I am med student doing mbbs in 4th year .. their is my pediatrics prac

I am med student doing mbbs in 4th year .. their is my pediatrics practical exam tommarow in viva their are drugs for spotting .. so I will tell u drug and you tell me what are it indication , dose, and diseases , in short

Ready! Go ahead and tell me the drug name - I'll give you a quick, exam-focused breakdown of:

Indication (what it's used for in pediatrics)
Dose (pediatric dose)
Key diseases it treats

Fire away!

Neostigmin

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Neostigmine - Exam Summary

Class: Anticholinesterase (reversible) - inhibits acetylcholinesterase → increases ACh at neuromuscular junction and muscarinic receptors

Indications & Diseases

Use	Details
Myasthenia Gravis	Main use - both diagnosis and treatment
Reversal of NMB	Reverses non-depolarizing neuromuscular blockers (e.g. vecuronium, pancuronium) post-op
Ogilvie's syndrome	Acute colonic pseudo-obstruction
Snake bite (neurotoxic)	Cobra & Russell's viper - reverses neuroparalysis
Urinary retention	Post-op non-obstructive urinary retention

Pediatric Doses

Indication	Route	Dose
MG Diagnosis	IM	0.025-0.04 mg/kg x 1 (give atropine before!)
MG Treatment	IM/IV/SC	0.01-0.04 mg/kg/dose Q2-4 hr PRN
NMB Reversal	IV	0.03-0.07 mg/kg/dose (max 5 mg)
Snake bite	IM	0.04 mg/kg (with atropine 0.01 mg/kg)

Key Viva Points

Always give with Atropine (0.011 mg/kg) to block muscarinic side effects
Does NOT cross BBB (quaternary amine) - no CNS effects
Contraindicated in GI obstruction, urinary obstruction
Side effects = SLUDGE: Salivation, Lacrimation, Urination, Defecation, GI cramps, Emesis
Antidote for overdose = Atropine
For NMB reversal - works on non-depolarizing blockers only (NOT succinylcholine)

(Source: Harriet Lane Handbook, 23rd ed.)

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Paracetamol

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Paracetamol (Acetaminophen) - Exam Summary

Class: Analgesic + Antipyretic (NOT anti-inflammatory)

Mechanism: Inhibits prostaglandin synthesis centrally (COX inhibition in CNS) - exact mechanism still debated

Indications & Diseases

Indication	Notes
Fever	Drug of choice for fever in children
Mild-moderate pain	Headache, post-vaccination pain, teething
Patent Ductus Arteriosus (PDA)	When NSAIDs are contraindicated or failed
Post-op analgesia	IV form used

Pediatric Doses

Oral / Rectal (PO/PR):

Neonates: 10-15 mg/kg/dose Q4-6 hr (max 75 mg/kg/24 hr)
Children: 10-15 mg/kg/dose Q4-6 hr (max 75 mg/kg/24 hr or 4 g/24 hr)
Do NOT exceed 5 doses in 24 hours

Quick age-based dose table (PO/PR):

Age	Dose
0-3 months	40 mg
4-11 months	80 mg
1-2 years	120 mg
2-3 years	160 mg
4-5 years	240 mg
6-8 years	320-325 mg
9-10 years	325-400 mg
11 years	480-500 mg

IV dose:

Neonates (≥32 wk, ≤28 days): 12.5 mg/kg Q6 hr
Infant ≥29 days to <2 yr: 15 mg/kg Q6 hr
Child 2-12 yr: 15 mg/kg Q6 hr (max 75 mg/kg/24 hr)
Adult <50 kg: max 3750 mg/24 hr | Adult ≥50 kg: max 4000 mg/24 hr

PDA dose: 15 mg/kg Q6 hr IV/PO x 3 days

Key Viva Points

NO anti-inflammatory activity - key difference from NSAIDs/aspirin
Toxic dose: ≥150 mg/kg (single ingestion) - causes liver necrosis
Antidote: N-Acetylcysteine (NAC)
Rumack-Matthew nomogram - used to assess toxicity risk
Avoid in G6PD deficiency (caution)
Hepatotoxicity risk increases with chronic alcohol, phenytoin, rifampicin (CYP 2E1 inducers)
Preferred over aspirin in children (aspirin avoided - risk of Reye's syndrome)
Safe in asthma (unlike NSAIDs)

(Source: Harriet Lane Handbook, 23rd ed.)

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Adrenaline bitrate

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Got all the data needed. Here's your viva answer:

Adrenaline (Epinephrine) - Exam Summary

Also called: Epinephrine HCl / Adrenaline bitartrate Class: Catecholamine - acts on α1, α2, β1, β2 adrenergic receptors

Indications & Diseases

Indication	Key Point
Anaphylaxis	Drug of CHOICE - first line
Cardiac arrest / Asystole / Pulseless arrest	PALS algorithm
Bronchospasm / Severe asthma	Bronchodilation via β2
Croup (nebulized)	Racemic or L-epinephrine
Bradycardia	Unresponsive to atropine
Septic/cardiogenic shock	IV infusion
Local anesthetic adjunct	Prolongs duration, reduces bleeding

Pediatric Doses

1. Anaphylaxis (IM - anterolateral thigh - preferred route):

Child/Adolescent: 0.01 mg/kg IM, max 0.3 mg (prepubertal) / 0.5 mg (adolescent), Q5-15 min PRN
EpiPen: 7.5-<30 kg → 0.15 mg | ≥30 kg → 0.3 mg

2. Cardiac arrest (IO/IV):

Neonate: 0.01-0.03 mg/kg of 1:10,000 solution Q3-5 min
Child: 0.01 mg/kg of 1:10,000 (0.1 mL/kg) IO/IV, max 1 mg, Q3-5 min
ET route: 0.1 mg/kg of 1:1,000 solution Q3-5 min

3. Bronchospasm (SC):

Infant/Child: 0.01 mL/kg/dose SC (1:1000), max 0.5 mL, Q15 min x 3-4 doses

4. IV infusion (shock/low cardiac output):

All ages: 0.1-1 mcg/kg/min - titrate to effect

5. Croup (nebulized):

Racemic epinephrine 2.25%: 0.05 mL/kg/dose (max 0.5 mL) in 3 mL NS
L-epinephrine (1:1000): 0.5 mL/kg/dose (max 5 mL) nebulized

Key Viva Points

Concentration trick:
- 1:1,000 = 1 mg/mL → used IM/SC/nebulized
- 1:10,000 = 0.1 mg/mL → used IV/IO (cardiac arrest)
Route of choice for anaphylaxis = IM into anterolateral thigh (NOT SC, NOT deltoid)
Do NOT give high-dose epi in cardiac arrest - not shown to improve outcomes
Biphasic anaphylaxis can recur up to 72 hours - observe 4-10 hrs after reaction
Side effects: tachycardia, hypertension, arrhythmia, tremor, anxiety
Caution: contains sulfites - can trigger bronchospasm in sulfite-sensitive asthmatics

(Source: Harriet Lane Handbook, 23rd ed.)

