Pharmacology Final Exam Study Guide

1. Opioids act on ________ receptors, predominantly interacting with the ________ receptor. A
synthetic opioid we administer as part of our ADULT analgesia protocol is ________. It has an
adult dose of ________.
a. Opioid, Mu, Fentanyl, 25-75mcg
b. Opioid, Mu, Glucagon, 25-75 mcg
c. Opioid, Foxtrot, Fentanyl, 25-75mcg
d. Toxidrome, Mu, Fentanyl, 25-75mcg
e. All the above

2. Potentiation is: A drug lacking an effect of its own but increases the effect of a second drug.
a. True
b. False
c. Glucagon is the ultimate potentiator

3. You have received an order to give Atropine 0.6mg. The drug is supplied as 1.0mg/10mls. How
much volume (ml) should you administer?
a. 0.6mls
b. 6.0mls
c. 60mls
d. 12mls of Glucagon
e. All the above, all at once.

4. Corticosteroids:
a. Have no place in medicine
b. Bind to cytosolic glucocorticoid receptors to decrease transcription and production of
inflammatory cytokines.
c. Slow conduction through the ventricles, atria and conduction system
d. Commonly used to treat HTN, and T2Diabetes when Glucagon not present
e. All the above

5. Angiotensin converting enzyme (ACE) prevents angiotensin 1 from becoming angiotensin 2 in

the ________. An example of an ACE inhibitor is ________.
a. Kidney, Adenosine
b. Liver, Enalapril
c. Lungs, Metoprolol
d. Lungs, Captopril
e. Brain, Glucagon
6. You notice your ACP partner administer 2.0ml of Fentanyl IV to your patient. The doctor ordered
100mcg to be given. The drug comes supplied at 100mcg/ml. Did your partner give the correct
dose?
a. Yes, that is perfect, some Glucagon should balance this out nicely
b. No, the patient is not breathing, and you have some creative documentation to do

7. Water Follows sodium. What % of sodium is reabsorbed into the blood stream at each site?
a. 20-25% at the Loop of Henle, 5-10% at the Distal Tubule, 3% in Collecting Duct
b. 5-10% at the Loop of Henle, 5-10% in Distal Tubule, 5-10% in Collecting Duct
c. 50% at the Loop of Henle, 25% in the Distal Tubule, 10% in Collecting Duct
d. 100% of Glucagon is reabsorbed in the Collecting Duct

8. Central Chemoreceptors measure PCO2 and PH in the cerebrospinal fluid, and increase
respirations when PCO2 rises and PH decreases?
a. True
b. False
c. Glucagon should solve this problem

9. ________ is a synthetic compound structurally similar to Atropine. It is used as a bronchodilator

in the management of cholinergic mediated bronchospasm associated with COPD?
a. Glucagon
b. Adenosine
c. Ipratropium Bromide (Atrovent)
d. Mucomyst

10. Indications for Fentanyl in your Analgesia directive are:

a. Hypoglycemic and Glucagon is contraindicated
b. Pain
c. “Minor ouchie”
d. “I just need a quick fix and ill sign off, bro”

11. Your sexy Advanced Pharmacology instructor, Prank Fotter, begins teaching you about the
concept of pharmacokinetics. Being the know-it-all student that you are, you don’t listen to a
single word he’s saying because you already know that pharmacokinetics describes how a
specific drug:
a. Is absorbed, distributed, metabolized, eliminated within the body
b. Interacts with various receptors, other drugs, and enzymes within the body
c. Changes from inactive form to active form through the P450 enzyme system
d. Is transported from the pharmaceutical company to the pharmacy where it is sold
e. Is to be administered (i.e. dose, route, frequency)
12. During a heated debate between you and Prank Fotter regarding the preferred use of diltiazem
over adenosine, he begins to complain of palpitations. Being the keen A+ student that you are,
you suspect that he may be suffering from a tachyarrhythmia. According to the current ALS PCS
v4.5, which of the following would NOT be one of your potential treatment modalities:
a. 150mg IV amiodarone over 10 minutes, synchronized cardioversion at 100J
b. Vagal maneuvers, 6mg IV adenosine, 12mg IV adenosine
c. Immediate synchronized cardioversion at 100J
d. Vagal maneuvers, followed by 150mg IV amiodarone over 10 minutes
e. Vagal maneuvers only

13. According to the Vaughan-Williams classification, which of the following groups of

antiarrhythmics are correct?
a. Class V: verapamil, diltiazem, etripamil
b. Class II: sotalol, ibutilide, dofetilide, amiodarone
c. Class IV: adenosine, digoxin
d. Class I: procainamide, quinidine, disopyramide, lidocaine, tocainide, phenytoin
e. Class III: bisoprolol, metoprolol, esmolol, carvedilol

14. Which of the following are used in the maintenance and treatment of asthma?
a. Beta-2 agonists: causes peripheral and hepatic vasodilation, relaxation of uterine
muscle, and dilation of bronchial airways
b. Corticosterioids: inhibits 5-lipoxygenase, blocking degranulation of cortisol, preventing
release of histamine
c. Leukotriene modifiers: directly inhibits production of mucus-causing leukocytes
d. Mast cell inhibitors: bind to cytosolic glucocorticoid receptors, reducing production of
inflammatory cytokines

