10 free Paramedic practice questions: Advanced Pharmacology Principles

Give the usual opioid dose and hold the benzodiazepine until the pain is controlled: Separating the two drugs is tempting because it removes the combination risk. The opioid alone is still cleared by an impaired liver and kidney, so a usual 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 is tempting because it sounds like a reduction. Peak effect after each full dose is unchanged, and oxygen saturation stays normal well past the point where ventilation has failed.

Give both at the usual doses and reassess the respiratory rate after each dose: Standard dosing with reassessment is tempting because reassessment feels like the safety net. A respiratory rate checked between doses lags behind the problem, and both drugs accumulate in a patient whose liver and kidneys cannot clear them.

Only the 95 percent that is bound acts, since protein carries it to the tissue: It is tempting to read protein binding as a delivery service, which makes the bound share sound like the working share. Binding occupies the drug rather than delivering it, and 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 do exchange continuously, which makes total release sound reasonable. At any given moment only the free fraction is active, and at 95 percent binding the great majority of the drug is unavailable.

None of it acts until the liver strips the protein off the drug molecule: The liver does change drugs chemically, so it is easy to hand it this job too. Protein binding is a reversible physical attachment out in the plasma, not something the liver has to undo before the drug can work.

Vessel tone rises, since dromotropy describes resistance: Vessel tone is a genuine adrenergic effect, so it belongs in the same conversation. Tone is an alpha-1 effect and carries no tropy term at all.

The squeeze strengthens, since dromotropy describes force: Contractile force is the effect most people picture when they hear a heart drug described. Force is inotropy, from the root ino, meaning fiber.

The heart rate rises, since dromotropy describes rate: Rate is the most familiar cardiac number, so it tends to attach itself to whichever term is in front of you. Rate is chronotropy, from the root chrono, meaning time.

Ipratropium blocks beta-2 receptors, so the two drugs cancel each other out: Anticholinergics and beta-agonists act through opposite branches of the autonomic nervous system, so cancellation sounds mechanically tidy. They act at different receptors on the same smooth muscle, and their bronchodilation adds together rather than cancelling.

Ipratropium is given alone only when the heart rate has climbed too high: Tachycardia from beta-1 spillover is a real reason to reconsider repeated albuterol, so this reads as clinically aware. A rising rate in a severe attack usually reflects the attack itself, and dropping the bronchodilator for the anticholinergic alone leaves the patient undertreated.

Ipratropium replaces the beta-agonist once the first treatment is finished: Alternating drugs sounds like a sensible way to spread out the dosing over a long transport. Albuterol is the primary bronchodilator here, and stepping away from it removes the strongest tool 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 factor pointed the wrong way, and the direction is easy to reverse under pressure. Multiplying turns 44 pounds into 96.8, which is well over double the child's real weight in kilograms.

Add the reported number to the age-based estimate and average the two: Cross-checking a reported weight against an estimate is a reasonable habit in principle. Averaging two numbers in different units produces a figure that is neither, and the age-based formula is the fallback for when no weight is available at all.

Use the reported number directly, since the dose scales either way: Using the number as reported is quick, and the dose calculation itself will look correct on the run sheet afterward. A pound figure used as kilograms overstates the weight by a factor above two, so every derived dose is more than doubled.

Right patient, medication, tubing, bag volume, and drip chamber position: Every item here belongs to running a line correctly, which makes the list look like careful practice. These are equipment checks rather than medication checks, and not one of them catches the wrong drug or the wrong dose.

Right patient, medication, diagnosis, transport decision, and destination: Diagnosis and destination are real clinical decisions, so a list of them sounds thorough. The rights are a drug administration checklist, and they sit downstream of the decision to treat rather than replacing it.

Right patient, medication, allergy list, vital signs, and family consent: Allergies and vital signs genuinely belong in the assessment before a drug is given, which makes this feel safe. The rights name the patient, drug, dose, route, and time, and folding assessment items into them blurs a checklist meant to be said identically every time.

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

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

Roughly twofold, since the two opioids differ by about that in potency: Potency really does differ between the two opioids, so a modest multiplier sounds like the reasonable answer. The difference that bites here is the unit printed on the label, not the relative potency of the drugs.

The usual dose given faster, since low cardiac output slows delivery: Low cardiac output does slow drug delivery to the tissue, which makes a faster push sound compensatory. Low output also slows hepatic clearance, so pushing faster raises the peak level in a patient who cannot clear it.

The usual dose repeated sooner, since clearance is already reduced: Shortening the interval sounds like a way to hold a therapeutic level in someone who is clearing slowly. Reduced clearance means the earlier dose is still present, so repeating sooner stacks doses on top of one another.

No adjustment, since lidocaine is cleared by the kidney rather than the liver: Plenty of drugs are renally cleared, so assigning lidocaine to the kidney is an understandable slip. Lidocaine's clearance is hepatic and flow-dependent, which is exactly why liver disease and low cardiac output both matter here.

Opioid agonist: the correct label for what this patient took, morphine, fentanyl, heroin, oxycodone: anything that binds the opioid receptor and turns it on, producing the analgesia, sedation, and respiratory depression being reversed here. The question states the drug given binds "without activating them," which is the precise opposite. The key beats it because agonist and antagonist differ on exactly one thing, whether occupying the receptor switches it on, and the question answers that directly.

Sympathomimetic: describes a drug that mimics the sympathetic nervous system, epinephrine, albuterol, dopamine, and would be right if the question described tachycardia, bronchodilation, or vasoconstriction. Nothing in this question touches adrenergic receptors; it names opioid receptors specifically. The key beats it because the classification has to match the receptor the question named.

Parasympatholytic: the right label for atropine, which blocks acetylcholine at muscarinic receptors and is why atropine raises heart rate and dries secretions. It shares the blocking half of the answer, which is what makes it tempting, but it blocks a completely different receptor. The key beats it because the question specifies opioid receptors, so the correct classification is the opioid-blocking one, not the acetylcholine-blocking one.

It lowers the chance of an allergic reaction to the infusion: Pretreating to blunt a reaction is a real strategy, but it belongs to a different setup, giving a different agent such as an antihistamine or a steroid before a known allergen exposure. A bolus of the same drug does not desensitize anyone; if anything, delivering a large amount rapidly raises the chance of an infusion-related reaction rather than lowering it. The key gives the actual reason, which is kinetic rather than immunologic: get the concentration into range now instead of in 6 to 8 hours.

It prevents the medication from being broken down in the liver: Blocking hepatic metabolism is something a specific enzyme-inhibiting drug can do, and it is why some combinations cause drug levels to climb. A bolus of the same medication does not change liver enzyme activity at all. In fact the premise of the pattern is that clearance keeps running normally, which is exactly why an infusion has to follow the bolus. The key separates the two roles: the bolus sets the starting level, the infusion covers ongoing clearance.

It keeps the medication from binding to plasma proteins: Plasma protein binding determines how much of a drug is free and active, so it is a real pharmacokinetic variable worth knowing, and displacement interactions genuinely matter for highly bound drugs. Bolus dosing does not alter the binding relationship; the bound fraction stays the same, just at a higher total concentration. The key identifies the actual purpose, filling the volume of distribution to reach a therapeutic level at once, which is a volume-and-time problem rather than a binding problem.