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USMLE Step 1 Pharmacology

Subjects : health-sciences, usmle-step-1

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
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. What is the formula for Volume of distribution (Vd)
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)
Rapid (seconds)
- DNA intercalator - Hodgkin's - myeloma - sarcoma - and solid tumors - Cardiotoxicity & alopecia
Vd= (Amt. of drug in body/ Plasma drug conc.)

2. What is the major side effect for Ampicillin and Amoxicillin?
Minor hepatotoxicity - Drug interactions (activates P450)
Hypersensitivity reactions
Modification via Acetylation - Adenylation - or Phosphorylation
- Dimercaprol - succimer

3. What is an acronym to remember Anti - TB drugs?
RESPIre
Penicillin - V
Sildenafil fills the penis
Clavulanic acid

4. What are common toxicities associated with Tetracyclines?

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5. Which drug(s) cause this reaction: Photosensitivity(3)?
- Tetracycline - amiodarone - sulfonamides
Systemic mycoses
Polymyxins
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine

6. Hydralazine - clinical use?
anticholinesterase glaucoma
AZT - to reduce risk of Fetal Transmission
Tetracycline - Doxycycline - Demeclocycline - Minocycline
severe hypertension - CHF

7. When is HIV therapy initiated?
- Daunorubicin & Doxorubicin
Ipratropium
Pseudomonas species and Gram - rods
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load

8. What are common toxicities related to Vancomycin therapy?

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9. For Heparin What is the Ability to inhibit coagulation in vitro
Neomycin
Yes
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.
Benzodiazepine.

10. Are Ampicillin and Amoxicillin are not...
Blood
penicillinase resistant
Hypersensitivity reactions
- Alkalate DNA - Brain tumors - CNS toxicity

11. MOA for Penicillin (3 answers)?
The PTT.
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.
Digoxin=urinary Digitoxin=biliary
1)Binds penicillin - binding proteins 2) Blocks transpeptidase cross - linking of cell wall 3) Activates autolytic enzymes

12. A 57 yo heart failure pt develops cardiac decompensation - What drug will give you adequate perfusion of his kidneys as well as tx for his Hypotension
Sulfamethoxazole (SMZ) - Sulfisoxazole - Triple sulfas - Sulfadiazine
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.
- Physostigmine salicylate
Dopamine

13. In What population does Gray Baby Syndrome occur? Why?
Premature infants - because they lack UDP- glucuronyl transferase
Praziquantel
torsade de pointes
- Chloramphenicol

14. MOA of Succinylcholine
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.
anuria - CHF
Prevents the release of Ca from SR of skeletal muscle
blocks SR Ca2+ channels

15. How is Griseofulvin used clinically?
GET on the Metro
Blood
Oral treatment of superficial infections
Digitoxin 168hrs Digoxin 40 hrs

16. Which drug(s) cause this reaction: Tardive dyskinesia?
AV nodal cells
- Antipsychotics
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia
Digitoxin 70% Digoxin 20-40%

17. Which cancer drugs effect nuclear DNA (4)?
- Cloazapine - carbamazapine - colchicine - PTU
first dose orthostatic hypotension - dizziness - headache
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide
Sotalol - Ibutilide - Bretylium - Amiodarone

18. Which Aminoglycoside is used for Bowel Surgery ?
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.
Due to the presence of a bulkier R group
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression
Neomycin

19. List the specific antidote for this toxin: Warfarin
- Vitamin K & fresh frozen plasma
Extended spectrum penicillin: certain Gram + bacteria and Gram - rods
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis
Muscarinic antagonist; competatively blocks muscarinic receptors - preventing bronchoconstriction.

20. Mannitol - mechanism?
osmotic diuretic - increase tubular fluid osmolarity - thereby increasing urine flow
- Steroids - Tamoxifen
TMP- SMZ
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.

21. What are the clinical uses for 1st Generation Cephalosporins?
Gram + - Gram - - Norcardia - Chlamydia
Acetylcholinesterase; ACh is broken down into choline and acetate.
Gram + cocci - Proteus mirabilis - E. coli - Klebsiella pneumoniae (PEcK)
- Phase I (clinical tests) - Phase II - Phase III - PhaseIV (surveillance)

22. What enzyme does Zileuton inhibit?
Pseudomonas species and Gram - rods
Butyrophenone (neuroleptic).
Lipoxygenase
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas

23. Adverse effects of Nifedipine - verapamil?
Megaloblastic anemia - Leukopenia - Granulocytopenia
dizziness - flushing - constipation (verapamil) - nausea
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)
Decreased uptake or Increased transport out of cell

24. What is the clinical use for Clomiphene?
sedation - depression - nasal stuffiness - diarrhea
Rheumatoid and osteoarthritis.
- Disulfram & also sulfonylureas - metronidazole
Treatment of infertility.

25. What are Aminoglycosides synergistic with?
Blocks Norepi - but not Dopamine
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas
Beta - lactam antibiotics
Acetylates and irreversibly inhibits cyclooxygenase (COX I and COX II) to prevent the conversion of arachidonic acid to prostaglandins.

