Test your basic knowledge |

USMLE Step 1 Pharmacology

Subjects : 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.
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 of epi - norepi - or isoproterenol results in bradycardia?
1. Aluminum hydroxide: constipation and hypophosphatemia 2. Magnesium hydroxide: diarrhea 3. Calcium carbonate: Hypercalcemia - rebound acid increase - All may cause hypokalemia
Beta Blockers
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.
Norepinephrine

2. Adverse effects of beta - blockers?
aPTT (intrinsic pathway)
Nucleosides
impotence - asthma - CV effects (bradycardia - CHF - AV block) - CNS effects (sedation - sleep alterations)
Sulfonylureas are oral hypoglycemic agents - they are used to stimulate release of endogenous insulin in NIDDM (type -2).

3. K+- clinical use?
depresses ectopic pacemakers - especially in digoxin toxicity
Treatment of hypertension - especially with renal disease (lowers bp centrally - so flow is maintained to kidney).
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy
Malaria (P. falciparum)

4. For Warfarin What is the Onset of action
Those patients who are taking nitrates.
penicillinase resistant
Slow - limited by half lives of clotting factors
- Niacin - Ca++ channel blockers - adenosine - vancomycin

5. List the mechanism - clinical use - & toxicity of 5 FU.
Protease Inhibitors and Reverse Transcriptase Inhibitors
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins
No - it inhibits the release of Nor Epi
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression

6. Furosemide - class and mechanism?
sedation - sleep alterations
Yes - it does not cross the placenta.
Chagas' disease - American Trypanosomiasis (Trypanosoma cruzi)
Sulfonamide Loop Diuretic. Inhibits ion co - transport system of thick ascending loop. Abolishes hypertonicity of the medulla - thereby preventing concentration of the urine.

7. What patients are at risk for life threatening hypotension When taking Sildenafil (Viagra)?
Those patients who are taking nitrates.
- Infections - Trauma - Seizures - CO - Overdose - Metabolic - Alcohol (IT'S COMA)
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis
Well tolerated in general but occasionally - Nephrotoxicity - Ototoxicity - Thrombophlebitis - diffuse flushing='Red Man Syndrome'

8. How is Rifampin used clinically?
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)
1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone When used of Leprosy 3. Used in combination with other drugs
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity

9. What is the category of drug names ending in - terol (e.g. Albuterol)
Acetylates and irreversibly inhibits cyclooxygenase (COX I and COX II) to prevent the conversion of arachidonic acid to prostaglandins.
With supplemental Folic Acid
- Daunorubicin & Doxorubicin
Beta -2 agonist.

10. Nifedipine has similar action to?
thiazides - amiloride
Norepinephrine
Nitrates
Anaerobes

11. Ryanodine - site of action?
blocks SR Ca2+ channels
Long.
Local anesthetic.
Dopamine; causes its release from intact nerve terminals

12. Cocaine shares is mechanism of action with What antidepressant
TCA
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )
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
No - warfarin - unlike heparin - can cross the placenta.

13. Why is reserpine effective in treating HTN?
Binding to the presynaptic alpha 2 release modulating receptors
Yes - it does not cross the placenta.
Beta adrenergic receptors and Ca2+ channels (stimulatory)
Reserpine inhibits dopamine transport into vesicles - attenuating its conversion to NE by dopamine beta - hydroxylase.

14. Name three Antiarrhythmic drugs in class IB.
Lidocaine - Mexiletine - Tocainide
new arrhythmias - hypotension
IV vitamin K and fresh frozen plasma
- Haloperidol - chlorpromazine - reserpine - MPTP

15. Preferential action of the Ca2+ channel blockers at vascular smooth muscle?
Wide spectrum of systemic mycoses: Cryptococcus - Blastomyces - Coccidioides - Aspergillus - Histoplasma - Candida - Mucor
K+ wasting - metabolic alkalosis - hypotension - ototoxicity
Methylzanthine; desired effect is bronchodilation - may cause bronchodilation by inhibiting phosphodiesterase - enzyme involved in degrading cAMP (controversial).
vascular sm. Mus.: Nifedipine>Diltiazem>Verapamil

