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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. Toxic effects of TMP include?
Megaloblastic anemia - Leukopenia - Granulocytopenia
NO HYPERURICEMIA - NO SULFA AllERGY; same as furosemide otherwise
Useful in muscle paralysis during surgery or mechanical ventilation.
Hypersensitivity reactions

2. Which drug(s) cause this reaction: Thrombotic complications?
Topical and Oral - for Oral Candidiasis (Thrush)
1. Addison's disease 2. Inflammation 3. Immune suppression 4. Asthma
- Oral Contraceptives
Mycobacterium tuberculosis - the only agent used as solo prophylaxis against TB

3. Name two organisms Vancomycin is commonly used for?
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression
PT
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.

4. Acetaminophen has What two clinical uses and lacks What one clinical use of the NSAIDs?
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.
Interferes with microtubule function - disrupts mitosis - inhibits growth
Quinolones

5. What is an acronym to remember Anti - TB drugs?
- MT polymerization inhibitor(M phase) - MOPP - lymphoma - Willm's & choriocarcinoma - neurotoxicity and myelosuppression
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
The only local anesthetic with vasoconstrictive properties.
RESPIre

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

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7. Antiarrhythmic class IC- effects?
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.)
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT
Ciprofloxacin - Norfloxacin - Ofloxacin - Grepafloxacin - Enoxacin - Nalidixic acid
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)

8. What are the side effects of Polymyxins?
1. Heavy bleeding 2. GI effects (n/v - anorexia) 3. Abdominal pain
Amphotericin B - Nystatin - Fluconazole/azoles
Neurotoxicity - Acute renal tubular necrosis
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

9. Beta Blockers - CNS toxicity?
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic
orthostatic and exercise hypotension - sexual dysfunction - diarrhea
Amphotericin B - Nystatin - Fluconazole/azoles
sedation - sleep alterations

10. For Heparin What is the Structure
Large anionic polymer - acidic
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal
GI upset - Superinfections - Skin rashes - Headache - Dizziness
anuria - CHF

11. Adverse effects of Reserpine?
- Alkalate DNA - Brain tumors - CNS toxicity
Prevents the release of Ca from SR of skeletal muscle
Impairs the synthesis of vitamin K- dependent clotting factors
sedation - depression - nasal stuffiness - diarrhea

12. Adverse effects of beta - blockers?
impotence - asthma - CV effects (bradycardia - CHF - AV block) - CNS effects (sedation - sleep alterations)
Neutropenia
Carbachol - pilocarpine - physostigmine - echothiophate
Quinidine - Amiodarone - Procainamide - Disopyramide

13. Why are albuterol and terbutaline effective in tx of acute asthmatic attacks?
These B-2 agonists cause respiratory smooth muscle to relax.
- Dimercaprol - succimer
not a sulfonamide - but action is the same as furosemide
GI distress - Skin rash - and Seizures at high plasma levels

14. List the mechanism - clinical use - & toxicity of Bleomycin.
reversible SLE- like syndrome
1. Gastric ulceration 2. Bleeding 3. Hyperventilation 4. Reye's syndrome 5. Tinnitus (CN VIII)
- DNA intercalator - testicular & lymphomas - Pulmonary fibrosis mild myelosuppression.
Md= (CpxCL)/F Cp= plas. Conc. CL=clear. F=bioaval.

15. What is a possible result of overdose of Acetaminophen?
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.
Anaerobic infections (e.g. - B. fragilis - C. perfringens)
They inhibit reuptake of NE at the nerve terminal (as does cocaine).
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.

16. What are common side effects of Protease Inhibitors?
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)
impotence - asthma - CV effects (bradycardia - CHF - AV block) - CNS effects (sedation - sleep alterations)
The only local anesthetic with vasoconstrictive properties.
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.

17. Explain differences between full and partial agonists(2).
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)
Tubocurarine - atracurium - mivacurium - pancuronium - vecuronium - rapacuronium
- Act on same receptor - Full has greater efficacy
prevention of nodal arrhythmias (SVT)

18. Which drug(s) cause this reaction: Gray baby syndrome?
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
- Nitrate - hydroxocobalamin thiosulfate
- Chloramphenicol
Slow - limited by half lives of clotting factors

19. For Warfarin What is the Onset of action
Increase target cell response to insulin.
- aminoglycosides - loop diuretics - cisplatin
Amphotericin B - Nystatin - Fluconazole/azoles
Slow - limited by half lives of clotting factors

20. What organisms does Griseofulvin target?
Dermatophytes (tinea - ringworm)
Beta -2 agonist.
Mebendazole/Thiabendazole - Pyrantel Pamoate
Inhibits DNA dependent RNA polymerase

21. Does Heparin have a long - medium - or short half life?
Short.
Anaerobic infections (e.g. - B. fragilis - C. perfringens)
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes

22. What are four conditions in Which H2 Blockers are used clinically?
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
cholestyramine - colestipol
With supplemental Folic Acid
Paranteral (IV - SC)

23. How is Griseofulvin used clinically?
Oral treatment of superficial infections
Inhibit intestinal bursh border Alpha - glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
BM suppression (neutropenia - anemia) - Peripheral neuropathy

24. What is the mechanism of action of Heparin?
Increases coumadin metabolism
Heparin catalyzes the activation of antithrombin III.
Zidovudine (AZT) - Didanosine (ddI) - Zalcitabine (ddC) - Stavudine (d4T) - Lamivudine (3TC)
thiazides - amiloride

25. What patients are at risk for life threatening hypotension When taking Sildenafil (Viagra)?
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.
Those patients who are taking nitrates.
Saquinavir - Ritonavir - Indinavir - Nelfinavir
Pretreat with antihistamines and a slow infusion rate

26. Resistance mechanisms for Tetracycline
- Glucocorticoid withdrawal
Decreased uptake or Increased transport out of cell
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis
-100% oxygen - hyperbaric

27. Which drug(s) cause this reaction: Stevens - Johnson syn. (3)?
- Dimercaprol - succimer
hypertension - CHF - diabetic renal disease
Beta antagonist.
- Ethosuxamide - sulfonamides - lamotrigine

28. What are two mechanisms of action of Propythiouracil?
GI distress - Tooth discoloration and Inhibition of bone growth in children - Fanconi's syndrome - Photosensitivity
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.
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
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).

