AEMCA - Advanced Emergency Medical Care Assistant Pharmacology for Paramedics Questions and Answers — Questions and Answers
Question 1: A patient in refractory ventricular fibrillation has received three defibrillations and an appropriate dose of epinephrine. According to Ontario's Advanced Life Support Patient Care Standards (ALS PCS), which of the following is the correct subsequent antiarrhythmic medication and dose?
- Lidocaine 100 mg IVP
- Amiodarone 300 mg IV/IO (Correct answer)
- Magnesium Sulfate 2 g IV/IO
- Procainamide 20 mg/min infusion
Correct answer: Amiodarone 300 mg IV/IO
According to the Ontario ALS PCS for medical cardiac arrest, after the third defibrillation and first dose of epinephrine have been administered, the next indicated medication for persistent Ventricular Fibrillation (VF) or pulseless Ventricular Tachycardia (pVT) is Amiodarone 300 mg via IV or IO push. Lidocaine is a secondary option if amiodarone is unavailable, and Magnesium is primarily for Torsades de Pointes.
Question 2: A paramedic is treating a 60-year-old male with chest pain and a BP of 110/70 mmHg. Which of the following patient statements would represent an absolute contraindication to the administration of Nitroglycerin?
- "I took my daily Aspirin this morning."
- "I have a history of a heart attack five years ago."
- "I am allergic to morphine."
- "I took a sildenafil (Viagra) pill yesterday evening." (Correct answer)
Correct answer: "I took a sildenafil (Viagra) pill yesterday evening."
The use of phosphodiesterase-5 (PDE5) inhibitors, such as sildenafil, within the last 24-48 hours is an absolute contraindication for administering nitroglycerin. The combination can cause a profound and potentially fatal hypotensive effect due to synergistic vasodilation. The other options are not contraindications.
Question 3: An 80-year-old female is found unconscious with a blood glucose level of 1.8 mmol/L. IV access is unsuccessful. What is the primary mechanism of action of the medication that should be administered via the intramuscular route?
- It directly provides glucose to the bloodstream.
- It stimulates the pancreas to release stored insulin.
- It facilitates the transport of glucose from the blood into the cells.
- It stimulates the liver to break down glycogen into glucose. (Correct answer)
Correct answer: It stimulates the liver to break down glycogen into glucose.
In this scenario, Glucagon would be administered IM. Glucagon's primary mechanism of action is to stimulate the liver to convert its stored glycogen into glucose (a process called glycogenolysis) and release it into the bloodstream, thereby raising the blood glucose level. It does not directly provide glucose or stimulate insulin release.
Question 4: You are treating a patient for severe musculoskeletal pain following a traumatic injury. You choose to administer fentanyl instead of morphine. What is a key pharmacological advantage of fentanyl in a potentially hemodynamically unstable patient?
- Fentanyl has a longer duration of action.
- Fentanyl causes less histamine release and has greater hemodynamic stability. (Correct answer)
- Fentanyl can be administered via the intramuscular route, unlike morphine.
- Fentanyl provides significant anti-inflammatory effects.
Correct answer: Fentanyl causes less histamine release and has greater hemodynamic stability.
Fentanyl is often preferred over morphine in trauma or cardiac patients because it is associated with less histamine release, leading to less vasodilation and a more stable hemodynamic profile (i.e., less likely to cause hypotension). Morphine is a more potent histamine-releasing agent, which can contribute to a drop in blood pressure.
Question 5: A 70 kg adult patient is in status epilepticus. The paramedic decides to administer midazolam via the IM route. The protocol calls for a dose of 10 mg. Your vial concentration is 5 mg/mL. How many milliliters should be administered?
- 1.0 mL
- 1.5 mL
- 2.0 mL (Correct answer)
- 0.5 mL
Correct answer: 2.0 mL
This is a drug calculation question. The formula is: (Dose Required / Concentration on Hand) = Volume to Administer. In this case, (10 mg / 5 mg/mL) = 2.0 mL. The paramedic should administer 2.0 mL of midazolam. The adult dose for status epilepticus is commonly a standard 10 mg IM for patients over a certain weight threshold, making this a typical prehospital scenario.
Question 6: Which of the following is a primary indication for the administration of dimenhydrinate according to Ontario paramedic standards?
- Management of acute anxiety or panic attacks.
- Treatment of nausea and vomiting associated with vertigo. (Correct answer)
- Prophylaxis against motion sickness during air transport.
- Reversal of extrapyramidal symptoms caused by antipsychotics.
Correct answer: Treatment of nausea and vomiting associated with vertigo.
In the prehospital setting under Ontario's ALS PCS, a primary indication for administering dimenhydrinate is for the management of nausea and vomiting, particularly when associated with vertigo or vestibular disturbances. While it can be used for other causes of nausea, its anticholinergic and antihistamine properties are especially effective for these conditions. The other options describe indications for different medications (benzodiazepines or diphenhydramine).
AEMCA - Advanced Emergency Medical Care Assistant Pharmacology for Paramedics Questions and Answers
A patient in refractory ventricular fibrillation has received three defibrillations and an appropriate dose of epinephrine.
According to Ontario's Advanced Life Support Patient Care Standards (ALS PCS), which of the following is the correct subsequent antiarrhythmic medication and dose?