Naked Science Forum
Life Sciences => Physiology & Medicine => Topic started by: pharmacist2030 on 26/06/2015 10:17:44
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I would like to ask GPs and practitioners, if it is possible to prescribe Dexamethasone nasal spray for a year and half old girl? The case that she had a high fever around 39 degrees and she experienced difficulty in breathing with cough. The doctors prescribed her a low dose nasal spray cortisone. My question is that is it possible to prescribe a one year old and half a cortisone? I look forward to hearing from you.
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I'm just a country nurse, but Dexamethasone is some powerful. er, "stuff" to use on an 18 month old kid. Unless the babe is turning blue, it raises serious concerns in my mind.
So I went to "Intranasal Steroids for Children With Allergic Rhinitis" (1.) and I found these dosing recommendations for kids on page 11. Please notice that there are a number of steroids but NO mention of Dexamethasone AND <<no>> mention of dosing a kid under 3 -- whereas this child is 18 months.
What I would do (If sweet reason and your professional cred fails) is write a letter to the doc and tell him this in the queen's English. If the doc thinks you might go over his head -- that's baseball. Your name may become mud, but it's a little kid. What alternative do you have?
Beclomethasone (Beconase ® or Beconase AQ ® )
Children 6-12 years: 1 spray (42 mcg) in each nostril twice daily
Adults: 1-2 sprays in each nostril twice daily
Budesonide (Rhinocort ® or Rhinocort Aqua ® )
Adults and children > 6 years: 2 sprays (32 mcg/spray) in each nostril twice daily or 4 sprays in each nostril once daily
Flunisolide (Nasalide ® or Nasarel ® )
Children 6-14 years: 1 spray (25 mcg) in each nostril three times daily
Adults: 1 spray in each nostril three times daily or 2 sprays in each nostril twice daily
Fluticasone (Flonase ® )
Children 4-12 years: 1 spray (50 mcg) in each nostril once daily
Adults: 2 sprays in each nostril once daily
Mometasone (Nasonex ® )
Children 3-12 years: 1 spray (50 mcg) in each nostril once daily
Adults: 2 sprays in each nostril once daily
Triamcinolone (Nasacort ® or Nasacort AQ ® )
Children 6-12 years: 1 spray (55 mcg) in each nostril once daily
Adults: 2 sprays in each nostril once daily
(1.) http://www.medscape.com/viewarticle/403370_9
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Thanks a lot Pecos for this piece of information. I am a pharmacist working in Kuwait, some doctors here are non-professional who work in the governmental hospitals, many of them are freshly graduated. I am concerned about doctors who prescribe Cortisone and Antibiotics, they are being prescribed all the time but when they are prescribed to pedriatrics who are less than 5 years old, I feel a shiver on my neck. The main problem that you can't get in touch with doctors here to get a feedback from them,it is not the same as the UK I believe. Therefore, I don't know what to do whether I don't prescribe the medicine or refer them to another doctor to make sure of the prescription. I looked up the British national formulary but I didn't find any type of cortisone given to children less than 3 years old but sometimes I say that these doctors might be more experienced and they know what they are doing but when it comes to cortisone, I have to be really careful because of its side effects.
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I once applied to work in Saudi, but was eventually refused because of my hypertension. They were offering a tres, gross pile of tax free money and the prospect of working with a bunch of Swedish and Irish nurses. I'm not sure what attracted me more - the money or the Flickas and colleens. I even started a correspondence course in Arabic from University of Wisconsin,extension..The word for elephant is "filun".
If you are female, it might be even more tough to reason with a male doctor in Saudi than even the US. Is there an influential person over there you can get on board?
When I worked at the VA ICU in Sepulveda the movie "Chinatown" had just come out. Whenever the VA would farkle somebody's treatment, we would sigh and repeat this phrase, "It's China down, Jake"
I suggest- if the dark side prevails - you watch Chinatown on a DVD, perhaps, and then say, "It's Kismet, Jake."
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I guess one of the luckiest things you did Pecos that you didn't work in KSA. Being a Doctor, Pharmacist or Nurse is totally different from what you experience in the states or Europe. There are still a few hospitals stick to the practise laws and regulations but overall the environment would be totally different from what you are used to. I have a master degree in clinical pharmacy, one of my dreams is to work in a hospital as a clinical pharmacist; unfortunately, I can't fullfill my dream because Kuwait hospitals lack my specialisation. Thanks for you advice again Pecos and I will make sure to watch Chinatown :))))
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It was said in my interview (but God knows all) that "fraternization" among unmarried personnel was enforced by Yemeni guards with assault rifles. Consequently, married couples would invite unmarried couples over to dinner and nobody would discuss what was going on in the back bedroom. That sort of thing sounds strangely intriguing when you are 28. Sort of like being 16 again.
I knew a frumpy RN who had gone there and suddenly had a calling to turn them all into Baptists. They jailed her about 15 minutes after she started her new career. Then they stuck her in a jeep and the next thing she new she was at the airport. I think she was lucky she didn't try that nowadays.
They also spoke of a "goat grab", like Lawrence described in "The Seven Pillars of Wisdom". Those were hashemite bedouins, but have you been to a "goat grab"? Sounds kind of like a 4th of July barbecue in some parts.