Title: Emt Pharmacology — LearnCoachAssist

Q: What are the "six rights" of medication administration in EMS?
A: Right patient, right medication, right dose, right route, right time, right documentation.

Q: Define "indication" in pharmacology.
A: A condition or situation for which a drug is appropriate to give.

Q: Define "contraindication" in pharmacology.
A: A condition or situation in which a drug should NOT be given.

Q: Define "side effect."
A: An unintended, usually undesired, effect of a medication at normal dosing.

Q: Define "untoward effect."
A: An unexpected or dangerous side effect of a medication.

Q: What is the generic name of a drug?
A: The official, non-proprietary chemical name (e.g., acetylsalicylic acid).

Q: What is the trade name of a drug?
A: The brand name given by the manufacturer (e.g., Bayer for aspirin).

Q: What does "route of administration" mean?
A: The pathway by which a drug enters the body (e.g., oral, IM, sublingual).

Q: Name the route: drug placed under the tongue.
A: Sublingual.

Q: Name the route: drug sprayed or inhaled into the lungs.
A: Inhalation/nebulized.

Q: Name the route: drug given by swallowing.
A: Oral (PO).

Q: Name the route: drug injected into muscle.
A: Intramuscular (IM).

Q: Name the route: drug given via rectum.
A: Rectal (PR).

Q: What does "onset of action" mean?
A: The time from administration until the drug begins to take effect.

Q: What does "duration of action" mean?
A: The length of time a drug remains effective.

Q: What is a drug's "mechanism of action"?
A: How the drug produces its effect on the body at a cellular/molecular level.

Q: What medications does an EMT-Basic typically carry on the ambulance?
A: Oxygen, oral glucose, aspirin, and (per protocol) activated charcoal.

Q: What patient-assist medications may an EMT help a patient self-administer?
A: Nitroglycerin, epinephrine auto-injector, and metered-dose inhaler (albuterol).

Q: What must an EMT confirm before assisting with a patient's own prescribed medication?
A: It is prescribed to that patient, is the correct medication, and has not expired.

Q: What is an "auto-injector"?
A: A spring-loaded syringe device that delivers a premeasured dose of medication through clothing/skin.

Q: What is a "metered-dose inhaler (MDI)"?
A: A handheld device that delivers a measured dose of aerosolized medication to the lungs.

Q: What does "PRN" mean on a medication order?
A: As needed.

Q: What does "NKDA" stand for?
A: No Known Drug Allergies.

Q: Why must an EMT ask about allergies before medication administration?
A: To avoid triggering an allergic or anaphylactic reaction.

Q: What is anaphylaxis?
A: A severe, life-threatening systemic allergic reaction.

Q: What does naloxone do pharmacologically?
A: It is an opioid antagonist that reverses opioid effects by competing for opioid receptors.

Q: What is a drug "agonist"?
A: A substance that binds to a receptor and activates it, producing a biological response.

Q: What is a drug "antagonist"?
A: A substance that binds to a receptor and blocks it without activating a response.

Q: Why do EMS protocols require medical direction for certain medications?
A: To ensure appropriate use and legal authorization under the EMT's scope of practice.

Q: What is "offline (standing order) medical direction"?
A: Pre-approved protocols allowing treatment without direct physician contact at the time of care.

Q: What is the medication classification of oxygen?
A: A gas classified as a medication; administered for hypoxia.

Q: What is the primary indication for supplemental oxygen in EMS?
A: Suspected or confirmed hypoxia or hypoxemia.

Q: What device delivers approximately 24-44% oxygen at 1-6 L/min?
A: Nasal cannula.

Q: What device delivers approximately 90-100% oxygen at 10-15 L/min?
A: Non-rebreather mask.

Q: What flow rate is used with a non-rebreather mask?
A: 10-15 L/min (enough to keep the reservoir bag inflated).

Q: What flow rate range is typical for a nasal cannula?
A: 1-6 L/min.

Q: What device is used to ventilate a non-breathing patient with supplemental oxygen?
A: Bag-valve mask (BVM).

Q: What oxygen flow rate is typically used with a BVM?
A: 15 L/min or higher, often with a reservoir attached.

Q: Should oxygen ever be withheld from a hypoxic patient in EMS?
A: No, oxygen should not be withheld from a patient who needs it due to hypoxia.

