Pharmacology Practice Questions for Paramedics

1,891 free paramedic practice questions on pharmacokinetics, pharmacodynamics, autonomic pharmacology, drug classes, medical math, routes of administration, IV and IO access, and emergency medications. Every question has the answer and a short explanation.

24 sample questions

1. Withdrawal from alcohol or benzodiazepines is more dangerous than opioid withdrawal because it can cause:

   1. A. Pinpoint pupils with apnea and coma
   2. B. Severe hypoglycemic coma
   3. C. Profound bradycardia
   4. D. Seizures and delirium tremens
   Show answer

   Answer: D. Seizures and delirium tremens

   Abrupt loss of chronic GABA enhancement leaves the brain overexcited: tremor, tachycardia, hyperthermia, seizures, and delirium tremens, which can be fatal. Pinpoint pupils with apnea and coma describe opioid toxicity, not withdrawal; severe hypoglycemic coma is not the pattern; and withdrawal causes tachycardia rather than profound bradycardia.

2. After a sublingual nitroglycerin, a patient's heart rate rises from 82 to 104 while the BP falls from 130/80 to 118/74. What explains the rise in heart rate?

   1. A. A new SVT that needs adenosine
   2. B. An allergic reaction to the drug
   3. C. Nitroglycerin's direct beta-1 effect
   4. D. Reflex tachycardia from vasodilation
   Show answer

   Answer: D. Reflex tachycardia from vasodilation

   Nitroglycerin lowers BP by vasodilation, and baroreceptors respond with a reflex increase in heart rate; it is an expected effect, but it raises oxygen demand, so monitor. A sinus rate that rises with a modest BP drop is not SVT. There are no signs of allergy. Nitroglycerin has no direct beta-1 action.

3. After ketamine 0.3 mg/kg IV for fracture pain, a patient has nystagmus and says he feels 'floaty,' with normal breathing and SpO2. What is appropriate?

   1. A. Give flumazenil for the nystagmus
   2. B. Give naloxone to reverse ketamine
   3. C. Intubate to protect the airway
   4. D. Reassure him; these are expected
   Show answer

   Answer: D. Reassure him; these are expected

   Nystagmus and mild perceptual changes are expected with sub-dissociative ketamine; reassure, keep the setting calm, and monitor. Naloxone and flumazenil do not reverse ketamine. Breathing is normal, so there is no reason to intubate.

4. Patients in shock may respond unpredictably to medications because:

   1. A. All drugs act faster because of compensatory tachycardia
   2. B. Drug receptors disappear entirely during shock states
   3. C. Hepatic metabolism accelerates markedly during shock
   4. D. Poor perfusion alters absorption and distribution
   Show answer

   Answer: D. Poor perfusion alters absorption and distribution

   Poor perfusion alters absorption and distribution, and acidosis may reduce drug effect. IV or IO routes are preferred in these patients.

5. How many milligrams of epinephrine are in 0.15 mL of the 1 mg/mL (1:1,000) concentration?

   1. A. 0.15 mg
   2. B. 0.0015 mg
   3. C. 1.5 mg
   4. D. 0.015 mg
   Show answer

   Answer: A. 0.15 mg

   1 mg/mL × 0.15 mL = 0.15 mg.

6. The subcutaneous route delivers medication:

   1. A. Into the muscle beneath the fascia
   2. B. Into a superficial vein of the arm
   3. C. Into the dermis just below the epidermis
   4. D. Into the fatty layer under the skin
   Show answer

   Answer: D. Into the fatty layer under the skin

   Absorption is slower than IM. Volume is limited to about 1 mL.

7. A patient with a long QT has recurrent torsades de pointes with a pulse after each pause in a slow rhythm, despite magnesium 2 g. Which next step is most appropriate?

