10 free Paramedic practice questions: Advanced Pharmacology Principles

Give the usual opioid dose and hold the benzodiazepine until the pain is controlled: Holding the benzodiazepine does take away the risk of the two drugs together. The opioid alone still has to be cleared by a damaged liver and damaged kidneys. A usual opioid dose is still an overdose for this patient.

Give the usual doses but space them further apart and monitor the oxygen saturation: Spacing the doses further apart sounds like giving less drug. Each full dose still has the same peak effect. Oxygen saturation also stays normal well past the point where ventilation has failed, so it warns you too late.

Give both at the usual doses and reassess the respiratory rate after each dose: Checking the respiratory rate after each dose sounds safe. A rate checked between doses lags behind the problem. At usual doses, both drugs also build up in this patient, because the liver and kidneys cannot clear them.

Only the 95 percent that is bound acts, since protein carries it to the tissue: Plasma protein does carry the drug through the blood, so the bound part sounds like the working part. Binding holds onto the drug instead of delivering the drug. A bound molecule cannot reach the receptor at all.

All of it acts, because bound drug releases the moment it reaches the tissue: Bound and unbound drug trade places all the time, so total release sounds reasonable. Only the free part is active at any one moment. At 95 percent binding, most of the drug cannot act.

None of it acts until the liver strips the protein off the drug molecule: The liver does change drugs chemically. Protein binding is a reversible attachment out in the plasma. The liver does not have to strip anything off before the drug can work.

Vessel tone rises, since dromotropy describes resistance: Rising vessel tone is a real alpha-1 effect, and plenty of catecholamines raise vessel tone. Vessel tone is not one of the tropy terms. A question about dromotropy cannot be asking about vessel tone.

The squeeze strengthens, since dromotropy describes force: A stronger squeeze is inotropy, from ino, meaning fiber. Inotropy fits a drug that makes the heart contract harder. This drug reference says dromotropic, not inotropic, so contraction force is not what is being described.

The heart rate rises, since dromotropy describes rate: Heart rate is chronotropy, from chrono, meaning time. Under beta-1 stimulation, rate and conduction speed often rise together. Dromotropy is about how the impulse travels through the conduction pathway, not how often the SA node fires. Conduction can speed up with no change in rate at all.

Ipratropium blocks beta-2 receptors, so the two drugs cancel each other out: Ipratropium and albuterol work through opposite branches of the autonomic nervous system, so cancelling out sounds logical. Ipratropium does not block beta-2 receptors. The two drugs act at different receptors on the same smooth muscle. Their bronchodilation adds together instead of cancelling out.

Ipratropium is given alone only when the heart rate has climbed too high: A fast heart rate from albuterol hitting beta-1 receptors is a real reason to rethink repeat albuterol doses. In a severe attack, a rising heart rate usually comes from the attack itself. Switching to ipratropium alone leaves this patient undertreated.

Ipratropium replaces the beta-agonist once the first treatment is finished: Switching drugs after the first treatment sounds like a way to spread out the doses. Albuterol is the main bronchodilator in this attack. Stepping away from albuterol removes your strongest drug while the patient is still in trouble.

Multiply the reported weight by 2.2 to express it in kilograms: Multiplying by 2.2 uses the right number in the wrong direction. Done that way, 44 pounds turns into 96.8. That number is well over double this child's real weight of about 20 kilograms.

Add the reported number to the age-based estimate and average the two: Checking a reported weight against an age-based estimate is a reasonable habit. Averaging a number in pounds with a number in kilograms gives you a number that is neither. The age-based formula is for when you have no weight at all.

Use the reported number directly, since the dose scales either way: Using the reported number directly is fast, and the math afterward will look correct. The 44 is in pounds, and using it as kilograms more than doubles this child's weight. Every dose calculated from that number is more than doubled too.

Right patient, medication, tubing, bag volume, and drip chamber position: Tubing, bag volume, and drip chamber position belong to setting up an IV line correctly. These are equipment checks. None of them catches the wrong drug or the wrong dose.

Right patient, medication, diagnosis, transport decision, and destination: Diagnosis, transport decision, and destination are real clinical decisions. The rights do not make those decisions. The rights are a checklist for giving the drug after you have already decided to treat.

Right patient, medication, allergy list, vital signs, and family consent: Allergies and vital signs belong in your assessment before you give any drug. Assessment items are not part of the rights. The rights name the patient, drug, dose, route, and time, and you say them the same way every time.

Roughly tenfold, since the two are packaged at concentrations ten apart: A tenfold error is the classic concentration mistake, and it is worth watching for. A tenfold gap comes from two concentrations of the same drug. Micrograms against milligrams is a thousandfold gap.

None, since both opioids are titrated to patient effect rather than to a number: Titrating opioids to effect is real practice, and titration does give some protection. Titration cannot rescue a dose a thousand times too large, because the first dose has already gone in.

Roughly twofold, since the two opioids differ by about that in potency: Fentanyl and morphine do differ in potency. The error here comes from the unit printed on the label, not from the potency of the drugs.

The usual dose given faster, since low cardiac output slows delivery: Low cardiac output does slow how fast a drug reaches the tissue. The same low output also slows how fast the liver clears lidocaine. Pushing the usual dose faster raises the peak level in a patient who cannot clear the drug.

The usual dose repeated sooner, since clearance is already reduced: Repeating a dose sooner would help hold a steady level if the drug were wearing off fast. This patient clears lidocaine slowly, so the earlier dose is still in the blood. A repeat dose on top of the earlier one stacks the level higher.

No adjustment, since lidocaine is cleared by the kidney rather than the liver: Plenty of drugs are cleared by the kidney, and lidocaine is not one of them. The liver clears lidocaine, and how fast depends on blood flow to the liver. That's why the cirrhosis and the low cardiac output both matter here.

Opioid agonist: An opioid agonist binds the opioid receptor and turns the receptor on. Morphine, fentanyl, heroin, and oxycodone are opioid agonists. Agonists cause the pain relief, sedation, and slowed breathing being reversed here. An opioid agonist is what this patient took, not the drug that reverses the overdose. The question says the drug binds "without activating them," which is the opposite of an agonist.

Sympathomimetic: A sympathomimetic copies the sympathetic nervous system. Epinephrine, albuterol, and dopamine are sympathomimetics. You would expect a sympathomimetic if the question described a fast heart rate, opened airways, or tightened blood vessels. This question names opioid receptors, not the sympathetic nervous system.

Parasympatholytic: A parasympatholytic like atropine blocks acetylcholine. Blocking acetylcholine is how atropine raises the heart rate and dries up secretions. Atropine is a blocker like this drug, but atropine blocks a different receptor. The drug in this question blocks opioid receptors.

It lowers the chance of an allergic reaction to the infusion: Pretreating to prevent an allergic reaction is a real strategy. Pretreatment uses a different drug, like an antihistamine or a steroid, before a known allergen. A bolus of the same drug does not prevent a reaction. If anything, giving a large amount quickly raises the chance of an infusion reaction instead of lowering it.

It prevents the medication from being broken down in the liver: Some drugs do block the liver enzymes that break other drugs down, and that is how some drug combinations make levels climb. A bolus of the same drug does not change how the liver works. The liver keeps clearing the drug at the normal rate. That's why the infusion has to follow the bolus.

It keeps the medication from binding to plasma proteins: Protein binding decides how much of a drug is free and active, and binding matters for drugs that bind heavily. A bolus does not change the binding. The bound share stays the same, just at a higher total level. Getting to a therapeutic level fast is a volume and time problem, not a binding problem.