Analgesics/Antipyretics

Paracetamol (Acetaminophen)

• Dose: Every 6 hours (4 doses in 24 hours).
  
  • 2 months–3 years: 125 mg.
  • 3-5 years: 250 mg.
• Class: Analgesic and antipyretic.
• Mechanism of Action: Inhibits prostaglandin synthesis, reducing pain and fever.
• Indications: Relief of mild to moderate pain, and fever reduction.
• Indications:
  
  1. Fever management
  2. Pain relief (e.g., headache, toothache)
  3. Post-immunization fever
  4. Musculoskeletal pain (mild to moderate)
  5. Management of pain in children post-surgery
  6. Fever due to infections
  7. Rheumatic disease pain
• Contraindications:
  
  1. Severe liver dysfunction
  2. Known hypersensitivity to paracetamol
  3. Active liver disease
  4. Caution in patients with chronic alcohol use
• Nursing Considerations:
  
  • Monitor for signs of overdose (e.g., nausea, vomiting).
  • Educate caregivers on dosage based on weight.
  • Assess liver function in patients with prolonged use.
  • Reinforce the importance of not exceeding the recommended dose.
• Pharmacokinetics: Absorbed from the small intestine, metabolized in the liver.
• Adverse Effects: Hepatotoxicity in overdose, rash, nausea.

Ibuprofen

• Dose: 5-10 mg/kg every 6-8 hours (max 40 mg/kg/day).
• Class: Non-steroidal anti-inflammatory drug (NSAID).
• Mechanism of Action: Inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis, thereby alleviating pain, inflammation, and fever.
• Indications: Management of pain, fever, and inflammation in children, particularly for conditions like juvenile idiopathic arthritis or post-vaccination fever.
• Indications:
  
  1. Fever reduction
  2. Mild to moderate pain (e.g., teething pain, earache)
  3. Inflammatory conditions (e.g., juvenile arthritis)
  4. Musculoskeletal injuries (sprains, strains)
  5. Post-surgical pain management
  6. Dysmenorrhea (in older children)
  7. Headaches and migraines
• Contraindications:
  
  1. Hypersensitivity to ibuprofen or other NSAIDs
  2. Active gastrointestinal bleeding or ulceration
  3. Severe renal impairment
  4. History of asthma exacerbated by NSAIDs
  5. Infants under 6 months (unless prescribed)
  6. Concurrent use with other NSAIDs or anticoagulants
• Nursing Considerations:
  
  • Monitor for gastrointestinal symptoms (e.g., abdominal pain, black stools).
  • Administer with food to minimize gastric irritation.
  • Assess renal function in prolonged use.
  • Educate on hydration and watching for signs of bleeding.
• Pharmacokinetics: Well absorbed orally, metabolized in the liver, excreted via kidneys.
• Adverse Effects: Gastrointestinal upset (nausea, dyspepsia), renal impairment, rash, headache.

Anticonvulsants/Antiepileptics

Diazepam

• Class: Benzodiazepine.
• Pediatric Dose: 0.5 mg/kg (rectal).
• Mechanism of Action: Diazepam acts on the gamma-aminobutyric acid (GABA) receptors, enhancing inhibitory neurotransmission, which results in sedation, muscle relaxation, and anti-convulsant effects.
• Indications in Pediatrics: Used for febrile seizures, status epilepticus, and acute anxiety disorders in children.
• Indications:
  
  1. Management of anxiety disorders
  2. Treatment of muscle spasm (e.g., from cerebral palsy)
  3. Control of seizures (status epilepticus)
  4. Sedation for medical procedures (preoperative sedation)
  5. Management of acute alcohol withdrawal symptoms
  6. Treatment of hyperactivity in specific cases
  7. Treatment of insomnia in short-term use
  8. Management of panic attacks
• Contraindications:
  
  1. Hypersensitivity to benzodiazepines
  2. Severe respiratory insufficiency (e.g., sleep apnea)
  3. Acute narrow-angle glaucoma
  4. Myasthenia gravis
  5. Pregnancy (especially during the first trimester)
  6. Lactation (not recommended in breastfeeding mothers)
  7. Children under six months of age (unless in severe cases)
• Nursing Considerations:
  
  • Monitor vital signs (respiration, heart rate) closely during treatment.
  • Assess for sedation levels and degree of muscle relaxation.
  • Educate families about the potential for dependence and withdrawal symptoms.
  • Administer the drug slowly intravenously (if applicable) to prevent hypotension.
• Side Effects: Sedation, dizziness, hypotension, and respiratory depression. In children, excessive drowsiness and ataxia can occur.

Phenobarbital

• Dose: 3-5 mg/kg/day oral/IV (loading 20 mg/kg for status epilepticus).
• Class: Barbiturate.
• Mechanism of Action: Enhances GABA-mediated inhibition, prolongs chloride channel opening.
• Indications: Neonatal seizures, febrile convulsions, status epilepticus.
• Indications:
  
  1. Control of seizures (e.g., neonatal seizures)
  2. Management of status epilepticus
  3. Treatment of febrile seizures
  4. Sedation in certain medical procedures
  5. Management of insomnia (short-term)
  6. Prevention of seizures in high-risk neonates
  7. Management of withdrawal syndromes
• Contraindications:
  
  1. Hypersensitivity to barbiturates
  2. Severe liver dysfunction
  3. Porphyria
  4. Respiratory depression
  5. Pregnancy (risk of fetal harm)
• Nursing Considerations:
  
  • Monitor respiratory rate and sedation levels.
  • Assess liver function tests periodically.
  • Educate on potential cognitive effects with long-term use.
  • Taper dose gradually to avoid withdrawal seizures.
• Pharmacokinetics: Long half-life (up to 100 hrs in neonates), metabolized in liver.
• Adverse Effects: Sedation, cognitive impairment, respiratory depression, hyperactivity (paradoxical).

