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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. How is Ganciclovir activated?
depresses ectopic pacemakers - especially in digoxin toxicity
hypertension - CHF - diabetic renal disease
Phosphorylation by a Viral Kinase
1)Binds penicillin - binding proteins 2) Blocks transpeptidase cross - linking of cell wall 3) Activates autolytic enzymes

2. What is the MOA for Carbenicillin - Piperacillin - and Ticarcillin?
Norepinephrine (Alpha1 -2 and beta 1)
Same as penicillin. Extended spectrum antibiotics
Those patients who are taking nitrates.
severe hypertension - CHF

3. Norepi feedbacks and inhibits the presynaptic receptor by What mechanism
Rash - Pseudomembranous colitis
With an amino acid change of D- ala D- ala to D- ala D- lac
Binding to the presynaptic alpha 2 release modulating receptors
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)

4. What is the clinical use for Sucralfate?
Indomethacin is used to close a patent ductus arteriosus.
Peptic ulcer disease.
- Cloazapine - carbamazapine - colchicine - PTU
Hypersensitivity reactions

5. What is the category of drug names ending in - pril (e.g. Captopril)
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.
ACE inhibitor.
No - hemicholinum block the uptake of Choline and thus Ach synthesis
cholestyramine - colestipol

6. Which drug(s) cause this reaction: Cough?
Inhibits cell wall mucopeptide formation - Bactericidal
anuria - CHF
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.
- ACE inhibitors (Losartan>no cough)

7. Adverse effects of Captopril?
It affects beta receptors equally and is used in AV heart block (rare).
Prevention of NSAID- induced peptic ulcers - maintains a PDA.
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
- Shifts the curve down - reduces Vmax

8. What are four H2 Blockers?
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).
cortical collecting tubule
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.

9. Which diuretics cause acidosis?
cardiac muscle: Verapamil>Diltiazem>Nifedipine
The PTT.
carbonic anhydrase inhibitors - K+ sparing diuretics
Stimulates beta adrenergic receptors

10. Explain differences between full and partial agonists(2).
- Class III antiarrhythmics (sotalol) - class IA (quinidine)
Systemic mycoses
- Act on same receptor - Full has greater efficacy
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.

11. Antiarrhythmic class IV- clinical use?
- Tetracycline
prevention of nodal arrhythmias (SVT)
Inhibt Assembly of new virus by Blocking Protease Enzyme
Blood

12. Which drug(s) cause this reaction: Tendonitis and rupture?
- Fluoroquinolones
Modification via Acetylation
first dose orthostatic hypotension - dizziness - headache
Beta1 more than B2

13. Name common Polymyxins
Acute gout.
Acetylcholinesterase; ACh is broken down into choline and acetate.
Polymyxin B - Polymyxin E
- Shifts the curve to the right - increases Km

14. Preferential action of the Ca2+ channel blockers at cardiac muscle?
- Penicillamine
Prophylaxis for Influenza A - Rubella; Parkinson's disease
GnRH analog with agonist properties When used in pulsatile fashion and antagonist properties When used in continuous fashion - causing a transient initial burst of LH and FSH
cardiac muscle: Verapamil>Diltiazem>Nifedipine

15. What are are the Sulfonylureas (general description) and What is their use?
Sulfonylureas are oral hypoglycemic agents - they are used to stimulate release of endogenous insulin in NIDDM (type -2).
1. Antiandrogen 2. Nausea 3. Vomiting
hypokalemia - slight hyperlipidemia - hyperuricemia - lassitude - hypercalcemia - hyperglycemia
Teratogenic - Carcinogenic - Confusion - Headaches

16. What are five advantages of Oral Contraceptives (synthetic progestins - estrogen)?
Same as penicillin. Extended spectrum antibiotics
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
Triple sulfas or SMZ
H2 antagonist

17. What are the side effects of Rifampin?
Beta -2 agonist.
Chronic anticoagulation.
Minor hepatotoxicity - Drug interactions (activates P450)
Beta lactams - inhibit cell wall synthesis - Bactericidal

18. Why are the Sulfonylureas inactive in IDDM (type -1)?
The PTT.
Triple sulfas or SMZ
- Class III antiarrhythmics (sotalol) - class IA (quinidine)
Because they require some residual islet function.

19. Antiarrhythmic Class III- effects?
INH: Injures Neurons and Hepatocytes
increase AP duration - increase ERP - increase QT interval - for use When other arrhythmics fail
- Tricyclic antidepressants
The only local anesthetic with vasoconstrictive properties.

20. The COX-2 inhibitors (celecoxib - rofecoxib) have similar side effects to the NSAIDs with What one exception?
Same as penicillin. Act as narrow spectrum antibiotics
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.
No - warfarin - unlike heparin - can cross the placenta.

21. Digoxin v. Digitoxin: excretion?
DOC in diagnosing and abolishing AV nodal arrhythmias
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic
Digoxin=urinary Digitoxin=biliary
1. Renal damage 2. Aplastic anemia 3. GI distress

22. List the specific antidote for this toxin: TPA & Streptokinase
cholestyramine - colestipol
- Aminocaproic acid
cardiac depression - peripheral edema - flushing - dizziness - constipation
cross - allergenic

23. Ethacrynic Acid - clinical use?
Beta1 more than B2
very short acting
Digitoxin 168hrs Digoxin 40 hrs
Diuresis in pateints with sulfa allergy

24. What is the mecanism of action of the COX-2 inhibitors (celecoxib - rofecoxib)?
Cryptococcal meningitis in AIDS patients and Candidal infections of all types
The PT.
Lovastatin - Pravastatin - Simvastatin - Atorvastatin
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.

25. MOA: Block protein synthesis at 50s subunit
Chloramphenicol - Erythromycin/macrolides - Lincomycin - Clindamycin - Streptogramins (quinupristin - dalfopristin)
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
torsade de pointes
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.

