PALS Pharmacology 4 — Questions and Answers
Question 1: A neonate in cardiogenic shock from ductal-dependent congenital heart disease requires which medication to keep the ductus arteriosus open?
- Indomethacin
- Prostaglandin E1 (alprostadil) (Correct answer)
- Furosemide
- Dopamine
Correct answer: Prostaglandin E1 (alprostadil)
Prostaglandin E1 (alprostadil) maintains or reopens the ductus arteriosus in neonates with ductal-dependent congenital heart defects.
Question 2: A 5-year-old presents with a heroin overdose and respiratory arrest. Which medication is administered first?
- Epinephrine
- Flumazenil
- Naloxone (Correct answer)
- Atropine
Correct answer: Naloxone
Naloxone is the opioid antagonist used to reverse respiratory depression caused by opioid overdose.
Question 3: What is the preferred route for naloxone administration when IV access is unavailable in a child?
- Sublingual
- Intranasal or IM (Correct answer)
- Rectal
- Endotracheal
Correct answer: Intranasal or IM
Intranasal or intramuscular naloxone is effective when IV/IO access is unavailable and is widely recommended in PALS.
Question 4: Which medication is used to treat supraventricular tachycardia in a hemodynamically stable child when adenosine fails?
- Epinephrine
- Verapamil (only in children > 1 year) (Correct answer)
- Atropine
- Vasopressin
Correct answer: Verapamil (only in children > 1 year)
Verapamil may be considered for SVT in children older than 1 year if adenosine fails, but is contraindicated in infants due to risk of cardiovascular collapse.
Question 5: A child in status epilepticus unresponsive to benzodiazepines is given phenobarbital. What is the primary concern with rapid IV administration?
- Hypertension and tachycardia
- Respiratory depression and hypotension (Correct answer)
- Hyperthermia
- Hyperglycemia
Correct answer: Respiratory depression and hypotension
Rapid IV phenobarbital can cause respiratory depression and hypotension, requiring careful monitoring and airway readiness.
Question 6: In a child with bradycardia unresponsive to atropine and epinephrine, which intervention should be considered next?
- Adenosine 0.1 mg/kg
- Amiodarone 5 mg/kg
- Transcutaneous pacing (Correct answer)
- Magnesium sulfate
Correct answer: Transcutaneous pacing
Transcutaneous pacing is indicated for bradycardia with a pulse that is unresponsive to medications and causing hemodynamic compromise.
Question 7: Which drug interaction is most clinically relevant when giving adenosine to a child taking theophylline?
- Theophylline potentiates adenosine's AV nodal block
- Theophylline blocks adenosine receptors, reducing its effectiveness (Correct answer)
- Theophylline prolongs adenosine's half-life
- Theophylline causes adenosine toxicity
Correct answer: Theophylline blocks adenosine receptors, reducing its effectiveness
Theophylline is an adenosine receptor antagonist and can block the therapeutic effect of adenosine, requiring higher doses to terminate SVT.
PALS Pharmacology 4
A neonate in cardiogenic shock from ductal-dependent congenital heart disease requires which medication to keep the ductus arteriosus open?