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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.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

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 effect would atropine have on a patient with peptic ulcer disease?
torsade de pointes - excessive Beta block
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.
Rheumatoid and osteoarthritis.
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).

2. How is Vancomycin used clinically?
Depolymerizes microtubules - impairing leukocyte chemotaxis and degranulation.
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)
vascular sm. Mus.: Nifedipine>Diltiazem>Verapamil
For serious - Gram + multidrug - resistant organisms

3. What is the category of drug names ending in - azine (e.g. Chlorpromazine)
Premature infants - because they lack UDP- glucuronyl transferase
Phenothiazine (neuroleptic - antiemetic).
1. Aluminum hydroxide: constipation and hypophosphatemia 2. Magnesium hydroxide: diarrhea 3. Calcium carbonate: Hypercalcemia - rebound acid increase - All may cause hypokalemia
Cilastatin

4. Amprotericin B ___________ the BBB
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
1. Addison's disease 2. Inflammation 3. Immune suppression 4. Asthma
Does not cross
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome

5. Name two organisms Vancomycin is commonly used for?
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)
1. Bleeding 2. Teratogenicity 3. Drug - drug interactions
Cyclooxygenases (COX I - COX II).
It acts presynaptically to increase NE release.

6. What are the clinical indications for Azole therapy?
compensatory tachycardia - fluid retention - lupus - like syndrome
Systemic mycoses
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis
Triple Therapy' 2 Nucleoside RT Inhibitors with a Protease Inhibitor

7. Clinical use of Isoniazid (INH)?
Protease inhibitor.
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.
Mycobacterium tuberculosis - the only agent used as solo prophylaxis against TB
Beta antagonist.

8. Name the common Azoles
Tricyclic antidepressant.
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).
Pseudomembranous colitis (C. difficile) - fever - diarrhea
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole

9. Guanethidine enhances the release of Norepi?
No - it inhibits the release of Nor Epi
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes
Chronic gout.
HTN - CHF - calcium stone formation - nephrogenic DI.

10. What is the clinical use of Mifepristone (RU486)?
- Ethosuxamide - sulfonamides - lamotrigine
Abortifacient.
Inhibits Viral DNA polymerase
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.

11. Name the common Aminoglycosides (5)
Triple sulfas or SMZ
As an anticholinesterase it increases endogenous ACh and thus increases strength.
It acts presynaptically to increase NE release.
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin

12. Which drug(s) cause this reaction: Pseudomembranous colitis?
- inhibits HGPRT (pur. Syn.) - Luk - Lymph
Epinephrine
- Clindamycin
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.

13. Adverse effects of Minoxidil?
Penicillin - G
Acute gout.
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
hyperaldosteronism - K+ depletion - CHF

14. Decrease Digoxin dose in renal failure?
Modification via Acetylation
YES
Methylation of rRNA near Erythromycin's ribosome binding site
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis

15. What is a possible toxicity of Ticlopidine - Clopidogrel usage?
Neostigmine - pyridostigmine edrophonium - physostigmine echothiophate
- reduction - oxy - & hydrolysis - H2O sol. Polar product - P450
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.
1. Acarbose 2. Miglitol

16. What are the clinical indications for neostigmine?
fetal renal toxicity - hyperkalemia
Post - op and neurogenic ileus and urinary retention - myasthenia gravis - and reversal of neuromuscular junction blockade (post - op) through anticholinesterase activity.
Gram + and Anerobes
Stimulates beta adrenergic receptors

17. What is the mechanism of action of Mifepristone (RU486)?
Competitive inibitor of progestins at progesterone receptors.
1. Reliable (<1% failure) 2. Lowers risk of endometrial and ovarian cancer 3. Decreased incidence of ectopic pregnancy 4. Lower risk of pelvic infections 5. Regulation of menses
Norepinephrine (Alpha1 -2 and beta 1)
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes

18. What would be the effect on blood pressure with infusion of the alpha -2 agonist clonidine?
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.
compensatory tachycardia - fluid retention - lupus - like syndrome
Acts as a wide spectrum carbapenem
Benzathine penicillin G

19. What type of patient should not take Misoprostol and why?
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.
Triple Therapy' 2 Nucleoside RT Inhibitors with a Protease Inhibitor
Ganciclovir is more toxic to host enzymes
Antimetabolite derivative of 6- mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.

20. How do you treat coma in the ER (4)?
- Methylene blue
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD
Chagas' disease - American Trypanosomiasis (Trypanosoma cruzi)
- Daunorubicin & Doxorubicin

21. Amiodarone - toxicity?
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.
Fever/Chills - Hypotension - Nephrotoxicity - Arrhythmias
Slow - limited by half lives of clotting factors
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.

22. Adverse effects of Hydralazine?
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.
Phosphorylation by a Viral Kinase
Post - op and neurogenic ileus and urinary retention - myasthenia gravis - and reversal of neuromuscular junction blockade (post - op) through anticholinesterase activity.
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention

23. For Warfarin What is the Ability to inhibit coagulation in vitro
No
Mg = Must go to the bathroom.
No - hemicholinum block the uptake of Choline and thus Ach synthesis
Blood

24. Ganciclovir associated toxicities?
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia
Disulfiram - like reaction with EtOH - Headache
Penicillin - Cephalosporins - Vancomycin - Aminoglycosides - Fluoroquinolones - Metronidazole
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity

25. Which diuretics increase urine NaCl?
all of them
Inhibits DNA dependent RNA polymerase
Rifampin - Ethambutol - Streptomycin - Pyrazinamide - Isoniazid (INH)
IV vitamin K and fresh frozen plasma

26. List the specific antidote for this toxin: Amphetamine
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
- Ammonium Chloride
- Corticosteroids - heparin
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis

27. Which of the following would atropine administration cause? Hypothermia - bradycardia - excess salivation - dry flushed skin - or diarrhea
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.
Used in combination therapy with SMZ to sequentially block folate synthesis
- Acetaldehyde - Nausea - vomiting - headache - & hypotension
H2 antagonist

28. Name the common Fluoroquinolones (6)
edematous states (CHF - cirrhosis - nephrotic syndrome - pulm edema) - HTN - hypercalcemia
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention
Ciprofloxacin - Norfloxacin - Ofloxacin - Grepafloxacin - Enoxacin - Nalidixic acid
Cyclooxygenases (COX I - COX II).

