Drug Classifications Practice Questions

85 multiple-choice questions on Drug classifications for paramedic and EMT students, from Chapter 13 (Principles of Pharmacology). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

85 practice questions

1. Opioid analgesics such as morphine and fentanyl act by:

   1. A. Binding opioid receptors in the CNS
   2. B. Enhancing GABA in the central nervous system
   3. C. Blocking sodium channels in nerves
   4. D. Blocking prostaglandin synthesis in tissues
   Show answer

   Answer: A. Binding opioid receptors in the CNS

   Respiratory depression is the main hazard.

2. NSAIDs such as ibuprofen reduce pain and inflammation by:

   1. A. Blocking histamine H1 receptors
   2. B. Stimulating beta-2 receptors on mast cells
   3. C. Binding opioid receptors in the spinal cord
   4. D. Inhibiting cyclooxygenase (COX) enzymes
   Show answer

   Answer: D. Inhibiting cyclooxygenase (COX) enzymes

   They also affect platelet function and the gastric lining. COX inhibition reduces prostaglandin production.

3. Benzodiazepines such as midazolam produce their effect by:

   1. A. Enhancing the inhibitory effect of GABA
   2. B. Stimulating acetylcholine release centrally
   3. C. Blocking serotonin reuptake in the synapse
   4. D. Blocking dopamine D2 receptors in the brain
   Show answer

   Answer: A. Enhancing the inhibitory effect of GABA

   They provide sedation, anxiolysis, and anticonvulsant effects.

4. The antidote for benzodiazepine overdose is:

   1. A. Atropine, titrated until secretions dry up
   2. B. Naloxone, titrated to restore adequate breathing
   3. C. Glucagon, given as a slow IV push over minutes
   4. D. Flumazenil, used cautiously for seizure risk
   Show answer

   Answer: D. Flumazenil, used cautiously for seizure risk

   Supportive care is usually preferred in the field. Flumazenil can precipitate seizures, especially in chronic benzodiazepine users.

5. Beta blockers such as metoprolol:

   1. A. Increase heart rate and myocardial oxygen demand
   2. B. Raise blood pressure through vasoconstriction
   3. C. Slow heart rate and lower contractility and BP
   4. D. Cause bronchodilation by blocking beta-2 receptors
   Show answer

   Answer: C. Slow heart rate and lower contractility and BP

   Nonselective agents may worsen bronchospasm.

6. Calcium channel blockers such as diltiazem:

   1. A. Slow heart rate only when taken in overdose
   2. B. Increase contractility and cardiac output
   3. C. Slow AV conduction and cause vasodilation
   4. D. Speed AV conduction and cause vasoconstriction
   Show answer

   Answer: C. Slow AV conduction and cause vasodilation

   They are used for rate control in atrial fibrillation.

7. ACE inhibitors such as lisinopril lower blood pressure by:

   1. A. Blocking L-type calcium channels in vessels
   2. B. Preventing conversion of angiotensin I to II
   3. C. Increasing sodium excretion in the loop of Henle
   4. D. Blocking angiotensin II at its AT1 receptor
   Show answer

   Answer: B. Preventing conversion of angiotensin I to II

   A dry cough and angioedema are known side effects. Blocking the AT1 receptor is how ARBs such as losartan work.

8. Diuretics such as furosemide:

   1. A. Retain sodium and water to expand blood volume
   2. B. Increase sodium and water excretion
   3. C. Constrict renal arterioles to reduce filtration
   4. D. Block beta receptors to reduce cardiac workload
   Show answer

   Answer: B. Increase sodium and water excretion

   Potassium loss is a common consequence. This reduces preload.

9. Nitroglycerin relieves chest pain primarily by:

   1. A. Slowing heart rate to lower oxygen demand
   2. B. Increasing contractility and coronary flow
   3. C. Dilating veins and coronary arteries
   4. D. Blocking pain receptors in the myocardium
   Show answer

   Answer: C. Dilating veins and coronary arteries

   Hypotension is the main risk, especially with volume depletion. Venodilation reduces preload; coronary dilation improves blood supply.

10. A patient taking dabigatran (Pradaxa) has a life-threatening bleed. The specific reversal agent is:

    1. A. Vitamin K (phytonadione)
    2. B. Protamine sulfate
    3. C. Idarucizumab (Praxbind)
    4. D. Andexanet alfa (Andexxa)
    Show answer

    Answer: C. Idarucizumab (Praxbind)

    Idarucizumab is a monoclonal antibody fragment that binds dabigatran, a direct thrombin inhibitor. Vitamin K (phytonadione) reverses warfarin, protamine sulfate reverses heparin, and andexanet alfa reverses factor Xa inhibitors such as apixaban and rivaroxaban.

