Chapter 13 - Principles of Pharmacology

Question 1

Which of the following statements regarding pharmacology is correct?
A) The selection and administration of most medications are based largely on anecdotal research.
B) The action of the human body in response to a particular medication is called pharmacology.
C) Evidence-based guidelines, while helpful, are not the primary factor that drives medication administration.
D) Despite the advanced science of pharmacology, adverse reactions are commonplace.

Answer 1

D) Despite the advanced science of pharmacology, adverse reactions are commonplace.

Question 2

Which of the following medications is derived from a plant source?
A) Lithium
B) Insulin
C) Heparin
D) Digoxin

Answer 2

D) Digoxin

Question 3

A medication is used “off-label.” This means that it:
A) is used for a purpose not approved by the FDA, at doses different from the recommended doses, or by a route of administration not approved by the FDA.
B) has been determined to be safe by a physician, and is used to treat a patient’s illness before the medication has been approved by the FDA for any purpose.
C) is administered in clinical trials while the manufacturer conducts further research and before the FDA has approved the medication for use.
D) is administered in an extreme emergency situation, but only if initial clinical trials have determined that the medication will not cause harm to the patient.

Answer 3

A) is used for a purpose not approved by the FDA, at doses different from the recommended doses, or by a route of administration not approved by the FDA.

Question 4

A(n) _________ medication typically includes a “stem” that links it to other medications in the same class.
A) trade
B) official
C) brand
D) generic

Answer 4

D) generic

Question 5

All of the following medications fall in the same classification, EXCEPT:
A) captopril
B) enalapril
C) diazepam
D) lisinopril

Answer 5

C) diazepam

Question 6

Metoprolol has the brand name _____________, which may be a subtle reference to lowering the blood pressure.
A) Cordarone
B) Lopressor
C) Vasotec
D) Norpramin

Answer 6

B) Lopressor

Question 7

Common components of a medication profile include all of the following, EXCEPT:
A) pregnancy risk factors.
B) the weight of the drug.
C) potential incompatibility.
D) mechanism of action.

Answer 7

B) the weight of the drug.

Question 8

Medications that are manufactured synthetically:
A) do not use animal, mineral, or vegetable sources.
B) include insulin, digitalis, and thyroid medications.
C) are derived from certain plants and animal organs.
D) include calcium, iron, magnesium, and other minerals.

Answer 8

A) do not use animal, mineral, or vegetable sources.

Question 9

The Comprehensive Drug Abuse Prevention and Control Act of 1970:
A) regulated the import, manufacture, prescription, and sale of several nonnarcotic medications and cocaine, opium, and their derivatives.
B) was aimed at protecting the public from mislabeled, poisonous, or otherwise harmful food, medications, and alcoholic beverages.
C) increased the penalties for violation of the Harrison Narcotic Act, made the possession of heroin illegal, and outlawed the acquisition and transportation of marijuana.
D) was a legislative act dealing with narcotic and nonnarcotic medications that have a potential for abuse, and developed a drug classification system according to the abuse potential of the medications.

Answer 9

D) was a legislative act dealing with narcotic and nonnarcotic medications that have a potential for abuse, and developed a drug classification system according to the abuse potential of the medications.

Question 10

Unlike Schedule I drugs, Schedule II drugs have:
A) accepted medical uses.
B) a higher abuse potential.
C) limited dependence potential.
D) no accepted medical application.

Answer 10

A) accepted medical uses.

Question 11

Compared to Schedule III drugs, Schedule IV drugs:
A) include medications such as Vicodin and have a high potential for psychological dependence.
B) have a moderate potential for physical dependence and include cough syrups that contain codeine.
C) may lead to severe addiction and include short-acting barbiturates, amphetamines, and opiates.
D) have a lower abuse potential and include medications such as diazepam (Valium) and lorazepam (Ativan).

Answer 11

D) have a lower abuse potential and include medications such as diazepam (Valium) and lorazepam (Ativan).

Question 12

All of the following are Schedule II substances, EXCEPT:
A) Ritalin.
B) fentanyl.
C) cocaine.
D) heroin.

Answer 12

D) heroin.

Question 13

The generic name of a medication:
A) does not require FDA approval.
B) is proposed by the manufacturer.
C) is proprietary and cannot be reproduced.
D) contains a string of letters and numbers.

Answer 13

B) is proposed by the manufacturer.

Question 14

The paramedic must use caution when referencing a medication in an American Medical Association (AMA) publication because:
A) the AMA publication only lists medications that are in human clinical trials.
B) not every medication listed in the compendium has received FDA approval.
C) medications listed in an AMA publication are typically not for prehospital use.
D) all medications in an AMA publication are listed by their chemical name only.

Answer 14

B) not every medication listed in the compendium has received FDA approval.

Question 15

The United States Pharmacopeia (USP) recommended temperature range for MOST medications in the prehospital setting is:
A) 40°F to 76°F.
B) 45°F to 80°F.
C) 55°F to 86°F.
D) 60°F to 90°F

Answer 15

C) 55°F to 86°F.

Question 16

The paramedic should be MOST suspicious that a controlled substance has been tampered with if:
A) repeated doses of the same drug are administered and the patient experiences an adverse reaction.
B) an appropriate dose of the drug seems ineffective, especially when patient tolerance is unlikely.
C) the box that the drug is stored in is torn, even if the drug cartridge itself is structurally intact.
D) there are any stray markings on the drug cartridge or vial, even if the contents are not discolored.

Answer 16

B) an appropriate dose of the drug seems ineffective, especially when patient tolerance is unlikely.

Question 17

The action of the body in response to a medication is called:
A) pharmacology.
B) biotransformation.
C) pharmacokinetics.
D) pharmacodynamics.

Answer 17

C) pharmacokinetics.

Question 18

Newer medications are designed to target only specific receptor sites on certain cells in an attempt to:
A) treat more than one condition.
B) minimize the adverse effects.
C) reduce their therapeutic effect.
D) eliminate all side effects.

Answer 18

B) minimize the adverse effects.