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Adrenaline bitrate

You already asked this one! Here's the summary again quickly:

Adrenaline (Epinephrine) - Quick Recap

Class: Catecholamine (α1, α2, β1, β2 agonist)

Indications

Anaphylaxis - Drug of CHOICE
Cardiac arrest / Asystole
Severe bronchospasm / Asthma
Croup (nebulized)
Bradycardia (unresponsive to atropine)
Shock (IV infusion)

Key Doses

Use	Dose
Anaphylaxis (IM)	0.01 mg/kg, max 0.3-0.5 mg
Cardiac arrest (IV/IO)	0.01 mg/kg of 1:10,000
ET tube	0.1 mg/kg of 1:1,000
IV infusion	0.1-1 mcg/kg/min

Must Remember

1:1,000 = IM/SC | 1:10,000 = IV/IO
Anaphylaxis → IM into anterolateral thigh
Antidote for own overdose = phentolamine (alpha blocker)

Did you mean a different drug, or do you want to move to the next one? 😊

Atropin

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Atropine Sulfate - Exam Summary

Class: Anticholinergic agent (competitive muscarinic receptor blocker)

Mechanism: Blocks muscarinic (M1, M2, M3) receptors - opposes acetylcholine effects

Indications & Diseases

Indication	Notes
Bradycardia	Symptomatic sinus bradycardia - first line
Cardiac arrest / CPR	Used in PALS algorithm
Organophosphate / Carbamate poisoning	Antidote for nerve agent/insecticide poisoning
Pre-intubation / Pre-anesthesia	Reduces secretions, prevents vagal bradycardia
Bronchospasm	Nebulized (adjunct)
With Neostigmine	Blocks muscarinic side effects of neostigmine
Uveitis (ophthalmic)	Cycloplegia / mydriasis
Anticholinergic antidote	Given before physostigmine

Pediatric Doses

Pre-intubation:

Neonate: 0.01-0.02 mg/kg IV/IM
Child: 0.02 mg/kg IV/IO/IM, max 0.5 mg/dose

Bradycardia / CPR:

Child: 0.02 mg/kg IV/IO/IM Q5 min x 2-3 doses
- Max single dose: 0.5 mg (child), 1 mg (adolescent)
- Max total: 1 mg (child), 2 mg (adolescent)
ET route: 0.04-0.06 mg/kg (diluted in 1-2 mL NS)

Organophosphate poisoning:

Child: 0.05-0.1 mg/kg Q5-10 min IV/IM - repeat until secretions dry up
Adolescent: 1-3 mg/dose Q3-5 min

AtroPen (IM autoinjector) for poisoning:

Age/Weight	Dose
<6 months (<7 kg)	0.25 mg
6 mo-4 yr (7-18 kg)	0.5 mg
4-10 yr (18-41 kg)	1 mg
>10 yr & adult (>41 kg)	2 mg

Bronchospasm (nebulized):

0.025-0.05 mg/kg/dose (max 2.5 mg) in 2.5 mL NS

Key Viva Points

End point in organophosphate poisoning = drying of secretions (NOT heart rate)
No minimum dose rule - old teaching of min 0.1 mg is no longer recommended (can overdose small children)
NOT used for neonatal bradycardia anymore
Contraindicated in: Glaucoma, tachycardia, obstructive uropathy, thyrotoxicosis
Side effects = "Hot as a hare, Dry as a bone, Red as a beet, Blind as a bat, Mad as a hatter"
- Fever, dry mouth, flushing, mydriasis, CNS effects (hallucinations, restlessness)
Ophthalmic - avoid in <3 months (systemic absorption risk)
Mnemonic: ATROPINE = Anticholinergic, Tachycardia, Retention (urine), Obstruction contraindication, Pupils dilate, Inhibits secretions, No sweating, Eyes blurred

(Source: Harriet Lane Handbook, 23rd ed.)

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Ondansetron

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Ondansetron - Exam Summary

Brand name: Zofran Class: Antiemetic - Selective 5-HT3 (serotonin) receptor antagonist

Mechanism: Blocks serotonin (5-HT3) receptors in the gut and CTZ (chemoreceptor trigger zone) - stops vomiting signals

Indications & Diseases

Indication	Notes
Chemotherapy-induced nausea/vomiting (CINV)	Main indication
Post-operative nausea/vomiting (PONV)	Pre-anesthesia
Acute gastroenteritis (AGE)	Vomiting in children
Radiation-induced nausea/vomiting	Before radiotherapy

Pediatric Doses

1. Acute Gastroenteritis (oral ODT - preferred):

Weight	Dose
8-15 kg	2 mg x 1
>15-30 kg	4 mg x 1
>30 kg	8 mg x 1

IV (≥1 month): 0.15-0.3 mg/kg/dose x 1, max 8 mg

2. Chemotherapy-induced vomiting (IV):

0.15 mg/kg/dose 30 min before chemo, then at 4 hr and 8 hr
Max dose: 8 mg (child), 16 mg (adult)

3. Post-operative nausea/vomiting (IV/IM):

Child 1 mo-12 yr:
- <40 kg: 0.1 mg/kg x 1
- ≥40 kg: 4 mg x 1
Adult: 4 mg x 1

4. Chemotherapy (oral by age):

Age	Dose
4-11 yr	4 mg TID
>11 yr / adult	8 mg TID

Key Viva Points

ODT (orally disintegrating tablet) - preferred in AGE as child can take it without water
Contraindicated in congenital long QT syndrome - can prolong QTc
ECG monitoring needed in: electrolyte abnormalities, CHF, bradyarrhythmias
Side effects: Headache, constipation, diarrhea, transient blindness (rare), QTc prolongation
Does NOT cause EPS (extrapyramidal side effects) - unlike metoclopramide
Metabolized via CYP450 (1A2, 2D6, 3A4)
Data limited in children <3 years old
Drug clearance is higher in children vs adults - may need dose adjustment

(Source: Harriet Lane Handbook, 23rd ed.)

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Dopamine

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Dopamine - Exam Summary

Class: Sympathomimetic agent (catecholamine precursor) Previously known as: Intropin

Mechanism: Acts on dopaminergic (D1, D2), β1, and α1 receptors - effects are dose-dependent

Indications & Diseases

Indication	Notes
Cardiogenic shock	Improves cardiac output
Septic shock	Vasopressor support
Hemodynamically unstable bradycardia	Increases HR
Acute renal failure / low renal perfusion	Low dose (controversial now)
Post-cardiac surgery hypotension	Inotropic support

Pediatric Dose - THE MOST IMPORTANT TABLE FOR VIVA

All ages - IV infusion (dose-dependent effects):

Dose	Receptors	Effect
Low: 2-5 mcg/kg/min	Dopaminergic (D1)	↑ Renal blood flow, renal vasodilation, ↑ urine output; minimal effect on HR/CO
Intermediate: 5-15 mcg/kg/min	β1	↑ Heart rate, ↑ contractility, ↑ cardiac output
High: >15 mcg/kg/min	α1	Vasoconstriction, ↓ renal perfusion, ↑ BP

Max dose: 20-50 mcg/kg/min IV
Always give via central line or large vein

Key Viva Points

Dose determines the effect - this is the #1 exam point for dopamine
Low dose "renal dose" is now CONTROVERSIAL - not proven to protect kidneys in studies
Extravasation → tissue necrosis - antidote is phentolamine (alpha blocker, inject locally)
Do NOT give in: Pheochromocytoma, tachyarrhythmias, uncorrected hypovolemia
Neonates - more sensitive to vasoconstrictive effects; children <2 yr clear it faster
Do NOT administer via umbilical arterial catheter
Correct hypovolemia first before starting dopamine
Side effects: Tachyarrhythmias, ectopic beats, hypertension, vomiting
Caution with phenytoin - can cause hypotension and bradycardia together

Receptor Summary (Easy Mnemonic)

"DoBeta Alpha" - as dose goes up, receptors added: D → β1 → α1

(Source: Harriet Lane Handbook, 23rd ed.)