26. What anticholinesterase crosses the blood - brain - barrier?
Gemfibrozil - Clofibrate
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.
toxic
physostigmine

27. What is the category - method of use - and adverse effects of Salmeterol in Asthma treatment?
CL= (rate of elimination of drug/ Plasma drug conc.)
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.
Ganciclovir is more toxic to host enzymes

28. What are two toxicities associated with Cyclosporine?
Mebendazole/Thiabendazole - Pyrantel Pamoate
TMP- SMZ (DOC) - aerosolized pentamidine
No - hemicholinum block the uptake of Choline and thus Ach synthesis
1. Predisposes to viral infections and lymphoma 2. Nephrotoxic (preventable with mannitol diuresis)

29. Beta Blockers - site of action?
- Atropine & pralidoxime
Beta adrenergic receptors and Ca2+ channels (stimulatory)
cortical collecting tubule
aPTT (intrinsic pathway)

30. What is the mechanism of Leuprolide?
Inhibits bacterial Dihydrofolate Reductase - Bacteriostatic
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.
GnRH analog with agonist properties When used in pulsatile fashion and antagonist properties When used in continuous fashion - causing a transient initial burst of LH and FSH
Fever/Chills - Hypotension - Nephrotoxicity - Arrhythmias

31. What is the mechanism of action of the H2 Blockers?
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).
Reversible block of histamine H2 receptors
sedation - sleep alterations
Because they require some residual islet function.

32. Hydralazine - clinical use?
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.
- Tricyclic antidepressants
severe hypertension - CHF
1. Hydrocortisone 2. Predisone 3. Triamcinolone 4. Dexamethasone 5. Beclomethasone

33. What are toxic side effects for Metronidazole?
Imipenem
Disulfiram - like reaction with EtOH - Headache
Treatment of infertility.
Short.

34. What is the mechanism of action of Misoprostol?
Hemolytic anemia
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
Wide spectrum of systemic mycoses: Cryptococcus - Blastomyces - Coccidioides - Aspergillus - Histoplasma - Candida - Mucor

35. Oral Penicillin
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).
Penicillin - V
Sulfonamides - Trimethoprim
CMV Retinitis in IC pts When Ganciclovir fails

36. Decrease Digitoxin dose in renal failure?
- N- acetylcystine
Mg = Must go to the bathroom.
NO
Tetracycline - Doxycycline - Demeclocycline - Minocycline

37. What is the MOA of Aztreonam?
decrease conduction velocity - increase ERP - increase PR interval
Beta -2 agonist.
Inhibits cell wall synthesis ( binds to PBP3). A monobactam
Cryptococcal meningitis in AIDS patients and Candidal infections of all types

38. What are five disadvantages of Oral Contraceptives (synthetic progestins - estrogen)?
Chronic Hepatitis A and B - Kaposi's Sarcoma
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).
GnRH analog with agonist properties When used in pulsatile fashion and antagonist properties When used in continuous fashion - causing a transient initial burst of LH and FSH

39. List the specific antidote for this toxin: Digitalis
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas
Butyrophenone (neuroleptic).
- Normalize K+ - Lidocaine - & Anti - dig Mab
Lovastatin - Pravastatin - Simvastatin - Atorvastatin

40. Ca2+ channel blockers - site of action?
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)
None. No - because atropine would block the postganglionic muscarinic receptors involved in sweat gland stimulation.
Cell membrane Ca2+ channels of cardiac sarcomere
Aminoglycosides

41. What is the chemical name for Ganciclovir?
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.
- Normalize K+ - Lidocaine - & Anti - dig Mab
DHPG (dihydroxy-2- propoxymethyl guanine)

42. Which cancer drugs inhibit nucleotide synthesis(3)?
amphetamine and ephedrine
Tubocurarine - atracurium - mivacurium - pancuronium - vecuronium - rapacuronium
- Methotrexate - 5 FU - 6 mercaptopurine
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.

43. Reserpine will block the syntheis of this drug and but not its precursor.
- Ammonium Chloride
Blocks Norepi - but not Dopamine
Inhibits reabsorption of uric acid.
Suramin

44. Name the common Azoles
- Oxalic acid - Acidosis & nephrotoxicity
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole
Tendonitis and Tendon rupture
With an amino acid change of D- ala D- ala to D- ala D- lac

45. What are the products and their toxicities of the metabolism of ethanol by / alcohol dehydrogenase?
Resistant Gram - infections
Md= (CpxCL)/F Cp= plas. Conc. CL=clear. F=bioaval.
- Acetaldehyde - Nausea - vomiting - headache - & hypotension
physostigmine

46. Triamterene and amiloride - mechanism?
Mebendazole/Thiabendazole - Pyrantel Pamoate
1. Buffalo hump 2. Moon facies 3. Truncal obesity 4. Muscle wasting 5. Thin skin 6. Easy bruisability 7. Osteoporosis 8. Adrenocortical atrophy 9. Peptic ulcers
block Na+ channels in the cortical collecting tubule
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.

47. For Heparin What is the Duration of action
Reserpine inhibits dopamine transport into vesicles - attenuating its conversion to NE by dopamine beta - hydroxylase.
Acute (hours)
- Flumazenil
- Formaldehyde & formic acid - severe acidosis & retinal damage

48. Name the Protease Inhibitors (4)
anticholinesterase glaucoma
- DNA intercalator - Hodgkin's - myeloma - sarcoma - and solid tumors - Cardiotoxicity & alopecia
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome
Saquinavir - Ritonavir - Indinavir - Nelfinavir

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

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50. What physiological effects was the Anes using Atropine to tx
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions
toxic
decrease
- NaHCO3