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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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1. What are four Sulfonylureas?
Pentavalent Antimony
1. Meningococcal carrier state 2. Chemoprophylaxis in contacts of children with H. influenzae type B
Tricyclic antidepressant.
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide

2. What is the formula for Clearance (CL)
CL= (rate of elimination of drug/ Plasma drug conc.)
1. Renal damage 2. Aplastic anemia 3. GI distress
Rifampin
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.

3. Which drug(s) cause this reaction: P450 induction(6)?
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)
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine
Binds ergosterol - Disrupts fungal membranes

4. What type of gout is treated with Colchicine?
- Alkalate DNA - Brain tumors - CNS toxicity
Gram + cocci - Gram - rods - and Anerobes
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic
Acute gout.

5. What drug is given for Pneumocystis carinii prophylaxis?
- Metronidazole - certain cephalosporins - procarbazine - sulfonylureas
Topical and Oral - for Oral Candidiasis (Thrush)
WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.
Pentamidine

6. What physiological effects was the Anes using Atropine to tx
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions
Forms toxic metabolites in the bacterial cell - Bactericidal
-100% oxygen - hyperbaric
Rheumatoid and osteoarthritis.

7. In What population does Gray Baby Syndrome occur? Why?
Paranteral (IV - SC)
Imipenem
Aplastic anemia (dose independent) - Gray Baby Syndrome
Premature infants - because they lack UDP- glucuronyl transferase

8. Acetazolamide - site of action?
Headache - flushing - dyspepsia - blue - green color vision.
Tendonitis and Tendon rupture
proximal convoluted tubule
Beta lactams - inhibit cell wall synthesis - Bactericidal

9. How are Sulfonamides employed clinically?
Gram + - Gram - - Norcardia - Chlamydia
Ipratropium
None. No - because atropine would block the postganglionic muscarinic receptors involved in sweat gland stimulation.
Rapid (seconds)

10. For Warfarin What is the Treatment for overdose
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.
glaucoma - urinary alkalinization - metabolic alkalosis - altitude sickness
IV vitamin K and fresh frozen plasma
NO HYPERURICEMIA - NO SULFA AllERGY; same as furosemide otherwise

11. Foscarnet does not require activation by a...
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.
- ACE inhibitors (Losartan>no cough)
viral kinase
Due to the presence of a bulkier R group

12. What is the category of drug names ending in - cycline (e.g. Tetracycline)
Prevention of NSAID- induced peptic ulcers - maintains a PDA.
Well tolerated in general but occasionally - Nephrotoxicity - Ototoxicity - Thrombophlebitis - diffuse flushing='Red Man Syndrome'
Norepinephrine
Antibiotic - protein synthesis inhibitor.

13. Adverse effects of Hydralazine?
- reduction - oxy - & hydrolysis - H2O sol. Polar product - P450
amphetamine and ephedrine
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention
Amphotericin B - Nystatin - Fluconazole/azoles

14. What are signs of Sildenafil (Viagra) toxicity?
1. Weight gain 2. Hepatotoxicity (troglitazone)
1. Renal damage 2. Aplastic anemia 3. GI distress
Headache - flushing - dyspepsia - blue - green color vision.
Hemolysis (if G6PD deficient) - Neurotoxicity - Hepatotoxicity - SLE- like syndrome

15. Which diuretics increase urine Ca2+?
loop diuretics - spironolactone
Pseudomonas species and Gram - rods
Gemfibrozil - Clofibrate
H2 antagonist

16. Name five Antiarrhythmic drugs in class II?
Blood
propanolol - esmolol - metoprolol - atenolol - timolol
- ED 50 is less than the Km (less than 50% of receptors)
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention

17. Mg+- clinical use?
Blocks Peptide Bond formation at the 50S subunit - Bacteriostatic
Mg = Must go to the bathroom.
effective in torsade de pointes and digoxin toxicity
- Dimercaprol - succimer

18. Will Hemicholinum affect the release of stored Ach during Cholinergic Stimulation
AV nodal cells
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride
No - hemicholinum block the uptake of Choline and thus Ach synthesis
Foscarnet = pyroFosphate analog

19. List the mechanism - clinical use - & toxicity of Etoposide.
Modification via Acetylation - Adenylation - or Phosphorylation
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
ARF - shock - drug overdose - decrease intracranial/intraocular pressure
- Infections - Trauma - Seizures - CO - Overdose - Metabolic - Alcohol (IT'S COMA)

20. Are Ampicillin and Amoxicillin are not...
Useful in muscle paralysis during surgery or mechanical ventilation.
Amphetamine and Ephedrine
penicillinase resistant
Prevents the release of Ca from SR of skeletal muscle

21. What is a common drug interaction associated with Griseofulvin?
Spironolactone - Triamterene - Amiloride (the K+ STAys)
As an anticholinesterase it increases endogenous ACh and thus increases strength.
In 4 half - lifes= (94%) T1/2 = (0.7x Vd)/CL
Increases coumadin metabolism

22. What is the enzyme inhibited - the effect of this inhibition - and the clinical use of the antiandrogren Finasteride?
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH
Same as penicillin. Act as narrow spectrum antibiotics
edrophonium (extremely short acting anticholinesterase)
reduce levels of Angiotensin II - thereby preventing the inactivation of bradykinin (a potent vasodilator); renin level is increased

23. List the mechanism - clinical use - & toxicity of Vincristine.

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24. Adverse effects of Nifedipine - verapamil?
dizziness - flushing - constipation (verapamil) - nausea
Erythromycin - Azithromycin - Clarithromycin
BM suppression (neutropenia - anemia) - Peripheral neuropathy
It inhibits release of NE.