Question 19

A medication that initiates or alters a cellular activity by attaching to receptor sites and prompting a cell response is said to be:
A) synergistic.
B) an agonist.
C) an antagonist.
D) a competitive binder.

Answer 19

B) an agonist.

Question 20

The term affinity, as it applies to pharmacology, is MOST accurately defined as the:
A) ability of a medication to bind to a receptor.
B) process of a medication binding to a receptor.
C) blocking of a receptor site by a particular medication.
D) strength of the bond between a medication and its receptor.

Answer 20

A) ability of a medication to bind to a receptor.

Question 21

A medication is called an antagonist if:
A) it has a higher affinity for the receptor site than the chemical mediator.
B) it stimulates a receptor site to cause the response that that receptor normally causes.
C) it attaches to a receptor site and produces an effect or series of effects.
D) the chemical mediator of a receptor has a higher affinity than the medication.

Answer 21

A) it has a higher affinity for the receptor site than the chemical mediator.

Question 22

The ability of a medication to initiate or alter cell activity in a therapeutic or desired manner is referred to as:
A) potency.
B) efficacy.
C) affinity.
D) the threshold level.

Answer 22

efficacy.

Question 23

Stimulation of alpha-1 receptors results in:
A) insulin secretion.
B) vasoconstriction.
C) arterial dilation.
D) glucagon secretion.

Answer 23

B) vasoconstriction.

Question 24

Stimulation of beta-1 adrenergic receptors would produce all of the following effects, EXCEPT:
A) an increase in heart rate.
B) increased renin secretion.
C) increased cardiac electrical conduction.
D) decreased myocardial contractility.

Answer 24

D) decreased myocardial contractility.

Question 25

In order to cause a negative inotropic effect on the heart, you would have to administer a(n):
A) beta-1 adrenergic antagonist.
B) alpha-2 adrenergic agonist.
C) beta-2 adrenergic agonist.
D) alpha-1 adrenergic antagonist.

Answer 25

A) beta-1 adrenergic antagonist.

Question 26

Stimulation of beta-2 receptors will cause:
A) bronchoconstriction.
B) the airway diameter to dilate.
C) vasoconstriction and hypertension.
D) a decreased release of norepinephrine.

Answer 26

B) the airway diameter to dilate.

Question 27

A medication that possesses a negative chronotropic effect will:
A) cause a decrease in the heart rate.
B) cause an increase in blood pressure.
C) decrease myocardial contractile force.
D) increase cardiac electrical conduction velocity.

Answer 27

A) cause a decrease in the heart rate.

Question 28

When a medication alters the velocity of the conduction of electricity through the heart, it is said to have a(n) _____________ effect.
A) inotropic
B) dromotropic
C) chronotropic
D) alpha agonistic

Answer 28

B) dromotropic

Question 29

Which adrenergic receptor, when stimulated, inhibits norepinephrine release?
A) Beta-1
B) Alpha-1
C) Alpha-2
D) Beta-2

Answer 29

C) Alpha-2

Question 30

In order to relieve the bronchospasm associated with an acute asthma attack, the paramedic would give a(n):
A) alpha-1 agonist.
B) beta-2 agonist.
C) beta-1 agonist.
D) alpha-2 agonist.

Answer 30

B) beta-2 agonist.

Question 31

Lipid-soluble medications require higher weight-based doses in elderly patients because:
A) there are fewer barriers to absorption in elderly patients.
B) elderly patients have a much faster basil metabolic rate.
C) elderly patients have a higher body fat percentage and fat distribution.
D) elderly patients have a higher overall percentage of body water.

Answer 31

C) elderly patients have a higher body fat percentage and fat distribution.

Question 32

What term is used to describe a situation in which a patient experiences clinical effects from a medication that are opposite from the intended effects?
A) Side effect
B) Subtherapeutic effect
C) Idiosyncrasy
D) Paradoxical reaction

Answer 32

D) Paradoxical reaction

Question 33

The ideal body weight for a woman who is 5 ft 5 in tall is:
A) 52 kg.
B) 57 kg.
C) 62 kg.
D) 66 kg.

Answer 33

B) 57 kg.

Question 34

Patients with primary pulmonary hypertension may experience acute decompensation if they are given a:
A) salicylate.
B) vasopressor.
C) diuretic.
D) bronchodilator.

Answer 34

B) vasopressor.

Question 35

Which of the following factors would be the LEAST likely to affect a patient’s response to a medication?
A) Body temperature
B) Pregnancy
C) Past medical history
D) Age and weight

Answer 35

C) Past medical history

Question 36

During a study, a patient experiences measurable clinical improvement or unexplained adverse effects after receiving a medication with no pharmacologic properties. This is referred to as:
A) an idiosyncrasy.
B) the placebo effect.
C) an untoward effect.
D) the therapeutic ratio.

Answer 36

B) the placebo effect.

Question 37

A drug is assigned a pregnancy category “A” if:
A) there is evidence of fetal risk based on human experience, and the risk of using the drug in pregnant women clearly outweighs any possible benefit.
B) there is positive evidence of human fetal risk, but the benefits from use in pregnant women may be acceptable despite the documented risk.
C) studies in animals have revealed adverse effects on the fetus and there are no controlled studies in women, or studies in women and animals are not available.
D) controlled studies in women fail to demonstrate a risk to the fetus in the first trimester, there is no evidence of risk in later trimesters, and the possibility of fetal harm appears remote.

Answer 37

D) controlled studies in women fail to demonstrate a risk to the fetus in the first trimester, there is no evidence of risk in later trimesters, and the possibility of fetal harm appears remote.

Question 38

If studies in animals or human beings have demonstrated fetal abnormalities, or if there is evidence of fetal risk based on human experience, a pregnancy category ___ is assigned to a medication.
A) B
B) C
C) D
D) X

Answer 38

D) X

Question 39

A paramedic gives a woman with chronic pain an injection of sterile saline and tells her that it is a narcotic analgesic. The paramedic’s action:
A) could result in criminal prosecution.
B) will likely be of therapeutic benefit.
C) is acceptable under the circumstances.
D) demonstrates compassion and empathy.

Answer 39

A) could result in criminal prosecution.

