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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 Reserpine?
- Quinidine - quinine
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.
Protamine sulfate
sedation - depression - nasal stuffiness - diarrhea

2. Triamterene and amiloride - mechanism?
block Na+ channels in the cortical collecting tubule
- Tetracycline
- Tricyclic antidepressants
Early myocardial infarction.

3. Which drug(s) cause this reaction: P450 induction(6)?
Keratin containing tissues - e.g. - nails
GI discomfort - Acute cholestatic hepatitis - Eosinophilia - Skin rashes
- Alkalinize urine & dialysis
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine

4. Hydrochlorothiazide - toxicity? (hyperGLUC - plus others)
Aminoglycosides
Hypokalemic metabolic alkalosis - hyponatremia - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia - sulfa allergy.
Chagas' disease - American Trypanosomiasis (Trypanosoma cruzi)
Suramin

5. List the mechanism - clinical use - & toxicity of Cyclophosphamide.
increase AP duration - increase ERP - increase QT interval - for use When other arrhythmics fail
Tetracycline - Doxycycline - Demeclocycline - Minocycline
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.
H2 antagonist

6. Antiarrhythmic class IC- toxicity?
Ibuprofen - Naproxen - and Indomethacin
Stimulates beta adrenergic receptors
Inhibits DNA dependent RNA polymerase
proarrhythmic

7. For Heparin What is the Mechanism of action
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic
Activates antithrombin III
TCA

8. Furosemide - clinical use?
edematous states (CHF - cirrhosis - nephrotic syndrome - pulm edema) - HTN - hypercalcemia
The only local anesthetic with vasoconstrictive properties.
Stimulating beta receptors stimulates heart rate - but beta receptor induced vasodilation reduces peripheral resistance.
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.

9. Are Ampicillin and Amoxicillin are not...
dizziness - flushing - constipation (verapamil) - nausea
penicillinase resistant
Modification via Acetylation - Adenylation - or Phosphorylation
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins

10. What is the clinical use for Nystatin?
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)
Inhibit intestinal bursh border Alpha - glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.
Topical and Oral - for Oral Candidiasis (Thrush)
- Antipsychotics

11. Ca2+ channel blockers - toxicity?
Short.
Increase target cell response to insulin.
cardiac depression - peripheral edema - flushing - dizziness - constipation
proximal convoluted tubule

12. Which drug(s) cause this reaction: Cinchonism (2)?
- Quinidine - quinine
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas
Quinolones
Ipratropium

13. ________ ae not resistant to penicillinase - - but they are less susceptible than the other Beta lactams
Md= (CpxCL)/F Cp= plas. Conc. CL=clear. F=bioaval.
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).
1. Pioglitazone 2. Rosiglitazone.
Cephalosporins

14. Foscarnet toxicity?
- Cimetidine - ketoconazole - grapefruit juice - erythromycin - INH - sulfonamides
Nephrotoxicity
Hypokalemic metabolic alkalosis - hyponatremia - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia - sulfa allergy.
Does not cross

15. Why are the Sulfonylureas inactive in IDDM (type -1)?
impotence - exacerbation of asthma - CV effects - CNS effects - may mask hypoclycemia
Because they require some residual islet function.
Na/K ATPase
Does not cross

16. For Heparin What is the Onset of action
Sulfonamides - Trimethoprim
decrease
Rapid (seconds)
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.)

17. Acetaldehyde is metabolized by Acetaldehyde dehydrogenase - Which drug inhibs this enzyme?
RESPIre
Erythromycin - Azithromycin - Clarithromycin
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal
- Disulfram & also sulfonylureas - metronidazole

18. What are five disadvantages of Oral Contraceptives (synthetic progestins - estrogen)?
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
Reversible block of histamine H2 receptors
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state
They inhibit reuptake of NE at the nerve terminal (as does cocaine).

19. Which H2 Blocker has the most toxic effects and What are they?
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.
collecting ducts
1. Gastric ulceration 2. Bleeding 3. Hyperventilation 4. Reye's syndrome 5. Tinnitus (CN VIII)
Inhibits Viral DNA polymerase

20. What are major side effects of Methicillin - Nafcillin - and Dicloxacillin?
decrease
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.
Hypersensitivity reactions
Methicillin - Nafcillin - and Dicloxacillin

21. How can the toxic effects of TMP be ameliorated?
Neomycin
The only local anesthetic with vasoconstrictive properties.
With supplemental Folic Acid
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids

22. What are common toxic side effects of Sulfonamides? (5)
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes
Cilastatin
- Hypersensitivity reactions - Hemolysis - Nephrotoxicity (tubulointerstitial nephritis) - Kernicterus in infants Displace other drugs from albumin (e.g. - warfarin)
troponin - tropomyosin system

23. For Heparin What is the Route of administration
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.
GI distress - Tooth discoloration and Inhibition of bone growth in children - Fanconi's syndrome - Photosensitivity
Paranteral (IV - SC)

24. What is clinical use for Carbenicillin - Piperacillin - and Ticarcillin?
Pseudomonas species and Gram - rods
impotence - exacerbation of asthma - CV effects - CNS effects - may mask hypoclycemia
Suramin
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)