15. If Prank Fotter’s Advanced Pharmacology course has taught you anything, it is that there are a
variety of street drugs that can cause a specific subset of recognizable signs and symptoms. To
make the course more “interesting”, which class of drugs would you attempt to score that will
produce the following signs and symptoms:
S/sx: involuntary tearing of the eyes, excessive vomiting, explosive diarrhea, uncontrollable
salivation, urinary incontinence, occasional seizure, cold sweats
a. Anticholinergics
b. Cholinergics
c. Sympathomimetics
d. Carcinogenics
e. Hallucinogenics
16. Which of the following is NOT one of the neurotransmitters in the brain?
a. Norepinephrine
b. Dopamine
c. Serotonin
d. Cholinesterase
e. Acetylcholine

17. When administering midazolam, which of the following should be considerations:

a. Sedatives and alcohol use can cause a potentiation effect
b. Sedatives are protein-bound, competing with other drugs for binding sites
c. May potentiate the action of other CNS depressants
d. Both a. and c.
e. All of the above

18. The main classes of anti-depressants in use today, include all except which of the following:
a. MAOI
b. SSRI
c. GHB
d. TCA

19. Your instructor Prank Fotter stumbles into the classroom, slurring his words and appearing
inebriated and intoxicated. He bellows loudly, “here we go again!” - and adds that he feels that
his brain’s GABA activity has been enhanced, and that his CNS activity has been down-regulated.
He also tells you that his sleep patterns have changed, resulting in an increased frequency and
duration of REM sleep. Based on your understanding of Advanced Pharmacology, you suspect
that he has taken:
a. Chloral hydrate
b. Barbiturates
c. Benzodiazepines
d. b) and c) only
e. All the above

20. Fast action potentials are found in _______ tissues, whereas slow action potentials are found in
_______ tissues.
a. Nodal, contractile
b. Contractile, nodal
c. Muscle, adipose
d. Infarcted, non-infarcted
e. Endocardial, epicardial
21. A healthy 40 y/o female, with no meds or allergies, is c/o of heart palpitations, or as she
describes it, being acutely aware of her heart beat. She states that she can feel it predominantly
in the neck and is feeling fatigued and light headed. She states that she has had this before, but
Adenosine didn’t work on the first try. On the cardiac monitor, the rhythm is regular and rapid
with narrow QRS complexes. Pt’s vitals are: P 190 Regular, RR 20, B/P 145/60, SPO2 99%, A/E
Clear, GCS 15, 12 Lead-STEMI NEG, and your partner was able to get an IV in the left AC. Your
treatment for this patient should include:
a. 2 attempts of the Valsalva Manoeuvre and BHP for Cardioversion
b. 150 mg of Amiodarone or 1.5mg/kg of Lidocaine, BHP for Cardioversion if unsuccessful
c. 2 attempts of the Valsalva Manoeuvre followed by 6 mg of Adenosine, and after 2 mins,
12 mg of Adenosine if required
d. Administer 12 mg of Adenosine, because the first dose didn’t work last time

22. A 10 y/o male had a cardiac arrest while playing soccer, you were across the street picking up
your Subway sub when someone ran over to get you. The patient is found to be in a VFIB and
you get a ROSC after 2 shocks. Pt’s vital are: P90, BP 60/40, ETCO2 45 mmHg, SPO2 92%, GCS 3.
You complete your ROSC check list and your partner was able to obtain a second IV access. For
this patient you should initially administer:
a. 300 ml of normal saline fluid bolus (reassessing lung sounds every 100 ml) and a
Dopamine infusion of 11 ml/hr (11 drops/min with a 60 drop set)
b. Normal saline fluid bolus of 300 ml/hr and call BHP for dopamine order, because the
patient is ≤12 years old
c. 600 ml of normal saline fluid bolus (reassessing lung sounds every 100 ml) and a
Dopamine infusion of 11 ml/hr (11 drops/min with a 60 drop set)
d. 300 ml of normal saline fluid bolus (reassessing lung sound every 100 ml) and a
Dopamine infusion of 23 ml/hr or (23 drops/min with a 60 drop set)
e. Normal saline fluid bolus of 300 ml/hr, but no dopamine because the patient is in a
Mechanical Shock State

23. Pt is found in a mall food court in a full body generalized motor seizure. The patient is with his
friends. The friends state that the patient is 16 y/o and they are not sure if he has ever had a
seizure before. They say that he has been convulsing for over 5 mins before you got there and
he has not stopped. You find a medical alert bracelet on the patient’s left wrist which reads: Non
Epileptic Seizure Disorder. NO CODINE. You are unable to obtain patient’s vitals, because he is in
active seizure. Your partner is able to obtain a Blood Sugar of 4.0 mmol. You eye ball the
patient’s weight to be about 60kg. Your treatment for this patient should include:
a. Obtain an IV and administer 12 mg of Midazolam
b. Administer 10 mg of Midazolam IM
c. Administer 6 mg of Midazolam IM
d. Obtain an IV and administer 6 mg of Midazolam
e. BHP for an order for Midazolam as this patient is ≤18 years old
24. 74 y/o male states that he feels too weak to stand. Pt was found sitting in his living room he
appears pale and very lethargic but is responsive and able to answer all questions appropriately.
He denies CP and A/E is clear. Pt’s medical history includes: Osteoarthritis, HTN, and a Heart
Transplant (2013). He doesn’t know the names of his medications, but he states that he is on
anti-rejection meds, anti-hypertensive, and a couple of blood thinners. He is allergic to NSAIDS.
Pt’s vitals: P 27, R 16, B/P 78/51, SPO2 92%, GCS 15.
Pt’s 12 Lead:

