2. Commonest: Case scenarios will be given...Drug
therapy will be part of the question.
Which drug is to be used?
Write the Prescription. (weight and age of the child
given)given)
eg: Write drug therapy for a 2yr old male child, 15 kg
with tuberculous meningitis according to IAP
guidelines.
Mention second line drugs if sensitivity results
shows e/o MDR TB.
http://indianpediatrics.net/dec1997/1093.pdfhttp://indianpediatrics.net/dec1997/1093.pdf

3. Drug therapy as a part of standard protocol can
be asked…
eg: Write flow chart for pulseless arrest in a three
year old child following accidental drowning…year old child following accidental drowning…
Tip: Know your PALS, NRP guidelines, IAP
guidelines and flow charts pit pat…. No room for
error.

4. Specific drug can be asked…
Classification, chemical structure, Indication,
dose, side effects, normal drug level…etc.
Tip: Newer drugs like Oseltamivir or drugs with
complicated dosing schedule like digoxin are most
likely.

5. Question on safety of drug in a specific situation
is a possibility..
Pregnancy categories, Breast feeding safety, Use
in G6PD deficient patients..etc.in G6PD deficient patients..etc.
Tip: Harriet Lane handbook gives a good chapter of
“special drug topics” in the end.

6. OSCE question on specific situations involving
use of drugs..
 Post exposure prophylaxis for HIV
 Malaria prophylaxis for travel Malaria prophylaxis for travel
 Therapy for perinatal exposure to maternal
varicella or maternal syphilis…etc.
 Pharmacologic prophylaxis for “H1N1 Novel
flu of Swine origin” contacts.

7. Specific antidote therapy for common drug overdosing with
doses and schedule can be asked…
 Paracetamol
 Opiates
 OPP OPP
 Calcium channel blockers
 Beta blockers
 Digoxin
 Benzodizapines
 Lead poisoning
 Iron toxicity
 Heparin

9.  A 3yr old male child involved in a fall from 4th
floor, injured his back, L4-5 #, with Paraparesis
and other root signs.
 Mention Initial Mainstay medical therapy and
the drug dosage and schedule
Mention Initial Mainstay medical therapy and
the drug dosage and schedule
 Mention 10 common side effects of the same
drug class

10.  IV Methylprednisolone sodium succinate, has
been shown to improve neurologic outcome up
to one year post-injury if administered within
eight hours of injury and in a dose regimen of:
Bolus 30mg/kg over 15 minutes, withBolus 30mg/kg over 15 minutes, with
maintenance infusion of 5.4 mg/kg per hour
infused for 23 hours

11.  Mnemonic: AM CUSHINGOID
 Acne,
Myopathy (prox) / muscle wasting (prox)
Cushingoid / Cataract,
Ulcers,Ulcers,
Striae, Skin thin (bruising),
Hypertension / Hairy,
Infection,
Glycosuria,
Obesity / Osteoporosis / Oedema,
Immunosuppression / Insomnia,
Depression

12. A 4 yr. old girl from Mumbai, 12 kg. had fever
with chills since 3 days, Her reports show Hb.
Of 9 gm%, platelet count of 40,000 / cumm.
Peripheral smear shows shizonts of Pl.
Falcifarum, P.I. of 3 %. Her hemodynamic &Falcifarum, P.I. of 3 %. Her hemodynamic &
resp parameters are stable, Conscious
Mention type of malaria according to WHO
classification
Write 2 alternative therapies according to WHO
guidelines

13.  Uncomplicated Pl.Falciparum malaria

14. Classification: Uncomplicated
http://whqlibdoc.who.int/publications/2006/9241546948_eng_full.pdf

16.  The same child redevelops fever after 12 days
of stopping your prescribed therapy…. Smear
again shows Falcifarum.
 How do we treat? Write the PrescriptionHow do we treat? Write the Prescription
 What is the role of Primaquine in pure
Falcifarum malaria?

19.  This 2-week-old infant, 4 kg, presented with irritability
and emesis.
 The initial heart rate was in the 300-BPM range, and
the infant exhibited grunting and tachypnea.
 DiagnoseDiagnose
 Write prescription for First line pharmacological
therapy, if it fails, what next? Mention technique of
administration
 Mention Contraindications and relative
contraindications for the use of first line therapy
 Mention 2 alternative drugs

20.  Adenosine 0.1 mg/kg (Max 6 mg) rapid bolus: Push
and Flush technique
 If no response
Adenosine 0.2 mg/kg (Max 12 mg) rapid bolus
Contraindications include a deinnervated heart (eg, Contraindications include a deinnervated heart (eg,
transplant) and second- or third-degree heart block.
 Additionally, adenosine can worsen bronchospasm in
asthmatics and increase heart block or precipitate
ventricular arrhythmias in those taking carbamazepine,
verapamil, or digoxin.