29. What are signs of Sildenafil (Viagra) toxicity?
Ceftriaxone
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).
Prophylaxis for Influenza A - Rubella; Parkinson's disease
Headache - flushing - dyspepsia - blue - green color vision.

30. What are the products and their toxicities of the metabolism of Methanol by / alcohol dehydrogenase?
Gram + cocci - Gram - rods - and Anerobes
- Formaldehyde & formic acid - severe acidosis & retinal damage
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
Acute gout.

31. What is a possible toxicity of Ticlopidine - Clopidogrel usage?
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.
Same as penicillin. Act as narrow spectrum antibiotics
Tetracycline - Doxycycline - Demeclocycline - Minocycline
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes

32. Is toxicity rare or common whith Cromolyn used in Asthma prevention?
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic
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
- Triggers apoptosis - CLL - Hodgkin's in MOPP - Cushing - like syndrome
Rare.

33. What type of gout is treated with Probenacid?
Anaerobic infections (e.g. - B. fragilis - C. perfringens)
Flecainide - Encainide - Propafenone
Succinylcholine
Chronic gout.

34. Explain pH dependent urinary drug elimination?
Large anionic polymer - acidic
Sulfonamides - Trimethoprim
Penicillin - Cephalosporins - Vancomycin - Aminoglycosides - Fluoroquinolones - Metronidazole
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more

35. What sympathomimetic would you not prescribe for hypotension in a pt with renal artery sclerosis.
Norepinephrine (Alpha1 -2 and beta 1)
Nifedipine - Verapamil - Diltiazem
Leukotrienes increasing bronchial tone.
No - hemicholinum block the uptake of Choline and thus Ach synthesis

36. What is the mechanism of action of Omeprazole - Lansoprazole?
CMV - esp in Immunocompromised patients
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.
atropine - homatropine - tropicamide
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA

37. List the specific antidote for this toxin: Opioids
Antileukotriene; blocks synthesis by lipoxygenase.
Gram + and Anerobes
torsade de pointes
- B51Naloxone / naltrexone (Narcan)

38. Name three Antiarrhythmic drugs in class IB.
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.
No - hemicholinum block the uptake of Choline and thus Ach synthesis
Lidocaine - Mexiletine - Tocainide

39. What is Ketoconazole specifically used for?
Long.
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism
Vd= (Amt. of drug in body/ Plasma drug conc.)
Meningitis (H. influenza - N. meningitidis - S. pneumoniae) - Conserative treatment due to toxicities

40. Name the common Azoles
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances
1. Gastric ulceration 2. Bleeding 3. Hyperventilation 4. Reye's syndrome 5. Tinnitus (CN VIII)
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole
Inhibits reabsorption of uric acid.

41. Quinidine - toxicity?
Paranteral (IV - SC)
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
Decrease the production of leukotrienes and protaglandins by inhibiting phospholipase A2 and expression of COX-2.
cinchonism: HA - tinnitus - thrombocytopenia - torsade de pointes due to increased QT interval

42. List the specific antidote for this toxin: Salicylates
- Alkalinize urine & dialysis
Sulfonylureas are oral hypoglycemic agents - they are used to stimulate release of endogenous insulin in NIDDM (type -2).
DHPG (dihydroxy-2- propoxymethyl guanine)
thiazides - amiloride

43. Which drug(s) cause this reaction: Tendonitis and rupture?
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide
- Fluoroquinolones

44. How is Acyclovir used clinically?
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA
HSV - VZV - EBV - Mucocutaneous and Genital Herpes Lesions - Prophylaxis in Immunocompromised pts
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.
Clavulanic acid

45. What is the mechanism of action of Probenacid used to treat chronic gout?
Teratogenic - Carcinogenic - Confusion - Headaches
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility
Leukotrienes increasing bronchial tone.
Inhibits reabsorption of uric acid.

46. What are Fluoroquinolones indicated for? (3)
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms
Aminoglycosides
Digitoxin 70% Digoxin 20-40%
Reversible block of histamine H2 receptors

47. What Sulfonamides are used for simple UTIs?
Beta1 more than B2
Triple sulfas or SMZ
impotence - asthma - CV effects (bradycardia - CHF - AV block) - CNS effects (sedation - sleep alterations)
- Isoniazid

48. List the mechanism - clinical use - & toxicity of Etoposide.
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
GI disturbances.
The PT.
competitive inhibirot of aldosterone in the cortical collecting tubule

49. Resistance mechanisms for Cephalosporins/Penicillins
loop diuretics - thiazides
Hydralazine and Minoxidil
Acute gout.
Beta - lactamase cleavage of Beta - lactam ring

50. What is are two clinical uses of Cyclosporine?
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
Cyclooxygenases (COX I - COX II).