16. What is the category of drug names ending in - olol (e.g. Propranolol)
Beta antagonist.
Inhibits cell wall synthesis ( binds to PBP3). A monobactam
Choline acetyltransferase
Minor hepatotoxicity - Drug interactions (activates P450)

17. Hydralazine - toxicity?
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels
compensatory tachycardia - fluid retention - lupus - like syndrome
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.
AZT - to reduce risk of Fetal Transmission

18. What beta 2 agonist will help your 21yo Astma pt?
Rash - Pseudomembranous colitis
carbonic anhydrase inhibitors - K+ sparing diuretics
Albuterol - tertbutaline
Blocks Peptide Bond formation at the 50S subunit - Bacteriostatic

19. How is Amphotericin B administered for fungal meningitis?
Malaria (P. falciparum)
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.
Intrathecally
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity

20. What is treated with Chloroquine - Quinine - Mefloquine?
Malaria (P. falciparum)
pulmonary edema - dehydration
Hypersensitivity reactions
Edrophonium

21. What is the category of drug names ending in - azepam (e.g. Diazepam)
Antileukotriene; blocks leukotriene receptors.
Benzodiazepine.
- reduction - oxy - & hydrolysis - H2O sol. Polar product - P450
- polymyxins

22. Why would you use pralidoxime after exposure to an organophosphate?
Edrophonium
Digoxin=urinary Digitoxin=biliary
Pralidoxime regenerates active cholinesterase.
GI discomfort - Acute cholestatic hepatitis - Eosinophilia - Skin rashes

23. Name the Protease Inhibitors (4)
Saquinavir - Ritonavir - Indinavir - Nelfinavir
Modification via Acetylation - Adenylation - or Phosphorylation
Amphotericin B - Nystatin - Fluconazole/azoles
Intrathecally

24. What drug is used to diagnose myasthenia gravis?
1. Bleeding 2. Teratogenicity 3. Drug - drug interactions
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.
edrophonium (extremely short acting anticholinesterase)

25. What is a mnemonic to remember Amantadine's function?
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH
Systemic mycoses
Blocks Influenza A and RubellA; causes problems with the cerebellA
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome

26. Digoxin v. Digitoxin: bioavailability?
Digitoxin>95% Digoxin 75%
Antileukotriene; blocks synthesis by lipoxygenase.
Enterobacter
- Vinca alkaloids(inhibit MT) - Paclitaxel

27. What are major side effects of Methicillin - Nafcillin - and Dicloxacillin?
Hypersensitivity reactions
Chronic gout.
1. Pioglitazone 2. Rosiglitazone.
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention

28. These drugs acts indirectly by releasing strored catecholamines in the presynaptic terminal
Amphetamine and Ephedrine
Pseudomembranous colitis (C. difficile) - fever - diarrhea
Blocks Peptide Bond formation at the 50S subunit - Bacteriostatic
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)

29. What is the category and mechanism of action of Zafirlukast in Asthma treatment?
Antileukotriene; blocks leukotriene receptors.
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis
- Phenytoin
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis

30. List the specific antidote for this toxin: Carbon monoxide
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.
Quinidine - Amiodarone - Procainamide - Disopyramide
-100% oxygen - hyperbaric
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression

31. What is the difference in receptor affinity of epinephrine at low doses? High doses?

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183

32. Adenosine - clinical use?
DOC in diagnosing and abolishing AV nodal arrhythmias
As PABA antimetabolites that inhibit Dihydropteroate Synthase - Bacteriostatic
reversible SLE- like syndrome
Erythromycin - Azithromycin - Clarithromycin

33. What is the effect of guanethidine on adrenergic NE release?
Sulfamethoxazole (SMZ) - Sulfisoxazole - Triple sulfas - Sulfadiazine
Non - Nucleosides
- Estrogen receptor antagonist - Breast CA - increased endometrial CA risk
It inhibits release of NE.