Question 40

A drug that possesses the same desired clinical effect in several smaller doses as it does in a larger single dose has demonstrated:
A) an idiosyncratic reaction.
B) the placebo effect.
C) a cumulative action.
D) cross-tolerance

Answer 40

C) a cumulative action.

Question 41

An undesirable clinical change caused by a medication that causes some degree of harm or discomfort to the patient is called a(n):
A) side effect.
B) idiosyncrasy.
C) placebo effect.
D) adverse effect.

Answer 41

D) adverse effect.

Question 42

Which of the following conditions would make a patient the MOST susceptible to an adverse effect from a medication?
A) Hypertension
B) Renal failure
C) Minor trauma
D) Chronic pain

Answer 42

B) Renal failure

Question 43

Certain antibiotics and antiseizure medications are known to cause Stevens-Johnson syndrome, which is a:
A) severe, possibly fatal reaction that mimics a burn.
B) rare condition characterized by painful neck spasms.
C) condition in which the renal system acutely fails.
D) nonfatal reaction characterized by a diffuse rash.

Answer 43

A) severe, possibly fatal reaction that mimics a burn.

Question 44

An abnormal susceptibility to a medication that is peculiar to an individual patient is called an:
A) untoward effect.
B) adverse reaction.
C) idiosyncratic reaction.
D) exaggerated therapeutic effect.

Answer 44

C) idiosyncratic reaction.

Question 45

The therapeutic index of a medication is defined as the:
A) plasma level at which the medication begins to exert its effect.
B) period of time in which the medication is excreted from the body.
C) duration of therapeutic action for a given medication on the body.
D) difference between the median effective dose and the median toxic dose.

Answer 45

D) difference between the median effective dose and the median toxic dose.

Question 46

A medication that has a narrow therapeutic index:
A) can be given, but not without close patient monitoring.
B) should not be given to patients over 50 years of age.
C) is safe to give because the chance of toxicity is remote.
D) should not be given because its effects are too harmful.

Answer 46

A) can be given, but not without close patient monitoring.

Question 47

Patients who are genetically predisposed to an immune-mediated medication response:
A) typically have a history of more than one autoimmune disorder.
B) had an initial exposure and sensitization to a particular antigen.
C) should be given an antihistamine before receiving the medication.
D) will experience a minor reaction that is generally limited to hives.

Answer 47

B) had an initial exposure and sensitization to a particular antigen.

Question 48

Which of the following medications MOST often causes an immune-mediated medication response?
A) Ibuprofen
B) Penicillin
C) Fentanyl
D) Atropine

Answer 48

B) Penicillin

Question 49

Decreased efficacy or potency of a medication when taken repeatedly by a patient is called:
A) addiction.
B) immunity.
C) tolerance.
D) habituation

Answer 49

C) tolerance.

Question 50

Cross-tolerance to a medication occurs when:
A) the body’s metabolism increases, resulting in a decreased concentration of the medication present near receptor sites.
B) repeated doses of a medication within a short time rapidly cause tolerance, which renders the medication ineffective.
C) repeated exposure to a medication causes an abnormal tolerance to the adverse or therapeutic effects of the medication.
D) repeated exposure to a medication within a particular class causes tolerance to other medications in the same class.

Answer 50

D) repeated exposure to a medication within a particular class causes tolerance to other medications in the same class.

Question 51

A patient receives several doses of the same drug within a short period of time, after which point the medication does not relieve his symptoms. Which of the following has MOST likely occurred?
A) Tachyphylaxis
B) Cross-tolerance
C) Down-regulation
D) Dependence

Answer 51

A) Tachyphylaxis

Question 52

The physical, emotional, or behavioral need for a medication in order to maintain a certain level of “normal” function is called:
A) withdrawal.
B) synergism.
C) dependence.
D) habituation.

Answer 52

C) dependence.

Question 53

Which of the following factors would have the LEAST influence on the duration and effectiveness of a medication?
A) Dose administered
B) Patient’s dietary habits
C) Route of administration
D) Patient’s clinical status

Answer 53

B) Patient’s dietary habits

Question 54

The peak of a medication’s effect depends on _____________, whereas the duration of effect depends on ______________.
A) distribution, absorption
B) absorption, metabolism
C) elimination, absorption
D) metabolism, distribution

Answer 54

B) absorption, metabolism

Question 55

The percentage of an unchanged medication that reaches the systemic circulation is referred to as:
A) bioavailability.
B) drug interference.
C) peak plasma level.
D) pharmacodynamics.

Answer 55

A) bioavailability.

Question 56

Medications administered by the ___________ route, by definition, have 100% bioavailability.
A) sublingual
B) intramuscular
C) endotracheal
D) intravenous

Answer 56

D) intravenous

Question 57

Medication X is given to increase the effects of medication Y, which provides more relief than if medication Y were given alone. This is an example of:
A) synergism.
B) summation.
C) potentiation.
D) antagonism.

Answer 57

C) potentiation.

Question 58

A patient experiences profound sedation when an opioid, such as fentanyl, is given together with a benzodiazepine, such as midazolam. This is an example of:
A) synergism.
B) summation.
C) potentiation.
D) antagonism.

Answer 58

A) synergism.

Question 59

Physiologic drug antagonism occurs when:
A) the action of one medication increases or decreases the ability of another medication to be absorbed by the body.
B) two medications, each producing opposite effects, are present simultaneously, resulting in minimal or no clinical changes.
C) the effect of one medication is enhanced by the presence of another medication, which does not have the ability to produce the same effect.
D) two medications, each producing identical effects, are present simultaneously, resulting in an enhanced physiologic response.

Answer 59

B) two medications, each producing opposite effects, are present simultaneously, resulting in minimal or no clinical changes.

Question 60

A medication undergoes first-pass metabolism in the:
A) liver.
B) spleen.
C) stomach.
D) bone marrow.

Answer 60

D) bone marrow.

Question 60

First-pass metabolism of a medication occurs when:
A) a medication’s effects are greatly enhanced by digestive enzymes in the stomach.
B) a medication’s bioavailability is immediately reduced when it enters the bloodstream.
C) the bioavailability of a medication is reduced before it reaches the systemic circulation.
D) the liver increases a medication’s effects before it reaches the systemic circulation.

