NREMT study guide · EMT level

NREMT Medications for EMTs: the 8 drugs you need to know

By Rounds EMS
Updated September 28, 2026 · 10 min read

Always follow your local protocols. Doses, drug lists and what an EMT may give vary by state, agency and medical director. This guide prepares you for the NREMT exam; your protocols decide what you do on a call.

Oxygen, nitroglycerin, aspirin, epinephrine, albuterol, naloxone, oral glucose and activated charcoal. These eight are the drugs the Rounds bank’s EMT questions are built around. Oxygen shows up in 78 of its 1,723 questions, nitroglycerin in 49. For each drug you need four answers: when to give it, when to hold it, how it goes in, and what to check after.

The 8 drugs on one chart

Doses are the common adult values from EMT education. Your state and your medical director set the real numbers, so check your protocol before you memorize a dose as fact.

Drug	Used for	Your role	Common adult dose	Hold it if
Oxygen	Hypoxia, shortness of breath, shock	Give	Nasal cannula for mild need; non-rebreather at high flow for serious need, per protocol	SpO₂ is normal and the patient is not in distress
Nitroglycerin	Chest pain from suspected heart ischemia	Assist with the patient’s own	0.4 mg under the tongue, repeat every 5 min, 3 doses max	Low blood pressure, a PDE-5 drug in the last 48 hours (erectile dysfunction or pulmonary hypertension), not their prescription
Aspirin	Suspected heart attack	Give	162–325 mg chewed (commonly two to four 81 mg tablets)	Aspirin allergy, active GI bleeding
Epinephrine	Anaphylaxis	Give or assist (auto-injector)	0.3 mg IM adult; 0.15 mg IM child (about 15–30 kg)	No true contraindication in anaphylaxis
Albuterol	Wheezing, asthma, COPD flare	Give or assist, per protocol	The patient’s prescribed puffs, or 2.5 to 5 mg nebulized where allowed	Assisting and it is not their prescription, or protocol max reached
Naloxone	Opioid overdose with slow or absent breathing	Give	4 mg nasal spray, or auto-injector where allowed	Breathing is adequate
Oral glucose	Low blood sugar in a patient who can swallow	Give	One tube, per protocol (national guideline adult dose: 25 g)	Cannot swallow or protect their airway
Activated charcoal	Some swallowed poisons	Give on medical direction	1 g/kg by mouth	Altered mental status, unprotected airway, swallowed acid, alkali or petroleum

How the exam actually asks about drugs

Exam-style medication questions rarely ask you to recite a dose. They hand you a patient, name the drug, and ask what you do next: give it, hold it, or reassess first. The hard part is the judgment, not the memorizing.

Three patterns cover most of it:

A contraindication hiding in the scenario. A blood pressure of 88/60, a pill for erectile dysfunction taken last night, a patient who cannot swallow. The drug is right for the complaint and wrong for this patient.
A dose already taken. The patient used their inhaler four times before you arrived, or already took the maximum your protocol allows. The drug is right, and the next dose is still not yours to give.
A failed check. The bottle expired 18 months ago, or the inhaler belongs to the patient’s spouse. Everything else lines up, and the answer is still no.

So learn each drug as a short decision, not a flashcard. That is how the sections below are laid out.

The Six Rights of medication administration

The national EMT guidelines list five rights: patient, medication, dose, route and time. Many EMT courses add a sixth, documentation, done after the drug is given.

Right patientThe drug is for this person. With nitroglycerin and inhalers, it must be their own prescription.
Right medicationRead the label and confirm the drug fits the patient’s condition.
Right doseThe amount your protocol allows, and how many doses they have already had.
Right routeUnder the tongue, chewed, into the thigh muscle, into the nose. The wrong route can make a correct drug useless.
Right timeThe drug is within its expiration date, and enough time has passed since the last dose. The national guideline defines right time by the expiration date.
Right documentationDrug, dose, route, time, and how the patient responded.

Oxygen

In 78 Rounds questions, the most of any drug

Give it when: The patient is hypoxic, short of breath, in shock, or has an oxygen saturation below the number your protocol sets.
Hold it when: Saturation is normal and the patient is comfortable. The national guideline gives oxygen for chest pain only when the patient is short of breath, has low saturation or shows signs of heart failure, with a target of 94–98%.
How: Nasal cannula for mild need. Non-rebreather at high flow for serious need, per protocol. Bag-valve mask with oxygen if breathing is inadequate.
After: Recheck the saturation and how hard the patient is working to breathe.

