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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. Sotalol - toxicity?
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol
Depolymerizes microtubules - impairing leukocyte chemotaxis and degranulation.
Treatment of infertility.
torsade de pointes - excessive Beta block

2. What beta 2 agonist will help your 21yo Astma pt?
- NaHCO3
Malaria (P. falciparum)
Albuterol - tertbutaline
Local anesthetic.

3. Loop diuretics (furosemide)- site of action?
Sulfonamides - Trimethoprim
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
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
thick ascending limb

4. Classes of antihypertensive drugs?
diuretics - sympathoplegics - vasodilators - ACE inhibitors - Angiotensin II receptor inhibitors
Treatment of hypertension - especially with renal disease (lowers bp centrally - so flow is maintained to kidney).
Norepinephrine
Sildenafil fills the penis

5. What is Niclosamide used for?
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis
dizziness - flushing - constipation (verapamil) - nausea
glaucoma - urinary alkalinization - metabolic alkalosis - altitude sickness
HSV - VZV - EBV - Mucocutaneous and Genital Herpes Lesions - Prophylaxis in Immunocompromised pts

6. What are two Glitazones?
Ganciclovir is more toxic to host enzymes
1. Pioglitazone 2. Rosiglitazone.
- Oral Contraceptives
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more

7. Acetazolamide - toxicity?
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy
- N- acetylcystine
Norepinephrine (Alpha1 -2 and beta 1)
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity

8. How do you treat coma in the ER (4)?
sedation - positive Coombs' test
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD
1. Meningococcal carrier state 2. Chemoprophylaxis in contacts of children with H. influenzae type B
1. Aluminum hydroxide: constipation and hypophosphatemia 2. Magnesium hydroxide: diarrhea 3. Calcium carbonate: Hypercalcemia - rebound acid increase - All may cause hypokalemia

9. What is the category of drug names ending in - ipramine (e.g. Imipramine)
Peptic ulcer disease.
1. Acarbose 2. Miglitol
Tricyclic antidepressant.
- Shifts the curve to the right - increases Km

10. Which drug(s) cause this reaction: Pulmonary fibrosis(3)?
Penicillin.
- Bleomycin - amiodarone - busulfan
Penicillin - Cephalosporins - Vancomycin - Aminoglycosides - Fluoroquinolones - Metronidazole
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic

11. What are the clinical indications for bethanechol?
Antimetabolite derivative of 6- mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.
Spironolactone - Triamterene - Amiloride (the K+ STAys)
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.
block Na+ channels in the cortical collecting tubule

12. For Warfarin What is the Treatment for overdose
IV vitamin K and fresh frozen plasma
Penicillin.
- B51Naloxone / naltrexone (Narcan)
hypertension - angina - arrhythmias

13. Ca2+ channel blockers - clinical use?
Tetracycline - Doxycycline - Demeclocycline - Minocycline
hypertension - angina - arrhythmias
Ceftriaxone
reversible SLE- like syndrome

14. What is a common drug interaction associated with Griseofulvin?
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
Increases coumadin metabolism
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.
Beta Blockers

15. Acetazolamide - clinical uses?
Immediate anticoagulation for PE - stroke - angina - MI - DVT.
AmOxicillin has greater Oral bioavailability
sedation - sleep alterations
glaucoma - urinary alkalinization - metabolic alkalosis - altitude sickness

16. Name five Antiarrhythmic drugs in class II?
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic
Sildenafil fills the penis
IV vitamin K and fresh frozen plasma
propanolol - esmolol - metoprolol - atenolol - timolol

17. Resistance mechanisms for Tetracycline
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.
1)Binds penicillin - binding proteins 2) Blocks transpeptidase cross - linking of cell wall 3) Activates autolytic enzymes
Decreased uptake or Increased transport out of cell
Aminoglycosides - Tetracyclines

18. Adverse effects of Minoxidil?
No
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention

19. MOA: Block mRNA synthesis
Interstitial nephritis
Rifampin
Interferes with microtubule function - disrupts mitosis - inhibits growth
Dopamine

20. Digitalis - site of action?
GI discomfort
Na/K ATPase
- Aminocaproic acid
Captopril - Enalapril - Lisinopril

21. What are four thrombolytics?
Topical and Oral - for Oral Candidiasis (Thrush)
Protamine sulfate
Lipoxygenase
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)

22. What is Fluconazole specifically used for?
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.
Rash - Pseudomembranous colitis
Hypersensitivity reactions
Cryptococcal meningitis in AIDS patients and Candidal infections of all types

23. What is a prerequisite for Acyclovir activation?
It must be Phosphorylated by Viral Thymidine Kinase
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.
increase AP duration - increase ERP - increase QT interval - for use When other arrhythmics fail
- Ethanol - dialysis - & fomepizole

24. Antiarrhythmic Class III- effects?
increase AP duration - increase ERP - increase QT interval - for use When other arrhythmics fail
constipation - flushing - edema - CV effects (CHF - AV block - sinus node depression) - and torsade de pointes (Bepridil)
Mycobacterium tuberculosis - the only agent used as solo prophylaxis against TB
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)