Answer 60

C) the bioavailability of a medication is reduced before it reaches the systemic circulation.

Question 61

Which of the following statements regarding the endotracheal route of medication administration is correct?
A) If a medication must be given via the endotracheal route, five times the standard IV dose should be given.
B) Evidence has shown that medications given via the endotracheal route quickly achieve a peak plasma level.
C) Medications given via the endotracheal route should be flushed with 20 to 30 mL of sterile water.
D) The endotracheal route is no longer considered a reliable method of medication administration.

Answer 61

D) The endotracheal route is no longer considered a reliable method of medication administration.

Question 62

Which of the following medications can be administered via the intranasal route?
A) Atropine
B) Diazepam
C) Morphine
D) Naloxone

Answer 62

D) Naloxone

Question 63

When the paramedic administers a medication via the IV route:
A) bioavailability of the medication is reduced by 50% as soon as it enters the systemic circulation.
B) he or she has the ability to titrate the medication carefully in a rapidly evolving clinical situation.
C) it is important for him or her to remember that the medication’s onset of action is relatively slow.
D) first-pass metabolism significantly alters the medication’s effects, thereby requiring frequent dosing.

Answer 63

B) he or she has the ability to titrate the medication carefully in a rapidly evolving clinical situation.

Question 64

IO infusion rates are comparable to IV infusion rates:
A) when a pressure bag or mechanical infusion device is used.
B) only when the extremity with the IO needle inserted is elevated.
C) if the patient’s systolic blood pressure is at least 100 mm Hg.
D) only if the IO needle is inserted in the proximal tibia.

Answer 64

A) when a pressure bag or mechanical infusion device is used.

Question 65

All of the following are common sites for emergency IO cannulation, EXCEPT the:
A) proximal humerus.
B) iliac crest.
C) proximal tibia.
D) manubrium.

Answer 65

B) iliac crest.

Question 66

Which of the following statements regarding the IM route of medication administration is correct?
A) Medications have a bioavailability of 75% to 100% following IM administration.
B) Any medication given by the IV route can be given by the IM route.
C) IM-administered medications are subject to first-pass metabolism in the liver.
D) Muscle perfusion has minimal effect on the absorption of IM-administered drugs.

Answer 66

A) Medications have a bioavailability of 75% to 100% following IM administration.

Question 67

Transdermal medication patches:
A) deliver a fluctuating dose of a medication over a relatively short period of time.
B) should never be removed by the paramedic, even if he or she is administering a drug of the same type.
C) may alter a patient’s clinical presentation or interfere with medications administered by the paramedic.
D) are a reliable medication delivery route because they are unaffected by the patient’s perfusion status.

Answer 67

C) may alter a patient’s clinical presentation or interfere with medications administered by the paramedic.

Question 68

Which of the following statements regarding the sublingual administration of nitroglycerin is correct?
A) Large doses of IV nitroglycerin are required to achieve the same effect as a single sublingual nitroglycerin dose
B) Sublingual nitroglycerin administration involves placing a tablet in between the patient’s cheek and gum
C) Sublingual nitroglycerin has a delayed onset of action, but nearly a 100% bioavailability
D) Nitroglycerin given by the sublingual route has a rapid onset of action, but a low bioavailability

Answer 68

D) Nitroglycerin given by the sublingual route has a rapid onset of action, but a low bioavailability

Question 69

Medications commonly administered via a nebulizer include all of the following, EXCEPT:
A) albuterol.
B) lidocaine.
C) Xopenex.
D) Racemic epinephrine.

Answer 69

B) lidocaine.

Question 70

The rectal route is preferred over the oral route for certain emergency medications because:
A) rectal medications are altered significantly by first-pass metabolism.
B) bioavailability of rectal medications does not exceed 50 percent.
C) the vasculature of the rectal mucosa allows for slow drug absorption.
D) rectal medications are usually not subject to first-pass metabolism.

Answer 70

D) rectal medications are usually not subject to first-pass metabolism.

Question 71

In which of the following situations would the paramedic MOST likely administer a drug via the rectal route?
A) Seizure termination
B) Acute renal failure
C) Respiratory failure
D) Anaphylactic shock

Answer 71

A) Seizure termination

Question 72

Which of the following structures contains epithelial cells that create a continuous barrier to medication absorption?
A) Liver
B) Urinary tract
C) Bone marrow
D) Vascular system

Answer 72

B) Urinary tract

Question 73

The process that the cells of large medication molecules use to ingest intracellular fluids and their contents is called:
A) osmosis.
B) filtration.
C) pinocytosis.
D) phagocytosis.

Answer 73

C) pinocytosis.

Question 74

Which of the following statements regarding plasma-protein binding is correct?
A) Plasma-protein binding is an irreversible process that decreases the amount of medication necessary for a desired clinical effect.
B) Plasma-protein binding releases medication as circulating levels of a particular medication begin to fall, leading to a longer duration of action.
C) If a patient has a safe level of a protein-bound medication, a second medication with a greater affinity greatly decreases the amount of the original medication.
D) As plasma protein levels decrease, the introduction of another protein-bound medication causes the concentration of the original medication to remain unchanged.

Answer 74

B) Plasma-protein binding releases medication as circulating levels of a particular medication begin to fall, leading to a longer duration of action.

Question 75

As a medication undergoes biotransformation, it becomes a(n):
A) compound.
B) molecule.
C) electrolyte.
D) metabolite.

Answer 75

D) metabolite.

Question 76

Most medication biotransformation occurs in the:
A) liver.
B) kidneys.
C) lungs.
D) GI tract.

Answer 76

A) liver.

Question 77

The paramedic should suspect altered medication metabolism in a patient with:
A) hypertension.
B) acute pancreatitis.
C) chronic alcoholism.
D) chronic renal failure.

Answer 77

C) chronic alcoholism.

