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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 are common serious side effects of Aminoglycosides and What are these associated with?
Immediate anticoagulation for PE - stroke - angina - MI - DVT.
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)
Inhibits cell wall mucopeptide formation - Bactericidal
Amphetamine and Ephedrine

2. Foscarnet does not require activation by a...
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)
Megaloblastic anemia - Leukopenia - Granulocytopenia
cholestyramine - colestipol
viral kinase

3. Which drug(s) cause this reaction: Adrenocortical Insufficiency
hyperaldosteronism - K+ depletion - CHF
Staphlococcus aureus
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)
- Glucocorticoid withdrawal

4. Antimicrobial prophylaxis for a history of recurrent UTIs
TMP- SMZ
penicillinase resistant
With supplemental Folic Acid
decrease conduction velocity - increase ERP - increase PR interval

5. What anticholinesterase crosses the blood - brain - barrier?
physostigmine
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.

6. Explain potency in relation to full and partial agonists(2).
Prevention of NSAID- induced peptic ulcers - maintains a PDA.
Diuresis in pateints with sulfa allergy
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.

7. For Warfarin What is the Route of administration
1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone When used of Leprosy 3. Used in combination with other drugs
Oral
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system

8. Adverse effects of Reserpine?
Pregnant women - Children; because animal studies show Damage to Cartilage
sedation - depression - nasal stuffiness - diarrhea
- Shifts the curve to the right - increases Km
No

9. What type of gout is treated with Colchicine?
- Oral Contraceptives
Acute gout.
1. Weight gain 2. Hepatotoxicity (troglitazone)
Rheumatoid and osteoarthritis.

10. What enzyme is responsible for the production of Ach from Acetyl CoA and Choline
Choline acetyltransferase
blocking the beta adrenergic receptor leads to decreased cAMP - and decreased Ca2+ flux
orthostatic and exercise hypotension - sexual dysfunction - diarrhea
Anaerobes

11. What are major side effects of Methicillin - Nafcillin - and Dicloxacillin?
1. Meningococcal carrier state 2. Chemoprophylaxis in contacts of children with H. influenzae type B
Hypersensitivity reactions
Gram + - Gram - - Norcardia - Chlamydia
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.

12. Does Warfarin have a long - medium - or short half life?
Long.
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.)
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis
decrease the slope of phase 4 - increase PR interval (the AV node is particularly sensitive)

13. Describe Phase II metabolism in liver(3)?
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity
- acetylation - glucuron. - & sulfation - Conjugation - Polar product
1. Addison's disease 2. Inflammation 3. Immune suppression 4. Asthma
torsade de pointes

14. Aztreonam is not ________ with penicillins
Treatment of hypertension - especially with renal disease (lowers bp centrally - so flow is maintained to kidney).
ACIDazolamide' causes acidosis
cross - allergenic
- Niacin - Ca++ channel blockers - adenosine - vancomycin

15. What drug is given for Pneumocystis carinii prophylaxis?
Pentamidine
Polymyxins
Antileukotriene; blocks leukotriene receptors.
Sulfonamides - Trimethoprim

16. Beta Blockers - site of action?
Blood
Reversibly inhibits cyclooxygenase - mostly in CNS. Inactivated peripherally.
Beta adrenergic receptors and Ca2+ channels (stimulatory)
Mebendazole/Thiabendazole - Pyrantel Pamoate

17. List the mechanism - clinical use - & toxicity of Cisplatin.
Na/K ATPase
Antileukotriene; blocks leukotriene receptors.
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
- Ethosuxamide - sulfonamides - lamotrigine

18. How is Leishmaniasis treated?
cholestyramine - colestipol
Aminoglycosides
Pentavalent Antimony
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol

19. What is Niclosamide used for?
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis
1. Acarbose 2. Miglitol
Indirect agonist - uptake inhibitor
Gram + - Gram - - Norcardia - Chlamydia

20. Are penicillinase resistant
Methicillin - Nafcillin - and Dicloxacillin
GI discomfort
Inhibits reabsorption of uric acid.
Indirect agonist - uptake inhibitor

21. What is the MOA for Metronidazole?
Succinylcholine
Forms toxic metabolites in the bacterial cell - Bactericidal
Aminoglycosides
Ganciclovir is more toxic to host enzymes

22. What is the main clinical use for the thrombolytics?
Early myocardial infarction.
It inhibits release of NE.
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.

23. List the mechanism - clinical use - & toxicity of Tamoxifen.
Ipratropium
- Estrogen receptor antagonist - Breast CA - increased endometrial CA risk
blocks SR Ca2+ channels
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )

24. What is the MOA of Polymyxins?
As PABA antimetabolites that inhibit Dihydropteroate Synthase - Bacteriostatic
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents
- Shifts the curve to the right - increases Km
cholestyramine - colestipol

25. Can Warfarin be used during pregnancy?
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic
Chronic gout.
No - warfarin - unlike heparin - can cross the placenta.
compensatory tachycardia - fluid retention - lupus - like syndrome

26. List five common glucocorticoids.
1. Hydrocortisone 2. Predisone 3. Triamcinolone 4. Dexamethasone 5. Beclomethasone
amphetamine and ephedrine
edematous states (CHF - cirrhosis - nephrotic syndrome - pulm edema) - HTN - hypercalcemia
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia

27. What is the category of drug names ending in - tropin (e.g. Somatotropin)
- Halothane - Valproic acid - acetaminophen - Amantia phalloides
toxic
G6PD deficient individuals
Pituitary hormone.

