Free Paramedics Pharmacology and Medication Administration Questions and Answers — Questions and Answers
Question 1: You are managing a patient in cardiac arrest. Intravenous access is unsuccessful after two attempts. Which of the following is the most appropriate next action for medication administration?
- Administer medications via the endotracheal (ET) tube since it is already in place.
- Establish an intraosseous (IO) line as it provides drug absorption comparable to IV access. (Correct answer)
- Administer intramuscular (IM) epinephrine while continuing to attempt IV access.
- Attempt to establish a subclavian central line for the most direct access to circulation.
Correct answer: Establish an intraosseous (IO) line as it provides drug absorption comparable to IV access.
When peripheral IV access cannot be quickly established in cardiac arrest, an intraosseous (IO) line is the preferred alternative. The highly vascular marrow of long bones provides a non-collapsible entry point to the systemic circulation, with drug absorption rates and effects that are comparable to IV administration. The ET route has poor and unpredictable drug absorption, IM is too slow in a low-flow state, and a central line is too time-consuming and high-risk for the prehospital setting.
Question 2: You are ordered to start a dopamine infusion at 5 mcg/kg/min for a 198 lb patient. Your dopamine concentration is 400 mg in 250 mL of D5W. Using a microdrip (60 gtt/mL) administration set, what is the correct drip rate?
- 21 gtts/min
- 11 gtts/min
- 34 gtts/min
- 17 gtts/min (Correct answer)
Correct answer: 17 gtts/min
Calculation Steps: 1. Convert weight: 198 lbs / 2.2 lbs/kg = 90 kg. 2. Calculate the desired dose: 5 mcg/kg/min * 90 kg = 450 mcg/min. 3. Calculate drug concentration: (400 mg * 1000 mcg/mg) / 250 mL = 1600 mcg/mL. 4. Calculate mL per minute: 450 mcg/min / 1600 mcg/mL = 0.28125 mL/min. 5. Calculate drops per minute: 0.28125 mL/min * 60 gtt/mL = 16.875 gtts/min, which rounds to 17 gtts/min.
Question 3: What is the primary mechanism of action by which adenosine terminates stable, narrow-complex supraventricular tachycardia (SVT)?
- It temporarily blocks conduction through the atrioventricular (AV) node. (Correct answer)
- It acts as a potent beta-blocker, decreasing myocardial contractility.
- It blocks sodium channels in the ventricular myocardium, slowing repolarization.
- It increases sympathetic tone, causing vasoconstriction and increasing heart rate.
Correct answer: It temporarily blocks conduction through the atrioventricular (AV) node.
Adenosine's primary antiarrhythmic effect is to slow or completely block electrical conduction through the AV node. This action interrupts the re-entry circuit that is responsible for most forms of SVT, allowing the sinoatrial (SA) node to regain control and restore a normal sinus rhythm.
Question 4: You are treating a 62-year-old male with substernal chest pain. His BP is 92/60 mmHg and he states he took tadalafil (Cialis) about 12 hours ago. Which of the following is correct regarding the administration of nitroglycerin?
- A lower dose of nitroglycerin (0.2 mg) should be administered cautiously.
- Nitroglycerin is indicated as long as the systolic blood pressure is above 90 mmHg.
- Nitroglycerin is contraindicated due to the risk of profound hypotension. (Correct answer)
- Nitroglycerin is indicated to relieve his pain by dilating the coronary arteries.
Correct answer: Nitroglycerin is contraindicated due to the risk of profound hypotension.
Nitroglycerin is absolutely contraindicated in patients who have recently used phosphodiesterase-5 (PDE-5) inhibitors like tadalafil (Cialis) or sildenafil (Viagra). Both drug classes cause vasodilation. When used together, they can cause a synergistic and severe drop in blood pressure that is often refractory to treatment. The time window for this contraindication is typically 24-48 hours.
Question 5: A 70-year-old is found unresponsive with severe bradycardia (30 bpm) and hypotension (BP 60/40 mmHg). Family states she may have taken too much of her metoprolol. After atropine is ineffective, which medication is the most appropriate specific antidote to consider?
- Calcium Chloride
- Glucagon (Correct answer)
- Epinephrine
- Dopamine
Correct answer: Glucagon
In a beta-blocker overdose, glucagon is a primary antidote. It increases heart rate and contractility by activating adenylate cyclase through a separate receptor, bypassing the blocked beta-adrenergic receptors and increasing intracellular cAMP. While vasopressors like epinephrine and dopamine may be used for supportive care, glucagon specifically counteracts the toxic effects of the beta-blockade.
Question 6: A paramedic draws up a medication, shows the vial to their partner who confirms it is the correct drug and dose, and then labels the syringe. This safety check primarily addresses which of the 'Six Rights of Medication Administration'?
- Right Route and Right Documentation
- Right Patient and Right Time
- Right Drug and Right Dose (Correct answer)
- Right Patient and Right Indication
Correct answer: Right Drug and Right Dose
This cross-check procedure is a critical safety step to prevent medication errors. Verbally and visually confirming the medication in the vial and the amount drawn into the syringe with a partner directly verifies the 'Right Drug' and 'Right Dose' before administration. This helps prevent look-alike/sound-alike errors and calculation mistakes.
Free Paramedics Pharmacology and Medication Administration Questions and Answers
You are managing a patient in cardiac arrest.
Intravenous access is unsuccessful after two attempts.
Which of the following is the most appropriate next action for medication administration?