Pediatric and Geriatric Pharmacology Practice Questions

Q: Which of the following statements are correct regarding management of hyperkalemia in a child? I. Intravenous calcium (gluconate or chloride) is given to enhance cellular uptake of potassium II. Beta adrenergic agonists (salbutamol or terbutaline) are used to stabilize myocardial cell membrane III. Regular insulin and glucose given intravenously enhance cellular uptake of potassium IV. Sodium polystyrene sulfonate enhances total body potassium elimination Select the answer using the code given below :

III and IV. ***III and IV*** - Intravenous **regular insulin and glucose** work by promoting the intracellular shift of potassium, thereby lowering serum potassium levels. Insulin stimulates the Na+-K+ ATPase pump, moving potassium into cells, and glucose is given to prevent **hypoglycemia**. - **Sodium polystyrene sulfonate (SPS)** is a cation exchange resin that binds potassium in the gastrointestinal tract and promotes its excretion in the stool, thus enhancing **total body potassium elimination**. *I and II* - Intravenous calcium (gluconate or chloride) is given to **stabilize the myocardial cell membrane**, reducing the risk of arrhythmias, not to enhance cellular uptake of potassium. - Beta-adrenergic agonists like **salbutamol** or **terbutaline** promote the intracellular shift of potassium, similar to insulin, but they **do not stabilize the myocardial cell** membrane. *II and III* - Beta-adrenergic agonists **(salbutamol or terbutaline)** promote the cellular uptake of potassium, but they do not stabilize the myocardial cell membrane; that is the role of calcium. - While regular insulin and glucose given intravenously do enhance cellular uptake of potassium, the statement regarding beta-adrenergic agonists is incorrect in its function to stabilize the myocardial cell membrane. *I and IV* - Intravenous calcium (gluconate or chloride) is administered to **protect the heart** from the effects of hyperkalemia by stabilizing the myocardial cell membrane, not to enhance cellular uptake of potassium. - Although sodium polystyrene sulfonate (SPS) correctly enhances total body potassium elimination, the initial statement regarding calcium's mechanism of action is incorrect.

Q: For the treatment of kala-azar, the daily dose of miltefosine in a 3-year-old child who weighs 15 kg is

40 mg. ***40 mg*** - Miltefosine dosage for children weighing 12 to 29 kg (including a 15 kg child) is typically **2.5 mg/kg body weight per day orally**. - For a 15 kg child, this translates to 2.5 mg/kg * 15 kg = **37.5 mg**, which is rounded to **40 mg** for practical dosing since miltefosine capsules come in 10 mg or 50 mg sizes. *20 mg* - This dose is lower than the recommended **2.5 mg/kg/day** for a 15 kg child, which would be 37.5 mg. - An underdose of miltefosine could lead to **treatment failure** and the development of drug resistance. *10 mg* - This dose is significantly lower than the recommended therapeutic dose for a 15 kg child, which requires approximately **37.5 mg daily**. - Such a low dose would be **ineffective** in treating kala-azar, risking worsening disease. *30 mg* - While closer than 10 mg or 20 mg, 30 mg is still below the calculated **37.5 mg/day** for a 15 kg child. - An insufficient dose may compromise the efficacy of treatment and lead to **suboptimal parasitic clearance**.

Q: What is the correct daily dose of Iron and Folic acid to be prescribed to a child aged 12 years?

60 mg elemental Iron and 300 mcg folic acid. ***60 mg elemental Iron and 300 mcg folic acid*** - This is the **standard daily prophylactic dose** recommended for children aged 10-19 years (adolescents) in India as per **WIFS (Weekly Iron and Folic Acid Supplementation) program** when given daily. - Aligns with **ICMR and National Iron+ Initiative** guidelines for daily supplementation in adolescents. - This dose provides adequate iron for growth requirements and prevention of **nutritional anemia** in this age group. *20 mg elemental Iron and 100 mcg folic acid* - This dose is **too low** for a 12-year-old child and does not meet the iron requirements for adolescents. - This might be appropriate for younger children (6-59 months) but is **inadequate for adolescent growth and development**. - Would not effectively prevent iron deficiency anemia in this age group. *100 mg elemental Iron and 500 mcg folic acid* - This is the dose recommended for **weekly prophylactic supplementation** under the WIFS program, not for daily use. - When used daily, this dose may be used for **treatment of established iron deficiency anemia** rather than routine prophylaxis. - Daily use at this dose may cause **gastrointestinal side effects** like nausea and constipation. *30 mg elemental Iron and 250 mcg folic acid* - This dose is **intermediate but not standard** as per Indian guidelines for this age group. - Does not align with recommended protocols for adolescent supplementation. - Provides suboptimal iron for the growth spurt and increased requirements in 12-year-olds.

Q: Least teratogenic antiepileptic drug in pregnancy is:

Levetiracetam. ***Levetiracetam*** - **Levetiracetam** is generally considered one of the **safest antiepileptic drugs (AEDs)** during pregnancy, with a lower risk of major congenital malformations compared to other AEDs. - Studies have shown a **low incidence of neural tube defects** and other severe malformations when used as monotherapy. *Carbamazepine* - **Carbamazepine** is associated with an increased risk of **neural tube defects**, particularly **spina bifida**, during pregnancy. - It can also cause other malformations such as **facial dysmorphism** and developmental delays. *Valproate* - **Valproate** has the **highest teratogenic potential** among common AEDs, linked to a significantly increased risk of **neural tube defects**, **cardiac anomalies**, and **cognitive impairment (fetal valproate syndrome)**. - Due to its high risk, its use is generally **contraindicated in women of childbearing potential** unless no other effective alternative exists. *Phenytoin* - **Phenytoin** is associated with **fetal hydantoin syndrome**, characterized by specific facial features, **growth deficiency**, developmental delay, and increased risk of cleft lip/palate, and **cardiac defects**. - It is known for its **dose-dependent teratogenicity**, making careful monitoring crucial.

Q: Prophylactic dose of Oseltamivir for infants (3-11 months) is?

3 mg/kg/day. ***3 mg/kg/day*** - The recommended **prophylactic dose of oseltamivir** for infants aged 3 to 11 months is **3 mg/kg once daily** for 10 days. - This dosage is essential for preventing **influenza** in this vulnerable age group when exposure is known or highly suspected. *5 mg/kg/day* - A dose of **5 mg/kg** is generally used for **treatment** of influenza in infants and children, not for prophylaxis. - This higher dose is administered twice daily for 5 days when a child is already symptomatic. *1 mg/kg/day* - This dosage is **too low** for either prophylactic or treatment use in infants and would likely be ineffective against influenza. - Sub-optimal dosing can lead to **treatment failure** and a higher risk of complications. *7 mg/kg/day* - This dosage is **higher than recommended** for prophylaxis and could potentially lead to increased adverse effects without offering additional benefit. - Higher doses are usually reserved for **severely immunocompromised** patients or specific treatment regimens, not standard prophylaxis.

Q: For a child 3-5 months of age with H1N1, treatment Oseltamivir dose is

20 mg BD X 5 days. ***20 mg BD X 5 days*** - For infants aged **3-5 months** with H1N1 influenza, the recommended dose of **Oseltamivir** is **20 mg twice daily** (BD) for **5 days**. This dosage is based on weight-based recommendations to ensure appropriate antiviral activity. - This treatment regimen is crucial for reducing the severity and duration of influenza symptoms in this vulnerable age group and should be initiated as early as possible. *12 mg BD X 5 days* - This dosage is typically recommended for younger infants, specifically those aged **less than 1 month up to 2 months** (up to 3 kg body weight). - It is **underdosing** for a child in the 3-5 months age range, which could lead to suboptimal antiviral effect. *25 mg BD X 5 days* - This dosage is generally used for children weighing **between 15 kg and 23 kg**, which is significantly higher than the average weight for an infant aged 3-5 months. - Administering this dose to a 3-5 month old would constitute an **overdose**, potentially leading to increased side effects such as nausea, vomiting, or other adverse reactions. *20 mg OD X 5 days* - While 20 mg is the correct single dose, giving it **once daily (OD)** is incorrect for treating H1N1 influenza in infants. - Oseltamivir requires a **twice-daily (BD)** regimen to maintain therapeutic drug levels and effectively inhibit viral replication over the 24-hour period.

