Paramedics Exam Pharmacology and Medication Administration 4 — Questions and Answers
Question 1: A patient receiving heparin develops sudden thrombocytopenia and new clots. Which complication has occurred?
- Disseminated intravascular coagulation
- Heparin-induced thrombocytopenia (HIT) (Correct answer)
- Vitamin K deficiency
- Warfarin toxicity
Correct answer: Heparin-induced thrombocytopenia (HIT)
HIT is an immune-mediated reaction to heparin causing platelet activation, paradoxically leading to thrombosis despite low platelet counts.
Question 2: What is the preferred route for epinephrine administration during cardiac arrest per current AHA guidelines?
- Endotracheal tube
- Subcutaneous
- Intravenous or intraosseous (Correct answer)
- Intramuscular
Correct answer: Intravenous or intraosseous
IV or IO are the preferred routes for epinephrine during cardiac arrest; the ET route is no longer recommended as a primary route.
Question 3: Amiodarone is used in refractory VF/pVT. What is the initial IV/IO bolus dose in adults?
- 75 mg
- 150 mg
- 300 mg (Correct answer)
- 450 mg
Correct answer: 300 mg
The initial dose of amiodarone for refractory VF/pVT is 300 mg IV/IO bolus per ACLS guidelines.
Question 4: A patient with a known penicillin allergy is prescribed a cephalosporin. The paramedic should be aware of:
- No cross-reactivity risk exists between these drug classes
- A 1–2% cross-reactivity risk due to similar beta-lactam ring structure (Correct answer)
- Complete cross-reactivity requiring a different antibiotic class entirely
- Cross-reactivity only with first-generation cephalosporins
Correct answer: A 1–2% cross-reactivity risk due to similar beta-lactam ring structure
There is a small (1–2%) cross-reactivity risk between penicillins and cephalosporins due to their shared beta-lactam structure.
Question 5: Which sympathomimetic drug has dose-dependent effects: renal vasodilation at low doses, beta-1 stimulation at moderate doses, and alpha-1 vasoconstriction at high doses?
- Norepinephrine
- Dopamine (Correct answer)
- Epinephrine
- Phenylephrine
Correct answer: Dopamine
Dopamine exhibits dose-dependent receptor activity: dopaminergic at 2–5 mcg/kg/min, beta-1 at 5–10, and alpha-1 dominant above 10 mcg/kg/min.
Question 6: A patient is prescribed a drug with a narrow therapeutic index. This means:
- The drug is effective at very low doses with no risk of toxicity
- The difference between the therapeutic dose and the toxic dose is small (Correct answer)
- The drug can only be used for one specific condition
- The drug has a long half-life requiring infrequent dosing
Correct answer: The difference between the therapeutic dose and the toxic dose is small
A narrow therapeutic index indicates a small margin between the dose that is therapeutic and the dose that causes toxicity.
Question 7: Which medication is the antidote for acetaminophen (Tylenol) overdose?
- Flumazenil
- N-acetylcysteine (NAC) (Correct answer)
- Activated charcoal only
- Sodium bicarbonate
Correct answer: N-acetylcysteine (NAC)
N-acetylcysteine replenishes glutathione stores, preventing hepatotoxicity from the toxic acetaminophen metabolite NAPQI.
Paramedics Exam Pharmacology and Medication Administration 4
A patient receiving heparin develops sudden thrombocytopenia and new clots.
Which complication has occurred?