26. Which diuretics cause acidosis?
block Na+ channels in the cortical collecting tubule
Lidocaine - Mexiletine - Tocainide
carbonic anhydrase inhibitors - K+ sparing diuretics
Nephrotoxicity

27. What are Fluoroquinolones indicated for? (3)
- Ammonium Chloride
- DNA intercalator - testicular & lymphomas - Pulmonary fibrosis mild myelosuppression.
Chagas' disease - American Trypanosomiasis (Trypanosoma cruzi)
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms

28. What is the category of drug names ending in - ane (e.g. Halothane)
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.)
Digitoxin 70% Digoxin 20-40%
Inhalational general anesthetic.
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD

29. Ca2+ channel blockers - mechanism?
- DNA intercalator - Hodgkin's - myeloma - sarcoma - and solid tumors - Cardiotoxicity & alopecia
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility
G6PD deficient individuals
Rash - Pseudomembranous colitis

30. List the specific antidote for this toxin: Methanol & Ethylene glycol
- Ethanol - dialysis - & fomepizole
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.
Bactericidal for: Gram + rod and cocci - Gram - cocci - and Spirochetes
- ED 50 is less than the Km (less than 50% of receptors)

31. Cautions When using Amiodarone?
Norepinephrine (Alpha1 -2 and beta 1)
GI distress - Tooth discoloration and Inhibition of bone growth in children - Fanconi's syndrome - Photosensitivity
check PFTs - LFTs - and TFTs
Onchocerciasis ('river blindness'-- rIVER- mectin)

32. What is the category - desired effect - and adverse effect of Isoproterenol in the treatment of Asthma?
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.
Inhibits platelet aggregation by irreversibly inhibiting the ADP pathway involved in the binding of fibrinogen.
Cardiac glycoside (inotropic agent).

33. Which receptors does phenylephrine act upon?
Butyrophenone (neuroleptic).
-100% oxygen - hyperbaric
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
Gram + cocci - Gram - rods - and Anerobes

34. Which drug increases Sys BP w/o affecting Pulse Pressure
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)
Epinephrine
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride

35. What is the MOA for the Azoles?
Phosphorylation by a Viral Kinase
Hemolysis (if G6PD deficient) - Neurotoxicity - Hepatotoxicity - SLE- like syndrome
Inhibit Ergosterol synthesis
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)

36. Decrease Digoxin dose in renal failure?
Nucleosides
YES
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load
sedation - positive Coombs' test

37. For Heparin What is the Treatment for overdose
amphetamine and ephedrine
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH
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.
Protamine sulfate

38. What neurotransmitter does Amantadine affect? How does it influence this NT?
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
It affects beta receptors equally and is used in AV heart block (rare).
Interstitial nephritis
Dopamine; causes its release from intact nerve terminals

39. Hydrochlorothiazide - clinical use?
HTN - CHF - calcium stone formation - nephrogenic DI.
Inhibits bacterial Dihydrofolate Reductase - Bacteriostatic
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy
Ipratropium

40. Why are albuterol and terbutaline effective in tx of acute asthmatic attacks?
These B-2 agonists cause respiratory smooth muscle to relax.
- Oxalic acid - Acidosis & nephrotoxicity
Antibiotic - protein synthesis inhibitor.
- Chlorpromazine - thioridazine - haloperidol

41. How does a competitive antagonist effect an agonist?
hypokalemia - slight hyperlipidemia - hyperuricemia - lassitude - hypercalcemia - hyperglycemia
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity
- Shifts the curve to the right - increases Km
It affects beta receptors equally and is used in AV heart block (rare).

42. What are five possible toxic effects of Aspirin therapy?

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43. Which individuals are predisposed to Sulfonamide - induced hemolysis?
G6PD deficient individuals
Inhibits DNA dependent RNA polymerase
Penicillin.
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.

44. Are not penicillinase resistant
1. Weight gain 2. Hepatotoxicity (troglitazone)
- Daunorubicin & Doxorubicin
Carbenicillin - Piperacillin - and Ticarcillin
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.

45. What drug is used to treat Trematode/fluke (e.g. - Schistosomes - Paragonimus - Clonorchis) or Cysticercosis
cinchonism: HA - tinnitus - thrombocytopenia - torsade de pointes due to increased QT interval
GET on the Metro
- Flumazenil
Praziquantel

46. How would you treat African Trypanosomiasis (sleeping sickness)?
Cimetidine is a potent inhibitor of P450; it also has an antiandrogenic effect and decreases renal excretion of creatinine. Other H2 blockers are relatively free of these effects.
Carbachol - pilocarpine - physostigmine - echothiophate
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
Suramin

47. What cholinergic inhibitor acts by directly inhibiting Ach release at the presynaptic terminal
Botulinum
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
dry mouth - sedation - severe rebound hypertension
Pseudomonas species and Gram - rods

48. What type of gout is treated with Allopurinol?
Chronic gout.
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)
1. Predisposes to viral infections and lymphoma 2. Nephrotoxic (preventable with mannitol diuresis)
Praziquantel

49. What are two toxicities of the Glitazones?
severe hypertension - CHF
1. Weight gain 2. Hepatotoxicity (troglitazone)
- Flumazenil
Captopril - Enalapril - Lisinopril

50. Will Hemicholinum affect the release of stored Ach during Cholinergic Stimulation
Pseudomonas species and Gram - rods
- Ethanol - dialysis - & fomepizole
No - hemicholinum block the uptake of Choline and thus Ach synthesis
Beta - lactamase cleavage of Beta - lactam ring