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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. What is the mechanism of action of Allopurinol used to treat chronic gout?
DHPG (dihydroxy-2- propoxymethyl guanine)
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.
Inhibits reabsorption of uric acid.
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.

2. IV Penicillin
1. Antipyretic 2. Analgesic 3. Anti - inflammatory
Norepinephrine (Alpha1 -2 and beta 1)
Penicillin - G
Scopolamine

3. What reversal agent could a Anes give to reverse the effects of Atropine
GI disturbances.
No
The only local anesthetic with vasoconstrictive properties.
Bethanechol - Neostigmine - physostigmine

4. Why is pyridostigmine effective in the treatment of myasthenia gravis?
amphetamine and ephedrine
Edrophonium
- Class III antiarrhythmics (sotalol) - class IA (quinidine)
As an anticholinesterase it increases endogenous ACh and thus increases strength.

5. Amiodarone - toxicity?
Same as penicillin. Extended spectrum antibiotics
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD
Nucleosides

6. What is the category of drug names ending in - navir (e.g. Saquinavir)
hypertension - angina - arrhythmias
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.
Protease inhibitor.

7. How does a noncompetitive antagonist effect an agonist?
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills
- Shifts the curve down - reduces Vmax
Polymyxins
Diarrhea - Urination - Miosis - Bronchospasm - Bradycardia - Excitation of skeletal muscle and CNS - Lacrimation - Sweating - and Salivation = DUMBBELS; also abdominal cramping

8. Which drug(s) cause this reaction: P450 inhibition(6)?
Inhibt Assembly of new virus by Blocking Protease Enzyme
- Cimetidine - ketoconazole - grapefruit juice - erythromycin - INH - sulfonamides
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.
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.

9. What is the mechanism of action of Warfarin (Coumadin)?
new arrhythmias - hypotension
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
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.
Antibiotic - protein synthesis inhibitor.

10. What are the clinical uses for Aztreonam?
atropine - homatropine - tropicamide
- Shifts the curve to the right - increases Km
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
Chronic gout.

11. What are four advantages of newer low - molecular - weight heparins (Enoxaparin)?
- Constant AMOUNT eliminated per unit time. - Etoh & ASA
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )
1. Better bioavailability 2. 2 to 4 times longer half life 3. Can be administered subcutaneously 4. Does not require laboratory monitoring
Zidovudine (AZT) - Didanosine (ddI) - Zalcitabine (ddC) - Stavudine (d4T) - Lamivudine (3TC)

12. Mannitol - clinical use?
ARF - shock - drug overdose - decrease intracranial/intraocular pressure
Hemolytic anemia
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin
Aplastic anemia (dose independent) - Gray Baby Syndrome

13. Does Ampicillin or Amoxicillin have a greater oral bioavailability?
- Cimetidine - ketoconazole - spironolactone - digitalis - EtOH - estrogens
Clavulanic acid
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.
AmOxicillin has greater Oral bioavailability

14. What are Methicillin - Nafcillin - and Dicloxacillin used for clinically?
IV vitamin K and fresh frozen plasma
Staphlococcus aureus
narcolepsy - obesity - and attention deficit disorder (I wouldn't recommend this)
thick ascending limb

15. What is the MOA of Ribavirin?
block Na+ channels in the cortical collecting tubule
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.
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.

16. Name common Polymyxins
Polymyxin B - Polymyxin E
Small lipid - soluble molecule
Tricyclic antidepressant.
Gram + - Gram - - Norcardia - Chlamydia

17. What is the memory key for Isoniazid (INH) toxicity?
Rifampin (DOC) - minocycline
Saquinavir - Ritonavir - Indinavir - Nelfinavir
Blocks Influenza A and RubellA; causes problems with the cerebellA
INH: Injures Neurons and Hepatocytes

18. What should not be taken with Tetracyclines? / Why?
- DNA intercalator - testicular & lymphomas - Pulmonary fibrosis mild myelosuppression.
severe hypertension - CHF
- Haloperidol - chlorpromazine - reserpine - MPTP
Milk or Antacids - because divalent cations inhibit Tetracycline absorption in the gut

19. What is the main clinical use for the thrombolytics?
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.
dizziness - flushing - constipation (verapamil) - nausea
1. Gastric ulceration 2. Bleeding 3. Hyperventilation 4. Reye's syndrome 5. Tinnitus (CN VIII)
Early myocardial infarction.

20. List the mechanism - clinical use - & toxicity of Prednisone.

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21. What is the MOA of Foscarnet?
Erythromycin - Azithromycin - Clarithromycin
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia
Inhibits Viral DNA polymerase
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.

22. Adverse effects of Hydrochlorothiazide?
hypokalemia - slight hyperlipidemia - hyperuricemia - lassitude - hypercalcemia - hyperglycemia
Non - Nucleosides
Anaerobic infections (e.g. - B. fragilis - C. perfringens)
It inhibits release of NE.

