Pediatric CCRN Pharmacology Flashcards

A 4-year-old with septic shock is on a norepinephrine infusion but remains hypotensive with vasodilatory shock. Which adjunct vasopressor is MOST appropriate to add?

Answer: Vasopressin

Vasopressin acts on V1 receptors in vascular smooth muscle independent of adrenergic pathways, making it an effective adjunct in catecholamine-refractory vasodilatory shock.

Which medication class is the FIRST-LINE treatment for hypertensive emergency in a child with acute glomerulonephritis?

Answer: Calcium channel blockers (nicardipine IV)

IV nicardipine provides rapid, titratable blood pressure reduction without the renal afferent arteriole risk of ACE inhibitors, making it preferred for hypertensive emergencies in children.

A 3-year-old on phenobarbital for seizure control requires a dose increase. Which monitoring is ESSENTIAL?

Answer: Serum phenobarbital levels and respiratory status

Phenobarbital has a narrow therapeutic index (15–40 mcg/mL); monitoring serum levels prevents toxicity while assessing respiratory status is critical as phenobarbital causes dose-dependent respiratory depression.

What is the PRIMARY concern when using succinylcholine for rapid sequence intubation in a child with a crush injury?

Answer: Life-threatening hyperkalemia

Crush injury causes massive upregulation of extrajunctional acetylcholine receptors; succinylcholine depolarization releases dangerous amounts of potassium into the circulation, risking fatal arrhythmias.

A 7-year-old is started on a heparin infusion for DVT. The anti-Xa level is subtherapeutic. Which factor MOST commonly explains heparin resistance in pediatric patients?

Answer: Low antithrombin III levels

Heparin requires antithrombin III as its cofactor; low AT-III levels (common in neonates, sepsis, and nephrotic syndrome) cause heparin resistance, reducing its anticoagulant effect.

A 2-year-old ingests an unknown medication and presents with miosis, bradycardia, excessive secretions, and muscle fasciculations. Which antidote is INDICATED?

Answer: Atropine and pralidoxime (2-PAM)

Miosis, bradycardia, secretions, and fasciculations represent cholinergic toxidrome from organophosphate or carbamate poisoning; atropine reverses muscarinic effects while pralidoxime reactivates acetylcholinesterase.