Q: What SpO2 reading generally indicates the need for supplemental oxygen?
A: Below 94% (per current guidelines) or per local protocol.

Q: What is a potential risk of high-flow oxygen in some COPD patients?
A: Blunting of hypoxic respiratory drive, though this should not delay needed oxygen therapy in acute hypoxia.

Q: What are signs of hypoxia an EMT should assess for?
A: Cyanosis, altered mental status, tachypnea, and tachycardia.

Q: Is oxygen considered safe to administer to almost all EMS patients?
A: Yes, oxygen has very few contraindications and is a mainstay of EMS treatment.

Q: What is a Venturi mask used for?
A: Delivering a precise, controlled percentage of oxygen.

Q: Why is humidified oxygen sometimes preferred for prolonged transport?
A: To prevent drying of mucous membranes and patient discomfort.

Q: What is the generic name for oral glucose gel?
A: Glucose (dextrose in oral gel form).

Q: What is the indication for oral glucose administration?
A: Suspected hypoglycemia in a conscious patient able to swallow/protect airway.

Q: What is the major contraindication to oral glucose?
A: Unconsciousness or inability to swallow/protect the airway.

Q: What is the typical adult dose of oral glucose?
A: One tube, approximately 15-25 g, administered buccally.

Q: What is the route of administration for oral glucose gel?
A: Oral, placed between cheek and gum (buccal).

Q: What blood glucose level generally indicates hypoglycemia in adults?
A: Below 60-70 mg/dL (per local protocol).

Q: What are signs/symptoms of hypoglycemia?
A: Altered mental status, diaphoresis, tachycardia, weakness, and confusion.

Q: What mechanism explains oral glucose's effect?
A: It provides a rapidly absorbed simple sugar to raise blood glucose levels.

Q: What must an EMT assess before giving oral glucose?
A: The patient's ability to swallow and protect their own airway.

Q: Why is oral glucose given buccally rather than swallowed whole?
A: For faster mucosal absorption and reduced aspiration risk in a marginally alert patient.

Q: What side effect might oral glucose cause?
A: Generally minimal; possible nausea.

Q: What condition commonly causes hypoglycemia in known diabetics?
A: Excess insulin or oral hypoglycemic use relative to food intake or exertion.

Q: What action should an EMT take if a hypoglycemic patient is unconscious?
A: Do not give oral glucose; secure the airway and transport (IV dextrose per ALS if available).

Q: What form does oral glucose typically come in for EMS use?
A: A gel tube (e.g., Glutose, Insta-Glucose).

Q: Can oral glucose be used for altered mental status consistent with hypoglycemia but unknown glucose level?
A: Yes, per protocol if the patient can protect their airway and swallow safely.

Q: What is the indication for activated charcoal administration?
A: Certain oral poisonings/overdoses, per medical direction and toxin type.

Q: What is the primary contraindication to activated charcoal?
A: Altered mental status/inability to protect airway, or ingestion of acids, alkalis, or hydrocarbons.

Q: What is the typical adult dose of activated charcoal?
A: Approximately 25-50 g (1 g/kg) mixed as a slurry.

Q: What is the route of administration for activated charcoal?
A: Oral.

Q: What is the mechanism of action of activated charcoal?
A: It adsorbs certain toxins/drugs in the GI tract, preventing systemic absorption.

Q: Why is activated charcoal not given for acid or alkali (caustic) ingestions?
A: It does not bind these substances well and can obscure endoscopic evaluation of burns.

Q: Why is activated charcoal not given for hydrocarbon ingestions?
A: Risk of vomiting and aspiration causing chemical pneumonitis, with limited benefit.

Q: What side effect is common with activated charcoal?
A: Black stools; possible vomiting.

Q: Has activated charcoal use by EMTs become less common in modern protocols?
A: Yes, many EMS systems have removed it from EMT scope due to limited prehospital benefit evidence.

Q: What must be true of a patient's mental status before giving activated charcoal?
A: The patient must be awake, alert, and able to protect their airway.

Q: What does activated charcoal look like?
A: A black, gritty suspension/slurry.

Q: Why must medical direction often be contacted before giving activated charcoal?
A: Because appropriateness depends on the specific poison ingested and timing.

