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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 are the side effects of Polymyxins?
Neurotoxicity - Acute renal tubular necrosis
decrease the slope of phase 4 - increase PR interval (the AV node is particularly sensitive)
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.
Chagas' disease - American Trypanosomiasis (Trypanosoma cruzi)

2. Which drug(s) cause this reaction: SLE- like syndrome?
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).
- Hydralazine - Procainamide - INH - phenytoin
- Vinca alkaloids(inhibit MT) - Paclitaxel

3. What drugs target anticholinesterase
Neostigmine - pyridostigmine edrophonium - physostigmine echothiophate
decrease conduction velocity - increase ERP - increase PR interval
troponin - tropomyosin system
- Physostigmine salicylate

4. What parasites are treated with Pyrantel Pamoate (more specific)?
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
Cephalosporins
Severe Gram - rod infections.
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)

5. Which diuretics cause acidosis?
loop diuretics - spironolactone
- Hydralazine - Procainamide - INH - phenytoin
Short.
carbonic anhydrase inhibitors - K+ sparing diuretics

6. List the specific antidote for this toxin: Digitalis
- Normalize K+ - Lidocaine - & Anti - dig Mab
Methicillin - Nafcillin - and Dicloxacillin
Sulfonylureas are oral hypoglycemic agents - they are used to stimulate release of endogenous insulin in NIDDM (type -2).
atropine - homatropine - tropicamide

7. Isopoterenol was given to a patient with a developing AV block - why?
Stimulates beta adrenergic receptors
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.
GI distress - Tooth discoloration and Inhibition of bone growth in children - Fanconi's syndrome - Photosensitivity
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin

8. Which diuretics increase urine Ca2+?
osmotic diuretic - increase tubular fluid osmolarity - thereby increasing urine flow
loop diuretics - spironolactone
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression
edrophonium (extremely short acting anticholinesterase)

9. What are two toxicities of the Glitazones?
Teratogenic - Carcinogenic - Confusion - Headaches
Milk or Antacids - because divalent cations inhibit Tetracycline absorption in the gut
1. Weight gain 2. Hepatotoxicity (troglitazone)
1. Gastric ulceration 2. Bleeding 3. Hyperventilation 4. Reye's syndrome 5. Tinnitus (CN VIII)

10. List the specific antidote for this toxin: Antimuscarinic (anticholinergic)
Clavulanic acid
Prevents release of mediators from mast cells. Effective only for the prophylaxis of asthma. Not effective during an acute attack.
- Physostigmine salicylate
orthostatic and exercise hypotension - sexual dysfunction - diarrhea

11. Which drug(s) cause this reaction: Focal to massive hepatic necrosis (4)?
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism
Ipratropium
- Halothane - Valproic acid - acetaminophen - Amantia phalloides

12. Acetazolamide causes?

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13. Name three K+ sparing diuretics?
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression
Spironolactone - Triamterene - Amiloride (the K+ STAys)
Ibuprofen - Naproxen - and Indomethacin
hypertension - CHF - diabetic renal disease

14. Name three Antiarrhythmic drugs in class IV.
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.
Those patients who are taking nitrates.
Verapamil - Diltiazem - Bepridil
Binds to the Pyrophosphate Binding Site of the enzyme

15. What are toxicities associated with Chloramphenicol?
cardiac depression - peripheral edema - flushing - dizziness - constipation
Inhibits Viral DNA polymerase
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis
Aplastic anemia (dose independent) - Gray Baby Syndrome

16. What type of patient should not take Misoprostol and why?
Inhibits cell wall mucopeptide formation - Bactericidal
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.
scopolamine
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis

17. How is Vancomycin used clinically?
increase AP duration - increase ERP - increase QT interval - for use When other arrhythmics fail
For serious - Gram + multidrug - resistant organisms
Acute (hours)
1. Renal damage 2. Aplastic anemia 3. GI distress

18. Which of epi - norepi - or isoproterenol results in bradycardia?
Centrally acting alpha agonist - thus causing a decrease in central adrenergic outflow - spairing renal blood flow
Norepinephrine
- Nitrate - hydroxocobalamin thiosulfate
With an amino acid change of D- ala D- ala to D- ala D- lac

19. Antiarrhythmic class IC- toxicity?
proarrhythmic
bradycardia - AV block - CHF
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism
loop diuretics - thiazides

20. Antimicrobial prophylaxis for a history of recurrent UTIs
TMP- SMZ
Cryptococcal meningitis in AIDS patients and Candidal infections of all types
sedation - positive Coombs' test
1. Pioglitazone 2. Rosiglitazone.

21. Which drug(s) cause this reaction: Extrapyramidal side effects (3)?
Pyridoxine (B6) administration
Lovastatin - Pravastatin - Simvastatin - Atorvastatin
Sulfamethoxazole (SMZ) - Sulfisoxazole - Triple sulfas - Sulfadiazine
- Chlorpromazine - thioridazine - haloperidol

22. What is the memory key for the effect of aluminum hydroxide overuse?
Beta adrenergic receptors and Ca2+ channels (stimulatory)
AluMINIMUM amount of feces.
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)
ACE inhibitor.

23. Which drug(s) cause this reaction: Pseudomembranous colitis?
- Clindamycin
Lipoxygenase
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention
Hypokalemic metabolic alkalosis - hyponatremia - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia - sulfa allergy.

