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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. Which drug(s) cause this reaction: Neuro and Nephrotoxic?
Lidocaine - Mexiletine - Tocainide
scopolamine
- polymyxins
1. Renal damage 2. Aplastic anemia 3. GI distress

2. Name three ACE inhibitors?
Inhibits reabsorption of uric acid.
Captopril - Enalapril - Lisinopril
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia

3. What is the category of drug names ending in - ipramine (e.g. Imipramine)
Sulfonamides - Trimethoprim
Benzodiazepine.
Erythromycin - Azithromycin - Clarithromycin
Tricyclic antidepressant.

4. Explain pH dependent urinary drug elimination?
Inhibits cGMP phosphodiesterase - casuing increased cGMP - smooth muscle relaxation in the corpus cavernosum - increased blood flow - and penile erection.
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more
- aminoglycosides - loop diuretics - cisplatin
Inhibits Viral DNA polymerase

5. MOA: Disrupt fungal cell membranes
Tricyclic antidepressant.
- Tricyclic antidepressants
Amphotericin B - Nystatin - Fluconazole/azoles
vasodilator - increases cGMP to induce smooth muscle relaxation (arterioles>veins; afterload reduction)

6. What do Aminoglycosides require for uptake?
Oxygen
Chronic Hepatitis A and B - Kaposi's Sarcoma
GI disturbances.
- Quinidine - quinine

7. What are five possible toxic effects of Aspirin therapy?

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8. Which drug(s) cause this reaction: Diabetes insipidus?
- Lithium
Intrathecally
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression
atropine - homatropine - tropicamide

9. A common side effects of Interferon (INF) treatment is?
Because they require some residual islet function.
not a sulfonamide - but action is the same as furosemide
Neutropenia
Paranteral (IV - SC)

10. What antimuscarinic drug is useful for the tx of asthma
Ipratropium
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.
- Phase I (clinical tests) - Phase II - Phase III - PhaseIV (surveillance)
- Ammonium Chloride

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

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12. List the mechanism - clinical use - & toxicity of Nitrosureas.
Severe Gram - rod infections.
- Physostigmine salicylate
- Alkalate DNA - Brain tumors - CNS toxicity
- DNA intercalator - testicular & lymphomas - Pulmonary fibrosis mild myelosuppression.

13. How does resistance to Vancomycin occur?
NO
reversible SLE- like syndrome
With an amino acid change of D- ala D- ala to D- ala D- lac
Beta antagonist.

14. What is the category and mechanism of action of Zafirlukast in Asthma treatment?
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.
Antileukotriene; blocks leukotriene receptors.
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin
Acute gout.

15. Are Ampicillin and Amoxicillin are not...
penicillinase resistant
dizziness - flushing - constipation (verapamil) - nausea
Sulfonylureas are oral hypoglycemic agents - they are used to stimulate release of endogenous insulin in NIDDM (type -2).
Chronic anticoagulation.

16. Adverse effect of Nitroprusside?
Inhalational general anesthetic.
cyanide toxicity (releases CN)
1. Pioglitazone 2. Rosiglitazone.
Erythromycin - Azithromycin - Clarithromycin

17. Which drug(s) cause this reaction: P450 inhibition(6)?
Chronic gout.
- Deferoxamine
- Penicillamine
- Cimetidine - ketoconazole - grapefruit juice - erythromycin - INH - sulfonamides

18. Which antimicrobials inhibit protein synthesis at the 50S subunit? (4)
Constant FRACTION eliminated per unit time.(exponential)
Gram + - Gram - - Norcardia - Chlamydia
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)

19. What is the category of drug names ending in - olol (e.g. Propranolol)
Beta antagonist.
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
physostigmine

20. What cholinergic inhibitor acts by directly inhibiting Ach release at the presynaptic terminal
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Slow - limited by half lives of clotting factors
Botulinum
VACUUM your Bed Room'

21. What is the mecanism of action - effective period - and ineffective period of use for Cromolyn in treating Asthma?
1. Antiandrogen 2. Nausea 3. Vomiting
orthostatic and exercise hypotension - sexual dysfunction - diarrhea
diuretics - sympathoplegics - vasodilators - ACE inhibitors - Angiotensin II receptor inhibitors
Prevents release of mediators from mast cells. Effective only for the prophylaxis of asthma. Not effective during an acute attack.

22. MOA: Block cell wall synthesis by inhib. Peptidoglycan cross - linking (7)
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins
- Glucocorticoid withdrawal
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).
Liver

23. Which drug(s) cause this reaction: Agranulocytosis (3)?
- Cloazapine - carbamazapine - colchicine - PTU
Increased systolic and pulse pressure - decreased diastolic pressure - and little change in mean pressure.
- Oxalic acid - Acidosis & nephrotoxicity
Minor hepatotoxicity - Drug interactions (activates P450)

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

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25. What is the memory key for the effect of magnesium hydroxide overuse?
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.
Extended spectrum penicillin: certain Gram + bacteria and Gram - rods
Mg = Must go to the bathroom.
Prophylaxis for Influenza A - Rubella; Parkinson's disease

26. Digoxin v. Digitoxin: protein binding?
Onchocerciasis ('river blindness'-- rIVER- mectin)
Digitoxin 70% Digoxin 20-40%
Bethanechol - Neostigmine - physostigmine
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia

