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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. Adverse effects of Minoxidil?
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol
cardiac depression - peripheral edema - flushing - dizziness - constipation
Digitoxin>95% Digoxin 75%

2. Antiarrhythmic class IV- toxicity?
constipation - flushing - edema - CV effects (CHF - AV block - sinus node depression) - and torsade de pointes (Bepridil)
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
Constant FRACTION eliminated per unit time.(exponential)
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic

3. Adverse effects of Guanethidine?
Blocks Influenza A and RubellA; causes problems with the cerebellA
orthostatic and exercise hypotension - sexual dysfunction - diarrhea
Inhibits DNA dependent RNA polymerase
Rash - Pseudomembranous colitis

4. Which drug(s) cause this reaction: Cardiac toxicity?
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )
- Daunorubicin & Doxorubicin
Beta -2 agonist.
INH: Injures Neurons and Hepatocytes

5. What is action of insulin in the liver - in muscle - and in adipose tissue?
Norepinephrine
Decreased uptake or Increased transport out of cell
thick ascending limb
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.

6. What are signs of Sildenafil (Viagra) toxicity?
Potent immunosuppressive used in organ transplant recipients.
- Ethosuxamide - sulfonamides - lamotrigine
Albuterol - tertbutaline
Headache - flushing - dyspepsia - blue - green color vision.

7. What is the category and mechanism of action of Zileuton in Asthma treatment?
Antileukotriene; blocks synthesis by lipoxygenase.
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
Topical and Oral - for Oral Candidiasis (Thrush)
- Corticosteroids - heparin

8. Which drug(s) cause this reaction: Neuro and Nephrotoxic?
- polymyxins
constipation - flushing - edema - CV effects (CHF - AV block - sinus node depression) - and torsade de pointes (Bepridil)
Beta lactams - inhibit cell wall synthesis - Bactericidal
No

9. What are three unwanted effects of Mifepristone?
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility
Intrathecally
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.
1. Heavy bleeding 2. GI effects (n/v - anorexia) 3. Abdominal pain

10. 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
G6PD deficient individuals
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol
Dopamine
NO

11. What is the mecanism of action of Sucralfate?
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
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.
Beta adrenergic receptors and Ca2+ channels (stimulatory)
Bacitracin - Vancomycin

12. Nifedipine has similar action to?
- Niacin - Ca++ channel blockers - adenosine - vancomycin
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
Nitrates
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.

13. Which drug(s) cause this reaction: Cough?
very short acting
- Upper respiratory tract infections - pneumonias - STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) - Mycoplasma - Legionella - Chlamydia - Neisseria
- ACE inhibitors (Losartan>no cough)
The PTT.

14. Thiazides - site of action?
ACIDazolamide' causes acidosis
- Penicillamine
distal convoluted tubule (early)
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.

15. What is the mechanism of action of Aspirin?
Large anionic polymer - acidic
- Deferoxamine
Dry flushed skin - due to inhibition of sympathetic post - ganglionic blockade on muscarinic receptors of sweat glands. All others are opposite of What would be expected.
Acetylates and irreversibly inhibits cyclooxygenase (COX I and COX II) to prevent the conversion of arachidonic acid to prostaglandins.

16. Which cancer drugs effect nuclear DNA (4)?
To inhibit renal Dihydropeptidase I and decrease Imipenem inactivation in the renal tubules
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide
Tetracycline - Doxycycline - Demeclocycline - Minocycline
- DNA intercalator - testicular & lymphomas - Pulmonary fibrosis mild myelosuppression.

17. What is the memory key involving the '4 R's of Rifampin?'
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
Babiturate.
1. Heavy bleeding 2. GI effects (n/v - anorexia) 3. Abdominal pain
Pseudomonas species and Gram - rods

18. Why would you give a drug like pancuronium or succinylcholine?
- Alkalate DNA - Brain tumors - CNS toxicity
Useful in muscle paralysis during surgery or mechanical ventilation.
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.
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.

