Paramedics Exam Pharmacology and Medication Administration 5 — Questions and Answers
Question 1: A patient in status epilepticus unresponsive to benzodiazepines requires phenytoin. What is the primary concern during IV administration?
- Anaphylaxis risk is too high for field use
- Rapid infusion can cause severe hypotension and cardiac dysrhythmias (Correct answer)
- Phenytoin is ineffective without concurrent glucose administration
- The drug must be diluted in D5W only
Correct answer: Rapid infusion can cause severe hypotension and cardiac dysrhythmias
Phenytoin must be administered slowly (≤50 mg/min IV) because rapid infusion causes hypotension and cardiac dysrhythmias.
Question 2: When establishing medication orders via medical direction, which type of order allows paramedics to administer medications without contacting a physician for each individual patient?
- On-line medical direction orders
- Off-line standing orders (protocols) (Correct answer)
- Verbal physician orders
- Patient-specific advance directives
Correct answer: Off-line standing orders (protocols)
Off-line standing orders (protocols) are pre-approved by medical directors, allowing paramedics to act without real-time physician contact.
Question 3: Which electrolyte imbalance most increases the risk of digoxin toxicity?
- Hypernatremia
- Hypokalemia (Correct answer)
- Hypermagnesemia
- Hypercalcemia
Correct answer: Hypokalemia
Hypokalemia increases digoxin toxicity by enhancing digoxin's binding to Na/K-ATPase and increasing cellular uptake.
Question 4: A paramedic accidentally administers 10 times the ordered dose of insulin. The most immediate life-threatening complication is:
- Hyperkalemia
- Severe hypoglycemia (Correct answer)
- Metabolic alkalosis
- Pulmonary edema
Correct answer: Severe hypoglycemia
Insulin overdose causes severe hypoglycemia by driving glucose into cells, depriving the brain of its primary fuel source.
Question 5: What is the mechanism of action of magnesium sulfate in the treatment of torsades de pointes?
- Prolongs the QT interval to stabilize repolarization
- Blocks calcium channels and stabilizes cardiac membranes by inhibiting sodium influx (Correct answer)
- Acts as a competitive antagonist at potassium channels
- Increases heart rate to overdrive the dysrhythmia
Correct answer: Blocks calcium channels and stabilizes cardiac membranes by inhibiting sodium influx
Magnesium stabilizes cardiac membranes and blocks calcium, interrupting the triggered activity responsible for torsades de pointes.
Question 6: Which term describes an unexpected and unpredictable adverse drug reaction that occurs in a small percentage of patients regardless of dose?
- Side effect
- Allergic reaction
- Idiosyncratic reaction (Correct answer)
- Cumulative effect
Correct answer: Idiosyncratic reaction
An idiosyncratic reaction is an abnormal, unpredictable response to a drug not related to the drug's pharmacology or immune sensitization.
Question 7: A conscious patient is experiencing supraventricular tachycardia at 180 bpm. After a failed vagal maneuver, which drug is given first?
- Amiodarone 300 mg IV
- Adenosine 6 mg rapid IV push (Correct answer)
- Diltiazem 20 mg IV over 2 minutes
- Metoprolol 5 mg IV
Correct answer: Adenosine 6 mg rapid IV push
Adenosine 6 mg given as a rapid IV push followed by a saline flush is the first-line pharmacologic treatment for stable SVT.
Paramedics Exam Pharmacology and Medication Administration 5
A patient in status epilepticus unresponsive to benzodiazepines requires phenytoin.
What is the primary concern during IV administration?