29. What are four H2 Blockers?
GI distress - Skin rash - and Seizures at high plasma levels
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine

30. Which drug(s) cause this reaction: Atropine - like side effects?
Sotalol - Ibutilide - Bretylium - Amiodarone
- Tricyclic antidepressants
No - it inhibits the release of Nor Epi
pulmonary edema - dehydration

31. What are four Sulfonylureas?
Ibuprofen - Naproxen - and Indomethacin
Saquinavir - Ritonavir - Indinavir - Nelfinavir
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide
Beta antagonist.

32. Where does Griseofulvin deposit?
- Phase I (clinical tests) - Phase II - Phase III - PhaseIV (surveillance)
Keratin containing tissues - e.g. - nails
Chloramphenicol - Erythromycin/macrolides - Lincomycin - Clindamycin - Streptogramins (quinupristin - dalfopristin)
Treatment of infertility.

33. What drug is used during the pregnancy of an HIV+ mother? - Why?
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.
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.)
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.
AZT - to reduce risk of Fetal Transmission

34. What are two toxicities associated with Cyclosporine?
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.
1. Predisposes to viral infections and lymphoma 2. Nephrotoxic (preventable with mannitol diuresis)
Edrophonium
Wide spectrum of systemic mycoses: Cryptococcus - Blastomyces - Coccidioides - Aspergillus - Histoplasma - Candida - Mucor

35. What type of gout is treated with Allopurinol?
- acetylation - glucuron. - & sulfation - Conjugation - Polar product
Chronic gout.
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.
Clavulanic acid

36. What are the products and their toxicities of the metabolism of Methanol by / alcohol dehydrogenase?
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
- Formaldehyde & formic acid - severe acidosis & retinal damage
1. Gastric ulceration 2. Bleeding 3. Hyperventilation 4. Reye's syndrome 5. Tinnitus (CN VIII)
all of them

37. What is the MOA of Griseofulvin?
Interferes with microtubule function - disrupts mitosis - inhibits growth
Tubocurarine - atracurium - mivacurium - pancuronium - vecuronium - rapacuronium
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.
Blood

38. Antimicrobial prophylaxis for Gonorrhea
thick ascending limb
TCA
Ceftriaxone
Inhibt Assembly of new virus by Blocking Protease Enzyme

39. What are four conditions in Which H2 Blockers are used clinically?
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
Aminoglycosides
- Steroids - Tamoxifen
- Methotrexate - 5 FU - 6 mercaptopurine

40. What is the mechanism of action of Heparin?
Heparin catalyzes the activation of antithrombin III.
YES
Chronic Hepatitis A and B - Kaposi's Sarcoma
Same as penicillin. Act as narrow spectrum antibiotics

41. What are the major structural differences between Penicillin and Cephalosporin?
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)
hypokalemia - slight hyperlipidemia - hyperuricemia - lassitude - hypercalcemia - hyperglycemia
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
1. Antiandrogen 2. Nausea 3. Vomiting

42. What is the most common cause of Pt noncompliance with Macrolides?
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.
GI discomfort
Lovastatin - Pravastatin - Simvastatin - Atorvastatin
Ibuprofen - Naproxen - and Indomethacin

43. Sotalol - toxicity?
Immediate anticoagulation for PE - stroke - angina - MI - DVT.
Cell membrane Ca2+ channels of cardiac sarcomere
torsade de pointes - excessive Beta block
Hypersensitivity reactions

44. Resistance mechanisms for Macrolides

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45. Which drug(s) cause this reaction: Osteoporosis (2)?
Inhibits reabsorption of uric acid.
Forms toxic metabolites in the bacterial cell - Bactericidal
Delirium - Tremor - Nephrotoxicity
- Corticosteroids - heparin

46. What are the clinical uses for 3rd Generation Cephalosporins?
Methicillin - Nafcillin - and Dicloxacillin
Edrophonium
Reversibly inhibits cyclooxygenase - mostly in CNS. Inactivated peripherally.
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)

47. Which diuretics decrease urine Ca2+?
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).
thiazides - amiloride
- Chloramphenicol
fetal renal toxicity - hyperkalemia

48. Mannitol - mechanism?
osmotic diuretic - increase tubular fluid osmolarity - thereby increasing urine flow
Activates antithrombin III
loop diuretics - spironolactone
No

49. What is the category of drug names ending in - barbital (e.g. Phenobarbital)
Decrease the production of leukotrienes and protaglandins by inhibiting phospholipase A2 and expression of COX-2.
Babiturate.
Does not cross
collecting ducts

50. What is the clinical use for Nystatin?
Topical and Oral - for Oral Candidiasis (Thrush)
Pseudomembranous colitis (C. difficile) - fever - diarrhea
Hypersensitivity reactions
Prefers beta's at low doses - but at higher doses alpha agonist effects are predominantly seen.