Stimulants, Hallucinogens, and Cannabis Practice Questions

25 multiple-choice questions on Stimulants, hallucinogens, and cannabis for paramedic and EMT students, from Chapter 28 (Toxicology). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. A man used cocaine while drinking heavily all night. The liver combines the two into cocaethylene, which:

   1. A. Lasts longer and is more toxic
   2. B. Cancels out the stimulant effect
   3. C. Is cleared faster than cocaine
   4. D. Reverses the alcohol's sedation
   Show answer

   Answer: A. Lasts longer and is more toxic

   Cocaethylene forms only when cocaine and ethanol are used together. It has a longer half-life than cocaine and adds to the heart toxicity and risk of sudden death. It does not cancel the stimulant effect or clear faster, and it does not reverse the depressant effects of alcohol; the combination is more dangerous than either drug alone.

2. During a police chase, a man swallowed several small bags of crack cocaine that were loosely wrapped. He is calm now. Compared with a body packer, this body stuffer:

   1. A. Carries a larger total drug load
   2. B. Can become toxic within hours
   3. C. Needs surgery to remove the bags
   4. D. Has no risk if he looks well now
   Show answer

   Answer: B. Can become toxic within hours

   Body stuffers swallow small amounts of drug in flimsy wrapping to hide it, so the drug can leak quickly and cause toxicity within a few hours; they need transport and monitoring. Body packers carry large amounts in sturdy, well-made packets for smuggling, so their total load is larger and surgery is reserved for packet rupture or obstruction. Looking well early does not exclude a stuffer's toxicity.

3. In cocaine-associated chest pain, aspirin and nitroglycerin are:

   1. A. Contraindicated because cocaine thins the blood
   2. B. Ineffective because the pain is only from anxiety
   3. C. Reasonable, since cocaine can cause a true MI
   4. D. Indicated only if the 12-lead ECG is normal
   Show answer

   Answer: C. Reasonable, since cocaine can cause a true MI

   Cocaine causes coronary vasospasm, thrombosis, and MI even in young patients. Treat it like any ACS with aspirin and nitrates unless contraindicated.

4. A cocaine user has a wide-complex tachycardia with a QRS of 160 ms. The specific treatment to consider is:

   1. A. Adenosine 6 mg rapid IV push
   2. B. Procainamide 20 mg/min infusion IV
   3. C. Diltiazem 0.25 mg/kg slow IV
   4. D. Sodium bicarbonate 1 to 2 mEq/kg
   Show answer

   Answer: D. Sodium bicarbonate 1 to 2 mEq/kg

   Cocaine blocks sodium channels like a TCA, and bicarbonate boluses counteract this. Procainamide is itself a sodium channel blocker and would worsen the QRS, while adenosine and diltiazem treat narrow-complex SVTs.

5. A 26-year-old who has been awake for 4 days is paranoid, picking at sores on his arms, and has severely decayed teeth. These findings are typical of:

   1. A. Chronic methamphetamine use
   2. B. Chronic heroin use with sedation
   3. C. Acute LSD intoxication
   4. D. Anticholinergic poisoning
   Show answer

   Answer: A. Chronic methamphetamine use

   Prolonged binges without sleep, paranoid psychosis, formication with skin picking, and rotted teeth ('meth mouth') are classic for chronic methamphetamine use, whose effects last 8 to 24 hours per dose. Chronic heroin use causes sedation, miosis, and track marks rather than days of wakefulness. LSD causes perceptual distortion lasting hours, not dental decay or skin picking. Anticholinergic poisoning is an acute delirium with dry, flushed skin and urinary retention, not a pattern of chronic changes. (Textbook toxicology chapter, stimulants; StatPearls, Methamphetamine Toxicity.)

6. Compared with cocaine, methamphetamine typically has:

   1. A. A much shorter duration of action
   2. B. No effect on body temperature
   3. C. Sedating rather than stimulating effects
   4. D. A much longer duration of action
   Show answer

   Answer: D. A much longer duration of action

   Cocaine lasts minutes to about an hour, while methamphetamine lasts many hours, so agitation and hyperthermia are prolonged.

7. A 16-year-old swallowed most of a bottle of caffeine tablets to stay awake for exams. She is vomiting and tremulous with HR 150. The most important complications to anticipate are:

   1. A. Pinpoint pupils and apnea
   2. B. Delayed liver failure
   3. C. Dysrhythmias and seizures
   4. D. Bleeding from low platelets
   Show answer

   Answer: C. Dysrhythmias and seizures

   Large caffeine overdoses cause vomiting, tremor, tachycardia, low potassium, and then life-threatening tachydysrhythmias and seizures, so place her on the monitor and prepare benzodiazepines. Pinpoint pupils and apnea fit opioids. Delayed liver failure is the danger of acetaminophen. Caffeine does not destroy platelets.