Your treatment for this patient should include:

a. Atropine 0.5mg IV x 2 Q5 mins then BHP for Transcutaneous Pacing, Dopamine
5mcg/kg/min, sedation and pain management
b. BHP for Transcutaneous Pacing, Dopamine 5mcg/kg/min sedation and pain
management. Pt is in a 2nd Degree Type II Block
c. Atropine 0.5mg IV, then BHP for Transcutaneous Pacing, Dopamine 5mcg/kg/min,
sedation and pain management
d. BHP for Transcutaneous Pacing, Dopamine 5mcg/kg/min, sedation and pain
management. Pt is in an 3rd Degree Block

25. The pharmacodynamics properties of Adenosine include:

a. It is an endogenous nucleoside found in all cells of the body
b. It slows conduction time throughout the AV node and interrupt AV nodal reentry
pathways
c. It is a potent vasodilator in most vascular beds, it relaxes vascular smooth muscles
through the reduction in calcium uptake by inhibition of slow inward calcium current
d. It has a negative chronotropic, dromotropic, and inotropic effects
e. All of the above
26. Which of the following are true about Leukotrienes:
i. Leukotrienes are released by mast cells, basophils and eosinophils
ii. There are two types of Leukotriene modifiers, they include: Leukotriene –receptor
antagonists and Leukotriene synthesis inhibitors
iii. Intal Inhaler, Gastrocom, and Tilade are common Leukotriene modifiers
iv. The release of leukotrienes causes airway dilation, increased mucus production and
swelling
v. An asthmatic using NSAIDs can cause Aspirin-induced Asthma, which in part is caused by
the increased release of leukotrienes

a. i, ii, iii, iv, v

b. iii, iv, v
c. i, ii, iii, v
d. i, ii, v
e. i, ii, iv, v

27. Which of the following are classifications of Dimenhydrinate:

a. Antiemetic
b. Antivertigo
c. Anticholinergic
d. A & C
e. All of the above

28. Which of the following antibiotics is considered to be the most toxic and likely to cause damage
to the kidneys:
a. Aminoglycosides
b. Fluoroquinolones
c. Sulfonamides
d. Tetracyclines
e. Cephalosporins

29. In which of the following toxidromes would you expect the patient to have mydriasis:
i. Anticholinergic
ii. Cholinergic
iii. Opioid
iv. Sympathomimetic
v. Sedative-Hypnotic

a. ii, iii
b. i, iv
c. i, iii, v
d. ii, iv, v
30. The mechanism of action of Metformin (Biguanides) is best described as:
a. lowering blood glucose by stimulating the beta cells of the pancreas to release insulin
b. lowering blood sugar levels by delaying the digestion of carbohydrates and the
absorption of carbohydrates in the intestines
c. reducing the hepatic glucose production and increasing insulin sensitivity in muscle and
fat cells
d. increasing blood glucose by converting stored glycogen into glucose

31. Opiates have the greatest affinity for which opioid receptor?
a. Mu
b. Delta
c. Kappa
d. Gabba

32. Benzodiazepines are an effective treatment for seizures; an example of a benzodiazepine would
be….
a. Haldol
b. Riatlin
c. Symbicort
d. Lorazepam
e. Ephedrine

33. Increased levels of nor-epinephrine, serotonin and dopamine in the brain cause an increase in…
a. Aggression
b. Fat storage
c. Mood
d. Depression

34. Proton pump inhibitors (PPI’s) are a medication class that inhibits…
a. Sodium (Na+) reuptake in the kidneys
b. Angiotensin 2 formation
c. Gastric motility
d. Stomach acid production

35. The Vaughn-Williams classifications are used to categorize …

a. The severity/ degree of congestive heart failure (CHF)
b. The percentage of necrosis following an myocardial infarction (MI)
c. The classifications of hypertension medications
d. The classes of anti-arrhythmic medications
36. Magnesium Sulfate (MgSO4) is a medication used in hospitals for a variety of reasons, one of
those reasons would be to treat persistent…
a. Priaprism
b. Increased cranial pressure (ICP)
c. Severe asthma exacerbations not responsive to traditional therapies
d. Prolonged cardiac arrest with asystole rhythms

37. Pitocin reduces uttering hemorrhage by sustaining…

a. Uterine contractions
b. Mean arterial pressure (MAP)
c. Lower than normal levels of lysine
d. International Normalized Ratio (INR) values

38. Addiction is only a psychological dependence that individuals may misinterpret as a physical
dependence.
a. True
b. False

39. A tricyclic anti-depressant overdose may present with…

a. Unilateral pupil dilation
b. Decreasing heart rate leading to asystole
c. Increased QT interval
d. Hypernatremia

40. Cephalosporins are classified by…

a. Potency
b. Generation
c. Size
d. Order of discovery/ production

41. You treat a patient in Ventricular Tachycardia with Lidocaine which you know is an
antiarrhythmic that works by:
a. Increasing contractility, systolic pressure and slows impulses from the SA node
b. Decreasing SA and AV node automaticity
c. Decreasing the action potential by shortening depolarization
d. Increases potassium efflux during the depolarization

42. You are called to a 25 year old male overdose. The patient tells you that he does not know what
he took. He presents with dilated pupils, flushed skin, warm and dry skin and he seems to begin
hallucinating. Based off his presentation you suspect he overdosed on:
a. Tricyclic Antidepressants
b. Mushrooms
c. Oxycodone
d. Benzodiazepines
43. All myocardial cells have characteristics of automaticity which means:
a. Electrical charge difference across a cell membrane when in a resting state
b. Cells ability to depolarize spontaneously without external stimuli
c. The ability to love everyone
d. They are created to send signals as directed from pacemaker cells

