5. ??????????????????? ???? G6PD def. ?????? hemolysis ????????????? sulfa

1
??????????????

• ??.????? ????????

2
??????????????????

• 1. ?????????????????????????? ????????????????????
  ?
• 2. ???????????????????????????????????????????????
  ????? ??????????????????????? ???????????????
  ??????????????????
• 3. ????????????????????????????????
  ????????????????????????????

3
??????????????????

• 4. ???????????? ?????????? ???????????????????
• 5. ??????????????????? ???? G6PD def. ??????
  hemolysis ????????????? sulfa
• 6. ???????????????????????????? drug-drug
  interaction
• 7. ??????????? ????????????????????????????????
  3 ???? ??????????????????????????????????? 3
  ???????? ????????????????????????????????

4
??????????????????

• 8.??????????????????????????????????????? ??????
  liquid gt suspension gt capsule gt tablet gt
  sustained release tablet
• 9. ???????????????????????????????????????????????
  ???????????????????????????

5
??????????????????

• ?????????????????? ?????????? ( maximal dose)
  ???????????????????????????????????
  ??????????????????????????????????????????????????
  ??
• ?????????????????? ??????????? ??????? ideal body
  weight ???? weight for height ??????? ??????????
  ???????????????????????????????
• ????????????????????????????????????
  ????????????????????????????????????

6
Metric system

• 5 ml 1 teaspoon (tsp.)
• 15 ml 1 tablespoon (table sp.)
• 30 ml 1 ounce 1 grain ( gr.1) 60 mg.
• Intervals
• OD ?????????? bid ????? 2 ?????
• tid ????? 3 ????? qid ????? 4 ?????

7
??????????????????

• ???????
• ????????? ( ac )
• 1 ??????? ?????????? Penicillin
• 30 ???? ???????????? ??????????
• ????????? ( pc )
• ?????? 15-30 ????
• ?????????????? Steroid , NSAIDS , Aspirin
  ??????????? ????????? 1 ?? . ????????????? 2 ?? .
  

8
Emergency medication

• Epinephrine
• ??? IV 0.01 mg/kg/dose or 0.1 ml/kg/dose (1
  10,000)
• ??? ETT 0.1 mg/kg/dose or 0.1 ml/kg/dose (1
  1,000) ???????? 5-10 ???? ???????????? arrythmia
  ,tachycardia, hypertension headache,
  nausea/voitting ???

9
Respiratory drugs

• ???????????????????????? ???????? 6 ?????
• 1. antihistamine
• 2. decongestants
• 3. expectorants
• 4. mucolytics mucoregulators
• 5. bronchodilators anti-inflammatory agents
• 6. cough suppressants

10
?????????????????

• . ??????????????????????? ????????????????????????
  ?????????????????????????????????????????????????
  ?????? ?????????????????????????
  ?????????????????????????????????????????????

11
Antihistamines

• ?????????? anticholinergic effect ??????????
  ?????????? secretion ??????????????
• ??????????????????? lt 3 ????? ????????????????????
  ? 2 nd 3 rd generation eg. Cetirizine,
  loratadine
• ????????????????????????????? ?????????? allergic
  rhinitis

12
Antihistamines

• Chlorpheniramine (CPM) 0.35 mg/kg/day PO tid-qid
  4 mg/tab. , 2 mg/5 ml Diphenhydramine-HCL 5
  mg/kg/day PO tid-qid (MAX. 300 mg/day)
• Benadryl cough syrup 12.5 mg/5 ml , 25 mg/cap
  Benadryl-decongestant ?? pseudoephedrine 30 mg/5
  ml

13
. Long acting antihistamines

• Ceterizine 0.25 mg/kg/day PO OD-bid Age 2-6 yr
  2.5 mg bid or 5 mg OD
• Age gt 6 yr 5-10 mg OD Zyrtec 10 mg/tab , 5 mg/5
  ml syrup
• SE ??????? ??????? ??????
• Loratadine ????????????? gt 2 ?? BW lt 30 kg 5 mg
  PO OD BW 30 kg 10 mg PO OD
• Clarityne, lorsedin 10mg/tab, 5 mg/5 ml syrup SE
  ??????? ?????? Prolong QT ????????????????
  erythromycin, keto/itraconazole

14
Decongestants

• ????????????????????????????????????????????????
  ?????????? adrenergic effect ??????????????????
  ??????????????????? lt 3 ????? ???????????????????
  ???????????????? 3-5 ??? ?????????????? rebound
  congestion ???
• 0.25 Ephedrine ??????????????? ????? 2-4 ?????
  ???????????????? 3-5 ??? gtgtgt rhinitis
  medicamentosa

15
Expectorants ( ?????????? )

• ??????????????????????? ?????????????
• Glyceryl guaiacolate (guaifeesine) 50-100 mg/dose
  PO tid-qid Robitussin syr. 100 mg/5 ml
  Therapeutic toxic range ??????????
  ????????????????????????
• Ammonium carbonate potassium nitrate 5-10 ml PO
  tid-qid M.tussis ?????????????????? ??????????)
  ???????????????????? ???????????????????

16
. Mucolytics ( ???????????? )

• ???????????????????????????????????
  ??????????????????????????????????????????????????
  ???????????????????????????????????? expectorant
  ???????? Acetylcysteine, carbocysteine,
  bromhexine, ambroxal
• Bromhexine
• Age lt 2 yr 1 mg , 2-5 yr 2 mg
• Age 5-10 yr 4 mg , gt 10 yr 8 mg Bisolvon 8
  mg/tab

17
Cough suppressants

• ??????????? ??????????????????????????????
  ???????????????????? ?????????????????????????????
  ? ??????????????????????????????????????????
  ?????????????????????????????????????
• Codeine Ropect SE ??????? , ???????
  ????????????????????????????????????????????
  ???????????????? Dextromethorphan Romilar SE
  ??????? , ???????? ??????? , ????????????????

