EMT Drug Cards Study Guide (The 14 Meds You Actually Need To Know Cold)

The trap with EMT drug cards is volume. Students download a deck of fifty cards, panic at the sight of half a paramedic formulary, and spend study hours on medications that are well outside their scope. The National EMS Education Standards keep BLS pharmacology tight. The list of medications an EMT can administer, assist with, or be tested on at the basic level is small enough to fit on a single page.

The NREMT cognitive exam tests pharmacology in a predictable way. They ask about indications, contraindications, dose and route for the meds in scope, and the common interactions or side effects you would actually need to recognize in the field. The questions are not meant to make you a pharmacologist. They are meant to confirm you know when to give the med, when to hold it, and what to watch for after.

This guide covers the fourteen medications that show up on the NREMT EMT-level exam in some form, what to lock in for each, and the spots where state scope varies. Verify your local protocol before patient care. The exam is national. Your scope is not.

These are medications an EMT can independently administer under standing orders or medical direction in most states. They are the highest-yield cards in your deck.

Oxygen. The most administered drug in EMS. Indications include any patient with signs of inadequate oxygenation, respiratory distress, chest pain, altered mental status from suspected hypoxia, shock, or significant trauma. Delivery devices include nasal cannula at 1 to 6 lpm for 24 to 44 percent FiO2, simple mask at 6 to 10 lpm, non-rebreather at 10 to 15 lpm for up to 90 percent FiO2, and bag-valve-mask at 15 lpm for the patient who is not breathing adequately on their own. Target SpO2 is 94 to 99 percent for most patients. For suspected COPD with chronic hypoxic drive, titrate to 88 to 92 percent. No absolute contraindications in emergency care.

Oral glucose. Indication is suspected hypoglycemia in a patient who is awake enough to protect their airway and swallow. Typical dose is one 15 gram tube placed between the cheek and gum or on the tongue. Contraindications include unresponsiveness, inability to swallow, and known allergy. Watch for aspiration risk. If the patient is altered to the point of being unable to manage their own airway, glucagon IM or IN per local scope, or wait for ALS for IV dextrose.

Activated charcoal. Indication is certain ingested poisonings within roughly one hour of ingestion, with medical direction approval. Typical dose is 1 gram per kilogram, often 25 to 50 grams for adults. Contraindications include altered mental status, inability to protect the airway, ingestion of caustics or hydrocarbons, and known allergy. This medication is falling out of favor in many systems but remains in the National Standard, so the NREMT can still test it.

Aspirin. Indication is suspected acute coronary syndrome in a patient with chest pain consistent with cardiac origin. Typical dose is 162 to 324 mg chewed, commonly four baby aspirin at 81 mg each. Contraindications include known allergy, active GI bleeding, known bleeding disorder, and recent intracranial bleed. Pediatric aspirin use for fever or viral illness is not appropriate due to Reye syndrome risk, but that is not the EMS indication being tested.

Naloxone. Indication is suspected opioid overdose with respiratory depression. Routes within EMT scope in most states are intranasal at 2 to 4 mg per nostril or intramuscular at 0.4 to 2 mg, depending on local protocol and the formulation supplied. Repeat dosing every 2 to 3 minutes as needed for continued respiratory depression. Watch for acute withdrawal, vomiting, and combative behavior after administration. Be prepared to support ventilation regardless of naloxone effect. Naloxone reverses the opioid, it does not replace your BVM.

These are medications the patient already has prescribed. EMT scope in most states allows you to assist the patient with their own medication under standing orders or with medical direction.

Nitroglycerin. Indication is chest pain consistent with angina or acute coronary syndrome in a patient who has been prescribed nitroglycerin. Standard dose is 0.4 mg sublingual tablet or spray, repeated every 3 to 5 minutes for a total of three doses if the patient remains in pain and meets criteria. Critical contraindications: systolic blood pressure under 100 mmHg in many protocols, recent use of phosphodiesterase inhibitors such as sildenafil, tadalafil, or vardenafil within 24 to 48 hours depending on the specific drug, right ventricular infarct, head injury, and known allergy. The PDE-5 interaction is a classic NREMT test point. Confirm the patient has not taken erectile dysfunction medications or PDE-5 inhibitors for pulmonary hypertension before assisting with nitro.

