17. Pediatric Conditions Flashcards Preview

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Flashcards in 17. Pediatric Conditions Deck (38):
1

Chief Complaint: "Our little boy is sick and getting worse"
History of Present Illness: BW is a 22 month old child brought to the Pediatric Emergency Department by his parents at 11:30pm on 12/14/14.  BW's father is a medical resident at the nearby orthopedic hospital so he is knowledgeable about the course of his son's illness.  He states that his son has had difficulty with asthma and allergies since he was 11 months old.  He sees a pediatrician pulmonologist.  About 3 days ago, he noticed that his son had developed a mild cough and a runny nose. They used a humidifier and continued his regular medications.  He seemed to be getting a little better.  This morning the cough was noticeably worse, but the parents became very worried when his temperature increased to 102.8 degrees Fahrenheit and he began to have shortness of breath about an hour ago.  They came to the ED immediately.        
Allergies:  NKDA
Past Medical History: Asthma and environmental allergies.  Child is up to date on all vaccinations. 
Medications: Pulmicort Respules 0.25 mg BID at 0700 and 1600 via nebulizer and Singulair 4 mg daily at 2000.      
Physical Exam / Vitals: 
Height: 33"  Weight: 22 lbs  
Vitals: BP: 100/72  HR: 103  RR: 25  Temp: 102.9 F  O2 sat: 96%   
General: Child is febrile accompanied by concerned parents.   Coughing continuously.  Low O2 sat and developing stridor.
Cardiovascular: RRR
Lungs: Clear to auscultation  
Extremities: No rashes or lesions 
Labs:
CBC and chemistry pending                     
Tests:
CXR and blood culture pending
Plan: Admit to medical floor for further work up and treatment.
Question:
BW's father thinks his child should have a lumbar puncture.  What disease is he concerned about?

A. Laryngotracheobronchitis
B. Meningitis
C. Respiratory syncytial virus 
D. Enuresis
E. Polio
 

B. A lumbar puncture is performed to definitively diagnose meningitis, since patients do not always present with classic symptoms.

2

A seven year-old male patient will receive Pediacare Children’s Cough and Runny Nose liquid. The medication contains 160 mg of acetaminophen, 1 mg of chlorpheniramine maleate and 5 mg of dextromethorphan per teaspoon.  Which of the following statements are correct? (Select ALL that apply.)

A. The FDA recommends that OTC cough and cold products should not be used for infants and children under 6 years of age due to the risk of serious and potentially life-threatening side effects.
B. The pharmacist should recommend that the parent use a standard size teaspoon in order to make sure the child receives an accurate dose; "teaspoons" come in different sizes. 
C. Chlorpheniramine is an antihistamine that will produce a sedative effect.
D. The parents need to be careful not to over-use acetaminophen, which may also be administered separately for pain or fever. 
E. Dextromethorphan is used as a mucolytic.
 

C, D. The FDA recommends that OTC cough and cold products should not be used for infants and children under 2 years of age due to the risk of serious and potentially life-threatening side effects. There is no “standard” size teaspoon. Children who are using liquid medications should receive the dose using a calibrated oral syringe or dosing cup.

3

A parent calls the pharmacy for a recommendation for her child's constipation. The child is 11 months old and has no medical problems. Which of the following is an appropriate recommendation? (Select ALL that apply.)

A. Dulcolax
B. Pedi-Lax
C. MiraLax
D. Glycerin suppository
E. Simethicone drops
 

B, C, D. Glycerin suppositories and polyethylene glycol (MiraLax) can be recommended for constipation in infants. Dietary measures and regular toileting (in older children) may also help. Continuing issues should be referred to a pediatrician.

4

Aaron is an eight year old boy with enuresis who will receive desmopressin tablets. Which of the following side effects is most likely?