11. Vitamin K reverses warfarin because warfarin works by:

    1. A. Blocking vitamin K-dependent factor synthesis
    2. B. Directly inhibiting thrombin already in the blood
    3. C. Destroying circulating platelets
    4. D. Activating plasminogen to lyse clots
    Show answer

    Answer: A. Blocking vitamin K-dependent factor synthesis

    Warfarin blocks the recycling of vitamin K, so the liver cannot make active factors II, VII, IX, and X; vitamin K restores their synthesis over hours (prothrombin complex concentrate works faster). Directly inhibiting thrombin already in the blood is how dabigatran works, warfarin is not destroying circulating platelets, and activating plasminogen to lyse clots is how fibrinolytics work.

12. Fibrinolytic agents:

    1. A. Increase platelet production and function
    2. B. Break down clots that have already formed
    3. C. Prevent new clots without affecting old ones
    4. D. Lower blood pressure to reduce bleeding
    Show answer

    Answer: B. Break down clots that have already formed

    Bleeding, including intracranial hemorrhage, is the major risk.

13. Beta-2 agonists such as albuterol are used to:

    1. A. Dry bronchial mucus secretions
    2. B. Constrict airway blood vessels
    3. C. Reduce airway inflammation
    4. D. Relax bronchial smooth muscle
    Show answer

    Answer: D. Relax bronchial smooth muscle

    Tachycardia and tremor are expected side effects. This relieves bronchospasm.

14. Corticosteroids such as methylprednisolone are given in asthma to:

    1. A. Reduce airway inflammation over hours
    2. B. Increase heart rate to improve oxygen delivery
    3. C. Produce immediate bronchodilation within minutes
    4. D. Dry airway secretions within the first hour
    Show answer

    Answer: A. Reduce airway inflammation over hours

    They do not relieve acute bronchospasm quickly.

15. Antipsychotic medications such as haloperidol may cause:

    1. A. Bronchospasm and laryngeal edema
    2. B. Hypertensive crisis and bradycardia
    3. C. Dystonic reactions and QT prolongation
    4. D. Hypoglycemia and excess insulin release
    Show answer

    Answer: C. Dystonic reactions and QT prolongation

    Diphenhydramine treats acute dystonic reactions. Sedation is also common.

16. Patients taking MAO inhibitors are at risk of:

    1. A. Hypertensive crisis with certain foods
    2. B. Severe hypoglycemia with sulfonylurea use
    3. C. Profound hypotension with decongestant use
    4. D. Profound bradycardia with beta blockers
    Show answer

    Answer: A. Hypertensive crisis with certain foods

    Serotonin syndrome is also a risk with certain combinations. Tyramine-rich foods and sympathomimetic drugs are the classic triggers.

17. Drugs are commonly classified by:

    1. A. Half-life and dosing interval
    2. B. Storage temperature and expected shelf life
    3. C. Year of FDA approval and patent status
    4. D. Body system, mechanism, or therapeutic use
    Show answer

    Answer: D. Body system, mechanism, or therapeutic use

    Classification schemes help predict effects of unfamiliar drugs. Half-life, dosing interval, storage temperature, and shelf life describe how a drug behaves or is handled, but they are not schemes for grouping drugs.

18. Analgesics are drugs that:

    1. A. Relieve pain
    2. B. Reduce fever only
    3. C. Induce sleep
    4. D. Treat infection
    Show answer

    Answer: A. Relieve pain

    Opioids and NSAIDs are analgesic classes.

19. Loperamide is an opioid antidiarrheal. Taken in massive doses to self-treat opioid withdrawal, it can cause:

    1. A. Severe diarrhea with dehydration and shock
    2. B. Hypertensive crisis and stroke
    3. C. Dysrhythmias and QT prolongation
    4. D. Hypoglycemia and seizures
    Show answer

    Answer: C. Dysrhythmias and QT prolongation

    At normal doses loperamide stays in the gut, but massive doses block cardiac sodium and potassium channels, causing QRS widening, QT prolongation, torsades, and cardiac arrest (FDA warning, 2016). It slows rather than causes severe diarrhea with dehydration, and hypertensive crisis and stroke or hypoglycemia and seizures are not its toxic pattern.

20. NSAIDs such as ketorolac are avoided in patients with kidney injury or a bleeding ulcer because they:

    1. A. Remove protective prostaglandins
    2. B. Activate platelets and promote clotting
    3. C. Act on opioid receptors in the gut
    4. D. Release histamine in the stomach
    Show answer

    Answer: A. Remove protective prostaglandins

    By inhibiting COX, NSAIDs remove prostaglandins that maintain renal blood flow and protect the stomach lining, so kidney injury and GI bleeding can worsen; they also inhibit platelets. They do not activate platelets and promote clotting, they do not act on opioid receptors in the gut, and they do not release histamine in the stomach.

