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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. Which diuretics increase urine K+?
Prevention of NSAID- induced peptic ulcers - maintains a PDA.
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins

2. A 12yo patient was treated for a reaction to a bee sting - What drug provides the best coverage of sympathomimetic receptors?
Penicillin.
impotence - asthma - CV effects (bradycardia - CHF - AV block) - CNS effects (sedation - sleep alterations)
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )
Epinephirine(Alpha1 -2 and Beta 1 -2)

3. Digitalis - site of action?
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide
Na/K ATPase
YES
- Ethanol - dialysis - & fomepizole

4. Beta Blockers - CNS toxicity?
Rifampin
sedation - sleep alterations
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine
Gram + cocci - Proteus mirabilis - E. coli - Klebsiella pneumoniae (PEcK)

5. What is the MOA for Ampicillin and Amoxicillin?
- Class III antiarrhythmics (sotalol) - class IA (quinidine)
Same as penicillin. Extended spectrum antibiotics
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
Potent immunosuppressive used in organ transplant recipients.

6. What are Aminoglycosides synergistic with?
Beta - lactam antibiotics
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.
Protamine sulfate
VACUUM your Bed Room'

7. Which H2 Blocker has the most toxic effects and What are they?
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)
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.
diuretics - sympathoplegics - vasodilators - ACE inhibitors - Angiotensin II receptor inhibitors
Cell membrane Ca2+ channels of cardiac sarcomere

8. Are Ampicillin and Amoxicillin are not...
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.
penicillinase resistant
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal
Malaria (P. falciparum)

9. What is the difference in receptor affinity of epinephrine at low doses? High doses?

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10. Why does atropine dilate the pupil?
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.
The PTT.
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)

11. Name four Antiarrhythmic drugs in class III.
Sotalol - Ibutilide - Bretylium - Amiodarone
Fast vs. Slow Acetylators
Albuterol - tertbutaline
- Shifts the curve down - reduces Vmax

12. Triamterene and amiloride - mechanism?
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.
block Na+ channels in the cortical collecting tubule
- Acetaldehyde - Nausea - vomiting - headache - & hypotension
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species

13. What is the category - desired effect - and period of use of albuterol in the treatment of Asthma?
Penicillin.
Flecainide - Encainide - Propafenone
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.

14. What Sulfonamides are used for simple UTIs?
Triple sulfas or SMZ
- Sulfonamides - furosemide - methicillin - rifampin - NSAIDS (ex. ASA)
reversible SLE- like syndrome
Beta - lactamase cleavage of Beta - lactam ring

15. Which diuretics increase urine Ca2+?
Local anesthetic.
loop diuretics - spironolactone
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia

16. List the specific antidote for this toxin: Benzodiazepines
Increase target cell response to insulin.
- Flumazenil
Heparin catalyzes the activation of antithrombin III.
Methylxanthine.

17. What side effect of using atropine to induce pupillary dilation would you expect?
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).
- Haloperidol - chlorpromazine - reserpine - MPTP
1. Heavy bleeding 2. GI effects (n/v - anorexia) 3. Abdominal pain
1. Hypoglycemia (more common with 2nd - generation drugs: glyburide - glipizide) 2. Disulfiram - like effects (not seen with 2nd - generation drugs).

18. List the specific antidote for this toxin: Beta Blockers
Dermatophytes (tinea - ringworm)
NO
- Glucagon
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents

19. List the mechanism - clinical use - & toxicity of Busulfan.
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
Hypersensitivity reactions
Vd= (Amt. of drug in body/ Plasma drug conc.)

20. ACE inhibitors - mechanism?
reduce levels of Angiotensin II - thereby preventing the inactivation of bradykinin (a potent vasodilator); renin level is increased
Nephrotoxicity
GI upset
hyperaldosteronism - K+ depletion - CHF

21. What is the memory key for the effect of aluminum hydroxide overuse?
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.
AluMINIMUM amount of feces.
fetal renal toxicity - hyperkalemia
They inhibit reuptake of NE at the nerve terminal (as does cocaine).

22. What are three complications of Warfarin usage?
These B-2 agonists cause respiratory smooth muscle to relax.
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.
1. Bleeding 2. Teratogenicity 3. Drug - drug interactions
Yes - it does not cross the placenta.

23. What are three types of antacids and the problems that can result from their overuse?
Enterobacter
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
1. Aluminum hydroxide: constipation and hypophosphatemia 2. Magnesium hydroxide: diarrhea 3. Calcium carbonate: Hypercalcemia - rebound acid increase - All may cause hypokalemia
Increase target cell response to insulin.

24. Which diuretics decrease urine Ca2+?
Does not cross
amphetamine and ephedrine
thiazides - amiloride
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents

25. What enzyme does Zileuton inhibit?
carbonic anhydrase inhibitors - K+ sparing diuretics
check PFTs - LFTs - and TFTs
- Vitamin K & fresh frozen plasma
Lipoxygenase

26. What is the MOA for Rifampin?
Inhibits DNA dependent RNA polymerase
Indirect agonist - uptake inhibitor
AmOxicillin has greater Oral bioavailability
diuretics - sympathoplegics - vasodilators - ACE inhibitors - Angiotensin II receptor inhibitors

27. Aztreonam is not usually...
Praziquantel
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity
- Oxalic acid - Acidosis & nephrotoxicity
toxic