8. A patient with agitation, extreme strength, hyperthermia, and insensitivity to pain who suddenly goes quiet during restraint should be assumed to be:

   1. A. Calming down from the sedation
   2. B. In cardiac arrest or near arrest
   3. C. Falling asleep after exhaustion
   4. D. Faking unresponsiveness to escape
   Show answer

   Answer: B. In cardiac arrest or near arrest

   Patients with hyperactive delirium can deteriorate suddenly, so a sudden calm demands an immediate check of breathing and pulse. Never leave such patients prone or unmonitored.

9. A 19-year-old at a dance festival is confused and seizing after taking 'Molly' and drinking large amounts of water. The most likely electrolyte problem is:

   1. A. Hyponatremia
   2. B. Hyperkalemia
   3. C. Hypercalcemia
   4. D. Hypernatremia
   Show answer

   Answer: A. Hyponatremia

   MDMA causes antidiuretic hormone release, and heavy water intake dilutes the sodium, leading to cerebral edema and seizures. Hyperthermia and serotonin syndrome are other MDMA dangers.

10. MDMA users commonly clench their jaws and grind their teeth, a finding called:

    1. A. Trismus
    2. B. Dystonia
    3. C. Bruxism
    4. D. Nystagmus
    Show answer

    Answer: C. Bruxism

    Users often chew pacifiers or gum to counter bruxism. Trismus is spasm of the jaw muscles seen with tetanus, and dystonia is a sustained abnormal posture.

11. A patient on PCP is violent, has vertical and horizontal nystagmus, and does not respond to pain. The best approach is to:

    1. A. Talk him down in a bright, busy room with family
    2. B. Give naloxone to reverse the effects of the drug
    3. C. Restrain him prone and transport him with one provider
    4. D. Limit stimulation, get help, and give a benzodiazepine
    Show answer

    Answer: D. Limit stimulation, get help, and give a benzodiazepine

    PCP causes dissociation, unpredictable violence, and analgesia. A quiet setting, enough personnel, and benzodiazepines are safest; there is no antidote.

12. Nystagmus in multiple directions in an agitated patient is a classic clue to intoxication with:

    1. A. Cocaine or methamphetamine
    2. B. Phencyclidine or ketamine
    3. C. LSD or psilocybin
    4. D. Heroin or fentanyl
    Show answer

    Answer: B. Phencyclidine or ketamine

    Dissociative agents characteristically cause horizontal, vertical, or rotary nystagmus. Stimulants and LSD cause mydriasis without prominent nystagmus.

13. Ketamine used recreationally produces:

    1. A. Profound respiratory depression and pinpoint miosis
    2. B. A dissociative state with intact airway reflexes
    3. C. Hot dry skin and urinary retention
    4. D. Heavy salivation and bronchospasm
    Show answer

    Answer: B. A dissociative state with intact airway reflexes

    Ketamine produces a feeling of detachment while usually keeping breathing intact. It can cause hypersalivation and laryngospasm, but not cholinergic bronchorrhea.

14. A college student who took LSD is frightened, seeing colors when music plays, and has dilated pupils with HR 104. Management should focus on:

    1. A. Activated charcoal and repeated naloxone doses
    2. B. Immediate intubation and mechanical ventilation
    3. C. A calm setting, reassurance, and sedation if needed
    4. D. Physostigmine to reverse the hallucinations
    Show answer

    Answer: C. A calm setting, reassurance, and sedation if needed

    LSD rarely causes direct physiologic harm; injuries come from behavior during a 'bad trip.' Reassurance, low stimulation, and benzodiazepines if needed are the mainstays.

15. Seeing sounds or hearing colors after a hallucinogen is called:

    1. A. Synesthesia
    2. B. Formication
    3. C. Flashback
    4. D. Paresthesia
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    Answer: A. Synesthesia

    Synesthesia mixes the senses and is typical of LSD and psilocybin. Formication is the sensation of bugs crawling on the skin, common with stimulants.

16. A man who smoked a synthetic cannabinoid ('K2' or 'spice') is severely agitated with HR 140 and has a seizure. Compared with marijuana, synthetic cannabinoids:

    1. A. Are less potent and rarely cause any symptoms
    2. B. Cause pinpoint pupils and respiratory depression
    3. C. Can be reversed reliably with naloxone
    4. D. Are more potent, with more seizures and psychosis
    Show answer

    Answer: D. Are more potent, with more seizures and psychosis

    Synthetic cannabinoids bind cannabinoid receptors more strongly and unpredictably, causing agitation, seizures, kidney injury, and psychosis. They do not respond to naloxone.

