Pediatric Prescribing and Ordering

Question 1

True or false: 2 patient identifiers from patient is enough before administering a medication.

Answer 1

False. Must also cross check with information listed in investigation order

Question 2

What are 4 RFs for medication errors in children?

Answer 2

1) Drug doses need to be calculated on child’s weight, age, body surface area (plus they change over time)

2) Drug doses need to be adjusted for organ funciton

3) Lack of sufficient information on pediatric dose (off label use)

4) Lack of appropriate child-friendly drug formulations/ concentration (eg. tablets)

5) Others (similar names, narrow TI, polypharmacy, rare drugs)

Question 3

What is the most common medication error in pediatrics?

Answer 3

Wrong dose
(esp 10-fold dosing error due to mistakes in calculation)

RFs:
- care settings (busy shift)
- HCW (tired, inexperienced)
- human factors (bad handwriting, typing mistakes, cannot do mental math)

Question 4

What are 5 common medication errors?

Answer 4

1) Wrong dosing
- usually human error

2) Wrong PT
- must check 2x ID on both patient AND order

3) Wrong drug strength/formulation
- esp similar name/ packaging, combination drugs

4) Wrong route
- eg. NG given as IV

5) Wrong timing
- delay in communication or misunderstanding of order (eg. BD 12hrly or 2x/day)

Question 5

What is the role of the pharmacist in the treatment of patients?

Answer 5

1) Review mediations and intervene as needed

2) Ensures timely and adequate supply of medication

Do not catch all mistakes

Question 6

What are 4 optional vaccines for children?

Answer 6

1) Rotavirus
2) VZV
3) Influenza
4) HPV

Question 7

Most vaccines may be administered simultaneously, but
when live vaccines are not given simultaneously,
administrations should be separated by at least ____________.

Answer 7

4 weeks

Question 8

True or false: The same vaccine should be used for repeat doses as far as possible.

Answer 8

True
- can consider substitution if same brand not available

Question 9

True or false: A child reporting they do not feel well is an immediate contraindication for vaccination.

Answer 9

False.
Minor illnesses are not contraindications for vaccination

Question 10

True or false: When giving vaccinations a pre-term child’s age needs to be adjusted for to ensure they are given the vaccine at the right age.

Answer 10

False.
Vaccinations, except for Hepatitis B (>2kg), should still be given based on the chronological age regardless of whether the
infant is pre-term or not

Question 11

What are 2 compulsory vaccinations in singapore?

Answer 11

1) Measles
- given as MMR

2) Diphtheria
-given as Tdap

Question 12

True or false: vaccines can be administered early if specifically requested by the patient/parents.

Answer 12

True BUT if administered early (>4days from minimum date), should be recommended at minimum age

Question 13

What are the contraindications for live viral vaccines?

Answer 13

1) Chronic high-dose corticosteroids
- Prednisolone > 2 mg/kg, or > 20 mg/day for children>10 kg, ≥2 weeks

2) Chemotherapy

3) Biologic therapies

4) Primary immunodeficiencies

Question 14

How should immunosuppressive therapy be discontinued and resumed for vaccines?

Answer 14

Must stop for 3 mths OR 11mths after receiving IVIG

Resume 1 mth after vax

Question 15

What are 4 examples of live attenuated vaccines?

Answer 15

1) MMR, varicella
2) Rotavirus (RV1, RV5)
3) Sabin/Oral polio vaccine
4) BCG

Question 16

What are 3 examples of conjugate vaccines?

Answer 16

1) Meningococcal (Manactra, Menveo)
2) Pneumococcal (PCV13)
3) HiB

Question 17

What are 5 examples of non-conjugate vaccines?

Answer 17

1) Hep A, B
2) Diphtheria, Tetanus, Pertussis
- DTap, Tdap, Td
3) Salk (Inactivated polio vax)
4) HPV
5) Influenza

Question 18

True or false: Acellular pertussis vaccine is less immunogenic than the whole cell pertussis.

Answer 18

False
- equally immunogenic but acellular wears off faster so needs more boosters

Question 19

Why do we give BCG if a child is not protected from pulmonary TB?

Answer 19

To build immunity against other more dangerous forms of TB (eg. milliary and TB encephalitis)

Question 20

True or false: 23-valent pneumococcal vaccine protects children from more strains than Prevenar 13.

Answer 20

False

Question 21

True or false: The HPV vaccine Gardasil is recommended for both males and females aged 11years and above.

Answer 21

True

Question 22

What are 4 contraindications of vaccines in children?

Answer 22

1) Anaphylaxis to a previous dose or component

2) Encephalopathy <7days after pertussis vax

3) Immunocompromised state for live vaccines

4) Hx of intussusception for rotavirus

Question 23

What are 5 relative contraindications for vaccines?

Answer 23

1) Moderate to severe acute illness

2) GBS <6weeks after tetanus or influenza vax

3) Hx of ITP for MMR

4) IVIG <11mths ago

5) Arthus-type reaction to previous diphtheria/tetanus toxoid vaccines