Question 78

Patients with _________________ are at significant risk for toxic effects of medications or metabolic waste products in the body.
A) renal failure
B) diabetes mellitus
C) stomach cancer
D) heart failure

Answer 78

A) renal failure

Question 79

Which of the following describes first-order elimination?
A) The more of a substance that is in the plasma, the less the body works to eliminate it.
B) The rate of elimination is directly influenced by the plasma levels of the substance.
C) A fixed amount of a substance is removed, regardless of the total amount in the body.
D) Biotransformation in the liver converts a substance to an active or inactive metabolite.

Answer 79

B) The rate of elimination is directly influenced by the plasma levels of the substance.

Question 80

A patient takes 500 mg of a medication that has a half-life of 2 hours. How much medication will be in the patient’s body after 6 hours?
A) 250 mg
B) 125 mg
C) 62.5 mg
D) 31.25 mg

Answer 80

C) 62.5 mg

Question 81

The paramedic can avoid technical errors in medication administration by:
A) using a current, reliable medication reference source before administering the medication.
B) having a partner confirm the volume in a syringe or a weight-based medication calculation.
C) contacting medical control and confirming that the proposed dose is appropriate for the patient.
D) evaluating a patient for medication allergies or hypersensitivity before administering the medication.

Answer 81

B) having a partner confirm the volume in a syringe or a weight-based medication calculation.

Question 82

Etomidate is a medication that:
A) chemically paralyzes a patient prior to intubation.
B) requires multiple doses to provide adequate sedation.
C) has a duration of action of approximately 45 minutes.
D) induces profound sedation following a single dose.

Answer 82

D) induces profound sedation following a single dose.

Question 83

A(n) __________________ agent is used to increase the pH of the serum or urine?
A) antacid
B) alkalinizing
C) anticoagulant
D) antihistamine

Answer 83

B) alkalinizing

Question 84

Which of the following medications possesses positive inotropic effects, allows the cellular uptake of glucose, and is used in the treatment of hyperkalemia?
A) Insulin
B) Osmitrol
C) Glucophage
D) Clopidogrel

Answer 84

A) Insulin

Question 84

All of the following medications are used to reduce a patient’s heart rate and blood pressure, EXCEPT:
A) lorazepam.
B) diltiazem.
C) metoprolol.
D) Tenormin.

Answer 84

A) lorazepam.

Question 85

Which of the following statements regarding benzodiazepine medications is NOT correct?
A) Benzodiazepines have potent anxiolytic, antiseizure, and sedative properties.
B) A benzodiazepine may be used as the primary sedative for advanced airway care.
C) High doses of a benzodiazepine may be needed to maintain a patient’s blood pressure.
D) Benzodiazepines are commonly used in the prehospital setting to terminate seizures.

Answer 85

C) High doses of a benzodiazepine may be needed to maintain a patient’s blood pressure.

Question 86

If seizures occur following the administration of flumazenil (Romazicon):
A) an opiate medication should be given immediately because of its potent antiseizure properties.
B) the patient should receive half the normal dose of a benzodiazepine in order to control the seizure.
C) the paramedic should give naloxone immediately in order to reverse the effects of the flumazenil.
D) benzodiazepine medications will be minimally effective or ineffective in controlling the seizure.

Answer 86

D) benzodiazepine medications will be minimally effective or ineffective in controlling the seizure.

Question 87

Neuromuscular blocking agents achieve chemical paralysis by:
A) agonizing muscarinic receptor sites and increasing acetylcholine production.
B) binding to nicotinic receptor sites on muscle cells and antagonizing acetylcholine.
C) inhibiting cerebellar activity, thereby decreasing voluntary muscle movement.
D) blocking the action of the sodium-potassium pump, causing muscle paralysis.

Answer 87

B) binding to nicotinic receptor sites on muscle cells and antagonizing acetylcholine.

Question 88

Succinylcholine should not be used in patients with:
A) a closed head injury.
B) known hyperkalemia.
C) a rapid heart rate.
D) suspected hypokalemia.

Answer 88

B) known hyperkalemia.

Question 89

Unlike a nondepolarizing paralytic, a competitive depolarizing paralytic:
A) causes muscle fasciculations.
B) does not induce full paralysis.
C) causes profound sedation.
D) lowers serum potassium.

Answer 89

A) causes muscle fasciculations.

Question 90

Which of the following statements regarding succinylcholine is correct?
A) It has a rapid onset of action and long duration of action.
B) It causes tachycardia, especially in small children.
C) It has a rapid onset of action and short duration of action.
D) It may induce or exacerbate existing hypokalemia.

Answer 90

C) It has a rapid onset of action and short duration of action.

Question 91

Compared to succinylcholine, rocuronium:
A) has a rapid (30 to 60 seconds) onset of action and a relatively brief (3 to 8 minutes) duration of action.
B) binds with nicotinic receptors on muscles and causes a brief activation known as fasciculation.
C) has a rapid onset of action, a longer (up to 60 minutes) duration of action, and fewer adverse effects.
D) does not bind with nicotinic receptor sites on muscle cells and does not antagonize acetylcholine.

Answer 91

C) has a rapid onset of action, a longer (up to 60 minutes) duration of action, and fewer adverse effects.

Question 92

The desired clinical effect after administering a beta-2 agonist medication is:
A) dilation of the systemic vasculature.
B) relaxation of bronchiole smooth muscle.
C) increased cardiac contractility
D) contraction of vascular smooth muscle.

Answer 92

B) relaxation of bronchiole smooth muscle.

Question 93

Which of the following medications promotes the cellular uptake of potassium, making it a potential temporary treatment for hyperkalemia?
A) Terbutaline
B) Ipratropium
C) Levalbuterol
D) Albuterol

Answer 93

D) Albuterol

Question 94

Ipratropium bromide (Atrovent) causes bronchodilation by:
A) antagonizing muscarinic receptors.
B) agonizing nicotinic receptors.
C) agonizing beta-2 receptors.
D) antagonizing beta-2 receptors

Answer 94

A) antagonizing muscarinic receptors.

