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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. How do we stop angina?
GET on the Metro
It affects beta receptors equally and is used in AV heart block (rare).
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
Bethanechol - Neostigmine - physostigmine

2. What is the MOA for Acyclovir?
The only local anesthetic with vasoconstrictive properties.
penicillinase resistant
- Alkalinize urine & dialysis
Inhibit viral DNA polymerase

3. How do you calculate maintenance dose?
- Tricyclic antidepressants
- Normalize K+ - Lidocaine - & Anti - dig Mab
1. Pioglitazone 2. Rosiglitazone.
Md= (CpxCL)/F Cp= plas. Conc. CL=clear. F=bioaval.

4. Which drug(s) cause this reaction: Cutaneous flushing (4)?
- Niacin - Ca++ channel blockers - adenosine - vancomycin
Inhibits cell wall mucopeptide formation - Bactericidal
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.
- ACE inhibitors (Losartan>no cough)

5. Why is there a drop in systolic - mean - and diastolic bp with infusion of isoproterenol?
Leukotrienes increasing bronchial tone.
Pentavalent Antimony
dry mouth - sedation - severe rebound hypertension
Stimulating beta receptors stimulates heart rate - but beta receptor induced vasodilation reduces peripheral resistance.

6. Antiarrhythmic class IB- clinical uses?
Amphotericin B - Nystatin - Fluconazole/azoles
post MI and digitalis induced arrhythmias
Modification via Acetylation
Inhibits DNA dependent RNA polymerase

7. Cocaine casues vasoconstriction and local anesthesia by What mechanism
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis
Protease Inhibitors and Reverse Transcriptase Inhibitors
1. Reliable (<1% failure) 2. Lowers risk of endometrial and ovarian cancer 3. Decreased incidence of ectopic pregnancy 4. Lower risk of pelvic infections 5. Regulation of menses
Indirect agonist - uptake inhibitor

8. Which Tetracycline is used in patients with renal failure? / Why?
Ototoxicity - Hypokalemia - Dehydration - Allergy (sulfa) - Nephritis (interstitial) - Gout
Doxycycline - because it is fecally eliminated
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.

9. IV Penicillin
Penicillin - G
Due to the presence of a bulkier R group
Prophylaxis for Influenza A - Rubella; Parkinson's disease
1. In liver - increases storage of glucose as glycogen. 2. In muscle - stimulates glycogen and protein synthesis - and K+ uptake. 3. In adipose tissue - facilitates triglyceride storage.

10. Which drug(s) cause this reaction: Gynecomastia (6)?
- Cimetidine - ketoconazole - spironolactone - digitalis - EtOH - estrogens
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more
Muscarinic antagonist; competatively blocks muscarinic receptors - preventing bronchoconstriction.
Blocks Influenza A and RubellA; causes problems with the cerebellA

11. What are the Anti - TB drugs?
GI side effects. (Indomethacin is less toxic - more commonly used.)
Verapamil - Diltiazem - Bepridil
Rifampin - Ethambutol - Streptomycin - Pyrazinamide - Isoniazid (INH)
NE acts presynaptically on alpha -2 receptors to inhibit its own release. ACh also acts presynaptically through M1 receptors to inhibit NE release.

12. How are Interferons (INF) used clinically?

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13. What is the formula for Volume of distribution (Vd)
Vd= (Amt. of drug in body/ Plasma drug conc.)
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.
Antileukotriene; blocks leukotriene receptors.
Cell membrane Ca2+ channels of cardiac sarcomere

14. List the specific antidote for this toxin: Arsenic (all heavy metals)
- Dimercaprol - succimer
Prefers beta's at low doses - but at higher doses alpha agonist effects are predominantly seen.
Short.
carbonic anhydrase inhibitors - K+ sparing diuretics

15. What is treated with Chloroquine - Quinine - Mefloquine?
- Acetaldehyde - Nausea - vomiting - headache - & hypotension
Dopamine; causes its release from intact nerve terminals
Malaria (P. falciparum)
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia

16. What is the MOA for Carbenicillin - Piperacillin - and Ticarcillin?
Doxycycline - because it is fecally eliminated
Digoxin=urinary Digitoxin=biliary
Same as penicillin. Extended spectrum antibiotics
- Glucagon

17. Adverse effects of Methyldopa?

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18. What are four thrombolytics?
Blood
1. Bleeding 2. Teratogenicity 3. Drug - drug interactions
hypokalemia - slight hyperlipidemia - hyperuricemia - lassitude - hypercalcemia - hyperglycemia
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)

19. What is Fluconazole specifically used for?
Similar to cyclosporine; binds to FK- binding protein - inhibiting secretion of IL-2 and other cytokines.
Cryptococcal meningitis in AIDS patients and Candidal infections of all types
thick ascending limb
Mg = Must go to the bathroom.

20. Foscarnet toxicity?
loop diuretics - thiazides
Decreases synthesis of Mycolic Acid
Nephrotoxicity
Praziquantel

21. What is the category of drug names ending in - azol (e.g. Ketoconazole)
1. Bleeding 2. Thrombocytopenia 3. Drug - drug interactions
Antifungal.
Inhibits cell wall synthesis ( binds to PBP3). A monobactam
Amphetamine and Ephedrine

22. How does a competitive antagonist effect an agonist?
blocks SR Ca2+ channels
Chronic anticoagulation.
Verapamil - Diltiazem - Bepridil
- Shifts the curve to the right - increases Km

23. For Heparin What is the Lab value to monitor
TMP- SMZ
aPTT (intrinsic pathway)
Antifungal.
- B51Naloxone / naltrexone (Narcan)

24. What is the memory key for the effect of magnesium hydroxide overuse?
- Alkalinize urine & dialysis
Mg = Must go to the bathroom.
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic
Acts as a wide spectrum carbapenem

25. How is Trimethoprim used clinically?
Used in combination therapy with SMZ to sequentially block folate synthesis
- Shifts the curve down - reduces Vmax
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).