44. The absolute refractory period is:

a. The period when cells can be stimulated by any strength of stimuli
b. The period when cells are vulnerable and can generate cycle from strong stimuli
c. The period when any stimuli would cause V-Tach or V-Fib
d. The period when membrane cells are insensitive to all stimuli regardless of strength

45. Central chemoreceptors measure:

a. PCO2 and pH in cerebrospinal fluid and increase respirations when PCO2 rises or pH falls
b. PO2 in arterial blood and decrease respirations when PO2 <60 mmHg
c. PO2 in venous blood and decrease respirations when PCO2 falls or pH increases
d. Carbonic acid and bicarbonate ion concentrations

46. Enteral medications have the following properties except for:

a. Given orally or rectally
b. Pass through the liver before being distributed throughout the body
c. Injectable medications given intravenous
d. Are absorbed through the GI tract

47. Synergism is how:

a. Drugs and receptors have some degree of chemical attraction toward one another
b. A drug produces the desired effects upon binding with a receptor
c. A drug is transported though the bloodstream to tissues and target sites
d. Effects of two medications when given concurrently are greater than the effects of
medications given individually

48. You find a 15 month old 10kg baby boy unresponsive. You determine the patient’s blood glucose
level was 2.4mmol/L. The correct treatment would be:
a. 20ml of 2ml/kg of D25W
b. 10ml of 1ml/kg of D50W
c. 20ml of 2ml/kg of D10W
d. 10ml of 2ml/kg of D25W
49. You know pitocin is used to control postpartum hemorrhage. The synthetic oxytocin is
administered when:
a. As soon as the patient begins labour
b. Once the patient is fully dilated prior to baby delivery
c. Once the baby is delivered prior to placenta delivery
d. Once the baby and placenta are fully delivered

50. After a long night of drinking, you want to sober up remember a classmate recommending
cocaine. The stimulant will produce the following effects except for:
a. Sense of enhanced energy and alertness
b. Euphoria
c. Disinhibition and amnesia
d. Hyperactivity

51. What sedative/hypnotic classified medication taken in severe overdoses can mimic brain death?
a. Zopiclone
b. Gamma Hydroxybutyrate (GHB)
c. Baclofen
d. Paraldehyde

52. Mast Cell inhibitors/stabilizers work by:

a. Block mast cell degranulation which stabilizes the cell and prevents further release of
histamine and related materials
b. Blocks muscarine cholinergic receptors without specificity for sub-types, resulting in a
decrease in the formation of cGMP
c. Prevents synthesis of leukotrines by blocking the enzyme 5-lipoxygenase
d. Bind to mast cell receptors and decrease transcription and production of inflammatory
cytokines

53. At what stage on a fast action potential diagram represents a Potassium and Calcium Efflux from
the cell?
a. 1
b. 2
c. 3
d. 4
54. Which of the following drugs would be labeled with a letter “C” on the container to indicate a
controlled substance?
1) Amphetamines
2) Sympathomimetics
3) Anabolic Steroids
4) Corticosteriods

a. 1,2
b. 2,3
c. 1,3,4
d. 1,3

55. In what instances as a paramedic would you decide not to administer Sodium Bicarbonate in the
field?
a. Crush Injuries
b. VSA with extended down times
c. VSA with Suspected extracellular alkalosis from pre-existing medical conditions
d. Tricyclic Antidepressants

56. Which classifications of drugs are used to treat Depression?

1) MAOI’S (Monoamine Oxidase Inhibitors)
2) Norepinephrine Reuptake amplifier
3) MCA’S (Monocyclic anti-depressants)
4) SSRI’S (Selective Serotonin Reuptake Inhibitors)

a. 1,3,4
b. 4
c. 3,4
d. 1,4

57. The Goal of Anit-infective drugs is to eliminate pathogens through:

a. Bactericidal and Bacteriostatic actions
b. Replication of T3 amino acids leading to cell death
c. Increase white blood cell factors with increased proteins to fight the infection
d. Syntheses of IgE mediated responses to fight the infection

58. At what point are Potassium Sparing Diuretics reabsorbed in the kidneys?
a. Loop of Henle
b. Distal Tubles
c. Collecting Ducts
d. Thick ascending limb
59. First Order Kinetics occurs in all routes of drug administration except:
a. Oral administration
b. Intra-muscular (IM) administration
c. Intravenous (IV) administration
d. Topical Administration

60. From the exert below from the beloved children’s poem the night before cheque day, which
treatment would be most appropriate to provide to this patient?

Twas the night before cheque day and all through the town,
All the creatures were stirring,
Ready to throw down,
The street mom in her mumu and me without shoes,
Had just settled down for a long herion snooze,
She steadied her spoon,
She dare not slosh,
As it was her turn for 2 points and a wash

And to the awe of tax payers should appear,

A ladder truck with 5 in full bunker gear
But your driver bitter and hungry,
Yelled from the window,
Don’t bring the hose,
there is no fire here
He was once nice, he was once polite,
But this was his fourth overdose tonight

a. Narcan 0.8 mg IV- slam it like Lebron James

b. Aggressive airway management with immediate tactile intubation and further
medications down the tube
c. Have Fire maintain the airway knowing they are competent well trained medical
professionals
d. Narcan IV slow push, until the patient start to breath on their own, up to 0.4mg

61. You are treating a patient in SVT. You have already performed valsava maneuver and 1 single
dose of 6mg of adenosine. Your patient appears to still be in an SVT and vitals are HR - 189bpm
BP – 101/69, SPO2 – 94%, GCS – 15. Your next course of treatment should be…
a. 6mg of adenosine
b. Patch BHP for synchronized cardioversion
c. 12mg of adenosine
d. Repeat valsava maneuver followed by 6mg of adenosine
62. A 9 y/o VSA patient in VFIB should receive what initial dose of amiodarone?
a. 150mg
b. 300mg
c. 140mg
d. 70mg

63. You have a 90kg STEMI patient that is hypotensive, proper treatment would be…
a. 900ml of 0.9% of NaCl fluid bolus, 30gtts/min of dopamine.
b. 900ml of 0.9% of NaCl fluid bolus, 38gtts/min of dopamine.
c. 900ml of 0.9% of NaCl fluid bolus, 34gtts/min of dopamine.
d. 900ml of 0.9% of NaCl fluid bolus, 32gtts/min of dopamine.

