Chapter 13 Principles of Pharmacology Flashcards
1
Q
- 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
A
D) Nitroglycerin given by the sublingual route has a rapid onset of action, but a low bioavailability
2
Q
151. All of the following medications possess antiemetic properties, EXCEPT: A) ondansetron. B) dolasetron. C) famotidine. D) prochlorperazine.
A
C) famotidine.
3
Q
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.
A
B) efficacy.
4
Q
154. What classification of medication is ketorolac (Toradol)? A) Opioid analgesic B) Corticosteroid anti-inflammatory C) Histamine-1 receptor antagonist D) Non-steroidal anti-inflammatory
A
D) Non-steroidal anti-inflammatory
5
Q
66. All of the following are common sites for emergency IO cannulation, EXCEPT the: A) proximal humerus. B) iliac crest. C) proximal tibia. D) manubrium.
A
B) iliac crest.
6
Q
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
A
B) Patient’s dietary habits
7
Q
133. 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
A
B) 225, 250
8
Q
70. Medications commonly administered via a nebulizer include all of the following, EXCEPT: A) albuterol. B) lidocaine. C) Xopenex. D) Racemic epinephrine.
A
B) lidocaine.
9
Q
- 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.
A
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.
10
Q
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
A
B) Lopressor
11
Q
- 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.
A
B) The rate of elimination is directly influenced by the plasma levels of the substance.
12
Q
- 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.
A
D) In general, the rate of administration of PRBCs should be proportional to the rate of blood cell loss.
13
Q
- 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.
A
B) blocking the conversion of angiotensin I to angiotensin II.
14
Q
137. The paramedic may be called upon to administer platelets to patients with: A) thrombocytopenia. B) hemolytic anemia. C) a low hematocrit. D) hypercoagulopathy.
A
A) thrombocytopenia.
15
Q
152. IV calcium is routinely used to treat: A) cardiopulmonary arrest. B) magnesium sulfate toxicity. C) sulfuric acid exposure. D) beta-blocker overdose.
A
B) magnesium sulfate toxicity.
16
Q
- 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.
A
C) has a rapid onset of action, a longer (up to 60 minutes) duration of action, and fewer adverse effects.
17
Q
113. Acetylcholinesterase is an enzyme that: A) decreases the heart rate. B) slows cardiac conduction. C) breaks down acetylcholine. D) promotes acetylcholine secretion.
A
C) breaks down acetylcholine.
18
Q
- 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.
A
D) rectal medications are usually not subject to first-pass metabolism.
19
Q
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.
A
C) potentiation
20
Q
- 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
A
C) High doses of a benzodiazepine may be needed to maintain a patient’s blood pressure.
21
Q
- 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.
A
A) can increase cardiac workload and myocardial oxygen demand.
22
Q
74. 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.
A
C) pinocytosis.
23
Q
85. 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.
A
A) lorazepam.
24
Q
- 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.
A
D) decreased myocardial contractility.
25
Q
- 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.
A
B) acetylcholine increases dramatically due to acetylcholinesterase inhibition.
26
Q
129. 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
A
A) Kidney dysfunction
27
Q
- 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.
A
D) The endotracheal route is no longer considered a reliable method of medication administration.
28
Q
- 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.
A
B) beta-2 receptors can potentially be antagonized, resulting in bronchospasm.
29
Q
72. 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
A
A) Seizure termination
30
Q
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.
A
A) bioavailability.
31
Q
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
A
B) dromotropic
32
Q
- 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.
A
D) difference between the median effective dose and the median toxic dose.
33
Q
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.
A
B) 57 kg.
34
Q
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
A
D) Paradoxical reaction
35
Q
- 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.
A
B) he or she has the ability to titrate the medication carefully in a rapidly evolving clinical situation.
36
Q
2. Which of the following medications is derived from a plant source? A) Lithium B) Insulin C) Heparin D) Digoxin
A
D) Digoxin
37
Q
- 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.
A
A) cause a decrease in the heart rate.
38
Q
60. A medication undergoes first-pass metabolism in the: A) liver. B) spleen. C) stomach. D) bone marrow.
A
A) liver.
39
Q
- 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.
A
B) Plasma-protein binding releases medication as circulating levels of a particular medication begin to fall, leading to a longer duration of action.
40
Q
- 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.
A
C) primarily stimulates alpha receptors.
41
Q
- 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.
A
A) diluting it in 20 mL of normal saline and giving it over 1 to 2 minutes.
42
Q
124. 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.
A
C) reduces cardiac afterload.
43
Q
135. Fresh frozen plasma is used to: A) increase the hematocrit. B) increase circulating volume. C) replace red blood cells. D) replace critical clotting factors.
A
D) replace critical clotting factors.
44
Q
- 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.
A
B) decreased preload and coronary vasodilation.
45
Q
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.
A
B) an agonist.
46
Q
- 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.
A
B) relaxation of bronchiole smooth muscle.
47
Q
- 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
A
A) Sodium influx decreases while potassium slowly exits the cell
48
Q
29. Which adrenergic receptor, when stimulated, inhibits norepinephrine release? A) Beta-1 B) Alpha-1 C) Alpha-2 D) Beta-2
A
C) Alpha-2
49
Q
- 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.
A
D) repeated exposure to a medication within a particular class causes tolerance to other medications in the same class.
50
Q
- 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.
A
A) can be given, but not without close patient monitoring.
51
Q
155. 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
A
A) Sodium bicarbonate
52
Q
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
A
B) Renal failure
53
Q
- 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.
A
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.
54
Q
142. Which of the following medications actually dissolves a clot? A) Plavix B) Aggrastat C) Warfarin D) Activase
A
D) Activase
55
Q
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.
A
B) the weight of the drug.
56
Q
122. At 15 g/kg/min, dopamine: A) reduces cardiac contractility. B) antagonizes alpha-1 receptors. C) activates beta-2 receptor sites. D) causes vigorous vasoconstriction
A
D) causes vigorous vasoconstriction
57
Q
115. 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.
A
D) in doses less than 0.1 mg.
58
Q
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.
A
B) the placebo effect.
59
Q
95. 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
A
D) Albuterol
60
Q
- 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.
A
D) They are not found naturally in the body.
61
Q
- 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.
A
C) FFP must be compatible with the recipient’s blood type, but does not have to be Rh compatible.
62
Q
77. Most medication biotransformation occurs in the: A) liver. B) kidneys. C) lungs. D) GI tract.
A
A) liver.
