AEMCA Pharmacology for Paramedics 3 — Questions and Answers
Question 1: Which route of administration provides the most rapid onset of medication action in a prehospital emergency?
- Sublingual
- Intramuscular
- Intravenous (Correct answer)
- Intranasal
Correct answer: Intravenous
IV administration delivers medication directly into systemic circulation, providing the fastest onset compared to all other routes.
Question 2: A patient on a beta-blocker overdose is in cardiogenic shock. After atropine fails, which medication is most appropriate?
- Epinephrine 1:1000 IM
- Glucagon IV bolus (Correct answer)
- Dopamine 2 mcg/kg/min
- Adenosine 6 mg IV push
Correct answer: Glucagon IV bolus
Glucagon bypasses beta receptors and directly stimulates adenylyl cyclase, increasing heart rate and contractility independent of adrenergic pathways.
Question 3: Nitroglycerin is contraindicated within 24-48 hours of which class of medications?
- Statins (HMG-CoA reductase inhibitors)
- PDE-5 inhibitors (e.g., sildenafil) (Correct answer)
- ACE inhibitors
- Calcium channel blockers
Correct answer: PDE-5 inhibitors (e.g., sildenafil)
Both nitroglycerin and PDE-5 inhibitors cause vasodilation; concurrent use can produce severe, refractory hypotension.
Question 4: When administering dopamine at 10-20 mcg/kg/min, the predominant clinical effect is:
- Renal vasodilation and diuresis
- Beta-1 stimulation increasing cardiac output
- Alpha-adrenergic vasoconstriction (Correct answer)
- Dopaminergic receptor stimulation only
Correct answer: Alpha-adrenergic vasoconstriction
At high doses (10-20 mcg/kg/min), dopamine predominantly stimulates alpha-1 receptors, causing significant vasoconstriction.
Question 5: A 32-year-old woman in status epilepticus has no IV access. The most appropriate route for midazolam administration is:
- Rectal diazepam
- Intramuscular midazolam (Correct answer)
- Intranasal lorazepam
- Sublingual clonazepam
Correct answer: Intramuscular midazolam
IM midazolam is the preferred route when IV access is unavailable and has been shown to be as effective as IV lorazepam for status epilepticus.
Question 6: Activated charcoal is MOST effective when given within which time frame after ingestion?
- Within 6 hours
- Within 4 hours
- Within 1 hour (Correct answer)
- Within 2 hours
Correct answer: Within 1 hour
Activated charcoal is most effective within 1 hour of ingestion before significant drug absorption has occurred.
Question 7: Which IV fluid is most appropriate for a patient in severe diabetic ketoacidosis presenting with hypotension?
- 0.45% NaCl (half-normal saline)
- Lactated Ringer's
- 0.9% NaCl (normal saline) (Correct answer)
- D5W (5% dextrose in water)
Correct answer: 0.9% NaCl (normal saline)
Normal saline is the initial resuscitation fluid of choice in DKA to restore intravascular volume before transitioning to hypotonic fluids.
AEMCA Pharmacology for Paramedics 3
Which route of administration provides the most rapid onset of medication action in a prehospital emergency?