1. Treatment of influenza A and B 1n patients >1 year of age, who have been symptomatic for not more than 2 days. Also used for prophylaxis

• . Neuraminidase inhibitor, prevents new viral particles from being released by infected cells.
• . By weight:

<15 kg: 30 mg BD for 5 days

15-23 kg: 45 mg BD for 5 days

24—40 kg: 60 mg BD for 5 days

40 kg: 75 mg BD for 5 days

For infants:

<3 mon: 12 mg BD for 5 days

3-5 mon: 20 mg BD for 5 days

6-11 mon: 25 mg BD for 5 days

• Probenazid.
• 5. Live attenuated influenza vaccine, intranasal.

— . MOA—inhibits inosine monophosphate (IMP) dehydrogenase, that is important for DNA formation

• . Indications: Nephrotic syndrome, SLE, rheumatoid arthnts, inflammatory bowel disease—Crohn's disease, ITP, myasthenia gravis, polymyositis, dermatomyositis, autoimmune hepatitis.
• . Dose: 40 to 50 mg/kg/day or 400-800 mg/m* twice daily
• . Serious adverse effects'
  • * Blood dyscrasias—leukopemia/pure red cell aplasia
  • * GI bleed /perforation/ ulcers
• . Drug interactions: Azathioprine, cholestyramine, norfloxacin, metronidazole, rifampicin, cyclosporin

. Oxazolidinones

• ho oi i Gram-positive organisms including MESA

Penicillin-resistant pneumococci

• * Gram-negative anaerobes
• * Mycobacteria
• . 10 mg/kg/dose 8 hourly
• . Multresistant gram-positive orgarusms, including MRSA who have failed to respond to vancomycin.

—_ . Parental nutrition

• 2. Dose 0.5-3.5 g/kg/day
• . When enteral nutrition is insufficient or contraindicated Day 1
• . Dyselectronemia, cholestasis, bacterial or fungal colonisation and sepsis, thrombosis, azotemia, thrombocytopenia

ee . PICC (peripheal inserted central catheter)

• . Preserves veins, allows concentrated infusates, permits long-term IV alrmentaton

• 3. 6 complications
  • * Catheter fracture and embolisation,
  • * Leakage
  • * Thrombosis of catheter
  • * Accidental displacement/hp migrahon
  • * Deep venous thrombosis
  • * Infection

Ans. 6. 1. Self mflating 250 ml AMBU-bag

• 2. Oxygen, air inlet, patient outlet, valve assembly, oxygen reservoir and pressure release valve.
• 3. Gasping/ apneic infant, cyanosis inspite of free flow oxygen and HR <100/m 30 sec after initial steps.
• 4. MSAF and suspected congenital diaphragmatic herma.
• 5. Wash with detergent and hot water. Dry thoroughly. If visibly soled with blood / body fluids, clean and send to central sterilization department.

Ans. 7. 1. Surfactant

• 2. ml/kg first dose than may again at 2 mg/kg/dose
• 3. Surfactant replacement therapy for prevention and treatment of RDS in preterms.
• 4. Survanta should not be removed from the refrigerator for more than 24 hours and it should not be warmed and returned to the refrigerator more than once.
  • * Donotsuction the imfant for 1 hour after dosing unless signs of sigmuficant airway obstruction occur.
  • * Marked improvements in oxygenation and decrease in lung complance may occur within munutes of admimustration of SURVANTA. Therefore, frequent and careful climucal observation and monitoring
  • * Do not shake the vial.

Ans. 8.

Surfactant	Source	Dose	Dose interval	Max doses
Survanta	Bovine	4ml/kg	6	4
Infasurf	Calf	a	12	4
Curosurf	Porcine	2.5	abs	3
Neosurf	Bovine	5	6	3

Ans. 9. 1. Double lumen endotracheal tube

• 2. For surfactant instillation
  • To aid lung lavage
• 3. Permits efficient drug instillation without interrupting ventilation

Ans. 10.1. Bubble CPAP apparatus

• 2. Indications
  • * If FiO, requirement is >0.3
  • * SA score >4
  • * ABG score >3 on oxygen therapy
  • * Frequent apnea with documented hypoxemia

• * Clinically significant chest retractions after extubation from mechanical ventilation

• . Complications

  • « Aur leak * Reduced venous return
  • « IVH

Ans. 11.1. Carbapenems

• 2 Widest spectrum of antimicrobial activity among the B-lactam antibiotics against both gm-ve and gm + organisms except MRSA.
• . 20-40 mg/kg/dose 8-12 hourly
• . Transient agranulocytosis, thrombocytopenia. Seizures