64. A fine young man named Mitchel was spending his Sunday afternoon doing his favorite activity,
which was watching some NASCAR and listening some Nickleback… with some cocaine. Due to a
series of misfortunate events Mitchel is now in the streets in a rage trying to flip parked vehicles
and attempting to stop traffic. PD calls you to scene, on arrival you find the patient being
restrained by 4 officers that are struggling to keep him apprehended. You suspect excited
delirium and patch BHP and get the order for ketamine. What dose should you proceed with if
the patient is approximately 80kg?
a. All aboard the KETAMINE TRAIN! 500mg with a repeated dose.
b. 300mg IM
c. 400mg IM
d. 200mg IM

65. You would like to provide analgesia for a 7 y/o patient with deformity of his R femur appropriate
course of treatment would be.
a. 2.4mg of morphine IV
b. 1.2mg of morphine IV
c. BHP patch, 24mcg of fentanyl
d. BHP patch, 2-10mg of morphine

66. How is calcium used to treat hyperkalemia?

a. Calcium lowers the serum potassium levels by shifting potassium back into the cell.
b. Calcium inhibits the sodium potassium pump.
c. It does this by increasing the Ca levels, which raises the threshold potential to shift
to less negative value and the myocardium becomes less excitable to
depolarization.
d. Calcium has negative chronotropic effects

67. How is Calcium properly administered?

a. Rapid IV push followed by NS flush.
b. 30 minute IV infusion
c. 2-3 minute IV infusion
d. 10 minute IV infusion
68. What drug classification is adenosine?
a. Antiarrhythmic
b. Anticholinergic
c. b&d
d. Antimuscurinic

69. Midazolam is classified as…

a. Sedative-hypnotic
b. CNS depressant
c. a,b,d
d. Short acting benzodiazepine

70. When co-administering midazolam with other drugs, what group of dugs should it be considered
that synergistic effects could take place?
a. Sympathomimetic
b. Antihistamines
c. Narcotics
d. Anticholinergic

71. Ketamine is considered a “dissociative anaesthetic” because:

a. It produces a cataleptic state
b. It is a potent antidepressant
c. It can cause dissociative identity disorder
d. It produces effects similar to alcohol intoxication
72. You are called code 4 to an alley in downtown Barrie for an overdose. As you arrive to the scene
you are met by a firefighter stating that the patient is a 25yom whom is semi-conscious. The
firefighter proudly tells you that they gave the patient 4mg of Naloxone IN, however, he is
confused as to why the patient has not responded. A friend of the patient tells you that the
patient has a history of using “Special K” to get high. You know that the Narcan given to the
patient will not reverse this overdose because:

i. The patient obviously took too much Ketamine, and 4mg is too small a dose
ii. Ketamine blocks the NMDA receptor
iii. Ketamine’s anaesthetic effects are due to its action on the Kappa and Zeta
opiate receptors, and Naloxone only acts on the Delta and Mu opiate receptors
iv. Narcan IN requires mechanical ventilation to make it work and the FD is not
bagging the patient
v. Naloxone has no effect on glutamate receptors of any type
vi. Ketamine is the only opiate that does not respond to Naloxone

a. i, iii, v, vi
b. ii, iii, v
c. ii only
d. ii, v
e. All of the above

73. You are called code 4 to an unconscious patient. When you arrive scene a firefighter tells you
that your patient is a 45yof whom ingested an entire bottle of meperidine and is breathing at a
rate of 4 breaths per minute. After establishing an IV, you ask your partner to draw up 0.4mg of
narcan. The fire captain laughs at you and tells you that this obviously isn’t an opiate overdose
because the patients pupils are not pinpoint. Why do we know that the fire captain is wrong?
a. Meperidine is not an opiate, but it has opiate-like effects
b. Meperidine does not cause miosis because it is a synthetic opiate
c. Meperidine does not cause miosis because of its anticholinergic properties
d. The patient also ingested cocaine

74. You and Frank respond code 4 to a residence for a 6yof who mistakenly ingested 100mg of her
mother's Nortriptyline medication. The child appears lethargic, but becomes significantly
frightened by Frank’s creepy Mo-vember mustache. You decide to take the call from Frank to
spare the child the trauma. What treatment options do we have within our scope to help this
patient?
a. Calcium Gluconate 1g IV over 2-3 minutes
b. Sodium Bicarbonate IV
c. 10cc/kg 0.9% NS IV fluid bolus
d. Ask dispatch if a more experienced ACP is available
75. A patient who has overdosed on amitriptyline may have which ECG findings?
a. Tachycardia, Long QT interval, and wide QRS
b. ST-segment elevation in all leads
c. Left axis deviation
d. Sinus Bradycardia

