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1. Which of the following statements is CORRECT?

A. Neonates have increased percentage of body fat and thus require lower doses of these drugs B. Neonates have increased volume of distribution of hydrophilic drugs and thus require higher doses of these drugs C. Neonates have increased percentage of body water and therefore decreased volume of distribution of hydrophilic drugs D. Neonates have decreased volume of distribution of lipophilic drugs and thus require higher doses of these drugs E. Unsure

2. Which of the following can be safely applied to the skin of a 1-week-old neonate?

A. Sunscreen B. Bacitracin zinc, neomycin sulfate, polymyxin B sulfate C. Triamcinolone 0.5% D. None of the above E. Unsure

3. Which of the following statements about drug metabolism is TRUE?

A. Chloramphenicol is metabolized by the sulfation pathway and thus is well tolerated in neonates B. Theophylline is metabolized to caffeine in adults, while caffeine is metabolized to theophylline in infants C. Acetaminophen is metabolized by the sulfation pathway in neonates and later by the glucuronidation pathway once it is mature D. Cisapride is metabolized by CYP3A4, which is active at birth and hence well tolerated even in preterm neonates E. Unsure

4. Which of the following drugs matches correctly with its adverse reaction?

A. Benzyl alcohol – gasping baby syndrome B. Propylene glycol – gray baby syndrome C. Aluminum – metabolic acidosis D. Thimerosal – osteomalacia E. Unsure

5. Commercially available oral dosage forms of medications may not be appropriate for pediatric patients because:

A. The strengths of oral dosage forms are usually not appropriate for pediatric patients younger than 10 to 12 years pf age B. Children under 5 years old usually have difficulty swallowing a tablet or capsule C. Some oral solutions are bitter and not palatable for pediatric patients D. All of the above E. Unsure

6. Which of the following is an acceptable practice to circumvent the challenges of administering oral medications to pediatric patients?

A. Administer injectable enalaprilat orally if enalapril tablet cannot be used to deliver the required dose. B. Administer sodium chloride 23.4% injectable orally if sodium chloride 1 g (17.1 mEq sodium) tablet cannot be used to deliver the required dose. C. Crush a clopidogrel 75 mg tablet, mix the powder in 10 mL of water, and draw up the appropriate aliquot for the dose. Since clopidogrel is not water soluble, take care to draw up as much of the undissolved powder as possible. D. Prepare an extemporaneous formulation of captopril based on a published stability study, but leave out the ascorbic acid injectable if it is not available in the pharmacy. E. Unsure

7. Which of the following statements regarding administration of injectable medications is FALSE:

A. Medication concentrations usually used for adult patients may be too dilute for neonatal patients, requiring a significant portion of the total daily fluid for medications instead of nutrition B. The dead space volume in syringes may lead to inadvertent underdose but not overdose in neonates C. The concentrations of commercially available medications may be too concentrated to enable accurate measurement of the dose for a neonate D. The dead space volume in syringes may lead to inadvertent overdose or underdose, especially in neonates E. Unsure

8. Pediatric patients are more prone to medication errors because:

A. Accurate calculations are necessary for dosing based on patient's weight B. Lack of commercially available dosage forms necessitates use of extemporaneous formulations, which are labor-intensive, time-consuming, and often complex C. Lack of published information or FDA-approved labeling regarding dosing, safety, and efficacy of drugs poses challenges on proper use and dosing of medications D. All of the above are reasons why pediatric patients are more prone to medication errors E. Unsure

9. Which of the following is NOT a strategy to prevent medication errors in pediatric patients?

A. Standardize and simplify processes B. Leverage automation and technology such as smart pumps and robotics C. Ensure clinicians memorize dosing of frequently used pediatric medications D. Engage the patient or family as a partner for safety check E. Unsure

10. Medication absorption in infants is:

A. Erratic when administered rectally due to variation in rectal pH and blood flow to the rectum and the propensity for infants and children to expel solid drugs from the rectum B. Increased when administered intramuscularly due to increased blood flow to muscles and increased muscle contractions C. Delayed when administered orally because of accelerated gastric emptying and intestinal motility D. Decreased when administered topically because the stratum corneum is thicker and skin is less hydrated, thus decreasing percutaneous permeability E. Unsure