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Test your basic knowledge |
USMLE Step 1 Pharmacology
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Study First
Subjects
:
health-sciences
,
usmle-step-1
Instructions:
Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can
study here
.
Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.
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. Mannitol - toxicity?
pulmonary edema - dehydration
Pretreat with antihistamines and a slow infusion rate
decrease conduction velocity - increase ERP - increase PR interval
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load
2. Would blockade of muscarininc receptors in the bladder be useful in treating urinary retention?
1. Hypoglycemia (more common with 2nd - generation drugs: glyburide - glipizide) 2. Disulfiram - like effects (not seen with 2nd - generation drugs).
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.
Potent immunosuppressive used in organ transplant recipients.
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy
3. Which drug(s) cause this reaction: Disulfram - like reaction (4) ?
Diuresis in pateints with sulfa allergy
DHPG (dihydroxy-2- propoxymethyl guanine)
sedation - sleep alterations
- Metronidazole - certain cephalosporins - procarbazine - sulfonylureas
4. For Warfarin What is the Duration of action
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.
1. Gastric ulceration 2. Bleeding 3. Hyperventilation 4. Reye's syndrome 5. Tinnitus (CN VIII)
The PTT.
Chronic (weeks or months)
5. IV Penicillin
Penicillin - G
cortical collecting tubule
Severe Gram - rod infections.
Clavulanic acid
6. K+- clinical use?
Give an antichloinesterase - neostigmine - edrophonium - etc
depresses ectopic pacemakers - especially in digoxin toxicity
Depolymerizes microtubules - impairing leukocyte chemotaxis and degranulation.
Acetylcholinesterase; ACh is broken down into choline and acetate.
7. What is a possible toxicity of Ticlopidine - Clopidogrel usage?
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.
AluMINIMUM amount of feces.
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.
Non - Nucleosides
8. Adverse effects of Nifedipine - verapamil?
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.
dizziness - flushing - constipation (verapamil) - nausea
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis
- Penicillamine
9. What is the memory key for Isoniazid (INH) toxicity?
Dermatophytes (tinea - ringworm)
Minor hepatotoxicity - Drug interactions (activates P450)
GI upset
INH: Injures Neurons and Hepatocytes
10. What cholinomimetics might your pt be taking for his glaucoma
Carbachol - pilocarpine - physostigmine - echothiophate
Systemic mycoses
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills
11. Acetaldehyde is metabolized by Acetaldehyde dehydrogenase - Which drug inhibs this enzyme?
- Disulfram & also sulfonylureas - metronidazole
IV vitamin K and fresh frozen plasma
- DNA intercalator - testicular & lymphomas - Pulmonary fibrosis mild myelosuppression.
Only in limited amounts
12. Which drug(s) cause this reaction: Cough?
Beta - lactam antibiotics
Praziquantel
- ACE inhibitors (Losartan>no cough)
- inhibits HGPRT (pur. Syn.) - Luk - Lymph
13. How is Griseofulvin used clinically?
Potent immunosuppressive used in organ transplant recipients.
Oral treatment of superficial infections
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.
Long.
14. What can result due to antacid overuse?
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.
Methicillin - Nafcillin - and Dicloxacillin
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.
- Halothane - Valproic acid - acetaminophen - Amantia phalloides
15. What conditions are treated with Metronidazole?
Pituitary hormone.
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas
- Vinca alkaloids(inhibit MT) - Paclitaxel
Erythromycin - Azithromycin - Clarithromycin
16. How does Ganciclovir's toxicity relate to that of Acyclovir?
Prevents the release of ACh - Which results in muscle paralysis.
Ganciclovir is more toxic to host enzymes
Ibuprofen - Naproxen - and Indomethacin
Carbachol - pilocarpine - physostigmine - echothiophate
17. Which drug(s) cause this reaction: Extrapyramidal side effects (3)?
Used in combination therapy with SMZ to sequentially block folate synthesis
- Chlorpromazine - thioridazine - haloperidol
H2 antagonist
hypokalemia - slight hyperlipidemia - hyperuricemia - lassitude - hypercalcemia - hyperglycemia
18. Guanethidine enhances the release of Norepi?
Inhibits DNA dependent RNA polymerase
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes
No - it inhibits the release of Nor Epi
Abortifacient.