19. What is the clinical use of Mifepristone (RU486)?
- inhibits HGPRT (pur. Syn.) - Luk - Lymph
Abortifacient.
aPTT (intrinsic pathway)
- acetylation - glucuron. - & sulfation - Conjugation - Polar product

20. Which individuals are predisposed to Sulfonamide - induced hemolysis?
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine
G6PD deficient individuals
1. Acarbose 2. Miglitol
- Infections - Trauma - Seizures - CO - Overdose - Metabolic - Alcohol (IT'S COMA)

21. How is Leishmaniasis treated?
Inhibits DNA dependent RNA polymerase
Pentavalent Antimony
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)

22. Mannitol - contraindications?
Increase target cell response to insulin.
1. Hypoglycemia (more common with 2nd - generation drugs: glyburide - glipizide) 2. Disulfiram - like effects (not seen with 2nd - generation drugs).
Dobutamine has more of an affintiy for beta -1 than beta -2 - and is used for treating heart failure and shock. Albuterol and terbutaline is the reverse - and is used in treatment of acute asthma.
anuria - CHF

23. What is the enzyme inhibited - the effect of this inhibition - and the clinical use of the antiandrogren Finasteride?
Blood
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH
Triple sulfas or SMZ
They inhibit reuptake of NE at the nerve terminal (as does cocaine).

24. What is used to reverse the action of Heparin?
For serious - Gram + multidrug - resistant organisms
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).
With supplemental Folic Acid
Rash - Pseudomembranous colitis

25. What patients are at risk for life threatening hypotension When taking Sildenafil (Viagra)?
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis
torsade de pointes - excessive Beta block
Those patients who are taking nitrates.
CMV Retinitis in IC pts When Ganciclovir fails

26. Resistance mechanisms for Macrolides

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27. Cocaine casues vasoconstriction and local anesthesia by What mechanism
- Oxalic acid - Acidosis & nephrotoxicity
Quinolones
Indirect agonist - uptake inhibitor
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole

28. What is the category of drug names ending in - tidine (e.g. Cimetidine)
H2 antagonist
Tricyclic antidepressant.
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine

29. What are Aminoglycosides used for clinically?
Severe Gram - rod infections.
Epinephirine(Alpha1 -2 and Beta 1 -2)
Bacitracin - Vancomycin
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents

30. What is the MOA for Nystatin?
ACE inhibitor.
Binds ergosterol - Disrupts fungal membranes
for RSV
Nevirapine - Delavirdine

31. Which drug(s) cause this reaction: Stevens - Johnson syn. (3)?
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.
Tricyclic antidepressant.
- Ethosuxamide - sulfonamides - lamotrigine
Minor hepatotoxicity - Drug interactions (activates P450)

32. These drugs acts indirectly by releasing strored catecholamines in the presynaptic terminal
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity
Succinylcholine
Amphetamine and Ephedrine

33. Which of the following would atropine administration cause? Hypothermia - bradycardia - excess salivation - dry flushed skin - or diarrhea
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state
Neostigmine - pyridostigmine edrophonium - physostigmine echothiophate
Dry flushed skin - due to inhibition of sympathetic post - ganglionic blockade on muscarinic receptors of sweat glands. All others are opposite of What would be expected.
Lipoxygenase

34. What two vasodilators require simultaneous treatment with beta blockers to prevent reflex tachycardia and diuretics to prevent salt retention?
Hydralazine and Minoxidil
Large anionic polymer - acidic
CL= (rate of elimination of drug/ Plasma drug conc.)
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention

35. Mnemonic for Foscarnet?
Polymyxin B - Polymyxin E
Lipoxygenase
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).
Foscarnet = pyroFosphate analog

