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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. Beta Blockers - BP?
Alpha -1 antagonist
decrease
Dermatophytes (tinea - ringworm)
Bacitracin - Vancomycin

2. Why are Methicillin - Nafcillin - and Dicloxacillin penicillinase resistant?
Same as penicillin. Extended spectrum antibiotics
Quinolones
Due to the presence of a bulkier R group
- Chlorpromazine - thioridazine - haloperidol

3. What are common toxicities related to Vancomycin therapy?

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4. For Heparin What is the Mechanism of action
Potent immunosuppressive used in organ transplant recipients.
Epinephrine
Benzathine penicillin G
Activates antithrombin III

5. Beta Blockers - site of action?
Beta adrenergic receptors and Ca2+ channels (stimulatory)
Norepinephrine (Alpha1 -2 and beta 1)
Rifampin
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome

6. How are the HIV drugs used clinically?

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7. What type of gout is treated with Probenacid?
Systemic mycoses
Chronic gout.
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.
Disulfiram - like reaction with EtOH - Headache

8. For Warfarin What is the Onset of action
viral kinase
The PTT.
For serious - Gram + multidrug - resistant organisms
Slow - limited by half lives of clotting factors

9. A fellow passenger on a Carnival cruise ship looks pale and diaphoretic - What antimuscarinic agent would you give them?
1. In liver - increases storage of glucose as glycogen. 2. In muscle - stimulates glycogen and protein synthesis - and K+ uptake. 3. In adipose tissue - facilitates triglyceride storage.
scopolamine
CL= (rate of elimination of drug/ Plasma drug conc.)
Beta1 more than B2

10. Which drug(s) cause this reaction: G6PD hemolysis(8)?
-100% oxygen - hyperbaric
AZT
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol
- Quinidine - quinine

11. What are two indirect acting adrenergic agonists?
Hemolysis (if G6PD deficient) - Neurotoxicity - Hepatotoxicity - SLE- like syndrome
amphetamine and ephedrine
check PFTs - LFTs - and TFTs
No

12. What is the category - desired effect - and adverse effect of Isoproterenol in the treatment of Asthma?
- Formaldehyde & formic acid - severe acidosis & retinal damage
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).
Rifampin - Ethambutol - Streptomycin - Pyrazinamide - Isoniazid (INH)

13. What are three toxicities of Propylthiouracil?
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
- Cimetidine - ketoconazole - grapefruit juice - erythromycin - INH - sulfonamides
Digitoxin>95% Digoxin 75%
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia

14. What is the category - method of use - and adverse effects of Salmeterol in Asthma treatment?
Gemfibrozil - Clofibrate
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.
Increase target cell response to insulin.
Ipratropium

15. What is the MOA of Ribavirin?
Beta -2 agonist.
Doxycycline - because it is fecally eliminated
vasodilator - increases cGMP to induce smooth muscle relaxation (arterioles>veins; afterload reduction)
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis

16. Adverse effect of Nitroprusside?
Acetylates and irreversibly inhibits cyclooxygenase (COX I and COX II) to prevent the conversion of arachidonic acid to prostaglandins.
- Lithium
- Deferoxamine
cyanide toxicity (releases CN)

17. How is Rifampin used clinically?
Antileukotriene; blocks leukotriene receptors.
Carbenicillin - Piperacillin - and Ticarcillin
1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone When used of Leprosy 3. Used in combination with other drugs
AV nodal cells

18. Mannitol - contraindications?
AV nodal cells
anuria - CHF
Does not cross
propanolol - esmolol - metoprolol - atenolol - timolol

19. What is the category of drug names ending in - tidine (e.g. Cimetidine)
depresses ectopic pacemakers - especially in digoxin toxicity
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.
H2 antagonist
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.)

20. Foscarnet does not require activation by a...
viral kinase
Non - Nucleosides
Botulinum
Same as penicillin. Extended spectrum antibiotics

21. Aztreonam ________ to penicillinase
is resistant
Amphotericin B - Nystatin - Fluconazole/azoles
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
YES

22. Acetazolamide - toxicity?
Prevents release of mediators from mast cells. Effective only for the prophylaxis of asthma. Not effective during an acute attack.
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy
Malaria (P. falciparum)
Extended spectrum penicillin: certain Gram + bacteria and Gram - rods

23. What are two clinical uses of Azathioprine?
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)
- Constant AMOUNT eliminated per unit time. - Etoh & ASA
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.
1. Gastric ulceration 2. Bleeding 3. Hyperventilation 4. Reye's syndrome 5. Tinnitus (CN VIII)

24. What neurotransmitter does Amantadine affect? How does it influence this NT?
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis
Dopamine; causes its release from intact nerve terminals
cinchonism: HA - tinnitus - thrombocytopenia - torsade de pointes due to increased QT interval
- Alkalate DNA - Brain tumors - CNS toxicity

25. What is the loading dose formula?
loop diuretics - thiazides
Inhibit Ergosterol synthesis
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.
Acetylcholine esterase

26. What is the category of drug names ending in - terol (e.g. Albuterol)
Local anesthetic.
Amphetamine and Ephedrine
Beta -2 agonist.
For serious - Gram + multidrug - resistant organisms

27. Name the common Azoles
Succinylcholine
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole
- Penicillamine
Babiturate.

