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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 is the memory key involving the '4 R's of Rifampin?'
As an anticholinesterase it increases endogenous ACh and thus increases strength.
TCA
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone

2. What enzymes are inhibited by NSAIDs - acetaminophen and COX II inhibitors?
Cyclooxygenases (COX I - COX II).
Well tolerated in general but occasionally - Nephrotoxicity - Ototoxicity - Thrombophlebitis - diffuse flushing='Red Man Syndrome'
Triple sulfas or SMZ
Dobutamine has more of an affintiy for beta -1 than beta -2 - and is used for treating heart failure and shock. Albuterol and terbutaline is the reverse - and is used in treatment of acute asthma.

3. What microorganisms are clinical indications for Tetracycline therapy?

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4. Adverse effects of Losartan?
fetal renal toxicity - hyperkalemia
Indomethacin is used to close a patent ductus arteriosus.
Ibuprofen - Naproxen - and Indomethacin
Binds to cyclophilins (peptidyl proline cis - trans isomerase) - blocking the differentiation and activation of T cells mainly by inhibiting the production of IL-2 and its receptor.

5. Which drug(s) cause this reaction: Tendonitis and rupture?
- Fluoroquinolones
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )
Inhibit viral DNA polymerase
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.

6. Classes of antihypertensive drugs?
- Hypersensitivity reactions - Hemolysis - Nephrotoxicity (tubulointerstitial nephritis) - Kernicterus in infants Displace other drugs from albumin (e.g. - warfarin)
diuretics - sympathoplegics - vasodilators - ACE inhibitors - Angiotensin II receptor inhibitors
- Glucocorticoid withdrawal
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention

7. What is the mechanism of action of Heparin?
HSV - VZV - EBV - Mucocutaneous and Genital Herpes Lesions - Prophylaxis in Immunocompromised pts
Carbachol - pilocarpine - physostigmine - echothiophate
Heparin catalyzes the activation of antithrombin III.
Systemic mycoses

8. What is the category of drug names ending in - azepam (e.g. Diazepam)
Benzodiazepine.
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.
AluMINIMUM amount of feces.
Oxygen

9. How can Vancomycin - induced 'Red Man Syndrome' be prevented?
Pretreat with antihistamines and a slow infusion rate
Neurotoxicity - Acute renal tubular necrosis
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)
prevention of nodal arrhythmias (SVT)

10. What is the MOA of Imipenem?
- Ethanol - dialysis - & fomepizole
Acts as a wide spectrum carbapenem
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT
sedation - depression - nasal stuffiness - diarrhea

11. What do you treat Nematode/roundworm (pinworm - whipworm) infections with?
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.
not a sulfonamide - but action is the same as furosemide
Mebendazole/Thiabendazole - Pyrantel Pamoate
Cimetidine is a potent inhibitor of P450; it also has an antiandrogenic effect and decreases renal excretion of creatinine. Other H2 blockers are relatively free of these effects.

12. Does Warfarin have a long - medium - or short half life?
fetal renal toxicity - hyperkalemia
Long.
- Tamoxifen
- Triggers apoptosis - CLL - Hodgkin's in MOPP - Cushing - like syndrome

13. What musculo - skeletal side effects in Adults are associated with Floroquinolones?
collecting ducts
first dose orthostatic hypotension - dizziness - headache
decrease
Tendonitis and Tendon rupture

14. What is the mechanism of action of Aspirin?
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)
anuria - CHF
Acetylates and irreversibly inhibits cyclooxygenase (COX I and COX II) to prevent the conversion of arachidonic acid to prostaglandins.
Erectile dysfunction.

15. What two vasodilators require simultaneous treatment with beta blockers to prevent reflex tachycardia and diuretics to prevent salt retention?
Slow - limited by half lives of clotting factors
- Class III antiarrhythmics (sotalol) - class IA (quinidine)
Bactericidal for: Gram + rod and cocci - Gram - cocci - and Spirochetes
Hydralazine and Minoxidil

16. What are four thrombolytics?
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)
Edrophonium
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load
Lovastatin - Pravastatin - Simvastatin - Atorvastatin

17. MOA: Block cell wall synthesis by inhib. Peptidoglycan cross - linking (7)
Diuresis in pateints with sulfa allergy
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins
cholestyramine - colestipol
- Cimetidine - ketoconazole - grapefruit juice - erythromycin - INH - sulfonamides

18. What antimuscarinic drug is useful for the tx of asthma
Indomethacin is used to close a patent ductus arteriosus.
Diarrhea - Urination - Miosis - Bronchospasm - Bradycardia - Excitation of skeletal muscle and CNS - Lacrimation - Sweating - and Salivation = DUMBBELS; also abdominal cramping
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills
Ipratropium

19. Why are the Sulfonylureas inactive in IDDM (type -1)?
Because they require some residual islet function.
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis
Rapid (seconds)
- Hydralazine - Procainamide - INH - phenytoin

20. Mg+- clinical use?
effective in torsade de pointes and digoxin toxicity
DOC in diagnosing and abolishing AV nodal arrhythmias
Tricyclic antidepressant.
Sulfonamide Loop Diuretic. Inhibits ion co - transport system of thick ascending loop. Abolishes hypertonicity of the medulla - thereby preventing concentration of the urine.

21. What type of gout is treated with Allopurinol?
Chronic gout.
Delirium - Tremor - Nephrotoxicity
As PABA antimetabolites that inhibit Dihydropteroate Synthase - Bacteriostatic
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin

22. Toxic side effects of the Azoles?
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills
- acetylation - glucuron. - & sulfation - Conjugation - Polar product
dizziness - flushing - constipation (verapamil) - nausea

23. What is the MOA for the Tetracyclines?
- Niacin - Ca++ channel blockers - adenosine - vancomycin
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic
- Hypersensitivity reactions - Hemolysis - Nephrotoxicity (tubulointerstitial nephritis) - Kernicterus in infants Displace other drugs from albumin (e.g. - warfarin)
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.