Question 95

Which of the following occurs during phase 1 of the cardiac cellular action potential?
A) Sodium influx decreases while potassium slowly exits the cell
B) Rapid influx of sodium ions through channels in the cardiac cell
C) Calcium enters the cell while potassium continues to leave the cell
D) Calcium movement ceases with continued outflow of potassium

Answer 95

A) Sodium influx decreases while potassium slowly exits the cell

Question 96

Repolarization and myocardial contraction are occurring through phases:
A) 0 and 1.
B) 1 and 2.
C) 2 and 3.
D) 3 and 4.

Answer 96

C) 2 and 3.

Question 97

What phases of the cardiac cellular action potential comprise the absolute refractory period?
A) 1 and 2 only
B) 2 and 3 only
C) 0 through 3
D) 0 through 4

Answer 97

C) 0 through 3

Question 98

Lidocaine is an antidysrhythmic that works by:
A) antagonizing beta-adrenergic receptors in the myocardium.
B) blocking sodium channels in the Purkinje fibers and ventricle.
C) displacing calcium at certain receptor sites in the myocardium.
D) increasing the duration of phases 1, 2, and 3 of the cardiac cycle.

Answer 98

B) blocking sodium channels in the Purkinje fibers and ventricle.

Question 99

Beta blockers should be used with extreme caution in patients with reactive airway because:
A) beta-1 receptor antagonism will result in profound bronchoconstriction.
B) beta-2 receptors can potentially be antagonized, resulting in bronchospasm.
C) there are no beta-blockers that selectively target beta-1 receptors only.
D) they inhibit catecholamine release, potentially causing bronchoconstriction.

Answer 99

B) beta-2 receptors can potentially be antagonized, resulting in bronchospasm.

Question 100

Toxic effects from beta blockers include all of the following, EXCEPT:
A) hypotension.
B) bradycardia.
C) conduction delays.
D) tachycardia.

Answer 100

D) tachycardia.

Question 101

Calcium chloride or calcium gluconate may mitigate hypotension or bradycardia following an overdose of:
A) diltiazem.
B) adenosine.
C) Cordarone.
D) metoprolol.

Answer 101

A) diltiazem.

Question 102

What class of medication is typically used to control the heart rate in patients with atrial fibrillation or atrial flutter?
A) Sodium channel blocker
B) Potassium channel blocker
C) Beta-adrenergic blocker
D) Calcium channel blocker

Answer 102

D) Calcium channel blocker

Question 103

Which of the following statements regarding adenosine is correct?
A) Adenosine has a half-life of between 20 and 30 seconds and should be given slowly.
B) Adenosine increases conduction velocity and shortens the effective refractory period.
C) Adenosine is used to assess for P waves when slowing a supraventricular tachycardia.
D) Ventricular tachycardia is often terminated following the administration of adenosine.

Answer 103

C) Adenosine is used to assess for P waves when slowing a supraventricular tachycardia.

Question 104

In general, alpha-adrenergic receptor antagonists:
A) decrease the heart rate.
B) lower the blood pressure.
C) are used for hypotension.
D) increase vascular resistance.

Answer 104

B) lower the blood pressure.

Question 105

Patients who take alpha-blocking medications at home are frequently prone to:
A) postural hypotension.
B) hypertensive crisis.
C) narrow-angle glaucoma.
D) vagal-induced bradycardia.

Answer 105

A) postural hypotension.

Question 106

Stimulation of alpha-2 receptors:
A) constricts the vascular smooth muscle.
B) suppresses the release of norepinephrine.
C) causes profound systemic hypertension.
D) increases the release of norepinephrine.

Answer 106

B) suppresses the release of norepinephrine.

Question 107

ACE inhibitor medications lower blood pressure by:
A) selectively binding to alpha-1 and alpha-2 receptors.
B) blocking the conversion of angiotensin I to angiotensin II.
C) increasing cardiac afterload and reducing cardiac output.
D) blocking the release of angiotensin I from the renal system.

Answer 107

B) blocking the conversion of angiotensin I to angiotensin II.

Question 108

Under normal conditions, the renin-angiotensin system functions by:
A) dilating the systemic vasculature and reducing cardiac afterload when arterial blood pressure increases.
B) stimulating alpha-1 receptors, thereby increasing the blood pressure in response to acute blood loss.
C) blocking alpha-2 receptors, thereby increasing the release of norepinephrine and raising blood pressure.
D) promoting vasoconstriction and fluid retention in response to hypotension or hypoperfusion.

Answer 108

D) promoting vasoconstriction and fluid retention in response to hypotension or hypoperfusion.

Question 109

Patients taking ACE inhibitor medications commonly have:
A) immunosuppression.
B) thin and fragile skin.
C) a chronic, dry cough.
D) a reduced platelet count.

Answer 109

C) a chronic, dry cough.

Question 110

The vagus nerve releases _________________, which acts on _________________ receptors.
A) acetylcholine, muscarinic-2
B) norepinephrine, alpha-1
C) epinephrine, beta-2
D) acetylcholinesterase, nicotinic

Answer 110

A) acetylcholine, muscarinic-2

Question 111

Acetylcholinesterase is an enzyme that:
A) decreases the heart rate.
B) slows cardiac conduction.
C) breaks down acetylcholine.
D) promotes acetylcholine secretion.

Answer 111

C) breaks down acetylcholine.

Question 112

Massive doses of atropine may be required when:
A) a patient strains to defecate and stimulates muscarinic-2 receptors.
B) acetylcholine increases dramatically due to acetylcholinesterase inhibition.
C) severe bradycardia is the result of a block in the cardiac conduction system.
D) a patient’s heart rate significantly increases and lowers the cardiac output.

Answer 112

B) acetylcholine increases dramatically due to acetylcholinesterase inhibition.

Question 113

Paradoxical bradycardia may occur if atropine is given:
A) too rapidly.
B) in doses greater than 2 mg.
C) for acetylcholinesterase inhibition.
D) in doses less than 0.1 mg.

Answer 113

D) in doses less than 0.1 mg.

Question 114

All of the following are endogenous catecholamines, EXCEPT:
A) dopamine.
B) atropine.
C) epinephrine.
D) norepinephrine.

Answer 114

B) atropine.

Question 115

Which of the following statements regarding sympathomimetic chemicals is correct?
A) They are not synthetically manufactured.
B) They block the release of acetylcholine.
C) They only stimulate alpha-1 receptors.
D) They are not found naturally in the body.

