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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.
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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. Are Ampicillin and Amoxicillin are not...
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
- Upper respiratory tract infections - pneumonias - STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) - Mycoplasma - Legionella - Chlamydia - Neisseria
Nephrotoxicity
penicillinase resistant

2. What is the memory key for Metronidazole's clinical uses?
DHPG (dihydroxy-2- propoxymethyl guanine)
local anesthetic. CNS stimulation or depression. CV depression.
torsade de pointes - excessive Beta block
GET on the Metro

3. What can result due to antacid overuse?
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.
It must be Phosphorylated by Viral Thymidine Kinase
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)
Ipratropium

4. What is the mechanism of action of Omeprazole - Lansoprazole?
Hemolytic anemia
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.
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. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.

5. How are Interferons (INF) used clinically?

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6. What are the side effects of Polymyxins?
- Aminocaproic acid
The only local anesthetic with vasoconstrictive properties.
Decreases synthesis of Mycolic Acid
Neurotoxicity - Acute renal tubular necrosis

7. Which drug(s) cause this reaction: Extrapyramidal side effects (3)?
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
- Chlorpromazine - thioridazine - haloperidol
Antibiotic - protein synthesis inhibitor.
Benzodiazepine.

8. What is the mechanism of Tacrolimus (FK506)?
Digitoxin 168hrs Digoxin 40 hrs
TCA
Similar to cyclosporine; binds to FK- binding protein - inhibiting secretion of IL-2 and other cytokines.
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.

9. List the mechanism - clinical use - & toxicity of 6 MP.
Premature infants - because they lack UDP- glucuronyl transferase
Blocks Peptide Bond formation at the 50S subunit - Bacteriostatic
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
- inhibits HGPRT (pur. Syn.) - Luk - Lymph

10. Name some common Sulfonamides (4)
Sulfamethoxazole (SMZ) - Sulfisoxazole - Triple sulfas - Sulfadiazine
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
Doxycycline - because it is fecally eliminated
- Tamoxifen

11. Which diuretics decrease urine Ca2+?
thiazides - amiloride
Nitrates
Scopolamine
Prevents the release of Ca from SR of skeletal muscle

12. Which drug(s) cause this reaction: Drug induced Parkinson's (4) ?
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic
- Haloperidol - chlorpromazine - reserpine - MPTP
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
Prevents the release of ACh - Which results in muscle paralysis.

13. Ca2+ channel blockers - mechanism?
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility
depresses ectopic pacemakers - especially in digoxin toxicity
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.

14. Name four Antiarrhythmic drugs in class III.
Hypersensitivity reactions
Sotalol - Ibutilide - Bretylium - Amiodarone
Extended spectrum penicillin: certain Gram + bacteria and Gram - rods
With supplemental Folic Acid

15. What is Imipenem always administered with?
Systemic mycoses
Inhibits cell wall synthesis ( binds to PBP3). A monobactam
DOC in diagnosing and abolishing AV nodal arrhythmias
Cilastatin

16. Hydralazine - clinical use?
cinchonism: HA - tinnitus - thrombocytopenia - torsade de pointes due to increased QT interval
loop diuretics - spironolactone
severe hypertension - CHF
Pregnant women - Children; because animal studies show Damage to Cartilage

17. Which drug(s) cause this reaction: Cough?
Staphlococcus aureus
- ACE inhibitors (Losartan>no cough)
Penicillin - Cephalosporins - Vancomycin - Aminoglycosides - Fluoroquinolones - Metronidazole
- Upper respiratory tract infections - pneumonias - STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) - Mycoplasma - Legionella - Chlamydia - Neisseria

18. List the specific antidote for this toxin: Benzodiazepines
Butyrophenone (neuroleptic).
Malaria (P. falciparum)
Binding to the presynaptic alpha 2 release modulating receptors
- Flumazenil

19. While at a tail gait party - you bite into a sandwich that a yellow jacket is also enjoying. Knowing your allergy to this creature - What should you do?
anticholinesterase glaucoma
Long.
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.

20. What is Niclosamide used for?
- Shifts the curve to the right - increases Km
Rapid (seconds)
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.

21. What is treated with Chloroquine - Quinine - Mefloquine?
Ceftriaxone
Beta adrenergic receptors and Ca2+ channels (stimulatory)
Aminoglycosides - Tetracyclines
Malaria (P. falciparum)

22. ___________ are Teratogenic
Decreases synthesis of Mycolic Acid
Inhibits formation of Initiation Complex - causes misreading of mRNA - Bactericidal
Leukotrienes increasing bronchial tone.
Aminoglycosides

23. What are two clinical uses of Azathioprine?
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)
cross - allergenic
K+ wasting - metabolic alkalosis - hypotension - ototoxicity

24. Which drug(s) cause this reaction: Thrombotic complications?
- Oral Contraceptives
The PTT.
Nevirapine - Delavirdine
proximal convoluted tubule

25. Which drug(s) cause this reaction: Photosensitivity(3)?
- Tetracycline - amiodarone - sulfonamides
Oral treatment of superficial infections
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)
Chronic anticoagulation.

26. Resistance mechanisms for Macrolides

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27. What is the category and mechanism of action of Zafirlukast in Asthma treatment?
1. Renal damage 2. Aplastic anemia 3. GI distress
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT
Antileukotriene; blocks leukotriene receptors.
It affects beta receptors equally and is used in AV heart block (rare).

