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USMLE Step 1 Pharmacology
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health-sciences
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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. Which diuretics increase urine K+?
Abortifacient.
Local anesthetic.
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole
2. What is Ketoconazole specifically used for?
Diuresis in pateints with sulfa allergy
Small lipid - soluble molecule
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism
- aminoglycosides - loop diuretics - cisplatin
3. How is Rifampin used clinically?
Bethanechol - Neostigmine - physostigmine
1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone When used of Leprosy 3. Used in combination with other drugs
orthostatic and exercise hypotension - sexual dysfunction - diarrhea
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).
4. What is the MOA for Carbenicillin - Piperacillin - and Ticarcillin?
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide
Same as penicillin. Extended spectrum antibiotics
Rapid (seconds)
Rifampin (DOC) - minocycline
5. What is the mechanism of Azathioprine?
Antimetabolite derivative of 6- mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.
These B-2 agonists cause respiratory smooth muscle to relax.
6. Foscarnet toxicity?
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.
Nephrotoxicity
7. How does angiotensin II affect NE release?
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
proximal convoluted tubule
Increases coumadin metabolism
It acts presynaptically to increase NE release.
8. Which receptors does phenylephrine act upon?
Aminoglycosides
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
Digoxin=urinary Digitoxin=biliary
vasodilator - increases cGMP to induce smooth muscle relaxation (arterioles>veins; afterload reduction)
9. What is the mechanism of action of Sildenafil (Viagra)?
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine
- Shifts the curve down - reduces Vmax
Inhibits cGMP phosphodiesterase - casuing increased cGMP - smooth muscle relaxation in the corpus cavernosum - increased blood flow - and penile erection.
10. Which drug(s) cause this reaction: Cardiac toxicity?
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
- Daunorubicin & Doxorubicin
Malaria (P. falciparum)
Choline acetyltransferase
11. Which antimicrobials inhibit protein synthesis at the 50S subunit? (4)
Prevents release of mediators from mast cells. Effective only for the prophylaxis of asthma. Not effective during an acute attack.
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis
Acts as a wide spectrum carbapenem
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic
12. List the specific antidote for this toxin: Iron
Resistant Gram - infections
Epinephirine(Alpha1 -2 and Beta 1 -2)
- Deferoxamine
- Methylene blue
13. Does Ampicillin or Amoxicillin have a greater oral bioavailability?
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)
AmOxicillin has greater Oral bioavailability
1. Heavy bleeding 2. GI effects (n/v - anorexia) 3. Abdominal pain
Pseudomonas species and Gram - rods
14. What is the category of drug names ending in - barbital (e.g. Phenobarbital)
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms
proarrhythmic
Same as penicillin. Extended spectrum antibiotics
Babiturate.
15. What is the MOA for Metronidazole?
Inhibits formation of Initiation Complex - causes misreading of mRNA - Bactericidal
Forms toxic metabolites in the bacterial cell - Bactericidal
carbonic anhydrase inhibitors - K+ sparing diuretics
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)
16. What are the side effects of Rifampin?
- Quinidine - quinine
Minor hepatotoxicity - Drug interactions (activates P450)
Antibiotic - protein synthesis inhibitor.
H2 antagonist
17. What is the MOA for Acyclovir?
Inhibit viral DNA polymerase
viral kinase
- Alkalate DNA - Brain tumors - CNS toxicity
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.
18. Which drug(s) cause this reaction: Gray baby syndrome?
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.
edrophonium (extremely short acting anticholinesterase)
- Chloramphenicol
torsade de pointes
19. What is the category of drug names ending in - azepam (e.g. Diazepam)
Benzodiazepine.
Blocks Peptide Bond formation at the 50S subunit - Bacteriostatic
Ceftriaxone
1. Addison's disease 2. Inflammation 3. Immune suppression 4. Asthma
20. Explain potency in relation to full and partial agonists(2).
1. Better bioavailability 2. 2 to 4 times longer half life 3. Can be administered subcutaneously 4. Does not require laboratory monitoring
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms
Prevents release of mediators from mast cells. Effective only for the prophylaxis of asthma. Not effective during an acute attack.
21. What are the clinical uses for Aztreonam?
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
cyanide toxicity (releases CN)
Ipratropium
carbonic anhydrase inhibitors - K+ sparing diuretics
22. Which drug(s) cause this reaction: Tendonitis and rupture?
- Fluoroquinolones
- Class III antiarrhythmics (sotalol) - class IA (quinidine)
Triple sulfas or SMZ
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
23. What is the category - method of use - and adverse effects of Salmeterol in Asthma treatment?
1. Bleeding 2. Thrombocytopenia 3. Drug - drug interactions
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.
Pyridoxine (B6) administration
- Tetracycline - amiodarone - sulfonamides
24. What is the lab value used to monitor the effectiveness of Heparin therapy?
- Shifts the curve down - reduces Vmax
The PTT.
Prevents the release of ACh - Which results in muscle paralysis.
- Antipsychotics
25. List the specific antidote for this toxin: Salicylates
- Normalize K+ - Lidocaine - & Anti - dig Mab
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
post MI and digitalis induced arrhythmias
- Alkalinize urine & dialysis
26. What is the mechanism of action of Mifepristone (RU486)?
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.