Exam trap: oxygen is almost never the whole answer. It shows up as a step inside stroke, asthma and chest pain scenarios. If the patient is not breathing adequately, a non-rebreather is wrong. They need ventilations.

Nitroglycerin

In 49 Rounds questions

Give it when: Chest pain from suspected heart ischemia, the patient has their own prescribed nitroglycerin, and the blood pressure is above your protocol’s floor.
Hold it when: Blood pressure is low. Commonly that means a systolic below 90 to 100, set by your protocol. The patient took a PDE-5 drug (sildenafil, tadalafil, vardenafil or avanafil) in the last 48 hours, whether for erectile dysfunction or for pulmonary hypertension. Ask about both. It is not their prescription. Or they have already had the maximum doses.
How: One 0.4 mg tablet or spray under the tongue. Repeat every 5 minutes if pain continues, up to 3 total, per protocol.
After: Reassess blood pressure and pain before each repeat dose. Headache and a drop in blood pressure are the expected side effects.

Exam trap: it widens blood vessels, so blood pressure drops. When the patient took a dose a few minutes ago and still hurts, the answer is to recheck blood pressure first.

Aspirin

In 20 Rounds questions

Give it when: Suspected heart attack or acute coronary syndrome in a patient who can swallow.
Hold it when: Aspirin allergy, active bleeding in the stomach or gut, or your protocol excludes the patient.
How: 162–325 mg, chewed, not swallowed whole. Chewing gets it into the blood faster.
After: Keep reassessing. Ongoing pain does not mean the aspirin failed.

Exam trap: for chest pain, aspirin is given to slow clotting, not to relieve the pain. An answer choice that gives aspirin “for the pain” has the reason wrong.

Epinephrine

In 26 Rounds questions

Give it when: Anaphylaxis: an allergic reaction with trouble breathing, wheezing, throat swelling, or signs of shock.
Hold it when: It is a mild reaction with hives or itching only and no breathing or circulation problem. Follow your protocol here.
How: Auto-injector into the outer thigh muscle, through clothing if needed. 0.3 mg for an adult or anyone over about 30 kg; 0.15 mg for a child of roughly 15 to 30 kg. The national guideline uses 25 kg as the cutoff, so follow your protocol.
After: Reassess breathing and blood pressure. A racing heart, shaking and anxiety are expected. Symptoms can return, so a second dose may be needed per protocol.

Exam trap: in true anaphylaxis, the EpiPen label says heart disease and older age call for caution, not for withholding it in a life-threatening reaction. Delaying epinephrine is the mistake the exam is testing for.

Albuterol

In 20 Rounds questions

Give it when: Wheezing and shortness of breath from asthma or a COPD flare. Depending on your protocol you give it, or you help the patient use their own prescribed inhaler.
Hold it when: You are assisting and it is not their prescription, or they have already taken the maximum your protocol allows.
How: Shake the inhaler, have them breathe out, seal their lips on it, press as they breathe in slowly, hold the breath. A spacer helps. Some systems let EMTs give it by nebulizer.
After: Listen for breath sounds and watch the work of breathing. A faster heart rate and shaky hands are normal side effects.

Exam trap: a quiet chest in a severe asthma patient is not improvement. It means almost no air is moving.

Naloxone (Narcan)

In 22 Rounds questions

Give it when: Suspected opioid overdose with slow, shallow or absent breathing.
Hold it when: The patient is breathing adequately. Naloxone is for the breathing, not the drowsiness.
How: 4 mg nasal spray into one nostril, or an auto-injector into a muscle where your protocol allows. Ventilate with a bag-valve mask first if breathing is inadequate.
After: Keep ventilating until they breathe on their own. Be ready for vomiting, withdrawal and agitation. It can wear off before the opioid does.

Exam trap: the goal is adequate breathing, not a fully awake patient. Airway and ventilation come before the spray.

Oral glucose

In 10 Rounds questions

Give it when: A patient with low blood sugar, or a known diabetic with altered mental status, who is awake enough to swallow and protect their own airway.
Hold it when: The patient is unresponsive or cannot swallow. That is a choking risk.
How: One tube by mouth, placed between the cheek and gum or swallowed. Tubes come in different sizes and the national model guideline’s adult dose is 25 g, so follow your protocol.
After: Recheck mental status and blood sugar if your protocol allows a glucose check.

