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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. Adverse effects of Loop Diuretics?
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.
K+ wasting - metabolic alkalosis - hypotension - ototoxicity
- Phenytoin
sedation - depression - nasal stuffiness - diarrhea

2. What is the category of drug names ending in - cycline (e.g. Tetracycline)
Alpha -1 antagonist
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.
Similar to cyclosporine; binds to FK- binding protein - inhibiting secretion of IL-2 and other cytokines.
Antibiotic - protein synthesis inhibitor.

3. Ganciclovir associated toxicities?
Diarrhea
Pentavalent Antimony
Beta1 more than B2
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity

4. What are toxicities associated with Chloramphenicol?
hypertension - CHF - diabetic renal disease
Wide spectrum of systemic mycoses: Cryptococcus - Blastomyces - Coccidioides - Aspergillus - Histoplasma - Candida - Mucor
Cilastatin
Aplastic anemia (dose independent) - Gray Baby Syndrome

5. What is the major side effect for Ampicillin and Amoxicillin?
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic
- Deferoxamine
NO HYPERURICEMIA - NO SULFA AllERGY; same as furosemide otherwise
Hypersensitivity reactions

6. In What population does Gray Baby Syndrome occur? Why?
Headache - flushing - dyspepsia - blue - green color vision.
Premature infants - because they lack UDP- glucuronyl transferase
It inhibits release of NE.
Digoxin=urinary Digitoxin=biliary

7. Ca2+ sensitizers'- site of action?
- Flumazenil
- DNA intercalator - testicular & lymphomas - Pulmonary fibrosis mild myelosuppression.
troponin - tropomyosin system
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more

8. Antiarrhythmic class IV- clinical use?
Same as penicillin. Extended spectrum antibiotics
K+ wasting - metabolic alkalosis - hypotension - ototoxicity
Tetracycline - Doxycycline - Demeclocycline - Minocycline
prevention of nodal arrhythmias (SVT)

9. How is Trimethoprim used clinically?
Used in combination therapy with SMZ to sequentially block folate synthesis
- NaHCO3
carbonic anhydrase inhibitors - K+ sparing diuretics
Decreases synthesis of Mycolic Acid

10. What is the category - mechanism of action - and particular use of beclomethasone and prednisone in Asthma treatment?
- Shifts the curve to the right - increases Km
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.)
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions
The PTT.

11. What are five toxicities associated with Tacrolimus (FK506)?
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
- Protamine
Protease inhibitor.
Reserpine inhibits dopamine transport into vesicles - attenuating its conversion to NE by dopamine beta - hydroxylase.

12. How is Chloramphenical used clinically?
TCA
Lidocaine - Mexiletine - Tocainide
- Lithium
Meningitis (H. influenza - N. meningitidis - S. pneumoniae) - Conserative treatment due to toxicities

13. What is the MOA of Amantadine?
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.

14. What are two mechanisms of action of Propythiouracil?
cardiac depression - peripheral edema - flushing - dizziness - constipation
1. Antipyretic 2. Analgesic 3. Anti - inflammatory
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.
narcolepsy - obesity - and attention deficit disorder (I wouldn't recommend this)

15. What are two clinical uses of Azathioprine?
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation
Mebendazole/Thiabendazole - Pyrantel Pamoate
Diarrhea - Urination - Miosis - Bronchospasm - Bradycardia - Excitation of skeletal muscle and CNS - Lacrimation - Sweating - and Salivation = DUMBBELS; also abdominal cramping
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)

16. What is an occasional side effect of Aztreonam?
Inhibits Viral DNA polymerase
Extended spectrum penicillin: certain Gram + bacteria and Gram - rods
- Formaldehyde & formic acid - severe acidosis & retinal damage
GI upset

17. Reserpine will block the syntheis of this drug and but not its precursor.
Decreases synthesis of Mycolic Acid
Blocks Norepi - but not Dopamine
new arrhythmias - hypotension
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.

18. What is the MOA for the Cephalosporins?
Digoxin=urinary Digitoxin=biliary
Penicillin.
Suramin
Beta lactams - inhibit cell wall synthesis - Bactericidal

19. What Sulfonamides are used for simple UTIs?
Pralidoxime regenerates active cholinesterase.
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.
Decrease the production of leukotrienes and protaglandins by inhibiting phospholipase A2 and expression of COX-2.
Triple sulfas or SMZ

20. What are three possible complications of Heparin therapy?
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine
- Cloazapine - carbamazapine - colchicine - PTU
1. Bleeding 2. Thrombocytopenia 3. Drug - drug interactions
Quinolones

21. Ca2+ channel blockers - mechanism?
To inhibit renal Dihydropeptidase I and decrease Imipenem inactivation in the renal tubules
Norepinephrine
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility

22. For Heparin What is the Route of administration
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load
- Cloazapine - carbamazapine - colchicine - PTU
Paranteral (IV - SC)
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention

23. What is the MOA of the RT Inhibitors?
amphetamine and ephedrine
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol
Triple Therapy' 2 Nucleoside RT Inhibitors with a Protease Inhibitor

24. What is the category of drug names ending in - navir (e.g. Saquinavir)
Rifampin (DOC) - minocycline
- Niacin - Ca++ channel blockers - adenosine - vancomycin
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori
Protease inhibitor.

