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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 are four H2 Blockers?
- Constant AMOUNT eliminated per unit time. - Etoh & ASA
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine
Tubocurarine - atracurium - mivacurium - pancuronium - vecuronium - rapacuronium
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism

2. What are common serious side effects of Aminoglycosides and What are these associated with?
Decrease the production of leukotrienes and protaglandins by inhibiting phospholipase A2 and expression of COX-2.
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
Inhibits DNA dependent RNA polymerase
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)

3. ___________ are Teratogenic
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.
Diarrhea
- Cimetidine - ketoconazole - spironolactone - digitalis - EtOH - estrogens
Aminoglycosides

4. Which H2 Blocker has the most toxic effects and What are they?
Inhibits cell wall mucopeptide formation - Bactericidal
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.
Inhibits Viral DNA polymerase
very short acting

5. ACE inhibitors - toxicity?
Chronic anticoagulation.
Antibiotic - protein synthesis inhibitor.
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)

6. Hydrochlorothiazide - toxicity? (hyperGLUC - plus others)
ACE inhibitor.
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
Hypokalemic metabolic alkalosis - hyponatremia - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia - sulfa allergy.
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.

7. In What population does Gray Baby Syndrome occur? Why?
Tubocurarine - atracurium - mivacurium - pancuronium - vecuronium - rapacuronium
Premature infants - because they lack UDP- glucuronyl transferase
1. Predisposes to viral infections and lymphoma 2. Nephrotoxic (preventable with mannitol diuresis)
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia

8. For Warfarin What is the Ability to inhibit coagulation in vitro
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression
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.
No
Chagas' disease - American Trypanosomiasis (Trypanosoma cruzi)

9. What is the category and mechanism of action of Zafirlukast in Asthma treatment?
Dermatophytes (tinea - ringworm)
carbonic anhydrase inhibitors - K+ sparing diuretics
Botulinum
Antileukotriene; blocks leukotriene receptors.

10. What are the four conditions in Which Omeprazole - Lansoprazole is used?
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol
Phosphorylation by a Viral Kinase
Inhibits Viral DNA polymerase
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome

11. MOA: Disrupt bacterial/fungal cell membranes
Polymyxins
Hypersensitivity reactions
Tricyclic antidepressant.
Sulfamethoxazole (SMZ) - Sulfisoxazole - Triple sulfas - Sulfadiazine

12. What are four clinical activities of Aspirin?
Selectively inhibit cyclooxygenase (COX) isoform 2 - Which is found in inflammatory cells nad mediates inflammation and pain; spares COX-1 Which helps maintain the gastric mucosa.
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.
Impairs the synthesis of vitamin K- dependent clotting factors

13. Oral Penicillin
NO HYPERURICEMIA - NO SULFA AllERGY; same as furosemide otherwise
- Ethanol - dialysis - & fomepizole
Penicillin - V
increase AP duration - increase ERP - increase QT interval - for use When other arrhythmics fail

14. Which diuretics increase urine NaCl?
physostigmine
all of them
Selectively inhibit cyclooxygenase (COX) isoform 2 - Which is found in inflammatory cells nad mediates inflammation and pain; spares COX-1 Which helps maintain the gastric mucosa.
Methylzanthine; desired effect is bronchodilation - may cause bronchodilation by inhibiting phosphodiesterase - enzyme involved in degrading cAMP (controversial).

15. What antimicrobial class is Aztreonam syngergestic with?
Buy AT 30 - CELL at 50'
Wide spectrum of systemic mycoses: Cryptococcus - Blastomyces - Coccidioides - Aspergillus - Histoplasma - Candida - Mucor
Gram + cocci - Gram - rods - and Anerobes
Aminoglycosides

16. Ethacrynic Acid - mechanism?
- Tamoxifen
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Beta Blockers
not a sulfonamide - but action is the same as furosemide

17. What is Fluconazole specifically used for?
physostigmine
1. Renal damage 2. Aplastic anemia 3. GI distress
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
Cryptococcal meningitis in AIDS patients and Candidal infections of all types

18. What is the most common cause of Pt noncompliance with Macrolides?
Disulfiram - like reaction with EtOH - Headache
GET on the Metro
GI discomfort
Inhalational general anesthetic.

19. Mannitol - toxicity?
pulmonary edema - dehydration
Digitoxin 168hrs Digoxin 40 hrs
- Quinidine - quinine
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.

20. What is the MOA of Foscarnet?
Inhibits Viral DNA polymerase
Hypersensitivity reactions
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.
Digitoxin>95% Digoxin 75%

21. Adverse effect of Nitroprusside?
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.
Aminoglycosides
cyanide toxicity (releases CN)
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.)

22. What is are two clinical uses of Cyclosporine?
1. Gastric ulceration 2. Bleeding 3. Hyperventilation 4. Reye's syndrome 5. Tinnitus (CN VIII)
Antifungal.
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.
Succinylcholine

23. What is the difference in receptor affinity of epinephrine at low doses? High doses?

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24. Why does NE result in bradycardia?
Leukotrienes increasing bronchial tone.
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
Aminoglycosides - Tetracyclines
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids

25. Antimicrobial prophylaxis for Meningococcal infection
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
- aminoglycosides - loop diuretics - cisplatin
Scopolamine
Rifampin (DOC) - minocycline

26. 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.
- Act on same receptor - Full has greater efficacy
for RSV
Spironolactone - Triamterene - Amiloride (the K+ STAys)

27. In coma situations you rule out What (7)?

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28. What are common toxicities associated with Macrolides? (4)
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol
Blocks Norepi - but not Dopamine
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.
GI discomfort - Acute cholestatic hepatitis - Eosinophilia - Skin rashes