18
. GI drugs

• Antiemetic drug
• Domperidone (motilium) 0.2-0.5mg/kg/dose PO
  tid-qid ac 5 mg/5 ml syr, 10 mg/tab SE ???????
  , ?????????? , extrapyramidal symptom
• Antispasmodic drug
• Hyoscine (buscopan) Age lt 1 yr 2.5 mg/dose,
  1-6 yr 5-10 mg/dose Age gt 6 yr 10-20 mg/dose
  PO tid-qid 0.3-0.6 mg/kg/dose IV,IM q 6-8 hr
  5mg/5ml syrup, 10 mg/tab, 20 mg/ml/amp SE
  ??????? , ?????? , ???????

19
???????????????? ( ORS )

• ??????????? 2 ?? ??? ORS 50 100 ????????? (1/4
  1/2 ??????? ) ????????????????????? 1 ??????
  ??? 1 2 ????
• ???? 2 ?? 10 ?? ??? ORS 100 200 ?????????
  (1/2 1 ??????? ) ???????????????????????????
  ?????
• ???? 10 ???????? ????????????? ??????????? 1
  ??????????

20
. GI drugs

• Antacid Aluminum hydroxide magnesium hydroxide
  (Alum milk)
• ???????? 5-15 ml/dose ?????? 15-45 ml/dose
  PO q 3-6 hr ????????????????????
  ????????????????????????????????????? 1-2 hr
• H2 receptor antagonist (Ranitidine)
• 3-5 mg/kg/day PO bid ( max. 300 mg/day)
  0.75-1.5 mg/kg/dose IV q 6-8 hr (max. 400mg/day)
• SE neutropenia, bradycardia, dizziness,
  headache, vomiting, diarrhea, constipation,
  pancreatitis, hepatitis, rash

21
???????

• Magnesium hydroxide Milk of magnesium
• Age lt 2 yr 0.5 ml/kg/day,
• 2-5 yr 5-15 ml/day
• 6-12 yr 15-30 ml/day, gt 12 yr 30-60 ml/day PO
  OD-bid SE ??????? , hypermagnesemia in renal
  failure

22
Skin drugs

• Antihistamine antipruritic Hydroxyzine (atarax)
  1-2 mg/kg/day PO tid-qid 10 mg/tab, 10 mg/5 ml SE
  ???????
• Soothing agent Calamine lotion Calamine Zinc
  oxideTalcum Apply OD- bid ????????
• Oral antifungal 0.5 Gentian violet Apply lesion
  bid Nystatin 1 ml water 2 ml PO tid qid
• Topical antiparasite 12.5 benzyl benzoate
  Scabies apply for 24 hr 3 days then repeat 3
  days later 3 days Lice apply hair for 8 hr
  then repeat 1 wk later

23
Topical corticosteroids

• Mid strength 0.1 Triamcinolone acetonide mild
  0.02 Triamcinolone acetonide
• 1. ??????????????????????
• 2. ??????????????? 1-2 ????? ??????????
  ???????????????????????????????
• 3. ???????????????????????????????????????
• 4. ???????????????????????????????????????????????
  ???????????????????? ?????????????????????
  ???????

24
Antimicrobial agents

• Aminopenicillin Amoxicillin
• 30-50 mg/kg/day PO bid-tid 250-500 mg/cap,
  125,250 mg/5 ml Rx URI, sinusitis, pneumonia,
  animal bite
• Antistaphylococcal penicillin
• Cloxacillin 50-200 mg/kg/day IV q 6 hr, PO qid ac
  0.5, 1 g inj., 250,500 mg/cap, 125mg/5 ml syrup
  Dicloxacillin 25-50 mg/kg/day PO qid ac 250
  mg/cap, 62.5 mg/5 ml syrup Rx skin soft
  tissue infection

25
Antimicrobial agents

• Macrolides Erythromycin
• 30-50 mg/kg/day PO tid-qid pc SE N/V, diarrhea,
  abdominal cramping Roxithromycin (Rulid) 6-10
  mg/kg/day PO bid Rx URI,pneumonia/atypical
  pneumonia, enteric fever
• Sulfonamides Co-trimoxazole (TMP-SMZ)
• 6-12 mg/kg/day PO bid 80 mg TMP/tab, 40 mg TMP/5
  ml SE rash, Stevens-Johnson syndrome ????????
  G6PD def., ????? sulfa Rx UTI, infectious
  diarrhea

26

• Fluoroquinolones Norfloxacin
• 15-20 mg/kg/day PO bid 100,200,400 mg/tab
  Ofloxacin 10-20 mg/kg/day PO bid 100,200,300
  mg/tab Rx UTI, infectious diarrhea
• ??????? ?????? Paracetamol (acetaminophen)
• 10-15 mg/kg/dose PO q 4-6 hr 120 mg/5 ml syr,
  325,500 mg/tab ????????????

27
????????????? ??????????????????

• 1. ??????????????????? ???????????????????????????
  ?????????????? ????????????????
• 2. ????????????????????????????????????????????
  ?????????????????????????????
• 3. ???????????????????????????????????????????????
  ???????????????
• 4. ????????????????????????????????????????????
• 5. ????????????????????????

28
THANK YOU FOR YOUR ATTENTION