A Headache
B. Seizures
C. Insomnia
D. Skin photosensitivity/photophobia
E. Irritability/mood swings
 

B. Headache, fatigue and possibly hyponatremia can occur; headache has the highest incidence (2% to 5%). These side effects are for the oral tablets. The nasal spray can cause other side effects, including rhinitis and epistaxis.

5

A 6-month-old, 4.1 pound baby who was born at 26 weeks gestation will be given palivizumab (Synagis) for prophylaxis of respiratory syncytial virus (RSV) infection. The infant will be given palivizumab 15 mg/kg IM, dosed on actual weight. Which of the following statements are correct? (Select ALL that apply.)

A. The dose of palivizumab, rounded to the nearest milligram, is 27 mg, to be administered by IM injection.
B. The dose of palivizumab, rounded to the nearest milligram, is 29 mg, to be administered by IM injection.
C. A correct site for administration in this patient is the anterolateral thigh muscle.
D. A correct site for administration in this patient is the fatty tissue under the triceps.
E. Frequent handwashing and wiping of hard surfaces with soap and water or disinfectant may help stop infection and spread of RSV.
 

C, E. The dose of palivizumab, rounded to the nearest milligram, is 28 mg, to be administered by IM injection. Premature infants are among the highest risk for severe disease during the RSV season of (approximately) November through April.

6

Which of the following statements about croup are correct? (Select ALL that apply.)

A. Croup is most common in children < 6 years old.
B. Croup is most commonly caused by a fungal infection.
C. Mild cases require admission to the hospital for antibiotics to prevent progression to severe illness.
D. Inflammation of the upper airway leads to the symptoms of croup.
E. Epinephrine is used in croup to relax bronchial smooth muscle and cause bronchodilation.

A, D, E. Mild cases of croup may only require supportive care.

7

A 2 week old female is brought to the hospital by her parents. She is sleeping more than usual and not eating.  After examining the patient, the pediatrician on duty believes this could be meningitis. Which of the following is an appropriate empiric regimen for this patient?

A. Vancomycin and ceftriaxone
B. Vancomycin and cefotaxime
C. Ampicillin monotherapy
D. Ampicillin and cefepime
E. Ampicillin and cefotaxime
 

E. For patients < 1 month of age, ampicillin + gentamicin or ampicillin + cefotaxime is recommended for empiric treatment of meningitis based on the common pathogens. Ceftriaxone should be avoided in neonates (can cause kernicterus & renal problems).

8

A mother has a "colicky" newborn. He is crying after she feeds him, which lasts about an hour. The child has been seen by the pediatrician who told the mother that the baby is fine and to use an over-the-counter anti-gas agent. Which of the following products should be chosen?

A. Advil infant drops
B. Mylicon infant drops
C. Acetaminophen infant drops
D. Gaviscon infant drops
E. Phillips infant drops
 

B. Simethicone (Mylicon) infant drops help break up gas bubbles so that the baby can pass them out, which relieves pain. They are not absorbed, work safely and provide a mild benefit. They are delivered via the dose calibrated dropper. Simethicone is taken after meals, and if needed, at bedtime.

9

In which of the following circumstances should the parent be referred to urgent care?

A. A 2 year old has a rectal temperature of 102.4 degrees Fahrenheit.
B. A 5 year old has a cough that has improved over several days.
C. A 4 month old has a rectal temperature of 101.5 degrees Fahrenheit.
D. A 6 year old has a mild rash and no fever.
E. A 5 year old has knee pain that goes away after one dose of ibuprofen.
 

C. 

10

Mallory is a 3 year girl being treated for otitis media. She will receive amoxicillin 90 mg/kg/day. The pharmacy has in stock amoxicillin suspension 250 mg/5 mL. Mallory weighs 33 pounds. How much amoxicillin suspension, in mL, should be administered to Mallory daily? Round the answer to the nearest milliliter. Do not enter units; enter the number only.

