Test your basic knowledge |

USMLE Step 1 Pharmacology

Subjects : health-sciences, usmle-step-1

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
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. Hydralazine - toxicity?
physostigmine
cortical collecting tubule
Cilastatin
compensatory tachycardia - fluid retention - lupus - like syndrome

2. What is a common drug interaction associated with Griseofulvin?
Lovastatin - Pravastatin - Simvastatin - Atorvastatin
Ataxia - Dizziness - Slurred speech
ACIDazolamide' causes acidosis
Increases coumadin metabolism

3. What is the clincial use for Misoprostol?
Prevention of NSAID- induced peptic ulcers - maintains a PDA.
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load
orthostatic and exercise hypotension - sexual dysfunction - diarrhea
Pretreat with antihistamines and a slow infusion rate

4. What is the MOA of the RT Inhibitors?
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity
Rapid (seconds)

5. Mg+- clinical use?
- inhibits HGPRT (pur. Syn.) - Luk - Lymph
effective in torsade de pointes and digoxin toxicity
Short.
pulmonary edema - dehydration

6. Name three Antiarrhythmic drugs in class IV.
thick ascending limb
Verapamil - Diltiazem - Bepridil
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.
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome

7. What cholinomimetic is useful in the diagnosis of Myasthenia Gravis
Edrophonium
Phenothiazine (neuroleptic - antiemetic).
blocking the beta adrenergic receptor leads to decreased cAMP - and decreased Ca2+ flux
atropine - homatropine - tropicamide

8. What do Aminoglycosides require for uptake?
Oxygen
Prefers beta's at low doses - but at higher doses alpha agonist effects are predominantly seen.
Benzathine penicillin G
Fast vs. Slow Acetylators

9. What is the mechanism of action of Colchicine used to treat acute gout?
Gram + and Anerobes
Ganciclovir is more toxic to host enzymes
Depolymerizes microtubules - impairing leukocyte chemotaxis and degranulation.
Inhibits platelet aggregation by irreversibly inhibiting the ADP pathway involved in the binding of fibrinogen.

10. What is the effect of epinephrine infusion on bp and pulse pressure?
DHPG (dihydroxy-2- propoxymethyl guanine)
Increased systolic and pulse pressure - decreased diastolic pressure - and little change in mean pressure.
HSV - VZV - EBV - Mucocutaneous and Genital Herpes Lesions - Prophylaxis in Immunocompromised pts
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.

11. Toxic effects of TMP include?
Megaloblastic anemia - Leukopenia - Granulocytopenia
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.
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.
Systemic mycoses

12. What enzyme is responsible for the degredation of Ach
decrease conduction velocity - increase ERP - increase PR interval
Gram + cocci - Gram - rods - and Anerobes
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.
Acetylcholine esterase

13. How is Amphotericin B used clinically?
Norepinephrine
Ipratropium
Gram + - Gram - - Norcardia - Chlamydia
Wide spectrum of systemic mycoses: Cryptococcus - Blastomyces - Coccidioides - Aspergillus - Histoplasma - Candida - Mucor

14. Antimicrobial prophylaxis for Gonorrhea
GI distress - Tooth discoloration and Inhibition of bone growth in children - Fanconi's syndrome - Photosensitivity
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.
Ceftriaxone
1. Hypoglycemia (more common with 2nd - generation drugs: glyburide - glipizide) 2. Disulfiram - like effects (not seen with 2nd - generation drugs).

15. Which drug(s) cause this reaction: Focal to massive hepatic necrosis (4)?
Rash - Pseudomembranous colitis
Neutropenia
toxic
- Halothane - Valproic acid - acetaminophen - Amantia phalloides

16. What is the only depolarizing neuromuscular blocking agent?
- Estrogen receptor antagonist - Breast CA - increased endometrial CA risk
Succinylcholine
Triple sulfas or SMZ
block Na+ channels in the cortical collecting tubule

17. What is the MOA of Aztreonam?
Captopril - Enalapril - Lisinopril
Epinephirine(Alpha1 -2 and Beta 1 -2)
- Act on same receptor - Full has greater efficacy
Inhibits cell wall synthesis ( binds to PBP3). A monobactam

18. Which drug(s) cause this reaction: Hot flashes?
- Tamoxifen
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy
CMV - esp in Immunocompromised patients
Penicillin.

19. ACE inhibitors - mechanism?
reduce levels of Angiotensin II - thereby preventing the inactivation of bradykinin (a potent vasodilator); renin level is increased
- EDTA - dimercaprol - succimer - & penicillamine
Decreased uptake or Increased transport out of cell
- Ammonium Chloride

20. Resistance mechanisms for Vancomycin
Rash - Pseudomembranous colitis
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity
Prefers beta's at low doses - but at higher doses alpha agonist effects are predominantly seen.
Onchocerciasis ('river blindness'-- rIVER- mectin)

21. For Warfarin What is the Treatment for overdose
IV vitamin K and fresh frozen plasma
Dermatophytes (tinea - ringworm)
Aminoglycosides - Tetracyclines
- Constant AMOUNT eliminated per unit time. - Etoh & ASA

22. What drug is used to treat Trematode/fluke (e.g. - Schistosomes - Paragonimus - Clonorchis) or Cysticercosis
Staphlococcus aureus
scopolamine
Praziquantel
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic

23. Common toxicities associated with Fluoroquinolones?
- Glucocorticoid withdrawal
Increased systolic and pulse pressure - decreased diastolic pressure - and little change in mean pressure.
Cilastatin
GI upset - Superinfections - Skin rashes - Headache - Dizziness

24. For Heparin What is the Duration of action
Digoxin=urinary Digitoxin=biliary
Acute (hours)
reversible SLE- like syndrome
Ganciclovir is more toxic to host enzymes

25. What are the clinical uses for 2nd Generation Cephalosporins?
Norepinephrine
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )
Decreases synthesis of Mycolic Acid

26. Why does NE result in bradycardia?
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
all of them
Yes
Heparin catalyzes the activation of antithrombin III.

