NREMT-P Pharmacology Practice Questions (90 Flashcards)

and what is the immediate pharmacological priority?

In patients with reduced cardiac output, heart failure, or hepatic/renal dysfunction, the Lidocaine maintenance infusion should be reduced by half to prevent toxicity. Lidocaine is metabolized by the liver; however, renal failure affects the clearance of metabolites. SIGNS OF TOXICITY: Slurred speech, altered mental status, seizures, and muscle twitching (often referred to as Lido-crazies).

Levetiracetam (Keppra). It is increasingly favored over Phenytoin/Fosphenytoin because it does not cause cardiac dysrhythmias or significant hypotension and requires no specific cardiac monitoring. Typical dose is 60 mg/kg (max ~4500 mg). Exam Tip: If Keppra isn't an option, Fosphenytoin is preferred over Phenytoin due to lower risk of tissue necrosis (Purple Glove Syndrome) and faster infusion rates.

Step 1: Identify volume and time: 100 mL to be infused over 10 minutes. Step 2: Use the flow rate formula: (Total Volume in mL × Drip Set) / Time in minutes. Step 3: Calculation: (100 mL × 10 gtt/mL) / 10 min = 1,000 / 10 = 100 gtt/min. Clinical Pearl: This is the 'loading dose' for stable wide-complex tachycardia. If the patient becomes unstable, stop the infusion and prepare for synchronized cardioversion. NREMT tests your ability to calculate both bolus infusions and maintenance drips (which would be 1 mg/min).

Magnesium Sulfate acts as a calcium channel blocker; it inhibits calcium uptake into bronchial smooth muscle, preventing contraction and promoting relaxation. It also inhibits histamine release from mast cells. **Contraindications:** Heart blocks, shock, or persistent hypotension (due to its vasodilatory effects) and renal failure. **NREMT Tip:** Monitor for signs of toxicity: loss of deep tendon reflexes (DTRs) and respiratory depression. It is a second-line rescue adjunct in severe, life-threatening bronchospasm.