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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 is the category of drug names ending in - tropin (e.g. Somatotropin)
NE acts presynaptically on alpha -2 receptors to inhibit its own release. ACh also acts presynaptically through M1 receptors to inhibit NE release.
- Lithium
Pituitary hormone.
- Alkalinize urine & dialysis

2. What is the effect of guanethidine on adrenergic NE release?
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.
It inhibits release of NE.
Rifampin - Ethambutol - Streptomycin - Pyrazinamide - Isoniazid (INH)
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)

3. What is used to reverse the action of Heparin?
Large anionic polymer - acidic
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).
GI distress - Skin rash - and Seizures at high plasma levels
- Deferoxamine

4. What is the MOA for Amphotericin B?
Pralidoxime regenerates active cholinesterase.
1. Pioglitazone 2. Rosiglitazone.
Clavulanic acid
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis

5. List the specific antidote for this toxin: Carbon monoxide
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
-100% oxygen - hyperbaric
Ototoxicity - Hypokalemia - Dehydration - Allergy (sulfa) - Nephritis (interstitial) - Gout
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.

6. What is the mechanism of action of Omeprazole - Lansoprazole?
Stimulating beta receptors stimulates heart rate - but beta receptor induced vasodilation reduces peripheral resistance.
cholestyramine - colestipol
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.
IV vitamin K and fresh frozen plasma

7. What microorganisms are clinical indications for Tetracycline therapy?

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8. What is the category of drug names ending in - triptyline (e.g. Amitriptyline)
cyanide toxicity (releases CN)
Tricyclic antidepressant.
Increase target cell response to insulin.
Reversibly inhibits cyclooxygenase - mostly in CNS. Inactivated peripherally.

9. IV Penicillin
Penicillin - G
VACUUM your Bed Room'
Edrophonium
Chronic gout.

10. What is the memory key for Metronidazole's clinical uses?
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT
Due to the presence of a bulkier R group
GET on the Metro
Dobutamine has more of an affintiy for beta -1 than beta -2 - and is used for treating heart failure and shock. Albuterol and terbutaline is the reverse - and is used in treatment of acute asthma.

11. MOA: Block peptidoglycan synthesis
Inhibits Viral DNA polymerase
- Alkalinize urine & dialysis
Bacitracin - Vancomycin
Muscarinic antagonist; competatively blocks muscarinic receptors - preventing bronchoconstriction.

12. Antiarrhythmic class IV- primary site of action?
AV nodal cells
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone

13. Which cancer drugs work at the level of mRNA(2)?
Penicillin.
- Steroids - Tamoxifen
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD
Gram + cocci - Gram - rods - and Anerobes

14. Name three calcium channel blockers?
Inhibits cGMP phosphodiesterase - casuing increased cGMP - smooth muscle relaxation in the corpus cavernosum - increased blood flow - and penile erection.
bradycardia - AV block - CHF
- Antipsychotics
Nifedipine - Verapamil - Diltiazem

15. List the mechanism - clinical use - & toxicity of Cyclophosphamide.
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions
all of them
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.
Dermatophytes (tinea - ringworm)

16. Which diuretics cause acidosis?
Neurotoxicity - Acute renal tubular necrosis
Muscarinic antagonist; competatively blocks muscarinic receptors - preventing bronchoconstriction.
carbonic anhydrase inhibitors - K+ sparing diuretics
HTN - CHF - calcium stone formation - nephrogenic DI.

17. Which antimicrobials inhibit protein synthesis at the 50S subunit? (4)
Penicillin - G
For serious - Gram + multidrug - resistant organisms
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic
Treatment of hypertension - especially with renal disease (lowers bp centrally - so flow is maintained to kidney).

18. How is Amantadine used clinically?

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19. What neurotransmitter does Amantadine affect? How does it influence this NT?
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.
Hemolysis (if G6PD deficient) - Neurotoxicity - Hepatotoxicity - SLE- like syndrome
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome
Dopamine; causes its release from intact nerve terminals

20. What are the clinical uses for Aztreonam?
penicillinase resistant
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
Sildenafil fills the penis
sedation - depression - nasal stuffiness - diarrhea

21. Are penicillinase resistant
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia
Methicillin - Nafcillin - and Dicloxacillin
Does not cross
No - it inhibits the release of Nor Epi

22. Name the common Nucleoside Reverse Transcriptase Inhibitors
- Flumazenil
cross - allergenic
Zidovudine (AZT) - Didanosine (ddI) - Zalcitabine (ddC) - Stavudine (d4T) - Lamivudine (3TC)
Sulfonamide Loop Diuretic. Inhibits ion co - transport system of thick ascending loop. Abolishes hypertonicity of the medulla - thereby preventing concentration of the urine.

23. How are the Latent Hypnozoite (Liver) forms of Malaria (P. vivax - P.ovale) treated?
Acetylcholinesterase; ACh is broken down into choline and acetate.
Primaquine
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
1. Antiandrogen 2. Nausea 3. Vomiting

24. How are the HIV drugs used clinically?

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25. Does Heparin have a long - medium - or short half life?
Malaria (P. falciparum)
Protamine sulfate
Short.
Prevents the release of Ca from SR of skeletal muscle

26. MOA: Disrupt fungal cell membranes
Amphotericin B - Nystatin - Fluconazole/azoles
Increases coumadin metabolism
- B51Naloxone / naltrexone (Narcan)
- Dimercaprol - succimer

27. Thiazides - site of action?
cross - allergenic
distal convoluted tubule (early)
first dose orthostatic hypotension - dizziness - headache
all of them