28. Name two bile acid resins.
post MI and digitalis induced arrhythmias
Ceftriaxone
cholestyramine - colestipol
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic

29. Antiarrhythmic class IV- toxicity?
constipation - flushing - edema - CV effects (CHF - AV block - sinus node depression) - and torsade de pointes (Bepridil)
Premature infants - because they lack UDP- glucuronyl transferase
Onchocerciasis ('river blindness'-- rIVER- mectin)
Sotalol - Ibutilide - Bretylium - Amiodarone

30. Antiarrhythmic class IV- primary site of action?
It inhibits release of NE.
It acts presynaptically to increase NE release.
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention
AV nodal cells

31. For Heparin What is the Site of action
Blood
Rifampin (DOC) - minocycline
local anesthetic. CNS stimulation or depression. CV depression.
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species

32. What do you treat Nematode/roundworm (pinworm - whipworm) infections with?
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances
Wide spectrum of systemic mycoses: Cryptococcus - Blastomyces - Coccidioides - Aspergillus - Histoplasma - Candida - Mucor
Mebendazole/Thiabendazole - Pyrantel Pamoate
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)

33. List the specific antidote for this toxin: Cyanide
blocks SR Ca2+ channels
- Nitrate - hydroxocobalamin thiosulfate
Protamine sulfate
- Chloramphenicol

34. Cocaine shares is mechanism of action with What antidepressant
narcolepsy - obesity - and attention deficit disorder (I wouldn't recommend this)
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH
TCA

35. Which individuals are predisposed to Sulfonamide - induced hemolysis?
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
- reduction - oxy - & hydrolysis - H2O sol. Polar product - P450
GI distress - Tooth discoloration and Inhibition of bone growth in children - Fanconi's syndrome - Photosensitivity
G6PD deficient individuals

36. How does dantrolene work?
Foscarnet = pyroFosphate analog
- Estrogen receptor antagonist - Breast CA - increased endometrial CA risk
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.
torsade de pointes - excessive Beta block

37. Classes of antihypertensive drugs?
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.
diuretics - sympathoplegics - vasodilators - ACE inhibitors - Angiotensin II receptor inhibitors
- Infections - Trauma - Seizures - CO - Overdose - Metabolic - Alcohol (IT'S COMA)
Same as penicillin. Act as narrow spectrum antibiotics

38. What parasitic condition is treated with Ivermectin?

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39. Resistance mechanisms for Vancomycin
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia
Inhibits CMV DNA polymerase
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels

40. What enzyme is responsible for the breakdown of ACh in the synaptic cleft?
local anesthetic. CNS stimulation or depression. CV depression.
- Flumazenil
Acetylcholinesterase; ACh is broken down into choline and acetate.
Chronic (weeks or months)

41. Antiarrhythmic class IV- effects?
Ipratropium
HTN - CHF - calcium stone formation - nephrogenic DI.
decrease conduction velocity - increase ERP - increase PR interval
aPTT (intrinsic pathway)

42. What is the memory key for organisms treated with Tetracyclines?

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43. Which drug(s) cause this reaction: Extrapyramidal side effects (3)?
- Chlorpromazine - thioridazine - haloperidol
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis
Hydralazine and Minoxidil
Imipenem

44. Ibutilide - toxicity?
Sildenafil fills the penis
Sotalol - Ibutilide - Bretylium - Amiodarone
torsade de pointes
narcolepsy - obesity - and attention deficit disorder (I wouldn't recommend this)

45. What are the classic symptoms of cholinesterase inhibitor poisoning (parathion or other organophosphates)?
Diarrhea - Urination - Miosis - Bronchospasm - Bradycardia - Excitation of skeletal muscle and CNS - Lacrimation - Sweating - and Salivation = DUMBBELS; also abdominal cramping
Captopril - Enalapril - Lisinopril
Rheumatoid and osteoarthritis.
Amphotericin B - Nystatin - Fluconazole/azoles

46. Acetaminophen has What two clinical uses and lacks What one clinical use of the NSAIDs?
Prevention of NSAID- induced peptic ulcers - maintains a PDA.
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.
Cell membrane Ca2+ channels of cardiac sarcomere
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.

47. What are common side effects of RT Inhibitors?
Gram + cocci - Gram - rods - and Anerobes
BM suppression (neutropenia - anemia) - Peripheral neuropathy
Inhalational general anesthetic.
Inhibits cell wall synthesis ( binds to PBP3). A monobactam

48. What drug is used to treat Trematode/fluke (e.g. - Schistosomes - Paragonimus - Clonorchis) or Cysticercosis
AluMINIMUM amount of feces.
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA
Prevention of NSAID- induced peptic ulcers - maintains a PDA.
Praziquantel

49. Antimicrobial prophylaxis for Syphilis
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis
proximal convoluted tubule
Benzathine penicillin G
- Aminocaproic acid

50. What is treated with Chloroquine - Quinine - Mefloquine?
- Quinidine - quinine
Malaria (P. falciparum)
is resistant
Pentamidine