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Vit k3

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Important clarification first, then full answer:

⚠️ Vit K3 = Menadione (synthetic, water-soluble) - largely obsolete/avoided in pediatrics due to toxicity. What is actually used clinically is Vitamin K1 = Phytonadione (natural, fat-soluble). Your viva will almost certainly be about K1. Both covered below.

Vitamin K - Exam Summary

Class: Fat-soluble vitamin (K1 = Phytonadione)

Mechanism: Essential cofactor for activation of clotting factors II, VII, IX, X (and proteins C & S) via gamma-carboxylation in the liver

Indications & Diseases

Indication	Notes
Hemorrhagic Disease of Newborn (HDN)	= Vitamin K Deficiency Bleeding (VKDB) - most important pediatric use
Warfarin overdose/reversal	Antidote
Vitamin K deficiency	Liver disease, cholestasis, malabsorption
Anticoagulant reversal	Pre-surgery

Pediatric Doses (Phytonadione / Vit K1)

1. HDN / Neonatal Prophylaxis (IM, within 1 hr of birth):

Birth weight	Dose
<1 kg	0.5 mg/kg x 1
1-1.5 kg	0.5 mg x 1
>1.5 kg (normal neonate)	1 mg IM x 1

2. HDN Treatment:

1-2 mg/24 hr IM/SC/IV

3. Vitamin K deficiency:

Liver disease: 2.5-5 mg/24 hr PO
Cholestasis: 2.5-15 mg/24 hr PO

4. Warfarin overdose (significant/life-threatening bleeding):

5-10 mg IV x 1 + FFP (10-15 mL/kg) or PCC (KCentra)

Key Viva Points

Vit K1 (Phytonadione) = used clinically; natural, fat-soluble
Vit K2 (Menaquinone) = produced by gut bacteria
Vit K3 (Menadione) = synthetic, water-soluble, AVOIDED in neonates - causes hemolytic anemia and hyperbilirubinemia (kernicterus risk)
Clotting factors activated: II, VII, IX, X (remember: 1972 or "Ten Nine Seven Two")
Coagulation response: 6-12 hrs after oral, 1-2 hrs after parenteral
IV/IM route risk: anaphylaxis, cardiac arrest - use only when oral not possible
Large doses (10-20 mg) in newborns → hyperbilirubinemia + hemolytic anemia
Warfarin resistance can last ≥1 week after high-dose Vit K
Mineral oil decreases oral Vit K absorption (concurrent use cautioned)
Monitor: PT/PTT to assess response

(Source: Harriet Lane Handbook, 23rd ed.)

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Phenylamine

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Quick note: "Phenylamine" most likely refers to Phentolamine - the alpha-blocker used in pediatrics. If you meant Phenylephrine (alpha-1 agonist), let me know and I'll do that one too!

Phentolamine - Exam Summary

Class: Non-selective alpha-adrenergic blocker (α1 + α2) - competitive, reversible

Mechanism: Blocks α1 and α2 receptors → vasodilation, ↓ blood pressure; also causes reflex tachycardia (blocks α2 presynaptic → ↑ norepinephrine release)

Indications & Diseases

Indication	Notes
Pheochromocytoma	Pre-op BP control + diagnosis (Regitine test)
Hypertensive crisis	Due to catecholamine excess (MAO inhibitor crisis, cocaine, clonidine withdrawal)
Vasopressor extravasation	Dopamine, norepinephrine, adrenaline skin necrosis antidote
Erectile dysfunction	Intracavernosal (with papaverine)

Pediatric Dose

Pheochromocytoma / Hypertensive crisis:

IV: 0.05-0.1 mg/kg/dose (max 5 mg/dose) - repeat Q5 min PRN until BP controlled
Adult: 2.5-5 mg IV, repeat as needed

Vasopressor extravasation (local infiltration):

Dilute 5 mg phentolamine in 10 mL NS
Inject 0.1-0.2 mg/kg (max 5 mg) subcutaneously into the extravasated area
Give within 12 hours of extravasation for best effect

Duration of action: ~4 hours after single injection

Key Viva Points

Regitine test (phentolamine test): Give 1 mg IV (child) → BP drop >35/25 mmHg = positive for pheochromocytoma (largely replaced by urine catecholamines now)
Antidote for dopamine/norepinephrine extravasation → inject phentolamine locally
Reflex tachycardia is a common side effect (blocks α2 presynaptic)
Do NOT give rapidly IV - causes severe hypotension
Side effects: Hypotension, tachycardia, arrhythmia, nasal stuffiness, GI distress
Compare with Phenoxybenzamine (irreversible, long-acting, oral - used for long-term pheochromocytoma management)
α1 blockade → vasodilation | α2 blockade → reflex tachycardia (the double effect)

Quick Comparison for Viva

Feature	Phentolamine	Phenoxybenzamine
Type	Reversible	Irreversible
Route	IV	Oral
Duration	Short (4 hr)	Long (24-48 hr)
Use	Acute crisis	Pre-op prep

(Sources: Harriet Lane Handbook 23rd ed., Goodman & Gilman, Lippincott Pharmacology)

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Dexamethasone

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Dexamethasone - Exam Summary

Brand: Decadron and generics Class: Corticosteroid (glucocorticoid)

Mechanism: Binds glucocorticoid receptors → inhibits phospholipase A2 → ↓ prostaglandins, leukotrienes → potent anti-inflammatory + immunosuppressant

Indications & Diseases

Indication	Notes
Croup (Laryngotracheobronchitis)	Drug of choice - single dose
Asthma exacerbation	Short course
Cerebral edema	Tumour, meningitis
Airway edema / Post-extubation stridor	Pre/post-extubation
Bacterial meningitis	Reduces neurological sequelae
Antiemetic (chemo-induced)	With ondansetron
Adrenal insufficiency	Stress dosing
Ophthalmic inflammation	Eye drops
Anti-inflammatory	General use

Pediatric Doses

Indication	Dose	Route	Frequency
Croup	0.6 mg/kg x 1 (max 16 mg)	PO/IV/IM	Single dose
Asthma exacerbation	0.6 mg/kg/dose (max 16 mg)	PO/IV/IM	Q24 hr x 1-2 doses
Airway edema/extubation	0.5 mg/kg/dose (max 10 mg)	IV/IM/PO	Q6 hr x 6 doses (start 6-12 hr before extubation)
Cerebral edema - Loading	1-2 mg/kg x 1	IV/IM	Once
Cerebral edema - Maintenance	1-2 mg/kg/24 hr (max 16 mg/24 hr)	IV/IM	÷ Q4-6 hr
Anti-inflammatory	0.08-0.3 mg/kg/24 hr	PO/IV/IM	÷ Q6-12 hr
Antiemetic (chemo)	10 mg/m²/dose (max 20 mg) initial, then 5 mg/m² Q6 hr	IV	-

Key Viva Points

Croup = most common pediatric use → single dose 0.6 mg/kg PO is the standard
NO mineralocorticoid effect (unlike prednisolone) - pure glucocorticoid
Most potent glucocorticoid among common steroids
Steroid equivalence (anti-inflammatory potency):
- Dexamethasone 0.75 mg = Prednisolone 5 mg = Hydrocortisone 20 mg
Bacterial meningitis: Give dexamethasone before or with first dose of antibiotic → reduces deafness and neurological damage (esp. Hib meningitis)
NOT recommended for chronic lung disease in very low birth weight infants (adverse effects)
Contraindicated in: Active untreated infections, fungal/viral/mycobacterial eye infections
Side effects (long-term): Hyperglycemia, hypertension, Cushingoid features, growth suppression, osteoporosis, immunosuppression
CYP3A4 substrate and moderate inducer - drug interactions
Oral peak: 1-2 hr | IM peak: within 8 hr

(Source: Harriet Lane Handbook, 23rd ed.)