24. What is Metronidazole combined with for 'triple therapy'? Against What organism?
Dermatophytes (tinea - ringworm)
dizziness - flushing - constipation (verapamil) - nausea
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori

25. Digoxin v. Digitoxin: excretion?
Sildenafil fills the penis
- Glucagon
Digoxin=urinary Digitoxin=biliary
- Act on same receptor - Full has greater efficacy

26. Acetazolamide - clinical uses?
Teratogenic - Carcinogenic - Confusion - Headaches
severe orthostatic hypotension - blurred vision - constipation - sexual dysfunction
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.
glaucoma - urinary alkalinization - metabolic alkalosis - altitude sickness

27. What sympathomimetic would you not prescribe for hypotension in a pt with renal artery sclerosis.
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)
Norepinephrine (Alpha1 -2 and beta 1)
- Tamoxifen
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis

28. What beta 2 agonist will help your 21yo Astma pt?
Albuterol - tertbutaline
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression
Protamine sulfate

29. How would you reverse the effect of a neuromuscular blocking agent?
Diuresis in pateints with sulfa allergy
Give an antichloinesterase - neostigmine - edrophonium - etc
Used in combination therapy with SMZ to sequentially block folate synthesis
ACE inhibitor.

30. Foscarnet toxicity?
Nephrotoxicity
Ganciclovir is more toxic to host enzymes
Gram + - Gram - - Norcardia - Chlamydia
CMV - esp in Immunocompromised patients

31. What are three toxicities of Leuprolied?
Inhibits formation of Initiation Complex - causes misreading of mRNA - Bactericidal
Acute gout.
1. Antiandrogen 2. Nausea 3. Vomiting
Cephalosporins

32. What is the possible mechanism and effect of Metformin in treating diabetes?
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide
These B-2 agonists cause respiratory smooth muscle to relax.
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.

33. List the mechanism - clinical use - & toxicity of Bleomycin.
- DNA intercalator - testicular & lymphomas - Pulmonary fibrosis mild myelosuppression.
Aminoglycosides
Nitrates
dizziness - flushing - constipation (verapamil) - nausea

34. How is Leishmaniasis treated?
thiazides - amiloride
Epinephrine
Pentavalent Antimony
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas

35. What is the category of drug names ending in - triptyline (e.g. Amitriptyline)
- polymyxins
Tricyclic antidepressant.
- Normalize K+ - Lidocaine - & Anti - dig Mab
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia

36. What is the MOA of Griseofulvin?
Cimetidine is a potent inhibitor of P450; it also has an antiandrogenic effect and decreases renal excretion of creatinine. Other H2 blockers are relatively free of these effects.
Interferes with microtubule function - disrupts mitosis - inhibits growth
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia
- Dimercaprol - succimer

37. What is the category of drug names ending in - cillin (e.g. Methicillin)
Extended spectrum penicillin: certain Gram + bacteria and Gram - rods
- Daunorubicin & Doxorubicin
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)
Penicillin.

38. Antiarrhythmic class IB- effects?
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system
It acts presynaptically to increase NE release.
Chronic anticoagulation.
It affects beta receptors equally and is used in AV heart block (rare).

39. How are the HIV drugs used clinically?

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40. In coma situations you rule out What (7)?

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41. Antimicrobial prophylaxis for Gonorrhea
Methylzanthine; desired effect is bronchodilation - may cause bronchodilation by inhibiting phosphodiesterase - enzyme involved in degrading cAMP (controversial).
Ceftriaxone
As PABA antimetabolites that inhibit Dihydropteroate Synthase - Bacteriostatic
Decrease the production of leukotrienes and protaglandins by inhibiting phospholipase A2 and expression of COX-2.

42. What is Ketoconazole specifically used for?
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism
cross - allergenic
Diarrhea
Edrophonium

43. Antimicrobial prophylaxis for a history of recurrent UTIs
No - it inhibits the release of Nor Epi
Beta - lactam antibiotics
Aminoglycosides - Tetracyclines
TMP- SMZ

44. Why are albuterol and terbutaline effective in tx of acute asthmatic attacks?
Indirect agonist - uptake inhibitor
Reversible block of histamine H2 receptors
- Isoniazid
These B-2 agonists cause respiratory smooth muscle to relax.

45. What drug is given for Pneumocystis carinii prophylaxis?
Carbachol - pilocarpine - physostigmine - echothiophate
Pentamidine
GI distress - Tooth discoloration and Inhibition of bone growth in children - Fanconi's syndrome - Photosensitivity
Imipenem

46. Which drug(s) cause this reaction: Gray baby syndrome?
sedation - depression - nasal stuffiness - diarrhea
Polymyxins
GI distress - Tooth discoloration and Inhibition of bone growth in children - Fanconi's syndrome - Photosensitivity
- Chloramphenicol

47. How is Amantadine used clinically?

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48. Adverse effects of Hydrochlorothiazide?
TCA
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole
hypokalemia - slight hyperlipidemia - hyperuricemia - lassitude - hypercalcemia - hyperglycemia
Inhibition of 50S peptidyl transferase - Bacteriostatic

49. List the mechanism - clinical use - & toxicity of Etoposide.
- Haloperidol - chlorpromazine - reserpine - MPTP
Penicillin.
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
orthostatic and exercise hypotension - sexual dysfunction - diarrhea

50. Why is carbachol and pilocarpine useful in treatment of glaucoma?
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine
Small lipid - soluble molecule
Na/K ATPase
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).