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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. What can result due to antacid overuse?
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.
Same as penicillin. Extended spectrum antibiotics
Babiturate.

2. Which drug(s) cause this reaction: Cough?
check PFTs - LFTs - and TFTs
- Act on same receptor - Full has greater efficacy
- ACE inhibitors (Losartan>no cough)
- DNA intercalator - testicular & lymphomas - Pulmonary fibrosis mild myelosuppression.

3. What is the category of drug names ending in - barbital (e.g. Phenobarbital)
Babiturate.
1. Addison's disease 2. Inflammation 3. Immune suppression 4. Asthma
YES
Pralidoxime regenerates active cholinesterase.

4. Which Aminoglycoside is used for Bowel Surgery ?
- Class III antiarrhythmics (sotalol) - class IA (quinidine)
Neomycin
Methicillin - Nafcillin - and Dicloxacillin
thiazides - amiloride

5. What are Methicillin - Nafcillin - and Dicloxacillin used for clinically?
It inhibits release of NE.
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.
Megaloblastic anemia - Leukopenia - Granulocytopenia
Staphlococcus aureus

6. What is the memory key for Isoniazid (INH) toxicity?
Nevirapine - Delavirdine
Methylxanthine.
INH: Injures Neurons and Hepatocytes
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.

7. What is the category of drug names ending in - azepam (e.g. Diazepam)
thiazides - amiloride
Benzodiazepine.
None. No - because atropine would block the postganglionic muscarinic receptors involved in sweat gland stimulation.
decrease conduction velocity - increase ERP - increase PR interval

8. What is the mechanism of action of Clomiphene?
Suramin
Polymyxins
Chloramphenicol - Erythromycin/macrolides - Lincomycin - Clindamycin - Streptogramins (quinupristin - dalfopristin)
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.

9. Toxic side effects of the Azoles?
- Lithium
atropine - homatropine - tropicamide
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills

10. What is the mechanism of action of Cyclosporine?
- Hypersensitivity reactions - Hemolysis - Nephrotoxicity (tubulointerstitial nephritis) - Kernicterus in infants Displace other drugs from albumin (e.g. - warfarin)
1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone When used of Leprosy 3. Used in combination with other drugs
Acts as a wide spectrum carbapenem
Binds to cyclophilins (peptidyl proline cis - trans isomerase) - blocking the differentiation and activation of T cells mainly by inhibiting the production of IL-2 and its receptor.

11. MOA: Block nucleotide synthesis
Sulfonamides - Trimethoprim
Liver
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic
Interstitial nephritis

12. What is the MOA for Ampicillin and Amoxicillin?
- Alkalinize urine & dialysis
Same as penicillin. Extended spectrum antibiotics
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels

13. Can Heparin be used during pregnancy?
- Metronidazole - certain cephalosporins - procarbazine - sulfonylureas
Yes - it does not cross the placenta.
AZT - to reduce risk of Fetal Transmission
Penicillin - Cephalosporins - Vancomycin - Aminoglycosides - Fluoroquinolones - Metronidazole

14. List the specific antidote for this toxin: Beta Blockers
Acetylcholine esterase
- Glucagon
Give an antichloinesterase - neostigmine - edrophonium - etc
It inhibits release of NE.

15. What is the category - desired effect - and possible mechanism of Theophylline in treating Asthma?
Methylzanthine; desired effect is bronchodilation - may cause bronchodilation by inhibiting phosphodiesterase - enzyme involved in degrading cAMP (controversial).
1. Heavy bleeding 2. GI effects (n/v - anorexia) 3. Abdominal pain
Hemolysis (if G6PD deficient) - Neurotoxicity - Hepatotoxicity - SLE- like syndrome
Same as penicillin. Extended spectrum antibiotics

16. Resistance mechanisms for Aminoglycosides
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia
- Shifts the curve to the right - increases Km
Acute gout.
Modification via Acetylation - Adenylation - or Phosphorylation

17. These drugs acts indirectly by releasing strored catecholamines in the presynaptic terminal
Amphetamine and Ephedrine
Sulfonamides - Trimethoprim
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis
Sulfonamide Loop Diuretic. Inhibits ion co - transport system of thick ascending loop. Abolishes hypertonicity of the medulla - thereby preventing concentration of the urine.

18. What type of gout is treated with Colchicine?
Acute gout.
Ipratropium
Nifedipine - Verapamil - Diltiazem
distal convoluted tubule (early)

19. A fellow passenger on a Carnival cruise ship looks pale and diaphoretic - What antimuscarinic agent would you give them?
scopolamine
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.
Onchocerciasis ('river blindness'-- rIVER- mectin)
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels

20. Which drug(s) cause this reaction: Osteoporosis (2)?
- Corticosteroids - heparin
Ototoxicity - Hypokalemia - Dehydration - Allergy (sulfa) - Nephritis (interstitial) - Gout
Chronic (weeks or months)
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)

21. ________ ae not resistant to penicillinase - - but they are less susceptible than the other Beta lactams
hypokalemia - slight hyperlipidemia - hyperuricemia - lassitude - hypercalcemia - hyperglycemia
Beta Blockers
Cephalosporins
No - hemicholinum block the uptake of Choline and thus Ach synthesis

22. What are Amantadine - associated side effects?
Ataxia - Dizziness - Slurred speech
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole
Cryptococcal meningitis in AIDS patients and Candidal infections of all types
Digitoxin 168hrs Digoxin 40 hrs

23. ACE inhibitors - clinical use?
Prevents the release of Ca from SR of skeletal muscle
hypertension - CHF - diabetic renal disease
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.)
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.

