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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. What is the clinical use for Heparin?
Immediate anticoagulation for PE - stroke - angina - MI - DVT.
- Nitrate - hydroxocobalamin thiosulfate
Inhibits Viral DNA polymerase
Bethanechol - Neostigmine - physostigmine

2. List the mechanism - clinical use - & toxicity of Vincristine.

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3. Which drug(s) cause this reaction: Hot flashes?
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol
Liver
- Haloperidol - chlorpromazine - reserpine - MPTP
- Tamoxifen

4. Digoxin v. Digitoxin: bioavailability?
GI discomfort
- Antipsychotics
Digitoxin>95% Digoxin 75%
Constant FRACTION eliminated per unit time.(exponential)

5. What are common serious side effects of Aminoglycosides and What are these associated with?
- Quinidine - quinine
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.
Nevirapine - Delavirdine
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)

6. What is combined with Ampicillin - Amoxicillin - Carbenicillin - Piperacillin - and Ticarcillin to enhance their spectrum?
Clavulanic acid
pulmonary edema - dehydration
ARF - shock - drug overdose - decrease intracranial/intraocular pressure
- Halothane - Valproic acid - acetaminophen - Amantia phalloides

7. How are Interferons (INF) used clinically?

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8. Name the common Nucleoside Reverse Transcriptase Inhibitors
Small lipid - soluble molecule
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids
Zidovudine (AZT) - Didanosine (ddI) - Zalcitabine (ddC) - Stavudine (d4T) - Lamivudine (3TC)
RESPIre

9. What patients are at risk for life threatening hypotension When taking Sildenafil (Viagra)?
Those patients who are taking nitrates.
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions
Decreased uptake or Increased transport out of cell

10. Why is carbachol and pilocarpine useful in treatment of glaucoma?
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
thiazides - amiloride
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).
CMV - esp in Immunocompromised patients

11. Do Tetracyclines penetrate the CNS?
Only in limited amounts
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin
1. Pioglitazone 2. Rosiglitazone.
Aplastic anemia (dose independent) - Gray Baby Syndrome

12. Amiodarone - toxicity?
Oral treatment of superficial infections
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.
Malaria (P. falciparum)
Dopamine

13. Is toxicity rare or common whith Cromolyn used in Asthma prevention?
Rare.
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
Tendonitis and Tendon rupture

14. What do you treat Nematode/roundworm (pinworm - whipworm) infections with?
Yes
Mebendazole/Thiabendazole - Pyrantel Pamoate
Nevirapine - Delavirdine
HSV - VZV - EBV - Mucocutaneous and Genital Herpes Lesions - Prophylaxis in Immunocompromised pts

15. What are three toxicities of Leuprolied?
As an anticholinesterase it increases endogenous ACh and thus increases strength.
Vd= (Amt. of drug in body/ Plasma drug conc.)
1. Antiandrogen 2. Nausea 3. Vomiting
- Chloramphenicol

16. MOA: Block protein synthesis at 30s subunit
Aminoglycosides - Tetracyclines
- Corticosteroids - heparin
Milk or Antacids - because divalent cations inhibit Tetracycline absorption in the gut
Rifampin

17. Your patient wants an effective drug to treat his motion sickness - What would you prescribe
Impairs the synthesis of vitamin K- dependent clotting factors
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.
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.
Scopolamine

18. What are three clinical uses of the Leuprolide?
1. Bleeding 2. Thrombocytopenia 3. Drug - drug interactions
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids
As an anticholinesterase it increases endogenous ACh and thus increases strength.
cortical collecting tubule

19. What is an occasional side effect of Aztreonam?
Oral treatment of superficial infections
GI upset
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine
Praziquantel

20. Which drug(s) cause this reaction: Disulfram - like reaction (4) ?
Scopolamine
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.
- Metronidazole - certain cephalosporins - procarbazine - sulfonylureas
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.

21. What is the major toxic side effect of Penicillin?
Suramin
AV nodal cells
Peptic ulcer disease.
Hypersensitivity reactions

22. Acetazolamide causes?

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23. Preferential action of the Ca2+ channel blockers at cardiac muscle?
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
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load
- Vinca alkaloids(inhibit MT) - Paclitaxel

24. Adenosine - clinical use?
Benzodiazepine.
DOC in diagnosing and abolishing AV nodal arrhythmias
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
Antileukotriene; blocks synthesis by lipoxygenase.

25. Which drug(s) cause this reaction: Focal to massive hepatic necrosis (4)?
Pyridoxine (B6) administration
Those patients who are taking nitrates.
- Halothane - Valproic acid - acetaminophen - Amantia phalloides
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal

26. What is the mechanism of action and clinical use of the antiandrogen Flutamide?
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.
The PTT.
Succinylcholine
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention

27. Which diuretics increase urine Ca2+?
loop diuretics - spironolactone
IV vitamin K and fresh frozen plasma
Liver
Tricyclic antidepressant.

