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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 major structural differences between Penicillin and Cephalosporin?
Inhibit intestinal bursh border Alpha - glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.
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)
Acute gout.
1. Gastric ulceration 2. Bleeding 3. Hyperventilation 4. Reye's syndrome 5. Tinnitus (CN VIII)

2. For Heparin What is the Route of administration
amphetamine and ephedrine
Paranteral (IV - SC)
Alpha -1 antagonist
Protamine sulfate

3. Name some common Tetracyclines (4)
Inhibit intestinal bursh border Alpha - glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.
Chronic anticoagulation.
Carbenicillin - Piperacillin - and Ticarcillin
Tetracycline - Doxycycline - Demeclocycline - Minocycline

4. List the mechanism - clinical use - & toxicity of 5 FU.
prevention of nodal arrhythmias (SVT)
Gram + - Gram - - Norcardia - Chlamydia
No - it inhibits the release of Nor Epi
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression

5. What populations are Floroquinolones contraindicated in? Why?
hypokalemia - slight hyperlipidemia - hyperuricemia - lassitude - hypercalcemia - hyperglycemia
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.
Digoxin=urinary Digitoxin=biliary
Pregnant women - Children; because animal studies show Damage to Cartilage

6. What is the category of drug names ending in - tropin (e.g. Somatotropin)
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol
Chronic Hepatitis A and B - Kaposi's Sarcoma
Pituitary hormone.
Beta1 more than B2

7. Name the common Fluoroquinolones (6)
Spironolactone - Triamterene - Amiloride (the K+ STAys)
first dose orthostatic hypotension - dizziness - headache
Ciprofloxacin - Norfloxacin - Ofloxacin - Grepafloxacin - Enoxacin - Nalidixic acid
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)

8. Cocaine shares is mechanism of action with What antidepressant
Hypokalemic metabolic alkalosis - hyponatremia - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia - sulfa allergy.
1. Meningococcal carrier state 2. Chemoprophylaxis in contacts of children with H. influenzae type B
Interferes with microtubule function - disrupts mitosis - inhibits growth
TCA

9. Antimicrobial prophylaxis for PCP
Pretreat with antihistamines and a slow infusion rate
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine
TMP- SMZ (DOC) - aerosolized pentamidine
decrease the slope of phase 4 - increase PR interval (the AV node is particularly sensitive)

10. What is the mechanism of action of the Alpha - glucosidase inhibitors?
Amphotericin B - Nystatin - Fluconazole/azoles
- Metronidazole - certain cephalosporins - procarbazine - sulfonylureas
Inhibit intestinal bursh border Alpha - glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.
Sulfonamides - Trimethoprim

11. Ethacrynic Acid - mechanism?
not a sulfonamide - but action is the same as furosemide
Slow - limited by half lives of clotting factors
proarrhythmic
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia

12. How is Vancomycin used clinically?
For serious - Gram + multidrug - resistant organisms
Erythromycin - Azithromycin - Clarithromycin
Prevents the release of ACh - Which results in muscle paralysis.
- Flumazenil

13. ACE inhibitors - mechanism?
reduce levels of Angiotensin II - thereby preventing the inactivation of bradykinin (a potent vasodilator); renin level is increased
Nifedipine - Verapamil - Diltiazem
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids
- Fluoroquinolones

14. What are the four conditions in Which Omeprazole - Lansoprazole is used?
Chagas' disease - American Trypanosomiasis (Trypanosoma cruzi)
Chronic Hepatitis A and B - Kaposi's Sarcoma
Verapamil - Diltiazem - Bepridil
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome

15. Which drug(s) cause this reaction: Adrenocortical Insufficiency
- Glucocorticoid withdrawal
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)
Diuresis in pateints with sulfa allergy
depresses ectopic pacemakers - especially in digoxin toxicity

