How pharmacology is examined
According to the FACEM Training Handbook, the Primary Written Examination is two three-hour papers, each of 180 select-choice questions, across anatomy, pathology, physiology and pharmacology. It can be attempted at any time in Training Stage 1, and the pass standard is a pre-defined level of performance. Once it is passed, the Primary Integrated Viva is four 10-minute stations, each scored across anatomy, pathology, physiology, pharmacology and clinical building blocks. Check the ACEM website for the current format and dates.
Questions test mechanisms of action, kinetics, adverse effects, interactions and antidotes, often in a clinical scenario.
Pharmacokinetic principles
| Concept | Key point |
|---|---|
| Volume of distribution | Dose needed to reach a plasma concentration; large Vd drugs are poorly dialysed |
| Clearance | Determines maintenance dose |
| Half-life | About 4 to 5 half-lives to reach steady state or eliminate a drug |
| Bioavailability | Fraction reaching systemic circulation; first-pass metabolism |
| Context-sensitive half-time | Time for plasma concentration to halve after an infusion stops |
| Zero-order kinetics | Constant amount eliminated: ethanol, phenytoin and aspirin at high doses |
Emergency drug groups
| Group | Examples | Key points |
|---|---|---|
| Induction agents | Propofol, ketamine, thiopental, etomidate | Haemodynamic effects; ketamine maintains airway reflexes and BP |
| Neuromuscular blockers | Suxamethonium, rocuronium | Suxamethonium raises potassium; sugammadex reverses rocuronium |
| Analgesics | Morphine, fentanyl, ketamine, NSAIDs, paracetamol | Opioid receptors and respiratory depression |
| Vasoactives | Adrenaline, noradrenaline, metaraminol, dobutamine | Receptor profiles |
| Antiarrhythmics | Amiodarone, adenosine, beta-blockers, verapamil | Vaughan Williams classes |
| Antidotes | Naloxone, flumazenil, acetylcysteine, digoxin Fab, sodium bicarbonate | Indications and limits |
Receptor pharmacology
- Agonist, partial agonist, antagonist, inverse agonist.
- Competitive antagonists shift the dose-response curve to the right.
- Adrenaline: alpha and beta; noradrenaline: mainly alpha with some beta-1.
- Therapeutic index and why some drugs need level monitoring.
Worked questions
Worked SCQ 1 · Neuromuscular block
Which adverse effect of suxamethonium is most dangerous in a patient with a crush injury several days old?
- A Bradycardia in children
- B Hyperkalaemia
- C Raised intraocular pressure
- D Fasciculation myalgia
- E Histamine release
Show the reasoning
Answer B. After burns, crush injury or denervation, extrajunctional acetylcholine receptors proliferate, and suxamethonium can cause a large potassium release and cardiac arrest.
Worked SCQ 2 · Kinetics
A drug has a half-life of 6 hours. Roughly how long after starting a regular dose will it reach steady state?
- A 6 hours
- B 12 hours
- C 24 to 30 hours
- D 3 days
- E 1 week or longer
Show the reasoning
Answer C. Steady state is reached after about 4 to 5 half-lives, which is 24 to 30 hours for a 6-hour half-life. A loading dose shortens the time to therapeutic levels.
A 6-week pharmacology plan alongside clinical work
| Week | Focus |
|---|---|
| 1 | Pharmacokinetics and pharmacodynamics |
| 2 | Induction, neuromuscular and analgesic drugs |
| 3 | Cardiovascular drugs and vasoactives |
| 4 | Antimicrobials |
| 5 | Toxicology and antidotes |
| 6 | Mixed timed sets and error log review |
Do 20 to 30 timed questions on most days and keep an error log: write the concept you missed in one line, then revisit it at the end of the week.
Common pharmacology traps
- Learning drug lists without mechanisms.
- Confusing receptor profiles of vasoactives.
- Forgetting zero-order kinetics.
- Neglecting toxicology.
- Ignoring adverse effects and interactions.
Free sample pharmacology questions
Questions from our Emergency (ACEM) bank. Choose your answer, then open the explanation.
What is the main mechanism of ketamine?
- ANMDA antagonism
- BAlpha-2 agonism
- CGABA-A agonism like propofol and the benzodiazepines
- DMu opioid agonism
- ESodium channel blockade
Show answer and explanation
Answer A. Ketamine is a non-competitive NMDA receptor antagonist producing dissociative anaesthesia and analgesia, with preserved airway reflexes and sympathomimetic effects (raised HR and BP). Emergence phenomena are common.
