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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 four Sulfonylureas?
It must be Phosphorylated by Viral Thymidine Kinase
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide
- Normalize K+ - Lidocaine - & Anti - dig Mab
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.

2. List the specific antidote for this toxin: Arsenic (all heavy metals)
Hypersensitivity reactions
Choline acetyltransferase
- Dimercaprol - succimer
GI discomfort - Acute cholestatic hepatitis - Eosinophilia - Skin rashes

3. What is the category - desired effect - and adverse effect of Isoproterenol in the treatment of Asthma?
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).
Yes - it does not cross the placenta.
In 4 half - lifes= (94%) T1/2 = (0.7x Vd)/CL
cinchonism: HA - tinnitus - thrombocytopenia - torsade de pointes due to increased QT interval

4. What populations are Floroquinolones contraindicated in? Why?
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide
Penicillin - G
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms
Pregnant women - Children; because animal studies show Damage to Cartilage

5. What are Aminoglycosides synergistic with?
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.
Fast vs. Slow Acetylators
Beta - lactam antibiotics

6. What is the category of drug names ending in - azol (e.g. Ketoconazole)
ACIDazolamide' causes acidosis
Antifungal.
very short acting
Fast vs. Slow Acetylators

7. Acetazolamide - toxicity?
Peptic ulcer disease.
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy
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.

8. What antimuscarinic drug is useful for the tx of asthma
Ipratropium
Beta antagonist.
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.
Erythromycin - Azithromycin - Clarithromycin

9. How is Trimethoprim used clinically?
Used in combination therapy with SMZ to sequentially block folate synthesis
Digoxin=urinary Digitoxin=biliary
GI upset - Superinfections - Skin rashes - Headache - Dizziness
Minor hepatotoxicity - Drug interactions (activates P450)

10. Sotalol - toxicity?
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation
dizziness - flushing - constipation (verapamil) - nausea
Indomethacin is used to close a patent ductus arteriosus.
torsade de pointes - excessive Beta block

11. List the specific antidote for this toxin: Acetaminophen
1. Meningococcal carrier state 2. Chemoprophylaxis in contacts of children with H. influenzae type B
Phenothiazine (neuroleptic - antiemetic).
severe hypertension - CHF
- N- acetylcystine

12. Antiarrhythmic class IC- toxicity?
proarrhythmic
1. Heavy bleeding 2. GI effects (n/v - anorexia) 3. Abdominal pain
physostigmine
- Tricyclic antidepressants

13. What is a possible result of overdose of Acetaminophen?
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
Aminoglycosides
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH
Short.

14. Mannitol - site of action?
Penicillin - G
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis
all of them
proximal convoluted tubule - thin descending limb - and collecting duct

15. What are are the Sulfonylureas (general description) and What is their use?
Sulfonylureas are oral hypoglycemic agents - they are used to stimulate release of endogenous insulin in NIDDM (type -2).
Inhibits cell wall synthesis ( binds to PBP3). A monobactam
sedation - sleep alterations
Imipenem

16. What is the MOA for the Cephalosporins?
Beta lactams - inhibit cell wall synthesis - Bactericidal
Digitoxin>95% Digoxin 75%
Foscarnet = pyroFosphate analog
proarrhythmic

17. What are Amantadine - associated side effects?
Ataxia - Dizziness - Slurred speech
Erythromycin - Azithromycin - Clarithromycin
torsade de pointes - excessive Beta block
increase AP duration - increase ERP - increase QT interval - for use When other arrhythmics fail

18. What anticholinesterase crosses the blood - brain - barrier?
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention
physostigmine
Leukotrienes increasing bronchial tone.
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).

19. Antimicrobial prophylaxis for Syphilis
is resistant
sedation - sleep alterations
Benzathine penicillin G
- Hydralazine - Procainamide - INH - phenytoin

20. Which drug(s) cause this reaction: Thrombotic complications?
AZT
- Oral Contraceptives
- Nitrate - hydroxocobalamin thiosulfate
- Act on same receptor - Full has greater efficacy

21. What are the products and their toxicities of the metabolism of Ethylene Glycol by / alcohol dehydrogenase?
Primaquine
- Oxalic acid - Acidosis & nephrotoxicity
Decreases synthesis of Mycolic Acid
- Formaldehyde & formic acid - severe acidosis & retinal damage

22. What are five disadvantages of Oral Contraceptives (synthetic progestins - estrogen)?
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state
Prevents the release of Ca from SR of skeletal muscle
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)
Acetylcholinesterase; ACh is broken down into choline and acetate.

23. What is the effect of TCA's on the adrenergic nerve?
Those patients who are taking nitrates.
compensatory tachycardia - fluid retention - lupus - like syndrome
They inhibit reuptake of NE at the nerve terminal (as does cocaine).
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine

24. What enzyme is responsible for the production of Ach from Acetyl CoA and Choline
Prefers beta's at low doses - but at higher doses alpha agonist effects are predominantly seen.
loop diuretics - thiazides
Choline acetyltransferase
- Hypersensitivity reactions - Hemolysis - Nephrotoxicity (tubulointerstitial nephritis) - Kernicterus in infants Displace other drugs from albumin (e.g. - warfarin)

25. How is Leishmaniasis treated?
Diarrhea - Urination - Miosis - Bronchospasm - Bradycardia - Excitation of skeletal muscle and CNS - Lacrimation - Sweating - and Salivation = DUMBBELS; also abdominal cramping
YES
Chronic gout.
Pentavalent Antimony

26. Antiarrhythmic Class III- effects?
Pregnant women - Children; because animal studies show Damage to Cartilage
- Cimetidine - ketoconazole - grapefruit juice - erythromycin - INH - sulfonamides
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
increase AP duration - increase ERP - increase QT interval - for use When other arrhythmics fail

27. What is the mechanism of action of the thrombolytics?
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)
Prevents the release of Ca from SR of skeletal muscle
Rifampin (DOC) - minocycline
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.)