27

11

A child who weighs 64 pounds will receive epinephrine at a dose of 0.01 mg per kilogram every 20 minutes as-needed, not to exceed 0.5 mg in a single dose.  Calculate the dose, in milligrams, rounded to the nearest tenth.  Do not enter units in the answer; enter the number only.

0.3

12

A prescription is written for cefuroxime oral suspension 30 mg/kg/day divided BID x 10 days for a 7 year old patient (weight 42 pounds).  How many milligrams should the patient receive for each dose?  Round to the nearest milligram. 

A. 72
B. 143
C. 286
D. 573
E. 630
 

C. 19 kg x 15 mg/kg/dose (or 30 mg/kg/day) = 286 mg per dose

13

Which of the following is correct about OTC medication use for common conditions in infants? (Select ALL that apply.) 

A Simethicone drops are safe to recommend for gas in infants.
B. Suctioning with saline drops is preferred over OTC cough and cold products for congestion in infants.
C. Parents should be counseled that using a household spoon is the most accurate way to measure infant medications.
D. Child and infant acetaminophen and ibuprofen products are all manufactured in the same concentration to minimize errors.
E. Diphenhydramine is safe for infants with runny nose and allergy symptoms.
 

A, B. Oral dosing syringes or dosing cups should always be used to measure liquid medications for pediatric patients.

14

A seven year-old male patient will receive Pediacare Children’s Cough and Runny Nose liquid. The father tells the pharmacist that the doctor said to give 2 teaspoons to his son 3-4 times daily, as needed. The medication contains 160 mg of acetaminophen, 1 mg of chlorpheniramine maleate and 5 mg of dextromethorphan per teaspoon. Which of the following statements are correct? (Select ALL that apply.)

A. The child will get overdosed on dextromethorphan if he is given the dose that was recommended by the child's doctor. 
B. The child will get overdosed on acetaminophen if he is given the dose that was recommended by the child's doctor. 
C. The doses are safe as recommended.
D. Chlorpheniramine is a decongestant.
E. Dextromethorphan by itself comes as the brand product Delsym.
 

C, E.

15

Samantha is a four year-old child who weighs 37 pounds and is 39.5 inches tall. She presents to the medical office with her mother. Samantha has a congenital ventricular septal defect and absence seizures, with breakthrough episodes on ethosuximide. She will be started on valproic acid at an initial dose of 15 mg/kg/day in an attempt to control the seizures.  Her parents will sprinkle the Depakote Sprinkle 125 mg capsules on a small amount of food twice daily, with breakfast and with dinner. Which of the following counseling statements should be provided to the parents by the pharmacist? (Select ALL that apply.)

A. This drug may cause very bad and sometimes deadly liver problems. This most often happens within the first 6 months of using this drug. Call your child's doctor if your child has dark urine, is feeling tired, is not hungry, has an upset stomach, is throwing up, or has yellowing of the skin or eyes. 
B. This drug may cause very bad and sometimes deadly pancreas problems (pancreatitis). This could happen in children at any time during care. Symptoms of pancreatitis include tummy pain, upset stomach, throwing up, or not feeling hungry. Call your child's doctor right away if your child has any of these symptoms.
C. This drug comes with an extra patient fact sheet called a Medication Guide. Read it with care. Read it again each time this drug is refilled.
D. This drug may cause very bad birth defects if your child takes it while your child is pregnant. It can also cause the baby to have a lower IQ. Do not give this drug to prevent migraine headaches if your child is pregnant. If your child is pregnant and takes this drug for seizures or bipolar disorder, talk to your child's doctor to see if your child needs to keep taking this drug.
E. It is important to chew the medicine thoroughly or not enough of the medicine will get into the child's body and the medicine may not work well
 

A, B, C. The sprinkle contents can be placed on a small amount of applesauce, pudding or mashed potatoes. The child needs to be able to swallow without chewing. A small amount is a small amount on a spoon. If this is not feasible, the liquid (syrup) can be used. Although it is true that the drug can cause serious birth defects this counseling is not necessary when the patient is a two year old child. It cannot be dispensed to a female patient for migraine headache prophylaxis who might become pregnant.

