg/mL. Compatible with NS To prepare an oral suspension, crush a 50 mg tablet in 4 mL of 5% mannitol then add 46 mL ofsterile water to make a final concentration of 1 mg/mL. Stable for7 days refrigerated. Neofax2011 ً‫ي‬‫ز‬‫ـدرالا‬‫ي‬‫ه‬(٥٠‫مجم‬‫قزص‬+٤‫ل‬‫ماهِخو‬ ‫ضم‬٥٪+٤٦‫مقطز‬ ‫ماء‬ ‫ضم‬)...‫ضم‬ ‫بالفم‬‫الزضاعت‬ ‫مع‬/٦-۸‫ضاعاث‬ NOTE: use with ß-Blockers  the anti-hypertensive effect and  the magnitude of the reflex tachycardia. This is expected to reduce hydralazine requirements to < 0.15 mg/kg/dose. USES Mild to moderate hypertension. Afterload reduction in patients with CHF. MONITOR Heart rate and Blood pressure. Guaiac stools. Periodic CBC for long term use. ADVERSEEFFECTS / PRECAUTIONS Diarrhea, emesis. Temporary agranulocytosis. Tachycardia, postural hypotension, headache, nausea, and a lupus-like syndrome (10-20% of adults). GI irritation, bleeding, drug fever, rash, conjunctivitis, and bone marrow suppression (in adults, uncommon).
  72. 72. Hydrochlorothiazide Hydretic® 12.5 mg tab PO: 1-2 mg/kg/dose Q12h. Neofax2011 Admi nister with food(improves absorption). ‫يتك‬‫ر‬‫هيد‬(‫قزص‬٥.٢٢‫م‬‫جم‬/٥‫م‬‫م‬‫ضم‬)...‫ضم‬‫بالفم‬‫الرضاعة‬ ‫مع‬/٢٢‫ضاع‬‫ت‬ Solution concentration 2.5 mg/mL. Effects increased when used in combination with furosemide or spironolactone. USES Mild to moderate edema. Mild to moderate hypertension. May improve pulmonary function in patients with BPD. Hydrochlorothiazide  renal excretion of calcium, inhibits pancreatic release of insulin and displaces bilirubin from albumin. MONITOR Serum electrolytes, calcium, phosphorus and glucose. Urine output and blood pressure. Onset of action is within 1 hour. ADVERSEEFFECTS / PRECAUTIONS Hypokalemia and other electrolytes abnormalities. Hyperglycemia. Hyperuricemia. Contraindicated in patients with significant impairment of renal or hepatic function.
  73. 73. Hydroferrin® or Ferose® Iron Polymaltose Complex For growing PT infants: 2 mg/kg/day (max. 15 mg/day), begin after 2 weeks ofage. <1.000 kg birth weight:4 mg/kg/day. Ifreceiving erythropoietin: 6 mg/kg/day. In 1 or 2 doses, diluted in formula. ‫ـروز‬‫ـ‬‫ف‬‫شراب‬(٥٠‫مجم‬/٥‫ضم‬)...‫الزضاعت‬ ‫مع‬ ‫ضم‬/٢٤‫ـت‬‫ع‬‫ضا‬ ً‫ي‬‫ر‬‫هيدروفي‬‫هقط‬(٥٠‫مجم‬/‫ضم‬)...‫الزضاعت‬ ‫مع‬ ‫ـت‬‫ط‬‫هق‬/٢٤‫ـت‬‫ع‬‫ضا‬ Each Hydroferrin® drop contains 1.67 mg elemental iron. USES Iron supplementation for prevention and treatment of anemia. MONITOR Hemoglobinand reticulocytecounts during therapy Observe stools. Check for constipation. ADVERSE EFFECTS / PRECAUTIONS In growing PT infants, iron supplementation should not be started until adequate vitamin E is supplied in diet: otherwise iron may  hemolysis. Nausea, constipation, black stools, erosion of gastric mucosa. Lethargy. Hypotension.