21. Compared with midazolam, IV lorazepam has:

    1. A. A faster onset and a shorter duration
    2. B. No anticonvulsant effect
    3. C. A slower onset and a longer duration
    4. D. A different receptor target
    Show answer

    Answer: C. A slower onset and a longer duration

    Lorazepam is less lipid-soluble, so it enters the brain more slowly but lasts longer, which suits status epilepticus once it has been given. A faster onset and a shorter duration describe midazolam, lorazepam has strong anticonvulsant activity, and both share the same receptor target, the benzodiazepine site on the GABA-A receptor.

22. Antiemetics such as ondansetron act by:

    1. A. Stimulating dopamine (D2) receptors
    2. B. Blocking serotonin (5-HT3) receptors
    3. C. Blocking histamine (H2) receptors
    4. D. Enhancing GABA (GABA-A) receptors
    Show answer

    Answer: B. Blocking serotonin (5-HT3) receptors

    Ondansetron is a 5-HT3 antagonist.

23. Antihistamines (H1 blockers) such as diphenhydramine are used for:

    1. A. Acute asthma as primary therapy
    2. B. Hypertension and tachycardia
    3. C. Moderate to severe acute pain
    4. D. Allergic and dystonic reactions
    Show answer

    Answer: D. Allergic and dystonic reactions

    Diphenhydramine blocks H1 receptors and has anticholinergic effects. Allergic reactions are the main use; dystonic reactions are a secondary one.

24. Oral dexamethasone is a common choice for croup because it:

    1. A. Gives immediate relief of stridor within minutes
    2. B. Lasts long enough for a single dose
    3. C. Is a short-acting beta-2 agonist
    4. D. Has strong salt-retaining effects
    Show answer

    Answer: B. Lasts long enough for a single dose

    Dexamethasone has a long biologic half-life (about 36 to 72 hours), so a single dose controls airway inflammation through the illness. Its effect builds over hours, so it does not give immediate relief of stridor within minutes (nebulized epinephrine does); it is a corticosteroid, not a short-acting beta-2 agonist; and it does not have strong salt-retaining (mineralocorticoid) effects.

25. A patient with asthma takes theophylline. This methylxanthine bronchodilator is a concern because:

    1. A. It causes bradycardia at normal doses
    2. B. It blocks alpha receptors and causes hypotension
    3. C. Toxicity causes seizures and dysrhythmias
    4. D. It causes hypoglycemic coma
    Show answer

    Answer: C. Toxicity causes seizures and dysrhythmias

    Theophylline has a narrow therapeutic index and many drugs raise its level; toxicity causes vomiting, tachydysrhythmias, hypokalemia, and seizures. It causes tachycardia rather than bradycardia at normal doses, it does not block alpha receptors, and it raises rather than lowers glucose, so hypoglycemic coma is not expected.

26. Montelukast (Singulair), taken nightly for asthma, is classified as a:

    1. A. Short-acting rescue beta-2 agonist
    2. B. Leukotriene receptor antagonist
    3. C. Inhaled corticosteroid
    4. D. Inhaled anticholinergic
    Show answer

    Answer: B. Leukotriene receptor antagonist

    Montelukast blocks leukotriene receptors to reduce airway inflammation over time; it is a controller with no role in acute rescue, and it carries an FDA boxed warning for neuropsychiatric effects. A short-acting rescue beta-2 agonist is albuterol, an inhaled corticosteroid is fluticasone or budesonide, and an inhaled anticholinergic is ipratropium or tiotropium.

27. Antiarrhythmics are classified by the Vaughan-Williams system into how many main classes?

    1. A. Two
    2. B. Four
    3. C. Six
    4. D. Eight
    Show answer

    Answer: B. Four

    Class I (sodium channel blockers), II (beta blockers), III (potassium channel blockers), IV (calcium channel blockers).

28. Amiodarone is primarily a Class ___ antiarrhythmic:

    1. A. II
    2. B. III
    3. C. I
    4. D. IV
    Show answer

    Answer: B. III

    Amiodarone prolongs repolarization (potassium channel blockade) with effects across classes.

29. Lidocaine is a Class ___ antiarrhythmic:

    1. A. IV
    2. B. II
    3. C. IB
    4. D. III
    Show answer

    Answer: C. IB

    Lidocaine is a sodium channel blocker (Class IB).

30. Diltiazem and verapamil are:

    1. A. Beta blockers (Class II)
    2. B. Calcium channel blockers (Class IV)
    3. C. Sodium channel blockers (Class I)
    4. D. Potassium channel blockers (Class III)
    Show answer

    Answer: B. Calcium channel blockers (Class IV)

    They slow AV conduction and are used for rate control in SVT/AF.