16

Samantha is a four year-old child who weighs 37 pounds and is 39.5 inches tall. She presents to the medical office with her mother. Samantha has a congenital ventricular septal defect and absence seizures, with breakthrough episodes on ethosuximide. She will be started on valproic acid at an initial dose of 15 mg/kg/day in an attempt to control the seizures.  Her parents will sprinkle the Depakote Sprinkle 125 mg capsules on a small amount of food twice daily, with breakfast and with dinner. How many capsule/s will she receive with breakfast?

A. 1 capsule
B. 2 capsules
C. 3 capsules
D. 4 capsules
E. 5 capsules
 

A.

17

Maya is a four-year old girl who has had a swollen knee for the past few weeks. She cannot fully extend her leg and has limped into the medical office. She presents with swelling (effusion) of her right knee.  She weighs 28.8 pounds. Labs reveal an ESR of 12 mm/hr and report the ANA as positive. She receives a diagnosis of juvenile rheumatoid arthritis and is started on methotrexate, and ibuprofen to be dosed at 10 mg/kg Q 8 hours. The pharmacy has generic and brand (Advil and Motrin) formulations of ibuprofen suspension 160 mg/5 mL. Select a correct recommendation for ibuprofen for Maya:


A. 2 mL Q 8 hours
B. 3 mL Q 8 hours
C. 4 mL Q 8 hours
D. 5 mL Q 8 hours
E. 5.5 mL Q 8 hours
 

C. Stores carry generic and brand ibuprofen and acetaminophen. The generic versions are less costly with the same active ingredients. Be cautious - infant and children's ibuprofen formulations come in different strengths. For all NSAID prescriptions: Identify on the prescription label if an NSAID is included, include a statement not to exceed the single and daily dosing, include a statement to avoid taking other NSAID products (OTC or Rx), avoid using with anticoagulants, steroids or diuretics, and avoid alcohol while using this product.

18

Desmopressin is a synthetic form of vasopressin (anti-diuretic hormone), which regulates fluid volume. It is used for patients with inadequate vasopressin (which results in diabetes insipidius), for treating bedwetting in children (enuresis) and for reducing bleeding in hemophilia (Von Willebrand’s disease). Select available formulations for desmopressin:

A. Injection
B. Suppository, rectal
C. Nasal spray
D. Topical paste
E. Oral tablet
 

A, C, E. If used in von Willebrand’s disease, desmopressin increases von willebrand factor, factor VIII, and t-PA, all of which shorten the aPTT (reducing bleeding time).

19

Which of the following is correct regarding Synagis prophylaxis? (Select ALL that apply.)

A. The correct dose of Synagis is 15 mg/kg IM daily for 5 months during RSV season.
B. Synagis is indicated to prevent serious cardiovascular disease caused by RSV.
C. Synagis prophylaxis is indicated for infants with chronic illness like congenital heart disease and chronic lung disease.
D. Synagis prophylaxis is indicated for infants born before 29 weeks gestation who are younger than 12 months at the start of RSV season.
E. RSV can be deadly in premature babies and neonates.
 

C, D, E. Synagis is dosed monthly to prevent serious lower respiratory tract disease.

20

A mother comes to the pharmacy asking for advice on something OTC to treat her daughter's fever.  Her daughter is 13 months old and weighs 11 pounds.  Her rectal temperature this morning was 39.7 degrees Celsius.  The most appropriate recommendation is:  

A. Monitor the child for another 24 hours to see if the fever subsides before treating with OTC medications.
B. Recommend ibuprofen 25-50 mg every 6-8 hours.
C. Recommend acetaminophen 50-75 mg every 4-6 hours.
D. Recommend a cool bath to lower the child's temperature.
E. Seek medical care for the child immediately.
 

E.