  74. 74. Intravenous Immune Globulin GAMMARAAS® 5% (Human) Usual Dose: 500-750 mg/kg/dos e (over 2-6h). Ne ofax2011 In Neonatal Alloimmune Thrombocytopenia: 400 mg – 1 g/kg Most studies have used a single dose, although additional doses have been given at 24h interval. Regimen 0.01 – 0.02 mL/kg/min over 30 minutes then the rest of the amount over 1½ h. Rate/h in 1 st 30 min = 0.02 X Wt (kg) X 60 ...‫ضم‬‫ن‬ ‫اميىوجلوبلي‬(٠‫جم‬/٠١‫صم‬)‫عخين‬‫ضا‬ ‫مدى‬ ‫على‬‫ورٍد‬‫بمعدل‬...‫م‬‫ض‬/‫لطاعت‬‫ا‬‫ل‬‫أو‬ ‫في‬ ‫بمعدل‬ ‫ثم‬ ‫عت‬‫ضا‬ ‫هصف‬...‫ضم‬/‫ف‬‫وهص‬ ‫ضاعت‬ ‫خالل‬ ‫عت‬‫الطا‬ Available as 1g in 20 mL – 2.5 g in 50 mL – 5 g in 100 mL Compatible with D5 W and D15W. USES Adjuvant treatment of fulminant neonatal s epsis, hemolytic jaundice, neonatal alloimmune thrombocytopenia. Total IgG titers in treated, septic neonates remain elevated for ~10 days. MONITOR HR and BP. IV sites for phlebitis. ADVERSEEFFECTS / PRECAUTIONS Hypoglycemia (rare). Transient tachycardia and hypotension, resolved after stopping the infusion. The risk of NEC may be increased in term and late preterm infants treated for isoimmune hemolytic jaundice. Associated with renal dysfunction, ARF and osmotic nephrosis; use minimum concentration with minimum rate of infusion in patients predisposed to ARF.
  75. 75. Indomethacin Liometacen® 50 mg vial 1 Closure of PDA: as table IVI over at least 30 minutes. Usually 3 doses per course, maximum 2 courses. Give at 12-24h intervals with clos e monitor to UOP, if anuria or severe oliguria, delay subsequent dose. Longer treatment courses may be used: 0.2 mg/kg/24h for a total of 5-7 days. Ne ofax2011 Prevention of IVH: 0.1 mg/kg Q24h, 3 doses start at 6-12h of age. Neofax2011 ‫لي‬‫ومي‬‫ت‬‫اصين‬(٥٠‫مجم‬/٢٠٠‫ضم‬)...‫ورٍد‬ ‫ضم‬‫ضاعت‬ ‫هصف‬‫مدى‬ ‫على‬/٢٢-٢٤ ‫ضاعت‬‫ملدة‬٣‫أًام‬ Stable for 12d when stored at room temperature or refrigerated. Compatible with sterile water, D2.5W, D5W, NS, Lasix, insulin, KCl and NaHCO3. Incompatible with D7.5W, D10W, calcium gluconate, dobutamine and dopamine. Age at 1st dose 1st 2nd 3rd < 48 h 0.2 mg/kg 0.1 0.1 2 – 7 d 0.2 0.2 0.2 > 7 d 0.2 0.25 0.25 USES Closure of PDA. Prevention of IVH. MONITOR Urine output, s erum electrolytes, creatinine and BUN. Blood glucose. Assess murmur and pulse pressure. GI bleeding (guaiacing stools and gastric aspirate). Platelet count or prolonged bleeding from puncture sites.