27. Which drug(s) cause this reaction: Gingival hyperplasia?
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins
Inhibit viral DNA polymerase
- Phenytoin
Penicillin - V

28. What are common toxicities associated with Tetracyclines?

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183

29. What is an occasional side effect of Aztreonam?
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).
compensatory tachycardia - fluid retention - lupus - like syndrome
GI upset

30. What is the MOA of Griseofulvin?
Slow - limited by half lives of clotting factors
- Hypersensitivity reactions - Hemolysis - Nephrotoxicity (tubulointerstitial nephritis) - Kernicterus in infants Displace other drugs from albumin (e.g. - warfarin)
Interferes with microtubule function - disrupts mitosis - inhibits growth
Methicillin - Nafcillin - and Dicloxacillin

31. What effect would atropine have on a patient with peptic ulcer disease?
It acts presynaptically to increase NE release.
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.
glaucoma - urinary alkalinization - metabolic alkalosis - altitude sickness
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).

32. Which drug(s) cause this reaction: Cough?
sedation - sleep alterations
- Estrogen receptor antagonist - Breast CA - increased endometrial CA risk
- ACE inhibitors (Losartan>no cough)
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.

33. As an Anes you want to use a depolarizing neuromuscular blocking drug on your pt - What do you use
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol
Succinylcholine
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin
TMP- SMZ

34. List the specific antidote for this toxin: Salicylates
- Alkalinize urine & dialysis
GET on the Metro
glaucoma - urinary alkalinization - metabolic alkalosis - altitude sickness
Binds to the Pyrophosphate Binding Site of the enzyme

35. List the specific antidote for this toxin: Arsenic (all heavy metals)
Inhibits DNA dependent RNA polymerase
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA
Because they require some residual islet function.
- Dimercaprol - succimer

36. What are three possible toxicities of NSAID usage?
They inhibit reuptake of NE at the nerve terminal (as does cocaine).
It would increase to ~ 100 beats/min. Both sympathetic and vagal stimulation would be knocked out - but the SA node has an intrinsic pace of 100 beats/min - Which is normally checked by vagal stimulation.
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.
1. Renal damage 2. Aplastic anemia 3. GI distress

37. Secretion of What drug is inhibited by Probenacid used to treat chronic gout?
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
- Metronidazole - certain cephalosporins - procarbazine - sulfonylureas
Penicillin.
Protease Inhibitors and Reverse Transcriptase Inhibitors

38. How does a competitive antagonist effect an agonist?
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
- Shifts the curve to the right - increases Km
Lipoxygenase
Interferes with microtubule function - disrupts mitosis - inhibits growth

39. What is the category and mechanism of action of Zafirlukast in Asthma treatment?
Lovastatin - Pravastatin - Simvastatin - Atorvastatin
- ED 50 is less than the Km (less than 50% of receptors)
Beta - lactam antibiotics
Antileukotriene; blocks leukotriene receptors.

40. A 12yo patient was treated for a reaction to a bee sting - What drug provides the best coverage of sympathomimetic receptors?
Blood
Dopamine
Epinephirine(Alpha1 -2 and Beta 1 -2)
block Na+ channels in the cortical collecting tubule

41. The MOA for Chloramphenicol is?
Inhibits DNA dependent RNA polymerase
Norepinephrine (Alpha1 -2 and beta 1)
Inhibition of 50S peptidyl transferase - Bacteriostatic
Scopolamine

42. Can Warfarin be used during pregnancy?
No - warfarin - unlike heparin - can cross the placenta.
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.

43. What is the major side effect for Carbenicillin - Piperacillin - and Ticarcillin?
- Shifts the curve down - reduces Vmax
-100% oxygen - hyperbaric
Erythromycin - Azithromycin - Clarithromycin
Hypersensitivity reactions

44. What is the category - mechanism of action - and effect of Ipratroprium in Asthma treatment?
Muscarinic antagonist; competatively blocks muscarinic receptors - preventing bronchoconstriction.
GI discomfort - Acute cholestatic hepatitis - Eosinophilia - Skin rashes
NO
CMV Retinitis in IC pts When Ganciclovir fails

45. Which H2 Blocker has the most toxic effects and What are they?
Does not cross
pulmonary edema - dehydration
- Formaldehyde & formic acid - severe acidosis & retinal damage
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.

46. How does a noncompetitive antagonist effect an agonist?
- Quinidine - quinine
- Shifts the curve down - reduces Vmax
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents
severe hypertension - CHF

47. Does Warfarin have a long - medium - or short half life?
No - hemicholinum block the uptake of Choline and thus Ach synthesis
Tetracycline - Doxycycline - Demeclocycline - Minocycline
Prevents release of mediators from mast cells. Effective only for the prophylaxis of asthma. Not effective during an acute attack.
Long.

48. Ca2+ channel blockers - mechanism?
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis
Zidovudine (AZT) - Didanosine (ddI) - Zalcitabine (ddC) - Stavudine (d4T) - Lamivudine (3TC)
Dopamine

49. Foscarnet does not require activation by a...
viral kinase
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.
Acetylcholine esterase
Hemolytic anemia

50. What is the MOA for Amphotericin B?
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis
Dopamine
Indomethacin is used to close a patent ductus arteriosus.
The PTT.