PALS PEDIATRIC FINAL PAPER 2025/2026 QUESTIONS
WITH SOLUTIONS RATED A+
✔✔Terbutaline MOA - ✔✔like albuterol
bronchodilation by B2 adrenergic
✔✔Ketamine MOA - ✔✔stimulate bronchodilation
✔✔Ketamine SE - ✔✔- Respiratory depression
- Cardiovascular (Brady/tachycardia, arrhythmia, hypo/hypertension
- CNS depression (SEDATIVE EFFECTS)
- Increased intracranial and ocular pressure
- Emergence reactions (when used as anesthetic)
✔✔Aminophylline is the - ✔✔prodrug of theophylline
✔✔Aminophylline to Theophylline Dosing Conversion - ✔✔0.8
*aminophylline=theophylline
✔✔Aminophylline/Theophylline Therapeutic Monitoring - ✔✔5-20mcg/mL
can do as a bolus or as continuous IV infusion
CLEARANCE affected by many things
✔✔Aminophylline/Theophylline SEs - ✔✔vesicant (ensure catheter placed)
tachycardia
tremor
insomnia
✔✔w/i 30 minutes of status epilepticus your benzos may become - ✔✔20 fold less
effective than they would have been at onset of seizure
✔✔What labs do we need on patient in status epilepticus? - ✔✔glucose
electrolyte levels
CBC, CMP
toxicology screen
infectious workup
✔✔If adolescent is at risk for Wernicke's encephalopathy with status epilepticus -
✔✔thiamine BEFORE dextrose 50%; dextrose oxidation requires thiamine, w/o thiamine
in thiamine deficient patients the dextrose will take the thiamine in patient making them
even more deficient
✔✔Stage 1 GCSE - ✔✔Impending
, seizing longer than 5 minutes or seizures without recovery of consciousness between
them
✔✔Benzodiazepines in Stage 1 GCSE (impending) Expectations - ✔✔stop seizure in 2-
3 minutes
all similar in efficacy but routes of admin is important
✔✔First Line Agents in Stage 2 Status Epilepticus - ✔✔phy
fosphenytoin
✔✔Phenytoin VS Fosphenytoin - ✔✔fosphenytoin is dosed in equivalence to phenytoin
; given IM but you really want to give IV or IO medications since IM takes long time to
absorb
only time seeing PHY given over FOS is if in drug shortage
fos can be admin more rapidly; PHY has severe infusion related reactions
✔✔Fosphenytoin/Phenytoin Therapeutic Monitoring - ✔✔Free PHY level may be more
accurate since it is highly protein bound
steady state 5-10 days
therapeutic level 10-20mcg/mL
free [ ] 1-2.5
✔✔>20mcg/mL PHY
>40mcg/mL PHY
>100mcg/mL - ✔✔nystagmus
altered mental status
death
✔✔Phenobarbitol Therapeutic Level - ✔✔15-30mcg/mL
✔✔Stage 3 Status Epilepticus Treatment Options - ✔✔Hi dose benzo
Pentobarbitol
Propofol
mechanical ventilation
✔✔Pentobarbitol when used for a long time - ✔✔accumulates in fat stores leading to
prolonged elimination
WBC dysfunction and increased infection risk
✔✔Propofol Advantage - ✔✔shorter half life - can turn the sedation off to assess
seizure (VS Pentobarb where you cant)
✔✔Stage 4 Status Epilepticus Therapy - ✔✔Topiramate
Immunimodulatory Compounds
hypothermia
WITH SOLUTIONS RATED A+
✔✔Terbutaline MOA - ✔✔like albuterol
bronchodilation by B2 adrenergic
✔✔Ketamine MOA - ✔✔stimulate bronchodilation
✔✔Ketamine SE - ✔✔- Respiratory depression
- Cardiovascular (Brady/tachycardia, arrhythmia, hypo/hypertension
- CNS depression (SEDATIVE EFFECTS)
- Increased intracranial and ocular pressure
- Emergence reactions (when used as anesthetic)
✔✔Aminophylline is the - ✔✔prodrug of theophylline
✔✔Aminophylline to Theophylline Dosing Conversion - ✔✔0.8
*aminophylline=theophylline
✔✔Aminophylline/Theophylline Therapeutic Monitoring - ✔✔5-20mcg/mL
can do as a bolus or as continuous IV infusion
CLEARANCE affected by many things
✔✔Aminophylline/Theophylline SEs - ✔✔vesicant (ensure catheter placed)
tachycardia
tremor
insomnia
✔✔w/i 30 minutes of status epilepticus your benzos may become - ✔✔20 fold less
effective than they would have been at onset of seizure
✔✔What labs do we need on patient in status epilepticus? - ✔✔glucose
electrolyte levels
CBC, CMP
toxicology screen
infectious workup
✔✔If adolescent is at risk for Wernicke's encephalopathy with status epilepticus -
✔✔thiamine BEFORE dextrose 50%; dextrose oxidation requires thiamine, w/o thiamine
in thiamine deficient patients the dextrose will take the thiamine in patient making them
even more deficient
✔✔Stage 1 GCSE - ✔✔Impending
, seizing longer than 5 minutes or seizures without recovery of consciousness between
them
✔✔Benzodiazepines in Stage 1 GCSE (impending) Expectations - ✔✔stop seizure in 2-
3 minutes
all similar in efficacy but routes of admin is important
✔✔First Line Agents in Stage 2 Status Epilepticus - ✔✔phy
fosphenytoin
✔✔Phenytoin VS Fosphenytoin - ✔✔fosphenytoin is dosed in equivalence to phenytoin
; given IM but you really want to give IV or IO medications since IM takes long time to
absorb
only time seeing PHY given over FOS is if in drug shortage
fos can be admin more rapidly; PHY has severe infusion related reactions
✔✔Fosphenytoin/Phenytoin Therapeutic Monitoring - ✔✔Free PHY level may be more
accurate since it is highly protein bound
steady state 5-10 days
therapeutic level 10-20mcg/mL
free [ ] 1-2.5
✔✔>20mcg/mL PHY
>40mcg/mL PHY
>100mcg/mL - ✔✔nystagmus
altered mental status
death
✔✔Phenobarbitol Therapeutic Level - ✔✔15-30mcg/mL
✔✔Stage 3 Status Epilepticus Treatment Options - ✔✔Hi dose benzo
Pentobarbitol
Propofol
mechanical ventilation
✔✔Pentobarbitol when used for a long time - ✔✔accumulates in fat stores leading to
prolonged elimination
WBC dysfunction and increased infection risk
✔✔Propofol Advantage - ✔✔shorter half life - can turn the sedation off to assess
seizure (VS Pentobarb where you cant)
✔✔Stage 4 Status Epilepticus Therapy - ✔✔Topiramate
Immunimodulatory Compounds
hypothermia
