Paeds Vivas · clinical-pharmacology-and-therapeutics
Developmental pharmacology and age-related pharmacokinetics — branching viva
Viva on ADME ontogeny across paediatric development, the classic neonatal toxicities, and the principles of maturation-adjusted paediatric prescribing.
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Target exams
RACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
A 7-day-old term neonate weighing 3.4 kg becomes apnoeic shortly after a weight-based morphine infusion is started for post-operative pain; the infusion has been stopped and the baby is dusky with a pulse; the registrar has used an adult morphine chart rather than the paediatric formulary.
Opening (candidate)
My first priority is the baby. I would support the airway and breathing with bag-mask ventilation, give naloxone titrated to respiratory effort, and call for senior paediatric and neonatal help. I would keep the infusion stopped and preserve the syringe and the original order, and I would check whether any other child is on the same protocol. Once the baby is safe I would escalate to the consultant, report the incident, and speak with the family honestly. [1] [5]
References5ShowHide
- [1]Kearns GL Developmental pharmacology--drug disposition, action, and therapy in infants and children. N Engl J Med, 2003.PMID 13679531
- [2]Hines RN The ontogeny of drug metabolism enzymes and implications for adverse drug events. Pharmacol Ther, 2008.PMID 18406467
- [4]de Wildt SN Drug metabolism for the paediatrician. Arch Dis Child, 2014.PMID 25187498
- [5]van den Anker J Considerations for Drug Dosing in Premature Infants. J Clin Pharmacol, 2021.PMID 34185893
- [7]Anderson BJ Mechanistic basis of using body size and maturation to predict clearance in humans. Drug Metab Pharmacokinet, 2009.PMID 19252334