AEMCA Pharmacology for Paramedics 2 — Questions and Answers
Question 1: A patient with suspected organophosphate poisoning presents with excessive secretions, miosis, and bradycardia. Which drug is the primary antidote?
- Pralidoxime alone
- Atropine (Correct answer)
- Naloxone
- Flumazenil
Correct answer: Atropine
Atropine blocks muscarinic receptors and reverses the cholinergic effects of organophosphate toxicity.
Question 2: Which benzodiazepine reversal agent should be used cautiously in patients with a history of seizure disorders?
- Naloxone
- Flumazenil (Correct answer)
- Physostigmine
- N-acetylcysteine
Correct answer: Flumazenil
Flumazenil can precipitate seizures in benzodiazepine-dependent patients by rapidly reversing CNS depression.
Question 3: A 68-year-old on warfarin has a femur fracture with uncontrolled bleeding. Which agent is most appropriate to reverse anticoagulation in the field?
- Vitamin K IV push
- Fresh frozen plasma
- Tranexamic acid (Correct answer)
- Protamine sulfate
Correct answer: Tranexamic acid
Tranexamic acid inhibits fibrinolysis and is a prehospital option for major hemorrhage, while FFP and Vitamin K are hospital-based.
Question 4: Which medication is contraindicated in patients with suspected cocaine-induced chest pain and hypertension?
- Nitroglycerin
- Aspirin
- Propranolol (Correct answer)
- Lorazepam
Correct answer: Propranolol
Non-selective beta-blockers like propranolol cause unopposed alpha-adrenergic stimulation, worsening coronary vasospasm in cocaine toxicity.
Question 5: A patient in SVT fails vagal maneuvers. The first-line pharmacological intervention is:
- Amiodarone 300 mg IV
- Adenosine 6 mg rapid IV push (Correct answer)
- Verapamil 5 mg IV slow push
- Metoprolol 5 mg IV
Correct answer: Adenosine 6 mg rapid IV push
Adenosine 6 mg given as a rapid IV push is first-line for stable SVT due to its ultra-short half-life and AV node blocking effect.
Question 6: The therapeutic effect of morphine sulfate in acute pulmonary edema is primarily due to:
- Bronchodilation and airway clearance
- Venodilation reducing preload and anxiolysis (Correct answer)
- Positive inotropic effect on the heart
- Diuresis through renal prostaglandin release
Correct answer: Venodilation reducing preload and anxiolysis
Morphine reduces venous return (preload) through venodilation and decreases the patient's anxiety-driven sympathetic drive.
Question 7: A patient receives succinylcholine for RSI. Which condition is a relative contraindication due to risk of life-threatening hyperkalemia?
- Acute asthma exacerbation
- Burns more than 72 hours old (Correct answer)
- Hypovolemic shock
- Acute closed-head injury
Correct answer: Burns more than 72 hours old
Denervation injuries and burns older than 48-72 hours cause upregulation of nicotinic receptors, leading to massive potassium efflux with succinylcholine.
AEMCA Pharmacology for Paramedics 2
A patient with suspected organophosphate poisoning presents with excessive secretions, miosis, and bradycardia.
Which drug is the primary antidote?