23. List the mechanism - clinical use - & toxicity of Cyclophosphamide.
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.
Bleeding.
Hypersensitivity reactions
1. Antipyretic 2. Analgesic 3. Anti - inflammatory

24. Digoxin v. Digitoxin: half life?
amphetamine and ephedrine
Dopamine
Digitoxin 168hrs Digoxin 40 hrs
- Tetracycline - amiodarone - sulfonamides

25. What is the category of drug names ending in - triptyline (e.g. Amitriptyline)
Tricyclic antidepressant.
Pyridoxine (B6) administration
Increases coumadin metabolism
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia

26. List the specific antidote for this toxin: Carbon monoxide
Inhibit viral DNA polymerase
-100% oxygen - hyperbaric
AV nodal cells
- Methylene blue

27. Adverse effects of Loop Diuretics?
Protease inhibitor.
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions
K+ wasting - metabolic alkalosis - hypotension - ototoxicity
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin

28. A fellow passenger on a Carnival cruise ship looks pale and diaphoretic - What antimuscarinic agent would you give them?
Neostigmine - pyridostigmine edrophonium - physostigmine echothiophate
scopolamine
Erythromycin - Azithromycin - Clarithromycin
prevention of nodal arrhythmias (SVT)

29. Sotalol - toxicity?
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)
- Aminocaproic acid
As an anticholinesterase it increases endogenous ACh and thus increases strength.
torsade de pointes - excessive Beta block

30. Which drug(s) cause this reaction: Stevens - Johnson syn. (3)?
glaucoma - urinary alkalinization - metabolic alkalosis - altitude sickness
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.
- Ethosuxamide - sulfonamides - lamotrigine
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions

31. Antiarrhythmic class IB- toxicity?
local anesthetic. CNS stimulation or depression. CV depression.
1. Bleeding 2. Teratogenicity 3. Drug - drug interactions
Pretreat with antihistamines and a slow infusion rate
Reserpine inhibits dopamine transport into vesicles - attenuating its conversion to NE by dopamine beta - hydroxylase.

32. What is a possible toxicity of Ticlopidine - Clopidogrel usage?
bradycardia - AV block - CHF
Same as penicillin. Extended spectrum antibiotics
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.
- Cloazapine - carbamazapine - colchicine - PTU

33. Name four HMG- CoA reductase inhibitors.
thick ascending limb
Phosphorylation by a Viral Kinase
- Corticosteroids - heparin
Lovastatin - Pravastatin - Simvastatin - Atorvastatin

34. Reserpine will block the syntheis of this drug and but not its precursor.
carbonic anhydrase inhibitors - K+ sparing diuretics
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.
Blocks Norepi - but not Dopamine
- Hydralazine - Procainamide - INH - phenytoin

35. ___________ are Teratogenic
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression
Malaria (P. falciparum)
blocking the beta adrenergic receptor leads to decreased cAMP - and decreased Ca2+ flux
Aminoglycosides

36. Which of the following would atropine administration cause? Hypothermia - bradycardia - excess salivation - dry flushed skin - or diarrhea
cortical collecting tubule
Dry flushed skin - due to inhibition of sympathetic post - ganglionic blockade on muscarinic receptors of sweat glands. All others are opposite of What would be expected.
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.)
These B-2 agonists cause respiratory smooth muscle to relax.

37. What is the category and mechanism of action of Zafirlukast in Asthma treatment?
Sulfamethoxazole (SMZ) - Sulfisoxazole - Triple sulfas - Sulfadiazine
1. Acarbose 2. Miglitol
Antileukotriene; blocks leukotriene receptors.
Rifampin (DOC) - minocycline

38. What are two toxicities of the Glitazones?
1. Weight gain 2. Hepatotoxicity (troglitazone)
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.
Nephrotoxicity
Inhibits CMV DNA polymerase

39. Which drug(s) cause this reaction: Atropine - like side effects?
Methicillin - Nafcillin - and Dicloxacillin
Decreased uptake or Increased transport out of cell
Penicillin.
- Tricyclic antidepressants

40. Amprotericin B ___________ the BBB
Does not cross
impotence - exacerbation of asthma - CV effects - CNS effects - may mask hypoclycemia
cinchonism: HA - tinnitus - thrombocytopenia - torsade de pointes due to increased QT interval
Sulfonamides - Trimethoprim

41. Name the Protease Inhibitors (4)
Gram + cocci - Gram - rods - and Anerobes
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD
Saquinavir - Ritonavir - Indinavir - Nelfinavir

42. What are common side effects of Amphotericin B?
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Fever/Chills - Hypotension - Nephrotoxicity - Arrhythmias
- Oral Contraceptives
Polymyxins

43. What is the effect of norepinephrine on bp and pulse pressure?
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.
Indomethacin is used to close a patent ductus arteriosus.
Increase target cell response to insulin.
block Na+ channels in the cortical collecting tubule

44. Why would a patient with cog - wheel rigidity and a shuffling gait be given benztropine?
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.
Small lipid - soluble molecule
Diarrhea - Urination - Miosis - Bronchospasm - Bradycardia - Excitation of skeletal muscle and CNS - Lacrimation - Sweating - and Salivation = DUMBBELS; also abdominal cramping
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels

45. What are signs of Sildenafil (Viagra) toxicity?
Ceftriaxone
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity
Headache - flushing - dyspepsia - blue - green color vision.
Rifampin - Ethambutol - Streptomycin - Pyrazinamide - Isoniazid (INH)

46. MOA: Block protein synthesis at 30s subunit
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
Fast vs. Slow Acetylators
Aminoglycosides - Tetracyclines
Centrally acting alpha agonist - thus causing a decrease in central adrenergic outflow - spairing renal blood flow

47. List some specifics of lead poisoning(4)?
Severe Gram - rod infections.
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia
impotence - exacerbation of asthma - CV effects - CNS effects - may mask hypoclycemia
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.

48. What are common toxicities associated with Macrolides? (4)
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).
amphetamine and ephedrine
GI discomfort - Acute cholestatic hepatitis - Eosinophilia - Skin rashes
Pentamidine

49. What is the category of drug names ending in - cycline (e.g. Tetracycline)
Beta adrenergic receptors and Ca2+ channels (stimulatory)
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms
Antibiotic - protein synthesis inhibitor.
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)

50. What physiological effects was the Anes using Atropine to tx
Buy AT 30 - CELL at 50'
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions
Doxycycline - because it is fecally eliminated