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Test your basic knowledge |
USMLE Step 1 Pharmacology
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Subjects
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health-sciences
,
usmle-step-1
Instructions:
Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can
study here
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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. Which cancer drugs work at the level of mRNA(2)?
- Steroids - Tamoxifen
Gemfibrozil - Clofibrate
Edrophonium
impotence - asthma - CV effects (bradycardia - CHF - AV block) - CNS effects (sedation - sleep alterations)
2. Acetazolamide causes?
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3. What is a possible result of overdose of Acetaminophen?
Give an antichloinesterase - neostigmine - edrophonium - etc
NE acts presynaptically on alpha -2 receptors to inhibit its own release. ACh also acts presynaptically through M1 receptors to inhibit NE release.
- Oxalic acid - Acidosis & nephrotoxicity
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
4. 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
- Penicillamine
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
Decreased uptake or Increased transport out of cell
- Tamoxifen
5. List the specific antidote for this toxin: Heparin
- Protamine
Albuterol - tertbutaline
WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.
Minor hepatotoxicity - Drug interactions (activates P450)
6. List the specific antidote for this toxin: Amphetamine
- Antipsychotics
Diarrhea
pulmonary edema - dehydration
- Ammonium Chloride
7. Decrease Digitoxin dose in renal failure?
Carbenicillin - Piperacillin - and Ticarcillin
Bethanechol - Neostigmine - physostigmine
loop diuretics - spironolactone
NO
8. How does botulinum toxin result in respiratory arrest?
Praziquantel
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
Prevents the release of ACh - Which results in muscle paralysis.
NO HYPERURICEMIA - NO SULFA AllERGY; same as furosemide otherwise
9. Which cancer drugs inhibit nucleotide synthesis(3)?
- DNA intercalator - Hodgkin's - myeloma - sarcoma - and solid tumors - Cardiotoxicity & alopecia
first dose orthostatic hypotension - dizziness - headache
- Methotrexate - 5 FU - 6 mercaptopurine
anuria - CHF
10. What is a common drug interaction associated with Griseofulvin?
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).
edematous states (CHF - cirrhosis - nephrotic syndrome - pulm edema) - HTN - hypercalcemia
Increases coumadin metabolism
Prefers beta's at low doses - but at higher doses alpha agonist effects are predominantly seen.
11. What is a common side effect of Colchicine used to treat acute gout - especially When given orally?
Treatment of infertility.
sedation - depression - nasal stuffiness - diarrhea
GI side effects. (Indomethacin is less toxic - more commonly used.)
Fast vs. Slow Acetylators
12. For Warfarin What is the Site of action
Liver
amphetamine and ephedrine
Benzodiazepine.
cardiac muscle: Verapamil>Diltiazem>Nifedipine
13. What are three possible toxicities of NSAID usage?
Butyrophenone (neuroleptic).
- Corticosteroids - heparin
1. Renal damage 2. Aplastic anemia 3. GI distress
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )
14. Which cancer drugs effect nuclear DNA (4)?
Aminoglycosides - Tetracyclines
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori
15. Which of epi - norepi - or isoproterenol results in bradycardia?
Antileukotriene; blocks leukotriene receptors.
Indomethacin is used to close a patent ductus arteriosus.
- Quinidine - quinine
Norepinephrine
16. Acetaldehyde is metabolized by Acetaldehyde dehydrogenase - Which drug inhibs this enzyme?
sedation - positive Coombs' test
- Disulfram & also sulfonylureas - metronidazole
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD
They inhibit reuptake of NE at the nerve terminal (as does cocaine).
17. What are three toxicities of Propylthiouracil?
Pretreat with antihistamines and a slow infusion rate
The only local anesthetic with vasoconstrictive properties.
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic
18. What is the main clinical use for the thrombolytics?
loop diuretics - spironolactone
Dermatophytes (tinea - ringworm)
Early myocardial infarction.
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity
19. List the mechanism - clinical use - & toxicity of Vincristine.
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20. Antimicrobial prophylaxis for PCP
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.
Inhibits CMV DNA polymerase
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.
TMP- SMZ (DOC) - aerosolized pentamidine
21. What enzyme does Zileuton inhibit?
Hypersensitivity reactions
Lipoxygenase
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.
Buy AT 30 - CELL at 50'
22. Name the common Azoles
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole
vascular sm. Mus.: Nifedipine>Diltiazem>Verapamil
23. What is the memory key for the effect of magnesium hydroxide overuse?
- Alkalate DNA - Brain tumors - CNS toxicity
Mg = Must go to the bathroom.
Anaerobes
G6PD deficient individuals
24. What is Ketoconazole specifically used for?
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism
decrease the slope of phase 4 - increase PR interval (the AV node is particularly sensitive)
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)
Activates antithrombin III
25. What organisms does Griseofulvin target?
Dermatophytes (tinea - ringworm)
Na/K ATPase
- Penicillin
Buy AT 30 - CELL at 50'
26. What are Aminoglycosides used for clinically?
- Tetracycline - amiodarone - sulfonamides
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.
- acetylation - glucuron. - & sulfation - Conjugation - Polar product
Severe Gram - rod infections.