24. What are Aminoglycosides synergistic with?
Beta - lactam antibiotics
Protease Inhibitors and Reverse Transcriptase Inhibitors
- polymyxins
narcolepsy - obesity - and attention deficit disorder (I wouldn't recommend this)

25. How do the Protease Inhibitors work?
- Acetaldehyde - Nausea - vomiting - headache - & hypotension
Foscarnet = pyroFosphate analog
Inhibt Assembly of new virus by Blocking Protease Enzyme
edematous states (CHF - cirrhosis - nephrotic syndrome - pulm edema) - HTN - hypercalcemia

26. Cocaine casues vasoconstriction and local anesthesia by What mechanism
vasodilator - increases cGMP to induce smooth muscle relaxation (arterioles>veins; afterload reduction)
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine
Indirect agonist - uptake inhibitor
- Class III antiarrhythmics (sotalol) - class IA (quinidine)

27. What is the MOA of Foscarnet?
Praziquantel
Neomycin
Inhibits Viral DNA polymerase
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin

28. What is the receptor affinity and clinical use of isoproterenol?
Digitoxin 168hrs Digoxin 40 hrs
severe orthostatic hypotension - blurred vision - constipation - sexual dysfunction
Hypersensitivity reactions
It affects beta receptors equally and is used in AV heart block (rare).

29. What antimicrobial class is Aztreonam syngergestic with?
Ciprofloxacin - Norfloxacin - Ofloxacin - Grepafloxacin - Enoxacin - Nalidixic acid
Aminoglycosides
Hydralazine and Minoxidil
YES

30. MOA: Block protein synthesis at 50s subunit
Chloramphenicol - Erythromycin/macrolides - Lincomycin - Clindamycin - Streptogramins (quinupristin - dalfopristin)
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.
Gemfibrozil - Clofibrate
Bacitracin - Vancomycin

31. What microorganisms is Aztreonam not effective against?
sedation - positive Coombs' test
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
AV nodal cells
Gram + and Anerobes

32. What is an occasional side effect of Aztreonam?
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.
- Nitrate - hydroxocobalamin thiosulfate
GI upset
fetal renal toxicity - hyperkalemia

33. Which drug(s) cause this reaction: Stevens - Johnson syn. (3)?
- Isoniazid
- Ethosuxamide - sulfonamides - lamotrigine
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine
Acute gout.

34. Beta Blockers - CNS toxicity?
Tricyclic antidepressant.
Rheumatoid and osteoarthritis.
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state
sedation - sleep alterations

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

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36. What are the indications for using amphetamine?

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37. What is the effect of norepinephrine on bp and pulse pressure?
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.
It inhibits release of NE.
increase AP duration - increase ERP - increase QT interval - for use When other arrhythmics fail
Cardiac glycoside (inotropic agent).

38. List the specific antidote for this toxin: Benzodiazepines
Dopamine; causes its release from intact nerve terminals
Neutropenia
hypertension - angina - arrhythmias
- Flumazenil

39. What is the mecanism of action of Sucralfate?
- Chloramphenicol
Sotalol - Ibutilide - Bretylium - Amiodarone
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
Aluminum sucrose sulfate polymerizes in the acid environment of the stomach and selectively binds necrotic peptic ulcer tissue. Acts as a barrier to acid - pepsin - and bile.

40. Name the common Azoles
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole
- Glucagon

41. What is the MOA for the Azoles?
Inhibit Ergosterol synthesis
Acute gout.
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load

42. Secretion of What drug is inhibited by Probenacid used to treat chronic gout?
Penicillin.
Bleeding.
Choline acetyltransferase
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).

43. Which drug(s) cause this reaction: Tardive dyskinesia?
post MI and digitalis induced arrhythmias
- Antipsychotics
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
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention

44. Does Warfarin have a long - medium - or short half life?
Long.
Beta Blockers
GI discomfort
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity

45. What is the clinical use for Sildenafil (Viagra)?
For serious - Gram + multidrug - resistant organisms
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
Penicillin - V
Erectile dysfunction.

46. For Warfarin What is the Onset of action
Slow - limited by half lives of clotting factors
Neomycin
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes

47. Which antimuscarinic agents are used in producing mydriasis and cycloplegia?
Rheumatoid and osteoarthritis.
- Tamoxifen
atropine - homatropine - tropicamide
Tendonitis and Tendon rupture

48. Acetaminophen has What two clinical uses and lacks What one clinical use of the NSAIDs?
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.
Inhalational general anesthetic.
1. Meningococcal carrier state 2. Chemoprophylaxis in contacts of children with H. influenzae type B
Norepinephrine

49. How is Chloramphenical used clinically?
Meningitis (H. influenza - N. meningitidis - S. pneumoniae) - Conserative treatment due to toxicities
- Chloramphenicol
vascular sm. Mus.: Nifedipine>Diltiazem>Verapamil
Resistant Gram - infections

50. MOA of Succinylcholine
As PABA antimetabolites that inhibit Dihydropteroate Synthase - Bacteriostatic
Prevents the release of Ca from SR of skeletal muscle
Penicillin.
- DNA intercalator - testicular & lymphomas - Pulmonary fibrosis mild myelosuppression.