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Artisunate

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Artesunate - Exam Summary

Class: Antimalarial - Artemisinin derivative (sesquiterpene lactone endoperoxide)

Mechanism: Artesunate is a prodrug converted to dihydroartemisinin (DHA) → reacts with heme iron in infected RBCs → generates free radicals → kills Plasmodium at all blood stages including ring stage (unique advantage)

Indications & Diseases

Indication	Notes
Severe / Complicated Falciparum Malaria	Drug of CHOICE - IV artesunate is first line
Uncomplicated Falciparum Malaria	Oral - part of ACT (Artemisinin Combination Therapy)
Malaria unable to tolerate oral drugs	IV route
Multi-drug resistant malaria	Effective where chloroquine/quinine fail

Pediatric Doses

Severe Malaria (IV Artesunate):

2.4 mg/kg IV at 0, 12, and 24 hours → then 2.4 mg/kg IV once daily until patient can take oral therapy
<20 kg children: some guidelines use 3 mg/kg/dose (higher dose for small children)
After IV course: switch to oral ACT (artemether-lumefantrine) to complete treatment

Uncomplicated Malaria (Oral ACT - Artemether-Lumefantrine):

Weight-based dosing (Coartem):
- 5-<15 kg: 1 tablet BD x 3 days
- 15-<25 kg: 2 tablets BD x 3 days
- 25-<35 kg: 3 tablets BD x 3 days
- ≥35 kg: 4 tablets BD x 3 days

Key Viva Points

IV artesunate = drug of CHOICE for severe/cerebral malaria (replaced IV quinine/quinidine)
Kills parasites at all asexual blood stages including early ring forms - faster clearance than quinine
ACT = Artesunate + partner drug (artemether-lumefantrine, artesunate-amodiaquine) - always used in combination to prevent resistance
Post-artesunate delayed haemolysis (PADH) - rare but important complication, monitor Hb after treatment
Administer IV artesunate as bolus injection (not infusion)
Contraindicated in 1st trimester pregnancy (teratogenic in animal studies) - use quinine + clindamycin in 1st trimester
Safe in 2nd & 3rd trimester - preferred over quinine
Works in chloroquine-resistant and multi-drug resistant P. falciparum
WHO recommends ACT as first-line for all falciparum malaria globally
Rectal artesunate (pre-referral) used in children unable to take oral drugs in remote settings - 10 mg/kg x 1 dose before transfer

Plasmodium species coverage:

P. falciparum - main use
P. vivax - can be used (but add primaquine for radical cure)

(Sources: Red Book 2021, Harrison's 22nd ed., Harriet Lane Handbook)

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Metronidazole

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Metronidazole - Exam Summary

Brand: Flagyl Class: Antibiotic + Antiprotozoal (nitroimidazole)

Mechanism: Prodrug - enters anaerobic organisms → reduced to toxic intermediates → damages DNA → cell death. Works only in anaerobic/low-oxygen environments

Indications & Diseases

Indication	Notes
Amoebiasis (E. histolytica)	Intestinal + hepatic amoebic abscess
Giardiasis (G. lamblia)	Drug of choice
Trichomoniasis	Treat sexual contacts too
Anaerobic bacterial infections	Intra-abdominal, pelvic, brain abscess
C. difficile infection	Mild-moderate (vancomycin for severe)
H. pylori	Part of triple therapy
Bacterial vaginosis	Oral/vaginal

Pediatric Doses

Indication	Dose	Duration
Amoebiasis	35-50 mg/kg/24 hr ÷ Q8 hr PO (max 750 mg/dose)	10 days
Giardiasis	15-30 mg/kg/24 hr ÷ TID PO (max 750 mg/24 hr)	5-7 days
Trichomoniasis (<45 kg)	45 mg/kg/24 hr ÷ TID (max 2 g/24 hr)	7 days
Anaerobic infection (child PO)	30-50 mg/kg/24 hr ÷ Q8 hr (max 2250 mg/24 hr)	-
Anaerobic infection (child IV)	22.5-40 mg/kg/24 hr ÷ Q6-8 hr (max 4 g/24 hr)	-
C. difficile (child)	30 mg/kg/24 hr ÷ Q6 hr PO	10 days
H. pylori (child)	20 mg/kg/24 hr ÷ BID PO (max 1 g/24 hr)	10-14 days

Neonate (anaerobic) - Loading dose: 15 mg/kg x 1, then maintenance by PMA:

PMA	Maintenance
24-25 wk	7.5 mg/kg Q24 hr
28-33 wk	7.5 mg/kg Q12 hr
34-40 wk	7.5 mg/kg Q8 hr
>40 wk	7.5 mg/kg Q6 hr

Key Viva Points

Spectrum: Anaerobes + protozoa (Entamoeba, Giardia, Trichomonas) - NO aerobic activity
"Metro kills things with no O2" - anaerobes and parasites
Disulfiram-like reaction with alcohol - patient must avoid alcohol for 24-48 hr after dose
Metallic taste - classic side effect, warn the patient
Crosses BBB - effective for brain abscess (anaerobic)
Contraindicated in:
- Cockayne syndrome (fatal liver failure)
- 1st trimester pregnancy (teratogenic risk)
IV infusion slowly over 1 hr (not bolus)
Drug interactions: Increases warfarin, phenytoin, lithium levels
Urine discoloration (dark/reddish-brown) - normal, not blood
Side effects: Nausea, metallic taste, peripheral neuropathy (long-term), leukopenia
Reduce dose by 50% in severe liver disease (Child-Pugh C)

(Source: Harriet Lane Handbook, 23rd ed.)

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Urine strips

Urine dipstick strips are a common spot/instrument in pediatric viva - here's everything you need:

Urine Dipstick (Reagent Strip) - Exam Summary

This is not a drug - it's a diagnostic tool commonly spotted in pediatric practical exams!