Answer 115

D) They are not found naturally in the body.

Question 116

Catecholamines and sympathomimetic medications should be administered with caution because they:
A) can increase cardiac workload and myocardial oxygen demand.
B) have an average duration of action of between 24 and 48 hours.
C) are associated with paradoxical bradycardia in younger patients.
D) have a tendency to cause a significant decrease in cardiac output.

Answer 116

A) can increase cardiac workload and myocardial oxygen demand.

Question 117

In contrast to epinephrine, norepinephrine:
A) specifically targets beta-1 receptors.
B) has minimal effect on blood pressure.
C) primarily stimulates alpha receptors.
D) stimulates beta-1 and beta-2 receptors.

Answer 117

C) primarily stimulates alpha receptors.

Question 118

At 5 to 10 μg/kg/min, dopamine:
A) activates beta-1 receptor sites, causing an increased heart rate and increased cardiac contractility.
B) activates dopaminergic receptor sites, causing renal and mesenteric artery vasodilation.
C) no longer activates dopaminergic receptor sites and predominately activates alpha-1 receptor sites.
D) has a negative chronotropic effect on the heart, but an increased inotropic effect.

Answer 118

A) activates beta-1 receptor sites, causing an increased heart rate and increased cardiac contractility.

Question 119

Dopamine is commonly used in the prehospital setting as the primary medication for:
A) right-sided heart failure.
B) nonhypovolemic hypotension.
C) severe intracranial hemorrhage.
D) vagal-induced bradycardia.

Answer 119

B) nonhypovolemic hypotension.

Question 120

At 15 μg/kg/min, dopamine:
A) reduces cardiac contractility.
B) antagonizes alpha-1 receptors.
C) activates beta-2 receptor sites.
D) causes vigorous vasoconstriction.

Answer 120

D) causes vigorous vasoconstriction.

Question 121

The primary physiologic effect of dobutamine is:
A) increased afterload.
B) increased inotropy.
C) profound vasoconstriction.
D) increased chronotropy.

Answer 121

B) increased inotropy.

Question 122

Hypotension may occur following initiation of a dobutamine infusion because it:
A) is a direct vasodilator.
B) blocks alpha-1 receptors.
C) reduces cardiac afterload.
D) has negative inotropic effects.

Answer 122

C) reduces cardiac afterload.

Question 123

Which of the following statements regarding vasopressin is correct?
A) Vasopressin is a naturally occurring hormone that is secreted in response to intravascular volume depletion.
B) In cardiac arrest, current guidelines recommend 20 to 40 units of vasopressin every 5 minutes.
C) Vasopressin reduces cardiac afterload, which may cause clinically significant hypotension.
D) Vasopressin is a useful medication for patients with right heart failure and peripheral edema.

Answer 123

A) Vasopressin is a naturally occurring hormone that is secreted in response to intravascular volume depletion.

Question 124

The physiologic effects of nitroglycerin when given to patients with cardiac-related chest pain include:
A) increased myocardial oxygen consumption.
B) decreased preload and coronary vasodilation.
C) coronary vasoconstriction and increased preload.
D) increased afterload and peripheral vasodilation.

Answer 124

B) decreased preload and coronary vasodilation.

Question 125

For which of the following conditions is sodium nitroprusside used?
A) Severe refractory hypotension
B) Vagal-induced bradycardia
C) Intracerebral hemorrhage
D) Unstable vascular aneurysm

Answer 125

D) Unstable vascular aneurysm

Question 126

What type of medication is used to eliminate certain toxins from the body?
A) Inotrope
B) Diuretic
C) Vasopressor
D) Vasodilator

Answer 126

B) Diuretic

Question 127

For which of the following conditions may a patient be prescribed furosemide?
A) Kidney dysfunction
B) Chronic dehydration
C) Low serum potassium
D) Reactive airway disease

Answer 127

A) Kidney dysfunction

Question 128

In critical care settings, mannitol is used to:
A) manage hypothermia.
B) lower the blood pressure.
C) reduce cerebral edema.
D) treat anaphylaxis.

Answer 128

C) reduce cerebral edema.

Question 129

If unmatched blood is administered in the prehospital setting, it will almost always be:
A) O, Rh-positive.
B) AB, Rh-negative.
C) O, Rh-negative.
D) AB, Rh-positive.

Answer 129

C) O, Rh-negative.

Question 130

The preferred IV fluid for Y-site tubing administration during a blood product transfusion is:
A) normal saline.
B) 5% dextrose in water.
C) lactated Ringer’s.
D) 0.45% sodium chloride.

Answer 130

A) normal saline.

Question 131

A unit of packed red blood cells contains approximately _____ to _____ mL of concentrated red blood cells.
A) 125, 200
B) 225, 250
C) 250, 500
D) 500, 725

Answer 131

B) 225, 250

Question 132

Which of the following statements regarding packed red blood cells (PRBCs) is correct?
A) For every 3 mL of whole blood that is lost, the patient should be given 1 to 2 mL of PRBCs.
B) PRBCs should not be given to patients with hemolysis, as this will cause a transfusion reaction.
C) In a patient with ongoing RBC loss, one unit of PRBCs will increase the hematocrit by about 5%.
D) In general, the rate of administration of PRBCs should be proportional to the rate of blood cell loss.

Answer 132

D) In general, the rate of administration of PRBCs should be proportional to the rate of blood cell loss.

Question 133

Fresh frozen plasma is used to:
A) increase the hematocrit.
B) increase circulating volume.
C) replace red blood cells.
D) replace critical clotting factors.

Answer 133

D) replace critical clotting factors.

Question 134

Which of the following statements regarding fresh frozen plasma (FFP) is correct?
A) FFP is the ideal volume expander for critically injured patients whose blood type is not known.
B) FFP is contraindicated in patients with warfarin (Coumadin) toxicity due to the risk of hemolysis.
C) FFP must be compatible with the recipient’s blood type, but does not have to be Rh compatible.
D) FFP should not be administered to patients who require large volumes of other blood products.

