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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 Amantadine used clinically?

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2. What is the memory key for organisms treated with Tetracyclines?

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3. Clonidine is the preferred sym pathomimetic tx of HTN in pts with renal disease - why??
decrease conduction velocity - increase ERP - increase PR interval
CMV - esp in Immunocompromised patients
Centrally acting alpha agonist - thus causing a decrease in central adrenergic outflow - spairing renal blood flow
- Oxalic acid - Acidosis & nephrotoxicity

4. Name four Antiarrhythmic drugs in class III.
Sotalol - Ibutilide - Bretylium - Amiodarone
Diarrhea
- DNA intercalator - Hodgkin's - myeloma - sarcoma - and solid tumors - Cardiotoxicity & alopecia
- Act on same receptor - Full has greater efficacy

5. MOA for Penicillin (3 answers)?
1)Binds penicillin - binding proteins 2) Blocks transpeptidase cross - linking of cell wall 3) Activates autolytic enzymes
Lovastatin - Pravastatin - Simvastatin - Atorvastatin
Inhibits reabsorption of uric acid.
Pentavalent Antimony

6. Furosemide - toxicity? (OH DANG)
Stimulating beta receptors stimulates heart rate - but beta receptor induced vasodilation reduces peripheral resistance.
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)
AluMINIMUM amount of feces.
Ototoxicity - Hypokalemia - Dehydration - Allergy (sulfa) - Nephritis (interstitial) - Gout

7. How are the Latent Hypnozoite (Liver) forms of Malaria (P. vivax - P.ovale) treated?
Hypersensitivity reactions
anuria - CHF
Primaquine
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis

8. What is the category - desired effect - and period of use of albuterol in the treatment of Asthma?
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.
- Act on same receptor - Full has greater efficacy
Methylation of rRNA near Erythromycin's ribosome binding site

9. Reserpine will block the syntheis of this drug and but not its precursor.
Blocks Norepi - but not Dopamine
Polymyxins
Hypersensitivity reactions
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.

10. 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
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
No - warfarin - unlike heparin - can cross the placenta.
Headache - flushing - dyspepsia - blue - green color vision.
These B-2 agonists cause respiratory smooth muscle to relax.

11. MOA: Bactericidal antibiotics
Beta1 more than B2
Penicillin - Cephalosporins - Vancomycin - Aminoglycosides - Fluoroquinolones - Metronidazole
1. Weight gain 2. Hepatotoxicity (troglitazone)
Treatment of infertility.

12. Ibutilide - toxicity?
torsade de pointes
Beta - lactam antibiotics
Increases coumadin metabolism
Butyrophenone (neuroleptic).

13. Which drug(s) cause this reaction: Oto and Nephrotoxicity (3)?
It must be Phosphorylated by Viral Thymidine Kinase
- aminoglycosides - loop diuretics - cisplatin
Clavulanic acid
Interstitial nephritis

14. Norepi feedbacks and inhibits the presynaptic receptor by What mechanism
Early myocardial infarction.
orthostatic and exercise hypotension - sexual dysfunction - diarrhea
Binding to the presynaptic alpha 2 release modulating receptors
Ganciclovir is more toxic to host enzymes

15. Resistance mechanisms for Vancomycin
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system
It acts presynaptically to increase NE release.

16. Which cancer drugs work at the level of proteins(2)?
Prefers beta's at low doses - but at higher doses alpha agonist effects are predominantly seen.
Mycobacterium tuberculosis - the only agent used as solo prophylaxis against TB
- Vinca alkaloids(inhibit MT) - Paclitaxel
Norepinephrine (Alpha1 -2 and beta 1)

17. What is the MOA for Amphotericin B?
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis
Used in combination therapy with SMZ to sequentially block folate synthesis
block Na+ channels in the cortical collecting tubule
Flecainide - Encainide - Propafenone

18. What are the Anti - TB drugs?
Chloramphenicol - Erythromycin/macrolides - Lincomycin - Clindamycin - Streptogramins (quinupristin - dalfopristin)
YES
Rifampin - Ethambutol - Streptomycin - Pyrazinamide - Isoniazid (INH)
Large anionic polymer - acidic

19. What is clinical use for Carbenicillin - Piperacillin - and Ticarcillin?
Chronic (weeks or months)
Hypersensitivity reactions
reduce levels of Angiotensin II - thereby preventing the inactivation of bradykinin (a potent vasodilator); renin level is increased
Pseudomonas species and Gram - rods

20. What is treated with Chloroquine - Quinine - Mefloquine?
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.
Malaria (P. falciparum)
aPTT (intrinsic pathway)
increase AP duration - increase ERP - increase QT interval - for use When other arrhythmics fail

21. How would you treat African Trypanosomiasis (sleeping sickness)?
Same as penicillin. Extended spectrum antibiotics
Suramin
Pralidoxime regenerates active cholinesterase.
Chronic (weeks or months)

22. What is the MOA for the Cephalosporins?
Ototoxicity - Hypokalemia - Dehydration - Allergy (sulfa) - Nephritis (interstitial) - Gout
Beta lactams - inhibit cell wall synthesis - Bactericidal
Reserpine inhibits dopamine transport into vesicles - attenuating its conversion to NE by dopamine beta - hydroxylase.
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.