26. Why are Methicillin - Nafcillin - and Dicloxacillin penicillinase resistant?
AmOxicillin has greater Oral bioavailability
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome
Due to the presence of a bulkier R group
edematous states (CHF - cirrhosis - nephrotic syndrome - pulm edema) - HTN - hypercalcemia

27. What are common side effects of Amphotericin B?
Staphlococcus aureus
Fever/Chills - Hypotension - Nephrotoxicity - Arrhythmias
Inhibits cell wall mucopeptide formation - Bactericidal
GI discomfort

28. Adverse effects of Loop Diuretics?
Antileukotriene; blocks synthesis by lipoxygenase.
Yes - it does not cross the placenta.
ACIDazolamide' causes acidosis
K+ wasting - metabolic alkalosis - hypotension - ototoxicity

29. Which individuals are predisposed to Sulfonamide - induced hemolysis?
G6PD deficient individuals
new arrhythmias - hypotension
- Quinidine - quinine
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas

30. What is the mechanism of action of the H2 Blockers?
Ipratropium
- Tricyclic antidepressants
Pregnant women - Children; because animal studies show Damage to Cartilage
Reversible block of histamine H2 receptors

31. Is toxicity rare or common whith Cromolyn used in Asthma prevention?
Does not cross
Rare.
Mycobacterium tuberculosis - the only agent used as solo prophylaxis against TB
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids

32. Side effects of Isoniazid (INH)?
Babiturate.
Hemolysis (if G6PD deficient) - Neurotoxicity - Hepatotoxicity - SLE- like syndrome
- Tetracycline - amiodarone - sulfonamides
- N- acetylcystine

33. What is the mechanism of action of Cyclosporine?
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.
GnRH analog with agonist properties When used in pulsatile fashion and antagonist properties When used in continuous fashion - causing a transient initial burst of LH and FSH
Fever/Chills - Hypotension - Nephrotoxicity - Arrhythmias
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.

34. What anticholinesterase crosses the blood - brain - barrier?
physostigmine
- Lithium
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.
No - hemicholinum block the uptake of Choline and thus Ach synthesis

35. Which diuretics increase urine Ca2+?
proximal convoluted tubule
loop diuretics - spironolactone
cyanide toxicity (releases CN)
Clomiphene is a partial agonist at estrogen receptors in the pituitary gland. Prevents normal feedback inhibition and increses release of LH and FSHfrom the pituitary - Which stimulates ovulation.

36. MOA: Block peptidoglycan synthesis
Short.
Bacitracin - Vancomycin
Diuresis in pateints with sulfa allergy
With an amino acid change of D- ala D- ala to D- ala D- lac

37. What are Aminoglycosides used for clinically?
Severe Gram - rod infections.
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.
Minor hepatotoxicity - Drug interactions (activates P450)
impotence - asthma - CV effects (bradycardia - CHF - AV block) - CNS effects (sedation - sleep alterations)

38. What is the mechanism of Azathioprine?
Meningitis (H. influenza - N. meningitidis - S. pneumoniae) - Conserative treatment due to toxicities
Teratogenic - Carcinogenic - Confusion - Headaches
Antimetabolite derivative of 6- mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.
Ataxia - Dizziness - Slurred speech

39. Adverse effects of beta - blockers?
Praziquantel
impotence - asthma - CV effects (bradycardia - CHF - AV block) - CNS effects (sedation - sleep alterations)
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids
dizziness - flushing - constipation (verapamil) - nausea

40. What physiological effects was the Anes using Atropine to tx
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
- Tamoxifen
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions
AV nodal cells

41. Antimicrobial prophylaxis for Syphilis
- Hydralazine - Procainamide - INH - phenytoin
Benzathine penicillin G
Carbenicillin - Piperacillin - and Ticarcillin
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)

42. Amprotericin B ___________ the BBB
Ipratropium
Prevents the release of Ca from SR of skeletal muscle
Nitrates
Does not cross

43. Hydralazine - clinical use?
- N- acetylcystine
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
severe hypertension - CHF
Rash - Pseudomembranous colitis

44. Which of epi - norepi - or isoproterenol results in bradycardia?
1. Hypoglycemia (more common with 2nd - generation drugs: glyburide - glipizide) 2. Disulfiram - like effects (not seen with 2nd - generation drugs).
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.
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.)
Norepinephrine

45. What type of gout is treated with Colchicine?
Treatment of infertility.
RESPIre
Ipratropium
Acute gout.

46. Antiarrhythmic class IV- toxicity?
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.
- Ammonium Chloride
constipation - flushing - edema - CV effects (CHF - AV block - sinus node depression) - and torsade de pointes (Bepridil)
Inhibits cell wall synthesis ( binds to PBP3). A monobactam

47. What conditions are treated with Metronidazole?
Inhibits reabsorption of uric acid.
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas
Rare.
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.

48. ___________ are Teratogenic
not a sulfonamide - but action is the same as furosemide
H2 antagonist
Aminoglycosides
Neurotoxicity - Acute renal tubular necrosis

49. What is the memory key for the effect of aluminum hydroxide overuse?
AluMINIMUM amount of feces.
Neomycin
Benzodiazepine.
proximal convoluted tubule

50. What is the category of drug names ending in - cycline (e.g. Tetracycline)
Immediate anticoagulation for PE - stroke - angina - MI - DVT.
Antibiotic - protein synthesis inhibitor.
Leukotrienes increasing bronchial tone.
Teratogenic - Carcinogenic - Confusion - Headaches