Pediatric and Geriatric Pharmacology Practice Questions

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: A pediatrician was called for attending a new born baby in the labour ward. The serum unconjugated bilirubin of this baby was 33 mg/dL. Which of the following drug taken by mother in late 3rd trimester may have led to this problem?

Cotrimoxazole. ***Cotrimoxazole*** - **Cotrimoxazole** (trimethoprim-sulfamethoxazole) can displace **bilirubin** from albumin-binding sites in the newborn, leading to increased levels of **unconjugated bilirubin** and a higher risk of kernicterus. - Sulfonamides, a component of cotrimoxazole, are known to interfere with **bilirubin metabolism** and transport in neonates, particularly when taken by the mother late in pregnancy. *Ampicillin* - **Ampicillin** is a penicillin-class antibiotic generally considered safe during pregnancy and is not known to cause significant neonatal **hyperbilirubinemia**. - Its mechanism of action does not involve competition for **albumin-binding sites** with bilirubin. *Azithromycin* - **Azithromycin** is a macrolide antibiotic commonly used in pregnancy and does not have a recognized association with significant **unconjugated hyperbilirubinemia** in newborns. - It does not significantly affect the **bilirubin-albumin binding** in neonates. *Chloroquine* - **Chloroquine** is an antimalarial drug, and while generally avoided in the first trimester, it has not been linked to severe neonatal **hyperbilirubinemia** similar to that caused by sulfonamides. - Its primary **side effects** in newborns are not related to bilirubin displacement.

Q: Which of the following statements about the rotavirus vaccine is true?

It is an oral pentavalent vaccine.. ***It is an oral pentavalent vaccine.*** - Rotavirus vaccines are **oral vaccines** that provide protection against rotavirus infection, a common cause of **severe diarrhea** in infants and young children. - **RotaTeq** is a **pentavalent live attenuated vaccine** containing five reassortant strains (G1, G2, G3, G4, and P1A) to induce a broad immune response. - **Rotarix** is a monovalent live attenuated vaccine containing one strain (G1P[8]). - Both vaccines are oral and live attenuated, but the statement correctly describes RotaTeq specifically. *It is a killed vaccine.* - The rotavirus vaccines currently in use (both RotaTeq and Rotarix) are **live attenuated vaccines**, not killed vaccines. - Live attenuated vaccines contain weakened versions of the virus that replicate in the host to stimulate an immune response without causing disease. *It is administered subcutaneously.* - The rotavirus vaccine is administered **orally**, typically dropped into the infant's mouth. - This route of administration is preferred for enteric infections like rotavirus, as it can induce **mucosal immunity** in the gastrointestinal tract. *It should be given after 5 years.* - The rotavirus vaccine is recommended for **infants and young children**, with the first dose typically given between **6 and 14 weeks of age**. - Catch-up vaccination is generally not recommended after 8 months of age, and the vaccine is not indicated for children over 5 years.

Q: Which drug is considered safest for treating latent tuberculosis in pregnancy?

INH. ***INH (Isoniazid)*** - **Isoniazid (INH)** is considered the **safest and preferred agent** for treating **latent tuberculosis infection (LTBI)** in pregnant women. - It can be given as a **6-9 month daily regimen** with **pyridoxine (vitamin B6)** supplementation to prevent maternal and fetal **peripheral neuropathy**. - Well-studied with extensive safety data in pregnancy (FDA Category A/C depending on source, but generally considered safe). *Rifampicin* - While generally safe in pregnancy for **active TB**, its use for **LTBI** is often deferred or avoided, particularly in the first trimester, due to theoretical concerns. - **Rifampicin** can interact with other medications through hepatic enzyme induction, which might be a consideration for pregnant women on multiple therapies. - Not the first-line choice for LTBI monotherapy in pregnancy. *Ethambutol* - **Ethambutol** is primarily used in **multi-drug regimens** for **active tuberculosis** and is less commonly used alone for **LTBI**. - Although generally considered safe in pregnancy, **INH** remains the preferred monotherapy for LTBI treatment due to more extensive safety data. *Streptomycin* - **Streptomycin** is **contraindicated during pregnancy** due to significant risk of **ototoxicity** (damage to cranial nerve VIII) in the fetus, leading to **permanent congenital deafness**. - It is an **aminoglycoside antibiotic** and should be avoided in pregnant women unless absolutely necessary for life-threatening conditions with no other alternatives.

Q: A pregnant lady in the third trimester is visiting a chloroquine-resistant malaria endemic area. Which drug is considered safe for her in terms of malaria prophylaxis?

Mefloquine. ***Mefloquine*** - **Mefloquine** is generally considered safe for malaria prophylaxis in pregnant women, especially during the second and third trimesters. - It is an effective drug against **chloroquine-resistant malaria** and has good tolerability in this population. *Doxycycline* - **Doxycycline** is contraindicated in pregnancy, particularly during the second and third trimesters, due to its potential to cause **fetal skeletal and dental abnormalities**. - It can lead to permanent tooth discoloration and inhibit bone growth in the fetus. *Atovaquone/Proguanil* - **Atovaquone/Proguanil** is generally not recommended for malaria prophylaxis during pregnancy due to **limited safety data**. - While animal studies have not shown significant teratogenicity, its use is usually reserved for situations where other safer options are unavailable or unsuitable. *Primaquine* - **Primaquine** is contraindicated in pregnancy because it can cause **hemolytic anemia** in the fetus if the fetus has **glucose-6-phosphate dehydrogenase (G6PD) deficiency**. - Its use is specifically avoided in pregnancy to prevent this risk.

