Which of the following medications should be avoided in children < 16 years old with symptoms of viral infection due to the risk of developing Reye's Syndrome?

A. Theratears Gel CMC 1%, sodium bicarbonate: This product is a lubricant eye drop designed to relieve dryness by stabilizing the tear film. It does not address the underlying allergic response, such as histamine release, so it is unlikely to relieve itching, redness, and watering associated with allergic conjunctivitis.

B. Opticrom–cromolyn sodium: Cromolyn sodium is a mast cell stabilizer that prevents release of histamine and other mediators. However, it requires consistent, scheduled use over several days to weeks for full effect, making it less suitable for intermittent, mild symptoms needing quick relief.

C. Refresh Tears–carboxymethylcellulose 0.5%: This is another artificial tear that helps with lubrication and dryness but does not treat allergic inflammation. Since NJ already tried similar tear drops without success, this would not provide additional benefit for her symptoms.

D. Opcon-A–naphazoline 0.02675% and pheniramine 0.315%: This combination provides both an antihistamine effect (pheniramine) to relieve itching and a vasoconstrictor (naphazoline) to reduce redness. It works quickly and is appropriate for short-term, intermittent allergic eye symptoms, aligning well with NJ’s presentation.

A. Loperamide 2 mg tablets - She should take 4 mg x 1 dose by mouth then 2 mg for each loose stool, do not exceed 8 mg/day, duration of use 48 hours: Loperamide is appropriate for acute, non-bloody diarrhea in otherwise healthy adults. It reduces intestinal motility, helping decrease stool frequency and improve comfort.

B. Bismuth subsalicylate liquid or tablets - She should take 525 mg every 30–60 minutes up to 4200 mg/day, duration of use 48 hours: Bismuth subsalicylate is effective for mild to moderate acute diarrhea and has antimicrobial and anti-secretory effects. It is particularly useful in cases of suspected infectious diarrhea from food exposure, such as a picnic setting, making it appropriate

C. A or B: Both loperamide and bismuth subsalicylate are appropriate first-line OTC treatments for acute diarrhea in a healthy adult without contraindications. Either can be selected based on patient preference, symptom severity, and tolerance, making this the best overall answer.

D. There are no appropriate recommendations for JW's diarrhea given in the options listed: JW’s presentation is consistent with uncomplicated acute diarrhea likely due to foodborne illness. She has no contraindications, so OTC options like loperamide or bismuth subsalicylate are appropriate and recommended.