A drug is assigned a pregnancy category “A” if:
controlled studies in women fail to demonstrate a risk to the fetus in the first trimester, there is no evidence of risk in later trimesters, and the possibility of fetal harm appears remote.

A drug that possesses the same desired clinical effect in several smaller doses as it does in a larger single dose has demonstrated:
a cumulative action.

A medication is called an antagonist if:
it has a higher affinity for the receptor site than the chemical mediator.

A medication is used “off-label.” This means that it:
is used for a purpose not approved by the FDA, at doses different from the recommended doses, or by a route of administration not approved by the FDA.

A medication that has a narrow therapeutic index:
can be given, but not without close patient monitoring.

A medication that initiates or alters a cellular activity by attaching to receptor sites and prompting a cell response is said to be:
an agonist.

A medication that possesses a negative chronotropic effect will:
cause a decrease in the heart rate

A medication undergoes first-pass metabolism in the:
liver

A paramedic gives a woman with chronic pain an injection of sterile saline and tells her that it is a narcotic analgesic. The paramedic’s action:
could result in criminal prosecution

A patient experiences profound sedation when an opioid, such as fentanyl, is given together with a benzodiazepine, such as midazolam. This is an example of:
synergism

A patient receives several doses of the same drug within a short period of time, after which point the medication does not relieve his symptoms. Which of the following has MOST likely occurred?
Tachyphylaxis

A patient takes 500 mg of a medication that has a half-life of 2 hours. How much medication will be in the patient’s body after 6 hours?
62.5 mg

A unit of packed red blood cells contains approximately _____ to _____ mL of concentrated red blood cells.
225, 250

A/an _________ medication typically includes a “stem” that links it to other medications in the same class.
generic

A/an __________________ agent is used to increase the pH of the serum or urine?
alkalinizing

ACE inhibitor medications lower blood pressure by:
blocking the conversion of angiotensin I to angiotensin II.

Acetylcholinesterase is an enzyme that:
breaks down acetylcholine.

All of the following are common sites for emergency IO cannulation, EXCEPT the:
iliac crest.

All of the following are endogenous catecholamines, EXCEPT:
atropine.

All of the following are Schedule II substances, EXCEPT:
A. Ritalin.
B. fentanyl.
C. cocaine.
D. heroin.
heroin.

All of the following medications are used to reduce a patient’s heart rate and blood pressure, EXCEPT:
A. lorazepam.
B. diltiazem.
C. metoprolol.
D. Tenormin.
lorazepam

All of the following medications fall in the same classification, EXCEPT:
A. captopril
B. enalapril
C. diazepam
D. lisinopril
diazepam

All of the following medications possess antiemetic properties, EXCEPT:
A. ondansetron.
B. dolasetron.
C. famotidine.
D. prochlorperazine.
famotidine

An abnormal susceptibility to a medication that is peculiar to an individual patient is called an:
idiosyncratic reaction.

An undesirable clinical change caused by a medication that causes some degree of harm or discomfort to the patient is called a(n):
adverse effect.

As a medication undergoes biotransformation, it becomes a(n):
metabolite

At 15 μg/kg/min, dopamine:
causes vigorous vasoconstriction.

At 5 to 10 μg/kg/min, dopamine:
activates beta-1 receptor sites, causing an increased heart rate and increased cardiac contractility.

Beta blockers should be used with extreme caution in patients with reactive airway because:
beta-2 receptors can potentially be antagonized, resulting in bronchospasm.

Calcium chloride or calcium gluconate may mitigate hypotension or bradycardia following an overdose of:
Diltiazem.

Catecholamines and sympathomimetic medications should be administered with caution because they:
Can increase cardiac workload and myocardial oxygen demand.

Certain antibiotics and antiseizure medications are known to cause Stevens-Johnson syndrome, which is a:
severe, possibly fatal reaction that mimics a burn.

Common components of a medication profile include all of the following, EXCEPT:

A. pregnancy risk factors.
B. the weight of the drug.
C. potential incompatibility.
D. mechanism of action.

the weight of the drug

Compared to succinylcholine, rocuronium:
has a rapid onset of action, a longer (up to 60 minutes) duration of action, and fewer adverse effects.

Cross-tolerance to a medication occurs when:
repeated exposure to a medication within a particular class causes tolerance to other medications in the same class.

Decreased efficacy or potency of a medication when taken repeatedly by a patient is called:
tolerance

Dopamine is commonly used in the prehospital setting as the primary medication for:
nonhypovolemic hypotension

During a study, a patient experiences measurable clinical improvement or unexplained adverse effects after receiving a medication with no pharmacologic properties. This is referred to as:
the placebo effect

Etomidate is a medication that:
induces profound sedation following a single dose.

Fentanyl (Sublimaze) is the preferred opioid analgesic for patients in critical or unstable condition because:
it is not as prone to causing hypotension as morphine.

First-pass metabolism of a medication occurs when:
the bioavailability of a medication is reduced before it reaches the systemic circulation.

