Pharmacology and Medication Safety
Domain 6 tests safe pediatric medication practice: weight-based dosing, calculations, high-alert medications, administration, and error prevention. The examiner looks for independent verification and awareness of age-specific risks.
Core rules
- Calculate mg/kg doses using the current weight; verify the safe range, maximum dose, and frequency.
- Use metric units; write leading zeros (0.5 mg) and avoid trailing zeros (5 mg, not 5.0 mg).
- Measure liquids in mL with an oral syringe; never use household teaspoons.
- Double-check high-alert drugs (insulin, opioids, anticoagulants, chemotherapy) with a second nurse per policy.
- Check allergies, renal/hepatic function, interactions, and age contraindications.
- Reconcile medications at transitions; teach families using the device they will use at home.
Worked example
An 18-kg child is ordered amoxicillin 45 mg/kg/day divided every 12 hours. Total daily dose = 45 × 18 = 810 mg/day; each dose = 405 mg. The suspension is 400 mg/5 mL, so 405 mg × 5 mL/400 mg = 5.06 mL, rounded to 5.1 mL. Check the maximum daily dose and renal function. Give with an oral syringe and document.
Traps
Confusing mL with teaspoons, decimal-point errors, exceeding maximum doses, and crushing extended-release tablets. Also do not assume a liquid concentration is the same across products, and do not skip a second check for high-alert drugs.