Seek urgent care if:

Age < 3 months with temp of 100.4 F (rectal)

Age 3-6 months with temp of 101 F (rectal)

Age > 6 months with temp of 103 F (rectal)

21

A child’s parents are concerned that giving acetaminophen to their child could cause severe rashes. They heard about this on the evening news on television. The pharmacist counsels the parents that the risk is very rare and informs them that acetaminophen has been used in most patients safely for years. To be safe, she wishes to inform the parents concerning early warning symptoms of a hypersensitivity reaction.  If a patient was to develop a severe skin reaction to acetaminophen (or another drug) what are the likely initial symptoms that would be seen prior to the onset of rash?

A. Nausea, vomiting
B. Fever and muscle aches
C. Yellowing skin
D. Tingling of the extremities
E. Severe headache, dry mouth, light sensitivity
 

B. Flu-like symptoms of fever and muscle aches are common initial presentations in the case of skin hypersensitivity reactions, which would be followed by rash, blistering and sloughing off of the outside of the skin. Breaking the skin barrier exposes patients to potentially fatal infections. Liver disease begins with weakness, fatigue, anorexia, and often jaundice (yellowing skin).

22

Latanya is a nine-year old African American who is hospitalized with acute sickle cell crisis. The pharmacist is preparing intravenous fluids for this patient. She adds 2 grams of potassium chloride to 1 L of D5W/1/2 normal saline. What is the estimated of the osmolarity per liter (mOsm/L) of this solution assuming the final volume is 1 L (MW of sodium = 23, potassium = 39, chloride = 35.5 and dextrose is 198)?

A. 64
B. 128
C. 256
D. 460
E. 512
 

D. To solve the problem calculate the contribution of each component and add them together: for example, for KCl: 2 grams ÷ 74.5 = 0.0268 mol or 26.8 mmols x 2 particles is 53.6. Calculate for the dextrose and the sodium and then add together. The problem asked per liter.

23

Armando is a pediatric patient with AIDS-wasting syndrome who is unable to meet his nutritional needs from normal intake. He has been receiving enteral formula to supplement his diet, which has resulted in stomach upset and diarrhea. To help alleviate the GI symptoms the pharmacist will reduce the osmolarity of the formula from 520 mOsm/L to 300 mOsm/L.  How many milliliters of purified water are needed to reduce 500 mL of this solution to the desired osmolarity of 300 mOsm/L?

A. 244 mL
B. 247 mL
C. 350 mL
D. 360 mL
E. 367 mL
 

E. This is solved by Q1C1=Q2C2. The initial strength and volume are provided (on one side of the equation) and the strength on the other side is provided. Solve for the volume.

24

Aaron is a healthy 8-year old boy with enuresis. He has not been able to stay dry at night since “potty training” began when he was 3 years old. His mother reports he was able to stay dry for an occasional night, but they are infrequent and non-sequential. The child is motivated to stop the bedwetting. His parents have tried stopping all fluid intake for 4-5 hours prior to bedtime. This did not help and increased constipation. Aaron’s father was a bedwetter himself until age 7 years. The pediatrician recommended a timed voiding schedule and alarm therapy, and this helped increase continence at night, with enuresis reported at 1-2 nights weekly. Diabetes insipidus has been ruled-out. Drug therapy is warranted at this time. Select the preferred medication for treating enuresis. 

A. Pseudoephedrine
B. Phenylephrine
C. Dexamethasone
D. Desmopressin
E. Imipramine

D. Preliminary management focusing on behavioral modification and positive reinforcement is often helpful. Most children will not wake to an alarm but they will stop wetting the bed, and the parent can escort the child to the bathroom. Desmopressin (DDAVP) is the only preferred medication for enuresis.

25

Which of the following is correct about chickenpox?

