CPJE PEDIATRICS sample questions, Cheat Sheet of Pharmacy

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Pediatrics

Alyssa Wu, Pharm.D., BCPPS, AE-C

Immersive Board Review

Learning Objectives

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• Explain after birth neonatal treatments and ongoing

supplementation

• Describe over the counter treatments for pediatric patients

• Analyze empiric treatment for common pediatric conditions

• Evaluate drugs not recommended for use in the pediatric

population

• Recall drugs with different indications in pediatrics than adults

• Summarize the CDC vaccine schedule

• Discuss oral medications that require refrigeration

• List intravenous medications that do not require refrigeration

Eyes and Thighs

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• You are processing orders as an inpatient pharmacist in a neonatal

intensive care unit. Vitamin K is ordered intramuscularly and

erythromycin ointment to be applied topically to the eyes.

• Why are these two medications ordered for every neonate?

Eyes and Thighs

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Brand Generic Dosing DDIs Indication ADRs Storage Preparation Clinical

Caveats

Phytonadione Vitamin K 0.5-1 mg IM

once at birth

None Prevention of

vitamin K

deficiency

bleeding

Injection site

pain

Protect

from light

IM undiluted

Erythromycin

ophthalmic

ointment

Topical to

both eyelids

once

None Prevention of

eye

infections

Eye irritation Do not flush eye

following

instillation

Supplementation After Birth

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American Academy of Pediatrics Recommendations:

● Vitamin D: 400 units for all solely breastfed babies

● Babies taking less than 27 oz of standard formula may also

need supplementation

○ Goal level: >

● Iron: 1-3 mg elemental iron/kg/day for all solely breastfed

babies at 4 months of age

Supplementation After Birth

Brand Generic Dosing DDIs Indication ADRs Storage Counseling

Points

Cholecalciferol Vitamin D Prevention: 400

units daily oral

beginning in the

first few days of

life

None Vitamin D

deficiency

prevention and

treatment

None Do not freeze,

protect from

light

Administer with

accurate

measuring

device, do not

use a teaspoon

Ferrous sulfate Iron Prevention: 1-

mg elemental

iron/kg/day oral

Antacids may

decrease

absorption; iron

may decrease

levothyroxine,

cefdinir and

phosphate

supplements

Iron deficiency

prevention and

treatment

Dark stools,

abdominal pain,

nausea,

constipation

Store out of

children’s

reach and in

child resistant

containers

(leading cause

of fatal

poisoning)

Do not

administer with

milk or milk

products

Can administer

with food to

decrease ADRs

Do not crush EC

or film-coated

tablets

OTC and Commonly Used Products

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Mild Pain and Fever

• Acetaminophen (Tylenol): 10-15 mg/kg/dose (max: 500-650mg per dose), NTE 75

mg/kg/day or 4 grams/day (whichever is less)

• Ibuprofen (Advil, Motrin): 5-10 mg/kg/dose (max: 600-800mg per dose), avoid in

patients <6 months of age due to risk of nephrotoxicity

• Aspirin: not recommended in patients <16 YOA due to risk of Reye’s syndrome

Intestinal Gas

• Simethicone: 20 mg, 1-4 times a day prn

Nasal Dryness/Congestion:

• Intranasal saline solution: 2-6 drops per nostril prn

• The FDA does not recommend use of OTC cough and cold medications in patients <

YOA

OTC and Commonly Used Products

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Constipation

● Polyethylene glycol (Miralax): 0.2-0.8 g/kg/day (max dose: 17 g or 1 capful)

● Docusate (Dulcolax): 5 mg/kg/day (max dose: 150mg)

● Sennoside (Senna): 2.2mg-16.6mg based on age

Diarrhea

● Bismuth subsalicylate should not be used due to the risk of Reye’s syndrome

● Loperamide should not be used in patients <2 YOA due to the risk of respiratory

depression and serious cardiac adverse reactions; 1-4mg based on age

Nausea

● Ondansetron: 0.15 mg/kg (max dose: 4 mg), ODT tab available (not OTC but

commonly used)

Common Conditions -

Bacterial Meningitis

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What is the most likely treatment for bacterial meningitis in a patient

less than 1 month old?

A. Ampicillin + cefotaxime

B. Vancomycin + 3rd generation cephalosporin

C. Ampicillin + gentamicin

D. A and C

E. All of the above

Common Conditions -

Bacterial Meningitis

Bacterial Meningitis

• Common pathogens differ in the neonatal and pediatric population

versus the adult population

Age Group Common Bacteria Empiric Treatment <1 month Streptococcus agalactiae (GBS), escherichia coli, listeria monocytogenes, klebsiella Ampicillin + cefotaxime OR Ampicillin + aminoglycoside (gentamicin) 1-23 months Streptococcus pneumoniae, neisseria meningitidis, GBS, haemophilus influenzae, e. coli Vancomycin + 3rd generation cephalosporin 2+ years Streptococcus pneumoniae, neisseria meningitidis Vancomycin + 3rd generation cephalosporin

Common Conditions - RSV

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Which of the following patients should receive palivizumab or

nirsevimab during the RSV season?

A. Premature infant <30 weeks gestation

B. Premature infant born <32 weeks gestation with chronic lung

disease who is <1 year of age

C. Infants <2 years of age with certain heart conditions

D. All patients under the age of 18

Common Conditions - RSV

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Respiratory Syncytial Virus (RSV)

● Very common virus that infects almost all children by the age of 2

● Can cause severe complications in premature babies, neonates and

immunocompromised children

RSV Monoclonal Antibodies

Brand Generic Dosing DDIs Indication ADRs Storage Preparation Clinical Caveats Synagis Palivizumab 15 mg/kg IM monthly during RSV season (NTE 5 doses per season) None Prevention of serious lower respiratory tract disease caused by respiratory syncytial virus (RSV) in pediatric patients Skin rash and fever Store in refrigerator Administer undiluted. Discard unused portion. $4,000 per mL Beyfortus Nirsevimab <5 kg: 50 mg IM once per RSV season

5 kg: 100 mg IM once per RSV season None Prevention of serious lower respiratory tract disease caused by respiratory syncytial virus (RSV) in pediatric patients Injection site reaction and rash Store in refrigerator, once removed, must use within 8 hours Administer full pre-filled syringe. $495 per vial

Common Conditions - Influenza

A. Oseltamavir B. Zanamavir^ C. Peramavir D. Oral treatment of influenza is not recommended

Which of the following is the oral treatment of choice for influenza in

pediatric patients?