Test your basic knowledge |

USMLE Step 1 Pharmacology

Subjects : health-sciences, usmle-step-1

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

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 RT inhibitors cause Lactic Acidosis?
Nucleosides
Captopril - Enalapril - Lisinopril
Increased systolic and pulse pressure - decreased diastolic pressure - and little change in mean pressure.
ARF - shock - drug overdose - decrease intracranial/intraocular pressure

2. What is the mechanism of action of the glucocorticoids?
Decrease the production of leukotrienes and protaglandins by inhibiting phospholipase A2 and expression of COX-2.
Chronic gout.
- Act on same receptor - Full has greater efficacy
Hypersensitivity reactions

3. What are common side effects of RT Inhibitors?
BM suppression (neutropenia - anemia) - Peripheral neuropathy
cholestyramine - colestipol
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride
new arrhythmias - hypotension

4. How is Leishmaniasis treated?
Competitive inibitor of progestins at progesterone receptors.
decrease conduction velocity - increase ERP - increase PR interval
Pentavalent Antimony
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances

5. What antimicrobial class is Aztreonam syngergestic with?
Aminoglycosides
Prevents release of mediators from mast cells. Effective only for the prophylaxis of asthma. Not effective during an acute attack.
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia

6. What musculo - skeletal side effects in Adults are associated with Floroquinolones?
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
Depolymerizes microtubules - impairing leukocyte chemotaxis and degranulation.
Tendonitis and Tendon rupture
Beta adrenergic receptors and Ca2+ channels (stimulatory)

7. Bretyllium - toxicity?
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances
- Isoniazid
new arrhythmias - hypotension
Aminoglycosides - Tetracyclines

8. What is the mechanism of Leuprolide?
1. Better bioavailability 2. 2 to 4 times longer half life 3. Can be administered subcutaneously 4. Does not require laboratory monitoring
Antileukotriene; blocks leukotriene receptors.
ARF - shock - drug overdose - decrease intracranial/intraocular pressure
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

9. How is Foscarnet used clinically?
Ipratropium
CMV Retinitis in IC pts When Ganciclovir fails
hypertension - CHF - diabetic renal disease
Neostigmine - pyridostigmine edrophonium - physostigmine echothiophate

10. What can result due to antacid overuse?
Lovastatin - Pravastatin - Simvastatin - Atorvastatin
torsade de pointes - excessive Beta block
Rare.
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.

11. MOA for Penicillin (3 answers)?
AZT - to reduce risk of Fetal Transmission
1)Binds penicillin - binding proteins 2) Blocks transpeptidase cross - linking of cell wall 3) Activates autolytic enzymes
- Clindamycin
Mg = Must go to the bathroom.

12. What is the mecanism of action - effective period - and ineffective period of use for Cromolyn in treating Asthma?
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
Prevents release of mediators from mast cells. Effective only for the prophylaxis of asthma. Not effective during an acute attack.
Penicillin - V
penicillinase resistant

13. Which drug(s) cause this reaction: P450 inhibition(6)?
Inhibits CMV DNA polymerase
- Ethanol - dialysis - & fomepizole
Hemolysis (if G6PD deficient) - Neurotoxicity - Hepatotoxicity - SLE- like syndrome
- Cimetidine - ketoconazole - grapefruit juice - erythromycin - INH - sulfonamides

14. List the mechanism - clinical use - & toxicity of Methotrexate.
Immediate anticoagulation for PE - stroke - angina - MI - DVT.
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression
Potent immunosuppressive used in organ transplant recipients.
Acetylcholinesterase; ACh is broken down into choline and acetate.

15. MOA: Block cell wall synthesis by inhib. Peptidoglycan cross - linking (7)
Sotalol - Ibutilide - Bretylium - Amiodarone
Nevirapine - Delavirdine
Hemolysis (if G6PD deficient) - Neurotoxicity - Hepatotoxicity - SLE- like syndrome
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins

16. Which of these three drugs will cause a reflex bradycardia in your pt (Norepi - Epi - or Isoporterenol)
CMV - esp in Immunocompromised patients
Norepinephrine (Alpha1 -2 and beta 1)
Norepinephrine
Aminoglycosides - Tetracyclines

17. What are major side effects of Methicillin - Nafcillin - and Dicloxacillin?
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression
Hypersensitivity reactions
VACUUM your Bed Room'
Cephalosporins

18. What is a possible result of overdose of Acetaminophen?
As PABA antimetabolites that inhibit Dihydropteroate Synthase - Bacteriostatic
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis
Foscarnet = pyroFosphate analog

19. Which drug(s) cause this reaction: Extrapyramidal side effects (3)?
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide
- Chlorpromazine - thioridazine - haloperidol
Neurotoxicity - Acute renal tubular necrosis
1. Pioglitazone 2. Rosiglitazone.

20. For Heparin What is the Onset of action
- Lithium
- Halothane - Valproic acid - acetaminophen - Amantia phalloides
Post - op and neurogenic ileus and urinary retention - myasthenia gravis - and reversal of neuromuscular junction blockade (post - op) through anticholinesterase activity.
Rapid (seconds)

21. What is the MOA of Ganciclovir?
is resistant
AZT - to reduce risk of Fetal Transmission
1. Gastric ulceration 2. Bleeding 3. Hyperventilation 4. Reye's syndrome 5. Tinnitus (CN VIII)
Inhibits CMV DNA polymerase

22. What is Imipenem always administered with?
Cilastatin
Inhibits cell wall mucopeptide formation - Bactericidal
Rare.
Acts as a wide spectrum carbapenem

23. Adverse effects of Hydralazine?
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).
- reduction - oxy - & hydrolysis - H2O sol. Polar product - P450
Polymyxin B - Polymyxin E
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention

24. IV Penicillin
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).
Hypersensitivity reactions
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.
Penicillin - G

25. How would hemicholinium treatment affect cholinergic neurons?
Fast vs. Slow Acetylators
Small lipid - soluble molecule
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.

