Citicoline: Neurotonics Patient:___Charles Gayo_____ Ward:____PICU______Bed No:____4____ DOSE & FREQUENCY: ______ Diluent of sterile water q6HIV x 4 doses

vit K 6 mg + PNSS__________ Medical Diagnosis:____ CHD cyanotic, TAPVR, acute kidney injury, acute liver failure secondary to myocardial failure, HIE, septic shock, pneumonia _______ GENERAL ACTION AND INFORMATION Citicoline seems to increase a brain chemical called phosphatidylcholine. This brain chemical is important for brain function. Citicoline might also decrease brain tissue damage when the brain is injured. This medication enhances the action of the brain stem ciliary body especially the ascending ciliary body activating system, which is closely related to consciousness, but does not exert effort on the extrapyramidal system. Citicoline increases cerebral blood flow and oxygen consumption of the brain and improves cerebral circulation and metabolism. Scientific research demonstrates that Citicoline consumption promotes brain metabolism by enhancing the synthesis of acetyl-choline, restoring phospholipid content in the brain and affecting neuron membrane excitability and osmosis (by its effect on the ATP-dependent sodium and potassium pump). When taken orally, its two main components, Cytidine and Choline are absorbed into the bloodstream. Citicoline is also believed to protect nerve cells when in low oxygen conditions. Citicoline may be used for nutritional support in cerebral vascular disease, head trauma, stroke, and cognitive disorders. It also is used by those who have age related mental decline, such as Alzheimers and Parkinsons. INDICATION related memory problems. Citicoline seems to help memory loss in people aged 50 to 85 years. Stroke recovery. Stroke patients who take citicoline by mouth within 24 hours of having the kind of stroke that is caused by a clot (ischemic stroke) are more likely than other ischemic stroke patients to have a complete recovery within 3 months. Long-term blood circulation problems in the brain (cerebrovascular diseases). There is some evidence that citicoline taken by mouth or given by IV or as a shot might improve memory and behavior in patients with long-term cerebrovascular diseases, such as stroke. PRECAUTIONS Pregnancy and breast-feeding Patients with acute, severe & progressive disturbance of consciousness Administration with hemostatics Intracranial pressure relieving drugs or use measures to keep body temp low. ADVERSE REACTIONS Insomnia headache diarrhea low or high blood pressure nausea, blurred vision chest pains, and others

PATIENT MONITORING Citicoline may be taken with or without food. Take it with or between meals. The supplement should not be taken in the late afternoon or at night because it can cause difficulty sleeping. Women who are pregnant or trying to become pregnant should consult with their doctor before taking the supplements. Not enough is known about the use of Citicoline during pregnancy and breast-feeding. Stay on the safe side and avoid use. Special attention should be paid for administration in the neonate, premature and children. Contact the physician immediately if allergic reaction such as hives, rash, or itching, swelling in your face or hands, mouth or throat, chest tightness or trouble breathing are experienced. Citicoline therapy should be started within 24 hours of a stroke. The physician will prescribe the correct dosage and the length of time it should be taken for a medical condition.