28. Which drug(s) cause this reaction: Torsade de pointes (2)?
- Class III antiarrhythmics (sotalol) - class IA (quinidine)
Oral
Neurotoxicity - Acute renal tubular necrosis
severe orthostatic hypotension - blurred vision - constipation - sexual dysfunction

29. Antimicrobial prophylaxis for Gonorrhea
prevention of nodal arrhythmias (SVT)
Acetylates and irreversibly inhibits cyclooxygenase (COX I and COX II) to prevent the conversion of arachidonic acid to prostaglandins.
It affects beta receptors equally and is used in AV heart block (rare).
Ceftriaxone

30. Is resistant to penicillinase?
Cell membrane Ca2+ channels of cardiac sarcomere
GI side effects. (Indomethacin is less toxic - more commonly used.)
hypertension - CHF - diabetic renal disease
Imipenem

31. How do Sulfonamides act on bacteria?
As PABA antimetabolites that inhibit Dihydropteroate Synthase - Bacteriostatic
It acts presynaptically to increase NE release.
Inhibits platelet aggregation by irreversibly inhibiting the ADP pathway involved in the binding of fibrinogen.
Ca2+ (Loops Lose calcium)

32. List the mechanism - clinical use - & toxicity of Doxorubicin.

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33. What cholinomimetics might your pt be taking for his glaucoma
Carbachol - pilocarpine - physostigmine - echothiophate
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.
Hydralazine and Minoxidil

34. What is the receptor affinity and clinical use of isoproterenol?
Beta - lactam antibiotics
It affects beta receptors equally and is used in AV heart block (rare).
Inhibits cell wall synthesis ( binds to PBP3). A monobactam
CMV - esp in Immunocompromised patients

35. How are the Latent Hypnozoite (Liver) forms of Malaria (P. vivax - P.ovale) treated?
Primaquine
Sulfonamide Loop Diuretic. Inhibits ion co - transport system of thick ascending loop. Abolishes hypertonicity of the medulla - thereby preventing concentration of the urine.
- EDTA - dimercaprol - succimer - & penicillamine
- Oxalic acid - Acidosis & nephrotoxicity

36. What drug is given for Pneumocystis carinii prophylaxis?
Pentamidine
Neomycin
effective in torsade de pointes and digoxin toxicity
very short acting

37. What are four clinical uses of glucocorticoids?

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38. What are two toxicities of the Sulfonylureas?
1. Hypoglycemia (more common with 2nd - generation drugs: glyburide - glipizide) 2. Disulfiram - like effects (not seen with 2nd - generation drugs).
Prevents the release of Ca from SR of skeletal muscle
Forms toxic metabolites in the bacterial cell - Bactericidal
Delirium - Tremor - Nephrotoxicity

39. MOA of Succinylcholine
Megaloblastic anemia - Leukopenia - Granulocytopenia
- Ethosuxamide - sulfonamides - lamotrigine
- Constant AMOUNT eliminated per unit time. - Etoh & ASA
Prevents the release of Ca from SR of skeletal muscle

40. For Heparin What is the Structure
Rifampin - Ethambutol - Streptomycin - Pyrazinamide - Isoniazid (INH)
1. Bleeding 2. Teratogenicity 3. Drug - drug interactions
Large anionic polymer - acidic
- Flumazenil

41. What type of gout is treated with Allopurinol?
Beta - lactamase cleavage of Beta - lactam ring
With an amino acid change of D- ala D- ala to D- ala D- lac
Chronic gout.
cross - allergenic

42. What is the most common cause of Pt noncompliance with Macrolides?
1. Bleeding 2. Teratogenicity 3. Drug - drug interactions
Useful in muscle paralysis during surgery or mechanical ventilation.
Muscarinic antagonist; competatively blocks muscarinic receptors - preventing bronchoconstriction.
GI discomfort

43. What are toxic side effects for Metronidazole?
GI disturbances.
- acetylation - glucuron. - & sulfation - Conjugation - Polar product
Disulfiram - like reaction with EtOH - Headache
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD

44. List the specific antidote for this toxin: Carbon monoxide
fetal renal toxicity - hyperkalemia
Dopamine; causes its release from intact nerve terminals
Rapid (seconds)
-100% oxygen - hyperbaric

45. What anticholinesterase crosses the blood - brain - barrier?
physostigmine
- Daunorubicin & Doxorubicin
- Methylene blue
glaucoma - urinary alkalinization - metabolic alkalosis - altitude sickness

46. Adverse effects of Guanethidine?
Staphlococcus aureus
orthostatic and exercise hypotension - sexual dysfunction - diarrhea
Neostigmine - pyridostigmine edrophonium - physostigmine echothiophate
Pyridoxine (B6) administration

47. Name three K+ sparing diuretics?
Hydralazine and Minoxidil
Spironolactone - Triamterene - Amiloride (the K+ STAys)
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis

48. What is the effect of epinephrine infusion on bp and pulse pressure?
Imipenem
Acetylcholinesterase; ACh is broken down into choline and acetate.
Foscarnet = pyroFosphate analog
Increased systolic and pulse pressure - decreased diastolic pressure - and little change in mean pressure.

49. MOA: Block mRNA synthesis
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
Rifampin
Same as penicillin. Extended spectrum antibiotics
Triple sulfas or SMZ

50. What is the mechanism of action of Warfarin (Coumadin)?
As an anticholinesterase it increases endogenous ACh and thus increases strength.
Hemolysis (if G6PD deficient) - Neurotoxicity - Hepatotoxicity - SLE- like syndrome
Digitoxin>95% Digoxin 75%
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.