25. What enzyme is responsible for the production of Ach from Acetyl CoA and Choline
Choline acetyltransferase
CL= (rate of elimination of drug/ Plasma drug conc.)
Beta1 more than B2
Ototoxicity - Hypokalemia - Dehydration - Allergy (sulfa) - Nephritis (interstitial) - Gout

26. What microorganisms is Aztreonam not effective against?
Prevents release of mediators from mast cells. Effective only for the prophylaxis of asthma. Not effective during an acute attack.
- reduction - oxy - & hydrolysis - H2O sol. Polar product - P450
Alpha -1 antagonist
Gram + and Anerobes

27. What enzyme does Zileuton inhibit?
aPTT (intrinsic pathway)
Lipoxygenase
Antibiotic - protein synthesis inhibitor.
Corticosteroids; prevent production of leukotrienes from arachodonic acid by blocking phospholipase A2. Drugs of choice in a patient with status asthmaticus (in combination with albuterol.)

28. Name the common Non - Nucleoside Reverse Transcriptase Inhibitors
Nevirapine - Delavirdine
Cryptococcal meningitis in AIDS patients and Candidal infections of all types
Minor hepatotoxicity - Drug interactions (activates P450)
- polymyxins

29. Antimicrobial prophylaxis for Gonorrhea
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
Botulinum
Ceftriaxone

30. What is a mnemonic to remember Amantadine's function?
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis
AZT
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.
Blocks Influenza A and RubellA; causes problems with the cerebellA

31. What is the memory key for the effect of magnesium hydroxide overuse?
AluMINIMUM amount of feces.
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)
Mg = Must go to the bathroom.
Erythromycin - Azithromycin - Clarithromycin

32. What is the category and mechanism of action of Zafirlukast in Asthma treatment?
In 4 half - lifes= (94%) T1/2 = (0.7x Vd)/CL
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
Antileukotriene; blocks leukotriene receptors.
Liver

33. What is the category of drug names ending in - azol (e.g. Ketoconazole)
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).
Antileukotriene; blocks synthesis by lipoxygenase.
Antifungal.
Erythromycin - Azithromycin - Clarithromycin

34. Acetazolamide - mechanism?
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.
Potent immunosuppressive used in organ transplant recipients.
dizziness - flushing - constipation (verapamil) - nausea
It must be Phosphorylated by Viral Thymidine Kinase

35. Name four HMG- CoA reductase inhibitors.
Acetylcholine esterase
Botulinum
Lovastatin - Pravastatin - Simvastatin - Atorvastatin
edrophonium (extremely short acting anticholinesterase)

36. Furosemide increases the excretion of What ion?
fetal renal toxicity - hyperkalemia
Ca2+ (Loops Lose calcium)
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)
Nitrates

37. Why does atropine dilate the pupil?
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances
The PT.
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.

38. Clonidine is the preferred sym pathomimetic tx of HTN in pts with renal disease - why??
hypertension - CHF - diabetic renal disease
loop diuretics - spironolactone
Centrally acting alpha agonist - thus causing a decrease in central adrenergic outflow - spairing renal blood flow
Topical and Oral - for Oral Candidiasis (Thrush)

39. What are three clinical uses of the NSAIDs?
1. Antipyretic 2. Analgesic 3. Anti - inflammatory
Antiprotozoal: Giardia - Entamoeba - Trichomonas - Gardnerella vaginalis Anaerobes: Bacteroides - Clostridium
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins
NO

40. What is the category of drug names ending in - olol (e.g. Propranolol)
Beta antagonist.
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas
Intrathecally

41. Toxic effects of TMP include?
- N- acetylcystine
GI upset
Megaloblastic anemia - Leukopenia - Granulocytopenia
Sulfonylureas are oral hypoglycemic agents - they are used to stimulate release of endogenous insulin in NIDDM (type -2).

42. List the specific antidote for this toxin: Beta Blockers
- Glucagon
Slow - limited by half lives of clotting factors
GI upset - Superinfections - Skin rashes - Headache - Dizziness
- Acetaldehyde - Nausea - vomiting - headache - & hypotension

43. How does a noncompetitive antagonist effect an agonist?
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
- Shifts the curve down - reduces Vmax
1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone When used of Leprosy 3. Used in combination with other drugs
- Penicillamine

44. What is the MOA for Rifampin?
TMP- SMZ (DOC) - aerosolized pentamidine
Inhibits DNA dependent RNA polymerase
As PABA antimetabolites that inhibit Dihydropteroate Synthase - Bacteriostatic
Inhibits cell wall synthesis ( binds to PBP3). A monobactam

45. What is the main clinical use for the thrombolytics?
Early myocardial infarction.
Mycobacterium tuberculosis - the only agent used as solo prophylaxis against TB
- Methylene blue
Cell membrane Ca2+ channels of cardiac sarcomere

46. List the specific antidote for this toxin: Carbon monoxide
Hypokalemic metabolic alkalosis - hyponatremia - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia - sulfa allergy.
post MI and digitalis induced arrhythmias
-100% oxygen - hyperbaric
Babiturate.

47. What conditions would you use dantrolene?
- Cimetidine - ketoconazole - grapefruit juice - erythromycin - INH - sulfonamides
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.
- Lithium
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide

48. What are four thrombolytics?
cardiac depression - peripheral edema - flushing - dizziness - constipation
Inhibit viral DNA polymerase
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)
Ataxia - Dizziness - Slurred speech

49. For Heparin What is the Onset of action
Rapid (seconds)
- Physostigmine salicylate
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.
Diuresis in pateints with sulfa allergy

50. What is the mechanism of action of Heparin?
Heparin catalyzes the activation of antithrombin III.
Premature infants - because they lack UDP- glucuronyl transferase
Reversibly inhibits cyclooxygenase - mostly in CNS. Inactivated peripherally.
Immediate anticoagulation for PE - stroke - angina - MI - DVT.