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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.
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. Antiarrhythmic class IV- primary site of action?
AV nodal cells
physostigmine
orthostatic and exercise hypotension - sexual dysfunction - diarrhea
narcolepsy - obesity - and attention deficit disorder (I wouldn't recommend this)

2. What enzyme is responsible for the degredation of Ach
With an amino acid change of D- ala D- ala to D- ala D- lac
Acetylcholinesterase; ACh is broken down into choline and acetate.
Mg = Must go to the bathroom.
Acetylcholine esterase

3. Would blockade of muscarininc receptors in the bladder be useful in treating urinary retention?
Md= (CpxCL)/F Cp= plas. Conc. CL=clear. F=bioaval.
Fever/Chills - Hypotension - Nephrotoxicity - Arrhythmias
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.
- Methylene blue

4. Which drug(s) cause this reaction: Cough?
No - it inhibits the release of Nor Epi
Does not cross
- ACE inhibitors (Losartan>no cough)
Norepinephrine

5. What is the MOA for Carbenicillin - Piperacillin - and Ticarcillin?
Same as penicillin. Extended spectrum antibiotics
Large anionic polymer - acidic
1. Addison's disease 2. Inflammation 3. Immune suppression 4. Asthma
Ceftriaxone

6. List the specific antidote for this toxin: Heparin
Phenothiazine (neuroleptic - antiemetic).
- Lithium
Milk or Antacids - because divalent cations inhibit Tetracycline absorption in the gut
- Protamine

7. Name two LPL stimulators.
Prophylaxis for Influenza A - Rubella; Parkinson's disease
Gemfibrozil - Clofibrate
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids
- Bleomycin - amiodarone - busulfan

8. What are the classic symptoms of cholinesterase inhibitor poisoning (parathion or other organophosphates)?
Lipoxygenase
Diarrhea - Urination - Miosis - Bronchospasm - Bradycardia - Excitation of skeletal muscle and CNS - Lacrimation - Sweating - and Salivation = DUMBBELS; also abdominal cramping
GET on the Metro
Erythromycin - Azithromycin - Clarithromycin

9. What is Niclosamide used for?
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.
Heparin catalyzes the activation of antithrombin III.
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more

10. Which drug(s) cause this reaction: Cinchonism (2)?
- Quinidine - quinine
Paranteral (IV - SC)
aPTT (intrinsic pathway)
Onchocerciasis ('river blindness'-- rIVER- mectin)

11. Name four Antiarrhythmic drugs in class IA.
Quinidine - Amiodarone - Procainamide - Disopyramide
The only local anesthetic with vasoconstrictive properties.
penicillinase resistant
- Penicillin

12. Name the common Aminoglycosides (5)
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD
Decrease the production of leukotrienes and protaglandins by inhibiting phospholipase A2 and expression of COX-2.

13. Cocaine shares is mechanism of action with What antidepressant
GI distress - Tooth discoloration and Inhibition of bone growth in children - Fanconi's syndrome - Photosensitivity
- Daunorubicin & Doxorubicin
compensatory tachycardia - fluid retention - lupus - like syndrome
TCA

14. What is the MOA for the Cephalosporins?
Beta lactams - inhibit cell wall synthesis - Bactericidal
Beta -2 agonist.
Early myocardial infarction.
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more

15. Which drug(s) cause this reaction: Cardiac toxicity?
Hypokalemic metabolic alkalosis - hyponatremia - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia - sulfa allergy.
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids
Systemic mycoses
- Daunorubicin & Doxorubicin

16. What microorganisms is Aztreonam not effective against?
Gram + and Anerobes
prevention of nodal arrhythmias (SVT)
Pentamidine
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.

17. Bretyllium - toxicity?
new arrhythmias - hypotension
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.
Gram + - Gram - - Norcardia - Chlamydia
Liver

18. Which drug(s) cause this reaction: Atropine - like side effects?
- Methotrexate - 5 FU - 6 mercaptopurine
Antifungal.
- Tricyclic antidepressants
- Vitamin K & fresh frozen plasma

19. How would you treat African Trypanosomiasis (sleeping sickness)?
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism
Quinolones
Pentamidine
Suramin

20. Name some common Tetracyclines (4)
Norepinephrine (Alpha1 -2 and beta 1)
Benzathine penicillin G
Tetracycline - Doxycycline - Demeclocycline - Minocycline
Hypersensitivity reactions

21. List the mechanism - clinical use - & toxicity of Etoposide.
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
- Physostigmine salicylate
- Phase I (clinical tests) - Phase II - Phase III - PhaseIV (surveillance)
osmotic diuretic - increase tubular fluid osmolarity - thereby increasing urine flow

22. What are two mechanisms of action of Propythiouracil?
- DNA intercalator - Hodgkin's - myeloma - sarcoma - and solid tumors - Cardiotoxicity & alopecia
For serious - Gram + multidrug - resistant organisms
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.
Chloramphenicol - Erythromycin/macrolides - Lincomycin - Clindamycin - Streptogramins (quinupristin - dalfopristin)

23. Name two classes of drugs for HIV therapy
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia
- inhibits HGPRT (pur. Syn.) - Luk - Lymph
Protease Inhibitors and Reverse Transcriptase Inhibitors
- Corticosteroids - heparin

24. Decrease Digoxin dose in renal failure?
GI upset
Ca2+ (Loops Lose calcium)
Prevents the release of Ca from SR of skeletal muscle
YES

25. Cautions When using Amiodarone?
Increased systolic and pulse pressure - decreased diastolic pressure - and little change in mean pressure.
Beta -2 agonist.
DHPG (dihydroxy-2- propoxymethyl guanine)
check PFTs - LFTs - and TFTs

26. Name some common Sulfonamides (4)
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA
Sulfamethoxazole (SMZ) - Sulfisoxazole - Triple sulfas - Sulfadiazine
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.