   1. A. Overdrive pacing to raise the heart rate
   2. B. Procainamide at 20 to 50 mg/min
   3. C. Metoprolol 5 mg IV push, repeated
   4. D. Amiodarone 150 mg IV over 10 more minutes
   Show answer

   Answer: A. Overdrive pacing to raise the heart rate

   Pause-dependent torsades with a long QT is suppressed by raising the heart rate, which shortens the QT; temporary overdrive pacing (or isoproterenol as a bridge) is used when magnesium is not enough. Amiodarone and procainamide prolong the QT further and can worsen torsades. A beta blocker slows the rate and lengthens pauses, which is the opposite of what this patient needs.

8. A partner performs an independent double-check before you start a norepinephrine infusion on a pump. What should the partner verify, without being told your numbers first?

   1. A. Drug, concentration, weight, dose, and rate
   2. B. That the bag is spiked and the line is primed
   3. C. The drug and dose, read off your pump screen
   4. D. The dose and rate, using your calculation
   Show answer

   Answer: A. Drug, concentration, weight, dose, and rate

   An independent double-check means the second person works from the source (drug, bag concentration, patient weight, ordered dose, and programmed rate) without being led by the first person's answer. Priming the line matters but catches no calculation or programming error, and reading your pump screen or reusing your math only confirms what you already entered, so neither check is independent.

9. An IV bolus of phenylephrine may cause:

   1. A. Reflex tachycardia from baroreceptor unloading
   2. B. Reflex bradycardia via baroreceptors
   3. C. Bronchodilation from beta-2 stimulation
   4. D. Hypoglycemia from increased insulin release
   Show answer

   Answer: B. Reflex bradycardia via baroreceptors

   Pure alpha-1 vasoconstriction raises blood pressure, triggering a vagal baroreceptor reflex.

10. After a serious medication error, the paramedic involved feels intense guilt and cannot sleep. A just-culture agency should:

    1. A. Suspend her until the guilt passes
    2. B. Offer peer support and counseling
    3. C. Require retraining before support
    4. D. Reassign her to non-drug duties
    Show answer

    Answer: B. Offer peer support and counseling

    Clinicians involved in errors are often 'second victims' with guilt, anxiety, and sleep loss; peer support and counseling (such as an EAP) help them recover and keep working safely. Suspension or reassignment for distress, or putting retraining ahead of support treats a second victim as the problem and raises the risk of future errors.

11. After giving 15 g of oral glucose to an alert hypoglycemic patient, when should the glucose be rechecked?

    1. A. In about 2 minutes
    2. B. In about 1 hour
    3. C. In about 45 minutes
    4. D. In about 15 minutes
    Show answer

    Answer: D. In about 15 minutes

    ADA guidance: give 15 to 20 g of glucose, recheck in about 15 minutes, and repeat if glucose is still low, then give food once it normalizes. 2 minutes is too soon for absorption, and waiting 45 minutes or an hour leaves persistent hypoglycemia untreated.

12. A drug has an LD50 of 200 mg/kg and an ED50 of 10 mg/kg. Its therapeutic index is:

    1. A. 0.05
    2. B. 20
    3. C. 2,000
    4. D. 190
    Show answer

    Answer: B. 20

    Therapeutic index equals LD50 divided by ED50: 200 / 10 = 20.

13. Using 70 mg/kg, what hydroxocobalamin dose is appropriate for a 20-kg child with suspected cyanide toxicity from smoke?

    1. A. 14 g IV
    2. B. 1.4 g IV
    3. C. 5 g IV
    4. D. 140 mg IV
    Show answer

    Answer: B. 1.4 g IV

    The pediatric hydroxocobalamin dose is 70 mg/kg, up to the adult dose of 5 g.

14. To make D25 for a child from a D50 syringe, you would mix:

    1. A. One part D50 to three parts normal saline
    2. B. D50 with an equal volume of D10
    3. C. Equal volumes of D50 and normal saline
    4. D. Two parts D50 to one part normal saline
    Show answer

    Answer: C. Equal volumes of D50 and normal saline

    Diluting D50 with an equal volume of normal saline halves the concentration to 25%. One part D50 to three parts normal saline gives about 12.5%, D50 with an equal volume of D10 gives 30%, and two parts D50 to one part normal saline gives about 33%.

