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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.
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. Furosemide - toxicity? (OH DANG)
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression
Ototoxicity - Hypokalemia - Dehydration - Allergy (sulfa) - Nephritis (interstitial) - Gout
Antibiotic - protein synthesis inhibitor.
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin

2. List the mechanism - clinical use - & toxicity of Cisplatin.
- Oral Contraceptives
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
Quinolones
- NaHCO3

3. Beta Blockers - CV toxicity?
It affects beta receptors equally and is used in AV heart block (rare).
bradycardia - AV block - CHF
distal convoluted tubule (early)
Rifampin (DOC) - minocycline

4. Ganciclovir associated toxicities?
atropine - homatropine - tropicamide
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity
Acetylcholine esterase

5. For Heparin What is the Ability to inhibit coagulation in vitro
Chronic gout.
Yes
1. Gastric ulceration 2. Bleeding 3. Hyperventilation 4. Reye's syndrome 5. Tinnitus (CN VIII)
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.

6. What is the MOA for Metronidazole?
Forms toxic metabolites in the bacterial cell - Bactericidal
Dermatophytes (tinea - ringworm)
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.)
Nifedipine - Verapamil - Diltiazem

7. What conditions are treated with Metronidazole?
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas
Neostigmine - pyridostigmine edrophonium - physostigmine echothiophate
Pseudomonas species and Gram - rods
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)

8. ACE inhibitors - toxicity?
Decrease the production of leukotrienes and protaglandins by inhibiting phospholipase A2 and expression of COX-2.
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic
Large anionic polymer - acidic
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)

9. What musculo - skeletal side effects in Adults are associated with Floroquinolones?
Reversibly inhibits cyclooxygenase - mostly in CNS. Inactivated peripherally.
cortical collecting tubule
- Quinidine - quinine
Tendonitis and Tendon rupture

10. Aztreonam is not usually...
Antibiotic - protein synthesis inhibitor.
Directly of indirectly aid conversion of plasminogen to plasmin Which cleaves thrombin and fibrin clots. (It is claimed that tPA specifically converts fibrin - bound plasminogen to plasmin.)
Phosphorylation by a Viral Kinase
toxic

11. List the mechanism - clinical use - & toxicity of Prednisone.

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12. Name four Antiarrhythmic drugs in class IA.
Acetylcholine esterase
Quinidine - Amiodarone - Procainamide - Disopyramide
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT
Aminoglycosides

13. What is the mechanism of action of the H2 Blockers?
Reversible block of histamine H2 receptors
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.
Blocks Peptide Bond formation at the 50S subunit - Bacteriostatic

14. How are Sulfonamides employed clinically?
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).
Gram + - Gram - - Norcardia - Chlamydia
- B51Naloxone / naltrexone (Narcan)
- Formaldehyde & formic acid - severe acidosis & retinal damage

15. What is the category of drug names ending in - phylline (e.g. Theophylline)
Fast vs. Slow Acetylators
GI discomfort - Acute cholestatic hepatitis - Eosinophilia - Skin rashes
Methylxanthine.
Topical and Oral - for Oral Candidiasis (Thrush)

16. List the mechanism - clinical use - & toxicity of Doxorubicin.

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17. Antiarrhythmic class IB- toxicity?
Onchocerciasis ('river blindness'-- rIVER- mectin)
local anesthetic. CNS stimulation or depression. CV depression.
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic
Polymyxins

18. What is the definition of zero - order kinetics? Example?
Ibuprofen - Naproxen - and Indomethacin
- Constant AMOUNT eliminated per unit time. - Etoh & ASA
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.
Ataxia - Dizziness - Slurred speech

19. For Heparin What is the Treatment for overdose
Same as penicillin. Extended spectrum antibiotics
Protamine sulfate
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
Malaria (P. falciparum)

20. Specifically - How does Foscarnet inhibit viral DNA pol?
Because they require some residual islet function.
Binds to the Pyrophosphate Binding Site of the enzyme
Treatment of hypertension - especially with renal disease (lowers bp centrally - so flow is maintained to kidney).
Pentamidine

21. For Warfarin What is the Onset of action
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
atropine - homatropine - tropicamide
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD
Slow - limited by half lives of clotting factors

22. What is the clinical use for Sildenafil (Viagra)?
DOC in diagnosing and abolishing AV nodal arrhythmias
- Hypersensitivity reactions - Hemolysis - Nephrotoxicity (tubulointerstitial nephritis) - Kernicterus in infants Displace other drugs from albumin (e.g. - warfarin)
- Bleomycin - amiodarone - busulfan
Erectile dysfunction.

23. What is the lab value used to monitor the effectiveness of Heparin therapy?
Ipratropium
Binds ergosterol - Disrupts fungal membranes
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.
The PTT.

24. What is an occasional side effect of Aztreonam?
Protease inhibitor.
GI upset
Ca2+ (Loops Lose calcium)
narcolepsy - obesity - and attention deficit disorder (I wouldn't recommend this)

25. Why would a patient with cog - wheel rigidity and a shuffling gait be given benztropine?
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.
hypertension - CHF - diabetic renal disease
cyanide toxicity (releases CN)
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy

26. What is the mechanism of action of Probenacid used to treat chronic gout?
Inhibits reabsorption of uric acid.
- Ethanol - dialysis - & fomepizole
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions
Mg = Must go to the bathroom.