Q: What time window after ingestion is activated charcoal generally most effective?
A: Within about 1 hour of ingestion.

Q: What is a risk if activated charcoal is aspirated?
A: Aspiration pneumonitis.

Q: Does activated charcoal work for all types of poisoning, such as iron, lithium, or alcohols?
A: No, it does not effectively bind certain substances like metals, iron, lithium, and alcohols.

Q: What is the generic name for aspirin?
A: Acetylsalicylic acid (ASA).

Q: What is the indication for administering aspirin in EMS?
A: Suspected acute coronary syndrome (ACS)/cardiac chest pain.

Q: What is the standard adult dose of aspirin for suspected ACS?
A: 160-325 mg chewed (commonly four 81 mg baby aspirin).

Q: What is the route of administration for aspirin in EMS?
A: Oral, chewed rather than swallowed whole, for faster absorption.

Q: What is the mechanism of action of aspirin in ACS?
A: It inhibits platelet aggregation (antiplatelet effect), reducing clot propagation.

Q: Name a contraindication to aspirin administration.
A: Known aspirin allergy.

Q: Name another contraindication to aspirin administration.
A: Active GI bleeding or a bleeding disorder.

Q: Should aspirin be given to a patient with suspected stroke?
A: No, aspirin is not indicated for suspected stroke by EMTs due to hemorrhage risk.

Q: Why is aspirin chewed rather than swallowed for cardiac chest pain?
A: Chewing increases surface area for faster buccal/GI absorption and quicker onset.

Q: What drug class does aspirin belong to?
A: NSAID (nonsteroidal anti-inflammatory drug) with antiplatelet properties.

Q: What side effect of aspirin should an EMT monitor for?
A: GI upset, bleeding, or allergic reaction.

Q: Why should aspirin generally not be given to children?
A: Risk of Reye's syndrome.

Q: Can aspirin be given if a patient already took their own aspirin at home?
A: Yes, but total dose should be considered per protocol/medical direction.

Q: What is the goal of giving aspirin early in suspected MI?
A: To reduce mortality by limiting clot formation/propagation in coronary arteries.

Q: What form of aspirin is preferred in EMS, chewable or enteric-coated?
A: Chewable (non-enteric-coated), for faster onset.

Q: Should aspirin be withheld if the patient is already on a daily aspirin regimen?
A: No, additional aspirin is still generally given per protocol unless contraindicated.

Q: What assessment finding might make an EMT hold aspirin administration?
A: Signs of active bleeding or a clear allergy history.

Q: What mnemonic is often used for early cardiac chest pain care that includes aspirin?
A: MONA: Morphine, Oxygen, Nitroglycerin, Aspirin (morphine is ALS-only).

Q: What is the indication for nitroglycerin administration?
A: Suspected cardiac chest pain/angina with a prescribed history and adequate blood pressure.

Q: What is the typical dose of sublingual nitroglycerin tablet or spray?
A: 0.4 mg (1 tablet or 1 spray).

Q: What is the route of administration for nitroglycerin in EMS?
A: Sublingual (tablet or spray).

Q: What is the mechanism of action of nitroglycerin?
A: Vasodilation of blood vessels, reducing cardiac preload and myocardial oxygen demand.

Q: Name a contraindication to nitroglycerin administration.
A: Hypotension (SBP < 100 mmHg, or per protocol threshold).

Q: Name another contraindication to nitroglycerin.
A: Recent use of a phosphodiesterase inhibitor (e.g., sildenafil) within 24-48 hours.

Q: Name a third contraindication to nitroglycerin.
A: Head injury or suspected increased intracranial pressure.

Q: Name a fourth contraindication to nitroglycerin.
A: Suspected right ventricular (inferior wall) myocardial infarction.

Q: What must an EMT verify before assisting with nitroglycerin?
A: It is prescribed to the patient, the patient has taken it before, and blood pressure is adequate.

Q: What vital sign must be reassessed before each nitroglycerin dose?
A: Blood pressure.

Q: What is the maximum number of nitroglycerin doses an EMT can typically assist with?
A: Up to 3 doses total, 5 minutes apart, per protocol/medical direction.