Extended spectrum penicillin: certain Gram + bacteria and Gram - rods
Delirium - Tremor - Nephrotoxicity
Competitive inibitor of progestins at progesterone receptors.
27. What is the effect of norepinephrine on bp and pulse pressure?
Aplastic anemia (dose independent) - Gray Baby Syndrome
- EDTA - dimercaprol - succimer - & penicillamine
proximal convoluted tubule
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.
28. What is Metronidazole combined with for 'triple therapy'? Against What organism?
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori
1. Antiandrogen 2. Nausea 3. Vomiting
narcolepsy - obesity - and attention deficit disorder (I wouldn't recommend this)
Neomycin
29. What are three possible complications of Heparin therapy?
1. Gastric ulceration 2. Bleeding 3. Hyperventilation 4. Reye's syndrome 5. Tinnitus (CN VIII)
1. Bleeding 2. Thrombocytopenia 3. Drug - drug interactions
- Atropine & pralidoxime
Acetylcholine esterase
30. What effect would atropine have on the preganglionic sympathetic activation of sweat glands? Would this person sweat?
None. No - because atropine would block the postganglionic muscarinic receptors involved in sweat gland stimulation.
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.
scopolamine
Protease Inhibitors and Reverse Transcriptase Inhibitors
31. Where does Griseofulvin deposit?
1. Meningococcal carrier state 2. Chemoprophylaxis in contacts of children with H. influenzae type B
thick ascending limb
Keratin containing tissues - e.g. - nails
Norepinephrine (Alpha1 -2 and beta 1)
32. What are four conditions in Which H2 Blockers are used clinically?
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills
Short.
Neutropenia
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
33. What is the memory key to remember Which pathway (extrinsic vs. intrinsic) and Which lab value Warfarin affects?
WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
- Act on same receptor - Full has greater efficacy
34. Which RT inhibitors cause a Rash?
- Dimercaprol - succimer
Non - Nucleosides
- Shifts the curve to the right - increases Km
Chronic gout.
35. List five common glucocorticoids.
1. Hydrocortisone 2. Predisone 3. Triamcinolone 4. Dexamethasone 5. Beclomethasone
is resistant
As an anticholinesterase it increases endogenous ACh and thus increases strength.
Botulinum
36. K+- clinical use?
- Niacin - Ca++ channel blockers - adenosine - vancomycin
In 4 half - lifes= (94%) T1/2 = (0.7x Vd)/CL
RESPIre
depresses ectopic pacemakers - especially in digoxin toxicity
37. What are common toxicities related to Vancomycin therapy?
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38. How are Interferons (INF) used clinically?
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39. What are two toxicities associated with Cyclosporine?
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy
1. Predisposes to viral infections and lymphoma 2. Nephrotoxic (preventable with mannitol diuresis)
Cephalosporins
GI discomfort
40. What type of gout is treated with Probenacid?
Chronic gout.
Neostigmine - pyridostigmine edrophonium - physostigmine echothiophate
- Ammonium Chloride
- Steroids - Tamoxifen
41. Digoxin v. Digitoxin: excretion?
Competitive inibitor of progestins at progesterone receptors.
Beta antagonist.
Benzathine penicillin G
Digoxin=urinary Digitoxin=biliary
42. What are three types of antacids and the problems that can result from their overuse?
HTN - CHF - calcium stone formation - nephrogenic DI.
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.
compensatory tachycardia - fluid retention - lupus - like syndrome
1. Aluminum hydroxide: constipation and hypophosphatemia 2. Magnesium hydroxide: diarrhea 3. Calcium carbonate: Hypercalcemia - rebound acid increase - All may cause hypokalemia
43. What are three unwanted effects of Mifepristone?
1. Heavy bleeding 2. GI effects (n/v - anorexia) 3. Abdominal pain
torsade de pointes
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.
decrease the slope of phase 4 - increase PR interval (the AV node is particularly sensitive)
44. What would be the effect on blood pressure with infusion of the alpha -2 agonist clonidine?
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.
It must be Phosphorylated by Viral Thymidine Kinase
- polymyxins
45. What are two indirect acting adrenergic agonists?
amphetamine and ephedrine
Inhibit intestinal bursh border Alpha - glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.
Imipenem
Buy AT 30 - CELL at 50'
46. Hydralazine - clinical use?
- Metronidazole - certain cephalosporins - procarbazine - sulfonylureas
Centrally acting alpha agonist - thus causing a decrease in central adrenergic outflow - spairing renal blood flow
severe hypertension - CHF
orthostatic and exercise hypotension - sexual dysfunction - diarrhea
47. Antimicrobial prophylaxis for Meningococcal infection
sedation - positive Coombs' test
Meningitis (H. influenza - N. meningitidis - S. pneumoniae) - Conserative treatment due to toxicities
Rifampin (DOC) - minocycline
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
48. Does Heparin have a long - medium - or short half life?
Short.
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.
Aminoglycosides
Chronic anticoagulation.
49. Name several common Macrolides (3)
Erythromycin - Azithromycin - Clarithromycin
VACUUM your Bed Room'
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia
Penicillin - Cephalosporins - Vancomycin - Aminoglycosides - Fluoroquinolones - Metronidazole
50. Decrease Digitoxin dose in renal failure?
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
NO
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.
Pralidoxime regenerates active cholinesterase.
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