Beta-2 agonists bronchodilate; tachycardia and tremor are expected side effects.
Before you read
Test yourself first: 5 questions
Question 1 of 5
What is the most common reason a patient with an acute coronary syndrome presents WITHOUT classic crushing chest pain?
Answer: A. Diabetic neuropathy, older age and female sex are the classic reasons ischemia shows up as breathlessness, fatigue, nausea or vague upper-abdominal discomfort instead of pressure. Clot size does not reliably predict pain, and a slow rate does not abolish ischemic symptoms, so treating 'no chest pain' as 'no heart attack' is the trap this item targets.
Question 2 of 5
Two workers are brought down from a hot roof. One is sweating heavily, alert and cramping. The other is confused and hot to the touch. The finding that separates an emergency from a lesser illness here is:
Answer: A. Central nervous system dysfunction is what makes heat illness life-threatening — it marks the point where thermoregulation has failed rather than merely struggled. Sweating is the classic teaching point and the classic trap, because a patient with heat stroke can still be wet. Fluid intake and hours worked describe the exposure, not the severity of the injury.
Question 3 of 5
Which syncope history is most concerning for a dangerous cardiac cause?
Answer: A. Syncope during exertion or without a prodrome suggests an arrhythmia or a fixed outflow obstruction that cannot raise output on demand. Prolonged standing, emotional triggers and coughing are classic reflex (vasovagal or situational) causes with a warning phase and quick recovery, which are reassuring rather than alarming.
Question 4 of 5
Which 12-lead finding in a patient with an inferior STEMI should make you cautious about giving a nitrate?
Answer: A. Right ventricular involvement makes the patient preload-dependent, so venodilation from a nitrate can drop the pressure sharply. ST elevation in V4R is the classic marker. Reciprocal lateral depression is expected with inferior injury and does not by itself predict nitrate-induced hypotension, and an inverted T in aVR is normal.
Question 5 of 5
A patient with acute pulmonary edema on CPAP is now drowsy, his respiratory rate has fallen to 8 and his saturation is dropping. What should you do?
Answer: A. CPAP depends on the patient driving each breath. A falling mental status and slowing rate mean respiratory failure, so the patient needs assisted ventilation, not more pressure. Reading drowsiness as relaxation is the classic error, and adding a cannula does not address the loss of ventilatory drive.
Keep the streak going with more questions like these, each with a full rationale.
What is pharmacology by class?
The exam tests the mechanism of each class, what the patient's home medications change about the assessment, and the contraindications that matter in the field.
Key points to remember
- Beta-2 agonists bronchodilate; tachycardia and tremor are expected side effects.
- Epinephrine: alpha raises vascular tone, beta-1 raises rate and contractility, beta-2 opens airways.
- Nitrates dilate veins and lower preload — avoid with hypotension, RV infarct or erectile dysfunction drugs.
- Opioids and benzodiazepines depress breathing; combined, the effect is greater.
- Anticoagulants and antiplatelets raise bleeding risk — a minor head injury becomes high risk.
Field priorities
- Six rights before every drug: patient, drug, dose, route, time, documentation.
- Reassess vital signs and effect after each administration.
- Home medication list is part of the history — it suggests diagnoses.
Coaching the patient
- Beta-blockers blunt the tachycardia of shock — do not be reassured by a normal rate.
Red flags: act now
- Beta-blocker patient with a normal heart rate in shock
- Blood thinner with a head strike
- Opioid given to a patient already on a sedative
Pharmacology by Class: FAQs
What are the priority actions for Pharmacology by Class in the field?
Six rights before every drug: patient, drug, dose, route, time, documentation. Reassess vital signs and effect after each administration. Home medication list is part of the history — it suggests diagnoses.
What findings in Pharmacology by Class change your plan or your transport decision?
Beta-blocker patient with a normal heart rate in shock. Blood thinner with a head strike. Opioid given to a patient already on a sedative.
What do I need to know about Pharmacology by Class for the NREMT?
Beta-2 agonists bronchodilate; tachycardia and tremor are expected side effects. Epinephrine: alpha raises vascular tone, beta-1 raises rate and contractility, beta-2 opens airways. Nitrates dilate veins and lower preload — avoid with hypotension, RV infarct or erectile dysfunction drugs. Opioids and benzodiazepines depress breathing; combined, the effect is greater.
What should the crew communicate or document for Pharmacology by Class?
Beta-blockers blunt the tachycardia of shock — do not be reassured by a normal rate.