A. It is caused by rubella and prevented with the Boostrix vaccine.
B. It is caused by human papillomavirus and prevented with the Zostavax vaccine.
C. It is caused by varicella zoster virus and prevented with the Zostavax vaccine.
D. It is caused by rotavirus and prevented with the Rotarix vaccine. 
E. It is caused by varicella zoster virus and prevented with the Varivax vaccine.
 

E. The vaccine for chickenpox is Varivax and the vaccine for shingles is Zostavax.

26

SA is a 2 year old male child. His parents brought him to Urgent Care because he has had a gradual loss of appetite for 4 days.  They say that they he doesn't want to get out of bed and seems tired during the day. SA's Mom says that he started to cry when she washed his hair during his bath today.  She thought maybe his head hurt.  Upon physical exam, his salivary glands are very swollen and tender to touch.  What childhood illness is most likely in this case? 

A. Varicella
B. Measles
C. Mumps
D. Polio
E. Pertussis

C. Swollen, tender salivary glands (parotitis) is emblematic of mumps. Many patients have very mild or no symptoms.

27

Which age range correctly defines an infant?

A. 0 - 28 days
B. 1 month - 6 months
C. 1 month - 12 months
D. 1 month to 18 months
E. 1 year - 12 years

C. An infant is 1 - 12 months old.

Neonate: 0-28 days

Infant: 1-12 months

Child: 1-12 years

Adolescent: 13-18 years

28

Jadan is a 2 year, 3-month-old boy being treated for otitis media. He is going to receive a prescription for amoxicillin 90 mg/kg/day. He weighs 26 pounds and is 35 inches tall.  Jadan is allergic to peanuts and has been prescribed an Epipen for use if accidental exposure.  His mother carries an Epipen in her purse and the daycare has an EpiPen for his use in the office.  Calculate the amoxicillin dose in milligrams that should be administered every 12 hours. Round the answer to the nearest 10-milligram dose. Do not enter units; enter the number only.

530

29

TW is a 6 year old female child being seen in the pediatrician's office today.  She has a temperature of 102.4 degrees Fahrenheit and a rash covering her entire body. According to TW's parents, they noticed the rash on her face yesterday morning and it spread to cover most of her body by today. Three days ago TW's Mom noticed spots in her daughter's mouth.  She said they were small, white and located on the inside of her daughter's cheeks. Based on this presentation and history, what childhood disease does TW have?

A. Mumps
B. Rubella
C. Varicella
D. Pertussis
E. Measles

E. The spots that the mother saw inside the child's mouth are called Koplik spots. They appear 2-5 days before the measles rash.

30

A 5-month-old female infant, weight 3.4 kg, was born at term with no known health problems is treated for her first case of otitis media with amoxicillin at a dose of 150 mg BID x 7 days. At the two-week follow-up visit the pediatrician has documented fullness in the middle ear and a cloudy tympanic membrane. The patient is febrile with a temperature of 38.7 degrees Celsius. Which one of the following represent preferred options for treatment? (Select ALL that apply.)

A. High-dose amoxicillin (90 mg/kg/day) for 7 days.
B. Amoxicillin/clavulanic acid dosed at 150 mg (of the amoxicillin component) BID x 7 days.
C. Amoxicillin/clavulanic acid dosed at 300 mg (of the amoxicillin component) BID x 7 days.
D. Cefuroxime 50 mg BID x 7 days.
E. Azithromycin 30 mg x 2 days.
 

B. The dose of amoxicillin the child initially received was correct at 90 mg/kg/day. Subsequent to amoxicillin failure the treatment is amoxicillin/clavulanic acid (Augmentin) dosed on the amoxicillin component, or ceftriaxone injection IM or IV. Azithromycin suspension is given as a 1, 3 or 5-day dosing regimen; this is not a preferred agent in the presence of amoxicillin initial treatment failure. It can be used if anaphylaxis to a beta-lactam has been documented.

31

Aaron is an eight year old boy with enuresis who will receive desmopressin tablets. Which of the following dosing regimens is correct for initiation of therapy?

