Pediatric CCRN Pharmacology Flashcards

A 10 kg child requires an epinephrine infusion at 0.1 mcg/kg/min. Using the rule of 6, how many mg of epinephrine should be added to 100 mL of D5W to run at 1 mL/hr?

Answer: 0.6 mg

Rule of 6: weight (kg) × 0.6 = mg to add to 100 mL; for 10 kg: 10 × 0.06 = 0.6 mg, resulting in a concentration where 1 mL/hr delivers 0.1 mcg/kg/min.

Which opioid is CONTRAINDICATED in a child with renal failure requiring pain management in the PICU?

Answer: Meperidine

Meperidine's active metabolite normeperidine accumulates in renal failure, causing CNS excitation, tremors, and seizures, making it contraindicated in patients with impaired renal function.

A 5-year-old receives IV vancomycin for MRSA bacteremia. Which monitoring parameter is MOST important to prevent toxicity?

Answer: AUC/MIC ratio via Bayesian pharmacokinetic monitoring

Current ASHP/IDSA guidelines recommend AUC/MIC-guided vancomycin dosing using Bayesian pharmacokinetic monitoring to optimize efficacy while minimizing nephrotoxicity.

What is the CORRECT dose of IV atropine to treat symptomatic bradycardia in a 20 kg child?

Answer: 0.02 mg/kg = 0.4 mg

The pediatric atropine dose for bradycardia is 0.02 mg/kg IV (minimum 0.1 mg, maximum 0.5 mg per dose); for a 20 kg child: 0.02 × 20 = 0.4 mg.

A child in the PICU receives a continuous midazolam infusion for 5 days. When the infusion is weaned, the child develops agitation, tremors, and diaphoresis. This presentation is MOST consistent with:

Answer: Benzodiazepine withdrawal syndrome

Prolonged benzodiazepine infusions cause physical dependence; abrupt weaning produces a withdrawal syndrome with CNS excitability, autonomic instability (diaphoresis, tachycardia), and tremors.

Which medication is the antidote for acetaminophen (paracetamol) toxicity in a pediatric patient?

Answer: N-acetylcysteine (NAC)

N-acetylcysteine replenishes hepatic glutathione, binding the toxic NAPQI metabolite to prevent liver injury, and is most effective when given within 8–10 hours of acetaminophen ingestion.