27. What are two toxicities of the Glitazones?
Penicillin - V
1. Weight gain 2. Hepatotoxicity (troglitazone)
Inhibits CMV DNA polymerase
- Quinidine - quinine

28. For Warfarin What is the Structure
Post - op and neurogenic ileus and urinary retention - myasthenia gravis - and reversal of neuromuscular junction blockade (post - op) through anticholinesterase activity.
INH: Injures Neurons and Hepatocytes
Small lipid - soluble molecule
Choline acetyltransferase

29. Toxicities associated with Acyclovir?
cross - allergenic
CL= (rate of elimination of drug/ Plasma drug conc.)
Binding to the presynaptic alpha 2 release modulating receptors
Delirium - Tremor - Nephrotoxicity

30. What is the MOA of Polymyxins?
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents
Yes - it does not cross the placenta.
Cardiac glycoside (inotropic agent).
Inhibt Assembly of new virus by Blocking Protease Enzyme

31. What is the MOA of Foscarnet?
Systemic mycoses
Norepinephrine
- Triggers apoptosis - CLL - Hodgkin's in MOPP - Cushing - like syndrome
Inhibits Viral DNA polymerase

32. What is the MOA for Amphotericin B?
cross - allergenic
- Triggers apoptosis - CLL - Hodgkin's in MOPP - Cushing - like syndrome
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis
It must be Phosphorylated by Viral Thymidine Kinase

33. What is the MOA for Rifampin?
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
Inhibits DNA dependent RNA polymerase
- Disulfram & also sulfonylureas - metronidazole
Only in limited amounts

34. Digitalis - site of action?
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine
cholestyramine - colestipol
Na/K ATPase
Cryptococcal meningitis in AIDS patients and Candidal infections of all types

35. How does a noncompetitive antagonist effect an agonist?
Leukotrienes increasing bronchial tone.
Digitoxin 70% Digoxin 20-40%
- Class III antiarrhythmics (sotalol) - class IA (quinidine)
- Shifts the curve down - reduces Vmax

36. Name some common Sulfonamides (4)
AZT
- Halothane - Valproic acid - acetaminophen - Amantia phalloides
Carbenicillin - Piperacillin - and Ticarcillin
Sulfamethoxazole (SMZ) - Sulfisoxazole - Triple sulfas - Sulfadiazine

37. Describe the MOA of Interferons (INF)
- Fluoroquinolones
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
dry mouth - sedation - severe rebound hypertension
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis

38. What cholinomimetics might your pt be taking for his glaucoma
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.)
Carbachol - pilocarpine - physostigmine - echothiophate
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.
Inhibits cell wall synthesis ( binds to PBP3). A monobactam

39. What musculo - skeletal side effects in Adults are associated with Floroquinolones?
Lovastatin - Pravastatin - Simvastatin - Atorvastatin
pulmonary edema - dehydration
reversible SLE- like syndrome
Tendonitis and Tendon rupture

40. When is HIV therapy initiated?
Nevirapine - Delavirdine
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load
Topical and Oral - for Oral Candidiasis (Thrush)
Chloramphenicol - Erythromycin/macrolides - Lincomycin - Clindamycin - Streptogramins (quinupristin - dalfopristin)

41. What are the major toxic side effects of the Cephalosporins?
1. Aluminum hydroxide: constipation and hypophosphatemia 2. Magnesium hydroxide: diarrhea 3. Calcium carbonate: Hypercalcemia - rebound acid increase - All may cause hypokalemia
- Corticosteroids - heparin
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
Zidovudine (AZT) - Didanosine (ddI) - Zalcitabine (ddC) - Stavudine (d4T) - Lamivudine (3TC)

42. 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
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic
Rifampin - Ethambutol - Streptomycin - Pyrazinamide - Isoniazid (INH)
-100% oxygen - hyperbaric
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)

43. How are the HIV drugs used clinically?

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44. What is the category of drug names ending in - azol (e.g. Ketoconazole)
Antifungal.
HTN - CHF - calcium stone formation - nephrogenic DI.
Bleeding.
Indomethacin is used to close a patent ductus arteriosus.

45. How are Sulfonamides employed clinically?
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.
GI discomfort
Pseudomembranous colitis (C. difficile) - fever - diarrhea
Gram + - Gram - - Norcardia - Chlamydia

46. What is the mechanism of action of Ticlopidine - Clopidogrel
To inhibit renal Dihydropeptidase I and decrease Imipenem inactivation in the renal tubules
- Phase I (clinical tests) - Phase II - Phase III - PhaseIV (surveillance)
Inhibits platelet aggregation by irreversibly inhibiting the ADP pathway involved in the binding of fibrinogen.
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions

47. What is the category - mechanism of action - and effect of Ipratroprium in Asthma treatment?
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
Hypersensitivity reactions
Muscarinic antagonist; competatively blocks muscarinic receptors - preventing bronchoconstriction.
Gram + - Gram - - Norcardia - Chlamydia

48. How would hemicholinium treatment affect cholinergic neurons?
Long.
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia
Chronic Hepatitis A and B - Kaposi's Sarcoma

49. What is an occasional side effect of Aztreonam?
Oral
GI upset
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.
Choline acetyltransferase

50. What is the MOA of Isoniazid (INH)?
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression
Decreases synthesis of Mycolic Acid
compensatory tachycardia - fluid retention - lupus - like syndrome
glaucoma - urinary alkalinization - metabolic alkalosis - altitude sickness