A. Take one 0.1 mg twice daily
B. Take one 0.1 mg three times daily
C. Take 0.2 mg at bedtime
D. Take 0.2 mg twice daily
E. Take 0.2 mg three times daily
 

C. This dose should have been an easy “guess” since you are treating a problem during sleep and would want the medication on board at that time only. Similarly, when treating restless leg with some type of dopaminergic agent, an immediate release formulation taken prior to sleep is the best option (not an extended release, which would take too much time to be effective).

32

Chief Complaint: "Our little boy is sick and getting worse"
History of Present Illness: BW is a 22 month old child brought to the Pediatric Emergency Department by his parents at 11:30pm on 12/14/14.  BW's father is a medical resident at the nearby orthopedic hospital so he is knowledgeable about the course of his son's illness.  He states that his son has had difficulty with asthma and allergies since he was 11 months old.  He sees a pediatrician pulmonologist.  About 3 days ago, he noticed that his son had developed a mild cough and a runny nose. They used a humidifier and continued his regular medications.  He seemed to be getting a little better.  This morning the cough was noticeably worse, but the parents became very worried when his temperature increased to 102.8 degrees Fahrenheit and he began to have shortness of breath about an hour ago.  They came to the ED immediately.        
Allergies:  NKDA
Past Medical History: Asthma and environmental allergies.  Child is up to date on all vaccinations. 
Medications: Pulmicort Respules 0.25 mg BID at 0700 and 1600 via nebulizer and Singulair 4 mg daily at 2000.      
Physical Exam / Vitals: 
Height: 33"  Weight: 22 lbs  
Vitals: BP: 100/72  HR: 103  RR: 25  Temp: 102.9 F  O2 sat: 96%   
General: Child is febrile accompanied by concerned parents.   Coughing continuously.  Low O2 sat and developing stridor.
Cardiovascular: RRR
Lungs: Clear to auscultation  
Extremities: No rashes or lesions 
Labs:
CBC and chemistry pending                     
Tests:
CXR and blood culture pending
Plan: Admit to medical floor for further work up and treatment.
Question:
The Emergency Department physician explains to BW's parents that he thinks BW's presentation is most consistent with RSV.   How is RSV generally managed in healthy older children?

A. Palivizumab
B. Vancomycin + cefotaxime
C. Dexamethasone + racemic epinephrine
D. Desmopressin
E. Supportive care
 

E. Palivizumab (Synagis) is indicated for prophylaxis of RSV - not for the treatment of it. If a patient receiving prophylaxis with Synagis develops RSV, prophylaxis should be discontinued for the remainder of RSV season. Treatment of RSV in older, otherwise healthy children is generally supportive. The child in this case became more ill from the virus, likely due to his baseline asthma and allergies, so he will require more intense medical care based on the results of his labs and tests.

33

David is an 8 week old infant with thrush. The physician has ordered nystatin suspension 100,000 units PO QID with instructions to the parents to brush the suspension into the recesses of the child's mouth. Which of the following statements concerning this prescription are correct? (Select ALL that apply.)

A. Nystatin suspension, if taken by a child or adult, should (preferably) be held in the mouth for a short while prior to swallowing; the usual instructions are to "swish and swallow."
B. There is no need to shake this type of formulation; it is retained in a uniform distribution.
C. The total daily dose is 400,000 units nystatin suspension.
D. Thrush is an infection caused by a fungus called trychophyton.
E. This medication is well-tolerated, but some patients get mild gastrointestinal side effects.

A, C, E. Suspensions, nearly always, must be dispersed (shaken, or in some cases such as insulin, rolled gently) prior to use since the components settle in an uneven distribution inside the container. Thrush is an oral candida albicans infection, also called oropharyngeal candidiasis. The only side effects with nystatin suspension are mild GI issues; the medication is not absorbed.

