BNF practice

A 7-year-old child with asthma requires pain relief for a fracture.

Which is MOST appropriate?

• Ibuprofen

• Paracetamol

• Codeine

✅ Paracetamol

• Safe in asthma

• First-line analgesic in children

❌ Ibuprofen

• NSAIDs may worsen asthma in some children

❌ Codeine

• Contraindicated in children

• Risk of respiratory depression

Check: BNFc → Analgesia → Contraindications → Asthma

An oral pain relief drug for a 10-year-old girl with Crohn’s disease following a traumatic injury.

Which is MOST appropriate?

• Fentanyl

• Paracetamol

• Ibuprofen

✅ Paracetamol

• Safe in inflammatory bowel disease

• Suitable oral analgesic

❌ Ibuprofen

• NSAIDs contraindicated in Crohn’s disease

• Risk of GI bleeding and flare

❌ Fentanyl

• Strong opioid

• Not first-line for mild–moderate pain

• Requires specialist input

Check: BNFc → NSAIDs → GI disease

A drug suitable to reverse opioid overdose in a 5-month-old infant.

Which is MOST appropriate?

• Naloxone

• Buprenorphine

• Acetylcysteine

✅ Naloxone

• Opioid antagonist

• Used to reverse opioid overdose

• Suitable in infants

❌ Buprenorphine

• Partial opioid agonist

• Would worsen or prolong opioid effects

❌ Acetylcysteine

• Used for paracetamol overdose

• No role in opioid toxicity

Check: BNFc → Poisoning → Opioids

An anticonvulsant suitable to treat tonic–clonic seizures in a child with bone marrow depression.

Which is MOST appropriate?

• Ethosuximide

• Carbamazepine

• Sodium valproate

✅ Sodium valproate

• Broad-spectrum anticonvulsant

• Effective for tonic–clonic seizures

❌ Ethosuximide

• Only used for absence seizures

• Not effective for tonic–clonic

❌ Carbamazepine

• Can cause bone marrow suppression

• Contraindicated in this scenario

Check: BNFc → Antiepileptics → Adverse effects

A 6-year-old child with a penicillin allergy requires treatment for a bacterial infection.

Which is MOST appropriate?

• Amoxicillin

• Clarithromycin

• Flucloxacillin

✅ Clarithromycin

• Suitable alternative in penicillin allergy

❌ Amoxicillin

• Penicillin → contraindicated

❌ Flucloxacillin

• Penicillin → contraindicated

Check: BNFc → Antibiotics → Allergy

A child with acute severe asthma.
Which drug is appropriate?

• Salbutamol

• Propranolol

• Morphine

✅ Salbutamol
❌ Propranolol – beta-blocker, worsens asthma

A child with bradycardia and heart block needs rate control.
Which drug should be avoided?

• Atenolol

• Digoxin

• Amiodarone

❌ Atenolol – beta-blocker worsens bradycardia

A 2-year-old with suspected sepsis needs IV antibiotics.
Which is most appropriate?

• Oral amoxicillin

• IV cefotaxime

• Oral azithromycin

✅ IV cefotaxime
❌ Oral options inappropriate in sepsis

A child with renal impairment requires analgesia.
Which drug should be avoided?

• Paracetamol

• Ibuprofen

• Codeine

❌ Ibuprofen – NSAIDs worsen renal function

A child with constipation.
Which is first-line?

• Lactulose

• Loperamide

• Codeine

✅ Lactulose
❌ Loperamide – for diarrhoea

A child under 12 with cough.
Which drug should be avoided?

• Honey

• Simple linctus

• Codeine

❌ Codeine – contraindicated in children

A 6-year-old child presents with vomiting and dehydration.
Which antiemetic is most appropriate?

• Metoclopramide

• Ondansetron

• Prochlorperazine

✅ Most appropriate: Ondansetron

❌ Metoclopramide excluded

• Risk of extrapyramidal side effects in children

❌ Prochlorperazine excluded

• Increased risk of dystonic reactions

A 9-year-old child is diagnosed with ADHD.
Which drug is most appropriate as first-line?

• Methylphenidate

• Diazepam

• Risperidone

✅ Most appropriate: Methylphenidate

❌ Diazepam excluded

• Not indicated for ADHD

❌ Risperidone excluded

• Used only for severe aggression when other measures fail

A 3-month-old infant presents with suspected bacterial meningitis. Which antibiotic is most appropriate?

Options:

• Cefotaxime

• Ciprofloxacin

• Doxycycline

Cefotaxime

• Licensed for infants

• Appropriate CNS penetration

• Ciprofloxacin generally avoided in children

• Doxycycline contraindicated in children under 12

• A 14-year-old girl with epilepsy requires contraception. Which option is most suitable?

  Options:

  • Combined oral contraceptive pill

  • Progestogen-only pill

  • Copper intrauterine device

Copper intrauterine device

• Not affected by enzyme-inducing antiepileptics

• Combined and progestogen-only pills may be less effective

• Consider safeguarding and consent

A 10-year-old boy with ADHD requires pharmacological treatment. Which medicine is first-line?

Options:

• Methylphenidate

• Diazepam

• Risperidone

Methylphenidate

• First-line for ADHD in children

• Diazepam not indicated

• Risperidone only for severe behavioural disturbance

A 5-year-old child presents with acute wheeze and shortness of breath. Which is the most appropriate first-line treatment?

Options:

• Salbutamol inhaler

• Oral prednisolone

• Montelukast

Salbutamol inhaler

• First-line bronchodilator

• Oral steroids used if severe

• Montelukast is preventative, not acute

A 12-year-old child with type 1 diabetes presents with hypoglycaemia. Which treatment is most appropriate?

Options:

• Oral glucose gel

• Metformin

• Insulin glargine

Oral glucose gel

• Immediate treatment for hypoglycaemia

• Metformin not used in type 1 diabetes

• Insulin would worsen hypoglycaemia

A 15-year-old girl with iron-deficiency anaemia requires treatment. Which is the most appropriate option?

Options:

• Oral ferrous sulfate

• Intravenous iron

• Vitamin B12 injections

Oral ferrous sulfate

• First-line treatment

• IV iron reserved for intolerance or malabsorption

• B12 only for B12 deficiency

A 4-year-old child presents with acute vomiting and dehydration. Which antiemetic is most appropriate?

Options:

• Ondansetron

• Metoclopramide

• Prochlorperazine

Ondansetron

• Used short-term in children

• Metoclopramide and prochlorperazine increase risk of extrapyramidal effects