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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 populations are Floroquinolones contraindicated in? Why?
YES
Digitoxin 70% Digoxin 20-40%
1. Acarbose 2. Miglitol
Pregnant women - Children; because animal studies show Damage to Cartilage

2. How does NE modulate its own release? What other neurotransmitter has this same effect?
Inhibition of 50S peptidyl transferase - Bacteriostatic
Hypersensitivity reactions
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
NE acts presynaptically on alpha -2 receptors to inhibit its own release. ACh also acts presynaptically through M1 receptors to inhibit NE release.

3. For Warfarin What is the Ability to inhibit coagulation in vitro
No
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
- polymyxins
- DNA intercalator - testicular & lymphomas - Pulmonary fibrosis mild myelosuppression.

4. What is a sign of toxicity with the use of thrombolytics?
Phosphorylation by a Viral Kinase
Amphetamine and Ephedrine
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.
Bleeding.

5. Adverse effects of Hydralazine?
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.
Dermatophytes (tinea - ringworm)
scopolamine

6. For Heparin What is the Duration of action
Lidocaine - Mexiletine - Tocainide
Acute (hours)
Anaerobes
cortical collecting tubule

7. What are four H2 Blockers?
Digitoxin 168hrs Digoxin 40 hrs
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine
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.

8. What enzyme does Zileuton inhibit?
- Cloazapine - carbamazapine - colchicine - PTU
- Isoniazid
- EDTA - dimercaprol - succimer - & penicillamine
Lipoxygenase

9. Acetazolamide - site of action?
As PABA antimetabolites that inhibit Dihydropteroate Synthase - Bacteriostatic
proximal convoluted tubule
Aminoglycosides
Antileukotriene; blocks synthesis by lipoxygenase.

10. What is the effect of the Glitazones in diabetes treatment?
Increase target cell response to insulin.
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility
loop diuretics - spironolactone
- Glucagon

11. Which drug(s) cause this reaction: Atropine - like side effects?
- Tricyclic antidepressants
check PFTs - LFTs - and TFTs
cortical collecting tubule
Aminoglycosides - Tetracyclines

12. In coma situations you rule out What (7)?

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13. What is Imipenem always administered with?
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.
Buy AT 30 - CELL at 50'
Cilastatin
GI discomfort - Acute cholestatic hepatitis - Eosinophilia - Skin rashes

14. What process does Zafirlukast interfere with?
Leukotrienes increasing bronchial tone.
Acute (hours)
Amphetamine and Ephedrine
The PTT.

15. What is the category of drug names ending in - zosin (e.g. Prazosin)
Used in combination therapy with SMZ to sequentially block folate synthesis
Alpha -1 antagonist
Rifampin
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.

16. What is the lab value used to monitor the effectiveness of Warfarin therapy?
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
Neomycin
The PT.
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)

17. Amprotericin B ___________ the BBB
Does not cross
Sulfamethoxazole (SMZ) - Sulfisoxazole - Triple sulfas - Sulfadiazine
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.
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

18. Foscarnet toxicity?
Nephrotoxicity
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)
Quinidine - Amiodarone - Procainamide - Disopyramide

19. Secretion of What drug is inhibited by Probenacid used to treat chronic gout?
Penicillin.
Sildenafil fills the penis
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
- Nitrate - hydroxocobalamin thiosulfate

20. Furosemide - class and mechanism?
- Ammonium Chloride
Sulfonamide Loop Diuretic. Inhibits ion co - transport system of thick ascending loop. Abolishes hypertonicity of the medulla - thereby preventing concentration of the urine.
WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.
Vd= (Amt. of drug in body/ Plasma drug conc.)

21. MOA of Succinylcholine
Prevents the release of Ca from SR of skeletal muscle
Inhalational general anesthetic.
Suramin
DOC in diagnosing and abolishing AV nodal arrhythmias

22. What is the category of drug names ending in - oxin (e.g. Digoxin)
troponin - tropomyosin system
Dermatophytes (tinea - ringworm)
Cardiac glycoside (inotropic agent).
CMV Retinitis in IC pts When Ganciclovir fails

23. When is Rifampin not used in combination with other drugs?
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.
1. Meningococcal carrier state 2. Chemoprophylaxis in contacts of children with H. influenzae type B
Inhibt Assembly of new virus by Blocking Protease Enzyme

24. A fellow passenger on a Carnival cruise ship looks pale and diaphoretic - What antimuscarinic agent would you give them?
TMP- SMZ (DOC) - aerosolized pentamidine
Post - op and neurogenic ileus and urinary retention - myasthenia gravis - and reversal of neuromuscular junction blockade (post - op) through anticholinesterase activity.
scopolamine
Inhibt Assembly of new virus by Blocking Protease Enzyme

25. ADH antagonists - site of action?
Erythromycin - Azithromycin - Clarithromycin
Prevents the release of ACh - Which results in muscle paralysis.
collecting ducts
Hydralazine and Minoxidil

26. Furosemide - toxicity? (OH DANG)
Ototoxicity - Hypokalemia - Dehydration - Allergy (sulfa) - Nephritis (interstitial) - Gout
- DNA intercalator - Hodgkin's - myeloma - sarcoma - and solid tumors - Cardiotoxicity & alopecia
Because they require some residual islet function.
sedation - positive Coombs' test

27. How is Vancomycin used clinically?
Mebendazole/Thiabendazole - Pyrantel Pamoate
For serious - Gram + multidrug - resistant organisms
Protease Inhibitors and Reverse Transcriptase Inhibitors
HTN - CHF - calcium stone formation - nephrogenic DI.