23. What type of gout is treated with Colchicine?
Beta antagonist.
Acute gout.
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole

24. Common toxicities associated with Griseofulvin?
Teratogenic - Carcinogenic - Confusion - Headaches
sedation - sleep alterations
Staphlococcus aureus
Quinolones

25. What are the Macrolides used for clinically?
- Upper respiratory tract infections - pneumonias - STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) - Mycoplasma - Legionella - Chlamydia - Neisseria
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine
very short acting
Scopolamine

26. List the specific antidote for this toxin: Carbon monoxide
- Alkalinize urine & dialysis
Inhibits cell wall mucopeptide formation - Bactericidal
Digoxin=urinary Digitoxin=biliary
-100% oxygen - hyperbaric

27. List the specific antidote for this toxin: Iron
- Deferoxamine
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.
proximal convoluted tubule - thin descending limb - and collecting duct
Bethanechol - Neostigmine - physostigmine

28. How does resistance to Vancomycin occur?
Dopamine; causes its release from intact nerve terminals
With an amino acid change of D- ala D- ala to D- ala D- lac
Ipratropium
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility

29. MOA: Block protein synthesis at 30s subunit
pulmonary edema - dehydration
Aminoglycosides - Tetracyclines
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
AluMINIMUM amount of feces.

30. What are two clinical uses of Azathioprine?
- acetylation - glucuron. - & sulfation - Conjugation - Polar product
Neutropenia
GI distress - Tooth discoloration and Inhibition of bone growth in children - Fanconi's syndrome - Photosensitivity
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)

31. What is the clinical use for Heparin?
Immediate anticoagulation for PE - stroke - angina - MI - DVT.
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention
Pseudomembranous colitis (C. difficile) - fever - diarrhea

32. MOA: Block cell wall synthesis by inhib. Peptidoglycan cross - linking (7)
osmotic diuretic - increase tubular fluid osmolarity - thereby increasing urine flow
PT
Tubocurarine - atracurium - mivacurium - pancuronium - vecuronium - rapacuronium
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins

33. What is used to reverse the action of Heparin?
Bleeding.
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).
blocks SR Ca2+ channels
torsade de pointes - excessive Beta block

34. What is Ketoconazole specifically used for?
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism
edrophonium (extremely short acting anticholinesterase)
Diarrhea
1. Renal damage 2. Aplastic anemia 3. GI distress

35. Specifically - How does Foscarnet inhibit viral DNA pol?
Pregnant women - Children; because animal studies show Damage to Cartilage
Binding to the presynaptic alpha 2 release modulating receptors
Aplastic anemia (dose independent) - Gray Baby Syndrome
Binds to the Pyrophosphate Binding Site of the enzyme

36. Antimicrobial prophylaxis for Gonorrhea
Nevirapine - Delavirdine
Short.
Acts as a wide spectrum carbapenem
Ceftriaxone

37. Acetaldehyde is metabolized by Acetaldehyde dehydrogenase - Which drug inhibs this enzyme?
Enterobacter
- Disulfram & also sulfonylureas - metronidazole
Rheumatoid and osteoarthritis.
- Isoniazid

38. List the specific antidote for this toxin: TPA & Streptokinase
Penicillin - V
Na/K ATPase
decrease the slope of phase 4 - increase PR interval (the AV node is particularly sensitive)
- Aminocaproic acid

39. Adverse effects of Minoxidil?
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
Sulfonylureas are oral hypoglycemic agents - they are used to stimulate release of endogenous insulin in NIDDM (type -2).
Pretreat with antihistamines and a slow infusion rate

40. What is a sign of toxicity with the use of thrombolytics?
Bleeding.
hypertension - angina - arrhythmias
Succinylcholine
all of them

41. List the specific antidote for this toxin: Copper
Antibiotic - protein synthesis inhibitor.
Penicillin.
- Penicillamine
Penicillin - G

42. Name the common Non - Nucleoside Reverse Transcriptase Inhibitors
Bleeding.
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills
Nevirapine - Delavirdine
new arrhythmias - hypotension

43. What is the category and mechanism of action of Zileuton in Asthma treatment?
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.
Topical and Oral - for Oral Candidiasis (Thrush)
Chronic anticoagulation.
Antileukotriene; blocks synthesis by lipoxygenase.

44. What musculo - skeletal side effects in Adults are associated with Floroquinolones?
Carbenicillin - Piperacillin - and Ticarcillin
- NaHCO3
for RSV
Tendonitis and Tendon rupture

45. What is the MOA of Imipenem?
PT
Inhibits cell wall mucopeptide formation - Bactericidal
Acts as a wide spectrum carbapenem
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.

46. Which drug(s) cause this reaction: Pseudomembranous colitis?
It must be Phosphorylated by Viral Thymidine Kinase
- Clindamycin
Milk or Antacids - because divalent cations inhibit Tetracycline absorption in the gut
None. No - because atropine would block the postganglionic muscarinic receptors involved in sweat gland stimulation.

47. Adverse effects of Captopril?
Indirect agonist - uptake inhibitor
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.

48. ________ ae not resistant to penicillinase - - but they are less susceptible than the other Beta lactams
Cephalosporins
Interstitial nephritis
Penicillin.
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy

49. Adverse effects of Hydralazine?
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention
Depolymerizes microtubules - impairing leukocyte chemotaxis and degranulation.
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.

50. List the mechanism - clinical use - & toxicity of Cyclophosphamide.
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
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.)
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.