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USMLE Step 1 Pharmacology

Subjects : health-sciences, usmle-step-1

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. What is Imipenem always administered with?
thiazides - amiloride
Indirect agonist - uptake inhibitor
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis
Cilastatin

2. What is the clinical use for Sucralfate?
Peptic ulcer disease.
No - warfarin - unlike heparin - can cross the placenta.
GI side effects. (Indomethacin is less toxic - more commonly used.)
Tricyclic antidepressant.

3. Will Hemicholinum affect the release of stored Ach during Cholinergic Stimulation
Gram + - Gram - - Norcardia - Chlamydia
Binds to the Pyrophosphate Binding Site of the enzyme
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin
No - hemicholinum block the uptake of Choline and thus Ach synthesis

4. List the specific antidote for this toxin: Arsenic (all heavy metals)
Chagas' disease - American Trypanosomiasis (Trypanosoma cruzi)
- Dimercaprol - succimer
- Tricyclic antidepressants
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load

5. Antiarrhythmic class IV- toxicity?
constipation - flushing - edema - CV effects (CHF - AV block - sinus node depression) - and torsade de pointes (Bepridil)
decrease
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome

6. Name the common Azoles
Liver
- Ethosuxamide - sulfonamides - lamotrigine
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole
Immediate anticoagulation for PE - stroke - angina - MI - DVT.

7. K+ sparing diuretics - clinical use?
Inhibits cGMP phosphodiesterase - casuing increased cGMP - smooth muscle relaxation in the corpus cavernosum - increased blood flow - and penile erection.
Imipenem
- reduction - oxy - & hydrolysis - H2O sol. Polar product - P450
hyperaldosteronism - K+ depletion - CHF

8. Which of the following would atropine administration cause? Hypothermia - bradycardia - excess salivation - dry flushed skin - or diarrhea
for RSV
Doxycycline - because it is fecally eliminated
orthostatic and exercise hypotension - sexual dysfunction - diarrhea
Dry flushed skin - due to inhibition of sympathetic post - ganglionic blockade on muscarinic receptors of sweat glands. All others are opposite of What would be expected.

9. Nifedipine has similar action to?
Tetracycline - Doxycycline - Demeclocycline - Minocycline
Norepinephrine (Alpha1 -2 and beta 1)
Beta adrenergic receptors and Ca2+ channels (stimulatory)
Nitrates

10. What Sulfonamides are used for simple UTIs?
Triple sulfas or SMZ
anuria - CHF
Warfarin interferes with the normal synthesis and gamma - carboxylation of vitamin K- dependent clotting factors II - VII - IX - and X - Protein C and S via vitamin K antagonism.
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.

11. In What population does Gray Baby Syndrome occur? Why?
Succinylcholine
Rheumatoid and osteoarthritis.
Premature infants - because they lack UDP- glucuronyl transferase
Sildenafil fills the penis

12. How are Interferons (INF) used clinically?

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13. Furosemide - clinical use?
edematous states (CHF - cirrhosis - nephrotic syndrome - pulm edema) - HTN - hypercalcemia
Bleeding.
RESPIre
Modification via Acetylation

14. What are three complications of Warfarin usage?
The PTT.
edematous states (CHF - cirrhosis - nephrotic syndrome - pulm edema) - HTN - hypercalcemia
Malaria (P. falciparum)
1. Bleeding 2. Teratogenicity 3. Drug - drug interactions

15. What are the major toxic side effects of Imipenem/cilastatin?
Spironolactone - Triamterene - Amiloride (the K+ STAys)
GI distress - Skin rash - and Seizures at high plasma levels
Teratogenic - Carcinogenic - Confusion - Headaches
Pentavalent Antimony

16. Describe Phase I metabolism in liver(3)?
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy
- reduction - oxy - & hydrolysis - H2O sol. Polar product - P450
hypertension - angina - arrhythmias
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.