For which of the following conditions is sodium nitroprusside used?
Unstable vascular aneurysm

For which of the following conditions may a patient be prescribed furosemide?
Kidney dysfunction

Fresh frozen plasma is used to:
replace critical clotting factors.

Glucagon is used in the treatment of beta-blocker overdose because it:
produces positive inotropic and chronotropic effects.

Hypotension may occur following initiation of a dobutamine infusion because it:
reduces cardiac afterload.

If seizures occur following the administration of flumazenil (Romazicon):
benzodiazepine medications will be minimally effective or ineffective in controlling the seizure.

If studies in animals or human beings have demonstrated fetal abnormalities, or if there is evidence of fetal risk based on human experience, a pregnancy category ___ is assigned to a medication.
X

Marks: 1
If unmatched blood is administered in the prehospital setting, it will almost always be:
O, Rh-negative

In contrast to epinephrine, norepinephrine:
primarily stimulates alpha receptors

In critical care settings, mannitol is used to:
reduce cerebral edema.

In general, alpha-adrenergic receptor antagonists:
lower the BP.

In order to cause a negative inotropic effect on the heart, you would have to administer a(n):
beta-1 adrenergic antagonist.

In order to relieve the bronchospasm associated with an acute asthma attack, the paramedic would give a(n):
beta-2 agonist

In up to one third of all patients, morphine sulfate causes:
nausea and vomiting.

In which of the following situations would the paramedic MOST likely administer a drug via the rectal route?
Seizure termination.

IO infusion rates are comparable to IV infusion rates:
when a pressure bag or mechanical infusion device is used.

Ipratropium bromide (Atrovent) causes bronchodilation by:
antagonizing muscarinic receptors.

IV calcium is routinely used to treat:
magnesium sulfate toxicity.

Lidocaine is an antidysrhythmic that works by:
Blocking sodium channels in the Purkinje fibers and ventricle.

Lipid-soluble medications require higher weight-based doses in elderly patients because:
elderly patients have a higher body fat percentage and fat distribution.

Massive doses of atropine may be required when:
acetylcholine increases dramatically due to acetylcholinesterase inhibition.

Medication X is given to increase the effects of medication Y, which provides more relief than if medication Y were given alone. This is an example of:
potentiation

Medications administered by the ___________ route, by definition, have 100% bioavailability.
intravenous

Medications commonly administered via a nebulizer include all of the following, EXCEPT:

A. albuterol.
B. lidocaine.
C. Xopenex.
D. Racemic epinephrine.

lidocaine

Medications that are manufactured synthetically:
do not use animal, mineral, or vegetable sources.

Metoprolol has the brand name _____________, which may be a subtle reference to lowering the blood pressure.
Lopressor

Most medication biotransformation occurs in the:
Liver.

Narcotic analgesics relieve pain by:
stimulating opioid receptors.

Neuromuscular blocking agents achieve chemical paralysis by:
binding to nicotinic receptor sites on muscle cells and antagonizing acetylcholine.

Newer medications are designed to target only specific receptor sites on certain cells in an attempt to:
minimize the adverse effects.

Patients taking ACE inhibitor medications commonly have:
a chronic, dry cough.

Patients who are genetically predisposed to an immune-medicated medication response:
had an initial exposure and sensitization to a particular antigen.

Patients who receive opioid substances on a long-term basis:
often need higher doses of an opioid medication for pain relief.

Patients with primary pulmonary hypertension may experience acute decompensation if they are given a:
vasopressor.

Patients with _______ are at significant risk for toxic effects of medications or metabolic waste products in the body.
renal failure.

Phenothiazine medications exert their antiemetic properties by:
activating dopaminergic receptors in the brain and releasing hormones that depress the reticular activating system.

Repolarization and myocardial contraction are occurring through phases:
2 and 3.

Stimulation of alpha-1 receptors results in:
vasoconstriction.

Stimulation of alpha-2 receptors:
suppresses the release of norepinephrine.

Simulation of beta-1 adrenergic receptors would produce all the following effects, EXCEPT:
decreased myocardial contractility.

Simulation of beta-2 receptors will cause:
the airway diameter to dilate.

Succinylcholine should not be used in patients with:
known hyperkalemia

The ability of a medication to initiate or alter cell activity in a therapeutic or desired manner is referred to as:
Efficacy.

Physiologic drug antagonism occurs when:
two medications, each producing opposite effects, are present simultaneously, resulting in minimal or no clinical changes.

The Comprehensive Drug Abuse Prevention and Control Act of 1970:
was a legislative act dealing with narcotic and nonnarcotic medications that have a potential for abuse, and developed a drug classification system according to the abuse potential of the medications.

The generic name of a medication:
is proposed by the manufacturer.

The ideal body weight for a woman who is 5 ft 5 in tall is:
57kg.

The paramedic can avoid technical errors in medication administration by:
having a partner confirm the volume in a syringe or a weight-based medication calculation.

The paramedic may be called upon to administer platelets to patients with:
thrombocytopenia.

thrombocytopenia
deficiency of platelets in the blood. This causes bleeding into the tissues, bruising, and slow blood clotting after injury.

