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Medication

Medication Summary

Drug therapy is not currently a component of the standard of care for Down syndrome. Medications are indicated only for symptomatic treatment of pain. Obviously, prolonged use of analgesics without diagnostic evaluation and an understanding of the underlying cause should not be encouraged. No particular analgesic is superior.

Diuretics and digoxin should be used to manage congestive heart failure secondary to congenital heart defect.

Class Summary

Pain control is essential to quality patient care. It ensures patient comfort and promotes pulmonary toilet, and analgesics have sedating properties that are beneficial for patients who have sustained trauma or injuries.

Acetaminophen and codeine (Tylenol #3, Capital and Codeine)

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Codeine is a centrally acting analgesic; acetaminophen is a peripherally acting analgesic. The combination is indicated for treatment of mild to moderately severe pain. Tablets contain acetaminophen 300 mg and codeine phosphate 30 mg; elixir contains acetaminophen 120 mg and codeine 12 mg per 5 mL.

Morphine sulfate (Duramorph, Astramorph, MS Contin, Oramorph SR)

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Morphine is a narcotic drug that interferes with opioid receptors; it mainly acts on the central nervous system (CNS) and the gastrointestinal (GI) tract.

Ibuprofen (Motrin, Advil, Caldolor)

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Ibuprofen is a member of the propionic acid group of nonsteroidal anti-inflammatory drugs (NSAIDs). It has anti-inflammatory, analgesic, and antipyretic activity. Its mode of action is not clear but might be related to prostaglandin synthetase inhibition.

Naproxen (Aleve, Anaprox, Naprosyn, Naprelan)

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Naproxen is an NSAID of the arylacetic acid group. It inhibits prostaglandin synthesis.

Class Summary

Antidysrhythmics may improve morbidity in patients with congestive heart failure secondary to congenital heart defect.

Digoxin (Lanoxin)

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Digoxin is a cardiac glycoside with direct inotropic effects in addition to indirect effects on the cardiovascular system. It acts directly on cardiac muscle, increasing myocardial systolic contractions. Indirect actions result in increased carotid sinus nerve activity and enhanced sympathetic withdrawal for any given increase in mean arterial pressure.

Class Summary

Diuretics should be used to manage congestive heart failure secondary to congenital heart defects.

Furosemide (Lasix)

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Furosemide increases excretion of water by interfering with the chloride-binding cotransport system, which, in turn, inhibits sodium and chloride reabsorption in the ascending loop of Henle and distal renal tubule. The bioavailability of oral furosemide is 50%. If a switch is made from intravenous to oral administration, an equivalent oral dose should be used. Doses vary depending on the patient's clinical condition.

Hydrochlorothiazide (Microzide)

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Hydrochlorothiazide inhibits reabsorption of sodium in distal tubules, causing increased excretion of sodium and water as well as potassium and hydrogen ions.

Metolazone (Zaroxolyn)

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Metolazone is a quinazoline diuretic with properties similar to those of thiazide diuretics. It inhibits sodium resorption at the cortical diluting site and the proximal convoluted tubule.

Questions

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Media Gallery

Infant with Down syndrome. Note up-slanting palpebral fissures, bilateral epicanthal folds, flat nasal bridge, open mouth with tendency for tongue protrusion, and small ear with overfolded helix.
Child with Down syndrome. Note up-slanting palpebral fissures, bilateral epicanthal folds, small nose with flat nasal bridge, open mouth with tendency for tongue protrusion, and small ears with overfolded helix.
G-banded karyotype showing trisomy 21 (47,XY,+21).
G-banded karyotype showing trisomy 21 of isochromosome arm 21q type [46,XY,i(21)(q10)].
Hand of infant with Down syndrome. Note transverse palmar crease and clinodactyly of fifth finger.
Ear of infant with Down syndrome. Note characteristic small ear with overfolded helix.
Characteristic flat facies with hypertelorism, depressed nasal bridge, and protrusion of tongue, as well as single palmar simian crease in 2-year-old girl with Down syndrome. Image courtesy of L. Dourmishev, MD, PhD, DSc.
Small auricle and anomalies of folds in patient with Down syndrome. Image courtesy of L. Dourmishev, MD, PhD, DSc.
Palmar simian crease in patient with Down syndrome. Image courtesy of L. Dourmishev, MD, PhD, DSc.
Patient with Down syndrome with protuberant abdomen and umbilical hernia. Image courtesy of L. Dourmishev, MD, PhD, DSc.
Wide gap between first and second toes and onychomycosis in patient with Down syndrome. Image courtesy of L. Dourmishev, MD, PhD, DSc.
Hypodontia in patient with Down syndrome. Image courtesy of L. Dourmishev, MD, PhD, DSc.