17. What is the clinical use for Heparin?
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.
Immediate anticoagulation for PE - stroke - angina - MI - DVT.
Prevents release of mediators from mast cells. Effective only for the prophylaxis of asthma. Not effective during an acute attack.
- Vitamin K & fresh frozen plasma

18. What are two indirect acting adrenergic agonists?
- ACE inhibitors (Losartan>no cough)
amphetamine and ephedrine
Activates antithrombin III
Buy AT 30 - CELL at 50'

19. For Heparin What is the Treatment for overdose
Neomycin
Protamine sulfate
Decreases synthesis of Mycolic Acid
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome

20. How do we stop angina?
- Daunorubicin & Doxorubicin
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
Intrathecally
1. Buffalo hump 2. Moon facies 3. Truncal obesity 4. Muscle wasting 5. Thin skin 6. Easy bruisability 7. Osteoporosis 8. Adrenocortical atrophy 9. Peptic ulcers

21. How is Amantadine used clinically?

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22. Which of epi - norepi - or isoproterenol results in bradycardia?
Norepinephrine
Pituitary hormone.
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis
Ceftriaxone

23. Ibutilide - toxicity?
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.
collecting ducts
Early myocardial infarction.
torsade de pointes

24. What is a possible toxicity of Alpha - glucosidase inhibitors used in type -2 diabetes?
- Flumazenil
Dermatophytes (tinea - ringworm)
Those patients who are taking nitrates.
GI disturbances.

25. What populations are Floroquinolones contraindicated in? Why?
Pregnant women - Children; because animal studies show Damage to Cartilage
Gram + and Anerobes
Butyrophenone (neuroleptic).
dizziness - flushing - constipation (verapamil) - nausea

26. What is the MOA for Trimethoprim (TMP)?
Inhibits bacterial Dihydrofolate Reductase - Bacteriostatic
Treatment of hypertension - especially with renal disease (lowers bp centrally - so flow is maintained to kidney).
Inhibition of 50S peptidyl transferase - Bacteriostatic
dry mouth - sedation - severe rebound hypertension

27. MOA: Block nucleotide synthesis
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).
- Haloperidol - chlorpromazine - reserpine - MPTP
is resistant
Sulfonamides - Trimethoprim

28. What is clinical use for Carbenicillin - Piperacillin - and Ticarcillin?
- Ammonium Chloride
- B51Naloxone / naltrexone (Narcan)
Pseudomonas species and Gram - rods
anuria - CHF

29. What drug is given for Pneumocystis carinii prophylaxis?
GI distress - Skin rash - and Seizures at high plasma levels
Rheumatoid and osteoarthritis.
Pentamidine
Same as penicillin. Extended spectrum antibiotics

30. Which drug(s) cause this reaction: Diabetes insipidus?
- Lithium
Pretreat with antihistamines and a slow infusion rate
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.
1. Antipyretic 2. Analgesic 3. Anti - inflammatory

31. Antiarrhythmic class IV- effects?
thick ascending limb
GI distress - Skin rash - and Seizures at high plasma levels
Methicillin - Nafcillin - and Dicloxacillin
decrease conduction velocity - increase ERP - increase PR interval

32. Which drug increases Sys BP w/o affecting Pulse Pressure
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.
1. Hypoglycemia (more common with 2nd - generation drugs: glyburide - glipizide) 2. Disulfiram - like effects (not seen with 2nd - generation drugs).
Epinephrine
GI distress - Skin rash - and Seizures at high plasma levels

33. What are the products and their toxicities of the metabolism of Methanol by / alcohol dehydrogenase?
- Estrogen receptor antagonist - Breast CA - increased endometrial CA risk
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
Inhibits CMV DNA polymerase
- Formaldehyde & formic acid - severe acidosis & retinal damage

34. What are toxic side effects for Metronidazole?
Penicillin - G
Binds to cyclophilins (peptidyl proline cis - trans isomerase) - blocking the differentiation and activation of T cells mainly by inhibiting the production of IL-2 and its receptor.
Disulfiram - like reaction with EtOH - Headache
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.