Parameters Tested & What They Mean

Parameter	Normal	Abnormal Finding	Disease/Significance
pH	4.5 - 8.0	Acidic <4.5	RTA (Type 1), starvation, acidosis
		Alkaline >8.0	UTI (urease-producing organisms), RTA Type 2
Specific Gravity	1.005 - 1.030	Low (<1.005)	Diabetes insipidus, overhydration
		High (>1.030)	Dehydration
Protein	Negative/Trace	+1 to +4	Nephrotic syndrome, UTI, glomerulonephritis
Glucose	Negative	Positive	Diabetes mellitus, Fanconi syndrome
Ketones	Negative	Positive	DKA, starvation, vomiting
Blood (RBCs)	Negative	Positive	UTI, glomerulonephritis, trauma, stones
Nitrites	Negative	Positive	Bacterial UTI (gram-negative organisms)
Leukocyte Esterase	Negative	Positive	UTI, pyuria
Bilirubin	Negative	Positive	Obstructive jaundice, liver disease
Urobilinogen	Trace (0.1-1 EU)	High	Haemolytic jaundice, liver disease
		Absent	Obstructive jaundice

Key Viva Points - Disease Patterns

Nephrotic Syndrome:

Protein: +++/++++
Blood: Negative/trace
Specific gravity: High

UTI:

Nitrites: Positive (gram-negative bacteria convert nitrates→nitrites)
Leukocyte esterase: Positive
Blood: Positive
Protein: Trace/+1

Diabetes Mellitus:

Glucose: Positive
Ketones: Positive (in DKA)

DKA:

Glucose: +++
Ketones: +++
pH: Acidic

Nephritic Syndrome:

Blood: +++
Protein: +/++
RBC casts on microscopy

Obstructive Jaundice:

Bilirubin: Positive
Urobilinogen: Absent/Low

Haemolytic Jaundice:

Bilirubin: Negative (conjugated bili not high)
Urobilinogen: High

Important Causes of False Results

Parameter	False Positive	False Negative
Protein	Alkaline urine, contamination	Dilute urine
Blood	Myoglobinuria, haemoglobinuria	High Vit C
Glucose	-	High Vit C
Nitrites	-	Non-nitrite-reducing organisms (Staph, Enterococcus)

How to Read in Viva

"This is a urine dipstick reagent strip used for rapid bedside urinalysis. It tests for pH, specific gravity, protein, glucose, ketones, blood, nitrites, leukocyte esterase, bilirubin and urobilinogen. It helps diagnose conditions like UTI, nephrotic syndrome, DKA and jaundice."

Next spot/drug - go ahead! 💊

Cefpodoxime proxetiland potassium calvunate

Finding Sources

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Finding Sources

Reading File

Here are both drugs together - this combination is commonly prescribed together in pediatrics:

Part 1: Cefpodoxime Proxetil - Exam Summary

Brand: Vantin (generics) Class: Antibiotic - 3rd Generation Cephalosporin (oral)

Mechanism: Beta-lactam - inhibits bacterial cell wall synthesis (binds PBPs) Note: Prodrug - de-esterified in GI tract to active cefpodoxime

Indications & Pediatric Doses (2 months - 11 years)

Indication	Dose	Duration
Acute Otitis Media (AOM)	10 mg/kg/24 hr ÷ Q12 hr PO (max 400 mg/24 hr)	5-10 days
Pharyngitis/Tonsillitis	10 mg/kg/24 hr ÷ Q12 hr PO (max 200 mg/24 hr)	5-10 days
Acute Sinusitis	10 mg/kg/24 hr ÷ Q12 hr PO (max 400 mg/24 hr)	10 days
CAP / Bronchitis (≥12 yr)	400 mg/24 hr ÷ Q12 hr	14 days
UTI (≥12 yr)	200 mg/24 hr ÷ Q12 hr	5-7 days

Key Points

Spectrum: MSSA, Strep pneumoniae, H. influenzae, Moraxella, E. coli
Take tablets WITH food (enhances absorption)
Suspension can be given without food
False positive urine glucose (Benedict's/Clinitest) - use enzymatic test instead
Adjust dose in renal failure

Part 2: Amoxicillin + Potassium Clavulanate - Exam Summary

Brand: Augmentin, Augmentin ES-600 Class: Aminopenicillin + Beta-lactamase inhibitor

Mechanism:

Amoxicillin - inhibits cell wall synthesis
Clavulanic acid (Clavulanate) - irreversibly binds and inhibits beta-lactamase enzymes → protects amoxicillin from destruction → extends spectrum

Indications & Diseases

Indication	Notes
Acute Otitis Media (AOM)	Especially beta-lactamase-producing organisms
Sinusitis	First/second line
Pneumonia (CAP)	Community acquired
Tonsillitis / Pharyngitis
UTI
Skin & soft tissue infections
Animal/human bites	Drug of CHOICE
Orbital cellulitis	High dose

Pediatric Doses (based on amoxicillin component)

Age/Weight	Dose	Frequency
Infant 1-<3 months	30 mg/kg/24 hr	÷ Q12 hr
Child ≥3 mo, <40 kg (standard)	20-40 mg/kg/24 hr	÷ Q8 hr (TID)
Child ≥3 mo, <40 kg (standard BID)	25-45 mg/kg/24 hr	÷ Q12 hr
High dose (>3 mo, <40 kg)	90 mg/kg/24 hr (use ES-600)	÷ Q8-12 hr
Adult	250-500 mg Q8 hr or 875 mg Q12 hr	-

High dose (90 mg/kg/24 hr) used for:

CAP, orbital cellulitis, severe infections, resistant S. pneumoniae

Key Viva Points

Clavulanate extends spectrum to: H. influenzae, Moraxella catarrhalis, beta-lactamase-producing Staph aureus, N. gonorrhoeae
BID dosing = less diarrhea than TID (important counselling point)
Most common side effect: Diarrhea (clavulanate causes GI upset)
Contraindicated if previous cholestatic jaundice/hepatic dysfunction from Augmentin
Drug of choice for animal/human bites (covers Pasteurella, Eikenella)
Ratio matters:
- Standard: 4:1 (amoxicillin:clavulanate)
- BID formulations: 7:1
- ES-600: 14:1 (high dose, less clavulanate side effects)
Do NOT use two standard suspensions to make high dose - risk of clavulanate toxicity

Quick Comparison for Viva

Feature	Cefpodoxime	Amoxicillin-Clavulanate
Class	3rd gen cephalosporin	Aminopenicillin + BLI
Route	Oral only	Oral
Beta-lactamase?	Resistant (3rd gen)	Clavulanate inhibits it
Main use	AOM, pharyngitis, UTI	AOM, bites, pneumonia

(Source: Harriet Lane Handbook, 23rd ed.)

Next drug - go ahead! 💊

Levetriacetam oral solution

Finding Sources

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Here's your complete viva answer:

Levetiracetam (Oral Solution) - Exam Summary

Brand: Keppra, Roweepra Class: Anticonvulsant (antiepileptic drug - AED) Oral solution: 100 mg/mL (dye free, contains parabens)

Mechanism: Binds SV2A (synaptic vesicle glycoprotein 2A) → inhibits neurotransmitter release → reduces neuronal hyperexcitability. Unique mechanism - unlike any other AED

Indications & Diseases

Indication	Age
Partial (focal) seizures	≥1 month
Myoclonic seizures (Juvenile Myoclonic Epilepsy)	≥12 yr
Primary generalized tonic-clonic seizures	≥6 yr
Refractory status epilepticus	All ages (IV/IO)

Pediatric Doses (Oral Solution = 100 mg/mL)

Partial Seizures:

Age	Starting Dose	Target Dose
Infant 1-5 months	7 mg/kg/dose BID	21 mg/kg/dose BID
Infant ≥6 mo - 3 yr	10 mg/kg/dose BID	25 mg/kg/dose BID
Child 4-15 yr	10 mg/kg/dose BID	30 mg/kg/dose BID (max 3000 mg/24 hr)
≥16 yr / Adult	500 mg BID	max 1500 mg BID

Increase dose by 10 mg/kg/dose BID every 2 weeks as tolerated

Tonic-Clonic Seizures (6-15 yr):

Start 10 mg/kg/dose BID → target 30 mg/kg/dose BID

Myoclonic Seizures (≥12 yr):

