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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. Name three Antiarrhythmic drugs in class IV.
cortical collecting tubule
Verapamil - Diltiazem - Bepridil
HSV - VZV - EBV - Mucocutaneous and Genital Herpes Lesions - Prophylaxis in Immunocompromised pts
Sildenafil fills the penis

2. List the specific antidote for this toxin: Carbon monoxide
-100% oxygen - hyperbaric
Alpha -1 antagonist
- MT polymerization inhibitor(M phase) - MOPP - lymphoma - Willm's & choriocarcinoma - neurotoxicity and myelosuppression
- Flumazenil

3. What are the side effects of Rifampin?
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
DOC in diagnosing and abolishing AV nodal arrhythmias
Minor hepatotoxicity - Drug interactions (activates P450)
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis

4. What is the MOA of Amantadine?
Impairs the synthesis of vitamin K- dependent clotting factors
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome
IV vitamin K and fresh frozen plasma
Liver

5. MOA: Disrupt fungal cell membranes
anuria - CHF
- Vitamin K & fresh frozen plasma
Amphotericin B - Nystatin - Fluconazole/azoles
Polymyxin B - Polymyxin E

6. What are three types of antacids and the problems that can result from their overuse?
Prevents release of mediators from mast cells. Effective only for the prophylaxis of asthma. Not effective during an acute attack.
Depolymerizes microtubules - impairing leukocyte chemotaxis and degranulation.
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.
1. Aluminum hydroxide: constipation and hypophosphatemia 2. Magnesium hydroxide: diarrhea 3. Calcium carbonate: Hypercalcemia - rebound acid increase - All may cause hypokalemia

7. For Warfarin What is the Treatment for overdose
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
IV vitamin K and fresh frozen plasma
for RSV

8. What is the category of drug names ending in - cillin (e.g. Methicillin)
- B51Naloxone / naltrexone (Narcan)
Penicillin.
Used in combination therapy with SMZ to sequentially block folate synthesis
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.

9. Name three ACE inhibitors?
Captopril - Enalapril - Lisinopril
Inhibits CMV DNA polymerase
- Methylene blue
Diarrhea - Urination - Miosis - Bronchospasm - Bradycardia - Excitation of skeletal muscle and CNS - Lacrimation - Sweating - and Salivation = DUMBBELS; also abdominal cramping

10. Antiarrhythmic class IV- toxicity?
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)
constipation - flushing - edema - CV effects (CHF - AV block - sinus node depression) - and torsade de pointes (Bepridil)
Alpha -1 antagonist
1. Hypoglycemia (more common with 2nd - generation drugs: glyburide - glipizide) 2. Disulfiram - like effects (not seen with 2nd - generation drugs).

11. Foscarnet toxicity?
Yes - it does not cross the placenta.
WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.
Nephrotoxicity
GI upset

12. What cholinomimetics might your pt be taking for his glaucoma
Carbachol - pilocarpine - physostigmine - echothiophate
INH: Injures Neurons and Hepatocytes
Neostigmine - pyridostigmine edrophonium - physostigmine echothiophate
sedation - depression - nasal stuffiness - diarrhea

13. Which drug(s) cause this reaction: Hepatitis?
- Isoniazid
Captopril - Enalapril - Lisinopril
Pentavalent Antimony
- Act on same receptor - Full has greater efficacy

14. Your patient wants an effective drug to treat his motion sickness - What would you prescribe
Rifampin (DOC) - minocycline
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic
toxic
Scopolamine

15. Which drug(s) cause this reaction: Tardive dyskinesia?
carbonic anhydrase inhibitors - K+ sparing diuretics
Hypersensitivity reactions
- Antipsychotics
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.