31. Adenosine is classified as:

    1. A. Class I sodium channel blocker
    2. B. Class II beta-adrenergic blocker
    3. C. Unclassified transient AV nodal blocker
    4. D. Class IV calcium channel blocker
    Show answer

    Answer: C. Unclassified transient AV nodal blocker

    Adenosine has a very short half-life and interrupts reentrant SVT. Adenosine transiently blocks AV node conduction.

32. Vasopressors are drugs that:

    1. A. Raise blood pressure by expanding blood volume
    2. B. Lower blood pressure by dilating arterioles
    3. C. Raise blood pressure by vasoconstriction
    4. D. Slow the heart to improve diastolic filling
    Show answer

    Answer: C. Raise blood pressure by vasoconstriction

    Norepinephrine, phenylephrine, and vasopressin are vasopressors.

33. Milrinone, used on some interfacility transports for heart failure, increases contractility by:

    1. A. Inhibiting phosphodiesterase-3 to raise cAMP
    2. B. Directly stimulating beta-1 adrenergic receptors
    3. C. Blocking L-type calcium channels
    4. D. Inhibiting the Na/K-ATPase pump
    Show answer

    Answer: A. Inhibiting phosphodiesterase-3 to raise cAMP

    Milrinone inhibits phosphodiesterase-3, so cAMP stays high in heart and vascular muscle: stronger contraction plus vasodilation, with hypotension as the main risk. It is not directly stimulating beta-1 adrenergic receptors (dobutamine does), blocking L-type calcium channels would weaken contraction, and inhibiting the Na/K-ATPase pump is digoxin's mechanism.

34. Second-generation antihistamines such as loratadine differ from diphenhydramine mainly because they:

    1. A. Cause much less sedation
    2. B. Block H2 receptors in the stomach
    3. C. Work faster in anaphylaxis
    4. D. Have strong anticholinergic effects
    Show answer

    Answer: A. Cause much less sedation

    Second-generation H1 blockers cross the blood-brain barrier poorly, so they cause much less sedation and have few anticholinergic effects. They do not block H2 receptors in the stomach, they do not work faster in anaphylaxis (epinephrine is the first-line drug), and it is diphenhydramine, not loratadine, that has strong anticholinergic effects.

35. Dromotropes affect:

    1. A. Preload returning to the heart
    2. B. Force of ventricular contraction
    3. C. Conduction velocity through the AV node
    4. D. Heart rate generated by the SA node
    Show answer

    Answer: C. Conduction velocity through the AV node

    Calcium channel blockers are negative dromotropes.

36. Enoxaparin (Lovenox), injected subcutaneously, is classified as a:

    1. A. Direct oral thrombin inhibitor
    2. B. Oral factor Xa inhibitor
    3. C. Vitamin K antagonist
    4. D. Low-molecular-weight heparin
    Show answer

    Answer: D. Low-molecular-weight heparin

    Enoxaparin is a low-molecular-weight heparin that mainly inhibits factor Xa through antithrombin; it is renally cleared and only partly reversed by protamine. A direct oral thrombin inhibitor is dabigatran, an oral factor Xa inhibitor is apixaban or rivaroxaban, and a vitamin K antagonist is warfarin.

37. Many stroke and STEMI systems use tenecteplase instead of alteplase mainly because tenecteplase:

    1. A. Has no risk of intracranial bleeding
    2. B. Works as an antiplatelet agent
    3. C. Is given as a single IV bolus
    4. D. Can be given by mouth
    Show answer

    Answer: C. Is given as a single IV bolus

    Tenecteplase is a fibrinolytic given as one weight-based IV bolus, while alteplase needs a bolus plus a 60-minute infusion, which simplifies care and interfacility transfer. It still carries a risk of intracranial bleeding, it dissolves fibrin rather than working as an antiplatelet agent, and it cannot be given by mouth.

38. Antiplatelet agents include:

    1. A. Heparin and enoxaparin
    2. B. Aspirin and clopidogrel
    3. C. Warfarin and apixaban
    4. D. Alteplase and tenecteplase
    Show answer

    Answer: B. Aspirin and clopidogrel

    They reduce platelet aggregation.

39. Sumatriptan, a triptan for migraine, is contraindicated in coronary artery disease because it:

    1. A. Dilates the coronary arteries too much
    2. B. Strongly inhibits platelets
    3. C. Causes marked bradycardia
    4. D. Can constrict the coronary arteries
    Show answer

    Answer: D. Can constrict the coronary arteries

    Triptans are serotonin (5-HT1B/1D) agonists that constrict cranial vessels and can also constrict the coronary arteries, causing ischemia or MI in patients with coronary disease. They do not dilate the coronary arteries too much, they do not strongly inhibit platelets, and they do not typically cause marked bradycardia.