Start 500 mg BID → target 1500 mg BID

Refractory Status Epilepticus (IV/IO - all ages):

60 mg/kg IV over 10 min x 1 (max 4500 mg/dose), then start maintenance

Key Viva Points

How to use oral solution: 100 mg/mL - use oral syringe, can mix with water
Always start LOW and increase gradually every 2 weeks
Do NOT stop abruptly - risk of rebound seizures (taper always)
No significant drug interactions - major advantage over old AEDs (no enzyme induction/inhibition)
No need for routine drug level monitoring (unlike phenytoin, phenobarbitone)
Behavioural side effects in children - ~3x more common than adults
- Agitation, aggression, mood swings, irritability ("Keppra rage")
Other side effects: Somnolence, fatigue, dizziness, headache, loss of appetite
Adjust dose in renal impairment (renally excreted)
Advantages: Few drug interactions, broad spectrum, available IV/PO, suitable for all ages
Disadvantage: Behavioural side effects in children

Oral Solution - Viva Spot Tips

"This is Levetiracetam oral solution 100 mg/mL (Keppra). It is an anticonvulsant used for partial, myoclonic, and generalized tonic-clonic seizures. The dose is weight-based, starting at 10 mg/kg/dose twice daily and titrated up every 2 weeks. It acts by binding SV2A receptors."

(Source: Harriet Lane Handbook, 23rd ed.)

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Budesonide

Finding Sources

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Here's your complete viva answer:

Budesonide - Exam Summary

Brands: Pulmicort Respules (nebulizer), Pulmicort Flexhaler (inhaler), Rhinocort (nasal) Class: Inhaled/topical Corticosteroid (ICS)

Mechanism: Binds glucocorticoid receptors → reduces airway inflammation, decreases mucus secretion, reduces bronchial hyperresponsiveness - local action, minimal systemic effects

Indications & Diseases

Indication	Form Used
Asthma - maintenance/prophylaxis	Nebulizer / DPI inhaler
Croup	Nebulized (acute treatment)
Allergic rhinitis	Nasal spray
Crohn's disease	Oral capsule
Ulcerative colitis	Oral/rectal

Pediatric Doses

1. Nebulized Inhalation (Pulmicort Respules - 0.25, 0.5, 1 mg/2 mL):

Age	Previous Therapy	Dose
Child 1-8 yr	No prior steroids	0.5 mg/24 hr once daily-BID (max 0.5 mg/24 hr)
Child 1-8 yr	Prior inhaled steroids	0.5 mg/24 hr once daily-BID (max 1 mg/24 hr)
Child 1-8 yr	Prior oral steroids	1 mg/24 hr once daily-BID (max 1 mg/24 hr)

NIH Asthma Guidelines - Nebulized Dose:

Age	Low	Medium	High
0-4 yr	0.25-0.5 mg/24 hr	0.5-1 mg/24 hr	>1 mg/24 hr
5-11 yr	0.5 mg/24 hr	1 mg/24 hr	2 mg/24 hr

2. Dry Powder Inhaler - Pulmicort Flexhaler:

Age	Dose
Child ≥6 yr	Start 180 mcg BID, max 360 mcg BID
Adult	Start 360 mcg BID, max 720 mcg BID

3. Nasal spray (allergic rhinitis):

Child ≥6 yr & adult: 1-2 sprays (32 mcg each) per nostril once daily

4. Croup (nebulized - acute):

2 mg (4 mL of 0.5 mg/2 mL) single nebulized dose - as effective as dexamethasone for mild-moderate croup

Key Viva Points

Pulmicort Respules = for infants/young children who can't use inhalers - given via jet nebulizer
NOT a bronchodilator - it is a preventer/controller, not a reliever
Onset: Nebulized = 2-8 days; Inhaler = within 1 day; peak effect at 4-6 weeks
After inhaler use: Rinse mouth with water to prevent oral candidiasis
Budesonide + Formoterol (Symbicort) = ICS + LABA combination (≥5 yr)
Systemic side effects minimal compared to oral steroids - mainly local
Croup: Nebulized budesonide 2 mg is an alternative to oral/IM dexamethasone
Safe in pregnancy (inhalation route = Category B)
Flexhaler requires inspiratory flow ~60 L/min - not suitable for very young children
Do NOT crush oral capsule (Crohn's/UC indication)

Formulations Summary (Spot the Bottle!)

Form	Brand	Use
Nebulizer suspension	Pulmicort Respules	Asthma <8 yr, Croup
DPI inhaler	Pulmicort Flexhaler	Asthma ≥6 yr
Nasal spray	Rhinocort	Allergic rhinitis
Oral capsule	Entocort EC	Crohn's disease
Oral tablet	Uceris	Ulcerative colitis

(Source: Harriet Lane Handbook, 23rd ed.)

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Piperaciline and tazobactam

Finding Sources

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Here's your complete viva answer:

Piperacillin + Tazobactam - Exam Summary

Brand: Zosyn and generics Class: Extended-spectrum Penicillin + Beta-lactamase inhibitor Ratio: 8:1 (Piperacillin : Tazobactam)

Mechanism:

Piperacillin - extended-spectrum penicillin, inhibits bacterial cell wall synthesis
Tazobactam - irreversible beta-lactamase inhibitor → protects piperacillin from degradation → extends spectrum to beta-lactamase-producing organisms

All doses based on PIPERACILLIN component

Indications & Diseases

Indication	Notes
Severe nosocomial infections	Hospital-acquired pneumonia
Intra-abdominal infections	Appendicitis, peritonitis
Sepsis	Broad-spectrum empiric coverage
Complicated UTI / Pyelonephritis
Skin & soft tissue infections
Febrile neutropenia	Empiric therapy
Cystic fibrosis	Antipseudomonal
Polymicrobial infections	Anaerobes + gram-negatives

Pediatric Doses (IV only)

Neonates/Infants (limited data):

Weight/Age	Dose
≤2 kg, ≤7 days	100 mg/kg/dose Q8 hr
≤2 kg, 8-28 days (≤30 wk PMA)	100 mg/kg/dose Q8 hr
≤2 kg, 8-28 days (>30 wk PMA)	80 mg/kg/dose Q6 hr
>2 kg, ≤60 days	80 mg/kg/dose Q6 hr

Child & Adolescent:

Indication	Age	Dose	Frequency
Severe infections / Pneumonia	2-9 mo	80 mg/kg/dose IV	Q6 hr
Severe infections / Pneumonia	>9 mo - adolescent	100 mg/kg/dose IV (max 4000 mg)	Q6 hr
Appendicitis / Peritonitis	2-9 mo	80 mg/kg/dose IV	Q8 hr
Appendicitis / Peritonitis	>9 mo, ≤40 kg	100 mg/kg/dose IV (max 3000 mg)	Q8 hr
Appendicitis / Peritonitis	>9 mo, >40 kg	3 g/dose IV	Q6 hr
Cystic fibrosis (antipseudomonal)	All ages	350-600 mg/kg/24 hr	÷ Q4-6 hr

Max dose (all ages): 16 g/24 hr

Adult:

Intra-abdominal/soft tissue: 3 g IV Q6 hr
Nosocomial pneumonia: 4 g IV Q6 hr

Key Viva Points

IV only - no oral formulation
Broadest spectrum penicillin - covers:
- Gram-positive (Staph, Strep)
- Gram-negative including Pseudomonas aeruginosa
- Anaerobes
- Beta-lactamase-producing organisms
Extended infusion (4 hr) - used to enhance pharmacodynamic properties for severe infections (time-dependent killing)
Drug of choice for febrile neutropenia (with/without aminoglycoside)
Contains sodium - 2.84 mEq Na/g piperacillin - caution in fluid-restricted patients
Adjust dose in renal failure
Side effects: Diarrhea, rash, hypersensitivity, ↑ LFTs, thrombocytopenia, hypokalemia
Contraindicated in penicillin allergy (cross-reactivity)
Does NOT cover: MRSA, VRE, Acinetobacter (resistant)

Quick Memory - Coverage

"Pip-Tazo covers PANS" Pseudomonas, Anaerobes, Normal gram-negatives, Staph (MSSA only)

(Source: Harriet Lane Handbook, 23rd ed.)