76. Which oral diabetic medications have the ability to precipitate Euglycemic Diabetic
Ketoacidosis?
a. Biguanides
b. DPP-4 inhibitors
c. Sulfonylureas
d. SGLT2 Inhibitors

77. Dipyridamole inhibits the cellular reuptake of adenosine into cells, thereby increasing the
extracellular concentrations. This is why adenosine administration is contraindicated in patients
using Dipyridamole.
a. True
b. False

78. As per our current seizure medical directive, which would be the preferential treatment for a 4
year old in active seizure with no IV access?
a. 3.6mg Midazolam IN
b. 2.8mg Midazolam IM
c. 3.6mg Midazolam Buccal
d. 1.8mg Midazolam IN
e. 3.6mg Midazolam IM

79. When assessing a patient with toxidromic effects, how can we differentiate between an
anticholinergic toxidrome, and a sympathomimetic toxidrome?
a. Play them the movie I Am Legend. Patient’s experiencing a sympathomimetic
overdose tend to show more sympathy when Will Smith’s dog dies
b. Assess their skin condition; patients with an anticholinergic toxidrome will have very
dry skin (“DRY AS A BONE”), and sympathomimetic toxidromes will be diaphoretic.
c. Ask them what they took
d. It doesn’t matter, let the hospital deal with it.
e. Anticholinergic overdoses tend to have pinpoint pupils, and sympathomimetic
overdoses tend to have fixed a blown pupils.

80. When administering Midazolam for a combative or agitated patient, you must always patch to a
Base Hospital Physician, even if you are able to assess for reversible causes.
a. True
b. False
81. What drug class is Ketamine?
a. dissociative anesthetic
b. GABA receptor agonist
c. NSAID
d. Narcotic

82. Being a patient advocate, what would be the most appropriate pain management option for the
multisystem trauma patient in severe pain who is conscious and alert but hemodynamically
unstable?
a. Morphine, patch first
b. Fentanyl, patch first
c. Ketorolac, patch first
d. None, honey badger don’t give a shit!

83. Your 18 y/o male patient has just admitted to consuming a bottle of pesticides in a suicide
attempt. What toxidrome would you expect to see as the call continues?
a. Sympathomimetic
b. Cholinergic
c. Anticholinergic
d. Sedative/hypnotic

84. Continuing the call above, while on route to the hospital his condition deteriorates and his LOA
decreases. You’re a pretty savy medic, so you patch to BHP to get an order to give which
medication?
a. Midazolam
b. Amiodarone
c. Epinephrine
d. Atropine

85. At what dose will Dopamine produce its Alpha effects?

a. Low dose
b. Medium dose
c. High dose
d. Dopamine doesn’t cause Alpha effects

86. What etiology of SVT is the least likely to successfully convert with adenosine/cardioversion?
a. Pre-excitation syndromes (WPW)
b. AV nodal Re-entry
c. Idiopathic
d. Cocaine induced
87. Which opioid does not cause miosis?
a. Demerol
b. Dilaudid
c. Percocet
d. Morphine

88. Why is Lasix not the best front-line medication to use in the management of acute cardiogenic
pulmonary edema?
a. It causes vasoconstriction
b. It can’t be given in patients with kidney dysfunction
c. It’s not the fastest acting drug to reduce volume overload
d. It is the best - we should be using it first

89. Your 58 y/o female patient was involved in a vehicle fire and has 2nd and 3rd degree burns to
approximately 40% of her body. Initially she is GCS 5, no stertorous respirations but has audible
stridor. Vitals are RR: 30, SpO2: 100%, HR: 144, BP: 162/101. What airway management option
would be most appropriate?
a. Intubation
b. Supraglottic airway
c. OPA
d. No airway adjunct required – patient is protecting her airway

90. While on route to hospital with the above-mentioned burn patient your PCP partner asks why
you are drawing up narcotics to give to the patient. What would be the most appropriate
answer?
a. Because narcotics are fun
b. Because I want to keep the patient sedated
c. Because I want to treat her pain
d. I don’t really know… good catch, I’ll put this away

91. What is not a part of pharmacokinetics?

a. Absorption
b. Distribution
c. Oxygenation
d. Metabolism
e. Excretion

92. What are the routes of medication administration ranked from fastest to slowest?
a. Intravenous, Oral, Intramuscular, Subcutaneous
b. Intramuscular, Intravenous, Subcutaneous, Oral
c. Intravenous, Intramuscular, Subcutaneous, Oral
d. Intramuscular, Oral, Intravenous, Subcutaneous
e. Subcutaneous, Intravenous, Intramuscular, Oral
93. What is the therapeutic index of a drug?
a. The measure of the drug’s safety margin
b. Where in the drug guide you would find the drug listed
c. The amount of drug required to produce an effect
d. A list of other medications that the drug interacts with
e. A list of possible side effects of the drug

94. How would you make 10 mL of D10W solution from a D50W preload?
a. Draw up 1 mL of D50W and 9 mL of normal saline
b. Draw up 2 mL of D50W and 8 mL of normal saline
c. Draw up 2 mL of D50W and 8 mL of Ringers Lactate
d. Draw up 1 mL of D50W and 9 ML of Ringers Lactate
e. You don’t, we only administer D50W and D25W

95. Which of these medications would be used to treat asthma?

1) Salbutamol (Ventolin)
2) Fluticasone (Flovent)
3) Tamsulosin (Flomax)
4) Montelukast (Singulair)
5) Ipratropium bromide (Atrovent)
a. 1 & 2 Only
b. 1, 2, 3, 5
c. 1, 2, 4, 5
d. 1, 2, 3, 4
e. All of the above