17. A 3-year-old ate several cannabis gummies and is now drowsy and ataxic. You should know that children with edible cannabis ingestions:

    1. A. Have no risk because cannabis is not toxic
    2. B. Usually become hyperactive and hyperthermic
    3. C. May develop coma and respiratory depression
    4. D. Need naloxone to reverse the cannabis
    Show answer

    Answer: C. May develop coma and respiratory depression

    Small bodies and concentrated edibles can cause deep CNS depression and even apnea, so airway monitoring is essential. Naloxone does not reverse THC.

18. A daily cannabis user has repeated bouts of severe vomiting and says hot showers relieve the symptoms. The most likely diagnosis is:

    1. A. Acute cannabis intoxication alone
    2. B. Cannabinoid hyperemesis syndrome
    3. C. Alcoholic ketoacidosis
    4. D. Acute appendicitis
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    Answer: B. Cannabinoid hyperemesis syndrome

    Cyclic vomiting relieved by hot showers in a heavy chronic user is the hallmark, and stopping cannabis resolves it. Appendicitis pain is not relieved by heat.

19. Bath salts (synthetic cathinones) most closely resemble the effects of:

    1. A. Heroin
    2. B. Alcohol
    3. C. Diphenhydramine
    4. D. Methamphetamine
    Show answer

    Answer: D. Methamphetamine

    Synthetic cathinones are stimulants that cause agitation, psychosis, and hyperthermia. Treatment mirrors other sympathomimetic toxicity, including benzodiazepines and cooling.

20. A cocaine user with chest pain and a stroke-like deficit is at risk of these problems because cocaine causes:

    1. A. Vasoconstriction and more platelet aggregation
    2. B. Vasodilation and decreased platelet aggregation
    3. C. Bradycardia and decreased blood pressure
    4. D. Hypoglycemia and decreased cardiac output
    Show answer

    Answer: A. Vasoconstriction and more platelet aggregation

    Coronary and cerebral vasospasm plus clot formation lead to MI and stroke. Cocaine raises, not lowers, heart rate and blood pressure.

21. A body packer who swallowed wrapped cocaine packets becomes agitated, tachycardic, and hypertensive during transport. This suggests:

    1. A. A packet has ruptured; he needs surgery
    2. B. The patient is anxious about being arrested
    3. C. Normal absorption that requires no treatment
    4. D. Opioid withdrawal from the long transport
    Show answer

    Answer: A. A packet has ruptured; he needs surgery

    Packet rupture releases a massive dose, which can be fatal, and surgical removal may be needed. Treat with benzodiazepines and alert the hospital early.

22. An agitated patient with suspected stimulant toxicity has a blood glucose of 52 mg/dL. You should:

    1. A. Ignore it because stimulants raise blood sugar
    2. B. Treat the hypoglycemia; it can cause agitation
    3. C. Delay treatment until the patient is sedated
    4. D. Give oral glucose while he is restrained
    Show answer

    Answer: B. Treat the hypoglycemia; it can cause agitation

    Always check and correct glucose in agitated patients, since hypoglycemia mimics drug toxicity. Oral glucose in a combative patient risks aspiration, so IV dextrose is preferred.

23. Inhalant abuse ('huffing') of solvents can cause sudden death mainly from:

    1. A. Blocking opioid receptors and causing apnea
    2. B. Producing severe hypertension and a stroke
    3. C. Sensitizing the heart to catecholamines (VF)
    4. D. Causing anaphylaxis to the inhaled solvent vapors
    Show answer

    Answer: C. Sensitizing the heart to catecholamines (VF)

    Hydrocarbons sensitize the myocardium, and a surge of adrenaline from fright or exertion triggers VF ('sudden sniffing death'). Keep these patients calm and avoid startling them.

24. A teen found with a bag and silver paint around the mouth is confused. To reduce the risk of a fatal dysrhythmia, you should:

    1. A. Give epinephrine to support his heart rate
    2. B. Have him walk to the ambulance to stay awake
    3. C. Hold him down firmly so he cannot get up
    4. D. Keep him calm and avoid sudden exertion
    Show answer

    Answer: D. Keep him calm and avoid sudden exertion

    Catecholamine surges in a sensitized myocardium cause VF. Calm handling and minimal exertion lower that risk.

25. A patient with suspected stimulant overdose is having a seizure. The first-line medication is:

    1. A. Phenytoin given IV over 20 minutes
    2. B. A benzodiazepine such as midazolam
    3. C. Haloperidol given intramuscularly
    4. D. Naloxone given intranasally
    Show answer

    Answer: B. A benzodiazepine such as midazolam

    Benzodiazepines stop toxin-induced seizures and reduce sympathetic overdrive. Phenytoin is generally ineffective for toxic seizures, and haloperidol lowers the seizure threshold.