  76. 76. Indomethacin Liometacen® 50 mg vial 2 ADVERSEEFFECTS If oliguria occurs, observe for hyponatremia and hypokalemia and consider prolonging the dosing interval of rreennaallllyy eexxccrreetteedd ddrruuggss. Consider withholding feedings. Hypoglycemia (avoided by  GIR by 2 mg/kg/min). Contraindicated in active bleeding, significant thrombocytopenia or coagulation defects, NEC and significantly impaired renal function. Avoid rapid infusion (< 5 min). GI perforation if used concurrently with steroids. INTERACTIONS WITH ACE Inhibitors: risk of renal impairment, also hypotensive effect antagoniz ed. Antibacterials: indometacin possibly  plasma concentration of amikacin and gentamicin in neonates; possible  risk of convulsions when given with quinolones. Antiepileptics: NSAIDs possibly  effects of phenytoin. Beta-blockers and Calcium-channel Blockers: NSAIDs antagoniz e hypotensive effect. Cardiac Glycosides: NSAIDs possibly  plasma concentration, possible exacerbation of heart failure and  of renal function. Corticosteroids: risk of GI bleeding and ulceration. Diazoxide: NSAIDs antagoniz e hypotensive effect. Diuretics: risk of nephrotoxicity of NSAIDs  by diuretics, also antagonism of diuretic effect; indometacin antagoniz es effects of diuretics;  risk of hyperkalemia when given with K + -sparing diuretics and aldosterone antagonists. Pentoxifylline: possible  risk of bleeding. NSAIDs antagonize hypotensive effect of hydralazine.
  77. 77. Inderal® or Mayestrotense® Propranolol 1 mg / mL 1 Hypertension and Tachyarrhythmias : Starting IV Dose: 0.01 mg/kg Q6h over 10 min. Increase as needed to max. 0.15 mg/kg/dose Q6h. Starting Oral Dose: 0.25 mg/kg/dose Q6h. Increase as needed to max. 3.5 mg/kg/dose Q6h. Neofax2011 Infantile Hemangiomas : MD: 2-3 mg/kg/day PO in 3 divided doses. Some recommends: starting dose of 0.3-1 mg/kg/day to assess tolerability and then increasing to 2 mg/kg/day incrementally over severaldays. Tapering periods have ranged from 2 weeks to 1 month. Neofax2011 ‫ـدرال‬‫ـ‬‫ه‬‫ا‬(٢‫جم‬‫م‬/٢‫م‬‫ض‬()٢‫ضم‬+٩‫م‬‫ض‬)...‫ور‬‫مدى‬ ‫على‬ ‫ٍد‬٢٠‫دقائق‬/٦‫ث‬ ‫ضاعا‬ IV solution concentration 0.1 mg/mL. Compatible with D5W and NS. ‫ـدرال‬‫ـ‬‫ه‬‫ا‬‫أقراص‬(٢٠‫مجم‬/٢٠‫ضم‬‫ما‬‫ء‬‫مقطز‬)...‫ب‬‫م‬‫لف‬‫ا‬/٦‫ث‬ ‫ضاعا‬ USE Tachyarrhythmias and hypertension. SVT especially if associated with Wolff-Parkinson-White syndrome. Palliation of TOF and HOCM. Adjuvant treatment of neonatal thyrotoxicosis. Infantile hemangiomas. MONITOR Continuous ECG monitor. Vital signs and systemic blood pressure. Blood glucose during initiation of treatment and after dosage changes. Assess for increased airway resistance. ADVERSE EFFECTS / PRECAUTIONS Hypotension, bradycardia, bronchospasm and hypoglycemia. For infants receiving propranolol, regular, frequent food intake (Q3-4h) is an important consideration with regards to risk for hypoglycemia. Contraindicated in patients with cardiogenic shock, sinus bradycardia greater than 1 st degree block, reactive airway disease or diminished myocardial contractility. A withdrawal syndrome (nervousness, tachycardia, sweating, hypertension) with sudden cessation of the drug.
  78. 78. Inderal® or Mayestrotense® Propranolol 1 mg / mL 2 INTERACTIONS Cardiac Glycosides:  risk of AV block and bradycardia. Hypotensive effect of beta-blockers antagonized by corticosteroids. Diazoxide: enhances hypotensive effect. Diuretics: enhances hypotensive effect. Thyroid Hormones: metabolism of propranolol is accelerated. Hydralazine: enhances hypotensive effect.
