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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 Fluoroquinolones indicated for? (3)
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms
Pseudomembranous colitis (C. difficile) - fever - diarrhea
1)Binds penicillin - binding proteins 2) Blocks transpeptidase cross - linking of cell wall 3) Activates autolytic enzymes
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)

2. List the mechanism - clinical use - & toxicity of Paclitaxel.
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.
Vd= (Amt. of drug in body/ Plasma drug conc.)
Norepinephrine
- Formaldehyde & formic acid - severe acidosis & retinal damage

3. Acetaldehyde is metabolized by Acetaldehyde dehydrogenase - Which drug inhibs this enzyme?
proximal convoluted tubule - thin descending limb - and collecting duct
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.
hypertension - angina - arrhythmias
- Disulfram & also sulfonylureas - metronidazole

4. Beta Blockers - CNS toxicity?
Blocks Peptide Bond formation at the 50S subunit - Bacteriostatic
sedation - sleep alterations
- EDTA - dimercaprol - succimer - & penicillamine
Suramin

5. Name several common Macrolides (3)
- Bleomycin - amiodarone - busulfan
- Niacin - Ca++ channel blockers - adenosine - vancomycin
Erythromycin - Azithromycin - Clarithromycin
hypertension - angina - arrhythmias

6. Adverse effects of Captopril?
Epinephirine(Alpha1 -2 and Beta 1 -2)
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Polymyxins
fetal renal toxicity - hyperkalemia

7. What is the major side effect for Ampicillin and Amoxicillin?
Polymyxins
Hypersensitivity reactions
- Methylene blue
is resistant

8. Which drug(s) cause this reaction: Cinchonism (2)?
cortical collecting tubule
- Quinidine - quinine
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system
cinchonism: HA - tinnitus - thrombocytopenia - torsade de pointes due to increased QT interval

9. What are the products and their toxicities of the metabolism of Ethylene Glycol by / alcohol dehydrogenase?
- Oxalic acid - Acidosis & nephrotoxicity
NO HYPERURICEMIA - NO SULFA AllERGY; same as furosemide otherwise
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
Peptic ulcer disease.

10. Antimicrobial prophylaxis for a history of recurrent UTIs
TMP- SMZ
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
Norepinephrine

11. How does a noncompetitive antagonist effect an agonist?
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.
GI distress - Tooth discoloration and Inhibition of bone growth in children - Fanconi's syndrome - Photosensitivity
Lovastatin - Pravastatin - Simvastatin - Atorvastatin
- Shifts the curve down - reduces Vmax

12. Amiodarone - toxicity?
Quinidine - Amiodarone - Procainamide - Disopyramide
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.
Milk or Antacids - because divalent cations inhibit Tetracycline absorption in the gut
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia

13. What are the major toxic side effects of Imipenem/cilastatin?
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)
GI distress - Skin rash - and Seizures at high plasma levels
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
Cephalosporins

14. How is Ganciclovir activated?
No
Hemolytic anemia
Phosphorylation by a Viral Kinase
Aminoglycosides

15. Acetaminophen has What two clinical uses and lacks What one clinical use of the NSAIDs?
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.
orthostatic and exercise hypotension - sexual dysfunction - diarrhea
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity

16. What are four clinical activities of Aspirin?
thiazides - amiloride
Antimetabolite derivative of 6- mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.
Quinolones

17. What Sulfonamides are used for simple UTIs?
Ibuprofen - Naproxen - and Indomethacin
Triple sulfas or SMZ
- Penicillin
Extended spectrum penicillin: certain Gram + bacteria and Gram - rods

18. List five common glucocorticoids.
1. Hydrocortisone 2. Predisone 3. Triamcinolone 4. Dexamethasone 5. Beclomethasone
Nitrates
- Steroids - Tamoxifen
Chronic anticoagulation.

19. What are the clinical uses for 3rd Generation Cephalosporins?
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
Aminoglycosides - Tetracyclines
Aplastic anemia (dose independent) - Gray Baby Syndrome
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)

20. How does dantrolene work?
GI discomfort - Acute cholestatic hepatitis - Eosinophilia - Skin rashes
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.
- Niacin - Ca++ channel blockers - adenosine - vancomycin

21. MOA: Block cell wall synthesis by inhib. Peptidoglycan cross - linking (7)
Liver
- Estrogen receptor antagonist - Breast CA - increased endometrial CA risk
Amphotericin B - Nystatin - Fluconazole/azoles
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins

22. Mannitol - site of action?
proximal convoluted tubule - thin descending limb - and collecting duct
very short acting
Onchocerciasis ('river blindness'-- rIVER- mectin)
- Tamoxifen

23. What enzyme is responsible for the degredation of Ach
Treatment of infertility.
Modification via Acetylation
Acetylcholine esterase
INH: Injures Neurons and Hepatocytes

24. What is the mechanism of action of NSAIDs other than Aspirin?
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia
CL= (rate of elimination of drug/ Plasma drug conc.)