Respiratory Drugs

Salbutamol (Albuterol)

• Dose:
  
  • Inhaler: 100–200 mcg (1–2 puffs) every 4–6 hrs.
  • Nebulizer: 2.5 mg every 4–6 hrs.
  • Oral: 2–4 mg 6–8 hourly.
• Class: Beta-2 adrenergic agonist (short-acting).
• Mechanism of Action: Relaxes bronchial smooth muscle via beta-2 receptors.
• Indications: Asthma exacerbations, bronchiolitis, croup.
• Indications:
  
  1. Acute asthma exacerbations
  2. Bronchiolitis
  3. Croup (laryngotracheobronchitis)
  4. Wheezing due to respiratory infections
  5. Exercise-induced bronchoconstriction
  6. Chronic obstructive pulmonary disease (COPD) in older children
  7. Allergic reactions with bronchospasm
• Contraindications:
  
  1. Hypersensitivity to salbutamol
  2. Uncontrolled tachyarrhythmias
  3. Caution in hyperthyroidism
  4. Severe cardiovascular disorders
• Nursing Considerations:
  
  • Monitor heart rate and respiratory function.
  • Teach proper inhaler/nebulizer technique.
  • Assess for tremor or palpitations.
  • Rinse mouth after inhalation to prevent thrush.
• Pharmacokinetics: Rapid onset (5–15 min inhaler), duration 4–6 hrs.
• Adverse Effects: Tremor, tachycardia, hypokalemia, hyperactivity.

Vitamins and Minerals

Vitamin A

• Dose:
  
  • Supplementation: 100,000 IU at 6 months, 200,000 IU every 6 months (9–59 months).
• Class: Fat-soluble vitamin.
• Mechanism of Action: Essential for vision, immune function, epithelial integrity.
• Indications: Prevention/treatment of vitamin A deficiency, measles complications.
• Indications:
  
  1. Prevention of vitamin A deficiency
  2. Treatment of xerophthalmia
  3. Measles prophylaxis
  4. Malnutrition support
  5. Immunocompromised children
  6. High-risk populations (e.g., refugees)
  7. Support in respiratory infections
• Contraindications:
  
  1. Hypervitaminosis A
  2. Known hypersensitivity
  3. Caution in liver disease
  4. Pregnancy (high doses)
• Nursing Considerations:
  
  • Administer with fatty meal for absorption.
  • Monitor for signs of toxicity (headache, nausea).
  • Educate on dietary sources (carrots, liver).
• Pharmacokinetics: Stored in liver, fat-soluble.
• Adverse Effects: Toxicity: hypercalcemia, hepatotoxicity.

Zinc Sulfate

• Dose: 20 mg elemental zinc daily for 10–14 days (diarrhea treatment).
• Class: Mineral supplement.
• Mechanism of Action: Supports immune function, enzyme activity, wound healing.
• Indications: Acute diarrhea (reduces duration/severity), malnutrition.
• Indications:
  
  1. Treatment of acute diarrhea
  2. Prevention of diarrhea in malnourished children
  3. Wound healing
  4. Immune support in infections
  5. Growth retardation in deficiency
  6. Acrodermatitis enteropathica
  7. Supplementation in sickle cell disease
• Contraindications:
  
  1. Known hypersensitivity
  2. Copper deficiency (zinc interferes)
  3. Caution in renal impairment
• Nursing Considerations:
  
  • Give with ORS for diarrhea.
  • Monitor for nausea; take with food.
  • Assess growth parameters.
• Pharmacokinetics: Absorbed in small intestine.
• Adverse Effects: Nausea, vomiting, abdominal pain.

Other Therapeutics

Oral Rehydration Salts (ORS)

• Dose: 75 mL/kg in first 4 hrs, then 5 mL/kg after each loose stool.
• Class: Electrolyte replacement.
• Mechanism of Action: Rehydrates by glucose-sodium co-transport in gut.
• Indications: Dehydration from diarrhea, vomiting.
• Indications:
  
  1. Mild to moderate dehydration
  2. Gastroenteritis
  3. Heat-related dehydration
  4. Post-surgical fluid replacement
  5. Maintenance in chronic conditions
• Contraindications:
  
  1. Severe dehydration (IV preferred)
  2. Unconsciousness
• Nursing Considerations:
  
  • Teach mixing (1 sachet/liter boiled water).
  • Monitor intake/output.
• Adverse Effects: None if used correctly; hypernatremia if overconcentrated.

Adrenaline (Epinephrine)

• Dose: 0.01 mg/kg IM (anaphylaxis).
• Class: Adrenergic agonist.
• Mechanism of Action: Alpha/beta stimulation → vasoconstriction, bronchodilation.
• Indications: Anaphylaxis, cardiac arrest.
• Indications:
  
  1. Anaphylaxis
  2. Cardiac arrest
  3. Severe asthma exacerbations
  4. Croup (nebulized)
  5. Hypotension in shock
• Contraindications:
  
  1. None in emergencies
  2. Caution in hypertension
• Nursing Considerations:
  
  • Use EpiPen if available.
  • Monitor HR, BP.
• Adverse Effects: Tachycardia, anxiety, hypertension.