The paramedic must use caution when referencing a medication in an American Medical Association (AMA) publication because:
not every medication listed in the compendium has received FDA approval

The paramedic should be MOST suspicious that a controlled substance has been tampered with if:
an appropriate dose of the drug seems ineffective, especially when patient tolerance is unlikely.

The paramedic should administer promethazine (Phenergan) by:
diluting it in 20 mL of normal saline and giving it over 1 to 2 minutes.

The paramedic should suspect altered medication metabolism in a patient with:
chronic alcoholism

The peak of a medication’s effect depends on _____________, whereas the duration of effect depends on ______________.
absorption, metabolism

The physiologic effects of nitroglycerin when given to patients with cardiac-related chest pain include:
decreased preload and coronary vasodilation.

The primary physiologic effect of dobutamine is:
increased inotropy.

The process that the cells of large medication molecules use to ingest intracellular fluids and their contents is called:
pinocytosis

The rectal route is preferred over the oral route for certain emergency medications because:
rectal medications are usually not subject to first-pass metabolism.

The term affinity, as it applies to pharmacology, is MOST accurately defined as the:
ability of a medication to bind to a receptor.

The therapeutic index of a medication is defined as the:
difference between the median effective dose and the median toxic dose

The United States Pharmacopeia (USP) recommended temperature range for MOST medications in the prehospital setting is:
55°F to 86°F.

Toxic effects from beta blockers include all of the following, EXCEPT:
tachycardia

Transdermal medication patches:
may alter a patient’s clinical presentation or interfere with medications administered by the paramedic.

What class of medication is typically used to control the heart rate in patients with atrial fibrillation or atrial flutter?
Calcium channel blocker

What classification of medication is ketorolac (Toradol)?
Non-steroidal anti-inflammatory

What term is used to describe a situation in which a patient experiences clinical effects from a medication that are opposite from the intended effects?
Paradoxical reaction Correct

What type of medication is used to decrease gastric acid secretion?
Histamine-2 receptor antagonist

What type of medication is used to eliminate certain toxins from the body?
Diuretic

When a medication alters the velocity of the conduction of electricity through the heart, it is said to have a(n) _____________ effect.
dromotropic

When administering naloxone to a patient who overdosed on an opioid, it is important for the paramedic to remember that:
the duration of action of naloxone in the body is less than that of many opioid chemicals

When is aspirin indicated for the treatment of a stroke?
Only after an intracranial hemorrhage has been ruled out

When the paramedic administers a medication via the IV route:
he or she has the ability to titrate the medication carefully in a rapidly evolving clinical situation.

Which adrenergic receptor, when stimulated, inhibits norepinephrine release?
Alpha-2

Which of the following conditions would make a patient the MOST susceptible to an adverse effect from a medication?
Renal Failure

Which of the following factors would be the LEAST likely to affect a patient’s response to a medication?
Past medical history

Which of the following is an influencing factor regarding the administration of a fibrinolytic drug to a patient experiencing an acute myocardial infarction?
Time of symptom onset

Which of the following is NOT an oral antiplatelet medication?
ReoPro

Which of the following medications actually dissolves a clot?
Activase

Which of the following medications can be administered via the intranasal route?
Naloxone

Which of the following medications is used to provide cardiac cell membrane stabilization following tricyclic antidepressant overdose?
Sodium bicarbonate

Which of the following medications promotes the cellular uptake of potassium, making it a potential temporary treatment for hyperkalemia?
Albuterol

Which of the following occurs during phase 1 of the cardiac cellular action potential?
Sodium influx decreases while potassium slowly exits the cell

Which of the following statements regarding benzodiazepine medications is NOT correct?
High doses of a benzodiazepine may be needed to maintain a patient’s blood pressure.

Which of the following statements regarding fresh frozen plasma (FFP) is correct?
FFP must be compatible with the recipient’s blood type, but does not have to be Rh compatible.

Which of the following statements regarding packed red blood cells (PRBCs) is correct?
In general, the rate of administration of PRBCs should be proportional to the rate of blood cell loss.

Which of the following statements regarding pharmacology is correct?
Despite the advanced science of pharmacology, adverse reactions are commonplace.

Which of the following statements regarding plasma-protein binding is correct?
Plasma-protein binding releases medication as circulating levels of a particular medication begin to fall, leading to a longer duration of action.

Which of the following statements regarding succinylcholine is correct?
It has a rapid onset of action and short duration of action.

Which of the following statements regarding sympathomimetic chemicals is correct?
They are not found naturally in the body.

Which of the following statements regarding the endotracheal route of medication administration is correct?
The endotracheal route is no longer considered a reliable method of medication administration.

Which of the following statements regarding the IM route of medication administration is correct?
Medications have a bioavailability of 75% to 100% following IM administration.

Which of the following statements regarding vasopressin is correct?
Vasopressin is a naturally occurring hormone that is secreted in response to intravascular volume depletion.

Which of the following statements regarding the sublingual administration of nitroglycerin is correct?
Nitroglycerin given by the sublingual route has a rapid onset of action, but a low bioavailability

Which of the following structures contains epithelial cells that create a continuous barrier to medication absorption?
Urinary tract

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