40. Acetazolamide, used to prevent acute mountain sickness, is classified as a:

    1. A. Loop diuretic
    2. B. Potassium-sparing aldosterone blocker
    3. C. Carbonic anhydrase inhibitor
    4. D. Osmotic diuretic
    Show answer

    Answer: C. Carbonic anhydrase inhibitor

    Acetazolamide inhibits carbonic anhydrase, increasing bicarbonate loss in the urine; the mild metabolic acidosis stimulates breathing and speeds acclimatization. Furosemide is a loop diuretic, spironolactone is a potassium-sparing aldosterone blocker, and mannitol is an osmotic diuretic.

41. Hydralazine, used for severe hypertension in pregnancy, lowers blood pressure by:

    1. A. Blocking beta-1 receptors in the heart
    2. B. Inhibiting angiotensin-converting enzyme
    3. C. Directly relaxing arterioles
    4. D. Blocking calcium channels in the AV node
    Show answer

    Answer: C. Directly relaxing arterioles

    Hydralazine works by directly relaxing arterioles (a direct vasodilator); reflex tachycardia is a common side effect. Blocking beta-1 receptors in the heart describes beta blockers, inhibiting angiotensin-converting enzyme describes ACE inhibitors (contraindicated in pregnancy), and blocking calcium channels in the AV node describes diltiazem and verapamil.

42. Antihypertensive drug classes include all EXCEPT:

    1. A. Sympathomimetic vasopressors
    2. B. Calcium channel blockers
    3. C. Beta blockers
    4. D. ACE inhibitors
    Show answer

    Answer: A. Sympathomimetic vasopressors

    Vasopressors raise, not lower, BP.

43. Hypoglycemic agents include:

    1. A. Dextrose and oral glucose gel
    2. B. Glucagon and thiamine
    3. C. Insulin, metformin, and sulfonylureas
    4. D. Epinephrine and corticosteroids
    Show answer

    Answer: C. Insulin, metformin, and sulfonylureas

    These lower blood glucose; sulfonylureas can cause prolonged hypoglycemia.

44. Glucagon is classified as:

    1. A. Hypoglycemic agent
    2. B. Centrally acting antiemetic
    3. C. Alpha-adrenergic vasopressor
    4. D. Hyperglycemic hormone
    Show answer

    Answer: D. Hyperglycemic hormone

    Glucagon is also used for beta-blocker overdose. It raises glucose by stimulating glycogenolysis.

45. Anticonvulsants used in EMS include:

    1. A. Benzodiazepines such as midazolam
    2. B. Salicylates such as aspirin
    3. C. Antihistamines such as diphenhydramine
    4. D. Antiemetics such as ondansetron
    Show answer

    Answer: A. Benzodiazepines such as midazolam

    Benzodiazepines are first-line for status epilepticus. Lorazepam and diazepam are also used.

46. Antipsychotics (e.g., haloperidol, olanzapine) act primarily by:

    1. A. Stimulating serotonin (5-HT3) receptors
    2. B. Enhancing GABA-A receptor activity
    3. C. Blocking dopamine (D2) receptors
    4. D. Blocking mu opioid receptors
    Show answer

    Answer: C. Blocking dopamine (D2) receptors

    D2 blockade can cause extrapyramidal/dystonic reactions.

47. Sedative-hypnotics include:

    1. A. NSAIDs and acetaminophen
    2. B. Benzodiazepines and barbiturates
    3. C. Amphetamines and caffeine
    4. D. Opioids and local anesthetics
    Show answer

    Answer: B. Benzodiazepines and barbiturates

    They depress the CNS to produce calm or sleep.

48. Dissociative anesthetics include:

    1. A. Midazolam
    2. B. Ketamine
    3. C. Fentanyl
    4. D. Propofol
    Show answer

    Answer: B. Ketamine

    Ketamine is an NMDA antagonist producing dissociation and analgesia.

49. Antidotes are drugs that:

    1. A. Reverse the patient's underlying disease
    2. B. Counteract a poison or drug's effects
    3. C. Relieve pain caused by a toxic exposure
    4. D. Induce vomiting to empty the stomach
    Show answer

    Answer: B. Counteract a poison or drug's effects

    Antidotes reverse specific toxic mechanisms. Examples include naloxone, atropine, and flumazenil. Antidotes counter a toxin's effects rather than treat underlying disease, and inducing vomiting is an outdated decontamination method, not an antidote action.

50. Oxytocin is classified as a:

    1. A. Tocolytic that suppresses contractions
    2. B. Uterotonic that stimulates contractions
    3. C. Antiemetic that reduces nausea
    4. D. Vasodilator that lowers blood pressure
    Show answer

    Answer: B. Uterotonic that stimulates contractions

    Used for postpartum hemorrhage.