  79. 79. Human Insulin, Short-acting Actrapid® 100 Units / mL 1 Continuous IVI: 0.01-0.1 unit/kg/h. Intermittent SC dose: 0.1-0.2 unit/kg Q6-12h. Ne ofax2011 For hyperkalemia: initial IVI dextrose (0.5 g/kg/h) and regular insulin (0.1-0.2 u/kg/h). D extrose and insulin dosages are adjusted based on s erum glucose and potassium concentration. Ne ofax2011 For hyperkalemia: begin with a bolus of insulin (0.05 u/kg) with 2 mL/kg of D10W followed by IVI of D10W at 2-4 mL/kg/h and regular insulin (0.1 u/mL) at 1 mL/kg/h. The two solutions may be prepared individually to allow adjustments in infusion rate in response to hyper- or hypoglycemia. MNC2012 To  absorption of insulin to IV solution bag or tubing, flush the line with solution, wait 20-30 min then flush the line again with solution prior to initiation. The actual amount of insulin being administrated could be less than the apparent amount. So, adjustment of the insulin rate should be based on the effect and not solely on the apparent insulin dose. Gome lla2009 andNe ofax2011 ‫ـرابيد‬‫ـ‬‫ت‬‫اك‬(‫مائي‬ ‫ولين‬‫اوض‬)(٥‫بطزهجت‬ ‫غزطاث‬٢٠٠+٥٠‫ج‬ ‫ضم‬٥٪)‫من‬ ‫لخخلص‬‫ا‬ ‫وٍخم‬٢٥‫م‬‫ض‬ ‫قبل‬ ‫الورٍد‬‫جهاس‬ ‫خالل‬ ‫من‬‫ال‬‫بد‬‫ء‬‫مدى‬ ‫على‬ ‫ٌعطى‬ ‫ثم‬٢٤‫بمعدل‬ ‫عت‬‫ضا‬...‫ضم‬/‫ـت‬‫ع‬‫ـا‬‫ط‬‫ل‬‫ا‬ Infusion solution concentration 0.1 u/mL. Maximum solution concentration 1 u/mL. Compatible with D5W, D10W, NS, dobutamine, heparin, midazolam, milrinone, KCl and NaHCO3. Incompatible with dopamine. ‫ـرابيد‬‫ـ‬‫ت‬‫اك‬(‫مائي‬ ‫اوضولين‬)(٢٠‫بطزهجت‬ ‫زطاث‬ ‫غ‬‫ين‬‫وطول‬‫ا‬٢٠٠+٢٠‫مقطز‬ ‫ماء‬ ‫ضم‬)...‫غزطت‬ ‫أوطولين‬ ‫بطزهجت‬٢٠٠‫كل‬ ‫الجلد‬ ‫جحت‬...‫ضاعت‬ SC solution concentration 0.5 - 1 u/mL DW or NS. Neofax2011
  80. 80. Human Insulin, Short-acting Actrapid® 100 Units / mL 2 USES Hyperglyce mic infants with persistent glucose intolerance : - Glucose > 250 mg/dL despite  GIR by 2 mg/kg/min Q4-6h. - Prolonged restriction of IV glucos e with  required calories. Routine use in VLBW to promote growth in nnoott warranted. Adjuvant therapy for hyperkalemia. MONITOR Blood glucose concentration Q15-30 minutes after starting infusion and after changes in infusion rate. ADVERSEEFFECTS / PRECAUTIONS Hypoglycemia. Insulin resistance. Euglycemic hyperinsulinemia due to exogenous insulin administration may caus e metabolic acidosis.  Glucose level gradually to avoid rapid fluid shifts.