Answer 134

C) FFP must be compatible with the recipient’s blood type, but does not have to be Rh compatible.

Question 135

The paramedic may be called upon to administer platelets to patients with:
A) thrombocytopenia.
B) hemolytic anemia.
C) a low hematocrit.
D) hypercoagulopathy.

Answer 135

A) thrombocytopenia.

Question 136

What is the mechanism of action of anticoagulant medications?
A) They dissolve existing clots, thereby restoring distal blood flow.
B) They prevent new clot formation and the growth of existing clots.
C) They inhibit platelet aggregation during acute coronary syndrome.
D) They promote hemostasis in patients with pulmonary emboli.

Answer 136

B) They prevent new clot formation and the growth of existing clots.

Question 137

When is aspirin indicated for the treatment of a stroke?
A) Within the first 15 minutes after the onset of symptoms
B) Only after an intracranial hemorrhage has been ruled out
C) Only if the patient is prescribed antiplatelet medications
D) Immediately upon arrival at the emergency department

Answer 137

B) Only after an intracranial hemorrhage has been ruled out

Question 138

Which of the following is NOT an oral antiplatelet medication?
A) ReoPro
B) Plavix
C) Ticlid
D) Aspirin

Answer 138

A) ReoPro

Question 139

Which of the following is an influencing factor regarding the administration of a fibrinolytic drug to a patient experiencing an acute myocardial infarction?
A) Quality of the chest pain
B) History of unstable angina
C) Time of symptom onset
D) Concurrent use of aspirin

Answer 139

C) Time of symptom onset

Question 140

Which of the following medications actually dissolves a clot?
A) Plavix
B) Aggrastat
C) Warfarin
D) Activase

Answer 140

D) Activase

Question 141

Narcotic analgesics relieve pain by:
A) blocking opioid receptors.
B) suppressing adrenergic function.
C) stimulating opioid receptors.
D) blocking neuromuscular activity.

Answer 141

C) stimulating opioid receptors.

Question 142

Patients who receive opioid substances on a long-term basis:
A) are less likely to develop cross-tolerance than a non-opioid user.
B) often need higher doses of an opioid medication for pain relief.
C) are less likely to experience severe nervous system depression.
D) typically respond to lower doses of an opioid medication.

Answer 142

B) often need higher doses of an opioid medication for pain relief.

Question 143

In up to one third of all patients, morphine sulfate causes:
A) nausea and vomiting.
B) severe hypotension.
C) complete heart block.
D) a reflex tachycardia.

Answer 143

A) nausea and vomiting.

Question 144

Fentanyl (Sublimaze) is the preferred opioid analgesic for patients in critical or unstable condition because:
A) its effects last much longer than any other opioid.
B) it is not as prone to causing hypotension as morphine.
C) it only requires one small dose to achieve analgesia.
D) it hyperstimulates mu (μ) opioid receptor sites.

Answer 144

B) it is not as prone to causing hypotension as morphine.

Question 145

When administering naloxone to a patient who overdosed on an opioid, it is important for the paramedic to remember that:
A) small doses of naloxone often cause severe withdrawal symptoms in long-term opioid users.
B) complete reversal of the opioid is essential if the patient receives opioids on a long-term basis.
C) an IV infusion of naloxone should be used for patients who are addicted to opioids.
D) the duration of action of naloxone in the body is less than that of many opioid chemicals.

Answer 145

D) the duration of action of naloxone in the body is less than that of many opioid chemicals.

Question 146

What type of medication is used to decrease gastric acid secretion?
A) Histamine-1 receptor antagonist
B) Alpha-2 receptor antagonist
C) Histamine-2 receptor antagonist
D) Phosphodiesterase-5 inhibitor

Answer 146

C) Histamine-2 receptor antagonist

Question 147

Phenothiazine medications exert their antiemetic properties by:
A) promoting the secretion of hormones in the brain that depress the function of the medulla oblongata.
B) antagonizing dopaminergic receptor sites in the brain, which suppresses the function of the hypothalamus.
C) blocking histamine-2 receptors, which inhibits gastric acid production and slows peristalsis.
D) activating dopaminergic receptors in the brain and releasing hormones that depress the reticular activating system.

Answer 147

D) activating dopaminergic receptors in the brain and releasing hormones that depress the reticular activating system.

Question 148

The paramedic should administer promethazine (Phenergan) by:
A) diluting it in 20 mL of normal saline and giving it over 1 to 2 minutes.
B) rapid IV push undiluted, as this will minimize the risk of vascular injury.
C) mixing it with 25 mg of diphenhydramine in order to prevent dystonia.
D) diluting it in 50 to 100 mL of normal saline and giving it over 30 minutes.

Answer 148

A) diluting it in 20 mL of normal saline and giving it over 1 to 2 minutes.

Question 149

IV calcium is routinely used to treat:
A) cardiopulmonary arrest.
B) magnesium sulfate toxicity.
C) sulfuric acid exposure.
D) beta-blocker overdose.

Answer 149

B) magnesium sulfate toxicity.

Question 150

Glucagon is used in the treatment of beta-blocker overdose because it:
A) causes vasoconstriction and increases blood pressure.
B) produces positive inotropic and chronotropic effects.
C) activates beta-1 receptors and increases the heart rate.
D) blocks alpha-2 receptors and increases blood pressure.

Answer 150

B) produces positive inotropic and chronotropic effects.

Question 151

What classification of medication is ketorolac (Toradol)?
A) Opioid analgesic
B) Corticosteroid anti-inflammatory
C) Histamine-1 receptor antagonist
D) Non-steroidal anti-inflammatory

Answer 151

D) Non-steroidal anti-inflammatory

Question 152

Which of the following medications is used to provide cardiac cell membrane stabilization following tricyclic antidepressant overdose?
A) Sodium bicarbonate
B) Magnesium sulfate
C) Diphenhydramine
D) Calcium chloride

Answer 152

A) Sodium bicarbonate

Question 153

All of the following medications possess antiemetic properties, EXCEPT:
A) ondansetron.
B) dolasetron.
C) famotidine.
D) prochlorperazine.

Answer 153

C) famotidine.