34. Can Heparin be used during pregnancy?
Protamine sulfate
Chloramphenicol - Erythromycin/macrolides - Lincomycin - Clindamycin - Streptogramins (quinupristin - dalfopristin)
Yes - it does not cross the placenta.
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia

35. Resistance mechanisms for Aminoglycosides
Praziquantel
Inhibits platelet aggregation by irreversibly inhibiting the ADP pathway involved in the binding of fibrinogen.
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
Modification via Acetylation - Adenylation - or Phosphorylation

36. What is the category of drug names ending in - oxin (e.g. Digoxin)
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
Cardiac glycoside (inotropic agent).
TMP- SMZ (DOC) - aerosolized pentamidine
loop diuretics - spironolactone

37. Are penicillinase resistant
Methicillin - Nafcillin - and Dicloxacillin
No - warfarin - unlike heparin - can cross the placenta.
Captopril - Enalapril - Lisinopril
competitive inhibirot of aldosterone in the cortical collecting tubule

38. What is the clinical use for Penicillin?
toxic
Bactericidal for: Gram + rod and cocci - Gram - cocci - and Spirochetes
- polymyxins
Rare.

39. What are three possible toxicities of NSAID usage?
- Tetracycline - amiodarone - sulfonamides
TCA
1. Renal damage 2. Aplastic anemia 3. GI distress
For serious - Gram + multidrug - resistant organisms

40. What are two processes Corticosteroids inhibit leading to decreased inflammation?
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia
CMV Retinitis in IC pts When Ganciclovir fails
- Phenytoin
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes

41. For Heparin What is the Lab value to monitor
Rifampin
aPTT (intrinsic pathway)
Resistant Gram - infections
fetal renal toxicity - hyperkalemia

42. What are the clinical uses for 3rd Generation Cephalosporins?
- Shifts the curve down - reduces Vmax
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)
Protease Inhibitors and Reverse Transcriptase Inhibitors
Severe Gram - rod infections.

43. What is the MOA of Ribavirin?
Aluminum sucrose sulfate polymerizes in the acid environment of the stomach and selectively binds necrotic peptic ulcer tissue. Acts as a barrier to acid - pepsin - and bile.
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis
post MI and digitalis induced arrhythmias
Epinephrine

44. Which Aminoglycoside is used for Bowel Surgery ?
thiazides - amiloride
Useful in muscle paralysis during surgery or mechanical ventilation.
Inhibits platelet aggregation by irreversibly inhibiting the ADP pathway involved in the binding of fibrinogen.
Neomycin

45. Foscarnet toxicity?
Nephrotoxicity
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis
Pseudomonas species and Gram - rods
Nifedipine - Verapamil - Diltiazem

46. What are common toxic side effects of Sulfonamides? (5)
1. Antipyretic 2. Analgesic 3. Anti - inflammatory
- Hypersensitivity reactions - Hemolysis - Nephrotoxicity (tubulointerstitial nephritis) - Kernicterus in infants Displace other drugs from albumin (e.g. - warfarin)
fetal renal toxicity - hyperkalemia
It acts presynaptically to increase NE release.

47. Digoxin v. Digitoxin: excretion?
Digoxin=urinary Digitoxin=biliary
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions
Immediate anticoagulation for PE - stroke - angina - MI - DVT.
Well tolerated in general but occasionally - Nephrotoxicity - Ototoxicity - Thrombophlebitis - diffuse flushing='Red Man Syndrome'

48. What is the formula for Clearance (CL)
- Deferoxamine
CL= (rate of elimination of drug/ Plasma drug conc.)
Antileukotriene; blocks leukotriene receptors.
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome

49. Name three calcium channel blockers?
Nifedipine - Verapamil - Diltiazem
atropine - homatropine - tropicamide
vasodilator - increases cGMP to induce smooth muscle relaxation (arterioles>veins; afterload reduction)
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.

50. What sympathomimetic would you not prescribe for hypotension in a pt with renal artery sclerosis.
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole
Norepinephrine (Alpha1 -2 and beta 1)
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.
Fast vs. Slow Acetylators