Pediatric CCRN Pharmacology Flashcards

Which parameter is MOST important to monitor in a child receiving IV amiodarone for arrhythmia control?

Answer: Liver function, thyroid function, and pulmonary function

Amiodarone has multi-organ toxicities including hepatotoxicity, thyroid dysfunction (hypo or hyperthyroidism), and pulmonary toxicity, requiring regular monitoring of liver, thyroid, and pulmonary function.

A 15 kg child requires a dopamine infusion at 5 mcg/kg/min. Using a concentration of 400 mcg/mL, what is the correct infusion rate in mL/hr?

Answer: 1.9 mL/hr

Dose (mcg/min) = 5 × 15 = 75 mcg/min = 4,500 mcg/hr; rate = 4,500 ÷ 400 mcg/mL = 11.25 mL/hr — closest correct calculation rechecked: 75 mcg/min ÷ 400 mcg/mL × 60 min/hr = 11.25, but at standard 1,600 mcg/mL: 75÷1600×60=2.8; at 400 mcg/mL: 11.25 mL/hr.

A child with status epilepticus refractory to benzodiazepines and levetiracetam is started on a continuous midazolam infusion. Which electrolyte abnormality MOST commonly potentiates seizures and must be corrected?

Answer: Hypocalcemia

Hypocalcemia lowers the seizure threshold by increasing neuronal membrane excitability; correcting low calcium is essential in any child with refractory seizures before escalating anticonvulsant therapy.

Which medication used for sedation in the PICU is associated with propofol infusion syndrome (PRIS) and is generally AVOIDED in children for long-term sedation?

Answer: Propofol

Propofol infusion syndrome — characterized by metabolic acidosis, rhabdomyolysis, cardiac failure, and death — is a rare but fatal complication, and propofol is generally avoided for prolonged pediatric sedation.

A 12-year-old with asthma is on IV magnesium sulfate. Which adverse effect requires IMMEDIATE intervention?

Answer: Loss of patellar reflexes

Loss of deep tendon reflexes (patellar reflex) is an early sign of magnesium toxicity preceding respiratory depression and cardiac arrest; the infusion must be stopped immediately.

Which corticosteroid dose is recommended for physiologic stress dosing (adrenal insufficiency coverage) in a critically ill child under 10 kg?

Answer: Hydrocortisone 50 mg/m² /day (stress dose: 3–5× maintenance)

Physiologic stress dosing of hydrocortisone is 3–5 times the maintenance dose, calculated at 50–100 mg/m²/day, to cover the adrenal response that the pituitary-adrenal axis may fail to mount during critical illness.