51. Tocolytics are drugs that:

    1. A. Prevent eclamptic seizures only
    2. B. Stimulate labor contractions
    3. C. Suppress uterine contractions
    4. D. Raise maternal blood pressure
    Show answer

    Answer: C. Suppress uterine contractions

    Tocolytics delay preterm labor. Examples include magnesium sulfate and terbutaline.

52. Compared with 10 mL of 10% calcium gluconate, 10 mL of 10% calcium chloride contains:

    1. A. The same amount of elemental calcium
    2. B. About 3 times the elemental calcium
    3. C. About one-third as much elemental calcium
    4. D. Calcium bound to sodium bicarbonate
    Show answer

    Answer: B. About 3 times the elemental calcium

    Calcium chloride 10% provides about 27 mg/mL of elemental calcium versus about 9 mg/mL for calcium gluconate 10%, so doses differ and chloride is harsher on veins. They do not contain the same amount of elemental calcium, chloride does not contain one-third as much, and neither contains calcium bound to sodium bicarbonate, which would precipitate.

53. Mucolytics and expectorants are:

    1. A. Antitussives that suppress the cough reflex
    2. B. Agents that thin or help clear secretions
    3. C. Inhaled steroids that reduce inflammation
    4. D. Bronchodilators that relax airway muscle
    Show answer

    Answer: B. Agents that thin or help clear secretions

    Rarely used in EMS but part of respiratory drug classification.

54. Antitussives:

    1. A. Stimulate a productive cough
    2. B. Dilate the small airways
    3. C. Suppress the cough reflex
    4. D. Thin and loosen secretions
    Show answer

    Answer: C. Suppress the cough reflex

    Cough suppressants act centrally. Examples include dextromethorphan and codeine.

55. Classifying a drug as an 'antihypertensive' rather than a 'beta blocker' is an example of classification by:

    1. A. Therapeutic use
    2. B. Mechanism of action
    3. C. Source
    4. D. Chemical structure
    Show answer

    Answer: A. Therapeutic use

    Therapeutic classes describe what condition a drug treats; pharmacologic classes describe how it works.

56. Etomidate is classified as a:

    1. A. Nondepolarizing neuromuscular blocker
    2. B. Short-acting opioid analgesic
    3. C. Nonbarbiturate sedative-hypnotic
    4. D. NMDA-blocking dissociative anesthetic
    Show answer

    Answer: C. Nonbarbiturate sedative-hypnotic

    Etomidate provides rapid, brief hypnosis with little effect on blood pressure, so it is used for RSI induction. It is short-acting and used for induction.

57. Tranexamic acid (TXA) is classified as an:

    1. A. Anticoagulant
    2. B. Antiplatelet agent
    3. C. Fibrinolytic
    4. D. Antifibrinolytic
    Show answer

    Answer: D. Antifibrinolytic

    TXA blocks plasminogen activation, slowing clot breakdown in hemorrhage.

58. Apixaban (Eliquis) and rivaroxaban (Xarelto) belong to which class?

    1. A. Direct factor Xa inhibitors
    2. B. Direct thrombin inhibitors
    3. C. Vitamin K antagonists
    4. D. P2Y12 inhibitors
    Show answer

    Answer: A. Direct factor Xa inhibitors

    These oral anticoagulants directly inhibit factor Xa.

59. Dabigatran (Pradaxa) is classified as a(n):

    1. A. Low-molecular-weight heparin
    2. B. Factor Xa inhibitor
    3. C. Vitamin K antagonist
    4. D. Direct thrombin inhibitor
    Show answer

    Answer: D. Direct thrombin inhibitor

    Dabigatran binds and inhibits thrombin (factor IIa) directly.

60. Clopidogrel (Plavix) prevents clot formation by:

    1. A. Blocking the P2Y12 ADP receptor on platelets
    2. B. Dissolving existing fibrin in the clot
    3. C. Inhibiting factor Xa in the clotting cascade
    4. D. Inhibiting vitamin K-dependent clotting factors
    Show answer

    Answer: A. Blocking the P2Y12 ADP receptor on platelets

    Clopidogrel is an antiplatelet agent often combined with aspirin after coronary stenting.

61. Metformin lowers blood glucose mainly by:

    1. A. Blocking glucose absorption in the kidney
    2. B. Stimulating insulin release from the pancreas
    3. C. Decreasing hepatic glucose production
    4. D. Replacing the patient's own insulin
    Show answer

    Answer: C. Decreasing hepatic glucose production

    Metformin is a biguanide and rarely causes hypoglycemia when used alone.

62. Sulfonylureas such as glipizide and glyburide lower blood glucose by:

    1. A. Stimulating insulin release from the pancreas
    2. B. Slowing gastric emptying after each meal
    3. C. Increasing glucose excretion by the kidneys
    4. D. Decreasing glucose production in the liver only
    Show answer

    Answer: A. Stimulating insulin release from the pancreas

    Because they drive insulin secretion, sulfonylureas can cause prolonged hypoglycemia. They act on pancreatic beta cells.