15. On standard peripheral IV catheters, a green hub indicates which gauge?

    1. A. 22 gauge
    2. B. 14 gauge
    3. C. 18 gauge
    4. D. 24 gauge
    Show answer

    Answer: C. 18 gauge

    Under the international color code, 14-gauge is orange, 16 gray, 18 green, 20 pink, 22 blue, and 24 yellow. Always confirm the printed gauge, since color is a cue, not a substitute for reading the label.

16. For a patient with a traumatic brain injury, which IV fluids should be avoided?

    1. A. Normal saline
    2. B. Hypertonic 3% saline
    3. C. Packed red blood cells
    4. D. D5W and 0.45% saline
    Show answer

    Answer: D. D5W and 0.45% saline

    Hypotonic fluids such as D5W (free water once the dextrose is used) and 0.45% saline move water into brain cells and can worsen cerebral edema. Normal saline is the usual isotonic choice, hypertonic saline is used to treat raised intracranial pressure, and blood is given for hemorrhage.

17. Intranasal naloxone dose is:

    1. A. 10 mg divided between nostrils
    2. B. 2–4 mg, depending on the device
    3. C. 0.1 mg in each nostril, repeated
    4. D. 0.4 mg, depending on the device
    Show answer

    Answer: B. 2–4 mg, depending on the device

    IN naloxone has slightly slower onset than IV.

18. A patient who received ketamine has copious oral secretions. What is the most appropriate response?

    1. A. Intubate all patients who develop secretions
    2. B. Suction as needed; hypersalivation is an expected effect
    3. C. Turn the sedated patient prone so the secretions can drain out
    4. D. Give naloxone to reverse the ketamine immediately
    Show answer

    Answer: B. Suction as needed; hypersalivation is an expected effect

    Ketamine stimulates salivary and bronchial secretions; suctioning usually suffices, and some protocols allow an antisialagogue. Prone positioning of a sedated patient risks positional asphyxia, and naloxone does not reverse ketamine.

19. While infusing through a tibial IO, the calf becomes swollen and firm. The paramedic should:

    1. A. Leave the needle in and slow the rate
    2. B. Raise the pressure to clear the line
    3. C. Stop the infusion and remove the needle
    4. D. Massage the calf to disperse the fluid
    Show answer

    Answer: C. Stop the infusion and remove the needle

    Extravasation into soft tissue can cause compartment syndrome. Monitor for compartment syndrome.

20. 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.

21. The maximum single dose of epinephrine in pediatric arrest is:

    1. A. 10 mg
    2. B. 0.5 mg
    3. C. 1 mg
    4. D. 0.1 mg
    Show answer

    Answer: C. 1 mg

    Pediatric epinephrine is capped at the adult dose of 1 mg.

22. The DEA primarily regulates:

    1. A. Drug purity and strength
    2. B. Hospital pharmacy staffing
    3. C. Drug advertising claims
    4. D. Drugs with high abuse potential
    Show answer

    Answer: D. Drugs with high abuse potential

    The Drug Enforcement Administration enforces the Controlled Substances Act. Drugs with abuse potential are designated controlled substances.

23. Glomerular filtration removes:

    1. A. All drug regardless of binding
    2. B. Only the unbound (free) drug
    3. C. Only lipid-soluble drug molecules
    4. D. Only the drug bound to albumin
    Show answer

    Answer: B. Only the unbound (free) drug

    Albumin-bound drug is too large to pass the glomerulus, so only free drug is filtered.

24. During a shortage, your agency stocks fentanyl 100 mcg/2 mL instead of 50 mcg/mL. What is required?

    1. A. Use the same volumes as before the change
    2. B. Double the usual volume drawn up
    3. C. Confirm the strength; recalculate
    4. D. Halve the usual volume
    Show answer

    Answer: C. Confirm the strength; recalculate

    Whenever a product's concentration or package differs, read the label and recalculate the volume for each dose; 100 mcg/2 mL equals 50 mcg/mL, but this must be confirmed rather than assumed. Using old volumes, doubling, or halving without checking invites errors.