Q: A newborn was given a drug in the neonatal ICU, but then was found in respiratory distress. The likely drug is?

Morphine. ***Morphine*** - **Morphine** is an opioid that can cause **respiratory depression** as a significant side effect, especially in neonates who have immature metabolic pathways. - Neonates have a reduced capacity to metabolize and excrete opioids, leading to prolonged effects and a higher risk of **respiratory distress**. *Naloxone* - **Naloxone** is an opioid antagonist used to **reverse opioid overdose** and respiratory depression. - Administering naloxone would improve, not worsen, respiratory distress if it were opioid-induced. *Salbutamol* - **Salbutamol** is a beta-agonist used to **dilate airways** and treat bronchospasm, which would typically improve breathing. - It is not known to cause respiratory distress; rather, it's used to alleviate it in conditions like asthma or bronchiolitis. *Sodium bicarbonate* - **Sodium bicarbonate** is used to treat **metabolic acidosis**, which can sometimes be associated with respiratory issues but does not directly cause respiratory distress itself. - Its primary action is to buffer excess acid in the blood, and while it might impact respiratory drive indirectly, it is not a direct cause of respiratory depression.

Q: A drug is more likely to cause toxicity in elderly patients due to all of the following reasons except which of the following?

decreased volume of distribution. ***decreased volume of distribution*** - A **decreased volume of distribution** would generally lead to a higher peak plasma concentration for a given dose, potentially increasing drug effect and thus toxicity, particularly for **hydrophilic drugs**. - However, for drugs that primarily distribute into **fat** or have a large volume of distribution, age-related changes in body composition (e.g., increased body fat, decreased total body water) can actually lead to an **increased volume of distribution** for some lipophilic drugs. *decreased renal excretion of drugs* - **Aging** is associated with a decline in **glomerular filtration rate (GFR)** and **renal tubular function**, leading to reduced drug clearance. - This results in a longer **half-life** and accumulation of renally excreted drugs, increasing the risk of **toxicity**. *decreased hepatic metabolism* - Liver size, blood flow, and the activity of some **cytochrome P450 enzymes** may decrease with age. - This leads to reduced **first-pass metabolism** and slower systemic clearance of many hepatically metabolized drugs, increasing their **bioavailability** and plasma concentrations. *increased receptor sensitivity* - Elderly patients often exhibit altered **pharmacodynamic responses**, including **increased sensitivity** to certain drugs. - This means a lower concentration of the drug at the receptor site can produce a greater therapeutic or toxic effect, making them more susceptible to **adverse drug reactions**.

Question 1

A 3-year-old child presents with febrile seizures. All of the following are correct about rectal administration of diazepam except:

Accepted Answer

With child on side separate the buttocks and insert lubricated tubing up to distance of 5 cm and inject the drug

Answer

Rate of drug delivery can be controlled

Answer

Attach soft plastic tube to syringe and push diazepam as prescribed

Answer

Remove tubing and hold buttock together

Question 2

Newborns as compared to adults eliminate lidocaine:

Accepted Answer

More slowly

Answer

Variable

Answer

More rapidly

Answer

Equally fast

Question 3

A pediatrician was called for attending a new born baby in the labour ward. The serum unconjugated bilirubin of this baby was 33 mg/dL. Which of the following drug taken by mother in late 3rd trimester may have led to this problem?

Accepted Answer

Cotrimoxazole

Answer

Ampicillin

Answer

Azithromycin

Answer

Chloroquine

Question 4

Which of the following statements about the rotavirus vaccine is true?

Accepted Answer

It is an oral pentavalent vaccine.

Answer

It is a killed vaccine.

Answer

It is administered subcutaneously.

Answer

It should be given after 5 years.

Question 5

Which drug is considered safest for treating latent tuberculosis in pregnancy?

Accepted Answer

INH

Answer

Rifampicin

Answer

Ethambutol

Answer

Streptomycin

Question 6

A pregnant lady in the third trimester is visiting a chloroquine-resistant malaria endemic area. Which drug is considered safe for her in terms of malaria prophylaxis?

Accepted Answer

Mefloquine

Answer

Doxycycline

Answer

Atovaquone/Proguanil

Answer

Primaquine

Question 7

A newborn was given a drug in the neonatal ICU, but then was found in respiratory distress. The likely drug is?

Accepted Answer

Morphine

Answer

Naloxone

Answer

Salbutamol

Answer

Sodium bicarbonate

Question 8

A drug is more likely to cause toxicity in elderly patients due to all of the following reasons except which of the following?

Accepted Answer

decreased volume of distribution

Answer

decreased renal excretion of drugs

Answer

decreased hepatic metabolism

Answer

increased receptor sensitivity

Pediatric and Geriatric Pharmacology — MCQs

Pediatric and Geriatric Pharmacology — MCQs

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