16. What is the effect of norepinephrine on bp and pulse pressure?
Meningitis (H. influenza - N. meningitidis - S. pneumoniae) - Conserative treatment due to toxicities
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.
TMP- SMZ
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms

17. What beta 2 agonist will help your 21yo Astma pt?
Extended spectrum penicillin: certain Gram + bacteria and Gram - rods
Aplastic anemia (dose independent) - Gray Baby Syndrome
decrease
Albuterol - tertbutaline

18. How is Ganciclovir activated?
Protamine sulfate
-100% oxygen - hyperbaric
constipation - flushing - edema - CV effects (CHF - AV block - sinus node depression) - and torsade de pointes (Bepridil)
Phosphorylation by a Viral Kinase

19. List the specific antidote for this toxin: Methemoglobin
- Methylene blue
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine
Butyrophenone (neuroleptic).
1. Addison's disease 2. Inflammation 3. Immune suppression 4. Asthma

20. What is the major toxic side effect of Penicillin?
No - it inhibits the release of Nor Epi
AluMINIMUM amount of feces.
Hypersensitivity reactions
Protease Inhibitors and Reverse Transcriptase Inhibitors

21. Which antimicrobials inhibit protein synthesis at the 50S subunit? (4)
Reversibly inhibits cyclooxygenase - mostly in CNS. Inactivated peripherally.
distal convoluted tubule (early)
Antimetabolite derivative of 6- mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic

22. What is the MOA for Ampicillin and Amoxicillin?
Same as penicillin. Extended spectrum antibiotics
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
Pentavalent Antimony
hypertension - CHF - diabetic renal disease

23. Hydralazine - toxicity?
compensatory tachycardia - fluid retention - lupus - like syndrome
Acute gout.
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT
Stimulating beta receptors stimulates heart rate - but beta receptor induced vasodilation reduces peripheral resistance.

24. What are common serious side effects of Aminoglycosides and What are these associated with?
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)
Pentavalent Antimony
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.
Teratogenic - Carcinogenic - Confusion - Headaches

25. For Heparin What is the Lab value to monitor
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
aPTT (intrinsic pathway)
Polymyxins

26. How does NE modulate its own release? What other neurotransmitter has this same effect?
- Tricyclic antidepressants
NE acts presynaptically on alpha -2 receptors to inhibit its own release. ACh also acts presynaptically through M1 receptors to inhibit NE release.
Interferes with microtubule function - disrupts mitosis - inhibits growth
dry mouth - sedation - severe rebound hypertension

27. List the specific antidote for this toxin: Methanol & Ethylene glycol
Impairs the synthesis of vitamin K- dependent clotting factors
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.
Inhibit Ergosterol synthesis
- Ethanol - dialysis - & fomepizole

28. Which antimuscarinic agents are used in producing mydriasis and cycloplegia?
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol
Norepinephrine
Sulfonamides - Trimethoprim
atropine - homatropine - tropicamide

29. Toxicities associated with Acyclovir?
Delirium - Tremor - Nephrotoxicity
competitive inhibirot of aldosterone in the cortical collecting tubule
Neomycin
Triple Therapy' 2 Nucleoside RT Inhibitors with a Protease Inhibitor

30. Acetaminophen has What two clinical uses and lacks What one clinical use of the NSAIDs?
Staphlococcus aureus
Stimulates beta adrenergic receptors
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.
Beta - lactamase cleavage of Beta - lactam ring

31. What are the clinical indications for Azole therapy?
Saquinavir - Ritonavir - Indinavir - Nelfinavir
Systemic mycoses
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.
- Act on same receptor - Full has greater efficacy

32. What is the clinical use of Mifepristone (RU486)?
Abortifacient.
Methylation of rRNA near Erythromycin's ribosome binding site
Cilastatin
Pentamidine

33. What is the mechanism of action of the Sulfonylureas?
Slow - limited by half lives of clotting factors
Because they require some residual islet function.
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.
BM suppression (neutropenia - anemia) - Peripheral neuropathy

34. A group of pts are rushed into the ER complaining of excessive sweating - tearing - salivation - HA - N and V - muscle twitching - difficulty breathing and diarrhea. What drug would be the most effective immediate tx
ACE inhibitor.
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
Diarrhea - Urination - Miosis - Bronchospasm - Bradycardia - Excitation of skeletal muscle and CNS - Lacrimation - Sweating - and Salivation = DUMBBELS; also abdominal cramping
With supplemental Folic Acid