36. What are two mechanisms of action of Propythiouracil?
Malaria (P. falciparum)
Diarrhea - Urination - Miosis - Bronchospasm - Bradycardia - Excitation of skeletal muscle and CNS - Lacrimation - Sweating - and Salivation = DUMBBELS; also abdominal cramping
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.
Lipoxygenase

37. List the specific antidote for this toxin: Heparin
propanolol - esmolol - metoprolol - atenolol - timolol
- Protamine
Ceftriaxone
dry mouth - sedation - severe rebound hypertension

38. How does angiotensin II affect NE release?
It acts presynaptically to increase NE release.
No
Dobutamine has more of an affintiy for beta -1 than beta -2 - and is used for treating heart failure and shock. Albuterol and terbutaline is the reverse - and is used in treatment of acute asthma.
- MT polymerization inhibitor(M phase) - MOPP - lymphoma - Willm's & choriocarcinoma - neurotoxicity and myelosuppression

39. List the specific antidote for this toxin: Benzodiazepines
Oral
Quinidine - Amiodarone - Procainamide - Disopyramide
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
- Flumazenil

40. Which drug(s) cause this reaction: Torsade de pointes (2)?
- Shifts the curve down - reduces Vmax
Nifedipine - Verapamil - Diltiazem
Decrease the production of leukotrienes and protaglandins by inhibiting phospholipase A2 and expression of COX-2.
- Class III antiarrhythmics (sotalol) - class IA (quinidine)

41. Mg+- clinical use?
effective in torsade de pointes and digoxin toxicity
Phenothiazine (neuroleptic - antiemetic).
Beta1 more than B2
1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone When used of Leprosy 3. Used in combination with other drugs

42. List some specifics of lead poisoning(4)?
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.
Diarrhea
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)

43. What is the MOA for Carbenicillin - Piperacillin - and Ticarcillin?
anticholinesterase glaucoma
Same as penicillin. Extended spectrum antibiotics
Quinidine - Amiodarone - Procainamide - Disopyramide
Diarrhea - Urination - Miosis - Bronchospasm - Bradycardia - Excitation of skeletal muscle and CNS - Lacrimation - Sweating - and Salivation = DUMBBELS; also abdominal cramping

44. What is the mechanism of action of the thrombolytics?
Directly of indirectly aid conversion of plasminogen to plasmin Which cleaves thrombin and fibrin clots. (It is claimed that tPA specifically converts fibrin - bound plasminogen to plasmin.)
- NaHCO3
is resistant
anticholinesterase glaucoma

45. Oral Penicillin
RESPIre
- Halothane - Valproic acid - acetaminophen - Amantia phalloides
Penicillin - V
TMP- SMZ (DOC) - aerosolized pentamidine

46. List the specific antidote for this toxin: Warfarin
- Vitamin K & fresh frozen plasma
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
physostigmine
prevention of nodal arrhythmias (SVT)

47. What is the mechanism of action of the Sulfonylureas?
Inhibit intestinal bursh border Alpha - glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.
Antileukotriene; blocks synthesis by lipoxygenase.
Diuresis in pateints with sulfa allergy
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.

48. What are four unwanted effects of Clomiphene use?
Prefers beta's at low doses - but at higher doses alpha agonist effects are predominantly seen.
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances
Reversibly inhibits cyclooxygenase - mostly in CNS. Inactivated peripherally.
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.

49. Which drug(s) cause this reaction: P450 inhibition(6)?
reduce levels of Angiotensin II - thereby preventing the inactivation of bradykinin (a potent vasodilator); renin level is increased
Abortifacient.
- Cimetidine - ketoconazole - grapefruit juice - erythromycin - INH - sulfonamides
Cell membrane Ca2+ channels of cardiac sarcomere

50. What is a prerequisite for Acyclovir activation?
Penicillin - Cephalosporins - Vancomycin - Aminoglycosides - Fluoroquinolones - Metronidazole
Neurotoxicity - Acute renal tubular necrosis
It must be Phosphorylated by Viral Thymidine Kinase
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms