WFR Wilderness Pharmacology & Medications 2 — Questions and Answers
Question 1: Acetazolamide (Diamox) is carried by wilderness travelers primarily to prevent and treat:
- Hypothermia
- Severe dehydration
- Acute Mountain Sickness (AMS) (Correct answer)
- Frostbite
Correct answer: Acute Mountain Sickness (AMS)
Acetazolamide speeds acclimatization by stimulating breathing and reducing bicarbonate levels, lowering the risk and severity of AMS at high altitude.
Question 2: The standard adult epinephrine auto-injector (EpiPen) delivers which dose intramuscularly?
- 0.1 mg
- 0.3 mg (Correct answer)
- 0.5 mg
- 1.0 mg
Correct answer: 0.3 mg
The standard adult EpiPen delivers 0.3 mg of epinephrine IM into the lateral thigh, the established dose for treating anaphylaxis.
Question 3: Ondansetron (Zofran) is most useful in the wilderness for controlling:
- Diarrhea and cramping
- Pain from fractures
- Nausea and vomiting (Correct answer)
- Anxiety and agitation
Correct answer: Nausea and vomiting
Ondansetron blocks 5-HT3 receptors to suppress nausea and vomiting, allowing the patient to stay hydrated and take oral medications.
Question 4: A key contraindication to acetazolamide (Diamox) use is a known allergy to:
- Penicillin
- Sulfa drugs (Correct answer)
- Latex
- Iodine
Correct answer: Sulfa drugs
Acetazolamide is a sulfonamide derivative, and patients with sulfa drug allergies risk cross-reactivity and adverse reactions.
Question 5: When should a second dose of epinephrine be considered after the first injection for anaphylaxis?
- Immediately after the first dose as standard protocol
- If symptoms persist or return after 5–15 minutes (Correct answer)
- Only if the patient becomes unresponsive
- After a mandatory 30-minute observation period
Correct answer: If symptoms persist or return after 5–15 minutes
A second dose is appropriate if symptoms do not improve or recur within 5–15 minutes because anaphylaxis can be biphasic and epinephrine's duration is short.
Question 6: Ibuprofen should generally be avoided in a wilderness patient who is:
- Running a mild fever below 101°F
- Moderately dehydrated with poor peripheral perfusion (Correct answer)
- Experiencing mild muscle soreness 24 hours after injury
- Taking vitamin C supplements
Correct answer: Moderately dehydrated with poor peripheral perfusion
NSAIDs reduce renal blood flow via prostaglandin inhibition, significantly increasing the risk of acute kidney injury in a volume-depleted patient.
Question 7: When a patient is unconscious or actively vomiting in the wilderness, the preferred route of medication administration is:
- Oral (swallowed)
- Sublingual (under the tongue)
- Intramuscular (IM injection) (Correct answer)
- Rectal suppository
Correct answer: Intramuscular (IM injection)
Intramuscular injection bypasses the GI tract, ensuring reliable systemic drug delivery when the oral route is unavailable due to altered consciousness or vomiting.
WFR Wilderness Pharmacology & Medications 2
Acetazolamide (Diamox) is carried by wilderness travelers primarily to prevent and treat: