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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 category of drug names ending in - phylline (e.g. Theophylline)
Treatment of hypertension - especially with renal disease (lowers bp centrally - so flow is maintained to kidney).
Inhibit Ergosterol synthesis
Neurotoxicity - Acute renal tubular necrosis
Methylxanthine.

2. IV Penicillin
Penicillin - G
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.
- Metronidazole - certain cephalosporins - procarbazine - sulfonylureas
Indomethacin is used to close a patent ductus arteriosus.

3. While at a tail gait party - you bite into a sandwich that a yellow jacket is also enjoying. Knowing your allergy to this creature - What should you do?
decrease the slope of phase 4 - increase PR interval (the AV node is particularly sensitive)
- Corticosteroids - heparin
Penicillin - G
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.

4. List the mechanism - clinical use - & toxicity of Cyclophosphamide.
Dermatophytes (tinea - ringworm)
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.
distal convoluted tubule (early)
AZT

5. What are the side effects of Polymyxins?
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
Paranteral (IV - SC)
Neurotoxicity - Acute renal tubular necrosis
Blocks Influenza A and RubellA; causes problems with the cerebellA

6. Beta Blockers - site of action?
Does not cross
- NaHCO3
Beta adrenergic receptors and Ca2+ channels (stimulatory)
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.

7. Beta Blockers - CNS toxicity?
sedation - sleep alterations
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.
GET on the Metro
edematous states (CHF - cirrhosis - nephrotic syndrome - pulm edema) - HTN - hypercalcemia

8. Guanethidine enhances the release of Norepi?
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride
Nephrotoxicity
IV vitamin K and fresh frozen plasma
No - it inhibits the release of Nor Epi

9. What are the Anti - TB drugs?
prevention of nodal arrhythmias (SVT)
Tendonitis and Tendon rupture
- Vinca alkaloids(inhibit MT) - Paclitaxel
Rifampin - Ethambutol - Streptomycin - Pyrazinamide - Isoniazid (INH)

10. What is the MOA of Griseofulvin?
Interferes with microtubule function - disrupts mitosis - inhibits growth
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.

11. What is a common side effect of Misoprostol?
Small lipid - soluble molecule
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide
Diarrhea
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression

12. List the mechanism - clinical use - & toxicity of Tamoxifen.
- Estrogen receptor antagonist - Breast CA - increased endometrial CA risk
1. Hypoglycemia (more common with 2nd - generation drugs: glyburide - glipizide) 2. Disulfiram - like effects (not seen with 2nd - generation drugs).
bradycardia - AV block - CHF
Forms toxic metabolites in the bacterial cell - Bactericidal

13. What is the mechanism of action of Misoprostol?
propanolol - esmolol - metoprolol - atenolol - timolol
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.
torsade de pointes - excessive Beta block
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.

14. What conditions are treated with Metronidazole?
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas
- Aminocaproic acid
- Physostigmine salicylate
- Triggers apoptosis - CLL - Hodgkin's in MOPP - Cushing - like syndrome

15. Cautions When using Amiodarone?
check PFTs - LFTs - and TFTs
1. Addison's disease 2. Inflammation 3. Immune suppression 4. Asthma
Sotalol - Ibutilide - Bretylium - Amiodarone
blocks SR Ca2+ channels

16. Which of the following would atropine administration cause? Hypothermia - bradycardia - excess salivation - dry flushed skin - or diarrhea
Stimulating beta receptors stimulates heart rate - but beta receptor induced vasodilation reduces peripheral resistance.
Because they require some residual islet function.
Interferes with microtubule function - disrupts mitosis - inhibits growth
Dry flushed skin - due to inhibition of sympathetic post - ganglionic blockade on muscarinic receptors of sweat glands. All others are opposite of What would be expected.

17. Which drug(s) cause this reaction: Diabetes insipidus?
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia
1. Bleeding 2. Thrombocytopenia 3. Drug - drug interactions
- Lithium
Rheumatoid and osteoarthritis.

18. What is an occasional side effect of Aztreonam?
The only local anesthetic with vasoconstrictive properties.
hypertension - CHF - diabetic renal disease
GI upset
AZT - to reduce risk of Fetal Transmission

19. What beta 2 agonist will help your 21yo Astma pt?
HSV - VZV - EBV - Mucocutaneous and Genital Herpes Lesions - Prophylaxis in Immunocompromised pts
Minor hepatotoxicity - Drug interactions (activates P450)
Albuterol - tertbutaline
Similar to cyclosporine; binds to FK- binding protein - inhibiting secretion of IL-2 and other cytokines.

20. List the mechanism - clinical use - & toxicity of Paclitaxel.
Post - op and neurogenic ileus and urinary retention - myasthenia gravis - and reversal of neuromuscular junction blockade (post - op) through anticholinesterase activity.
- Vitamin K & fresh frozen plasma
- Formaldehyde & formic acid - severe acidosis & retinal damage
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.

21. K+ sparing diuretics - site of action?
cortical collecting tubule
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis
Rare.
Bethanechol - Neostigmine - physostigmine

22. Antiarrhythmic class IC- effects?
physostigmine
1. Meningococcal carrier state 2. Chemoprophylaxis in contacts of children with H. influenzae type B
Anaerobes
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT

23. What are major side effects of Methicillin - Nafcillin - and Dicloxacillin?
Diarrhea - Urination - Miosis - Bronchospasm - Bradycardia - Excitation of skeletal muscle and CNS - Lacrimation - Sweating - and Salivation = DUMBBELS; also abdominal cramping
Hypersensitivity reactions
Blocks Norepi - but not Dopamine
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin

24. What are three toxicities of Propylthiouracil?
Same as penicillin. Extended spectrum antibiotics
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia
bradycardia - AV block - CHF

25. List the specific antidote for this toxin: Acetaminophen
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids
Mg = Must go to the bathroom.
- N- acetylcystine
Triple sulfas or SMZ

26. What cholinomimetic is useful in the diagnosis of Myasthenia Gravis
Methylxanthine.
Edrophonium
- Vitamin K & fresh frozen plasma
Chronic gout.

