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TCDHA PHARM MIDTERM EXAM 2026
- The study of natural drug sources that has been expanded to include chemicals developed and used in laboratory research most correctly describes: A) Pharmacology. B) Pharmacodynamics. C) Pharmacognosy. D) Pharmacokinetics. - ANSWER - Answer: C Explanation: A) Pharmacology is the study of drugs and their actions on the body. B) Pharmacodynamics refers to the mechanisms by which medications produce biochemical or physiological changes in the body. C) Study of natural drug sources that has been expanded to include chemicals developed and used in lab research. D) The study of how medications enter the body, reach their site of action and eventually become eliminated. Page Ref: 2
- Atropine is a powerful organic alkaloid that reacts with acid to form a salt that is readily soluble in body fluids. From which of the following sources is atropine derived? A) Plant B) Animal C) Mineral D) Synthetic - ANSWER - Answer: A Explanation: A) Atropine is developed from the plant Atropa belladonna. B) Animal sources are extracted from the body fluids of animals. C) Mineral sources provide inorganic material not available from plants or animals. D) Synthetic sources are created in the lab using processes such as recombinant DNA. They may be used in combination with natural sources. Page Ref: 3
- Examples of synthetically produced medications include: A) Diazepam, fentanyl, and adenosine. B) Pepsin, pancreatin, and oxytocin.
C) Atropine, morphine, and digitalis. D) Magnesium, sodium bicarbonate, and calcium chloride. - ANSWER - Answer: A Explanation: A) Diazepam, fentanyl, and adenosine are all produced synthetically. B) Pepsin, pancreatin, and oxytocin are derived from animal sources. C) Atropine, morphine, and digitalis are identified as plant sources. D) Magnesium, sodium bicarbonate, and calcium chloride are identified as mineral sources of drugs. Page Ref: 3
- In order to obtain the MOST current information related to a medication, it is suggested that the prehospital provider: A) Use only local protocol as your source. B) Use multiple sources and compare information in conjunction with medical direction. C) Rely on an EMS guide as the sole source of information. D) Utilize the internet as a resource because it is most correct. - ANSWER - Answer: B Explanation: A) Local protocols may not encompass the many medications currently available. B) Using multiple sources as well as comparing information will provide the provider with the most current information. Medical direction is also imperative. C) While EMS guides may provide some information, they may not include all relevant information. D) Internet sources are sometimes difficult to determine validity of information present and should be verified. Page Ref: 4, 5
- The phase of drug testing that includes determining toxicity, pharmacokinetics, and determining a drug's "therapeutic index" occurs during: A) Postmarketing surveillance. B) New drug application. C) Clinical research and development. D) Preclinical testing, research, and development. - ANSWER - Answer: D
- The phase of drug testing that determines the pharmacokinetics, toxicity, and safe dose in humans is: A) Phase one. B) Phase two. C) Phase three. D) Phase four. - ANSWER - Answer: A Explanation: A) The primary purpose of phase one testing is to determine the pharmacokinetics, toxicity, and safe dose in humans. B) The primary purpose of phase two testing is to find the therapeutic medication level and watch carefully for toxic and side effects. C) The primary purpose of phase three testing is to refine the usual therapeutic dose and to collect relevant data on side effects. D) The primary purpose of phase four testing involves postmarketing analysis during conditional approval. Page Ref: 9
- An example of a drug that may receive expedited medical approval would be: A) A drug used to treat a rare disease that affects less than 200,000 people. B) A placebo that is administered to provide psychological control of responses. C) A drug that may help prevent a public health threat such as HIV. D) A drug that is being evaluated in order to determine the therapeutic index. - ANSWER - Answer: C Explanation: A) This Answer describes the definition of an orphan drug. B) A placebo is used in testing and does not require expedited medical approval. C) Expedited approval may be granted when a drug may be of use in treating a public health threat such as HIV. D) The therapeutic index is obtained during preclinical phase of drug testing and does not require expedited approval. Page Ref: 10
- A drug in which potential tax credits or grants may provide incentives to assist in the research and development for a condition
that affects a very small portion of the general population is known as a/an ________. A) Orphan drug B) Expedited drug C) Investigational new drug D) Phase 1 drug - ANSWER - Answer: A Explanation: A) A company may receive incentives to encourage research and development of a drug that is meant for a small percentage of the general population. B) An expedited drug is a drug that moves quickly through the normal phases of human testing when that drug may help in the prevention of a public health crisis. C) A drug gains the status of investigational new drug when it has completed its preclinical testing phase and is ready for human testing. D) Phase one refers to a drug testing and approval phase. Page Ref: 10
