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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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1. List the specific antidote for this toxin: Heparin
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression
1. Predisposes to viral infections and lymphoma 2. Nephrotoxic (preventable with mannitol diuresis)
- Upper respiratory tract infections - pneumonias - STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) - Mycoplasma - Legionella - Chlamydia - Neisseria
- Protamine

2. What is the effect of the Glitazones in diabetes treatment?
AmOxicillin has greater Oral bioavailability
Increase target cell response to insulin.
hypokalemia - slight hyperlipidemia - hyperuricemia - lassitude - hypercalcemia - hyperglycemia
Binding to the presynaptic alpha 2 release modulating receptors

3. Adverse effects of Nifedipine - verapamil?
cholestyramine - colestipol
dizziness - flushing - constipation (verapamil) - nausea
The only local anesthetic with vasoconstrictive properties.
Inhibit intestinal bursh border Alpha - glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.

4. Why would you use pralidoxime after exposure to an organophosphate?
Headache - flushing - dyspepsia - blue - green color vision.
Pralidoxime regenerates active cholinesterase.
Antifungal.
Stimulates beta adrenergic receptors

5. For Warfarin What is the Onset of action
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis
distal convoluted tubule (early)
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
Slow - limited by half lives of clotting factors

6. Which drug(s) cause this reaction: Tubulointerstitial Nephritis (5)?
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)
Enterobacter
- Hydralazine - Procainamide - INH - phenytoin
- Sulfonamides - furosemide - methicillin - rifampin - NSAIDS (ex. ASA)

7. Which drug(s) cause this reaction: Hepatitis?
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.
- Ethanol - dialysis - & fomepizole
Dopamine; causes its release from intact nerve terminals
- Isoniazid

8. Antimicrobial prophylaxis for Meningococcal infection
Rifampin (DOC) - minocycline
Bleeding.
1. Renal damage 2. Aplastic anemia 3. GI distress
- Methylene blue

9. Antiarrhythmic class IB- effects?
Abortifacient.
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system
Nifedipine - Verapamil - Diltiazem

10. Name two organisms Vancomycin is commonly used for?
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)
Ceftriaxone
Increases coumadin metabolism
propanolol - esmolol - metoprolol - atenolol - timolol

11. What are the indications for using amphetamine?

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12. What drug is given for Pneumocystis carinii prophylaxis?
Reserpine inhibits dopamine transport into vesicles - attenuating its conversion to NE by dopamine beta - hydroxylase.
Bethanechol - Neostigmine - physostigmine
Pentamidine
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.

13. What is treated with Chloroquine - Quinine - Mefloquine?
Malaria (P. falciparum)
Does not cross
H2 antagonist
Neutropenia

14. Hydrochlorothiazide - mechanism?
Prevents the release of ACh - Which results in muscle paralysis.
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.
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.
- Methylene blue

15. K+ sparing diuretics - toxicity?
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)
Modification via Acetylation - Adenylation - or Phosphorylation
Inhibits CMV DNA polymerase

16. A common side effects of Interferon (INF) treatment is?
Neutropenia
scopolamine
Succinylcholine
- EDTA - dimercaprol - succimer - & penicillamine

17. Toxic side effects of the Azoles?
Antibiotic - protein synthesis inhibitor.
Lovastatin - Pravastatin - Simvastatin - Atorvastatin
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills
- reduction - oxy - & hydrolysis - H2O sol. Polar product - P450

18. What enzymes are inhibited by NSAIDs - acetaminophen and COX II inhibitors?
Hemolysis (if G6PD deficient) - Neurotoxicity - Hepatotoxicity - SLE- like syndrome
Cyclooxygenases (COX I - COX II).
- Triggers apoptosis - CLL - Hodgkin's in MOPP - Cushing - like syndrome
orthostatic and exercise hypotension - sexual dysfunction - diarrhea

19. What is the category and mechanism of action of Zileuton in Asthma treatment?
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
- Ethanol - dialysis - & fomepizole
Antileukotriene; blocks synthesis by lipoxygenase.
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.

20. Acetazolamide - mechanism?
No - warfarin - unlike heparin - can cross the placenta.
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.
Inhibits cell wall mucopeptide formation - Bactericidal
- Chloramphenicol

21. What are common toxicities associated with Tetracyclines?

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22. What is the clinical use for Nystatin?
Cell membrane Ca2+ channels of cardiac sarcomere
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
Topical and Oral - for Oral Candidiasis (Thrush)
Teratogenic - Carcinogenic - Confusion - Headaches

23. Explain pH dependent urinary drug elimination?
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more
1. Heavy bleeding 2. GI effects (n/v - anorexia) 3. Abdominal pain
GI upset

24. List five common glucocorticoids.
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills
Diuresis in pateints with sulfa allergy
1. Hydrocortisone 2. Predisone 3. Triamcinolone 4. Dexamethasone 5. Beclomethasone
GI upset

25. What is the effect of epinephrine infusion on bp and pulse pressure?
Immediate anticoagulation for PE - stroke - angina - MI - DVT.
Increased systolic and pulse pressure - decreased diastolic pressure - and little change in mean pressure.
Antimetabolite derivative of 6- mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.
Penicillin - V

26. What is the mechanism of action of the Sulfonylureas?
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.
- Flumazenil
Doxycycline - because it is fecally eliminated
GI discomfort

27. What sympathomimetic would you not prescribe for hypotension in a pt with renal artery sclerosis.
Sulfonamides - Trimethoprim
Tricyclic antidepressant.
Norepinephrine (Alpha1 -2 and beta 1)
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.