19. Which drug(s) cause this reaction: Gray baby syndrome?
cyanide toxicity (releases CN)
Beta1 more than B2
AZT - to reduce risk of Fetal Transmission
- Chloramphenicol
20. Resistance mechanisms for Vancomycin
- Constant AMOUNT eliminated per unit time. - Etoh & ASA
Neurotoxicity - Acute renal tubular necrosis
Depolymerizes microtubules - impairing leukocyte chemotaxis and degranulation.
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity
21. Adverse effects of Clonidine?
dry mouth - sedation - severe rebound hypertension
- DNA intercalator - testicular & lymphomas - Pulmonary fibrosis mild myelosuppression.
Anaerobic infections (e.g. - B. fragilis - C. perfringens)
Same as penicillin. Extended spectrum antibiotics
22. What are the major toxic side effects of the Cephalosporins?
Yes
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.
Onchocerciasis ('river blindness'-- rIVER- mectin)
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
23. What drug is used to treat Trematode/fluke (e.g. - Schistosomes - Paragonimus - Clonorchis) or Cysticercosis
GI discomfort - Acute cholestatic hepatitis - Eosinophilia - Skin rashes
Praziquantel
CMV - esp in Immunocompromised patients
Blocks Peptide Bond formation at the 50S subunit - Bacteriostatic
24. Why is carbachol and pilocarpine useful in treatment of glaucoma?
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).
Due to the presence of a bulkier R group
Penicillin.
Dopamine; causes its release from intact nerve terminals
25. List the specific antidote for this toxin: Tricyclic antidepressants
depresses ectopic pacemakers - especially in digoxin toxicity
NO
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.
- NaHCO3
26. What is the difference in receptor affinity of epinephrine at low doses? High doses?
27. What are the phases of succinylcholine neuromuscular blockade?
TMP- SMZ
Prevention of NSAID- induced peptic ulcers - maintains a PDA.
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.
- Hypersensitivity reactions - Hemolysis - Nephrotoxicity (tubulointerstitial nephritis) - Kernicterus in infants Displace other drugs from albumin (e.g. - warfarin)
28. What enzyme is responsible for the production of Ach from Acetyl CoA and Choline
Choline acetyltransferase
- Alkalinize urine & dialysis
NE acts presynaptically on alpha -2 receptors to inhibit its own release. ACh also acts presynaptically through M1 receptors to inhibit NE release.
Imipenem
29. Describe the MOA of Interferons (INF)
- Glucocorticoid withdrawal
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori
Fever/Chills - Hypotension - Nephrotoxicity - Arrhythmias
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis
30. What is the category - desired effect - and adverse effect of Isoproterenol in the treatment of Asthma?
Babiturate.
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).
Only in limited amounts
- NaHCO3
31. What is the memory key for Metronidazole's clinical uses?
Beta lactams - inhibit cell wall synthesis - Bactericidal
Cryptococcal meningitis in AIDS patients and Candidal infections of all types
Used in combination therapy with SMZ to sequentially block folate synthesis
GET on the Metro
32. How does NE modulate its own release? What other neurotransmitter has this same effect?
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.
NE acts presynaptically on alpha -2 receptors to inhibit its own release. ACh also acts presynaptically through M1 receptors to inhibit NE release.
hypertension - CHF - diabetic renal disease
Diarrhea
33. Which cancer drugs effect nuclear DNA (4)?
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide
Norepinephrine (Alpha1 -2 and beta 1)
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load
- Bleomycin - amiodarone - busulfan
34. For Heparin What is the Treatment for overdose
severe orthostatic hypotension - blurred vision - constipation - sexual dysfunction
1. Acarbose 2. Miglitol
hypertension - angina - arrhythmias
Protamine sulfate
35. Which antimicrobial classes inhibit protein synthesis at the 30S subunit? (2)
Hydralazine and Minoxidil
Aminoglycosides - Tetracyclines
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic
- Hypersensitivity reactions - Hemolysis - Nephrotoxicity (tubulointerstitial nephritis) - Kernicterus in infants Displace other drugs from albumin (e.g. - warfarin)