- The FDA may require the manufacture of a drug to post a prominent "black box" warning when: A) The drug receives IND status (Investigational new drug). B) Following phase one human testing. C) Unlabeled uses of the drug occur. D) A problem may arise that may lead to death or severe injury if the medication is used. - ANSWER - Answer: D Explanation: A) A drug gains the status of investigational new drug when it has completed its preclinical testing phase and is ready for human testing. B) The primary purpose of phase one testing is to determine the pharmacokinetics, toxicity, and safe dose in humans. C) Unlabeled uses of a drug may occur when a physician or group of peers determines that a drug that has indications for one disorder inadvertently is beneficial for another disorder that it was not given an indication for during the human testing phases. D) The FDA requires a prominent "black box" warning when the use of a prescribed drug may lead to death or injury as a result of its use. Page Ref: 11
Drug, and Cosmetic Act required a statement that accurately described a package's content. C) Established the FDA and prohibited the sale of medicinal preparations that had little or no use and restricted the sale of drugs with a potential of abuse. It was not as all-encompassing as its originators envisioned. D) The Kefauer-Harris Amendment was an amendment to the Federal Food, Drug, and Cosmetic Act that required pharmaceutical manufacturers to provide proof of the safety and effectiveness of their drugs. Page Ref: 13
- Which of the following is TRUE of the Comprehensive Drug Abuse Prevention and Control Act of 1970? A) It required labeling of all medications. B) It required that manufactures provide proof of safety and effectiveness prior to production. C) Controlled import, manufacture, and sale of the opium plant and derivatives. D) Provided classifications of drugs into five different categories or "schedules." - ANSWER - Answer: D Explanation: A) Labeling of medications was required by the Federal Food, Drug, and Cosmetic Act. B) The Kefauer-Harris Amendment was an addition to the Federal Food, Drug, and Cosmetic Act. C) The Harrison Narcotic Act of 1914 regulated the importation, manufacture, and sale of the opium and its derivatives. D) The Controlled Substances Act of 1970, or the Comprehensive Drug Abuse Prevention and Control Act of 1970 classifies drugs used in medicine into five different categories, or schedules. Page Ref: 14
- Which of the following would be listed as a Schedule I drug? A) Heroin B) Hydromorphone C) Codeine D) Tramadol - ANSWER - Answer: A
Explanation: A) Heroin has no medical use and is scheduled as a Schedule I drug. B) Hydromorphone is a Schedule II drug. C) Codeine is a Schedule III drug. D) Tramadol is a Schedule IV drug. Page Ref: 15
- Careful management of narcotic medications carried on emergency service vehicles includes: A) Eliminating standing orders and protocols when using narcotics. B) Only using Schedule IV narcotics if necessary. C) Ensuring that the medications are stored in a substantial safe or cabinet or have a tamperproof seal. D) Allowing Schedule I drug if an unlabeled medication use exists according to current literature. - ANSWER - Answer: C Explanation: A) Standing orders may be necessary in circumstances where on-line medical direction is not available. B) Schedule IV narcotics generally do not have application to prehospital care. C) All narcotics should be stored in a substantial safe or cabinet or have a tamperproof seal if necessary to remove from unit. D) Schedule I narcotics have no acceptable use in prehospital care and often are illegal. Page Ref: 15
- A term that refers to the amount of drug that is absorbed and reaches the general circulation is: A) Purity. B) Potency. C) Efficacy. D) Bioavailability. - ANSWER - Answer: D Explanation: A) Purity refers to the uncontaminated amount of the drug containing only one active component. B) Potency refers to a drugs strength or power to produce the desired effect. C) Efficacy refers to how well the drug works in terms of treatment effect. D) Bioavailability is the degree to which a drug becomes absorbed and reaches general circulation. Page Ref: 17
which it would be harmful to administer a medication. C) An adverse reaction is the same as a side effect. D) An antagonism signifies the opposition between two or more medications such as morphine and naloxone. Page Ref: 21
- Two major divisions of pharmacology are: A) Pharmacokinetics and pharmacodynamics. B) Pharmacognosy and biotransformation. C) Active transport and diffusion. D) Biotransformation and elimination. - ANSWER - Answer: A Explanation: A) Pharmacokinetics and pharmacodynamics are the two major divisions of pharmacology. B) Pharmacognosy refers to the broad study of natural and synthetic drugs and biotransformation is a function of pharmacokinetics. C) Active transport and diffusion explain how a medication moves. D) Biotransformation and elimination is a function of pharmacokinetics. Page Ref: 26
- Which of the following factors is NOT a component of pharmacokinetics? A) Absorption B) Distribution C) Biotransformation D) Binding - ANSWER - Answer: D Explanation: A) Absorption explains the movement of a medication into the system. B) Distribution is how the medication travels to target tissues or organs. C) Biotransformation is how a medication is broken down in the system. D) Binding is a component of pharmacodynamics. Page Ref: 26