27. Acetazolamide - site of action?
1. Heavy bleeding 2. GI effects (n/v - anorexia) 3. Abdominal pain
Heparin catalyzes the activation of antithrombin III.
Imipenem
proximal convoluted tubule

28. Bretyllium - toxicity?
Pretreat with antihistamines and a slow infusion rate
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic
new arrhythmias - hypotension
Beta adrenergic receptors and Ca2+ channels (stimulatory)

29. What type of gout is treated with Colchicine?
Norepinephrine (Alpha1 -2 and beta 1)
Acute gout.
Hypersensitivity reactions
YES

30. The COX-2 inhibitors (celecoxib - rofecoxib) have similar side effects to the NSAIDs with What one exception?
Decreases synthesis of Mycolic Acid
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.
Beta adrenergic receptors and Ca2+ channels (stimulatory)
impotence - exacerbation of asthma - CV effects - CNS effects - may mask hypoclycemia

31. What is the category of drug names ending in - navir (e.g. Saquinavir)
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.
Treatment of hypertension - especially with renal disease (lowers bp centrally - so flow is maintained to kidney).
Protease inhibitor.
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.

32. What is the mechanism of action of Heparin?
Heparin catalyzes the activation of antithrombin III.
- acetylation - glucuron. - & sulfation - Conjugation - Polar product
Short.
- Clindamycin

33. What is the mechanism of action of Warfarin (Coumadin)?
- Tetracycline
thiazides - amiloride
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.
not a sulfonamide - but action is the same as furosemide

34. Antiarrhythmic Class III- effects?
increase AP duration - increase ERP - increase QT interval - for use When other arrhythmics fail
Only in limited amounts
block Na+ channels in the cortical collecting tubule
Short.

35. How would you reverse the effect of a neuromuscular blocking agent?
aPTT (intrinsic pathway)
Give an antichloinesterase - neostigmine - edrophonium - etc
Abortifacient.
1. Antiandrogen 2. Nausea 3. Vomiting

36. Cocaine casues vasoconstriction and local anesthesia by What mechanism
INH: Injures Neurons and Hepatocytes
Sulfonamide Loop Diuretic. Inhibits ion co - transport system of thick ascending loop. Abolishes hypertonicity of the medulla - thereby preventing concentration of the urine.
Indirect agonist - uptake inhibitor
Flecainide - Encainide - Propafenone

37. What is the mechanism of action of Omeprazole - Lansoprazole?
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
Yes
- ACE inhibitors (Losartan>no cough)
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.

38. What antimicrobial class is Aztreonam syngergestic with?
Reserpine inhibits dopamine transport into vesicles - attenuating its conversion to NE by dopamine beta - hydroxylase.
Aminoglycosides
thick ascending limb
With an amino acid change of D- ala D- ala to D- ala D- lac

39. MOA: Block mRNA synthesis
G6PD deficient individuals
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism
Rifampin
Malaria (P. falciparum)

40. What do Aminoglycosides require for uptake?
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions
- Steroids - Tamoxifen
Neostigmine - pyridostigmine edrophonium - physostigmine echothiophate
Oxygen

41. Resistance mechanisms for Aminoglycosides
Antimetabolite derivative of 6- mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.
Modification via Acetylation - Adenylation - or Phosphorylation
troponin - tropomyosin system
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD

42. What is the memory key for the effect of aluminum hydroxide overuse?
AluMINIMUM amount of feces.
Pralidoxime regenerates active cholinesterase.
INH: Injures Neurons and Hepatocytes
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).

43. What is the category - desired effect - and period of use of albuterol in the treatment of Asthma?
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.
Beta Blockers
Only in limited amounts
Potent immunosuppressive used in organ transplant recipients.

44. What is the category and mechanism of action of Zafirlukast in Asthma treatment?
Antileukotriene; blocks leukotriene receptors.
Same as penicillin. Act as narrow spectrum antibiotics
Blocks Norepi - but not Dopamine
Lovastatin - Pravastatin - Simvastatin - Atorvastatin

45. What is the effect of guanethidine on adrenergic NE release?
It inhibits release of NE.
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis
G6PD deficient individuals
effective in torsade de pointes and digoxin toxicity

46. Which drug(s) cause this reaction: Cinchonism (2)?
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide
- Quinidine - quinine
- ACE inhibitors (Losartan>no cough)
Succinylcholine

47. Which drug(s) cause this reaction: G6PD hemolysis(8)?
Dermatophytes (tinea - ringworm)
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.
These B-2 agonists cause respiratory smooth muscle to relax.
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol

48. Resistance mechanisms for Macrolides

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49. What are common side effects of Protease Inhibitors?
- Lithium
- Haloperidol - chlorpromazine - reserpine - MPTP
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)
Tendonitis and Tendon rupture

50. How does resistance to Vancomycin occur?
GI upset
Premature infants - because they lack UDP- glucuronyl transferase
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.
With an amino acid change of D- ala D- ala to D- ala D- lac