  81. 81. Kayexalate® Sodium Polystyrene Sulfonate DOSE: 1 g/kg/dose PO Q6h via NGT or PR Q2-6h ‫كل‬ ‫شرجية‬ ‫حقىة‬ ‫كايكضاالت‬٦‫صاعات‬ For PO use: Dilute in 3-4 mL fluid per g of resin; 10% sorbitol, water, or syrup may be usedas diluent. For PR use: Dilute in water or 25% sorbitol at a concentration of 0.3-0.5 g/mL; retain enema for at least 30-60 min orseveral hours ifpossible The Na+ content is ~100mg/g (4.1 mEq/g) ofthe drug Also available as Sorbisterit® (calcium polystyrene sulfonate) USES Treatment ofhyperkalemia ADVERSE EFFECTS Hypokalemia Sodium retension Hypocalcemia and hypomagnesemia Fecal impaction
  82. 82. Klacid® Clarithromycin 250 mg / 5 mL Dose: 7.5 mg/kg/dose PO Q12h. BNFC2011-12 ‫اب‬‫ر‬‫ش‬ ‫كالصيد‬(٢٥٠‫مجم‬/٥‫ضم‬)...‫ضم‬/٢٢‫ضاعت‬ Solution concentration 50 mg/mL. USES Clarithromycin acts like erythromycin and has a similar spectrum of antibacterial activity i.e. mainly against G+ve organisms, although it is usefully more active against Haemophilus influenzae. It’s used for respiratory tract infections including atypical pneumonias and soft tissue infections. ADVERSE EFFECTS Macrolides are enzyme inhibitors and interfere with the metabolic inactivation of some drugs, e.g. theophylline, increasing their effects.
  83. 83. Konakion® Vitamin K1 10 mg / ml Prophylaxis at birth: 0.5 - 1 mg IM (0.05-0.1 mL). PT < 32 wk (> 1 kg): 0.5 mg IM (0.05 mL). PT < 32 wk (< 1 kg): 0.3 mg IM (0.03 mL). Severe hemorrhagic disease: 1-10 mg IV slow push. Ne ofax2011 ‫ن‬‫هاكيو‬‫و‬‫ك‬(٢٠‫مجم‬/٢‫ضم‬)٥–٢٠‫لين‬‫و‬‫اوط‬ ‫هجت‬‫ز‬‫بط‬‫غزطاث‬٢٠٠‫عضل‬ ‫ن‬‫هاكيو‬‫و‬‫ك‬(٢٠‫مجم‬/٢‫ضم‬()٢‫ضم‬+٩‫ضم‬)٢‫ضم‬‫وريد‬‫ببطء‬‫اضبوعُا‬ ‫جين‬‫ز‬‫م‬ IV infusion rate should not exceed 1 mg/min. Protect from light. Compatible with D5 W, D10W and NS. USES Prophylaxis and therapy of hheemmoorrrrhhaaggiicc ddiisseeaassee ooff nneewwbboorrnn. HHyyppoopprrootthhrroommbbiinneemmiiaa; s econdary to factors limiting absorption or synthesis of vitamin K1. IInnffaannttss rreecceeiivviinngg TTPPNN aanndd iinnffaannttss rreecceeiivviinngg aannttiibbiioottiiccss ffoorr >> 22 wweeeekkss should be given at least 0.5 mg of vitamin K1 (IM or IV) weekly to prevent vitamin K depletion. MONITOR PT (when treating clotting abnormalities) after 2-4 h. ADVERSEEFFECTS Pain and swelling at IM site. Efficacy is decreased in liver disease. Ineffective in hereditary hypoprothrombinemia or hypoprothrombinemia caused by s evere liver disease. MNC2012 Vitamin K1 may require 3h or more to stop active bleeding so FFP (10 mL/kg) may be necessary when bleeding is severe. The drug has no antagonistic effects against heparin.