Q: American Heart Association standard pediatric dose of amoxicillin for antibiotic prophylaxis, in cases of endocarditis is

50mg/kg. ***50mg/kg*** - The **American Heart Association (AHA)** guidelines recommend **50 mg/kg** of amoxicillin as the standard pediatric dose for antibiotic prophylaxis against infective endocarditis before certain dental procedures. - This dose is typically given orally, as a single dose, 30-60 minutes before the procedure. *20mg/kg* - This dose is lower than the recommended **AHA guideline** for infective endocarditis prophylaxis in children. - Administering this dose could result in **subtherapeutic levels**, failing to adequately prevent bacterial colonization and infection. *125mg/kg* - This dosage is significantly higher than the standard **AHA recommendation** for endocarditis prophylaxis. - Such a high dose could increase the risk of **adverse effects** without providing additional prophylactic benefit. *100mg/kg* - While higher than the standard 50mg/kg, this dose also exceeds the **AHA guidelines** for pediatric endocarditis prophylaxis. - Overdosing can lead to increased **gastrointestinal side effects** and other unwanted drug reactions.

Q: Newborns as compared to adults eliminate lidocaine:

More slowly. ***More slowly*** - Newborns have **immature hepatic enzyme systems**, particularly for **CYP1A2** and **CYP3A4**, which are crucial for lidocaine metabolism. - Reduced **plasma protein binding** and a larger **volume of distribution** in newborns can also impact lidocaine clearance, leading to slower elimination. *Variable* - While there can be individual variability in drug metabolism, the general trend for lidocaine elimination in newborns is consistently slower due to physiological immaturity, not merely variable. - This option does not capture the overall physiological characteristic of drug elimination in neonates. *More rapidly* - This is incorrect because newborns have underdeveloped liver function and enzyme systems, which would hinder, not accelerate, the metabolism and elimination of drugs like lidocaine. - A more rapid elimination would suggest a highly efficient metabolic pathway, which is not the case in neonates. *Equally fast* - This is incorrect as the **pharmacokinetic profile** of drugs, including lidocaine, differs significantly between newborns and adults due to developmental differences in organ function (e.g., liver, kidneys). - The liver's metabolic capacity in newborns is not fully mature enough to eliminate lidocaine at the same rate as in adults.

Q: What is the recommended intramuscular (IM) dose of midazolam in children?

0.1 mg/kg. ***0.1 mg/kg*** - For **intramuscular (IM) administration** in children, the recommended dose of **midazolam for procedural sedation** is typically **0.1-0.15 mg/kg** (maximum 10 mg). - This dose provides **effective sedation** with a favorable safety profile, minimizing the risk of respiratory depression. - This is the **standard dose cited in pediatric pharmacology** references for IM premedication and sedation. *0.25 mg/kg* - A dose of **0.25 mg/kg** IM is **higher than the standard sedation dose** but may be used in specific contexts such as management of acute seizures. - For routine procedural sedation, this dose is **higher than necessary** and increases the risk of adverse effects including respiratory depression. - This dose approaches the range used for **buccal/intranasal midazolam** in status epilepticus (0.2-0.3 mg/kg). *0.5 mg/kg* - A dose of **0.5 mg/kg** IM is **excessively high** for standard procedural sedation in children. - This dose significantly **exceeds recommended guidelines** and carries substantial risk of profound sedation, respiratory depression, and prolonged recovery time. - Such high doses are **not recommended** for routine IM sedation in pediatric practice. *2.5 mg/kg* - A dose of **2.5 mg/kg** IM would be **dangerously high** and could lead to life-threatening respiratory depression, cardiovascular compromise, and prolonged unconsciousness. - This dosage is **far outside the therapeutic range** and represents a potential fatal overdose in pediatric patients.