28. What populations are Floroquinolones contraindicated in? Why?
Interferes with microtubule function - disrupts mitosis - inhibits growth
first dose orthostatic hypotension - dizziness - headache
- Flumazenil
Pregnant women - Children; because animal studies show Damage to Cartilage

29. Which antimicrobial classes inhibit protein synthesis at the 30S subunit? (2)
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.
Antiprotozoal: Giardia - Entamoeba - Trichomonas - Gardnerella vaginalis Anaerobes: Bacteroides - Clostridium

30. Acetazolamide - toxicity?
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy
Blocks Norepi - but not Dopamine
Carbenicillin - Piperacillin - and Ticarcillin
AZT

31. What are toxicities associated with Chloramphenicol?
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation
Rifampin (DOC) - minocycline
Wide spectrum of systemic mycoses: Cryptococcus - Blastomyces - Coccidioides - Aspergillus - Histoplasma - Candida - Mucor
Aplastic anemia (dose independent) - Gray Baby Syndrome

32. What are the side effects of Polymyxins?
Neurotoxicity - Acute renal tubular necrosis
Does not cross
Tetracycline - Doxycycline - Demeclocycline - Minocycline
- Clindamycin

33. List the mechanism - clinical use - & toxicity of 5 FU.
Severe Gram - rod infections.
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD

34. Name the Protease Inhibitors (4)
Saquinavir - Ritonavir - Indinavir - Nelfinavir
Norepinephrine
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.
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.

35. What are the major structural differences between Penicillin and Cephalosporin?
GI discomfort - Acute cholestatic hepatitis - Eosinophilia - Skin rashes
Cephalosporin: 1) has a 6 member ring attached to the Beta lactam instead of a 5 member ring 2)has an extra functional group ( attached to the 6 member ring)
Clomiphene is a partial agonist at estrogen receptors in the pituitary gland. Prevents normal feedback inhibition and increses release of LH and FSHfrom the pituitary - Which stimulates ovulation.
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity

36. What is the main clinical use for the thrombolytics?
Early myocardial infarction.
Centrally acting alpha agonist - thus causing a decrease in central adrenergic outflow - spairing renal blood flow
Reversible block of histamine H2 receptors
- ACE inhibitors (Losartan>no cough)

37. What antimuscarinic drug is useful for the tx of asthma
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions
Ipratropium
DHPG (dihydroxy-2- propoxymethyl guanine)
Prefers beta's at low doses - but at higher doses alpha agonist effects are predominantly seen.

38. Cocaine casues vasoconstriction and local anesthesia by What mechanism
1. Antiandrogen 2. Nausea 3. Vomiting
GET on the Metro
carbonic anhydrase inhibitors - K+ sparing diuretics
Indirect agonist - uptake inhibitor

39. What is the MOA for the Aminoglycosides?
Digitoxin 70% Digoxin 20-40%
Resistant Gram - infections
Inhibits formation of Initiation Complex - causes misreading of mRNA - Bactericidal
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome

40. As an Anes you want to use a depolarizing neuromuscular blocking drug on your pt - What do you use
Muscarinic antagonist; competatively blocks muscarinic receptors - preventing bronchoconstriction.
Succinylcholine
Carbachol - pilocarpine - physostigmine - echothiophate
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state

41. What musculo - skeletal side effects in Adults are associated with Floroquinolones?
Pretreat with antihistamines and a slow infusion rate
Tendonitis and Tendon rupture
cholestyramine - colestipol
Succinylcholine

42. MOA: Block peptidoglycan synthesis
Quinidine - Amiodarone - Procainamide - Disopyramide
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy
- Ethanol - dialysis - & fomepizole
Bacitracin - Vancomycin

43. What is Niclosamide used for?
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism
- Triggers apoptosis - CLL - Hodgkin's in MOPP - Cushing - like syndrome

44. Which drug(s) cause this reaction: P450 inhibition(6)?
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide
- Cimetidine - ketoconazole - grapefruit juice - erythromycin - INH - sulfonamides
Indirect agonist - uptake inhibitor
Prevents the release of ACh - Which results in muscle paralysis.

45. What is the loading dose formula?
1. Heavy bleeding 2. GI effects (n/v - anorexia) 3. Abdominal pain
- Ethanol - dialysis - & fomepizole
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.
Oxygen

46. Beta Blockers - CNS toxicity?
Diarrhea
Binds ergosterol - Disrupts fungal membranes
Beta adrenergic receptors and Ca2+ channels (stimulatory)
sedation - sleep alterations

47. Name three ACE inhibitors?
1)Binds penicillin - binding proteins 2) Blocks transpeptidase cross - linking of cell wall 3) Activates autolytic enzymes
Captopril - Enalapril - Lisinopril
Hypersensitivity reactions
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state

48. What is the clincial use for Misoprostol?
Modification via Acetylation
Prevention of NSAID- induced peptic ulcers - maintains a PDA.
DHPG (dihydroxy-2- propoxymethyl guanine)
Dopamine; causes its release from intact nerve terminals

49. What is the MOA of Ganciclovir?
Inhibits CMV DNA polymerase
Gram + - Gram - - Norcardia - Chlamydia
Gram + cocci - Proteus mirabilis - E. coli - Klebsiella pneumoniae (PEcK)
GI upset

50. Acetazolamide - site of action?
proximal convoluted tubule
Pyridoxine (B6) administration
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori
cardiac depression - peripheral edema - flushing - dizziness - constipation