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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 Mifepristone (RU486)?
Competitive inibitor of progestins at progesterone receptors.
- Dimercaprol - succimer
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
Protamine sulfate

2. Beta Blockers - BP?
Chronic gout.
- Flumazenil
decrease
competitive inhibirot of aldosterone in the cortical collecting tubule

3. What are Fluoroquinolones indicated for? (3)
Inhalational general anesthetic.
Chronic gout.
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms

4. What is the category of drug names ending in - barbital (e.g. Phenobarbital)
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.
Sildenafil fills the penis
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.
Babiturate.

5. What is are two clinical uses of Cyclosporine?
1. Renal damage 2. Aplastic anemia 3. GI distress
proximal convoluted tubule
Gram + - Gram - - Norcardia - Chlamydia
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.

6. What is the category of drug names ending in - caine (e.g. Lidocaine)
Local anesthetic.
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)
Polymyxin B - Polymyxin E
- Phenytoin

7. What is the category of drug names ending in - azol (e.g. Ketoconazole)
Antifungal.
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.
Digitoxin 168hrs Digoxin 40 hrs
cross - allergenic

8. What is the mecanism of action of Sucralfate?
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels
edrophonium (extremely short acting anticholinesterase)
Aluminum sucrose sulfate polymerizes in the acid environment of the stomach and selectively binds necrotic peptic ulcer tissue. Acts as a barrier to acid - pepsin - and bile.
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.

9. Beta Blockers - CV toxicity?
post MI and digitalis induced arrhythmias
- Physostigmine salicylate
bradycardia - AV block - CHF
Penicillin - G

10. What is the category of drug names ending in - oxin (e.g. Digoxin)
Bactericidal for: Gram + rod and cocci - Gram - cocci - and Spirochetes
proximal convoluted tubule - thin descending limb - and collecting duct
Cardiac glycoside (inotropic agent).
Protease Inhibitors and Reverse Transcriptase Inhibitors

11. A 12yo patient was treated for a reaction to a bee sting - What drug provides the best coverage of sympathomimetic receptors?
The PTT.
Epinephirine(Alpha1 -2 and Beta 1 -2)
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)

12. What are common side effects of RT Inhibitors?
Primaquine
BM suppression (neutropenia - anemia) - Peripheral neuropathy
Nifedipine - Verapamil - Diltiazem
thick ascending limb

13. What are two mechanisms of action of Propythiouracil?
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.
Stimulating beta receptors stimulates heart rate - but beta receptor induced vasodilation reduces peripheral resistance.
cortical collecting tubule
Tetracycline - Doxycycline - Demeclocycline - Minocycline

14. Nifedipine has similar action to?
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin
Well tolerated in general but occasionally - Nephrotoxicity - Ototoxicity - Thrombophlebitis - diffuse flushing='Red Man Syndrome'
- Bleomycin - amiodarone - busulfan
Nitrates

15. List the specific antidote for this toxin: Arsenic (all heavy metals)
very short acting
- Dimercaprol - succimer
Na/K ATPase
Prefers beta's at low doses - but at higher doses alpha agonist effects are predominantly seen.

16. What are the Anti - TB drugs?
Rifampin - Ethambutol - Streptomycin - Pyrazinamide - Isoniazid (INH)
Forms toxic metabolites in the bacterial cell - Bactericidal
Fast vs. Slow Acetylators
Slow - limited by half lives of clotting factors

17. Cocaine shares is mechanism of action with What antidepressant
Praziquantel
Same as penicillin. Extended spectrum antibiotics
TCA
Lovastatin - Pravastatin - Simvastatin - Atorvastatin

18. What is the category - method of use - and adverse effects of Salmeterol in Asthma treatment?
Lovastatin - Pravastatin - Simvastatin - Atorvastatin
Depolymerizes microtubules - impairing leukocyte chemotaxis and degranulation.
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.
Chronic gout.

19. Name five Antiarrhythmic drugs in class II?
propanolol - esmolol - metoprolol - atenolol - timolol
Acts as a wide spectrum carbapenem
hyperaldosteronism - K+ depletion - CHF
anuria - CHF

20. Mannitol - mechanism?
HTN - CHF - calcium stone formation - nephrogenic DI.
osmotic diuretic - increase tubular fluid osmolarity - thereby increasing urine flow
- Alkalate DNA - Brain tumors - CNS toxicity
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin

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.
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load
Chronic gout.
- ACE inhibitors (Losartan>no cough)

22. List the specific antidote for this toxin: Methanol & Ethylene glycol
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole
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.)
new arrhythmias - hypotension
- Ethanol - dialysis - & fomepizole

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

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24. How are Sulfonamides employed clinically?
Inhibit intestinal bursh border Alpha - glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.
1. Meningococcal carrier state 2. Chemoprophylaxis in contacts of children with H. influenzae type B
Gram + - Gram - - Norcardia - Chlamydia
Pretreat with antihistamines and a slow infusion rate

25. Adverse effects of Nifedipine - verapamil?
Decreases synthesis of Mycolic Acid
As an anticholinesterase it increases endogenous ACh and thus increases strength.
dizziness - flushing - constipation (verapamil) - nausea
- Glucagon

26. What is the category of drug names ending in - cillin (e.g. Methicillin)
Penicillin.
Reversible block of histamine H2 receptors
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.

27. What is the MOA for the Macrolides?
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
hypertension - angina - arrhythmias
Phenothiazine (neuroleptic - antiemetic).

