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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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1. List the specific antidote for this toxin: Benzodiazepines
Chronic Hepatitis A and B - Kaposi's Sarcoma
It must be Phosphorylated by Viral Thymidine Kinase
- Flumazenil
Phenothiazine (neuroleptic - antiemetic).

2. What is a common side effect of Misoprostol?
Beta - lactam antibiotics
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.
Diarrhea
carbonic anhydrase inhibitors - K+ sparing diuretics

3. ACE inhibitors - toxicity?
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.
cyanide toxicity (releases CN)
Give an antichloinesterase - neostigmine - edrophonium - etc

4. Beta Blockers - site of action?
- Nitrate - hydroxocobalamin thiosulfate
Beta adrenergic receptors and Ca2+ channels (stimulatory)
Cilastatin
Tendonitis and Tendon rupture

5. Why is pyridostigmine effective in the treatment of myasthenia gravis?
As an anticholinesterase it increases endogenous ACh and thus increases strength.
Beta lactams - inhibit cell wall synthesis - Bactericidal
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
- Hypersensitivity reactions - Hemolysis - Nephrotoxicity (tubulointerstitial nephritis) - Kernicterus in infants Displace other drugs from albumin (e.g. - warfarin)

6. What is the lab value used to monitor the effectiveness of Heparin therapy?
Reserpine inhibits dopamine transport into vesicles - attenuating its conversion to NE by dopamine beta - hydroxylase.
CMV - esp in Immunocompromised patients
The PTT.
Gemfibrozil - Clofibrate

7. Side effects of Isoniazid (INH)?
Sulfamethoxazole (SMZ) - Sulfisoxazole - Triple sulfas - Sulfadiazine
Hemolysis (if G6PD deficient) - Neurotoxicity - Hepatotoxicity - SLE- like syndrome
GET on the Metro
troponin - tropomyosin system

8. What are common side effects of Protease Inhibitors?
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)
Rapid (seconds)
Gemfibrozil - Clofibrate
Pituitary hormone.

9. ACE inhibitors - clinical use?
Chagas' disease - American Trypanosomiasis (Trypanosoma cruzi)
hypertension - CHF - diabetic renal disease
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic
Same as penicillin. Extended spectrum antibiotics

10. What is the category and mechanism of action of Zafirlukast in Asthma treatment?
loop diuretics - spironolactone
Antileukotriene; blocks leukotriene receptors.
thiazides - amiloride
VACUUM your Bed Room'

11. Ibutilide - toxicity?
viral kinase
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
torsade de pointes
Used in combination therapy with SMZ to sequentially block folate synthesis

12. What is the category of drug names ending in - ipramine (e.g. Imipramine)
Prevents the release of ACh - Which results in muscle paralysis.
Tricyclic antidepressant.
Inhibits bacterial Dihydrofolate Reductase - Bacteriostatic
Bleeding.

13. What is the mechanism of action of Mifepristone (RU486)?
Competitive inibitor of progestins at progesterone receptors.
glaucoma - urinary alkalinization - metabolic alkalosis - altitude sickness
- DNA intercalator - testicular & lymphomas - Pulmonary fibrosis mild myelosuppression.
Same as penicillin. Extended spectrum antibiotics

14. What is the clinical use for Heparin?
PT
Penicillin - Cephalosporins - Vancomycin - Aminoglycosides - Fluoroquinolones - Metronidazole
block Na+ channels in the cortical collecting tubule
Immediate anticoagulation for PE - stroke - angina - MI - DVT.

15. What is the category of drug names ending in - triptyline (e.g. Amitriptyline)
Tricyclic antidepressant.
INH: Injures Neurons and Hepatocytes
Potent immunosuppressive used in organ transplant recipients.
local anesthetic. CNS stimulation or depression. CV depression.

16. What are toxicities associated with Chloramphenicol?
Meningitis (H. influenza - N. meningitidis - S. pneumoniae) - Conserative treatment due to toxicities
Aplastic anemia (dose independent) - Gray Baby Syndrome
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia
- Alkalinize urine & dialysis

17. Adenosine - clinical use?
bradycardia - AV block - CHF
DOC in diagnosing and abolishing AV nodal arrhythmias
The only local anesthetic with vasoconstrictive properties.
GET on the Metro

18. What is the category of drug names ending in - tropin (e.g. Somatotropin)
Pituitary hormone.
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
GI discomfort
1. Antiandrogen 2. Nausea 3. Vomiting

19. What are two clinical uses of Azathioprine?
Pregnant women - Children; because animal studies show Damage to Cartilage
Staphlococcus aureus
Interstitial nephritis
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)

20. What is the category of drug names ending in - tidine (e.g. Cimetidine)
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole
- Phenytoin
H2 antagonist

21. K+- clinical use?
Beta antagonist.
reduce levels of Angiotensin II - thereby preventing the inactivation of bradykinin (a potent vasodilator); renin level is increased
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load
depresses ectopic pacemakers - especially in digoxin toxicity

22. List the mechanism - clinical use - & toxicity of Prednisone.

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23. What is the MOA for Acyclovir?
Inhibit viral DNA polymerase
- Atropine & pralidoxime
proximal convoluted tubule
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine

24. Reserpine will block the syntheis of this drug and but not its precursor.
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas
Blocks Norepi - but not Dopamine
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.