28. MOA: Block mRNA synthesis
Rifampin
Oral
edrophonium (extremely short acting anticholinesterase)
Binding to the presynaptic alpha 2 release modulating receptors

29. What is the category of drug names ending in - tropin (e.g. Somatotropin)
distal convoluted tubule (early)
Phenothiazine (neuroleptic - antiemetic).
Beta1 more than B2
Pituitary hormone.

30. What antimuscarinic agent is used in asthma and COPD?
Inhibt Assembly of new virus by Blocking Protease Enzyme
Ipratropium
- Daunorubicin & Doxorubicin
cyanide toxicity (releases CN)

31. What is the mechanism of action and clinical use of the antiandrogen Flutamide?
1. Aluminum hydroxide: constipation and hypophosphatemia 2. Magnesium hydroxide: diarrhea 3. Calcium carbonate: Hypercalcemia - rebound acid increase - All may cause hypokalemia
Flecainide - Encainide - Propafenone
diuretics - sympathoplegics - vasodilators - ACE inhibitors - Angiotensin II receptor inhibitors
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.

32. How do Sulfonamides act on bacteria?
1. Acarbose 2. Miglitol
Hydralazine and Minoxidil
As PABA antimetabolites that inhibit Dihydropteroate Synthase - Bacteriostatic
- Ethanol - dialysis - & fomepizole

33. What is used to reverse the action of Heparin?
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).
Early myocardial infarction.
Only in limited amounts

34. Which diuretics cause acidosis?
Teratogenic - Carcinogenic - Confusion - Headaches
carbonic anhydrase inhibitors - K+ sparing diuretics
Inhibits DNA dependent RNA polymerase
hypokalemia - slight hyperlipidemia - hyperuricemia - lassitude - hypercalcemia - hyperglycemia

35. Hydralazine - clinical use?
Buy AT 30 - CELL at 50'
- Oxalic acid - Acidosis & nephrotoxicity
severe hypertension - CHF
Chronic gout.

36. What is the category of drug names ending in - caine (e.g. Lidocaine)
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.
carbonic anhydrase inhibitors - K+ sparing diuretics
Local anesthetic.

37. Which RT inhibitors cause Lactic Acidosis?
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.
Acute (hours)
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)
Nucleosides

38. Antiarrhythmic class IV- effects?
collecting ducts
dry mouth - sedation - severe rebound hypertension
Norepinephrine
decrease conduction velocity - increase ERP - increase PR interval

39. Clinical use of Isoniazid (INH)?
Mycobacterium tuberculosis - the only agent used as solo prophylaxis against TB
Decreases synthesis of Mycolic Acid
Protease Inhibitors and Reverse Transcriptase Inhibitors
Beta antagonist.

40. How is Acyclovir used clinically?
GI distress - Skin rash - and Seizures at high plasma levels
Nephrotoxicity
HSV - VZV - EBV - Mucocutaneous and Genital Herpes Lesions - Prophylaxis in Immunocompromised pts
ARF - shock - drug overdose - decrease intracranial/intraocular pressure

41. Why are Methicillin - Nafcillin - and Dicloxacillin penicillinase resistant?
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis
Due to the presence of a bulkier R group
all of them
1. Pioglitazone 2. Rosiglitazone.

42. Ca2+ channel blockers - mechanism?
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility
Beta -2 agonist.
vasodilator - increases cGMP to induce smooth muscle relaxation (arterioles>veins; afterload reduction)
troponin - tropomyosin system

43. What is the category of drug names ending in - barbital (e.g. Phenobarbital)
Botulinum
Babiturate.
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
- Dimercaprol - succimer

44. Which receptors does phenylephrine act upon?
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
is resistant
- DNA intercalator - testicular & lymphomas - Pulmonary fibrosis mild myelosuppression.

45. What is the category of drug names ending in - cillin (e.g. Methicillin)
Antibiotic - protein synthesis inhibitor.
impotence - exacerbation of asthma - CV effects - CNS effects - may mask hypoclycemia
Primaquine
Penicillin.

46. Which drug(s) cause this reaction: Osteoporosis (2)?
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic
- Corticosteroids - heparin
proximal convoluted tubule
No

47. How is Griseofulvin used clinically?
Oral treatment of superficial infections
Na/K ATPase
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA
viral kinase

48. What is the category of drug names ending in - zosin (e.g. Prazosin)
AZT
Alpha -1 antagonist
Quinidine - Amiodarone - Procainamide - Disopyramide
Rifampin (DOC) - minocycline

49. What are Amantadine - associated side effects?
Saquinavir - Ritonavir - Indinavir - Nelfinavir
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.
Ataxia - Dizziness - Slurred speech
amphetamine and ephedrine

50. Bretyllium - toxicity?
new arrhythmias - hypotension
Gram + and Anerobes
atropine - homatropine - tropicamide
Choline acetyltransferase