A typical protocol book has 40 to 50 medications, each with adult and pediatric doses, several routes and overlapping contraindications. Epinephrine alone shows up in arrest, anaphylaxis and asthma at different doses. And your agency's doses may not match what you learned in class. That's hundreds of facts to pull from memory on scene, often at 3 AM. Here's how to actually retain them.

Group by system, not alphabet

Adenosine has nothing to do with albuterol. Study by system:

  • Cardiac: Amiodarone, Lidocaine, Adenosine, Atropine, Epinephrine (cardiac doses), Dopamine, Aspirin, Nitroglycerin
  • Respiratory: Albuterol, Ipratropium, Epinephrine (anaphylaxis/asthma doses), CPAP adjuncts, Magnesium Sulfate (for severe asthma)
  • Pain management: Fentanyl, Morphine, Ketamine (analgesic doses), Ketorolac, Acetaminophen
  • Sedation/RSI: Ketamine (RSI doses), Midazolam, Etomidate, Succinylcholine, Rocuronium
  • Neurological: Midazolam (seizures), Dextrose, Glucagon, Naloxone, Thiamine
  • OB/GYN: Oxytocin, Magnesium Sulfate (eclampsia)

Studying a class together forces comparison (amiodarone or lidocaine, and why?), and that understanding is what keeps you from freezing on a call.

Know 9 things about every drug

  1. Adult dosing: dose, route, repeats.
  2. Pediatric dosing: usually mg/kg. A missed decimal here has real consequences.
  3. Classification: tells you why it works and how it behaves.
  4. Indications: when to give it.
  5. Adverse effects: what to watch for after you push it.
  6. Contraindications: when not to give it. The highest-stakes item on the list.
  7. Mechanism: connects the other facts so they stick.
  8. Special notes: max doses, infusion rates, anything agency-specific.
  9. Base contact rules: standing order or medical control. This varies a lot between agencies.

If you only know the adult dose, you have a gap that will show up at the worst time.

Quiz yourself, don't re-read

Seeing "adenosine 6 mg" and thinking "I know that" is recognition, not recall. Nobody on a call hands you four options. Cover the answer, produce it, check the source when you miss, and try again later.

Example: adenosine

  • Adult dosing: 6mg rapid IVP with a 20mL NS flush; 12mg if ineffective. Some protocols allow a second 12mg.
  • Pediatric dosing: 0.1 mg/kg (max 6mg), then 0.2 mg/kg (max 12mg), same rapid push and flush.
  • Indications: stable narrow-complex SVT that failed vagal maneuvers.
  • Adverse effects: brief transient asystole, chest tightness, flushing. Warn the patient.
  • Contraindications: second or third-degree block, sick sinus syndrome. Extreme caution (or avoid, per protocol) in WPW with A-fib: it can drive conduction into V-fib.
  • Mechanism: briefly blocks the AV node. Half-life under 10 seconds, so push rapid and proximal.
  • Special notes: pacing pads on first, continuous rhythm strip.

Example: ketamine

  • Analgesic: 0.1-0.3 mg/kg IV (0.5-1 mg/kg IN/IM). Sub-dissociative; the patient stays conscious.
  • RSI/sedation: 1-2 mg/kg IV (3-4 mg/kg IM). Dissociative; the patient loses consciousness.

That's a factor of ten between a femur fracture and an intubation. Study ketamine twice, once with pain and once with RSI.

A study plan

  • Contraindications first. Five minutes on a drug? Spend them on when not to give it.
  • Run scenarios. Chest pain, diaphoresis, Viagra in the last 24 hours. Do you catch the nitro contraindication?

How ProtoQuiz Handles Pharmacology

Every medication in your protocol, quizzed across all 9 categories, every answer page-cited to your PDF.

ProtoQuiz works with whatever PDF your agency uses, whether it's a state set, a regional set or your own. Pair it with spaced repetition and scenario-based practice. If your agency or training program wants to track pharmacology across a team, we do that too.

Back to the blog for more EMS study tips and app updates.

Keep reading: Get the ProtoQuiz app · How to study EMS protocols · Med Mastery grading