63. Semaglutide (Ozempic) is classified as a:

    1. A. Long-acting insulin
    2. B. SGLT2 inhibitor
    3. C. GLP-1 receptor agonist
    4. D. Sulfonylurea
    Show answer

    Answer: C. GLP-1 receptor agonist

    GLP-1 agonists increase glucose-dependent insulin secretion, slow gastric emptying, and reduce appetite.

64. Insulin glargine (Lantus) is classified as:

    1. A. An oral hypoglycemic agent
    2. B. A long-acting basal insulin
    3. C. A rapid-acting mealtime insulin
    4. D. An intermediate-acting NPH insulin
    Show answer

    Answer: B. A long-acting basal insulin

    Glargine provides steady background insulin for about 24 hours. It has no pronounced peak.

65. Sertraline and fluoxetine belong to which class?

    1. A. Tricyclic antidepressants
    2. B. Monoamine oxidase inhibitors
    3. C. Selective serotonin reuptake inhibitors
    4. D. Serotonin-norepinephrine reuptake inhibitors
    Show answer

    Answer: C. Selective serotonin reuptake inhibitors

    SSRIs block serotonin reuptake and are safer in overdose than tricyclics.

66. Lithium is primarily classified as a:

    1. A. Benzodiazepine used for acute anxiety
    2. B. Anticonvulsant used for status epilepticus
    3. C. Antipsychotic used for schizophrenia
    4. D. Mood stabilizer used for bipolar disorder
    Show answer

    Answer: D. Mood stabilizer used for bipolar disorder

    Lithium stabilizes mood but has a narrow therapeutic index.

67. A seizure patient takes 'Keppra.' This drug (levetiracetam) is classified as an:

    1. A. Anticonvulsant
    2. B. Antidepressant
    3. C. Anticoagulant
    4. D. Antipsychotic
    Show answer

    Answer: A. Anticonvulsant

    Levetiracetam is a widely used antiepileptic drug.

68. Atorvastatin and simvastatin lower cholesterol by:

    1. A. Inhibiting platelet aggregation
    2. B. Inhibiting HMG-CoA reductase
    3. C. Blocking angiotensin II receptors
    4. D. Binding bile acids in the gut
    Show answer

    Answer: B. Inhibiting HMG-CoA reductase

    Statins inhibit a key enzyme in cholesterol synthesis in the liver.

69. Losartan differs from lisinopril in that losartan:

    1. A. Is a loop diuretic that lowers volume
    2. B. Is a beta blocker that also lowers renin
    3. C. Is a dihydropyridine calcium channel blocker
    4. D. Blocks the angiotensin II receptor
    Show answer

    Answer: D. Blocks the angiotensin II receptor

    ARBs block the receptor directly and cause less bradykinin-related cough than ACE inhibitors. It does not inhibit ACE.

70. Spironolactone is a potassium-sparing diuretic that works by:

    1. A. Inhibiting carbonic anhydrase
    2. B. Antagonizing aldosterone
    3. C. Acting as an osmotic agent
    4. D. Inhibiting the Na-K-2Cl transporter in the loop of Henle
    Show answer

    Answer: B. Antagonizing aldosterone

    Blocking aldosterone causes sodium loss with potassium retention, which can lead to hyperkalemia.

71. Hydrochlorothiazide is a thiazide diuretic commonly associated with:

    1. A. Bradycardia
    2. B. Hyperkalemia
    3. C. Hypokalemia
    4. D. Hypernatremia
    Show answer

    Answer: C. Hypokalemia

    Thiazides increase potassium loss in the urine.

72. Omeprazole reduces stomach acid by:

    1. A. Inhibiting the parietal cell proton pump
    2. B. Blocking histamine H2 receptors
    3. C. Neutralizing acid chemically in the stomach
    4. D. Blocking muscarinic receptors on parietal cells
    Show answer

    Answer: A. Inhibiting the parietal cell proton pump

    Proton pump inhibitors block the last step of acid secretion. The proton pump is the H+/K+ ATPase.

73. Famotidine is sometimes given as an adjunct in allergic reactions because it is a(n):

    1. A. Mast cell stabilizer
    2. B. H2 receptor antagonist
    3. C. Beta-2 agonist
    4. D. H1 receptor antagonist
    Show answer

    Answer: B. H2 receptor antagonist

    Combining H1 and H2 blockade may improve some histamine-mediated symptoms; epinephrine remains first-line for anaphylaxis.