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Author

Gratias Tom Mundakel, MBBS, DCH Attending Neonatologist, Kings County Hospital; Clinical Assistant Professor, Department of Pediatrics, State University of New York Downstate Medical Center

Gratias Tom Mundakel, MBBS, DCH is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Coauthor(s)

Purushottam Lal, MD Resident Physician, Department of Pediatrics, Children's Hospital at SUNY Downstate

Purushottam Lal, MD is a member of the following medical societies: Delhi Medical Council, Indian Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Lois J Starr, MD, FAAP Assistant Professor of Pediatrics, Clinical Geneticist, Munroe Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center

Lois J Starr, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Medical Genetics and Genomics

Disclosure: Nothing to disclose.

Chief Editor

Maria Descartes, MD Professor, Department of Human Genetics and Department of Pediatrics, University of Alabama at Birmingham School of Medicine

Maria Descartes, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Medical Genetics and Genomics, American Medical Association, American Society of Human Genetics, Society for Inherited Metabolic Disorders, International Skeletal Dysplasia Society, Southeastern Regional Genetics Group

Disclosure: Nothing to disclose.

Additional Contributors

Harold Chen, MD, MS, FAAP, FACMG Professor, Department of Pediatrics, Louisiana State University Medical Center

Harold Chen, MD, MS, FAAP, FACMG is a member of the following medical societies: American Academy of Pediatrics, American College of Medical Genetics and Genomics, American Medical Association, American Society of Human Genetics

Disclosure: Nothing to disclose.

Michael M Henry, MD Fellow in Neonatal/Perinatal Medicine, Children’s Hospital at SUNY Downstate Medical Center

Michael M Henry, MD is a member of the following medical societies: Brooklyn Pediatric Society

Disclosure: Nothing to disclose.

Acknowledgements

James Bowman, MD Senior Scholar of Maclean Center for Clinical Medical Ethics, Professor Emeritus, Department of Pathology, University of Chicago

James Bowman, MD is a member of the following medical societies: Alpha Omega Alpha, American Society for Clinical Pathology, American Society of Human Genetics, Central Society for Clinical Research, and College of American Pathologists

Disclosure: Nothing to disclose.

David Flannery, MD, FAAP, FACMG Vice Chair of Education, Chief, Section of Medical Genetics, Professor, Department of Pediatrics, Medical College of Georgia

David Flannery, MD, FAAP, FACMG is a member of the following medical societies: American Academy of Pediatrics and American College of Medical Genetics

Disclosure: Nothing to disclose.

Mary L Windle, PharmD, Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Down Syndrome Medication

Medication Summary

Analgesics, Other

Class Summary

Acetaminophen and codeine (Tylenol #3, Capital and Codeine)

Acetaminophen and codeine (Tylenol #3, Capital and Codeine)

Morphine sulfate (Duramorph, Astramorph, MS Contin, Oramorph SR)

Morphine sulfate (Duramorph, Astramorph, MS Contin, Oramorph SR)

Ibuprofen (Motrin, Advil, Caldolor)

Ibuprofen (Motrin, Advil, Caldolor)

Naproxen (Aleve, Anaprox, Naprosyn, Naprelan)

Naproxen (Aleve, Anaprox, Naprosyn, Naprelan)

Antidysrhythmics, Ia

Class Summary

Digoxin (Lanoxin)

Digoxin (Lanoxin)

Diuretics, Other

Class Summary

Furosemide (Lasix)

Furosemide (Lasix)

Hydrochlorothiazide (Microzide)

Hydrochlorothiazide (Microzide)

Metolazone (Zaroxolyn)

Metolazone (Zaroxolyn)

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Down Syndrome Medication

Medication Summary

Analgesics, Other

Class Summary

Acetaminophen and codeine (Tylenol #3, Capital and Codeine)

Morphine sulfate (Duramorph, Astramorph, MS Contin, Oramorph SR)

Ibuprofen (Motrin, Advil, Caldolor)

Naproxen (Aleve, Anaprox, Naprosyn, Naprelan)

Antidysrhythmics, Ia

Class Summary

Digoxin (Lanoxin)

Diuretics, Other

Class Summary

Furosemide (Lasix)

Hydrochlorothiazide (Microzide)

Metolazone (Zaroxolyn)

References

Tables

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