28. List the specific antidote for this toxin: Digitalis
Edrophonium
very short acting
Nifedipine - Verapamil - Diltiazem
- Normalize K+ - Lidocaine - & Anti - dig Mab

29. How do you calculate maintenance dose?
Na/K ATPase
Beta1 more than B2
Md= (CpxCL)/F Cp= plas. Conc. CL=clear. F=bioaval.
Triple Therapy' 2 Nucleoside RT Inhibitors with a Protease Inhibitor

30. What is a prerequisite for Acyclovir activation?
- Disulfram & also sulfonylureas - metronidazole
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
Mycobacterium tuberculosis - the only agent used as solo prophylaxis against TB
It must be Phosphorylated by Viral Thymidine Kinase

31. List the specific antidote for this toxin: Methanol & Ethylene glycol
- Ethanol - dialysis - & fomepizole
thick ascending limb
Neutropenia
- Disulfram & also sulfonylureas - metronidazole

32. ___________ are Teratogenic
Aminoglycosides
severe hypertension - CHF
Md= (CpxCL)/F Cp= plas. Conc. CL=clear. F=bioaval.
decrease conduction velocity - increase ERP - increase PR interval

33. Which drug(s) cause this reaction: Cutaneous flushing (4)?
Hypersensitivity reactions
- Niacin - Ca++ channel blockers - adenosine - vancomycin
With an amino acid change of D- ala D- ala to D- ala D- lac
cholestyramine - colestipol

34. What patients are at risk for life threatening hypotension When taking Sildenafil (Viagra)?
Those patients who are taking nitrates.
Cell membrane Ca2+ channels of cardiac sarcomere
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.
CL= (rate of elimination of drug/ Plasma drug conc.)

35. What cholinomimetics might your pt be taking for his glaucoma
BM suppression (neutropenia - anemia) - Peripheral neuropathy
Succinylcholine
Ca2+ (Loops Lose calcium)
Carbachol - pilocarpine - physostigmine - echothiophate

36. How is Acyclovir used clinically?
Competitive inibitor of progestins at progesterone receptors.
Intrathecally
- reduction - oxy - & hydrolysis - H2O sol. Polar product - P450
HSV - VZV - EBV - Mucocutaneous and Genital Herpes Lesions - Prophylaxis in Immunocompromised pts

37. What is the mechanism of action of the glucocorticoids?
Verapamil - Diltiazem - Bepridil
1. Antipyretic 2. Analgesic 3. Anti - inflammatory
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.)
Decrease the production of leukotrienes and protaglandins by inhibiting phospholipase A2 and expression of COX-2.

38. What is the category - method of use - and adverse effects of Salmeterol in Asthma treatment?
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity
Indirect agonist - uptake inhibitor
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.

39. How are Interferons (INF) used clinically?

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40. What are two indirect acting adrenergic agonists?
penicillinase resistant
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)
amphetamine and ephedrine
Acetylcholine esterase

41. What are the clinical uses for Ticlopidine - Clopidogrel?
bradycardia - AV block - CHF
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
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.
cinchonism: HA - tinnitus - thrombocytopenia - torsade de pointes due to increased QT interval

42. Name four HMG- CoA reductase inhibitors.
No - it inhibits the release of Nor Epi
Lovastatin - Pravastatin - Simvastatin - Atorvastatin
- Ammonium Chloride
Inhibit Ergosterol synthesis

43. What is the clinical use for Clomiphene?
Antibiotic - protein synthesis inhibitor.
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.
H2 antagonist
Treatment of infertility.

44. How is Ribavirin used clinically?
Erectile dysfunction.
distal convoluted tubule (early)
orthostatic and exercise hypotension - sexual dysfunction - diarrhea
for RSV

45. What are four clinical activities of Aspirin?
K+ wasting - metabolic alkalosis - hypotension - ototoxicity
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.
- Phenytoin
Cimetidine is a potent inhibitor of P450; it also has an antiandrogenic effect and decreases renal excretion of creatinine. Other H2 blockers are relatively free of these effects.

46. What is the mechanism of Tacrolimus (FK506)?
Inhibits cell wall mucopeptide formation - Bactericidal
Similar to cyclosporine; binds to FK- binding protein - inhibiting secretion of IL-2 and other cytokines.
Used in combination therapy with SMZ to sequentially block folate synthesis
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.

47. ACE inhibitors - clinical use?
With supplemental Folic Acid
hypertension - CHF - diabetic renal disease
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.
Blocks Peptide Bond formation at the 50S subunit - Bacteriostatic

48. What is the mechanism of action of Colchicine used to treat acute gout?
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia
CMV Retinitis in IC pts When Ganciclovir fails
Depolymerizes microtubules - impairing leukocyte chemotaxis and degranulation.
Succinylcholine

49. Reserpine will block the syntheis of this drug and but not its precursor.
Inhibits formation of Initiation Complex - causes misreading of mRNA - Bactericidal
Ipratropium
Blocks Norepi - but not Dopamine
Tendonitis and Tendon rupture

50. Furosemide - class and mechanism?
Topical and Oral - for Oral Candidiasis (Thrush)
cinchonism: HA - tinnitus - thrombocytopenia - torsade de pointes due to increased QT interval
Sulfonamide Loop Diuretic. Inhibits ion co - transport system of thick ascending loop. Abolishes hypertonicity of the medulla - thereby preventing concentration of the urine.
Oxygen