- Drug A requires the use of adenosine triphosphate (ATP) in order to move into the cellular membrane. This type of diffusion is known as:A)
Elimination. B) Active transport. C) Facilitated. D) Osmosis. - ANSWER - Answer: B Explanation: A) Elimination is the removal of a drug from the body. B) Active transport involves the use of energy, such as ATP to move a substance through a membrane that otherwise would not be able to penetrate. C) Facilitated diffusion requires the use of a helper protein (such as insulin with glucose) to cause a change in the cellular membrane allowing entry of the substance. D) Osmosis is a passive process involving the movement of water. Page Ref: 26
- Glucose in the bloodstream is a large molecule that cannot readily enter a cell unless it binds with insulin. This BEST describes: A) Osmosis. B) Diffusion. C) Carrier-mediated diffusion. D) Absorption. - ANSWER - Answer: C Explanation: A) Osmosis involves the movement of solvent, normally water. B) Diffusion is a general term related to the movement of substances and involves both active and passive forms, of which carrier- mediated diffusion is included. C) Carrier-mediated diffusion most correctly explains the process described. D) Absorption encompasses a medications progress from its pharmaceutical dosage form to a biologically available substance that can then pass through or across tissues. Page Ref: 26
- The term ________ describes the movement of molecules across a membrane down a pressure gradient from an area of higher pressure to and area of lower pressure normally resulting from hydrostatic forces. A) Filtration B) Carrier-mediated diffusion C) Active transport D) Osmosis - ANSWER - Answer: A
refers to the relative amount of a medication required to produce the desired response. Page Ref: 37
- Which of the following forms of absorption is generally the slowest due to the decreased vascular supply? A) Subcutaneous B) Intramuscular C) Intravenous D) Sublingual - ANSWER - Answer: A Explanation: A) The subcutaneous layer of the skin is composed of dense fatty tissue that has poor vascular supply and slow absorption of medications. B) Muscles generally have very good blood supply promoting absorption. C) Intravenous injection provides the most rapid (and common) route of absorption. D) The sublingual area is highly vascular resulting in rapid absorption. Page Ref: 28
- ________ BEST describes the process in which a medication is transported from the site of absorption to the site of action. A) Active transport B) Diffusion C) Distribution D) Elimination - ANSWER - Answer: C Explanation: A) Active transport involves the movement of a substance across the cellular membrane utilizing an energy source. B) Diffusion describes movement across the cellular membrane and can be an active or passive process. C) Distribution is the process whereby a medication is transported from the site of absorption to the site of action. D) Elimination is removal of a substance from the body. Page Ref: 30
- You are treating a patient who suffers from renal disease and decreased perfusion of the kidneys. What effect will this have on the distribution of a drug that normally acts on kidneys, such as the diuretic
medication Lasix? A) The drug will be present in increased concentrations at the kidneys resulting in toxicity. B) The drug will be poorly delivered to the kidneys due to a decreased perfusion and will not produce the desired results. C) As the kidneys are a primary organ of elimination, the effects of the drug will be unchanged. D) The drug will most likely be metabolized by the liver resulting in the same effects systemically. - ANSWER - Answer: B Explanation: A) Decreased renal blood flow results in poor delivery of the medication to the kidney. B) Correct. C) The decreased blood flow to the kidney will prevent the drug from producing the desired results. D) If a drug is meant for a specific organ of tissue, it must reach the site in order to be effective. Page Ref: 31
- While researching the drug amiodarone, you read that the drug is considered to be highly protein bound upon entering the body. Knowing this, you can deduce that: A) The drug is largely ineffective when administered by intravenous route. B) The drugs half-life will be relatively short due to the rapid elimination of the free, or unbound, percentage. C) Much of the drug remains active in the bloodstream and only a small percentage is bound in tissues. D) The drug remains bound to proteins but will slowly release the active component when necessary resulting in a long half-life. - ANSWER - Answer: D Explanation: A) When administered in therapeutic dosages, intravenous routes provide the most rapid, effective dose. B) The drug will have a long half-life as the bound component will slowly release as the free or unbound active component is metabolized C) When the drug is highly protein bound, much of the drug will be stored in protein reservoirs. Only a small amount remains in the bloodstream as an active metabolite. D) Correct. Page Ref: 32
Explanation: A) Concentration refers to the amount of drug available. B) The therapeutic index is the difference between minimal therapeutic dose and toxic level of dose. C) Correct. D) This defines the process of elimination. Page Ref: 34