Q: What is the drug of choice for acute treatment of febrile seizures?

Diazepam. ***Diazepam*** - **Diazepam** is the drug of choice for the acute treatment of febrile seizures because of its **rapid onset of action** and effectiveness in stopping ongoing seizures [1]. - It is often administered **rectally** or intramuscularly in an emergency setting by parents or caregivers, which is crucial given the urgency of treating a seizure [1]. *Phenobarbitone* - While **phenobarbitone** has anticonvulsant properties, it is typically used for **long-term prophylaxis** in children with recurrent or high-risk febrile seizures, not for acute treatment. - It has a **slower onset of action** and can cause **sedation**, making it less suitable for immediate seizure termination [3]. *Valproate* - **Valproate** is an antiepileptic drug used for various seizure types but is generally **not recommended for acute treatment of febrile seizures** due to its slower onset and potential side effects in young children [2]. - Its use is more relevant in epilepsy management and **long-term seizure prevention**, not as a first-line agent for acute febrile seizure termination [2]. *Carbamazepine* - **Carbamazepine** is primarily used for **focal seizures** and **trigeminal neuralgia** and is not indicated for the acute management of febrile seizures [2]. - It has a **slower onset** and a different mechanism of action that is not optimal for rapidly stopping a febrile seizure.

Question 1

Which of the following statements are correct regarding management of hyperkalemia in a child?
I. Intravenous calcium (gluconate or chloride) is given to enhance cellular uptake of potassium
II. Beta adrenergic agonists (salbutamol or terbutaline) are used to stabilize myocardial cell membrane
III. Regular insulin and glucose given intravenously enhance cellular uptake of potassium
IV. Sodium polystyrene sulfonate enhances total body potassium elimination

Select the answer using the code given below :

Accepted Answer

III and IV

Answer

I and II

Answer

II and III

Answer

I and IV

Question 2

For the treatment of kala-azar, the daily dose of miltefosine in a 3-year-old child who weighs 15 kg is

Accepted Answer

40 mg

Answer

20 mg

Answer

10 mg

Answer

30 mg

Question 3

What is the correct daily dose of Iron and Folic acid to be prescribed to a child aged 12 years?

Accepted Answer

60 mg elemental Iron and 300 mcg folic acid

Answer

30 mg elemental Iron and 250 mcg folic acid

Answer

20 mg elemental Iron and 100 mcg folic acid

Answer

100 mg elemental Iron and 500 mcg folic acid

Question 4

Least teratogenic antiepileptic drug in pregnancy is:

Accepted Answer

Levetiracetam

Answer

Carbamazepine

Answer

Valproate

Answer

Phenytoin

Question 5

Prophylactic dose of Oseltamivir for infants (3-11 months) is?

Accepted Answer

3 mg/kg/day

Answer

5 mg/kg/day

Answer

1 mg/kg/day

Answer

7 mg/kg/day

Question 6

For a child 3-5 months of age with H1N1, treatment Oseltamivir dose is

Accepted Answer

20 mg BD X 5 days

Answer

12 mg BD X 5 days

Answer

25 mg BD X 5 days

Answer

20 mg OD X 5 days

Question 7

American Heart Association standard pediatric dose of amoxicillin for antibiotic prophylaxis, in cases of endocarditis is

Accepted Answer

50mg/kg

Answer

20mg/kg

Answer

125mg/kg

Answer

100mg/kg

Question 8

Newborns as compared to adults eliminate lidocaine:

Accepted Answer

More slowly

Answer

Variable

Answer

More rapidly

Answer

Equally fast

Question 9

What is the recommended intramuscular (IM) dose of midazolam in children?

Accepted Answer

0.1 mg/kg

Answer

0.5 mg/kg

Answer

2.5 mg/kg

Answer

0.25 mg/kg

Question 10

What is the drug of choice for acute treatment of febrile seizures?

Accepted Answer

Diazepam

Answer

Phenobarbitone

Answer

Valproate

Answer

Carbamazepine

Pediatric and Geriatric Pharmacology — MCQs

Pediatric and Geriatric Pharmacology — MCQs

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