Pediatric Malignant Pericardial Effusion Medication
- Author: Poothirikovil Venugopalan, MBBS, MD, FRCPCH; Chief Editor: Stuart Berger, MD more...
Hemodynamic support is of some value until drainage of pericardial fluid can be accomplished. Pericardiocentesis and intrapericardial sclerosis are effective therapies for malignant pericardial effusions that recur. Intrapericardial administration of drugs, such as cisplatin, can be important. Use anti-inflammatory drugs for viral pericarditis.
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
Nonsteroidal anti-inflammatory drugs (NSAIDs) are analgesics that offer anti-inflammatory action. They have analgesic, anti-inflammatory, and antipyretic activities. Their main mechanism of action is inhibition of cyclooxygenase activity and prostaglandin synthesis. They may act through other mechanisms as well (eg, by inhibiting leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell-membrane functions).
Ibuprofen is a propionic acid derivative that reduces the formation of inflammatory mediators by enzyme inhibition.
Naproxen is a propionic acid derivative that reduces the formation of inflammatory mediators by enzyme inhibition.
Diclofenac possesses properties similar to those of the propionic acid derivatives and reduces the formation of inflammatory mediators by enzyme inhibition. The tablets are immediate-release formulations.
Indomethacin behaves in the same manner as the propionic acid derivatives and inhibits the formation of inflammatory mediators. It is rapidly absorbed and is metabolized in the liver through demethylation, deacetylation, and glucuronide conjugation. Indomethacin inhibits prostaglandin synthesis.
Ketoprofen is used for relief of mild to moderate pain and inflammation. Small dosages are indicated initially in small patients, elderly patients, and patients with renal or liver disease. Doses higher than 75 mg do not increase the therapeutic effects. Administer high doses with caution, and closely observe the patient's response.
Corticosteroids elicit anti-inflammatory and immunosuppressive properties and cause profound and varied metabolic effects. They modify the body’s immune response to diverse stimuli.
Prednisone is used for patients with severe inflammatory pericardial effusions or for those in whom initial treatment with NSAIDs has failed.
Methylprednisolone is available in IV/IM and oral form. It decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing increased capillary permeability. It is used for patients with severe inflammatory pericardial effusions or for those in whom initial treatment with NSAIDs has failed.
Prednisolone is available in tablet and liquid forms. It decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing increased capillary permeability. It is used for patients with severe inflammatory pericardial effusions or for those in whom initial treatment with NSAIDs has failed.
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