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Amoxiclav

You already covered this one! Amoxiclav = Amoxicillin + Potassium Clavulanate (Augmentin) - here's a quick recap:

Amoxiclav (Amoxicillin-Clavulanate) - Quick Recap

Brand: Augmentin / Augmentin ES-600 Class: Aminopenicillin + Beta-lactamase inhibitor

Indications

Acute Otitis Media (AOM)
Sinusitis, Tonsillitis, Pharyngitis
CAP (Community-acquired pneumonia)
UTI
Animal/human bites - Drug of CHOICE
Skin & soft tissue infections
Orbital cellulitis (high dose)

Key Pediatric Doses

Indication	Dose (amoxicillin component)	Frequency
Standard (child <40 kg)	20-40 mg/kg/24 hr	÷ Q8 hr (TID)
Standard BID	25-45 mg/kg/24 hr	÷ Q12 hr
High dose (severe/resistant)	90 mg/kg/24 hr (ES-600)	÷ Q8-12 hr
Infant 1-3 months	30 mg/kg/24 hr	÷ Q12 hr

Must-Remember Points

Clavulanate extends coverage to beta-lactamase-producing H. influenzae, Moraxella, Staph aureus
BID = less diarrhea than TID
Contraindicated if prior cholestatic jaundice from Augmentin
Most common side effect = Diarrhea (clavulanate)
Drug of choice for bites (animal/human)
Do NOT double the standard suspension to get high dose - use ES-600 formulation

Want to move to the next drug? 💊

Ceftriaxone

Finding Sources

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Here's your complete viva answer:

Ceftriaxone - Exam Summary

Class: Antibiotic - 3rd Generation Cephalosporin Route: IV / IM only (no oral form)

Mechanism: Beta-lactam - inhibits bacterial cell wall synthesis (binds PBPs). Unique: biliary excretion (35-45%) + renal excretion - long half-life allows once daily dosing

Indications & Diseases

Indication	Notes
Bacterial Meningitis	Most important pediatric use
Severe/complicated infections	Sepsis, pneumonia
Typhoid fever	Drug of choice in children
Acute Otitis Media (AOM)	Single IM dose option
Gonorrhea / PID	STI treatment
Lyme disease	IV for CNS involvement
Endocarditis prophylaxis	Dental/respiratory procedures
Neonatal gonococcal ophthalmia	Prophylaxis + treatment

Pediatric Doses

Indication	Dose	Frequency
Mild/moderate infections	50-75 mg/kg/24 hr (max 2 g/24 hr)	÷ Q12-24 hr
Severe infections / Meningitis	100 mg/kg/24 hr (max 2 g/dose, 4 g/24 hr)	÷ Q12 hr
Penicillin-resistant pneumococcus	80-100 mg/kg/24 hr (max 4 g/24 hr)	÷ Q12-24 hr
Acute Otitis Media	50 mg/kg IM/IV x 1 (max 1 g)	Single dose
Lyme disease	50-75 mg/kg/dose (max 2 g) IV	Once daily
Neonatal gonococcal	25-50 mg/kg/dose (max 250 mg) IM/IV	x 1 dose
Endocarditis prophylaxis	50 mg/kg IV/IM (max 1 g)	30-60 min before procedure

Adult: 1-2 g Q12-24 hr IV/IM (max 4 g/24 hr)

Key Viva Points

Long half-life (~8 hr) → can be given once or twice daily - major advantage
Biliary excretion → can cause biliary sludge/pseudolithiasis (reversible)
NEVER mix with calcium-containing solutions (IV) in any age group - risk of precipitate
AVOID in neonates (<28 days) with hyperbilirubinemia - displaces bilirubin from albumin → kernicterus
AVOID in neonates when IV calcium needed (use cefotaxime instead)
Covers: Strep pneumoniae, H. influenzae, Neisseria, E. coli, Klebsiella, Salmonella
Does NOT cover: Pseudomonas, MRSA, Listeria, anaerobes
Meningitis dose = 100 mg/kg/24 hr (higher than standard) - critical point
Side effects: Rash, diarrhea, biliary sludge, eosinophilia, false positive Coombs test
Adjust in renal AND hepatic failure (dual clearance)

Quick Dose Memory

"50 for mild, 100 for meningitis" 50-75 mg/kg/24 hr → mild/moderate 100 mg/kg/24 hr → severe/meningitis

(Source: Harriet Lane Handbook, 23rd ed.)

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Make table of all the drug their main 2- 3 indications , type ,and mechanism in very very short no need for doses and make pdf also

Reading File

Running Command

Writing File

Running Command

Here's your PDF! 🎉

Pediatrics Drug Summary

PDF Document · PDF

Here's the table in text form too for quick reading right now:

Drug	Type	Mechanism	Main Indications
Neostigmine	Anticholinesterase	Inhibits AChE → ↑ACh	MG, NMB reversal, OP poisoning
Paracetamol	Analgesic/Antipyretic	COX inhibition (central)	Fever, Pain, PDA
Adrenaline	Catecholamine (α,β agonist)	Stimulates adrenergic receptors	Anaphylaxis, Cardiac arrest, Croup
Atropine	Anticholinergic	Blocks muscarinic receptors	Bradycardia, OP poisoning, Pre-intubation
Ondansetron	5-HT3 antagonist	Blocks serotonin in gut/CTZ	CINV, Gastroenteritis, PONV
Dopamine	Sympathomimetic	D1→β1→α1 (dose-dependent)	Shock, Low CO, Bradycardia
Vitamin K1	Fat-soluble vitamin	Activates clotting factors II,VII,IX,X	HDN, Warfarin reversal, Deficiency
Phentolamine	α-blocker (non-selective)	Blocks α1+α2 → vasodilation	Phaeochromocytoma, HTN crisis, Extravasation
Dexamethasone	Glucocorticoid	Inhibits phospholipase A2 → ↓PGs	Croup, Meningitis, Asthma
Artesunate	Artemisinin antimalarial	→DHA→free radicals→kills Plasmodium	Severe malaria, Cerebral malaria, MDR malaria
Metronidazole	Nitroimidazole	Toxic radicals damage DNA (anaerobes)	Amoebiasis, Giardiasis, Anaerobic infections
Cefpodoxime	3rd gen cephalosporin (oral)	Beta-lactam → inhibits PBPs	AOM, Pharyngitis, UTI
Amoxiclav	Aminopenicillin + BLI	Cell wall inhibition + β-lactamase block	AOM, Bites (DOC), CAP
Levetiracetam	AED	Binds SV2A → ↓neurotransmitter release	Partial seizures, Tonic-clonic, Status epilepticus
Budesonide	Inhaled corticosteroid	↓airway inflammation locally	Asthma (maintenance), Croup, Allergic rhinitis
Pip-Tazo	Extended-spectrum penicillin + BLI	Cell wall + β-lactamase inhibition	Nosocomial infections, Neutropenic fever, Pseudomonas
Ceftriaxone	3rd gen cephalosporin (IV/IM)	Beta-lactam → inhibits PBPs	Meningitis, Typhoid, Sepsis