34

A 3 year old male child is in the emergency department.  His parents are very worried because he hasn't been sleeping due to a cough that seems to be worse at night.  The barking cough is evident throughout the exam and the child is inconsolable.  Other pertinent findings include significant inspiratory stridor.  Chest is clear to auscultation and the patient is afebrile.  Based on the presentation described, which of the following drug regimens is warranted?

A. Dexamethasone only
B. Nebulized racemic epinephrine only
C. Nebulized racemic epinephrine and dexamethasone
D. Nebulized racemic epinephrine, dexamethasone, and amoxicillin
E. Dexamethasone and nebulized budesonide
 

C. Corticosteroids and nebulized racemic epinephrine are appropriate given the symptoms of moderate-severe croup in the case. Antibiotics are only used if there is lack of improvement due to a bacterial infection.

35

Which of the following is correct about vaccination to prevent transmission of pertussis? (Select ALL that apply.)

A. Pregnant women (weeks 27-36) should receive DTaP.
B. Children < 7 years of age should the receive DTaP series.
C. Infants and children should receive Tdap at 2, 4, 6 and 12-15 months.
D. Pregnant women (weeks 27-36) should receive Td.
E. Children 7 - 10 years of age who were not fully vaccinated should receive a one time dose of DTaP.
 

B. Pediatric formulations have an upper case D (DTaP) and the adult formations have a lower case d (Tdap or Td).

36

Which of the following groups of medications are generally not used in pediatric patients?

A. Iron, tetracyclines, morphine, and codeine
B. Tetracyclines, promethazine, acetaminophen, and fluoroquinolones
C. Codeine, iron, fluoroquinolones, and promethazine
D. Tetracyclines, codeine, promethazine, and fluoroquinolones
E. Morphine, promethazine, fluoroquinolones, and tetracyclines
 

D. 

37

Randa is a 13-month old child with a viral-induced fever. She is 18.4 pounds and 28.8 inches. Her parents report that she has been fussy and irritable and feels "hot".  She has a fever of 39.4 degrees Celsius. Which of the following dosing recommendations for acetaminophen for this child is correct?

A. 80 mg every 2-4 hours as-needed for fever.
B. 80 mg every 8-12 hours as-needed for fever.
C. 100 mg every 4-6 hours as-needed for fever.
D. 140 mg every 6-8 hours as-needed for fever.
E. 184 mg every 4-6 hours as-needed for fever.
 

C. The correct dosing of acetaminophen for infants (except neonates) and for children is 10 - 15 mg/kg PO every 4-6 hours PRN. For all acetaminophen prescriptions: Do not use the abbreviation APAP, Identify on the prescription label that acetaminophen is included, include a statement to avoid use of other acetaminophen products, include a statement not to exceed the single and daily dosing, and to avoid alcohol while using this product.

38

Randa’s parents ask the pharmacist about recent reports concerning the safety of acetaminophen. Which of the following statements are correct? (Select ALL that apply.)

A. The FDA has warned that acetaminophen has been associated with a risk of rare but serious and potentially fatal skin reactions, including Stevens-Johnson syndrome, toxic epidermal necrolysis (TEN), and acute generalized exanthematous pustulosis (AGEP).
B. Anyone who develops a skin rash or reaction while using acetaminophen or any other pain reliever/fever reducer should stop taking the drug and seek medical attention immediately.
C. Patients who have experienced a serious skin reaction with acetaminophen should not take the drug again.
D. The FDA recommends that the safe dose of acetaminophen is 325 mg or less per dosage unit. 
E. Keeping the unit dose to less than 325 mg reduces the risk of severe skin reactions.
 

A, B, C, D. The safe dosage unit of 325 mg (two units of 325 mg, or 650 mg, can be used in some cases) was issued in January of 2014. The recommendation reads: “There are no available data to show that taking more than 325 mg of acetaminophen per dosage unit provides additional benefit that outweighs the added risks for liver injury.” The risk of severe skin reactions is not dose-related.

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