Commonest: Case scenarios will be given...Drug
therapy will be part of the question.
Which drug is to be used?
Write the P...
Drug therapy as a part of standard protocol can
be asked…
eg: Write flow chart for pulseless arrest in a three
year old ch...
Specific drug can be asked…
Classification, chemical structure, Indication,
dose, side effects, normal drug level…etc.
Tip...
Question on safety of drug in a specific situation
is a possibility..
Pregnancy categories, Breast feeding safety, Use
in ...
OSCE question on specific situations involving
use of drugs..
 Post exposure prophylaxis for HIV
 Malaria prophylaxis fo...
Specific antidote therapy for common drug overdosing with
doses and schedule can be asked…
 Paracetamol
 Opiates
 OPP ...
 A 3yr old male child involved in a fall from 4th
floor, injured his back, L4-5 #, with Paraparesis
and other root signs....
 IV Methylprednisolone sodium succinate, has
been shown to improve neurologic outcome up
to one year post-injury if admin...
 Mnemonic: AM CUSHINGOID
 Acne,
Myopathy (prox) / muscle wasting (prox)
Cushingoid / Cataract,
Ulcers,Ulcers,
Striae, Sk...
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 ...
 Uncomplicated Pl.Falciparum malaria
Classification: Uncomplicated
http://whqlibdoc.who.int/publications/2006/9241546948_eng_full.pdf
 The same child redevelops fever after 12 days
of stopping your prescribed therapy…. Smear
again shows Falcifarum.
 How ...
 This 2-week-old infant, 4 kg, presented with irritability
and emesis.
 The initial heart rate was in the 300-BPM range,...
 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) ra...
Alternates:
RightRight AnwsersAnwsers::
 Procainamide (15 mg/kg, IV, over 30–60 min
or at 20–80 mg/kg/min)or at 20–80 mg/...
Alternates:
WrongWrong AnwsersAnwsers::
Amiodarone should not be used in newborns during
the first month of life because i...
 Antiarrhythmics: classification
Mnemonic: I to IV MBA College
 Membrane Stabilisers (Na. channel blockers)
 Beta Block...
 IA: Disopyramide, Quinidine, Procainamide (VPC, VT,AF, PAT)
 IB: Lidocaine, Mexilitine (VT, VF, VPC: Only Ventricular
a...
 Propranolol, Esmolol, Acebutalol (Only Atrial
tachycardias: atrial flutter, atrial fibrillation,
and paroxysmal atrial t...
 Slow repolarization, prolong the refractory period
and duration of the action potential.
Mnemonic: BIAS
 Bretylium
Ibut...
 Verapamil, Diltiazem (supraventricular
arrhythmias with a rapid ventricular response
(rapid heart rate in which the rhyt...
 Adenosine is an injectable antiarrhythmic
indicated for acute treatment of PSVT, esp. re-
enterant tachycardias involvin...
This 7 year old girl, 20 kg, operated with
palliative Bidirectional Glenn shunt for a
DORV needs to undergo a Upper GI sco...
 If she was to undergo Dental extraction instead
of GI scopy, would your advise change? What
would it be?
 If Hypothetically the said patient had an
unrepaired swiss cheese ventricular septal
defect instead of the DORV, and req...
 Newer Antifungals-Caspofungin
 Newer antibiotics: Tigicycline, Doripenam,
Etrapenam, Daptomycin, colistin
 Hemodynamic...
 Monoclonal antibodies: Rituximab,
Ofatumumab etc.
 HIV therapy
 Anti tubercular treatment guidelines-MDR-TB Anti tube...
N-Acetylcystine
 PO
Loading dose: 140 mg/kg PO once
Maintenance dosage (start 4 h after loading dose): 70 mg/kg PO q4h fo...
Atropine (Isopto, Atropair)
 Initiated in patients with OP toxicity who present with muscarinic
symptoms.
The endpoint fo...
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  1. 1. 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
  2. 2. 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.
  3. 3. 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.
  4. 4. 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.
  5. 5. 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.
  6. 6. 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
  7. 7.  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
  8. 8.  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
  9. 9.  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
  10. 10. 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
  11. 11.  Uncomplicated Pl.Falciparum malaria
  12. 12. Classification: Uncomplicated http://whqlibdoc.who.int/publications/2006/9241546948_eng_full.pdf
  13. 13.  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?
  14. 14.  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
  15. 15.  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.
  16. 16. 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
  17. 17. 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
  18. 18.  Antiarrhythmics: classification Mnemonic: I to IV MBA College  Membrane Stabilisers (Na. channel blockers)  Beta Blockers Beta Blockers  Action Potential widening agents  Calcium channel blockers
  19. 19.  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
  20. 20.  Propranolol, Esmolol, Acebutalol (Only Atrial tachycardias: atrial flutter, atrial fibrillation, and paroxysmal atrial tachycardia)
  21. 21.  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)
  22. 22.  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.
  23. 23.  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.
  24. 24. 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
  25. 25.  If she was to undergo Dental extraction instead of GI scopy, would your advise change? What would it be?
  26. 26.  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?
  27. 27.  Newer Antifungals-Caspofungin  Newer antibiotics: Tigicycline, Doripenam, Etrapenam, Daptomycin, colistin  Hemodynamic drugs..Must know Hemodynamic drugs..Must know  Newer Oral chelators: Defasirox (Exjade / Asundra)
  28. 28.  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
  29. 29. 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
  30. 30. 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)
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