27. Which diuretics increase urine NaCl?
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
propanolol - esmolol - metoprolol - atenolol - timolol
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.
all of them
28. Oral Penicillin
amphetamine and ephedrine
Penicillin - V
Onchocerciasis ('river blindness'-- rIVER- mectin)
Gemfibrozil - Clofibrate
29. List the mechanism - clinical use - & toxicity of Tamoxifen.
- Niacin - Ca++ channel blockers - adenosine - vancomycin
- Alkalate DNA - Brain tumors - CNS toxicity
- Estrogen receptor antagonist - Breast CA - increased endometrial CA risk
Interferes with microtubule function - disrupts mitosis - inhibits growth
30. MOA: Block protein synthesis at 30s subunit
Doxycycline - because it is fecally eliminated
GI upset - Superinfections - Skin rashes - Headache - Dizziness
- Bleomycin - amiodarone - busulfan
Aminoglycosides - Tetracyclines
31. What are common side effects of Amphotericin B?
- Formaldehyde & formic acid - severe acidosis & retinal damage
Inhibit intestinal bursh border Alpha - glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.
Fever/Chills - Hypotension - Nephrotoxicity - Arrhythmias
Prevents release of mediators from mast cells. Effective only for the prophylaxis of asthma. Not effective during an acute attack.
32. How is Amphotericin B administered for fungal meningitis?
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
Local anesthetic.
- Daunorubicin & Doxorubicin
Intrathecally
33. What microorganisms are clinical indications for Tetracycline therapy?
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34. K+ sparing diuretics - clinical use?
Doxycycline - because it is fecally eliminated
increase AP duration - increase ERP - increase QT interval - for use When other arrhythmics fail
carbonic anhydrase inhibitors - K+ sparing diuretics
hyperaldosteronism - K+ depletion - CHF
35. Adverse effects of Methyldopa?
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36. For Warfarin What is the Mechanism of action
Impairs the synthesis of vitamin K- dependent clotting factors
- reduction - oxy - & hydrolysis - H2O sol. Polar product - P450
Alpha -1 antagonist
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
37. What is the mechanism of action of the glucocorticoids?
Babiturate.
Abortifacient.
Decrease the production of leukotrienes and protaglandins by inhibiting phospholipase A2 and expression of COX-2.
decrease conduction velocity - increase ERP - increase PR interval
38. Antiarrhythmic class IV- effects?
Tricyclic antidepressant.
Fast vs. Slow Acetylators
These B-2 agonists cause respiratory smooth muscle to relax.
decrease conduction velocity - increase ERP - increase PR interval
39. In What population does Gray Baby Syndrome occur? Why?
depresses ectopic pacemakers - especially in digoxin toxicity
Premature infants - because they lack UDP- glucuronyl transferase
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility
Inhibits reabsorption of uric acid.
40. Are penicillinase resistant
Fast vs. Slow Acetylators
Methicillin - Nafcillin - and Dicloxacillin
Pralidoxime regenerates active cholinesterase.
No - warfarin - unlike heparin - can cross the placenta.
41. Preferential action of the Ca2+ channel blockers at cardiac muscle?
Wide spectrum of systemic mycoses: Cryptococcus - Blastomyces - Coccidioides - Aspergillus - Histoplasma - Candida - Mucor
cardiac muscle: Verapamil>Diltiazem>Nifedipine
reversible SLE- like syndrome
proximal convoluted tubule
42. Nifedipine has similar action to?
Nitrates
Competitive inibitor of progestins at progesterone receptors.
Well tolerated in general but occasionally - Nephrotoxicity - Ototoxicity - Thrombophlebitis - diffuse flushing='Red Man Syndrome'
Ibuprofen - Naproxen - and Indomethacin
43. Which Tetracycline is used in patients with renal failure? / Why?
amphetamine and ephedrine
Doxycycline - because it is fecally eliminated
Treatment of infertility.
Antimetabolite derivative of 6- mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.
44. What is an acronym to remember Anti - TB drugs?
Headache - flushing - dyspepsia - blue - green color vision.
Chagas' disease - American Trypanosomiasis (Trypanosoma cruzi)
RESPIre
proarrhythmic
45. What is the mechanism of action of the Sulfonylureas?
Lidocaine - Mexiletine - Tocainide
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.
46. What musculo - skeletal side effects in Adults are associated with Floroquinolones?
Tendonitis and Tendon rupture
hypertension - CHF - diabetic renal disease
ARF - shock - drug overdose - decrease intracranial/intraocular pressure
GI disturbances.
47. Do Tetracyclines penetrate the CNS?
Rheumatoid and osteoarthritis.
Erectile dysfunction.
Only in limited amounts
amphetamine and ephedrine
48. Adverse effects of Hydrochlorothiazide?
No - hemicholinum block the uptake of Choline and thus Ach synthesis
hypokalemia - slight hyperlipidemia - hyperuricemia - lassitude - hypercalcemia - hyperglycemia
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.
Sulfonamide Loop Diuretic. Inhibits ion co - transport system of thick ascending loop. Abolishes hypertonicity of the medulla - thereby preventing concentration of the urine.
49. What are five disadvantages of Oral Contraceptives (synthetic progestins - estrogen)?
AZT
decrease conduction velocity - increase ERP - increase PR interval
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state
Short.
50. What is the formula for Clearance (CL)
Immediate anticoagulation for PE - stroke - angina - MI - DVT.
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia
CL= (rate of elimination of drug/ Plasma drug conc.)
Antibiotic - protein synthesis inhibitor.