28. Which individuals are predisposed to Sulfonamide - induced hemolysis?
G6PD deficient individuals
physostigmine
GI discomfort - Acute cholestatic hepatitis - Eosinophilia - Skin rashes
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention

29. Amprotericin B ___________ the BBB
Tendonitis and Tendon rupture
Does not cross
- Ammonium Chloride
Ibuprofen - Naproxen - and Indomethacin

30. For Warfarin What is the Mechanism of action
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.
edrophonium (extremely short acting anticholinesterase)
1. Antipyretic 2. Analgesic 3. Anti - inflammatory
Impairs the synthesis of vitamin K- dependent clotting factors

31. Name four Antiarrhythmic drugs in class IA.
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic
Quinidine - Amiodarone - Procainamide - Disopyramide
Acetylcholine esterase

32. MOA for Penicillin (3 answers)?
Sulfamethoxazole (SMZ) - Sulfisoxazole - Triple sulfas - Sulfadiazine
1)Binds penicillin - binding proteins 2) Blocks transpeptidase cross - linking of cell wall 3) Activates autolytic enzymes
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility
Antibiotic - protein synthesis inhibitor.

33. What is the most common cause of Pt noncompliance with Macrolides?
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
GI discomfort
Ganciclovir is more toxic to host enzymes

34. What is the effect of TCA's on the adrenergic nerve?
They inhibit reuptake of NE at the nerve terminal (as does cocaine).
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.
Penicillin - Cephalosporins - Vancomycin - Aminoglycosides - Fluoroquinolones - Metronidazole

35. What enzyme is responsible for the breakdown of ACh in the synaptic cleft?
Reserpine inhibits dopamine transport into vesicles - attenuating its conversion to NE by dopamine beta - hydroxylase.
Acetylcholinesterase; ACh is broken down into choline and acetate.
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.
dry mouth - sedation - severe rebound hypertension

36. Acetazolamide - clinical uses?
Verapamil - Diltiazem - Bepridil
glaucoma - urinary alkalinization - metabolic alkalosis - altitude sickness
proximal convoluted tubule - thin descending limb - and collecting duct
ACE inhibitor.

37. Adverse effects of Reserpine?
No - warfarin - unlike heparin - can cross the placenta.
Epinephirine(Alpha1 -2 and Beta 1 -2)
sedation - depression - nasal stuffiness - diarrhea
- Oxalic acid - Acidosis & nephrotoxicity

38. Which drug(s) cause this reaction: Cutaneous flushing (4)?
- Niacin - Ca++ channel blockers - adenosine - vancomycin
- Deferoxamine
Same as penicillin. Extended spectrum antibiotics
Carbachol - pilocarpine - physostigmine - echothiophate

39. Mannitol - site of action?
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
Impairs the synthesis of vitamin K- dependent clotting factors
proximal convoluted tubule - thin descending limb - and collecting duct
Hypokalemic metabolic alkalosis - hyponatremia - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia - sulfa allergy.

40. Mannitol - toxicity?
1. Hydrocortisone 2. Predisone 3. Triamcinolone 4. Dexamethasone 5. Beclomethasone
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol
pulmonary edema - dehydration
- Niacin - Ca++ channel blockers - adenosine - vancomycin

41. What are the side effects of Rifampin?
Minor hepatotoxicity - Drug interactions (activates P450)
Increase target cell response to insulin.
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state

42. What are two Glitazones?
1. Pioglitazone 2. Rosiglitazone.
increase AP duration - increase ERP - increase QT interval - for use When other arrhythmics fail
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.

43. How can Vancomycin - induced 'Red Man Syndrome' be prevented?
Severe Gram - rod infections.
Cardiac glycoside (inotropic agent).
Pretreat with antihistamines and a slow infusion rate
Tetracycline - Doxycycline - Demeclocycline - Minocycline

44. How is Ribavirin used clinically?
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions
Ataxia - Dizziness - Slurred speech
for RSV
Triple sulfas or SMZ

45. What is an acronym to remember Anti - TB drugs?
Saquinavir - Ritonavir - Indinavir - Nelfinavir
RESPIre
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis

46. What are two processes Corticosteroids inhibit leading to decreased inflammation?
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
Erectile dysfunction.
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes
Stimulating beta receptors stimulates heart rate - but beta receptor induced vasodilation reduces peripheral resistance.

47. What enzymes are inhibited by NSAIDs - acetaminophen and COX II inhibitors?
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine
Cyclooxygenases (COX I - COX II).
Chronic anticoagulation.
Forms toxic metabolites in the bacterial cell - Bactericidal

48. Mannitol - mechanism?
Well tolerated in general but occasionally - Nephrotoxicity - Ototoxicity - Thrombophlebitis - diffuse flushing='Red Man Syndrome'
Inhibits cGMP phosphodiesterase - casuing increased cGMP - smooth muscle relaxation in the corpus cavernosum - increased blood flow - and penile erection.
osmotic diuretic - increase tubular fluid osmolarity - thereby increasing urine flow
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)

49. How can Isoniazid (INH)- induced neurotoxicity be prevented?
Pyridoxine (B6) administration
Delirium - Tremor - Nephrotoxicity
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole
Chronic gout.

50. For Heparin What is the Onset of action
VACUUM your Bed Room'
Acute gout.
Rapid (seconds)
1. Buffalo hump 2. Moon facies 3. Truncal obesity 4. Muscle wasting 5. Thin skin 6. Easy bruisability 7. Osteoporosis 8. Adrenocortical atrophy 9. Peptic ulcers