Drug References
What type of resource summarizes or interprets original works
tertiary literature/resource
A child is discharged on a new medication. Where in Lexicomp can you find the common adverse effects to discuss with the caregiver?
The Adverse Reactions section
What otoscopy finding best distinguishes AOM from otitis media with effusion?
Bulging of the tympanic membrane
What is the high-dose first-line antibiotic for most children with AOM?
Amoxicillin 80–90 mg/kg/day divided BID
A 2-month-old infant weighs 4 kg. How many mg of epinephrine should you prepare for a code dose?
0.04 mg
A nurse asks whether norepinephrine and epinephrine can run through the same IV line at the same time. Which drug information resource would you use to check compatibility?
Trissels IV compatibility
A 12-year-old is discharged on doxycycline. What administration counseling should be provided to reduce the risk of esophageal irritation?
Take with plenty of water and remain upright for at least 30 minutes to reduce esophageal irritation.
What are the "severe symptom" criteria that call for immediate antibiotics at any age?
Moderate-to-severe otalgia, otalgia ≥48 hours, or temperature ≥39°C
What is the per-dose amount for a 15 kg child on amoxicillin 90 mg/kg/day divided BID?
675 mg/dose
Practice! A 4-month-old infant weighing 5 kg requires calcium chloride 20 mg/kg IV during a code. The concentration is 100 mg/mL. How many mL should you prepare?
1 mL (100 mg)
A physician asks whether a medication is safe to administer to a 2-week-old infant because the package insert only provides adult dosing. Which resource would be especially useful for finding neonatal-specific dosing recommendations?
Neofax or Lexicomp Pediatric & Neonatal Dosage
A parent comes into your pharmacy and asks if her child's levothyroxine can be given with food. What do you tell her?
It's best if given on an empty stomach at the same time each day, 30-60 minutes prior to breakfast.
What is the recommended management for a 9-month-old with nonsevere bilateral AOM?
Immediate antibiotics
What three situations favor amoxicillin-clavulanate over plain amoxicillin?
Antibiotic use in the past 30 days, concurrent purulent conjunctivitis, or TM rupture
Practice! You are on code blue response and need to prepare code dose epinephrine for a 3 year old about to arrive to the ED. How many mL do you draw up?
1.4 mL (0.14 mg)
A pharmacist needs to determine whether a medication requires dose adjustment in a child with renal impairment. Which section of a drug monograph should they review?
Dosage adjustment in renal impairment in Lexicomp
A child is discharged on levetiracetam oral solution. The caregiver asks whether they can stop giving it once the child has gone several days without a seizure. What should you explain?
Do not stop levetiracetam without guidance from the prescriber. Abrupt discontinuation can increase seizure risk.
What two things must be in place to safely choose observation (watchful waiting)?
Assured follow-up within 48–72 hours and analgesia, through shared decision-making
What are the treatment durations for (a) <2 years or severe, (b) 2–5 years nonsevere, and (c) ≥6 years nonsevere?
10 days, 7 days, and 5–7 days
Practice! You are preparing RSI medications for a 14kg patient. What dose and volume of ketamine (50 mg/mL) will you use?
28 mg (0.56 mL)- 2 mg/kg
A parent asks whether a medication can be taken with grapefruit juice. Which part of a drug monograph would you check first?
Drug interactions and food interactions
Practice! A child is prescribed cephalexin 375 mg per dose. The suspension contains 250 mg/5 mL. How many milliliters should be prepared for one dose?
7.5 mL
What is the definition of recurrent AOM?
≥3 episodes in 6 months, or ≥4 in 12 months with at least one in the prior 6 months
What are the acceptable alternative antibiotics if a child fails first-line amoxicillin?
Amoxicillin-clavulanate, cefdinir, cefpodoxime, cefuroxime, or IM ceftriaxone × 3 days
You are on your NICU APPE rotation and the team would like to give a phenobarbital loading dose to a 2 day old patient who is seizing. What dose do you recommend in mg/kg and what resource do you use to find this information?
Neofax; 20 mg/kg IV