Metered-dose inhaler, albuterol or levalbuterol. Indication is acute bronchospasm in a patient with prescribed inhaler, typically asthma or COPD exacerbation with wheezing. Typical dose is one to two puffs, repeated per protocol. Contraindications include inability to use the device, known allergy, and tachycardia at a level your protocol identifies as a hold criterion. Common side effects include tachycardia, tremor, and anxiety. The patient must be able to follow commands and coordinate the inhalation with the actuation, otherwise you use a spacer if available or assist a small-volume nebulizer where local scope permits.

Epinephrine auto-injector. Indication is anaphylaxis or severe allergic reaction with respiratory compromise or signs of shock. Adult dose is 0.3 mg IM auto-injector into the lateral thigh, pediatric dose is 0.15 mg IM via the pediatric auto-injector for patients under approximately 30 kg, with thresholds varying slightly by manufacturer and protocol. There are no absolute contraindications when anaphylaxis is present. Relative caution in elderly patients with significant cardiac history, but anaphylaxis is itself fatal, so when in doubt and the criteria are met, give the epi. Many states now allow EMTs to administer epinephrine from a vial drawn into a syringe rather than only by auto-injector. Verify scope.

These six round out the standard EMT pharmacology coverage. Some are scope expansions, some are background knowledge for recognition of the medication the patient is already taking.

Glucagon. Indication is severe hypoglycemia in a patient who cannot safely take oral glucose, where it is in the EMT scope. Typical dose is 1 mg IM or intranasal. Onset is slower than IV dextrose, often 10 to 15 minutes. Side effects include nausea and vomiting. State scope varies, glucagon is increasingly in the EMT formulary as part of expanded scope but is not universal.

Acetaminophen and ibuprofen. Some EMT-A or advanced EMT scopes allow administration for fever and pain. Indications, doses, and routes follow standard adult and pediatric dosing on the packaging. For NREMT EMT-Basic, recognition of these as common patient medications is the typical test point rather than administration.

Inhaled corticosteroids and combination inhalers. Patients you encounter with asthma or COPD are often on inhaled steroids such as fluticasone or combination inhalers such as fluticasone with salmeterol. These are maintenance medications, not rescue medications. Critical concept for the exam, do not assist a patient with their daily steroid inhaler in an acute bronchospasm. The rescue medication is the short-acting beta-agonist.

Tylenol versus Tylenol PM, prescribed sleep aids, and benzodiazepines. Recognition only. Be able to identify the medication on a list and note it under SAMPLE history.

Aspirin in pediatric patients. Recognition that pediatric aspirin for fever is contraindicated due to Reye syndrome risk. The EMS indication of aspirin is adult cardiac chest pain, not pediatric antipyresis.

Patient-prescribed cardiac and respiratory medications. Beta-blockers, ACE inhibitors, calcium channel blockers, anticoagulants, antiplatelets, statins, diuretics, long-acting bronchodilators. You do not administer these. You recognize them on a med list to flag potential complications. A patient on warfarin who fell has a higher risk of intracranial bleed even with minor head trauma. A patient on a beta-blocker who is in shock may not mount the expected tachycardic response.

The wrong way to study EMT pharmacology is to make a flashcard for every medication in your textbook glossary and try to memorize all of them. The right way is to organize your cards by indication first, then drill the holds.

For each of the medications in scope, write a card that covers four pieces of information in this order. Indication, contraindications and holds, dose and route, side effects and what to watch for. Then for any med where assist is the route, add who the medication belongs to and the documentation requirement.

Drill the holds harder than the doses. The NREMT loves to set up a scenario where the indication clearly applies but the contraindication is hidden in the history. A chest pain patient who took sildenafil six hours ago. A hypoglycemic patient who is too altered to swallow. An asthma patient with a heart rate of 160. The students who score well on pharmacology questions recognize the trap before they answer.

The StruckBox NREMT EMT prep library runs scenario-based pharmacology questions in the same trap-the-hold format the exam uses, with explanations that show why the obvious answer was wrong and where the contraindication was buried in the case. Pair that with the focused fourteen-card deck above and you cover the pharmacology section in study time that fits between shifts, not weekends locked in a textbook.