. Methylxanthine

• Respiratory centre stimulation, antagonism of adenosine, mcreased diaphragm contractility
• Apnea of prematurity
• Lading dose 20 mg/kg IV followed by 5-12 mg/kg
• Cardiac arrhythmma, tachycardia, irritability
• Pulmonary vasodilatation and attenuates hypoxic vasoconstriction of pulmonary blood vessel
  • Decrease in the cardiac output
  • Betal agonist
  • Betal > beta2 > alpha
  • No effect on HR, PVR and BP
  • 1-20 pg/kg /mun
• Rituximab-monoclonal antibody CD20
  • Non-Hodgkin's lymphoma (NHL), (ALL), Hodgkin's lymphoma (HL), Chronic ITP, SLE, nephrotic syndrome, JIA.
  • . Diluted in NS, D5 to achieve final concentration of 1-4 mg/ml premedication 4% hour prior with paracetamol, antihistamiruc, corticosteroid started with 50 mg/ hour, then stepped up by 50 mg/hour every half hourly
  • . Infusion reactions, B cell depletion, cardiovascular reactions, kidney failure, tumor lysis syndrome

Ans. 15, 1. Indications

• a. Transposition of the great vessels

• b. Lesions with ductal dependent pulmonary blood flow—TOF, PS, pulmonary atresia, tricuspid atresia, Ebstein's anomaly

• c. Lesions with ductal dependent systemic blood flow—A5S, COA, hypoplastic left heart syndrome, interrupted aortic arch.

• . Adverse effects

  • 1 Apnoea; 2. Hypotension; 3. Hyperthermia (transient); 4 Hypoglycaemia;
  • 5. Cortical proliferation of the long bones.

• . Monitoring

  • * Observe respiratory effort closely
  • * Monitor arterial pressure closely.

• * Watch for apnea

• * Watch for bleeding diathesis

• Gama aminobutyric acid, transaminase inhibitor

  • . 30 mg/kg/d, OD/BD up to 100 mg/kg/d
  • . Visual field constriction, optic atrophy, optic neuritis
  • . Infantile spasms, tuberous sclerosis adjuvant for poorly controlled seizures
• 1. Spirometry

• in. To differentiate obstructive in restrictive respiratory diseases.

• m. FVC and FeV1

• iv. FVC, FEV1 both low—trestrictive

FVC-N FEV1 Low—obstructive

FVC low FEV1 very low—mixed diseases.

• 1. Ca gluconate 10% (1 ml = 9 mg elemental Ca)
• ii. Do not mix with HCO,
• 11. Bradycardia, asystole and sclerosis

Ans. 18. 1. Anti-arrhythmic

2. IV/1O:

First dose—0.1 mg/kg rapid push (max 6 mg Second dose—0.2 mg/kg rapid push (max 12 mg)

. MOA

Interrupt re-entry pathway stimulate adenosine receptor depress sinus node automaticity

• Giving via central route, rapid push, ECG monitoring continue
• Theophylline is adenosine receptor antagonist so decrease its effectiveness
• BP, ECG
• 10 sec
• dizziness, numbness, blurred vision
• Urine
• 6mg/2 ml
• . Class I anti-arrhythnue
  • . SVT, VT with pulse, pulse less arrest
  • . 50 mg/ml
  • . IV/IO—5 mg/kg over 20 minute (max 300 mg), repeat to max daily dose 15 mg/ kg
  • neuropathy . Pulmonary fibrosis, hypothyroidism, hypotension, hyperthyroidism, peripheral
  • . Sinus node dysfunction, 2 and 3 degree AV block

Ans. 20.1. A: Croup, asthma, cerebral edema

B: Adrenal insufficiency, persistent hypoglycemia

C Asthma, anaphylactic shock

2 A: PO/IM/IV

B: IV/1IO

C:IV/IM/1O

• 3. A: 1 hour, B 0-30 minutes
• 4, Croup—0.6 mg/kg (max 16 mg) Cerebral edema—1-2 mg/kg (max 16 mg)

Ans. 21.

Drug	Epinephrine	Dobutamine
1. Class	Catecholamine inotrope, vasopressure	Catecholamine inotrope, vasopressure
2. Indication	Cardiogenic, distributive shock, anaphylactic, NRP	Shock, asthma, croup, pulseless arrest, blocker toxicity
3. Available form	IV: 40 mg/ml	Img/ml
4. Doses	NRP: .13 mg/kg Shock: 2-20 pg/kg /min	Shock: 0.1-1 pg/kg /min Asthma: 0.01 mg/kg IM/SC
5. Action	Alpha—increase SVR fl—increase HR f2—low SVR
6. Max infusion rate	20 pe /ke/min

No model answer in source material.

No model answer in source material.

No model answer in source material.

No model answer in source material.

No model answer in source material.

No model answer in source material.

No model answer in source material.

No model answer in source material.

No model answer in source material.

No model answer in source material.

No model answer in source material.

No model answer in source material.

No model answer in source material.

No model answer in source material.

No model answer in source material.