28. What is the MOA for Acyclovir?
Norepinephrine (Alpha1 -2 and beta 1)
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Inhibit viral DNA polymerase
Inhibits bacterial Dihydrofolate Reductase - Bacteriostatic

29. When is HIV therapy initiated?
Pseudomonas species and Gram - rods
- Corticosteroids - heparin
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load
not a sulfonamide - but action is the same as furosemide

30. K+ sparing diuretics - clinical use?
Inhibt Assembly of new virus by Blocking Protease Enzyme
cross - allergenic
hyperaldosteronism - K+ depletion - CHF
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills

31. What is the MOA for the Fluoroquinolones?
Aminoglycosides
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)

32. Name common Polymyxins
vascular sm. Mus.: Nifedipine>Diltiazem>Verapamil
1. Gastric ulceration 2. Bleeding 3. Hyperventilation 4. Reye's syndrome 5. Tinnitus (CN VIII)
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
Polymyxin B - Polymyxin E

33. What are common toxicities associated with Tetracyclines?

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34. What are Methicillin - Nafcillin - and Dicloxacillin used for clinically?
Penicillin - G
Staphlococcus aureus
Hydralazine and Minoxidil
Benzathine penicillin G

35. Digoxin v. Digitoxin: bioavailability?
Succinylcholine
1. Hydrocortisone 2. Predisone 3. Triamcinolone 4. Dexamethasone 5. Beclomethasone
Digitoxin>95% Digoxin 75%
- Metronidazole - certain cephalosporins - procarbazine - sulfonylureas

36. List the specific antidote for this toxin: Anticholinesterases (organophosphate.)
- Atropine & pralidoxime
fetal renal toxicity - hyperkalemia
Rifampin - Ethambutol - Streptomycin - Pyrazinamide - Isoniazid (INH)
Reversible block of histamine H2 receptors

37. What is the lab value used to monitor the effectiveness of Heparin therapy?
anticholinesterase glaucoma
The PTT.
Antibiotic - protein synthesis inhibitor.
Clomiphene is a partial agonist at estrogen receptors in the pituitary gland. Prevents normal feedback inhibition and increses release of LH and FSHfrom the pituitary - Which stimulates ovulation.

38. Which drug(s) cause this reaction: P450 inhibition(6)?
- Cimetidine - ketoconazole - grapefruit juice - erythromycin - INH - sulfonamides
These B-2 agonists cause respiratory smooth muscle to relax.
It affects beta receptors equally and is used in AV heart block (rare).
- Formaldehyde & formic acid - severe acidosis & retinal damage

39. Which RT inhibitor causes Megaloblastic Anemia?
AZT
Zidovudine (AZT) - Didanosine (ddI) - Zalcitabine (ddC) - Stavudine (d4T) - Lamivudine (3TC)
-100% oxygen - hyperbaric
Reversibly inhibits cyclooxygenase - mostly in CNS. Inactivated peripherally.

40. What is the definition of zero - order kinetics? Example?
- Constant AMOUNT eliminated per unit time. - Etoh & ASA
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.
GI upset
Sotalol - Ibutilide - Bretylium - Amiodarone

41. What microorganisms is Aztreonam not effective against?
Gram + and Anerobes
Abortifacient.
proximal convoluted tubule
1. Antiandrogen 2. Nausea 3. Vomiting

42. What is the category of drug names ending in - navir (e.g. Saquinavir)
Methylxanthine.
Tricyclic antidepressant.
Forms toxic metabolites in the bacterial cell - Bactericidal
Protease inhibitor.

43. Adverse effects of Guanethidine?
Hypersensitivity reactions
Inhibits Viral DNA polymerase
1. Bleeding 2. Teratogenicity 3. Drug - drug interactions
orthostatic and exercise hypotension - sexual dysfunction - diarrhea

44. Which cancer drugs effect nuclear DNA (4)?
Pretreat with antihistamines and a slow infusion rate
Pseudomembranous colitis (C. difficile) - fever - diarrhea
propanolol - esmolol - metoprolol - atenolol - timolol
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide

45. Which of epi - norepi - or isoproterenol results in bradycardia?
Due to the presence of a bulkier R group
cinchonism: HA - tinnitus - thrombocytopenia - torsade de pointes due to increased QT interval
Norepinephrine
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)

46. Your patient wants an effective drug to treat his motion sickness - What would you prescribe
Scopolamine
- Acetaldehyde - Nausea - vomiting - headache - & hypotension
Binds to the Pyrophosphate Binding Site of the enzyme
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy

47. How would you treat African Trypanosomiasis (sleeping sickness)?
Beta1 more than B2
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions
Ca2+ (Loops Lose calcium)
Suramin

48. Spironolactone - mechanism?
competitive inhibirot of aldosterone in the cortical collecting tubule
- Isoniazid
Beta - lactam antibiotics
Small lipid - soluble molecule

49. How would hemicholinium treatment affect cholinergic neurons?
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.
Liver
Succinylcholine
Interferes with microtubule function - disrupts mitosis - inhibits growth

50. What are four H2 Blockers?
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.
Nifedipine - Verapamil - Diltiazem
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.