26. What is the lab value used to monitor the effectiveness of Heparin therapy?
The PTT.
cholestyramine - colestipol
- Phase I (clinical tests) - Phase II - Phase III - PhaseIV (surveillance)
Cell membrane Ca2+ channels of cardiac sarcomere

27. Name two bile acid resins.
cholestyramine - colestipol
Non - Nucleosides
Staphlococcus aureus
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide

28. Do Tetracyclines penetrate the CNS?
- NaHCO3
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression
Only in limited amounts
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)

29. What is the MOA of Polymyxins?
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents
Pseudomembranous colitis (C. difficile) - fever - diarrhea
- EDTA - dimercaprol - succimer - & penicillamine
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole

30. MOA: Disrupt bacterial/fungal cell membranes
Beta -2 agonist.
INH: Injures Neurons and Hepatocytes
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.)
Polymyxins

31. What are the nondepolarizing neuromuscular blocking drugs?
Pituitary hormone.
GI disturbances.
Tubocurarine - atracurium - mivacurium - pancuronium - vecuronium - rapacuronium
Succinylcholine

32. Decrease Digoxin dose in renal failure?
1. Hydrocortisone 2. Predisone 3. Triamcinolone 4. Dexamethasone 5. Beclomethasone
Acute (hours)
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
YES

33. How would you reverse the effect of a neuromuscular blocking agent?
DHPG (dihydroxy-2- propoxymethyl guanine)
- NaHCO3
Imipenem
Give an antichloinesterase - neostigmine - edrophonium - etc

34. What is the mechanism of action of Omeprazole - Lansoprazole?
Neomycin
Phenothiazine (neuroleptic - antiemetic).
Yes - it does not cross the placenta.
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.

35. What is the memory key for organisms treated with Tetracyclines?

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183

36. How does botulinum toxin result in respiratory arrest?
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal
Prevents the release of ACh - Which results in muscle paralysis.
Pyridoxine (B6) administration
Cephalosporins

37. What is the MOA for the Azoles?
Binding to the presynaptic alpha 2 release modulating receptors
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome
Inhibit Ergosterol synthesis

38. Procainamide - toxicity?
reversible SLE- like syndrome
anticholinesterase glaucoma
- Bleomycin - amiodarone - busulfan
Protamine sulfate

39. Name the common Fluoroquinolones (6)
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic
Modification via Acetylation - Adenylation - or Phosphorylation
Ciprofloxacin - Norfloxacin - Ofloxacin - Grepafloxacin - Enoxacin - Nalidixic acid
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels

40. What is the mechanism of action of Clomiphene?
Ibuprofen - Naproxen - and Indomethacin
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.
Imipenem
Enterobacter

41. List the mechanism - clinical use - & toxicity of Cyclophosphamide.
Extended spectrum penicillin: certain Gram + bacteria and Gram - rods
- Hydralazine - Procainamide - INH - phenytoin
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.
Diarrhea - Urination - Miosis - Bronchospasm - Bradycardia - Excitation of skeletal muscle and CNS - Lacrimation - Sweating - and Salivation = DUMBBELS; also abdominal cramping

42. Why would you use pralidoxime after exposure to an organophosphate?
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic
Pralidoxime regenerates active cholinesterase.
Mg = Must go to the bathroom.
- Glucagon

43. Which individuals are predisposed to Sulfonamide - induced hemolysis?
Inhibits platelet aggregation by irreversibly inhibiting the ADP pathway involved in the binding of fibrinogen.
Praziquantel
Cryptococcal meningitis in AIDS patients and Candidal infections of all types
G6PD deficient individuals

44. What are two types of drugs that interfere with the action of Sucralfate and why?
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.
osmotic diuretic - increase tubular fluid osmolarity - thereby increasing urine flow

45. Hydralazine - toxicity?
- inhibits HGPRT (pur. Syn.) - Luk - Lymph
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
compensatory tachycardia - fluid retention - lupus - like syndrome
Albuterol - tertbutaline

46. Adverse effects of ganglionic blockers?
Hypersensitivity reactions
severe orthostatic hypotension - blurred vision - constipation - sexual dysfunction
aPTT (intrinsic pathway)
1. Pioglitazone 2. Rosiglitazone.

47. What are the clinical uses for 2nd Generation Cephalosporins?
sedation - depression - nasal stuffiness - diarrhea
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
1. Weight gain 2. Hepatotoxicity (troglitazone)
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )

48. Digoxin v. Digitoxin: half life?
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system
- DNA intercalator - Hodgkin's - myeloma - sarcoma - and solid tumors - Cardiotoxicity & alopecia
Forms toxic metabolites in the bacterial cell - Bactericidal
Digitoxin 168hrs Digoxin 40 hrs

49. What is a sign of toxicity with the use of thrombolytics?
Triple Therapy' 2 Nucleoside RT Inhibitors with a Protease Inhibitor
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
Bleeding.
Tendonitis and Tendon rupture

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

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183