35. Aztreonam is not ________ with penicillins
Inhibit Ergosterol synthesis
Prevention of NSAID- induced peptic ulcers - maintains a PDA.
1. Acarbose 2. Miglitol
cross - allergenic

36. What is the memory key for Metronidazole's clinical uses?
It acts presynaptically to increase NE release.
Tubocurarine - atracurium - mivacurium - pancuronium - vecuronium - rapacuronium
edematous states (CHF - cirrhosis - nephrotic syndrome - pulm edema) - HTN - hypercalcemia
GET on the Metro

37. What is the effect of TCA's on the adrenergic nerve?
Rifampin - Ethambutol - Streptomycin - Pyrazinamide - Isoniazid (INH)
cyanide toxicity (releases CN)
Rash - Pseudomembranous colitis
They inhibit reuptake of NE at the nerve terminal (as does cocaine).

38. What is the clinical utility of cocaine?
The only local anesthetic with vasoconstrictive properties.
reduce levels of Angiotensin II - thereby preventing the inactivation of bradykinin (a potent vasodilator); renin level is increased
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.

39. Which drug(s) cause this reaction: Pseudomembranous colitis?
osmotic diuretic - increase tubular fluid osmolarity - thereby increasing urine flow
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.
anticholinesterase glaucoma
- Clindamycin

40. Name four Antiarrhythmic drugs in class IA.
Chronic gout.
Rheumatoid and osteoarthritis.
- Acetaldehyde - Nausea - vomiting - headache - & hypotension
Quinidine - Amiodarone - Procainamide - Disopyramide

41. What is Ketoconazole specifically used for?
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism
Pretreat with antihistamines and a slow infusion rate
sedation - sleep alterations
1. Meningococcal carrier state 2. Chemoprophylaxis in contacts of children with H. influenzae type B

42. What is the mechanism of action and clinical use of the antiandrogen Flutamide?
block Na+ channels in the cortical collecting tubule
Scopolamine
Inhalational general anesthetic.
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.

43. Which Tetracycline is used in patients with renal failure? / Why?
Binds to the Pyrophosphate Binding Site of the enzyme
Doxycycline - because it is fecally eliminated
- DNA intercalator - Hodgkin's - myeloma - sarcoma - and solid tumors - Cardiotoxicity & alopecia
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis

44. List the specific antidote for this toxin: Lead
- Penicillin
- EDTA - dimercaprol - succimer - & penicillamine
INH: Injures Neurons and Hepatocytes
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia

45. How are Interferons (INF) used clinically?

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46. What are four clinical uses of glucocorticoids?

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47. What are the major toxic side effects of Imipenem/cilastatin?
GI distress - Skin rash - and Seizures at high plasma levels
Phenothiazine (neuroleptic - antiemetic).
Inhibit intestinal bursh border Alpha - glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.
Aplastic anemia (dose independent) - Gray Baby Syndrome

48. Furosemide increases the excretion of What ion?
Immediate anticoagulation for PE - stroke - angina - MI - DVT.
Triple sulfas or SMZ
Ca2+ (Loops Lose calcium)
Tubocurarine - atracurium - mivacurium - pancuronium - vecuronium - rapacuronium

49. ________ ae not resistant to penicillinase - - but they are less susceptible than the other Beta lactams
Prefers beta's at low doses - but at higher doses alpha agonist effects are predominantly seen.
Cephalosporins
- Oxalic acid - Acidosis & nephrotoxicity
Beta1 more than B2

50. What is the category of drug names ending in - navir (e.g. Saquinavir)
NE acts presynaptically on alpha -2 receptors to inhibit its own release. ACh also acts presynaptically through M1 receptors to inhibit NE release.
In 4 half - lifes= (94%) T1/2 = (0.7x Vd)/CL
depresses ectopic pacemakers - especially in digoxin toxicity
Protease inhibitor.