36. Antiarrhythmic class IB- clinical uses?
- Ammonium Chloride
post MI and digitalis induced arrhythmias
reduce levels of Angiotensin II - thereby preventing the inactivation of bradykinin (a potent vasodilator); renin level is increased
Selectively inhibit cyclooxygenase (COX) isoform 2 - Which is found in inflammatory cells nad mediates inflammation and pain; spares COX-1 Which helps maintain the gastric mucosa.
37. Why is reserpine effective in treating HTN?
carbonic anhydrase inhibitors - K+ sparing diuretics
- Aminocaproic acid
Reserpine inhibits dopamine transport into vesicles - attenuating its conversion to NE by dopamine beta - hydroxylase.
Due to the presence of a bulkier R group
38. List the specific antidote for this toxin: Opioids
- B51Naloxone / naltrexone (Narcan)
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
Oral treatment of superficial infections
Amphotericin B - Nystatin - Fluconazole/azoles
39. MOA: Block cell wall synthesis by inhib. Peptidoglycan cross - linking (7)
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins
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
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).
Inhibits DNA dependent RNA polymerase
40. Antimicrobial prophylaxis for Gonorrhea
Ceftriaxone
IV vitamin K and fresh frozen plasma
Methylzanthine; desired effect is bronchodilation - may cause bronchodilation by inhibiting phosphodiesterase - enzyme involved in degrading cAMP (controversial).
Inhibt Assembly of new virus by Blocking Protease Enzyme
41. Which receptors does phenylephrine act upon?
Intrathecally
Blocks Influenza A and RubellA; causes problems with the cerebellA
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
Corticosteroids; prevent production of leukotrienes from arachodonic acid by blocking phospholipase A2. Drugs of choice in a patient with status asthmaticus (in combination with albuterol.)
42. Your patient wants an effective drug to treat his motion sickness - What would you prescribe
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.
Scopolamine
Inhibit Ergosterol synthesis
- Lithium
43. Furosemide - class and mechanism?
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
1. Heavy bleeding 2. GI effects (n/v - anorexia) 3. Abdominal pain
- DNA intercalator - Hodgkin's - myeloma - sarcoma - and solid tumors - Cardiotoxicity & alopecia
Sulfonamide Loop Diuretic. Inhibits ion co - transport system of thick ascending loop. Abolishes hypertonicity of the medulla - thereby preventing concentration of the urine.
44. Which drug(s) cause this reaction: Torsade de pointes (2)?
Benzathine penicillin G
Penicillin - Cephalosporins - Vancomycin - Aminoglycosides - Fluoroquinolones - Metronidazole
- Class III antiarrhythmics (sotalol) - class IA (quinidine)
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
45. Adverse effects of Methyldopa?
46. Name the common Non - Nucleoside Reverse Transcriptase Inhibitors
Teratogenic - Carcinogenic - Confusion - Headaches
Nevirapine - Delavirdine
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
carbonic anhydrase inhibitors - K+ sparing diuretics
47. What is the MOA of the RT Inhibitors?
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA
- MT polymerization inhibitor(M phase) - MOPP - lymphoma - Willm's & choriocarcinoma - neurotoxicity and myelosuppression
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin
Edrophonium
48. How is Leishmaniasis treated?
Inhibition of 50S peptidyl transferase - Bacteriostatic
Hemolytic anemia
Pentavalent Antimony
post MI and digitalis induced arrhythmias
49. Decrease Digoxin dose in renal failure?
YES
Systemic mycoses
orthostatic and exercise hypotension - sexual dysfunction - diarrhea
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.
50. Which drug(s) cause this reaction: Agranulocytosis (3)?
Dopamine; causes its release from intact nerve terminals
Acts as a wide spectrum carbapenem
- Cloazapine - carbamazapine - colchicine - PTU
- Methotrexate - 5 FU - 6 mercaptopurine