28. How does resistance to Vancomycin occur?
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic
Dermatophytes (tinea - ringworm)
Acetylcholine esterase
With an amino acid change of D- ala D- ala to D- ala D- lac

29. What are two types of drugs that interfere with the action of Sucralfate and why?
narcolepsy - obesity - and attention deficit disorder (I wouldn't recommend this)
cardiac depression - peripheral edema - flushing - dizziness - constipation
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.
scopolamine

30. List some specifics of lead poisoning(4)?
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia
Beta Blockers
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.
Keratin containing tissues - e.g. - nails

31. Antiarrhythmic class II- mechanism?
1. In liver - increases storage of glucose as glycogen. 2. In muscle - stimulates glycogen and protein synthesis - and K+ uptake. 3. In adipose tissue - facilitates triglyceride storage.
Leukotrienes increasing bronchial tone.
blocking the beta adrenergic receptor leads to decreased cAMP - and decreased Ca2+ flux
Chronic gout.

32. What is the chemical name for Ganciclovir?
- Steroids - Tamoxifen
AmOxicillin has greater Oral bioavailability
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
DHPG (dihydroxy-2- propoxymethyl guanine)

33. What is the MOA of Isoniazid (INH)?
Bacitracin - Vancomycin
Inhibits cell wall mucopeptide formation - Bactericidal
Gram + cocci - Proteus mirabilis - E. coli - Klebsiella pneumoniae (PEcK)
Decreases synthesis of Mycolic Acid

34. What are four thrombolytics?
Pentavalent Antimony
Beta -2 agonist.
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)
Pregnant women - Children; because animal studies show Damage to Cartilage

35. What is the category and mechanism of action of Zileuton in Asthma treatment?
Norepinephrine
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA
Interstitial nephritis
Antileukotriene; blocks synthesis by lipoxygenase.

36. What do you treat Nematode/roundworm (pinworm - whipworm) infections with?
aPTT (intrinsic pathway)
Binds ergosterol - Disrupts fungal membranes
Mebendazole/Thiabendazole - Pyrantel Pamoate
Same as penicillin. Extended spectrum antibiotics

37. What is the category of drug names ending in - zosin (e.g. Prazosin)
Alpha -1 antagonist
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.)
Pretreat with antihistamines and a slow infusion rate
severe hypertension - CHF

38. What is the mechanism of action of the thrombolytics?
- Chlorpromazine - thioridazine - haloperidol
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
anuria - CHF
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.)

39. What is the loading dose formula?
dry mouth - sedation - severe rebound hypertension
Paranteral (IV - SC)
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.
compensatory tachycardia - fluid retention - lupus - like syndrome

40. What is the MOA of Ribavirin?
ACE inhibitor.
- reduction - oxy - & hydrolysis - H2O sol. Polar product - P450
Ca2+ (Loops Lose calcium)
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis

41. Thiazides - site of action?
Neutropenia
Premature infants - because they lack UDP- glucuronyl transferase
- Alkalinize urine & dialysis
distal convoluted tubule (early)

42. Preferential action of the Ca2+ channel blockers at cardiac muscle?
Lovastatin - Pravastatin - Simvastatin - Atorvastatin
cardiac muscle: Verapamil>Diltiazem>Nifedipine
Inhibits platelet aggregation by irreversibly inhibiting the ADP pathway involved in the binding of fibrinogen.
Oral

43. Name three Antiarrhythmic drugs in class IB.
cardiac muscle: Verapamil>Diltiazem>Nifedipine
Diuresis in pateints with sulfa allergy
Post - op and neurogenic ileus and urinary retention - myasthenia gravis - and reversal of neuromuscular junction blockade (post - op) through anticholinesterase activity.
Lidocaine - Mexiletine - Tocainide

44. List the mechanism - clinical use - & toxicity of Cisplatin.
local anesthetic. CNS stimulation or depression. CV depression.
for RSV
GI side effects. (Indomethacin is less toxic - more commonly used.)
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.

45. What is the MOA for the Aminoglycosides?
Methylation of rRNA near Erythromycin's ribosome binding site
Inhibits formation of Initiation Complex - causes misreading of mRNA - Bactericidal
Rash - Pseudomembranous colitis
Nitrates

46. How can the toxic effects of TMP be ameliorated?
- Deferoxamine
depresses ectopic pacemakers - especially in digoxin toxicity
- Corticosteroids - heparin
With supplemental Folic Acid

47. List five common glucocorticoids.
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.
1. Hydrocortisone 2. Predisone 3. Triamcinolone 4. Dexamethasone 5. Beclomethasone
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)

48. Why would a patient with cog - wheel rigidity and a shuffling gait be given benztropine?
Premature infants - because they lack UDP- glucuronyl transferase
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.
Ibuprofen - Naproxen - and Indomethacin
- aminoglycosides - loop diuretics - cisplatin

49. How do spare receptors effect the Km?
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
NO HYPERURICEMIA - NO SULFA AllERGY; same as furosemide otherwise
- ED 50 is less than the Km (less than 50% of receptors)
Headache - flushing - dyspepsia - blue - green color vision.

50. What is the category of drug names ending in - tidine (e.g. Cimetidine)
Neomycin
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride
Premature infants - because they lack UDP- glucuronyl transferase
H2 antagonist