24. List the specific antidote for this toxin: Methemoglobin
dizziness - flushing - constipation (verapamil) - nausea
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions
hyperaldosteronism - K+ depletion - CHF
- Methylene blue

25. Name two bile acid resins.
Only in limited amounts
cholestyramine - colestipol
Decrease the production of leukotrienes and protaglandins by inhibiting phospholipase A2 and expression of COX-2.
Resistant Gram - infections

26. MOA: Bactericidal antibiotics
thiazides - amiloride
1. Antiandrogen 2. Nausea 3. Vomiting
aPTT (intrinsic pathway)
Penicillin - Cephalosporins - Vancomycin - Aminoglycosides - Fluoroquinolones - Metronidazole

27. What are the products and their toxicities of the metabolism of Methanol by / alcohol dehydrogenase?
- Formaldehyde & formic acid - severe acidosis & retinal damage
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)

28. What is the mechanism of action of Allopurinol used to treat chronic gout?
In 4 half - lifes= (94%) T1/2 = (0.7x Vd)/CL
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.
Liver

29. What is the category of drug names ending in - ane (e.g. Halothane)
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis
Inhalational general anesthetic.
Chloramphenicol - Erythromycin/macrolides - Lincomycin - Clindamycin - Streptogramins (quinupristin - dalfopristin)
Anaerobes

30. What is the memory aid for subunit distribution of ribosomal inhibitors?

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31. Are Ampicillin and Amoxicillin are not...
- Clindamycin
Treatment of hypertension - especially with renal disease (lowers bp centrally - so flow is maintained to kidney).
penicillinase resistant
check PFTs - LFTs - and TFTs

32. A group of pts are rushed into the ER complaining of excessive sweating - tearing - salivation - HA - N and V - muscle twitching - difficulty breathing and diarrhea. What drug would be the most effective immediate tx
Cephalosporins
- Vinca alkaloids(inhibit MT) - Paclitaxel
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
Short.

33. Which drug(s) cause this reaction: Hot flashes?
Beta Blockers
Inhibit intestinal bursh border Alpha - glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.
- Ethosuxamide - sulfonamides - lamotrigine
- Tamoxifen

34. How do you calculate maintenance dose?
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.
propanolol - esmolol - metoprolol - atenolol - timolol
Md= (CpxCL)/F Cp= plas. Conc. CL=clear. F=bioaval.
orthostatic and exercise hypotension - sexual dysfunction - diarrhea

35. List the specific antidote for this toxin: TPA & Streptokinase
- Aminocaproic acid
YES
scopolamine
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT

36. Which Aminoglycoside is used for Bowel Surgery ?
Neomycin
propanolol - esmolol - metoprolol - atenolol - timolol
Inhibit Ergosterol synthesis
Binds to the Pyrophosphate Binding Site of the enzyme

37. What is the major toxic side effect of Penicillin?
Decreased uptake or Increased transport out of cell
Give an antichloinesterase - neostigmine - edrophonium - etc
Hypersensitivity reactions
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin

38. What effect would atropine have on the preganglionic sympathetic activation of sweat glands? Would this person sweat?
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole
None. No - because atropine would block the postganglionic muscarinic receptors involved in sweat gland stimulation.
YES

39. Why are the Sulfonylureas inactive in IDDM (type -1)?
Polymyxin B - Polymyxin E
Because they require some residual islet function.
hyperaldosteronism - K+ depletion - CHF
- DNA intercalator - Hodgkin's - myeloma - sarcoma - and solid tumors - Cardiotoxicity & alopecia

40. Where does Griseofulvin deposit?
Gram + cocci - Gram - rods - and Anerobes
Keratin containing tissues - e.g. - nails
GI discomfort
Mycobacterium tuberculosis - the only agent used as solo prophylaxis against TB

41. Guanethidine enhances the release of Norepi?
No - it inhibits the release of Nor Epi
Triple sulfas or SMZ
Anaerobic infections (e.g. - B. fragilis - C. perfringens)
Carbenicillin - Piperacillin - and Ticarcillin

42. What is the MOA for the Aminoglycosides?
Premature infants - because they lack UDP- glucuronyl transferase
Inhibits formation of Initiation Complex - causes misreading of mRNA - Bactericidal
With an amino acid change of D- ala D- ala to D- ala D- lac
Early myocardial infarction.

43. What is the MOA for Rifampin?
loop diuretics - thiazides
Oxygen
Inhibits DNA dependent RNA polymerase
Gram + cocci - Gram - rods - and Anerobes

44. If a patient is given hexamethonium - What would happen to his/her heart rate?
It would increase to ~ 100 beats/min. Both sympathetic and vagal stimulation would be knocked out - but the SA node has an intrinsic pace of 100 beats/min - Which is normally checked by vagal stimulation.
1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone When used of Leprosy 3. Used in combination with other drugs
Acts as a wide spectrum carbapenem
Antifungal.

45. Name five Antiarrhythmic drugs in class II?
propanolol - esmolol - metoprolol - atenolol - timolol
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
- Acetaldehyde - Nausea - vomiting - headache - & hypotension
Edrophonium

46. What is the category - mechanism of action - and particular use of beclomethasone and prednisone in Asthma treatment?
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.)
Heparin catalyzes the activation of antithrombin III.
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.

47. What is a common side effect of Misoprostol?
1. Meningococcal carrier state 2. Chemoprophylaxis in contacts of children with H. influenzae type B
cinchonism: HA - tinnitus - thrombocytopenia - torsade de pointes due to increased QT interval
Teratogenic - Carcinogenic - Confusion - Headaches
Diarrhea

48. Which cancer drugs work at the level of proteins(2)?
- Vinca alkaloids(inhibit MT) - Paclitaxel
post MI and digitalis induced arrhythmias
Cephalosporins
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome

49. List the specific antidote for this toxin: Amphetamine
- Ammonium Chloride
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy
Diuresis in pateints with sulfa allergy
cinchonism: HA - tinnitus - thrombocytopenia - torsade de pointes due to increased QT interval

50. What are the clinical uses for Aztreonam?
Fast vs. Slow Acetylators
dry mouth - sedation - severe rebound hypertension
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
Oral treatment of superficial infections