21. Alternates:
RightRight AnwsersAnwsers::
 Procainamide (15 mg/kg, IV, over 30–60 min
or at 20–80 mg/kg/min)or at 20–80 mg/kg/min)
 β blockers such as propranolol or esmolol may
be used but with caution because they may
induce hypotension
 Digoxin: but may be proarrythmic in WPW

22. Alternates:
WrongWrong AnwsersAnwsers::
Amiodarone should not be used in newborns during
the first month of life because it contains the
preservative benzyl alcohol that has beenpreservative benzyl alcohol that has been
associated with a gasping syndrome.
Verapamil should be avoided in children less than 1
year of age because cardiovascular collapse and
death can occur

23.  Antiarrhythmics: classification
Mnemonic: I to IV MBA College
 Membrane Stabilisers (Na. channel blockers)
 Beta Blockers Beta Blockers
 Action Potential widening agents
 Calcium channel blockers

24.  IA: Disopyramide, Quinidine, Procainamide (VPC, VT,AF, PAT)
 IB: Lidocaine, Mexilitine (VT, VF, VPC: Only Ventricular
arrythmias)
 IC: Flecainide, Propafenone (Resistant ventricular arrythmias,
High incidence of Mortality in structural heart disease)
Memory joggerMemory jogger
To remember the main differences between what Class IA, Class IB,
and Class IC antiarrhythmics do, just think of their names:
 Class IA: Alters the myocardial cell membrane
 Class IB: Blocks the rapid influx of sodium ions
 Class IC: slows Conduction

25.  Propranolol, Esmolol, Acebutalol (Only Atrial
tachycardias: atrial flutter, atrial fibrillation,
and paroxysmal atrial tachycardia)

26.  Slow repolarization, prolong the refractory period
and duration of the action potential.
Mnemonic: BIAS
 Bretylium
Ibutilide
AmiodaroneAmiodarone
Sotalol
(Amiodarone is the first-line drug of choice for
ventricular tachycardia and ventricular fibrillation.
All are used for only Ventricular arrhythmias)

27.  Verapamil, Diltiazem (supraventricular
arrhythmias with a rapid ventricular response
(rapid heart rate in which the rhythm
originates above the ventricles)
Some calcium channel blockers (diltiazem and Some calcium channel blockers (diltiazem and
verapamil) reduce the heart rate by slowing
conduction through the SA and AV nodes.

28.  Adenosine is an injectable antiarrhythmic
indicated for acute treatment of PSVT, esp. re-
enterant tachycardias involving AV node.
 Adenosine depresses the pacemaker activity of the
SA node, reducing the heart rate and the ability ofSA node, reducing the heart rate and the ability of
the AV node to conduct impulses from the atria to
the ventricles.
Trivia: Neonates on caffeine and heavy coffee
drinkers require higher doses, as caffeine
antagonizes Adenosine.

29. This 7 year old girl, 20 kg, operated with
palliative Bidirectional Glenn shunt for a
DORV needs to undergo a Upper GI scopy for
persistent vomiting.
What advise will you give? She is not allergic to
penicillin, but cannot take orally

32.  If she was to undergo Dental extraction instead
of GI scopy, would your advise change? What
would it be?

34.  If Hypothetically the said patient had an
unrepaired swiss cheese ventricular septal
defect instead of the DORV, and required
dental extraction, what would you advise?

36.  Newer Antifungals-Caspofungin
 Newer antibiotics: Tigicycline, Doripenam,
Etrapenam, Daptomycin, colistin
 Hemodynamic drugs..Must know Hemodynamic drugs..Must know
 Newer Oral chelators: Defasirox (Exjade /
Asundra)

37.  Monoclonal antibodies: Rituximab,
Ofatumumab etc.
 HIV therapy
 Anti tubercular treatment guidelines-MDR-TB Anti tubercular treatment guidelines-MDR-TB
 ALL / Lymphoma protocols
 I.V. Immunoglobulin

39. N-Acetylcystine
 PO
Loading dose: 140 mg/kg PO once
Maintenance dosage (start 4 h after loading dose): 70 mg/kg PO q4h for 17 doses; total
18 doses administered equaling 1330 mg/kg over 72 h
IV (patients >40 kg)
Acute (8-10 h after ingestion)
Loading dose: 150 mg/kg IV infused over 1 h; dilute in 250 mL D5W
First maintenance dose: 50 mg/kg IV infused over 4 h; dilute in 500 mL D5W
Second maintenance dose: 100 mg/kg IV infused over 16 h; dilute in 1000 mL D5WSecond maintenance dose: 100 mg/kg IV infused over 16 h; dilute in 1000 mL D5W
Each infusion immediately follows the previous; total treatment time 21 h
Late presenting or chronic (>10 h after ingestion)
Loading dose: 140 mg/kg IV infused over 1 h; dilute in 500 mL D5W
Maintenance doses: 70 mg/kg IV q4h for at least 12 doses; dilute each dose in 250 mL of
D5W and infuse over minimum 1 h; total treatment time 48 h
Decrease total volume of D5W if fluid restriction required

40. Atropine (Isopto, Atropair)
 Initiated in patients with OP toxicity who present with muscarinic
symptoms.
The endpoint for atropinization is dried pulmonary secretions and
adequate oxygenation. Tachycardia and mydriasis must not be used to
limit or to stop subsequent doses of atropine.
0.05 mg/kg IV, repeat q1-5min prn for control of airway secretions
Strongly consider doubling each subsequent dose to rapidly stabilizeStrongly consider doubling each subsequent dose to rapidly stabilize
patients with severe respiratory distress
PAM (Pralidoxime)
20-40 mg/kg in 100 mL isotonic sodium chloride soln/D5W IV over 15-30
min; repeat in 1-2 h if muscle weakness not relieved; repeat q10-12h prn
to relieve cholinergic symptoms
Other dosing regimens have been used, including continuous drip; start
with bolus of 25-50 mg/kg (up to 2 g); then 10-20 mg/kg/h (up to 500mg)