25. Resistance mechanisms for Vancomycin
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity
Teratogenic - Carcinogenic - Confusion - Headaches
Abortifacient.
fetal renal toxicity - hyperkalemia

26. Name the steps in drug approval(4)?
Inhibits Viral DNA polymerase
- Phase I (clinical tests) - Phase II - Phase III - PhaseIV (surveillance)
Increased systolic and pulse pressure - decreased diastolic pressure - and little change in mean pressure.
Blood

27. As an Anes you want to use a depolarizing neuromuscular blocking drug on your pt - What do you use
vasodilator - increases cGMP to induce smooth muscle relaxation (arterioles>veins; afterload reduction)
Competitive inibitor of progestins at progesterone receptors.
Succinylcholine
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.

28. What drug is used to diagnose myasthenia gravis?
edrophonium (extremely short acting anticholinesterase)
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention
- Atropine & pralidoxime
Same as penicillin. Extended spectrum antibiotics

29. What is the category of drug names ending in - azine (e.g. Chlorpromazine)
vascular sm. Mus.: Nifedipine>Diltiazem>Verapamil
1. Renal damage 2. Aplastic anemia 3. GI distress
edrophonium (extremely short acting anticholinesterase)
Phenothiazine (neuroleptic - antiemetic).

30. What is action of insulin in the liver - in muscle - and in adipose tissue?
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.
Chronic gout.
Staphlococcus aureus
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.)

31. Which antimuscarinic agents are used in producing mydriasis and cycloplegia?
atropine - homatropine - tropicamide
IV vitamin K and fresh frozen plasma
Binds ergosterol - Disrupts fungal membranes
impotence - exacerbation of asthma - CV effects - CNS effects - may mask hypoclycemia

32. Adverse effects of beta - blockers?
loop diuretics - thiazides
In 4 half - lifes= (94%) T1/2 = (0.7x Vd)/CL
impotence - asthma - CV effects (bradycardia - CHF - AV block) - CNS effects (sedation - sleep alterations)
To inhibit renal Dihydropeptidase I and decrease Imipenem inactivation in the renal tubules

33. What drug is given for Pneumocystis carinii prophylaxis?
Penicillin.
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH
physostigmine
Pentamidine

34. Ethacrynic Acid - clinical use?
Diuresis in pateints with sulfa allergy
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.
Acetylcholine esterase
Inhibit Ergosterol synthesis

35. What drugs target anticholinesterase
Captopril - Enalapril - Lisinopril
very short acting
Neostigmine - pyridostigmine edrophonium - physostigmine echothiophate
Cephalosporins

36. What can result due to antacid overuse?
Inhibition of 50S peptidyl transferase - Bacteriostatic
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.
RESPIre

37. What is the MOA of Imipenem?
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)
Tricyclic antidepressant.
Acts as a wide spectrum carbapenem
Nephrotoxicity

38. Common side effects associated with Clindamycin include?
Bactericidal for: Gram + rod and cocci - Gram - cocci - and Spirochetes
Pseudomembranous colitis (C. difficile) - fever - diarrhea
reversible SLE- like syndrome
Similar to cyclosporine; binds to FK- binding protein - inhibiting secretion of IL-2 and other cytokines.

39. What is the major side effect for Ampicillin and Amoxicillin?
HSV - VZV - EBV - Mucocutaneous and Genital Herpes Lesions - Prophylaxis in Immunocompromised pts
Same as penicillin. Act as narrow spectrum antibiotics
Hypersensitivity reactions
1. Predisposes to viral infections and lymphoma 2. Nephrotoxic (preventable with mannitol diuresis)

40. What is the MOA for the Cephalosporins?
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine
Pyridoxine (B6) administration
decrease conduction velocity - increase ERP - increase PR interval
Beta lactams - inhibit cell wall synthesis - Bactericidal

41. Which diuretics decrease urine Ca2+?
Aminoglycosides
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.
Phenothiazine (neuroleptic - antiemetic).
thiazides - amiloride

42. Adverse effects of Hydralazine?
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention
Binds to the Pyrophosphate Binding Site of the enzyme
As PABA antimetabolites that inhibit Dihydropteroate Synthase - Bacteriostatic
Digoxin=urinary Digitoxin=biliary

43. What are major side effects of Methicillin - Nafcillin - and Dicloxacillin?
scopolamine
Hypersensitivity reactions
Cephalosporins
cortical collecting tubule

44. What is the category of drug names ending in - zosin (e.g. Prazosin)
Primaquine
carbonic anhydrase inhibitors - K+ sparing diuretics
Triple sulfas or SMZ
Alpha -1 antagonist

45. Describe Phase I metabolism in liver(3)?
- reduction - oxy - & hydrolysis - H2O sol. Polar product - P450
competitive inhibirot of aldosterone in the cortical collecting tubule
TCA
Nephrotoxicity

46. How is Ganciclovir activated?
Phosphorylation by a Viral Kinase
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis
proarrhythmic
- Acetaldehyde - Nausea - vomiting - headache - & hypotension

47. What is the mecanism of action of Sucralfate?
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.
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.
hyperaldosteronism - K+ depletion - CHF
Useful in muscle paralysis during surgery or mechanical ventilation.

48. Resistance mechanisms for Tetracycline
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.
Decreased uptake or Increased transport out of cell
competitive inhibirot of aldosterone in the cortical collecting tubule
GI distress - Tooth discoloration and Inhibition of bone growth in children - Fanconi's syndrome - Photosensitivity

49. Antiarrhythmic class IB- effects?
Ganciclovir is more toxic to host enzymes
Penicillin - Cephalosporins - Vancomycin - Aminoglycosides - Fluoroquinolones - Metronidazole
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system
Inhibits reabsorption of uric acid.

50. How do we stop angina?
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
reduce levels of Angiotensin II - thereby preventing the inactivation of bradykinin (a potent vasodilator); renin level is increased
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.