28. MOA for Penicillin (3 answers)?
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal
1)Binds penicillin - binding proteins 2) Blocks transpeptidase cross - linking of cell wall 3) Activates autolytic enzymes
- Triggers apoptosis - CLL - Hodgkin's in MOPP - Cushing - like syndrome
- Tetracycline - amiodarone - sulfonamides

29. What are Polymyxins used for?
CMV - esp in Immunocompromised patients
torsade de pointes - excessive Beta block
Resistant Gram - infections
blocking the beta adrenergic receptor leads to decreased cAMP - and decreased Ca2+ flux

30. Which diuretics cause alkalosis?
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.
loop diuretics - thiazides
severe orthostatic hypotension - blurred vision - constipation - sexual dysfunction
AluMINIMUM amount of feces.

31. What are common serious side effects of Aminoglycosides and What are these associated with?
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)
Penicillin - Cephalosporins - Vancomycin - Aminoglycosides - Fluoroquinolones - Metronidazole
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.
Norepinephrine

32. What is the MOA of Ganciclovir?
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.
Inhibits CMV DNA polymerase
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)
Zidovudine (AZT) - Didanosine (ddI) - Zalcitabine (ddC) - Stavudine (d4T) - Lamivudine (3TC)

33. How is Ganciclovir used clinically?
Diarrhea
CMV - esp in Immunocompromised patients
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state
Decreases synthesis of Mycolic Acid

34. What are four thrombolytics?
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)
Only in limited amounts
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).

35. What is the difference between the affinity for beta receptors between albuterol/terbutaline and dantroline?
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.
- Physostigmine salicylate
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
- Fluoroquinolones

36. What is the effect of guanethidine on adrenergic NE release?
Teratogenic - Carcinogenic - Confusion - Headaches
It inhibits release of NE.
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.
Increase target cell response to insulin.

37. What drug is used to treat Trematode/fluke (e.g. - Schistosomes - Paragonimus - Clonorchis) or Cysticercosis
Same as penicillin. Extended spectrum antibiotics
Inhibit intestinal bursh border Alpha - glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.
Praziquantel
fetal renal toxicity - hyperkalemia

38. What is the mecanism of action of the COX-2 inhibitors (celecoxib - rofecoxib)?
Selectively inhibit cyclooxygenase (COX) isoform 2 - Which is found in inflammatory cells nad mediates inflammation and pain; spares COX-1 Which helps maintain the gastric mucosa.
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
Pretreat with antihistamines and a slow infusion rate
Mg = Must go to the bathroom.

39. Acetaldehyde is metabolized by Acetaldehyde dehydrogenase - Which drug inhibs this enzyme?
- Disulfram & also sulfonylureas - metronidazole
Selectively inhibit cyclooxygenase (COX) isoform 2 - Which is found in inflammatory cells nad mediates inflammation and pain; spares COX-1 Which helps maintain the gastric mucosa.
loop diuretics - thiazides
- Tetracycline - amiodarone - sulfonamides

40. List the mechanism - clinical use - & toxicity of Cyclophosphamide.
Pseudomonas species and Gram - rods
hyperaldosteronism - K+ depletion - CHF
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.

41. What are common side effects of RT Inhibitors?
BM suppression (neutropenia - anemia) - Peripheral neuropathy
Intrathecally
sedation - positive Coombs' test
Phenothiazine (neuroleptic - antiemetic).

42. What are three clinical uses of the Leuprolide?
Same as penicillin. Act as narrow spectrum antibiotics
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids
physostigmine
Inhibit Ergosterol synthesis

43. What are four clinical activities of Aspirin?
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.
Polymyxin B - Polymyxin E
Intrathecally
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.

44. What is a possible toxicity of Ticlopidine - Clopidogrel usage?
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.
Tricyclic antidepressant.
Increase target cell response to insulin.
- Alkalate DNA - Brain tumors - CNS toxicity

45. Name three Antiarrhythmic drugs in class IV.
Non - Nucleosides
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.
Well tolerated in general but occasionally - Nephrotoxicity - Ototoxicity - Thrombophlebitis - diffuse flushing='Red Man Syndrome'
Verapamil - Diltiazem - Bepridil

46. What are the side effects of Polymyxins?
Neurotoxicity - Acute renal tubular necrosis
1. Antipyretic 2. Analgesic 3. Anti - inflammatory
bradycardia - AV block - CHF
Chronic (weeks or months)

47. How is Amphotericin B administered for fungal meningitis?
constipation - flushing - edema - CV effects (CHF - AV block - sinus node depression) - and torsade de pointes (Bepridil)
Intrathecally
Chronic gout.
Amphotericin B - Nystatin - Fluconazole/azoles

48. How is Chloramphenical used clinically?
1. Heavy bleeding 2. GI effects (n/v - anorexia) 3. Abdominal pain
WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.
Meningitis (H. influenza - N. meningitidis - S. pneumoniae) - Conserative treatment due to toxicities
cholestyramine - colestipol

49. What is the MOA for the Fluoroquinolones?
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal
Cephalosporins
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic

50. What is the mechanism of action of Allopurinol used to treat chronic gout?
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.
Acute gout.
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.
Dopamine; causes its release from intact nerve terminals