16. What parasites are treated with Pyrantel Pamoate (more specific)?
Beta -2 agonist.
- Cimetidine - ketoconazole - grapefruit juice - erythromycin - INH - sulfonamides
Severe Gram - rod infections.
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)

17. Name three calcium channel blockers?
Nifedipine - Verapamil - Diltiazem
aPTT (intrinsic pathway)
reversible SLE- like syndrome
1. Antipyretic 2. Analgesic 3. Anti - inflammatory

18. What beta 2 agonist will help your 21yo Astma pt?
Albuterol - tertbutaline
- Tricyclic antidepressants
osmotic diuretic - increase tubular fluid osmolarity - thereby increasing urine flow
Butyrophenone (neuroleptic).

19. Adverse effects of Prazosin?
first dose orthostatic hypotension - dizziness - headache
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)
No - hemicholinum block the uptake of Choline and thus Ach synthesis
1. Renal damage 2. Aplastic anemia 3. GI distress

20. Hydralazine - clinical use?
Methylzanthine; desired effect is bronchodilation - may cause bronchodilation by inhibiting phosphodiesterase - enzyme involved in degrading cAMP (controversial).
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.
Bacitracin - Vancomycin
severe hypertension - CHF

21. The COX-2 inhibitors (celecoxib - rofecoxib) have similar side effects to the NSAIDs with What one exception?
No - warfarin - unlike heparin - can cross the placenta.
Nephrotoxicity
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.
Chronic (weeks or months)

22. What is an additional side effect of Methicillin?
Epinephrine
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.
Interstitial nephritis
orthostatic and exercise hypotension - sexual dysfunction - diarrhea

23. Adverse effects of Losartan?
Wide spectrum of systemic mycoses: Cryptococcus - Blastomyces - Coccidioides - Aspergillus - Histoplasma - Candida - Mucor
1. Gastric ulceration 2. Bleeding 3. Hyperventilation 4. Reye's syndrome 5. Tinnitus (CN VIII)
fetal renal toxicity - hyperkalemia
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )

24. What are Aminoglycosides used for clinically?
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system
- Aminocaproic acid
Severe Gram - rod infections.
AV nodal cells

25. What is the MOA for the Tetracyclines?
- acetylation - glucuron. - & sulfation - Conjugation - Polar product
Fast vs. Slow Acetylators
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic
With supplemental Folic Acid

26. Name two LPL stimulators.
Those patients who are taking nitrates.
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Slow - limited by half lives of clotting factors
Gemfibrozil - Clofibrate

27. Acetazolamide - mechanism?
TCA
Rapid (seconds)
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.
Indomethacin is used to close a patent ductus arteriosus.

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

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29. What are major side effects of Methicillin - Nafcillin - and Dicloxacillin?
Acts as a wide spectrum carbapenem
thick ascending limb
Hypersensitivity reactions
Beta - lactamase cleavage of Beta - lactam ring

30. Ganciclovir associated toxicities?
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity
Digitoxin>95% Digoxin 75%
1. Predisposes to viral infections and lymphoma 2. Nephrotoxic (preventable with mannitol diuresis)

31. Which drug(s) cause this reaction: Cutaneous flushing (4)?
- Niacin - Ca++ channel blockers - adenosine - vancomycin
penicillinase resistant
Succinylcholine
Indirect agonist - uptake inhibitor

32. What is the category of drug names ending in - zosin (e.g. Prazosin)
Protamine sulfate
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori
proximal convoluted tubule - thin descending limb - and collecting duct
Alpha -1 antagonist

33. Which drug(s) cause this reaction: Tendonitis and rupture?
torsade de pointes
For serious - Gram + multidrug - resistant organisms
- Fluoroquinolones
Inhibits CMV DNA polymerase

34. Is resistant to penicillinase?
Suramin
- acetylation - glucuron. - & sulfation - Conjugation - Polar product
Neutropenia
Imipenem

35. What are three toxicities of Propylthiouracil?
Rifampin (DOC) - minocycline
new arrhythmias - hypotension
loop diuretics - spironolactone
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia

36. What is the category - mechanism of action - and effect of Ipratroprium in Asthma treatment?
- ED 50 is less than the Km (less than 50% of receptors)
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy
It affects beta receptors equally and is used in AV heart block (rare).
Muscarinic antagonist; competatively blocks muscarinic receptors - preventing bronchoconstriction.

