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401 Quiz Pediatrics - Dr. Kraus November 3, 2003

The year is 2005 and you work at Andrew's Hospital in Mayberry, Illinois. You receive medication orders for patient AR. AR is a 3 week old male, born at 40 weeks gestational age, who was receiving ampicillin and gentamicin for r/o sepsis. Current weight = 5 kg; Scr = 0.2 mg/dl. The MD now suspects Pseudomonas sepsis and writes the following orders: Discontinue Gentamicin Discontinue Ampicillin 1. Start Tobramycin: dosing per pharmacy Start Piperacillin 250 mg IV q 6 hours

/ (4 points) What is your assessment of the piperacillin order for AR and what should be done next ? (see piperacillin dosing guidelines below) The dose is too low. The doctor should be called and told about the problem. A dose of 600 mg IV q 6 hours should be recommended. B. The dose is too high. The doctor should be called and told about the problem. A dose of 250 mg IV q 8 hours should be recommended. C. The dose is too high. The doctor should be called and told about the problem. A dose of 150 mg IV q 6 hours should be recommended. D. The dose is too low. The doctor should be called and told about the problem. A dose of 1000 mg IV q 6 hours should be recommended.. E. The dose is correct. The medication should be dispensed as written. A.

2. (4 pts) 2 days later, AR develops renal dysfunction. Estimated Clcr = 30 ml/min. What dose of piperacillin now recommended? A. 1000 mg IV Q8H B. 250 mg IV Q8H C. 500 mg IV Q12H D. 150 mg IV Q8H E. 250 mg IV Q12H Interval extention method (NL = 250 Q6H, so now new dose is Q8H) Piperacillin Usual Dosage: I.M., I.V.: Neonates: < 7 days: 150 mg/kg/day divided every 8 hours ; >7 days: 200 mg/kg/day divided every 6 hours Infants and children: 200-300 mg/kg/day divided doses every 4-6 hours; maximum dose: 24 g/day Higher doses have been used in cystic fibrosis: 350-500 mg/kg/day in divided doses every 4 hours Adults: 2-4 g/dose every 4-8 hours; maximum dose: 24 g/day

Dosing Interval in renal impairment: Clcr 20-40 ml/min: Administer Q8H Clcr <20 ml/min: Administer Q12H

Later that same day, AR's blood cultures (drawn 2 days ago) come back positive for Pseudomonas aeruginosa, sensitive to tobramycin, piperacillin, and krausomycin (pronounced kraus-o-mycin). The MD asks you about the use of krausomycin in this patient. He's heard about the drug and its use in adults and wants to know if he could use it in this patient. Since you keep up with all the new drugs, you know the following information about Krausomycin: * The drug is acidic * It is metabolized by the P-450 enzyme system via hydroxylation and glucuronide conjugation * The drug is available both as po and IV preparations * The oral preparation contains benzyl alcohol * There are no published studies in newborns, neonates or infants 3. ( 4 points) Which of the following would be true about the use of krausomycin in this patient ? A. B. The oral preparation would be safer to use than the IV The drug's oral bioavailability would be increased C. The expected maintenance dose per kg would be higher than that recommended in adults. The expected maintenance dose per kg would be lower than that recommended in adults. The expected maintenance dose per kg would be the same as recommended in Adults

AR is now 4 months old and comes to your outpatient clinic for a routine checkup. He is diagnosed with a left otitis media and prescribed high-dose oral amoxicillin / clavulanic acid (Augmentin) suspension. 4. ( (4 points) Which of the following devices is not recommended to deliver oral liquid x medications because choking and acute life threatening events may occur if the cap is not removed ? Rx Medibottle , Oral medication Syringe, Injectable syringe, Graduated medicine spoon, Medicine dropper

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