28. What are Amantadine - associated side effects?
- inhibits HGPRT (pur. Syn.) - Luk - Lymph
cardiac muscle: Verapamil>Diltiazem>Nifedipine
- ED 50 is less than the Km (less than 50% of receptors)
Ataxia - Dizziness - Slurred speech

29. What is the memory key for the effect of magnesium hydroxide overuse?
Aminoglycosides
Mg = Must go to the bathroom.
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
Similar to cyclosporine; binds to FK- binding protein - inhibiting secretion of IL-2 and other cytokines.

30. What are Aminoglycosides synergistic with?
Beta - lactam antibiotics
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
Corticosteroids; prevent production of leukotrienes from arachodonic acid by blocking phospholipase A2. Drugs of choice in a patient with status asthmaticus (in combination with albuterol.)
Antibiotic - protein synthesis inhibitor.

31. What enzyme is responsible for the production of Ach from Acetyl CoA and Choline
Inhibits CMV DNA polymerase
new arrhythmias - hypotension
Choline acetyltransferase
Increased systolic and pulse pressure - decreased diastolic pressure - and little change in mean pressure.

32. Why would a patient with cog - wheel rigidity and a shuffling gait be given benztropine?
Stimulates beta adrenergic receptors
No - it inhibits the release of Nor Epi
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.
hyperaldosteronism - K+ depletion - CHF

33. Which drug(s) cause this reaction: Agranulocytosis (3)?
first dose orthostatic hypotension - dizziness - headache
Short.
- Protamine
- Cloazapine - carbamazapine - colchicine - PTU

34. What antimuscarinic drug is useful for the tx of asthma
- Isoniazid
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)
Ipratropium

35. If a patient is given hexamethonium - What would happen to his/her heart rate?
Ciprofloxacin - Norfloxacin - Ofloxacin - Grepafloxacin - Enoxacin - Nalidixic acid
cortical collecting tubule
It would increase to ~ 100 beats/min. Both sympathetic and vagal stimulation would be knocked out - but the SA node has an intrinsic pace of 100 beats/min - Which is normally checked by vagal stimulation.
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances

36. Which drug(s) cause this reaction: Atropine - like side effects?
physostigmine
- Tricyclic antidepressants
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention
Mebendazole/Thiabendazole - Pyrantel Pamoate

37. What is the effect of norepinephrine on bp and pulse pressure?
proarrhythmic
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.
VACUUM your Bed Room'
- Fluoroquinolones

38. Which drug(s) cause this reaction: Neuro and Nephrotoxic?
Penicillin - V
Nifedipine - Verapamil - Diltiazem
Similar to cyclosporine; binds to FK- binding protein - inhibiting secretion of IL-2 and other cytokines.
- polymyxins

39. What antimicrobial class is Aztreonam syngergestic with?
-100% oxygen - hyperbaric
Aminoglycosides
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
Ganciclovir is more toxic to host enzymes

40. Antiarrhythmic class IA effects?
Yes
Minor hepatotoxicity - Drug interactions (activates P450)
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.
Nifedipine - Verapamil - Diltiazem

41. For Warfarin What is the Treatment for overdose
Well tolerated in general but occasionally - Nephrotoxicity - Ototoxicity - Thrombophlebitis - diffuse flushing='Red Man Syndrome'
IV vitamin K and fresh frozen plasma
Neutropenia
blocking the beta adrenergic receptor leads to decreased cAMP - and decreased Ca2+ flux

42. What is an additional side effect of Methicillin?
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal
Rash - Pseudomembranous colitis
Interstitial nephritis
TMP- SMZ (DOC) - aerosolized pentamidine

43. Name the common Azoles
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole
- Tamoxifen
Gram + - Gram - - Norcardia - Chlamydia
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.

44. Antiarrhythmic class IC- effects?
Aluminum sucrose sulfate polymerizes in the acid environment of the stomach and selectively binds necrotic peptic ulcer tissue. Acts as a barrier to acid - pepsin - and bile.
Inhibits cell wall synthesis ( binds to PBP3). A monobactam
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT
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

45. Which diuretics increase urine Ca2+?
Albuterol - tertbutaline
Spironolactone - Triamterene - Amiloride (the K+ STAys)
- Haloperidol - chlorpromazine - reserpine - MPTP
loop diuretics - spironolactone

46. What conditions are treated with Metronidazole?
Aminoglycosides
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas
- Deferoxamine
cortical collecting tubule

47. Digoxin v. Digitoxin: half life?
Rifampin
Digitoxin 168hrs Digoxin 40 hrs
NO HYPERURICEMIA - NO SULFA AllERGY; same as furosemide otherwise
not a sulfonamide - but action is the same as furosemide

48. How does a competitive antagonist effect an agonist?
- Shifts the curve to the right - increases Km
Flecainide - Encainide - Propafenone
Beta -2 agonist.
Ipratropium

49. What is the category - mechanism of action - and particular use of beclomethasone and prednisone in Asthma treatment?
It acts presynaptically to increase NE release.
Anaerobes
Gram + cocci - Proteus mirabilis - E. coli - Klebsiella pneumoniae (PEcK)
Corticosteroids; prevent production of leukotrienes from arachodonic acid by blocking phospholipase A2. Drugs of choice in a patient with status asthmaticus (in combination with albuterol.)

50. Name several common Macrolides (3)
Erythromycin - Azithromycin - Clarithromycin
osmotic diuretic - increase tubular fluid osmolarity - thereby increasing urine flow
Immediate anticoagulation for PE - stroke - angina - MI - DVT.
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.