Q: What common side effect does nitroglycerin cause?
A: Headache, hypotension, dizziness, or flushing.

Q: What position should a patient be in after receiving nitroglycerin?
A: Sitting or supine, to reduce fall risk from hypotension.

Q: How should nitroglycerin tablets be stored?
A: In their original dark glass container, protected from light, heat, and moisture.

Q: What sensation indicates a nitroglycerin tablet is still potent?
A: A burning/tingling sensation under the tongue.

Q: What form of nitroglycerin besides tablets is commonly prescribed?
A: Sublingual spray.

Q: What effect does nitroglycerin have on blood pressure?
A: Lowers blood pressure due to vasodilation.

Q: Why is nitroglycerin dangerous when combined with erectile dysfunction medications?
A: The combination can cause severe, profound hypotension.

Q: Should nitroglycerin be swallowed?
A: No, it should be administered sublingually, not swallowed.

Q: What effect does nitroglycerin have that can relieve angina pain?
A: Reduces myocardial oxygen demand by decreasing preload and dilating coronary arteries.

Q: If a patient's chest pain is unrelieved after nitroglycerin, what should the EMT suspect?
A: Possible ongoing myocardial infarction requiring further ALS/hospital care.

Q: What minimum systolic blood pressure is commonly required before giving nitroglycerin?
A: Generally at least 100-110 mmHg, per local protocol.

Q: What is the indication for epinephrine auto-injector use?
A: Anaphylaxis or severe allergic reaction.

Q: What is the adult dose delivered by an EpiPen?
A: 0.3 mg IM.

Q: What is the pediatric dose delivered by an EpiPen Jr?
A: 0.15 mg IM.

Q: What is the route of administration for an epinephrine auto-injector?
A: Intramuscular (IM), typically lateral thigh.

Q: Where on the body is an epinephrine auto-injector typically administered?
A: The lateral mid-thigh.

Q: What is the mechanism of action of epinephrine in anaphylaxis?
A: Alpha and beta adrenergic stimulation causing vasoconstriction, bronchodilation, and increased cardiac output.

Q: Name a contraindication to epinephrine auto-injector use.
A: None absolute in true anaphylaxis; it is life-saving and should be given.

Q: What are signs/symptoms of anaphylaxis requiring epinephrine?
A: Hives, swelling, difficulty breathing/wheezing, hypotension, and throat tightness.

Q: Can epinephrine be given through clothing via auto-injector?
A: Yes, most auto-injectors can be administered through light clothing.

Q: What side effects might occur after epinephrine administration?
A: Tachycardia, anxiety, tremors, and palpitations.

Q: How long should the auto-injector needle be held in the thigh after triggering?
A: About 3-10 seconds, per device instructions.

Q: Can an EMT assist with a second dose of epinephrine if symptoms persist?
A: Yes, per protocol/medical direction if symptoms do not improve or recur.

Q: What must an EMT confirm before assisting with a patient's epinephrine auto-injector?
A: It is prescribed to the patient and the patient is exhibiting anaphylaxis symptoms.

Q: What effect does epinephrine have on bronchioles?
A: Bronchodilation, easing breathing.

Q: What effect does epinephrine have on blood vessels systemically?
A: Vasoconstriction, raising blood pressure and reducing swelling/edema.

Q: What brand names are common for epinephrine auto-injectors?
A: EpiPen, Auvi-Q, and Adrenaclick.

Q: What should be done with the auto-injector after use?
A: Transport it with the patient to the hospital and note the time given.

Q: Why is epinephrine considered a first-line, time-critical treatment for anaphylaxis?
A: Delay increases risk of airway obstruction and cardiovascular collapse.

Q: What class of drug is epinephrine?
A: Sympathomimetic (adrenergic agonist).

Q: What should an EMT do immediately after administering epinephrine for anaphylaxis?
A: Continue monitoring ABCs, prepare for further doses, and transport promptly.

Q: Why might a second dose of epinephrine be needed?
A: Its effects are short-lived (10-20 minutes) and symptoms can recur or persist.

Q: What position should be avoided in a hypotensive anaphylaxis patient?
A: Standing/sitting upright suddenly; prefer supine with legs elevated if tolerated.

Q: What is the indication for albuterol (MDI) administration?
A: Bronchospasm/wheezing associated with asthma, COPD, or other respiratory distress.