25. Which cancer drugs work at the level of proteins(2)?
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.
No - hemicholinum block the uptake of Choline and thus Ach synthesis
Teratogenic - Carcinogenic - Confusion - Headaches
- Vinca alkaloids(inhibit MT) - Paclitaxel

26. Which drug(s) cause this reaction: G6PD hemolysis(8)?
viral kinase
Fever/Chills - Hypotension - Nephrotoxicity - Arrhythmias
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT

27. Ryanodine - site of action?
ACE inhibitor.
blocks SR Ca2+ channels
Non - Nucleosides
Rheumatoid and osteoarthritis.

28. What is the MOA for Clindamycin?
orthostatic and exercise hypotension - sexual dysfunction - diarrhea
Dopamine
Hypersensitivity reactions
Blocks Peptide Bond formation at the 50S subunit - Bacteriostatic

29. What beta 2 agonist will help your 21yo Astma pt?
check PFTs - LFTs - and TFTs
- polymyxins
Hypersensitivity reactions
Albuterol - tertbutaline

30. What type of patient should not take Misoprostol and why?
AluMINIMUM amount of feces.
Early myocardial infarction.
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)

31. What is an acronym to remember Anti - TB drugs?
Give an antichloinesterase - neostigmine - edrophonium - etc
No - warfarin - unlike heparin - can cross the placenta.
Well tolerated in general but occasionally - Nephrotoxicity - Ototoxicity - Thrombophlebitis - diffuse flushing='Red Man Syndrome'
RESPIre

32. Acetazolamide - site of action?
Post - op and neurogenic ileus and urinary retention - myasthenia gravis - and reversal of neuromuscular junction blockade (post - op) through anticholinesterase activity.
proximal convoluted tubule
Benzodiazepine.
Alpha -1 antagonist

33. What are three complications of Warfarin usage?
Early myocardial infarction.
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)
1. Bleeding 2. Teratogenicity 3. Drug - drug interactions
Neurotoxicity - Acute renal tubular necrosis

34. What is a possible toxicity of Alpha - glucosidase inhibitors used in type -2 diabetes?
GI disturbances.
Flecainide - Encainide - Propafenone
H2 antagonist
Pseudomembranous colitis (C. difficile) - fever - diarrhea

35. What is the category - mechanism of action - and effect of Ipratroprium in Asthma treatment?
Protamine sulfate
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
Muscarinic antagonist; competatively blocks muscarinic receptors - preventing bronchoconstriction.
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis

36. Antiarrhythmic class IV- primary site of action?
Beta Blockers
- Constant AMOUNT eliminated per unit time. - Etoh & ASA
AV nodal cells
block Na+ channels in the cortical collecting tubule

37. Bretyllium - toxicity?
new arrhythmias - hypotension
Hydralazine and Minoxidil
Hypersensitivity reactions
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide

38. What enzyme does Zileuton inhibit?
- Niacin - Ca++ channel blockers - adenosine - vancomycin
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.
Lipoxygenase
Primaquine

39. What is the MOA for the Fluoroquinolones?
GI distress - Skin rash - and Seizures at high plasma levels
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal
Useful in muscle paralysis during surgery or mechanical ventilation.
very short acting

40. Explain pH dependent urinary drug elimination?
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression
Premature infants - because they lack UDP- glucuronyl transferase
Pituitary hormone.
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more

41. Why would a patient with cog - wheel rigidity and a shuffling gait be given benztropine?
- EDTA - dimercaprol - succimer - & penicillamine
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.
- Haloperidol - chlorpromazine - reserpine - MPTP
- polymyxins

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

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43. Name five Antiarrhythmic drugs in class II?
propanolol - esmolol - metoprolol - atenolol - timolol
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine
GI disturbances.
Praziquantel

44. 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
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin
- Antipsychotics
Dopamine
Beta1 more than B2

45. Which drug(s) cause this reaction: Cough?
Digoxin=urinary Digitoxin=biliary
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.
- ACE inhibitors (Losartan>no cough)
Well tolerated in general but occasionally - Nephrotoxicity - Ototoxicity - Thrombophlebitis - diffuse flushing='Red Man Syndrome'

46. Antimicrobial prophylaxis for Meningococcal infection
Rifampin (DOC) - minocycline
- EDTA - dimercaprol - succimer - & penicillamine
Topical and Oral - for Oral Candidiasis (Thrush)
1. Renal damage 2. Aplastic anemia 3. GI distress

47. Name the common Non - Nucleoside Reverse Transcriptase Inhibitors
Amphetamine and Ephedrine
Gram + and Anerobes
With supplemental Folic Acid
Nevirapine - Delavirdine

48. List the specific antidote for this toxin: Anticholinesterases (organophosphate.)
The only local anesthetic with vasoconstrictive properties.
cinchonism: HA - tinnitus - thrombocytopenia - torsade de pointes due to increased QT interval
- Atropine & pralidoxime
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism

49. Name two organisms Vancomycin is commonly used for?
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)
Benzodiazepine.
- DNA intercalator - Hodgkin's - myeloma - sarcoma - and solid tumors - Cardiotoxicity & alopecia
- Penicillin

50. What is the memory key for the effect of aluminum hydroxide overuse?
In 4 half - lifes= (94%) T1/2 = (0.7x Vd)/CL
AluMINIMUM amount of feces.
Staphlococcus aureus
Ganciclovir is more toxic to host enzymes