74. Droperidol is classified as a:

    1. A. Dissociative anesthetic
    2. B. Butyrophenone antipsychotic
    3. C. Short-acting benzodiazepine
    4. D. 5-HT3 receptor antagonist
    Show answer

    Answer: B. Butyrophenone antipsychotic

    Droperidol, like haloperidol, is a butyrophenone that blocks dopamine (D2) receptors. It is also used as an antiemetic and sedative.

75. Procainamide is a Vaughan-Williams Class ___ antiarrhythmic:

    1. A. IB
    2. B. III
    3. C. IV
    4. D. IA
    Show answer

    Answer: D. IA

    Class IA agents block sodium channels and prolong repolarization; lidocaine is IB.

76. In the Vaughan-Williams system, metoprolol is a Class ___ antiarrhythmic:

    1. A. II
    2. B. I
    3. C. IV
    4. D. III
    Show answer

    Answer: A. II

    Class II antiarrhythmics are beta blockers; Class IV are calcium channel blockers.

77. Digoxin is classified as a cardiac glycoside that:

    1. A. Blocks potassium channels to prolong repolarization
    2. B. Increases contractility and slows AV node conduction
    3. C. Blocks beta-1 receptors to slow the heart
    4. D. Decreases contractility and speeds AV conduction
    Show answer

    Answer: B. Increases contractility and slows AV node conduction

    Digoxin inhibits Na/K-ATPase and increases vagal tone, giving positive inotropy and negative dromotropy.

78. Nalbuphine and butorphanol are classified as:

    1. A. Pure opioid receptor antagonists
    2. B. Nonopioid centrally acting analgesics
    3. C. Pure mu receptor agonists
    4. D. Mixed opioid agonist-antagonists
    Show answer

    Answer: D. Mixed opioid agonist-antagonists

    They can precipitate withdrawal in opioid-dependent patients and have a ceiling effect.

79. Acetaminophen is best classified as an:

    1. A. Antiplatelet agent similar to low-dose aspirin
    2. B. NSAID with strong anti-inflammatory effects
    3. C. Non-NSAID analgesic and antipyretic
    4. D. Weak opioid analgesic acting on mu receptors
    Show answer

    Answer: C. Non-NSAID analgesic and antipyretic

    Acetaminophen does not meaningfully reduce inflammation or affect platelets, unlike NSAIDs. It has minimal anti-inflammatory effect.

80. Which is NOT a typical prehospital indication for magnesium sulfate?

    1. A. Severe refractory bronchospasm
    2. B. Eclamptic seizures
    3. C. Stable sinus tachycardia
    4. D. Torsades de pointes
    Show answer

    Answer: C. Stable sinus tachycardia

    Magnesium is used for eclampsia, torsades, and severe asthma, not for sinus tachycardia.

81. Thiamine is classified as a:

    1. A. Hormone replacement agent
    2. B. Water-soluble vitamin (B1)
    3. C. Carbohydrate energy source
    4. D. Electrolyte replacement agent
    Show answer

    Answer: B. Water-soluble vitamin (B1)

    Malnourished or alcohol-dependent patients may need thiamine with glucose. It is given to prevent or treat Wernicke encephalopathy.

82. Levalbuterol differs from albuterol in that it:

    1. A. Is an inhaled corticosteroid preparation
    2. B. Is a long-acting beta-2 agonist (LABA)
    3. C. Contains only the active R-isomer
    4. D. Is an anticholinergic bronchodilator
    Show answer

    Answer: C. Contains only the active R-isomer

    Albuterol is a racemic mixture; levalbuterol is its single active enantiomer.

83. Nebulized racemic epinephrine is used in croup to:

    1. A. Reduce subglottic airway edema
    2. B. Thin and loosen airway secretions
    3. C. Treat the underlying bacterial infection
    4. D. Sedate the child to reduce agitation
    Show answer

    Answer: A. Reduce subglottic airway edema

    Mucosal vasoconstriction shrinks airway swelling; patients need observation for rebound. The vasoconstriction is alpha-mediated.

84. Which antidote-poison pairing is correct?

    1. A. Naloxone - benzodiazepines
    2. B. N-acetylcysteine - methanol
    3. C. Hydroxocobalamin - cyanide
    4. D. Fomepizole - acetaminophen
    Show answer

    Answer: C. Hydroxocobalamin - cyanide

    Hydroxocobalamin binds cyanide to form cyanocobalamin; fomepizole treats toxic alcohols and NAC treats acetaminophen.

85. Fomepizole is used for methanol or ethylene glycol poisoning because it:

    1. A. Antagonizes GABA receptors
    2. B. Inhibits alcohol dehydrogenase
    3. C. Speeds metabolism of the alcohol
    4. D. Binds the alcohol in the stomach
    Show answer

    Answer: B. Inhibits alcohol dehydrogenase

    Blocking alcohol dehydrogenase stops conversion to formic acid or oxalic acid while the parent compound is removed. This prevents formation of toxic metabolites.