Q: What is the typical dose of albuterol via MDI?
A: 1-2 puffs (approximately 90 mcg/puff), repeated per protocol.

Q: What is the route of administration for albuterol via MDI?
A: Inhalation.

Q: What is the mechanism of action of albuterol?
A: Beta-2 adrenergic agonist causing bronchodilation via smooth muscle relaxation in the airways.

Q: Name a contraindication to assisting with albuterol MDI.
A: Patient unable to inhale/coordinate use, or no physician prescription for the patient.

Q: What device can improve MDI drug delivery for patients who struggle with coordination?
A: A spacer device.

Q: What side effects can albuterol cause?
A: Tachycardia, tremors, nervousness, and palpitations.

Q: What must an EMT verify before assisting with a patient's MDI?
A: It is prescribed to the patient and appropriate for their current symptoms.

Q: How should a patient be coached to use an MDI for best effect?
A: Exhale fully, seal lips around mouthpiece, inhale deeply while pressing canister, hold breath about 10 seconds.

Q: What is the purpose of shaking an MDI canister before use?
A: To ensure the medication is evenly mixed/suspended for accurate dosing.

Q: What condition characterized by bronchoconstriction commonly requires albuterol treatment in EMS?
A: Asthma exacerbation.

Q: Can albuterol be delivered via nebulizer instead of MDI?
A: Yes, nebulized albuterol is a common alternative delivery method.

Q: What breath sound is commonly associated with the need for albuterol?
A: Expiratory wheezing.

Q: What class of medication is albuterol?
A: Bronchodilator (short-acting beta-2 agonist, SABA).

Q: Why might albuterol be less effective if inhalation technique is poor?
A: Poor technique reduces drug delivery to the lower airways.

Q: What time interval is often used between repeat albuterol doses in EMS protocols?
A: Every 5-20 minutes as needed, per local protocol.

Q: Should albuterol be given to a patient with no prescription and no protocol allowance?
A: No, without a prescription or protocol/medical direction it should not be assisted with by an EMT.

Q: What effect does albuterol have on heart rate?
A: It commonly increases heart rate as a side effect.

Q: What is the onset of action of inhaled albuterol?
A: Rapid, typically within 5 minutes.

Q: Besides asthma, what other chronic condition commonly involves albuterol use?
A: COPD (chronic obstructive pulmonary disease).

Q: What is the indication for naloxone administration?
A: Suspected opioid overdose with respiratory depression.

Q: What is the mechanism of action of naloxone?
A: Competitive opioid receptor antagonist that displaces opioids from receptors.

Q: What routes can naloxone be administered by EMTs?
A: Intranasal (IN) is most common for EMT-Basics; also IM, per protocol/scope.

Q: What is a common intranasal naloxone dose?
A: 4 mg per spray (one spray per nostril, e.g., Narcan Nasal Spray).

Q: What are signs of opioid overdose that indicate naloxone use?
A: Respiratory depression/apnea, pinpoint pupils, and decreased level of consciousness.

Q: What side effect can occur after naloxone reverses an opioid overdose?
A: Acute opioid withdrawal symptoms, such as agitation, nausea, or combativeness.

Q: Why might repeat doses of naloxone be needed?
A: Naloxone's duration of action is shorter than many opioids, so re-sedation can occur.

Q: What is the priority action before/with giving naloxone in an overdose?
A: Support airway and breathing (ventilation) as needed.

Q: What brand name is commonly associated with naloxone nasal spray?
A: Narcan.

Q: Is naloxone effective against non-opioid overdoses such as benzodiazepines or stimulants?
A: No, it specifically reverses opioid effects only.

Q: What contraindication exists for naloxone administration?
A: Known hypersensitivity/allergy to naloxone (rare); otherwise minimal contraindications.

Q: What should an EMT expect after administering naloxone to an opioid-dependent patient?
A: Possible sudden agitation, combativeness, or withdrawal symptoms as consciousness returns.

Q: How quickly does intranasal naloxone typically take effect?
A: Within 2-5 minutes.

Q: What is the pupil finding classically associated with opioid overdose?
A: Miosis (pinpoint pupils).