37. What is the main clinical use for the thrombolytics?
Inhibit Ergosterol synthesis
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.
Early myocardial infarction.

38. What is the category of drug names ending in - ipramine (e.g. Imipramine)
Interferes with microtubule function - disrupts mitosis - inhibits growth
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)
Tricyclic antidepressant.
thiazides - amiloride

39. Why are the Sulfonylureas inactive in IDDM (type -1)?
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy
cinchonism: HA - tinnitus - thrombocytopenia - torsade de pointes due to increased QT interval
Because they require some residual islet function.
Tetracycline - Doxycycline - Demeclocycline - Minocycline

40. What antimuscarinic drug is useful for the tx of asthma
torsade de pointes - excessive Beta block
Ipratropium
Treatment of infertility.
BM suppression (neutropenia - anemia) - Peripheral neuropathy

41. Furosemide increases the excretion of What ion?
Ca2+ (Loops Lose calcium)
impotence - exacerbation of asthma - CV effects - CNS effects - may mask hypoclycemia
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
new arrhythmias - hypotension

42. Mannitol - clinical use?
Topical and Oral - for Oral Candidiasis (Thrush)
Inhibit intestinal bursh border Alpha - glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.
ARF - shock - drug overdose - decrease intracranial/intraocular pressure
Dopamine

43. What are the major toxic side effects of the Cephalosporins?
Peptic ulcer disease.
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
Sulfonamide Loop Diuretic. Inhibits ion co - transport system of thick ascending loop. Abolishes hypertonicity of the medulla - thereby preventing concentration of the urine.
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori

44. What is the category of drug names ending in - terol (e.g. Albuterol)
NO HYPERURICEMIA - NO SULFA AllERGY; same as furosemide otherwise
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Hypersensitivity reactions
Beta -2 agonist.

45. Does Heparin have a long - medium - or short half life?
Short.
- Infections - Trauma - Seizures - CO - Overdose - Metabolic - Alcohol (IT'S COMA)
HSV - VZV - EBV - Mucocutaneous and Genital Herpes Lesions - Prophylaxis in Immunocompromised pts
- Normalize K+ - Lidocaine - & Anti - dig Mab

46. Name five Antiarrhythmic drugs in class II?
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
torsade de pointes
propanolol - esmolol - metoprolol - atenolol - timolol
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.

47. Name some common Sulfonamides (4)
CMV - esp in Immunocompromised patients
torsade de pointes - excessive Beta block
Sulfamethoxazole (SMZ) - Sulfisoxazole - Triple sulfas - Sulfadiazine
Oxygen

48. Toxic effects of TMP include?
- MT polymerization inhibitor(M phase) - MOPP - lymphoma - Willm's & choriocarcinoma - neurotoxicity and myelosuppression
Megaloblastic anemia - Leukopenia - Granulocytopenia
atropine - homatropine - tropicamide
Pralidoxime regenerates active cholinesterase.

49. What is the MOA for Ampicillin and Amoxicillin?
Same as penicillin. Extended spectrum antibiotics
for RSV
Cardiac glycoside (inotropic agent).
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.

50. Why is there a drop in systolic - mean - and diastolic bp with infusion of isoproterenol?
- Acetaldehyde - Nausea - vomiting - headache - & hypotension
Cryptococcal meningitis in AIDS patients and Candidal infections of all types
Stimulating beta receptors stimulates heart rate - but beta receptor induced vasodilation reduces peripheral resistance.
Inhibits CMV DNA polymerase