27. What cholinomimetic is useful in the diagnosis of Myasthenia Gravis
- acetylation - glucuron. - & sulfation - Conjugation - Polar product
Edrophonium
Inhibit Ergosterol synthesis
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.

28. Which diuretics decrease urine Ca2+?
thiazides - amiloride
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)
Sulfonamide Loop Diuretic. Inhibits ion co - transport system of thick ascending loop. Abolishes hypertonicity of the medulla - thereby preventing concentration of the urine.
Quinidine - Amiodarone - Procainamide - Disopyramide

29. What is the category of drug names ending in - oxin (e.g. Digoxin)
cinchonism: HA - tinnitus - thrombocytopenia - torsade de pointes due to increased QT interval
Give an antichloinesterase - neostigmine - edrophonium - etc
Due to the presence of a bulkier R group
Cardiac glycoside (inotropic agent).

30. How is Ganciclovir activated?
Phosphorylation by a Viral Kinase
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic
Tricyclic antidepressant.

31. How do you calculate maintenance dose?
Hemolytic anemia
- Infections - Trauma - Seizures - CO - Overdose - Metabolic - Alcohol (IT'S COMA)
Albuterol - tertbutaline
Md= (CpxCL)/F Cp= plas. Conc. CL=clear. F=bioaval.

32. Antimicrobial prophylaxis for a history of recurrent UTIs
TMP- SMZ
Penicillin - G
Inhibits CMV DNA polymerase
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.

33. Adverse effects of Reserpine?
Ataxia - Dizziness - Slurred speech
Stimulating beta receptors stimulates heart rate - but beta receptor induced vasodilation reduces peripheral resistance.
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic
sedation - depression - nasal stuffiness - diarrhea

34. What is the mechanism of action of NSAIDs other than Aspirin?
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.
Decrease the production of leukotrienes and protaglandins by inhibiting phospholipase A2 and expression of COX-2.
The PTT.
GI disturbances.

35. Common side effects associated with Clindamycin include?
Pseudomembranous colitis (C. difficile) - fever - diarrhea
- Act on same receptor - Full has greater efficacy
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
Topical and Oral - for Oral Candidiasis (Thrush)

36. For Warfarin What is the Site of action
Short.
- Tricyclic antidepressants
ACE inhibitor.
Liver

37. What type of patient should not take Misoprostol and why?
Antileukotriene; blocks synthesis by lipoxygenase.
- Disulfram & also sulfonylureas - metronidazole
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.
Inhibits cell wall synthesis ( binds to PBP3). A monobactam

38. Which cancer drugs work at the level of proteins(2)?
- Vinca alkaloids(inhibit MT) - Paclitaxel
Aminoglycosides - Tetracyclines
Gram + cocci - Gram - rods - and Anerobes
hypokalemia - slight hyperlipidemia - hyperuricemia - lassitude - hypercalcemia - hyperglycemia

39. How is Amantadine used clinically?

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40. What is the MOA for Acyclovir?
- Tamoxifen
Penicillin.
Inhibit viral DNA polymerase
Increase target cell response to insulin.

41. What are the clinical uses for 3rd Generation Cephalosporins?
Pseudomembranous colitis (C. difficile) - fever - diarrhea
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.)
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)
prevention of nodal arrhythmias (SVT)

42. What is the clinical use for Heparin?
Immediate anticoagulation for PE - stroke - angina - MI - DVT.
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)
Meningitis (H. influenza - N. meningitidis - S. pneumoniae) - Conserative treatment due to toxicities

43. List the specific antidote for this toxin: Beta Blockers
physostigmine
- Glucagon
Pyridoxine (B6) administration
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins

44. Name the common Azoles
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole
Bleeding.
1. Meningococcal carrier state 2. Chemoprophylaxis in contacts of children with H. influenzae type B
- Ammonium Chloride

45. Digoxin v. Digitoxin: protein binding?
distal convoluted tubule (early)
Digitoxin 70% Digoxin 20-40%
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.
osmotic diuretic - increase tubular fluid osmolarity - thereby increasing urine flow

46. Why is carbachol and pilocarpine useful in treatment of glaucoma?
Heparin catalyzes the activation of antithrombin III.
Binds ergosterol - Disrupts fungal membranes
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).
ACIDazolamide' causes acidosis

47. What are the clinical uses for 2nd Generation Cephalosporins?
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )
Chronic (weeks or months)
- Ethanol - dialysis - & fomepizole
Chronic gout.

48. Adverse effects of Clonidine?
blocking the beta adrenergic receptor leads to decreased cAMP - and decreased Ca2+ flux
Pseudomonas species and Gram - rods
dry mouth - sedation - severe rebound hypertension
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis

49. What are the Macrolides used for clinically?
Rifampin (DOC) - minocycline
- Upper respiratory tract infections - pneumonias - STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) - Mycoplasma - Legionella - Chlamydia - Neisseria
It inhibits release of NE.
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)

50. Which drug(s) cause this reaction: Gingival hyperplasia?
Topical and Oral - for Oral Candidiasis (Thrush)
Local anesthetic.
- Phenytoin
Beta adrenergic receptors and Ca2+ channels (stimulatory)