96. What medication may be given to control postpartum hemorrhage?

a. Vitamin B12
b. Folic Acid
c. Pitocin
d. Plavix
e. Naproxen

97. What medication is considered the “Gold Standard” for benzodiazepines?

a. Diazepam (Valium)
b. Lorazepam (Ativan)
c. Alprazolam (Xanax)
d. Clonazepam (Klonopin)
e. Triazolam (Halcion)

98. Which drug class is not used to treat bacterial infections?

a. Penicillins
b. Cephalosporins
c. Sulfonamides
d. Methaqualones
e. Macrolides
99. What is the street name given to the sedative-hypnotic mixture of chloral hydrate and alcohol?
a. Mickey Mouse
b. Finn McCool
c. Micky Finn
d. Donald Duck
e. Filthy McNasty

100. What is the most likely working diagnosis for a 26 year old female who is complaining of 6/10
burning chest pain, that began after her third cup of coffee of the morning, before her final
exam. Pain is worse with coughing, and when she lies down, and moves with swallowing. Pt skin
is pink, warm, and dry. No previous medical history. Afebrile. 12 lead is unremarkable.
a. Pericarditis
b. Acute Myocardial Infarction
c. Gastroesophageal Reflux Disorder
d. Costochondritis
e. Esophageal Varices

101. Lidocaine while being a local anaesthetic, is also classified as what subclass of sodium channel
blockers?
a. Class 1c
b. Class 1a
c. Class 1b
d. Class 1d

102. Pirenzepine is a medication used to reduce gastric acid secretions. Which muscarinic receptor
dies this medication act on?
a. M3
b. M1
c. M2
d. None of the above

103. Which diabetic medication uses the renal system as its primary method of glucose excretion?
a. Metformin
b. Glyburide
c. Avandia
d. Canagliflozin

104. You arrive on scene to a patent who is very agitated, hypotensive, tachycardic, and seems to be
having serious muscle twitches. You notice a bottle of Amoxapine on the floor next to the
patient. Being a smart ACP you hook up your 12 lead and expect to see what?
a. Lengthened QT
b. ST elevation
c. Shortened QT
d. ST depression
105. Drugs that act of GABA receptors are classified as
a. Sympathomimetics
b. Benzodiazepines
c. Anticholinergics
d. Barbiturates
e. B and D

106. Magnesium Sulphate is contraindicated in which obstetrical patients?

a. Patients with breast implants
b. Patients with nocturia
c. Patients with myasthenia gravis
d. Patients with hyperhidrosis

107. H2 Agonists are used to treat GERD, ulcers and other gastrointestinal hypersecretory
conditions.
a. True
b. False

108. Pitocin is a synthetic oxytocin which is used to:

a. Depress central nervous system
b. Stimulate lactation
c. Stimulate uterine smooth muscle contractions
d. Release digestive enzymes from the pancreas

109. You are called CODE 4 to a residence where a 9 year old boy is febrile, altered, experiencing
tachycardia. When asked if he has any past medical history the mother states “some sort of
adrenal problem” as she hands you a bottle of hydrocortisone. What is the correct dose for this
patient?
a. 60 mg IM
b. 50 mg IM
c. 56 mg IM
d. 28 mg IV

110. SSRI’s are typically prescribed for anxiety disorders, panic disorders, eating disorders, and OCD.
What other uses have SSRI’s been used for?
a. Menopause, Impotence
b. Premature ejaculation, IBS
c. Seizures, Hypertension
d. Hemorrhoids, Dysarthria
111. What type of drug is Tenecteplase
a. Anti fibrinolytic
b. Antiplatelet
c. Antihistamine
d. Antipyretic

112. In the cardiac fast potential cycle what phase has the fast influx on Na+.
a. Phase 0
b. Phase 1
c. Phase 3
d. Phase 4

113. Dimenhydrinate classification are:

a. Antiemetic
b. Antivertigo
c. Antihistamine
d. Anticholinergic
e. All of the above

114. Dopamine given at 10-20mcg have what effects

a. Alpha
b. Beta
c. Delta
d. Charlie

115. A 50 year old patient who weighs 80kg is in cardiogenic shock and needs dopamine. What is the
dosage for this patient starting at 5mcg/kg/min with a single strength bag.
a. 30 drips/min
b. 25drips/min
c. 35drips/min
d. 40drips/min

116. A 30 year old patient was being very aggressive on paramedics arrival and were called by police.
Justin Bishop arrived on scene and called BHP for ketamine. Justin got the approval and noticed
pt weighed approximately 80kg. What is the dosage?
a. 500mg
b. 400mg
c. 450mg
d. 350mg
117. What class of drugs need to be bought through a pharmacy with a prescription?
a. Class 1
b. Class 2
c. Class 3
d. Class 4

118. In an asthmatic attack what phase is leukotrienes released:

a. Immediate phase
b. Intermediate phase
c. Late phase

119. Chronic bronchitis etiology usually presents as except for:

a. Pink puffer
b. Typical patient is overweight
c. 2:1 ratio females to males
d. Commonly associated with emphysema

120. The onset for lidocaine is :

a. 2 minutes
b. 4 minutes
c. 6 minutes
d. 8 minutes

121. Atropine works by:

a. activating the muscrinic and nicotinic receptors similar to acetycholine
b. competitively inhibiting muscrinic and nicotinic receptors from acetycholine
c. activating alpha and beta cells
d. inhibiting alpha and beta cells