25. Which drug(s) cause this reaction: Thrombotic complications?
cholestyramine - colestipol
Hypokalemic metabolic alkalosis - hyponatremia - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia - sulfa allergy.
Norepinephrine (Alpha1 -2 and beta 1)
- Oral Contraceptives

26. What is the category of drug names ending in - cillin (e.g. Methicillin)
- aminoglycosides - loop diuretics - cisplatin
Penicillin.
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine

27. What organisms does Griseofulvin target?
1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone When used of Leprosy 3. Used in combination with other drugs
Ipratropium
- Methylene blue
Dermatophytes (tinea - ringworm)

28. What are the major toxic side effects of the Cephalosporins?
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy
Same as penicillin. Act as narrow spectrum antibiotics
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
1. Bleeding 2. Thrombocytopenia 3. Drug - drug interactions

29. What are Polymyxins used for?
dizziness - flushing - constipation (verapamil) - nausea
Resistant Gram - infections
Antimetabolite derivative of 6- mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.

30. Which drug(s) cause this reaction: Anaphylaxis?
- Penicillin
Alpha -1 antagonist
new arrhythmias - hypotension
Treatment of hypertension - especially with renal disease (lowers bp centrally - so flow is maintained to kidney).

31. The MOA for Chloramphenicol is?
Inhibition of 50S peptidyl transferase - Bacteriostatic
competitive inhibirot of aldosterone in the cortical collecting tubule
These B-2 agonists cause respiratory smooth muscle to relax.
With supplemental Folic Acid

32. Antiarrhythmic class IV- clinical use?
Dopamine
CMV - esp in Immunocompromised patients
prevention of nodal arrhythmias (SVT)
Ganciclovir is more toxic to host enzymes

33. Mannitol - site of action?
- NaHCO3
osmotic diuretic - increase tubular fluid osmolarity - thereby increasing urine flow
proximal convoluted tubule - thin descending limb - and collecting duct
Paranteral (IV - SC)

34. What is the MOA for the Fluoroquinolones?
Rapid (seconds)
Chronic gout.
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal

35. What antimuscarinic drug is useful for the tx of asthma
Inhibits reabsorption of uric acid.
Ipratropium
1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone When used of Leprosy 3. Used in combination with other drugs
Beta - lactam antibiotics

36. MOA of Succinylcholine
Prevents the release of Ca from SR of skeletal muscle
Headache - flushing - dyspepsia - blue - green color vision.
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic

37. Which drug(s) cause this reaction: SLE- like syndrome?
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.
Methicillin - Nafcillin - and Dicloxacillin
- Hydralazine - Procainamide - INH - phenytoin

38. Adverse effects of Hydrochlorothiazide?
Protamine sulfate
Decrease the production of leukotrienes and protaglandins by inhibiting phospholipase A2 and expression of COX-2.
hypokalemia - slight hyperlipidemia - hyperuricemia - lassitude - hypercalcemia - hyperglycemia
toxic

39. Which antimicrobials inhibit protein synthesis at the 50S subunit? (4)
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic
impotence - asthma - CV effects (bradycardia - CHF - AV block) - CNS effects (sedation - sleep alterations)
- Methylene blue

40. List the specific antidote for this toxin: Salicylates
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
thiazides - amiloride
Carbachol - pilocarpine - physostigmine - echothiophate
- Alkalinize urine & dialysis

41. What are Amantadine - associated side effects?
AZT
Ataxia - Dizziness - Slurred speech
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)

42. What is the mechanism of action of Aspirin?
Acetylates and irreversibly inhibits cyclooxygenase (COX I and COX II) to prevent the conversion of arachidonic acid to prostaglandins.
Hypersensitivity reactions
toxic
Bacitracin - Vancomycin

43. List the specific antidote for this toxin: Cyanide
Ibuprofen - Naproxen - and Indomethacin
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation
- Nitrate - hydroxocobalamin thiosulfate
Pituitary hormone.

44. What are common side effects of Protease Inhibitors?
Edrophonium
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide
Cyclooxygenases (COX I - COX II).

45. Acetazolamide - site of action?
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.
Keratin containing tissues - e.g. - nails
proximal convoluted tubule
Saquinavir - Ritonavir - Indinavir - Nelfinavir

46. What parasites are treated with Pyrantel Pamoate (more specific)?
- Alkalate DNA - Brain tumors - CNS toxicity
- Deferoxamine
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)

47. Foscarnet toxicity?
AluMINIMUM amount of feces.
- Niacin - Ca++ channel blockers - adenosine - vancomycin
Nephrotoxicity
GI discomfort

48. What is an additional side effect of Methicillin?
Increases coumadin metabolism
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.
check PFTs - LFTs - and TFTs
Interstitial nephritis

49. Name three Antiarrhythmic drugs in class IC.
Flecainide - Encainide - Propafenone
Rash - Pseudomembranous colitis
Nucleosides
Pyridoxine (B6) administration

50. Which drug(s) cause this reaction: Extrapyramidal side effects (3)?
Prevention of NSAID- induced peptic ulcers - maintains a PDA.
decrease the slope of phase 4 - increase PR interval (the AV node is particularly sensitive)
- reduction - oxy - & hydrolysis - H2O sol. Polar product - P450
- Chlorpromazine - thioridazine - haloperidol