  84. 84. L-Carnitine® (300 mg / ml Oral Liquid) or (1 g / 5 ml IV) IV (included in TPN): Gomella2009 Starting dose of 10 mg/kg/day PO: 25 mg/kg/dose Q6h. Primary deficiency and organic acidemias: BNFC2011-12 PO: 50 mg/kg Q12h, higher doses up to 200 mg/kg daily occasionally required. IVI: initially 100 mg/kg over 30 minutes followed by a continuous infusion of4 mg/kg/h. Slow IV injection over 2–3 minutes: 100 mg/kg/daily in 2–4 divided doses USES L-Carnitine is used in the management ofa range of rare genetic conditions associated with carnitine deficiency. It is essential for the entry of long-chain fatty acids into the mitochondria, where theyare oxidized. ADVERSE EFFECTS Nausea, vomiting, abdominal painand diarrhea. Fishy body odour Side-effects may be dose-related - monitor tolerance during first week andafter any dose increase.
  85. 85. Lanoxin® Digoxin 500 μg / 2 mL 1 LD “Digitalization”: Generally used only when treating arrhythmias and acute CHF. Give over 24h as 3 divided doses IV slow push over 5-10 min. Oral Doses: should be 25% greater than IV doses. Don’t administer IM Ne ofax2011 ‫الهوكضين‬(٥٠٠‫ام‬‫ز‬‫مُكزوج‬/٢‫ضم‬( )٢‫ضم‬+٤‫ضم‬)...‫الى‬ ‫َطخكمل‬‫و‬( ....٤‫أضعاف‬ ‫ج‬ ‫الجزعت‬ ‫كمُت‬٥٪)‫َعطى‬‫و‬‫ور‬‫يد‬‫غدًد‬ ‫ببطء‬/…‫ت‬‫ـ‬‫ع‬‫ضا‬ Infusion solution concentration 0.05 mg/mL. ‫شراب‬ ‫الهوكضين‬(٥٠‫مُكزوجزام‬/٢‫ضم‬)...‫ين‬‫وطول‬‫ا‬ ‫بطزهجت‬ ‫غزطت‬٢٠٠‫م‬‫بالف‬/…‫ـت‬‫ع‬‫ـا‬‫ض‬ Total Loading Dose Maintenance Doses PMA wks IV μg/kg PO μg/kg PMA wks IV μg/kg PO μg/kg Interval hours ≤ 29 15 20 ≤ 29 4 5 24 30-36 20 25 30-36 5 6 24 37-48 30 40 37-48 4 5 12 ≥ 49 40 50 ≥ 49 5 6 12 Divide into 3 doses over24h Titrate based on clinical response USES Heart failure caus ed by diminished myocardial contractility. SVT, atrial flutter and AF. MONITOR HR, Rhythm and Periodic ECG (to assess desired effects and signs of toxicity). Serum K + , Ca, Mg (esp. with diuretics or amphotericin B); K + , Ca, Mg predispose to toxicity. Renal function. TThheerraappeeuuttiicc sseerruumm lleevveell (1-2 ng/mL). Be aware of drug interactions.
  86. 86. Lanoxin® Digoxin 500 μg / 2 mL 2 ADVERSEEFFECTS / PRECAUTIONS Toxic Cardiac Effects: - PR interval prolongation. - Atrial or nodal ectopic beats. - Sinus bradycardia or SAblock. - Ventricular arrhythmias. Non ToxicCardiac Effects: - QTc interval shortening. - T-wave amplitude dampening - ST segment sagging. - HRslowing. Feeding intolerance, vomiting anddiarrhea. Lethargy. INTERACTIONS ACE Inhibitors: plasma concentration possibly  by captopril. Analgesics: plasma concentration possibly  by NSAIDs, also possible exacerbation of heart failure and reduction of renal function. Antibacterials: plasma concentration possibly  by gentamicin and trimethoprim; plasma concentration possibly  by rifampicin; plasma concentration  by macrolides ( risk of toxicity). Antiepileptics: plasma concentration possibly  by phenytoin. Amphotericin:  cardiac toxicity if hypokalemia occurs. Corticosteroids:  risk of hypokalemia. Diuretics:  cardiac toxicity if hypokalemia occurs with acetazolamide, loop diuretics or thiazides and related diuretics; plasma concentration  by spironolactone.