122. The initial dose of atropine is can be:

a. 0.5 mg IV
b. 0.5 mg IM
c. 0.5 G IV
d. 0.5 mg ETT

123. Atropine can be given to 3rd degree heart blocks and 2nd degree II, but may not be as effective
unless the block is high in the AV node (indicated by a narrow QRS)
a. TRUE
b. False
124. Gravol is classes as a:
a. antimetic
b. antivertigo
c. anti-motion sickness
d. all of the above

125. Drugs commonly used in for date rape include:

a. rophynol
b. gamma hydoxybutrate
c. epinephrine
d. all of the above
e. A and B

126. Amiodarone is
a. used in v-tact or v-fib
b. class 3 antiarrhythmic
c. given as 300 mg then 150 mg in cardiac arrest
d. all of the above

127. Corticosteroids, mast cell inhibitors, beta adrenergic drugs, anti-cholinergics can all be used to
treat
a. chest pain
b. asthma
c. HTN
d. high cholesterol

128. salivation, bronchoconstriction, diaphoresis, constricted pupils can be seen with

a. opiod OD
b. cholinergic crisis
c. date rape drugs
d. all of the above

129. Lidocaine is given pre-intubation because it

a. slows down heart conductions so the patient doesn't get too excited
b. blocks the nerve signals at the throat to prevent gag-reflex
c. reduce ICP
d. a and b

130. penicillin kills bacteria by

a. kill bacteria by disrupting their cell wall
b. causing bacteria to lysis themselves
c. stimulate the immune system
d. act as a placebo
131. An example of a long-acting barbiturate is:
a. Amytal
b. Penthathiol
c. Phenobarbital
d. Alcohol
e. Tangerine Dream pre-roll

132. While titrating your dopamine drip to reach it’s desired effect for the patient you just ROSC’ed,
you recall that beta effects are achieved when a rate of 5-10 mcg/kg/min is delivered, and alpha
effects are achieved when a rate of 10-20 mcg/kg/min is delivered. You sigh with relief,
remembering your pharmacology instructor was:
a. Vaughan Williams
b. Pank Frotter
c. Frank Potter
d. Stank Hotter
e. Walter White

133. Dimenhydrinate is classified as an antihistamine, anticholinergic, antimotion sickness and

antivertigo medication, in addition to it’s primary use as an:
a. Analgesic
b. BLS sedation medication
c. Antiemetic
d. Anticonvulsant
e. Antiarrythmic

134. In a casual, workplace-appropriate discussion about refractory periods, you explain to your
coworkers that you were only aware that the heart is incapable of generating another response
during its absolute refractory period. This only lasts for ________, which invariably you thought
was a larger amount of time.
a. 2.5 – 3.5 seconds
b. Exactly 1 second
c. 0.25 – 0.30 seconds
d. 0.0025 – 0.0030 seconds
e. 5 mcg/kg/min
135. Diazepam is an anticonvulsant given to treat prolonged seizures. You remember from school an
anecdote recounting a patient with status seizures, an elevator and gross indecency. This always
brings to mind an image of Chris Farley recounting a well-repeated line. You are thankful for
protocol updates. Diazepam is a longer lasting sedative than midazolam, and along with all
benzodiazepines it is metabolized by the:
a. Lungs
b. Kidneys
c. Liver
d. Vallecula
e. Rectum

136. While backing up an ambulance from a neighbouring service, you notice they equip Lidocaine on
their trucks. You remember this medication, which does not come in burgundy packaging,
belongs to the following class:
a. Class III
b. Remedial Class
c. Class Ib
d. The Last Class
e. Stay Classy, San Diego

137. While on an extended offload delay, being the proactive paramedic you are, you decide
to review your protocols. While waiting the remainder of your shift for the Ontario Paramedic
Clinical Guide app to finish downloading the latest images for offline viewing so that you may
begin to view the protocols, your patient asks if they can take their corticosteroid inhaler. They
present you with their medications, including a number of inhalers. Examples of corticosteroid
inhalers include:
a. Ventolin, Salvent, Albuterol
b. Ipatropium Bromide, Atrovent, Combivent
c. Flovent, Pulmicort, Qvar
d. Singulair, Zyflo, Accolate
e. Intal, Gastrocom, Tilade

138. A well known narcotic user in the community you provide paramedic services to has found to
have suffered a suspected overdose. Upon giving the patient a dosage of naloxone, titrated to
effect, the patient’s condition improves and he is transported to hospital. Your partner,
impressed with your quick thinking, asks why the patient did not have pinpoint pupils. An opioid
that does not cause miosis is:
a. Heroin
b. Percodan
c. Demerol
d. Codeine
e. Morphine
139. While attempting to finish your McDonald’s french fries while your partner completes
documentation, a local urban adventurer approaches you with an offer to exchange goods for
services. You decline their offer, as you do not engage in such commercial transactions, and are
confused at the relative value of salted potato in this community. Your partner states you made
a very good decision as this person likely had Rocky Mountain Spotted Fever. If your partner’s
roadside diagnosis is correct, this person should be treated with:
a. Penicillin
b. Cephalosporin
c. Tetracycline
d. Fluoroquinolones
e. Sulfonamides

140. You attend a residence for a patient who has attempted suicide by overdosing on their
medication. Your partner is able to locate an empty bottle of Elavil, which you immediately
recognize as a TCA. You know one drug you carry may help block the drug’s effect on the heart
and conduction system. As a result, while completing your assessment and treatments, you
patch to base hospital in an attempt to get an order for:
a. Calcium Gluconate
b. Nebulized ASA
c. Sodium Bicarbonate
d. Magnesium Sulfate
e. Needle cricothyroidotomy