Exam trap: an unresponsive diabetic never gets oral glucose. Manage the airway and transport.

Activated charcoal

In 4 Rounds questions

Give it when: Medical direction orders it for an alert patient who swallowed certain poisons or overdosed on some medications, usually within about an hour of swallowing it.
Hold it when: Altered mental status, an unprotected airway, cannot swallow, or they swallowed an acid, alkali or petroleum product.
How: By mouth, commonly 1 g per kg, shaken well. Some systems no longer carry it, so check your protocol.
After: Watch for vomiting and protect the airway.

Exam trap: the answer usually hinges on the patient’s mental status or what they swallowed, not on the dose.

Try one from the Rounds bank

A real nitroglycerin question

A 64-year-old patient is experiencing crushing substernal chest pain that began while mowing the lawn. The patient is alert and oriented, has a prescribed nitroglycerin medication, denies taking any erectile dysfunction medication, and has a blood pressure of 136/82 mmHg. After confirming the Six Rights of medication administration, what is the MOST appropriate next action?

Obtain a 12-lead ECG before assisting with the nitroglycerin.
Reassess the blood pressure after several minutes before deciding whether to assist with the nitroglycerin.
Assist the patient with the prescribed nitroglycerin according to local protocol.
Have the patient rest and reassess the chest discomfort before assisting with the nitroglycerin.

Show the answer

C. Assist with the prescribed nitroglycerin. The key clues are that the patient has prescribed nitroglycerin, an adequate blood pressure, and no identified contraindication. The Six Rights are already confirmed, so the checks are done.

A, B and D each sound careful, and each one delays a drug the patient needs with no reason in the question to wait. A 12-lead is useful but not a requirement before nitroglycerin. The blood pressure is already adequate. Waiting to see if rest fixes it is not a reason to hold treatment.

When the question has cleared every check, the answer is to act.

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Frequently asked questions

What medications can an EMT give?

The core EMT list is oxygen, aspirin, oral glucose, epinephrine by auto-injector, naloxone and albuterol, plus helping patients take their own prescribed nitroglycerin. The 2019 national scope model also allows some over-the-counter pain and fever medicines with medical oversight. Activated charcoal is carried only where local protocol still includes it. Your state and medical director set the final list.

Do I need to memorize doses for the NREMT?

Know the common ones, like 0.4 mg nitroglycerin, 162–325 mg aspirin and 0.3 mg epinephrine for an adult. But the exam spends far more questions on whether and when to give a drug than on the number. Put your time into contraindications and reassessment.

What are the Six Rights of medication administration?

The national EMT guidelines list five: right patient, right medication, right dose, right route and right time. Many courses add a sixth, right documentation, done after the drug is given.

Why isn’t adenosine or amiodarone on this list?

Those are paramedic drugs. They are outside the EMT scope in the national scope model. A paramedic pharmacology list is built for a different exam and costs you study time on the one you are taking.

Can an EMT give nitroglycerin?

In most systems an EMT helps a patient take their own prescribed nitroglycerin after checking blood pressure and asking about PDE-5 drugs such as sildenafil, taken for erectile dysfunction or pulmonary hypertension. The national scope model limits EMTs to the patient’s own nitroglycerin. Follow your protocol.

Sources

Doses, thresholds and scope on this page were checked against these documents. Question counts come from the Rounds EMS question bank as of September 27, 2026.

National Model EMS Clinical Guidelines, Version 3.0. NASEMSO, 2022.
National EMS Scope of Practice Model 2019, with Change Notices 1.0 and 2.0 (DOT HS 813 151). NHTSA, 2021.
National EMS Education Standards: Emergency Medical Technician Instructional Guidelines. NHTSA, 2009.
EpiPen and EpiPen Jr (epinephrine injection) Prescribing Information. U.S. FDA, 2026.
Nitrostat (nitroglycerin sublingual tablets) Prescribing Information. U.S. FDA, 2018.
Narcan (naloxone hydrochloride) Nasal Spray Prescribing Information. U.S. FDA, 2023.

Please follow your local protocols and your medical director’s orders. This guide is for exam study only and does not replace them.