25. Antiarrhythmic class IB- toxicity?
local anesthetic. CNS stimulation or depression. CV depression.
Aplastic anemia (dose independent) - Gray Baby Syndrome
Nifedipine - Verapamil - Diltiazem
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.

26. What is the most common cause of Pt noncompliance with Macrolides?
local anesthetic. CNS stimulation or depression. CV depression.
Carbenicillin - Piperacillin - and Ticarcillin
GI discomfort
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).

27. Furosemide increases the excretion of What ion?
Ca2+ (Loops Lose calcium)
Those patients who are taking nitrates.
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia
Edrophonium

28. What physiological effects was the Anes using Atropine to tx
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia
Oral
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions

29. Why does NE result in bradycardia?
- Deferoxamine
Immediate anticoagulation for PE - stroke - angina - MI - DVT.
Na/K ATPase
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.

30. Which drug(s) cause this reaction: SLE- like syndrome?
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
- Estrogen receptor antagonist - Breast CA - increased endometrial CA risk
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
- Hydralazine - Procainamide - INH - phenytoin

31. What are two types of drugs that interfere with the action of Sucralfate and why?
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic
Hydralazine and Minoxidil
loop diuretics - spironolactone

32. What are the clinical uses for 2nd Generation Cephalosporins?
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.
None. No - because atropine would block the postganglionic muscarinic receptors involved in sweat gland stimulation.
- Methotrexate - 5 FU - 6 mercaptopurine
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )

33. When is Rifampin not used in combination with other drugs?
severe hypertension - CHF
1. Meningococcal carrier state 2. Chemoprophylaxis in contacts of children with H. influenzae type B
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.
Liver

34. Classes of antihypertensive drugs?
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic
Protamine sulfate
- Chlorpromazine - thioridazine - haloperidol
diuretics - sympathoplegics - vasodilators - ACE inhibitors - Angiotensin II receptor inhibitors

35. In coma situations you rule out What (7)?

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36. What is the MOA for the Azoles?
Scopolamine
Inhibit Ergosterol synthesis
Inhibits Viral DNA polymerase
Beta lactams - inhibit cell wall synthesis - Bactericidal

37. For Heparin What is the Site of action
- Niacin - Ca++ channel blockers - adenosine - vancomycin
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.
Interferes with microtubule function - disrupts mitosis - inhibits growth
Blood

38. Foscarnet does not require activation by a...
Pituitary hormone.
Protease inhibitor.
Chronic gout.
viral kinase

39. What cholinomimetic is useful in the diagnosis of Myasthenia Gravis
- Oxalic acid - Acidosis & nephrotoxicity
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy
Edrophonium

40. What is the mechanism of action of Acetaminophen?
Reversibly inhibits cyclooxygenase - mostly in CNS. Inactivated peripherally.
Epinephrine
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
Triple Therapy' 2 Nucleoside RT Inhibitors with a Protease Inhibitor

41. Dobutamine used for the tx of shock acts on Which receptors
Mg = Must go to the bathroom.
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents
Beta1 more than B2

42. Furosemide - clinical use?
AZT - to reduce risk of Fetal Transmission
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.
Give an antichloinesterase - neostigmine - edrophonium - etc
edematous states (CHF - cirrhosis - nephrotic syndrome - pulm edema) - HTN - hypercalcemia

43. Digitalis - site of action?
Quinolones
Na/K ATPase
HTN - CHF - calcium stone formation - nephrogenic DI.
Gram + - Gram - - Norcardia - Chlamydia

44. Which drug(s) cause this reaction: Disulfram - like reaction (4) ?
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)
- Metronidazole - certain cephalosporins - procarbazine - sulfonylureas
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
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. Name the common Nucleoside Reverse Transcriptase Inhibitors
Zidovudine (AZT) - Didanosine (ddI) - Zalcitabine (ddC) - Stavudine (d4T) - Lamivudine (3TC)
Lidocaine - Mexiletine - Tocainide
hypertension - CHF - diabetic renal disease
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.

46. List the mechanism - clinical use - & toxicity of Cisplatin.
Acetylates and irreversibly inhibits cyclooxygenase (COX I and COX II) to prevent the conversion of arachidonic acid to prostaglandins.
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
- EDTA - dimercaprol - succimer - & penicillamine
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.

47. List the mechanism - clinical use - & toxicity of Cyclophosphamide.
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.
anticholinesterase glaucoma
Interstitial nephritis
Beta - lactam antibiotics

48. What is combination TMP- SMZ used to treat?
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity
In 4 half - lifes= (94%) T1/2 = (0.7x Vd)/CL
1. Bleeding 2. Thrombocytopenia 3. Drug - drug interactions

49. For Warfarin What is the Onset of action
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.
Blocks Influenza A and RubellA; causes problems with the cerebellA
hypertension - angina - arrhythmias
Slow - limited by half lives of clotting factors

50. Which antimuscarinic agents are used in producing mydriasis and cycloplegia?
atropine - homatropine - tropicamide
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
Digoxin=urinary Digitoxin=biliary
-100% oxygen - hyperbaric