Learning point: Ketamine: NMDA antagonist, preserves airway reflexes and BP.
In tricyclic antidepressant overdose with QRS widening, what is the key treatment?
- AIV physostigmine
- BIV amiodarone first line
- CIV sodium bicarbonate
- DOral potassium
- EIV flumazenil
Show answer and explanation
Answer C. TCAs block sodium channels causing QRS widening, arrhythmias and seizures. Sodium bicarbonate (alkalinisation and sodium load) narrows the QRS. Avoid flumazenil and class Ia/Ic antiarrhythmics.
Learning point: TCA toxicity: wide QRS treated with sodium bicarbonate.
What is the usual insulin regimen in adult DKA?
- ALarge IV bolus of 50 units
- BOral hypoglycaemics
- CFixed-rate 0.1 units/kg/hour
- DSubcutaneous long-acting only
- EInsulin only after ketones clear
Show answer and explanation
Answer C. DKA is treated with IV fluids, potassium replacement and a fixed-rate insulin infusion (0.1 units/kg/hour), adding glucose when blood glucose falls below about 14 mmol/L while ketones are still present. Continue usual basal insulin.
Learning point: DKA: fixed-rate insulin 0.1 u/kg/h; add glucose when BGL under about 14.
Practise more pharmacology questions free
Every pharmacology subtopic in our bank
The bank holds 35 pharmacology questions across 34 subtopics. You can filter by any of them, build a custom block and track your accuracy subtopic by subtopic.
- Acute dystonia1
- Adenosine1
- Adrenaline in arrest1
- Aminoglycoside kinetics1
- Amiodarone in arrest1
- Anticholinergic toxidrome1
- Antiemetics1
- Benzodiazepine in seizures1
- Beta-blocker overdose1
- Calcium channel blocker overdose1
- Ceftriaxone1
- Digoxin antidote1
- Digoxin toxicity1
- Insulin in DKA1
- Ketamine1
- Ketamine pharmacology1
- Lithium toxicity1
- Local anaesthetic toxicity2
- Magnesium uses1
- Maximum lignocaine dose1
- Naloxone1
- Opioid equivalence1
- Opioid receptor pharmacology1
- Organophosphate poisoning1
- Paracetamol nomogram1
- Pharmacokinetics in elderly1
- Propofol haemodynamics1
- Rocuronium reversal1
- Serotonin toxicity1
- Suxamethonium1
- Thrombolysis contraindication1
- Tranexamic acid1
- Tricyclic overdose1
- Warfarin interactions1
Common questions
Is toxicology part of Primary pharmacology?
Yes. Mechanisms of toxicity and antidotes are core emergency pharmacology.
How much pharmacokinetics do I need?
Enough to apply concepts such as Vd, clearance and half-life to dosing scenarios.
Do I need doses?
Know the doses of common emergency drugs and the principles behind them.
How many pharmacology questions are in the Emergency (ACEM) bank?
There are 35 pharmacology questions across 34 subtopics, and the bank grows as new questions pass review.
Can I practise only pharmacology questions?
Yes. Filter by area or by any subtopic to build a custom block, in tutor mode with explanations after each question or in timed mode.
How are pharmacology questions explained?
Every question explains why the answer is right and why each other option is wrong, with a learning point and the Australian source behind it.
How much of the Emergency (ACEM) mock is pharmacology?
About 25 questions in each 100-question mock come from pharmacology, following our mock blueprint.
Which sources is this pharmacology page based on?
It summarises current Australian guidance, including ACEM FACEM Training Handbook (Primary Written Examination and Integrated Viva); Australian Medicines Handbook; Therapeutic Guidelines. Guidelines change, so always check the latest edition.
When was this pharmacology guide last updated?
It was last reviewed on 9 November 2026. We update topic pages when the exam or Australian guidance changes.
How do I unlock all Emergency (ACEM) questions?
Choose a Emergency (ACEM) plan: 3 or 6 months of access, from A$469.99, one payment with no auto-renew. It opens every area, not just pharmacology.
Sources
Clinical content is summarised from current Australian guidance at the date above. Guidelines change, so always check the latest edition.