25. What is the mechanism of action and clinical use of the antiandrogens Ketoconazole and Spironolactone?
cardiac muscle: Verapamil>Diltiazem>Nifedipine
Tendonitis and Tendon rupture
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.

26. What are four H2 Blockers?
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine
Rash - Pseudomembranous colitis
CL= (rate of elimination of drug/ Plasma drug conc.)
Acetylcholine esterase

27. Describe Phase I metabolism in liver(3)?
distal convoluted tubule (early)
- reduction - oxy - & hydrolysis - H2O sol. Polar product - P450
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.
Pregnant women - Children; because animal studies show Damage to Cartilage

28. Bretyllium - toxicity?
- Glucagon
proarrhythmic
new arrhythmias - hypotension
Ipratropium

29. Name three calcium channel blockers?
Well tolerated in general but occasionally - Nephrotoxicity - Ototoxicity - Thrombophlebitis - diffuse flushing='Red Man Syndrome'
Due to the presence of a bulkier R group
Nifedipine - Verapamil - Diltiazem
sedation - positive Coombs' test

30. What parasitic condition is treated with Ivermectin?

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31. Which RT inhibitors cause a Rash?
Megaloblastic anemia - Leukopenia - Granulocytopenia
Pyridoxine (B6) administration
Treatment of infertility.
Non - Nucleosides

32. Explain potency in relation to full and partial agonists(2).
sedation - sleep alterations
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.
-100% oxygen - hyperbaric
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels

33. What are three toxicities of Leuprolied?
Babiturate.
1. Antiandrogen 2. Nausea 3. Vomiting
- Haloperidol - chlorpromazine - reserpine - MPTP
Increases coumadin metabolism

34. What is Nifurtimox administered for?

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35. Guanethidine enhances the release of Norepi?
No - it inhibits the release of Nor Epi
Reversible block of histamine H2 receptors
Aminoglycosides
- Steroids - Tamoxifen

36. What is the category - desired effect - and possible mechanism of Theophylline in treating Asthma?
Rheumatoid and osteoarthritis.
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol
Chloramphenicol - Erythromycin/macrolides - Lincomycin - Clindamycin - Streptogramins (quinupristin - dalfopristin)
Methylzanthine; desired effect is bronchodilation - may cause bronchodilation by inhibiting phosphodiesterase - enzyme involved in degrading cAMP (controversial).

37. A fellow passenger on a Carnival cruise ship looks pale and diaphoretic - What antimuscarinic agent would you give them?
- Atropine & pralidoxime
scopolamine
Rifampin - Ethambutol - Streptomycin - Pyrazinamide - Isoniazid (INH)
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.

38. What is the clinical utility of clonidine?
Chronic gout.
Polymyxin B - Polymyxin E
Treatment of hypertension - especially with renal disease (lowers bp centrally - so flow is maintained to kidney).
Give an antichloinesterase - neostigmine - edrophonium - etc

39. What is the MOA for Rifampin?
- Alkalate DNA - Brain tumors - CNS toxicity
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
Inhibits DNA dependent RNA polymerase

40. Antiarrhythmic class II- mechanism?
blocking the beta adrenergic receptor leads to decreased cAMP - and decreased Ca2+ flux
Inhibit Ergosterol synthesis
Hypersensitivity reactions
CL= (rate of elimination of drug/ Plasma drug conc.)

41. Why is pyridostigmine effective in the treatment of myasthenia gravis?
impotence - asthma - CV effects (bradycardia - CHF - AV block) - CNS effects (sedation - sleep alterations)
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)
As an anticholinesterase it increases endogenous ACh and thus increases strength.

42. Ethacrynic Acid - mechanism?
Clavulanic acid
vasodilator - increases cGMP to induce smooth muscle relaxation (arterioles>veins; afterload reduction)
not a sulfonamide - but action is the same as furosemide
Buy AT 30 - CELL at 50'

43. What is the mechanism of action of Heparin?
- Oral Contraceptives
impotence - exacerbation of asthma - CV effects - CNS effects - may mask hypoclycemia
Heparin catalyzes the activation of antithrombin III.
vascular sm. Mus.: Nifedipine>Diltiazem>Verapamil

44. What is the category of drug names ending in - azol (e.g. Ketoconazole)
BM suppression (neutropenia - anemia) - Peripheral neuropathy
- Daunorubicin & Doxorubicin
Paranteral (IV - SC)
Antifungal.

45. Acetazolamide causes?

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46. Aztreonam is not ________ with penicillins
- Cloazapine - carbamazapine - colchicine - PTU
cross - allergenic
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins
Rifampin (DOC) - minocycline

47. Mnemonic for Foscarnet?
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression
Stimulates beta adrenergic receptors
Non - Nucleosides
Foscarnet = pyroFosphate analog

48. Which drug(s) cause this reaction: G6PD hemolysis(8)?
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol
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
Gram + and Anerobes

49. List the mechanism - clinical use - & toxicity of Doxorubicin.

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50. What are three common NSAIDS other than Aspirin?
Ibuprofen - Naproxen - and Indomethacin
viral kinase
- MT polymerization inhibitor(M phase) - MOPP - lymphoma - Willm's & choriocarcinoma - neurotoxicity and myelosuppression
bradycardia - AV block - CHF