27. Toxic effects of TMP include?
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids
Megaloblastic anemia - Leukopenia - Granulocytopenia
Suramin

28. What is the clinical use for Heparin?
- Estrogen receptor antagonist - Breast CA - increased endometrial CA risk
Does not cross
Immediate anticoagulation for PE - stroke - angina - MI - DVT.
- Glucocorticoid withdrawal

29. What is the clinical utility of cocaine?
Tetracycline - Doxycycline - Demeclocycline - Minocycline
Gram + cocci - Gram - rods - and Anerobes
- Chloramphenicol
The only local anesthetic with vasoconstrictive properties.

30. Clonidine is the preferred sym pathomimetic tx of HTN in pts with renal disease - why??
Centrally acting alpha agonist - thus causing a decrease in central adrenergic outflow - spairing renal blood flow
Bactericidal for: Gram + rod and cocci - Gram - cocci - and Spirochetes
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.
1. Pioglitazone 2. Rosiglitazone.

31. Name three K+ sparing diuretics?
The PTT.
Erythromycin - Azithromycin - Clarithromycin
Spironolactone - Triamterene - Amiloride (the K+ STAys)
- Oxalic acid - Acidosis & nephrotoxicity

32. How do you calculate maintenance dose?
Md= (CpxCL)/F Cp= plas. Conc. CL=clear. F=bioaval.
Cardiac glycoside (inotropic agent).
Malaria (P. falciparum)
Anaerobes

33. Which drug(s) cause this reaction: Pseudomembranous colitis?
- Clindamycin
Digitoxin 168hrs Digoxin 40 hrs
Onchocerciasis ('river blindness'-- rIVER- mectin)
Because they require some residual islet function.

34. The MOA for Chloramphenicol is?
Chronic anticoagulation.
- Act on same receptor - Full has greater efficacy
Forms toxic metabolites in the bacterial cell - Bactericidal
Inhibition of 50S peptidyl transferase - Bacteriostatic

35. Acetaldehyde is metabolized by Acetaldehyde dehydrogenase - Which drug inhibs this enzyme?
- Disulfram & also sulfonylureas - metronidazole
It would increase to ~ 100 beats/min. Both sympathetic and vagal stimulation would be knocked out - but the SA node has an intrinsic pace of 100 beats/min - Which is normally checked by vagal stimulation.
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
GI discomfort - Acute cholestatic hepatitis - Eosinophilia - Skin rashes

36. What type of gout is treated with Allopurinol?
- Methotrexate - 5 FU - 6 mercaptopurine
- Oxalic acid - Acidosis & nephrotoxicity
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes
Chronic gout.

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

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38. Toxic side effects of the Azoles?
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
anticholinesterase glaucoma
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin

39. What is the MOA for Trimethoprim (TMP)?
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.
Inhibits bacterial Dihydrofolate Reductase - Bacteriostatic
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.

40. What is the effect of the Glitazones in diabetes treatment?
Increase target cell response to insulin.
amphetamine and ephedrine
GI discomfort
1. Gastric ulceration 2. Bleeding 3. Hyperventilation 4. Reye's syndrome 5. Tinnitus (CN VIII)

41. What are two indirect acting adrenergic agonists?
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression
Albuterol - tertbutaline
amphetamine and ephedrine
Norepinephrine

42. Specifically - How does Foscarnet inhibit viral DNA pol?
Polymyxin B - Polymyxin E
Binds to the Pyrophosphate Binding Site of the enzyme
torsade de pointes
Methicillin - Nafcillin - and Dicloxacillin

43. How is Chloramphenical used clinically?
Meningitis (H. influenza - N. meningitidis - S. pneumoniae) - Conserative treatment due to toxicities
cross - allergenic
decrease conduction velocity - increase ERP - increase PR interval
Inhibit viral DNA polymerase

44. What are three clinical uses of the Leuprolide?
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids
Short.
is resistant
Rare.

45. For Heparin What is the Onset of action
decrease the slope of phase 4 - increase PR interval (the AV node is particularly sensitive)
Rapid (seconds)
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.
fetal renal toxicity - hyperkalemia

46. What are the products and their toxicities of the metabolism of ethanol by / alcohol dehydrogenase?
- Acetaldehyde - Nausea - vomiting - headache - & hypotension
Prophylaxis for Influenza A - Rubella; Parkinson's disease
Gram + cocci - Proteus mirabilis - E. coli - Klebsiella pneumoniae (PEcK)
Pralidoxime regenerates active cholinesterase.

47. List the specific antidote for this toxin: Tricyclic antidepressants
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)
- NaHCO3
Anaerobic infections (e.g. - B. fragilis - C. perfringens)
Aminoglycosides

48. What enzymes are inhibited by NSAIDs - acetaminophen and COX II inhibitors?
collecting ducts
atropine - homatropine - tropicamide
Cyclooxygenases (COX I - COX II).
CMV Retinitis in IC pts When Ganciclovir fails

49. What is the category - mechanism of action - and effect of Ipratroprium in Asthma treatment?
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).
Binds ergosterol - Disrupts fungal membranes
Teratogenic - Carcinogenic - Confusion - Headaches
Muscarinic antagonist; competatively blocks muscarinic receptors - preventing bronchoconstriction.

50. What effect would atropine have on a patient with peptic ulcer disease?
- Hypersensitivity reactions - Hemolysis - Nephrotoxicity (tubulointerstitial nephritis) - Kernicterus in infants Displace other drugs from albumin (e.g. - warfarin)
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids
Pyridoxine (B6) administration
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).