Q: What population increasingly carries naloxone for bystander use?
A: Family/friends of opioid users and community members via take-home naloxone programs.

Q: What should an EMT do if the first dose of naloxone does not improve respirations?
A: Continue ventilatory support and administer additional doses per protocol.

Q: What class of drug is naloxone?
A: Opioid antagonist.

Q: Why is naloxone considered very safe even if given when opioids are not actually involved?
A: It has minimal effect/adverse risk in the absence of opioids in the system.

Q: Can naloxone be given IM by auto-injector device?
A: Yes, devices like Evzio deliver IM naloxone.

Q: What should be prioritized in an unresponsive patient with suspected opioid overdose besides naloxone?
A: Airway management and ventilatory support (BVM); naloxone doesn't replace airway care.

Q: What is the purpose of beta blockers, such as metoprolol or atenolol?
A: Treat hypertension, angina, and arrhythmias by blocking beta-adrenergic receptors.

Q: What EMS-relevant effect can beta blockers cause that masks the body's compensatory response to shock?
A: Blunted tachycardic response despite hypotension/shock.

Q: What is the purpose of ACE inhibitors, such as lisinopril or enalapril?
A: Treat hypertension and heart failure by blocking angiotensin-converting enzyme, causing vasodilation.

Q: What common side effect is associated with ACE inhibitors that EMTs should recognize?
A: A persistent dry cough; rarely angioedema.

Q: What is the purpose of statins, such as atorvastatin or simvastatin?
A: Lower cholesterol/LDL to reduce cardiovascular disease risk.

Q: What is the purpose of anticoagulants, such as warfarin, apixaban, or rivaroxaban?
A: Prevent/treat blood clots by inhibiting the clotting cascade.

Q: Why is anticoagulant use critical information for EMTs in trauma patients?
A: Increased bleeding risk, including risk of significant intracranial hemorrhage after head trauma.

Q: What is the purpose of antiplatelet drugs, such as clopidogrel?
A: Prevent platelet aggregation to reduce clot formation, often after cardiac stent placement.

Q: What is the purpose of insulin?
A: Lower blood glucose by facilitating cellular glucose uptake in diabetic patients.

Q: What EMS emergency can result from too much insulin relative to food or activity?
A: Hypoglycemia.

Q: What is the purpose of oral hypoglycemic agents, such as metformin or glipizide?
A: Lower blood glucose in type 2 diabetes management.

Q: What is the purpose of diuretics, such as furosemide (Lasix)?
A: Reduce fluid volume by increasing urine output; used for hypertension and heart failure/pulmonary edema.

Q: What electrolyte imbalance is a concern with diuretic use?
A: Hypokalemia (low potassium).

Q: What is the purpose of chronic bronchodilator inhalers, such as ipratropium or tiotropium?
A: Maintain airway patency in COPD/asthma by relaxing bronchial smooth muscle.

Q: What is the purpose of anticonvulsants, such as phenytoin or levetiracetam?
A: Prevent or control seizures.

Q: What is the purpose of benzodiazepines, such as diazepam or alprazolam, as home medications?
A: Treat anxiety, seizures, or insomnia by enhancing GABA activity as a CNS depressant.

Q: What is a risk of combining opioids and benzodiazepines?
A: Significantly increased risk of respiratory depression.

Q: What is the purpose of antihistamines, such as diphenhydramine?
A: Block histamine receptors to relieve allergic symptoms.

Q: What is the purpose of corticosteroids, such as prednisone?
A: Reduce inflammation; used for asthma/COPD exacerbations, allergic reactions, and autoimmune conditions.

Q: What is the purpose of antidepressants, such as SSRIs like sertraline?
A: Treat depression/anxiety by increasing serotonin availability in the brain.

Q: What EMS concern is associated with tricyclic antidepressant (TCA) overdose?
A: Cardiac dysrhythmias and seizures, a serious toxicological emergency.

Q: What is the purpose of antipsychotic medications, such as risperidone or haloperidol?
A: Manage psychotic symptoms/schizophrenia or severe agitation by blocking dopamine receptors.

Q: What is the purpose of erectile dysfunction medications, such as sildenafil (Viagra), relevant to EMS drug interactions?
A: They potentiate nitrate-induced hypotension, making nitroglycerin administration dangerous if recently used.