35. Which drug(s) cause this reaction: Cardiac toxicity?
- Quinidine - quinine
- Daunorubicin & Doxorubicin
Antiprotozoal: Giardia - Entamoeba - Trichomonas - Gardnerella vaginalis Anaerobes: Bacteroides - Clostridium
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)

36. What is the formula for Clearance (CL)
CL= (rate of elimination of drug/ Plasma drug conc.)
viral kinase
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system
Acute gout.

37. List the mechanism - clinical use - & toxicity of Etoposide.
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.
- Hydralazine - Procainamide - INH - phenytoin
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
GnRH analog with agonist properties When used in pulsatile fashion and antagonist properties When used in continuous fashion - causing a transient initial burst of LH and FSH

38. What is the possible mechanism and effect of Metformin in treating diabetes?
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels
Increases coumadin metabolism
Acetylcholine esterase

39. Acetazolamide - toxicity?
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy
dizziness - flushing - constipation (verapamil) - nausea
- Constant AMOUNT eliminated per unit time. - Etoh & ASA
No - it inhibits the release of Nor Epi

40. Which antimicrobial classes inhibit protein synthesis at the 30S subunit? (2)
Cephalosporin: 1) has a 6 member ring attached to the Beta lactam instead of a 5 member ring 2)has an extra functional group ( attached to the 6 member ring)
Headache - flushing - dyspepsia - blue - green color vision.
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic
The only local anesthetic with vasoconstrictive properties.

41. ________ ae not resistant to penicillinase - - but they are less susceptible than the other Beta lactams
Tubocurarine - atracurium - mivacurium - pancuronium - vecuronium - rapacuronium
- Haloperidol - chlorpromazine - reserpine - MPTP
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility
Cephalosporins

42. Name the steps in drug approval(4)?
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.
Fast vs. Slow Acetylators
1. Hydrocortisone 2. Predisone 3. Triamcinolone 4. Dexamethasone 5. Beclomethasone
- Phase I (clinical tests) - Phase II - Phase III - PhaseIV (surveillance)

43. What are common serious side effects of Aminoglycosides and What are these associated with?
Dry flushed skin - due to inhibition of sympathetic post - ganglionic blockade on muscarinic receptors of sweat glands. All others are opposite of What would be expected.
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)
Rapid (seconds)
viral kinase

44. What organisms does Griseofulvin target?
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.
Dermatophytes (tinea - ringworm)
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).
- Upper respiratory tract infections - pneumonias - STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) - Mycoplasma - Legionella - Chlamydia - Neisseria

45. Adverse effects of Prazosin?
Anaerobic infections (e.g. - B. fragilis - C. perfringens)
AZT
Prefers beta's at low doses - but at higher doses alpha agonist effects are predominantly seen.
first dose orthostatic hypotension - dizziness - headache

46. Which drug(s) cause this reaction: Cough?
prevention of nodal arrhythmias (SVT)
- ACE inhibitors (Losartan>no cough)
- Hydralazine - Procainamide - INH - phenytoin
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin

47. Beta Blockers - BP?
Nucleosides
Chronic (weeks or months)
decrease
Inhibit intestinal bursh border Alpha - glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.

48. MOA: Block peptidoglycan synthesis
Abortifacient.
Bacitracin - Vancomycin
impotence - exacerbation of asthma - CV effects - CNS effects - may mask hypoclycemia
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.

49. What antimicrobial class is Aztreonam syngergestic with?
Methicillin - Nafcillin - and Dicloxacillin
Cephalosporin: 1) has a 6 member ring attached to the Beta lactam instead of a 5 member ring 2)has an extra functional group ( attached to the 6 member ring)
Aminoglycosides
- reduction - oxy - & hydrolysis - H2O sol. Polar product - P450

50. How does a competitive antagonist effect an agonist?
Delirium - Tremor - Nephrotoxicity
Antileukotriene; blocks leukotriene receptors.
aPTT (intrinsic pathway)
- Shifts the curve to the right - increases Km