29. What are the clinical indications for Azole therapy?
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity
Immediate anticoagulation for PE - stroke - angina - MI - DVT.
Systemic mycoses
cinchonism: HA - tinnitus - thrombocytopenia - torsade de pointes due to increased QT interval

30. List the mechanism - clinical use - & toxicity of Cisplatin.
Teratogenic - Carcinogenic - Confusion - Headaches
- Shifts the curve down - reduces Vmax
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility

31. Which RT inhibitor causes Megaloblastic Anemia?
Beta -2 agonist.
- Chloramphenicol
AZT
- Atropine & pralidoxime

32. Antimicrobial prophylaxis for a history of recurrent UTIs
Beta -2 agonist.
Antileukotriene; blocks leukotriene receptors.
TMP- SMZ
- Ammonium Chloride

33. Name four HMG- CoA reductase inhibitors.
Lovastatin - Pravastatin - Simvastatin - Atorvastatin
Teratogenic - Carcinogenic - Confusion - Headaches
Mebendazole/Thiabendazole - Pyrantel Pamoate
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.

34. What side effect of using atropine to induce pupillary dilation would you expect?
Rifampin (DOC) - minocycline
Erythromycin - Azithromycin - Clarithromycin
- Tetracycline - amiodarone - sulfonamides
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).

35. Does Warfarin have a long - medium - or short half life?
Same as penicillin. Act as narrow spectrum antibiotics
Diarrhea - Urination - Miosis - Bronchospasm - Bradycardia - Excitation of skeletal muscle and CNS - Lacrimation - Sweating - and Salivation = DUMBBELS; also abdominal cramping
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis
Long.

36. As an Anes you want to use a depolarizing neuromuscular blocking drug on your pt - What do you use
- Class III antiarrhythmics (sotalol) - class IA (quinidine)
- Ethanol - dialysis - & fomepizole
Reserpine inhibits dopamine transport into vesicles - attenuating its conversion to NE by dopamine beta - hydroxylase.
Succinylcholine

37. What are toxic side effects for Metronidazole?
Disulfiram - like reaction with EtOH - Headache
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)
YES
NO HYPERURICEMIA - NO SULFA AllERGY; same as furosemide otherwise

38. Which drug(s) cause this reaction: Fanconi's syndrome?
Warfarin interferes with the normal synthesis and gamma - carboxylation of vitamin K- dependent clotting factors II - VII - IX - and X - Protein C and S via vitamin K antagonism.
Activates antithrombin III
Prevents release of mediators from mast cells. Effective only for the prophylaxis of asthma. Not effective during an acute attack.
- Tetracycline

39. What is action of insulin in the liver - in muscle - and in adipose tissue?
INH: Injures Neurons and Hepatocytes
- Halothane - Valproic acid - acetaminophen - Amantia phalloides
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.
BM suppression (neutropenia - anemia) - Peripheral neuropathy

40. What are two toxicities of the Sulfonylureas?
1. Hypoglycemia (more common with 2nd - generation drugs: glyburide - glipizide) 2. Disulfiram - like effects (not seen with 2nd - generation drugs).
Pralidoxime regenerates active cholinesterase.
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.
Modification via Acetylation - Adenylation - or Phosphorylation

41. What organism is Imipenem/cilastatin the Drug of Choice for?
1. Bleeding 2. Teratogenicity 3. Drug - drug interactions
1. Antipyretic 2. Analgesic 3. Anti - inflammatory
Enterobacter
thick ascending limb

42. A group of pts are rushed into the ER complaining of excessive sweating - tearing - salivation - HA - N and V - muscle twitching - difficulty breathing and diarrhea. What drug would be the most effective immediate tx
Phenothiazine (neuroleptic - antiemetic).
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome
Teratogenic - Carcinogenic - Confusion - Headaches

43. Where does Griseofulvin deposit?
- EDTA - dimercaprol - succimer - & penicillamine
Keratin containing tissues - e.g. - nails
Same as penicillin. Extended spectrum antibiotics
cortical collecting tubule

44. What are Fluoroquinolones indicated for? (3)
cardiac depression - peripheral edema - flushing - dizziness - constipation
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH

45. How is Amphotericin B used clinically?
- Normalize K+ - Lidocaine - & Anti - dig Mab
Wide spectrum of systemic mycoses: Cryptococcus - Blastomyces - Coccidioides - Aspergillus - Histoplasma - Candida - Mucor
Epinephirine(Alpha1 -2 and Beta 1 -2)
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).

46. Adverse effects of Clonidine?
Ca2+ (Loops Lose calcium)
dry mouth - sedation - severe rebound hypertension
Keratin containing tissues - e.g. - nails
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.

47. MOA of Succinylcholine
1. Antiandrogen 2. Nausea 3. Vomiting
TCA
Prevents the release of Ca from SR of skeletal muscle
- Upper respiratory tract infections - pneumonias - STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) - Mycoplasma - Legionella - Chlamydia - Neisseria

48. What are two types of drugs that interfere with the action of Sucralfate and why?
Pregnant women - Children; because animal studies show Damage to Cartilage
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.
- acetylation - glucuron. - & sulfation - Conjugation - Polar product
Pentavalent Antimony

49. Name the common Aminoglycosides (5)
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin
cyanide toxicity (releases CN)
Norepinephrine
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).

50. Name three K+ sparing diuretics?
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
GI discomfort
prevention of nodal arrhythmias (SVT)
Spironolactone - Triamterene - Amiloride (the K+ STAys)