- ________ is the length of time that a medication concentration is sufficient in the blood to produce a therapeutic response. A) Half-life B) Duration of action C) Efficacy D) Affinity - ANSWER - Answer: B Explanation: A) Half-life is the time required for one-half of the dose of a medication to be removed from the body. B) Correct. C) Efficacy is the ability of a drug to produce the expected response. D) Affinity is the force of attraction between a drug and its receptor site. Page Ref: 34
- Which of the following is the MOST common way that medications exert their actions? A) Receptor site binding. B) Changing the physical properties of a cell. C) Chemically combining with another chemical. D) Altering the normal metabolic pathway. - ANSWER - Answer: A Explanation: A) Correct. B) While all answers listed are ways in which a drug may exert its actions, receptor site binding is the most common. C) While all answers listed are ways in which a drug may exert its actions, receptor site binding is the most common. D) While all answers listed are ways in which a drug may exert its actions, receptor site binding is the most common. Page Ref: 35
- A medication such as nalbuphine binds with a specific receptor site causing an expected effect, but blocks another medication from
triggering the receptor. This is known as a/an: A) Agonist. B) Antagonist. C) Agonist-antagonist. D) Beta blocker. - ANSWER - Answer: C Explanation: A) An agonist binds to a specific receptor causing a desired response. B) An antagonist blocks a receptor site, but does not produce the expected result. C) Correct. D) A beta blocker is an example of an antagonistic effect. Page Ref: 36
- ________ is the relative amount of a medication required to produce a desired response. A) Antagonism B) Efficacy C) Therapeutic threshold D) Potency - ANSWER - Answer: D Explanation: A) An antagonism produces a blocking effect at a receptor site. B) Efficacy is the power of a medication to produce a therapeutic effect. C) Therapeutic threshold is the minimum concentration of a medication required to cause a desired response. D) Correct. Page Ref: 37
- If a drug exceeds its therapeutic index, the drug will: A) Cause the desired response. B) Be toxic to the patient. C) Not have any effect on the patient. D) Be present in the minimal level and may not cause the desired response. - ANSWER - Answer: B Explanation: A) For a drug to cause a desired response, it must remain within the therapeutic index. B) The difference between the minimum effective concentration and the toxic level is the therapeutic index. C) If
percent of its beginning level. D) Pharmacodynamics refers to how a specific drug acts on the system. Page Ref: 47
- You have just received a verbal order from medical direction to administer 2 mg of morphine sulfate to a patient. You should immediately: A) Inquire about allergies. B) Confirm the narcotic log is correct. C) Gather the appropriate syringe and needle applicable to the situation. D) Repeat the medication order to base physician. - ANSWER
- Answer: D Explanation: A) While inquiring about patient allergies is relevant; the order should be repeated immediately. B) Narcotic logs should be kept up-to-date and checked at shift beginning and end or when removing from storage. C) Gathering equipment should occur following confirmation of order. D) Correct. Page Ref: 48
- Medical direction has ordered that you administer a medication to a patient that you believe will cause harm to the patient if administered. After reading back the order to medical direction, the physician insists that you give the medication. Which of the following BEST describes your next actions? A) State your objections, but give the medication per medical controls advice. B) State your objectives, withhold the medication, and document carefully. C) Give the medication and carefully observe your patient. D) Refuse to acknowledge medical direction on the radio and document radio interference on your report.
- ANSWER - Answer: B Explanation: A) If you believe that a medication or procedure may unnecessarily harm your patient, you should act in the patient's best interest and avoid the medication or procedure. B) Correct. C)
Knowingly administering a medication or procedure that causes unnecessary harm violates the code of conduct expected of a paramedic and may place you in legal jeopardy. D) Answer implies unethical behavior. Page Ref: 48
- Managing multiple patients, such as at a mass-casualty situation places the paramedic at risk when considering medication administration because of potential communication issues with medical direction. Which of the following will help ensure patient status? A) Use only the patient's last name when communicating. B) Only one paramedic should administer medication during a multi-patient incident. C) Use of an incident command system to ensure proper identification of patients. D) Avoid the use of medications in the field during operations deferring emergency care to the hospital staff. - ANSWER - Answer: C Explanation: A) Multiple patients may share same name. B) It is not practical to have only one paramedic administer medications at a mass- casualty situation. C) Correct. D) Patients may be in need of urgent care at the scene.
- When selecting a medication, a prehospital provider should check the label at least ________ times. A) One B) Two C) Three D) Four - ANSWER - Answer: C C) When ordered to administer a medication, the provider should check label at least three times. First, when selecting a medication; second when you draw the medication; and third, prior to administration.