All the best for your viva tomorrow! 🌟 You've covered a great list of drugs - go get it! 💊

Zinc gluconate

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Here's your complete viva answer:

Zinc Gluconate / Zinc Salts - Exam Summary

Class: Trace mineral / Micronutrient Forms available:

Zinc Sulfate (23% elemental Zn) - most common oral form
Zinc Gluconate - OTC supplement
Zinc Acetate (Galzin) - Wilson's disease
Zinc Chloride - IV/injection

Indications & Diseases

Indication	Notes
Zinc Deficiency	Malnutrition, malabsorption
Acute Diarrhoea in children	WHO recommendation - reduces severity & duration
Wilson's Disease	Blocks copper absorption
Acrodermatitis enteropathica	Inherited zinc deficiency
Parenteral nutrition supplementation	TPN
Burns / Excessive losses	Replacement

Pediatric Doses

Zinc Deficiency:

Infant & child: 0.5-2 mg elemental Zn/kg/24 hr PO ÷ once daily-TID

Acute Diarrhoea (WHO/UNICEF recommendation):

Age	Dose	Duration
<6 months	10 mg/day	10-14 days
≥6 months	20 mg/day	10-14 days

Wilson's Disease:

Child ≥5-<10 yr: 75 mg elemental Zn/24 hr ÷ TID
Child ≥10 yr: 75-150 mg elemental Zn/24 hr ÷ TID

Key Viva Points

Zinc + ORS = standard management of acute diarrhoea in children (WHO/IAP guideline)
Zinc reduces diarrhoea duration by ~25% and severity by ~30%
Also reduces recurrence of diarrhoea for 2-3 months after course
Mechanism in diarrhoea: ↑ intestinal water & electrolyte absorption, ↑ gut mucosal immunity, ↑ brush border enzyme activity
Zinc deficiency features:
- Growth retardation, poor wound healing
- Acrodermatitis enteropathica (perioral/perianal rash)
- Hypogonadism, anorexia, immune deficiency
- Night blindness (also needs Vit A)
Wilson's disease: Zinc blocks intestinal copper absorption via metallothionein induction - safer long-term alternative to penicillamine
Therapeutic zinc level: 70-130 mcg/dL
Drug interactions: Reduces absorption of penicillamine, tetracyclines, fluoroquinolones - give 2 hrs apart
Side effects: Nausea, vomiting, GI upset, metallic taste; high doses → leukopenia, gastric ulcers, hypotension
H2 blockers/PPIs reduce zinc absorption (↑ gastric pH)
Zinc gluconate = most common OTC form; better tolerated than sulfate (less GI upset)

Zinc in Diarrhoea - Viva One-liner

"Zinc 20 mg/day x 14 days along with ORS is the WHO-recommended adjunct therapy for acute diarrhoea in children ≥6 months - it reduces duration, severity and risk of recurrence."

(Source: Harriet Lane Handbook, 23rd ed.)

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Biors withe pre and pro biotics

Finding Sources

This is a conceptual/product topic rather than a single drug - here's a complete viva-ready answer:

Prebiotics, Probiotics & Synbiotics - Exam Summary

Biors is a brand name combining digestive enzymes + prebiotics + probiotics (synbiotic product). For viva, you need to know the concepts well.

Definitions (Must Know!)

Term	Definition	Example
Probiotic	Live microorganisms that, when given in adequate amounts, confer health benefit on the host	Lactobacillus, Bifidobacterium, Saccharomyces
Prebiotic	Non-digestible food ingredient that selectively stimulates growth/activity of beneficial gut bacteria	FOS, GOS, Inulin, Lactulose
Synbiotic	Combination of probiotic + prebiotic together	Biors, Enterogermina + FOS
Postbiotic	Metabolic byproducts of probiotics that benefit the host	SCFAs, bacteriocins

Common Probiotic Organisms

Organism	Notes
Lactobacillus rhamnosus GG (LGG)	Most evidence-based; best studied
Lactobacillus reuteri DSM 17938	Infant colic, diarrhoea
Bifidobacterium lactis	Common in infant formulas
Saccharomyces boulardii	Yeast; antibiotic-associated diarrhoea
Streptococcus thermophilus	Yogurt organism

Indications in Pediatrics

Indication	Evidence	Notes
Acute Infectious Diarrhoea	✅ Good	Reduces duration ~1 day; LGG and S. boulardii best evidence
Antibiotic-Associated Diarrhoea	✅ Good	Give probiotic with antibiotic course
C. difficile Prevention	✅ Moderate	S. boulardii + LGG
Infant Colic	✅ Moderate	L. reuteri DSM 17938 in breastfed infants
Necrotizing Enterocolitis (NEC) prevention	✅ Good	In preterm neonates
Constipation	✅ Some evidence	L. reuteri, B. lactis
Atopic dermatitis prevention	✅ Some evidence	Prenatal + postnatal use
IBD maintenance	✅ Ulcerative colitis	VSL#3 combination
Irritable Bowel Syndrome	✅ Moderate

Pediatric Doses (General)

Product	Dose
LGG (Culturelle)	10 billion CFU once or twice daily
S. boulardii (Florastor)	250-500 mg BID
L. reuteri drops	5 drops (10⁸ CFU) once daily (infant colic)
VSL#3	1 sachet/day (child)

(Doses vary by brand; CFU = Colony Forming Units)

Prebiotics in Pediatrics

Prebiotic	Source	Function
FOS (Fructooligosaccharides)	Onion, garlic, banana	Feeds Bifidobacteria in colon
GOS (Galactooligosaccharides)	Human breast milk	Promotes Bifidobacterium growth
Inulin	Chicory root	Bifidogenic effect
Lactulose	Synthetic	Prebiotic + laxative

Breast milk is the best natural prebiotic - contains HMOs (Human Milk Oligosaccharides)

Key Viva Points

Mechanism of probiotics:
- Compete with pathogens for adhesion sites
- Produce bacteriocins & lactic acid → hostile environment for pathogens
- ↑ secretory IgA → mucosal immunity
- Restore normal gut flora (dysbiosis)
- Strengthen epithelial tight junctions
Best evidence in pediatrics = acute diarrhoea & antibiotic-associated diarrhoea
NEC prevention in premature neonates - strong evidence (WHO recommends)
NOT universally recommended for AGE by all guidelines (AAP cautious)
Safe in immunocompetent children - avoid in immunocompromised (risk of bacteremia/fungemia)
Biors (or similar synbiotic brands) = contain Lactobacillus + Bifidobacterium + FOS/GOS
Store probiotics in cool, dry place (some need refrigeration)
Give 2 hours apart from antibiotics so antibiotic doesn't kill the probiotic

Viva One-liner

"Probiotics are live microorganisms that restore gut flora; prebiotics are non-digestible substrates that feed them. Together (synbiotics), they are used in pediatrics mainly for acute diarrhoea, antibiotic-associated diarrhoea, infant colic, and NEC prevention in preterm neonates."

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