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. What is the clinical use for Penicillin?
Bactericidal for: Gram + rod and cocci - Gram - cocci - and Spirochetes
Megaloblastic anemia - Leukopenia - Granulocytopenia
Same as penicillin. Extended spectrum antibiotics
- Quinidine - quinine

2. How are Interferons (INF) used clinically?

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

3. What are four Sulfonylureas?
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide
Quinolones
HTN - CHF - calcium stone formation - nephrogenic DI.
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.

4. What are five disadvantages of Oral Contraceptives (synthetic progestins - estrogen)?
local anesthetic. CNS stimulation or depression. CV depression.
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state
GI disturbances.
AZT - to reduce risk of Fetal Transmission

5. Which RT inhibitors cause Lactic Acidosis?
1. Renal damage 2. Aplastic anemia 3. GI distress
check PFTs - LFTs - and TFTs
Nucleosides
Inhibit viral DNA polymerase

6. ACE inhibitors - mechanism?
reduce levels of Angiotensin II - thereby preventing the inactivation of bradykinin (a potent vasodilator); renin level is increased
- Acetaldehyde - Nausea - vomiting - headache - & hypotension
dry mouth - sedation - severe rebound hypertension
CMV Retinitis in IC pts When Ganciclovir fails

7. What is a common side effect of Misoprostol?
Diarrhea
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.
Quinolones
Methylation of rRNA near Erythromycin's ribosome binding site

8. What is the MOA for Trimethoprim (TMP)?
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.
Bleeding.
Phenothiazine (neuroleptic - antiemetic).
Inhibits bacterial Dihydrofolate Reductase - Bacteriostatic

9. What is the MOA of Amantadine?
Inhibits formation of Initiation Complex - causes misreading of mRNA - Bactericidal
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome
Leukotrienes increasing bronchial tone.
- Normalize K+ - Lidocaine - & Anti - dig Mab

10. What drug is used to treat Trematode/fluke (e.g. - Schistosomes - Paragonimus - Clonorchis) or Cysticercosis
Benzodiazepine.
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances
Praziquantel
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.

11. Describe the MOA of Interferons (INF)
Rifampin - Ethambutol - Streptomycin - Pyrazinamide - Isoniazid (INH)
1. Addison's disease 2. Inflammation 3. Immune suppression 4. Asthma
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis
1. Better bioavailability 2. 2 to 4 times longer half life 3. Can be administered subcutaneously 4. Does not require laboratory monitoring

12. Name three Antiarrhythmic drugs in class IV.
Norepinephrine (Alpha1 -2 and beta 1)
Verapamil - Diltiazem - Bepridil
1. Acarbose 2. Miglitol
No - it inhibits the release of Nor Epi

13. Adverse effects of Clonidine?
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.
Beta1 more than B2
AmOxicillin has greater Oral bioavailability
dry mouth - sedation - severe rebound hypertension

14. Beta Blockers - BP?
decrease
Nevirapine - Delavirdine
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity
- B51Naloxone / naltrexone (Narcan)

15. What is treated with Chloroquine - Quinine - Mefloquine?
- Cimetidine - ketoconazole - spironolactone - digitalis - EtOH - estrogens
Malaria (P. falciparum)
Treatment of infertility.
Alpha -1 antagonist

16. List the specific antidote for this toxin: Iron
- Deferoxamine
- Cloazapine - carbamazapine - colchicine - PTU
proarrhythmic
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.

17. Name three Antiarrhythmic drugs in class IB.
Acetylcholine esterase
Lidocaine - Mexiletine - Tocainide
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
Acute gout.

18. A group of pts are rushed into the ER complaining of excessive sweating - tearing - salivation - HA - N and V - muscle twitching - difficulty breathing and diarrhea. What drug would be the most effective immediate tx
It affects beta receptors equally and is used in AV heart block (rare).
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
1. Bleeding 2. Thrombocytopenia 3. Drug - drug interactions

19. List the specific antidote for this toxin: Heparin
- Protamine
Ataxia - Dizziness - Slurred speech
effective in torsade de pointes and digoxin toxicity
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome

20. What sympathomimetic would you not prescribe for hypotension in a pt with renal artery sclerosis.
Benzodiazepine.
Norepinephrine (Alpha1 -2 and beta 1)
Botulinum
AmOxicillin has greater Oral bioavailability

21. What is Metronidazole used for clinically?
Antiprotozoal: Giardia - Entamoeba - Trichomonas - Gardnerella vaginalis Anaerobes: Bacteroides - Clostridium
Mycobacterium tuberculosis - the only agent used as solo prophylaxis against TB
Headache - flushing - dyspepsia - blue - green color vision.
Gram + cocci - Gram - rods - and Anerobes

22. MOA: Block protein synthesis at 50s subunit
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA
GI upset - Superinfections - Skin rashes - Headache - Dizziness
torsade de pointes
Chloramphenicol - Erythromycin/macrolides - Lincomycin - Clindamycin - Streptogramins (quinupristin - dalfopristin)

23. K+ sparing diuretics - toxicity?
Hypersensitivity reactions
Ganciclovir is more toxic to host enzymes
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.

24. List the mechanism - clinical use - & toxicity of Cisplatin.
1. Predisposes to viral infections and lymphoma 2. Nephrotoxic (preventable with mannitol diuresis)
Wide spectrum of systemic mycoses: Cryptococcus - Blastomyces - Coccidioides - Aspergillus - Histoplasma - Candida - Mucor
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH

25. List the mechanism - clinical use - & toxicity of 6 MP.
Ibuprofen - Naproxen - and Indomethacin
Inhibits DNA dependent RNA polymerase
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).
- inhibits HGPRT (pur. Syn.) - Luk - Lymph

26. Which drug(s) cause this reaction: Gray baby syndrome?
K+ wasting - metabolic alkalosis - hypotension - ototoxicity
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)
- Chloramphenicol
Inhibits Viral DNA polymerase

27. MOA: Block protein synthesis at 30s subunit
Diuresis in pateints with sulfa allergy
- Upper respiratory tract infections - pneumonias - STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) - Mycoplasma - Legionella - Chlamydia - Neisseria
Aminoglycosides - Tetracyclines
YES

28. What is a mnemonic to remember Amantadine's function?
Chronic Hepatitis A and B - Kaposi's Sarcoma
1. Pioglitazone 2. Rosiglitazone.
Blocks Influenza A and RubellA; causes problems with the cerebellA
WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.

29. IV Penicillin
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.
Penicillin - G
Acute (hours)

30. What are the Macrolides used for clinically?
osmotic diuretic - increase tubular fluid osmolarity - thereby increasing urine flow
Anaerobes
hypertension - CHF - diabetic renal disease
- Upper respiratory tract infections - pneumonias - STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) - Mycoplasma - Legionella - Chlamydia - Neisseria

31. Which drug(s) cause this reaction: Tardive dyskinesia?
- Antipsychotics
TCA
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).
propanolol - esmolol - metoprolol - atenolol - timolol

32. Ca2+ channel blockers - mechanism?
Peptic ulcer disease.
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility
Protease inhibitor.
- Lithium

33. What is a sign of toxicity with the use of thrombolytics?
1. Hydrocortisone 2. Predisone 3. Triamcinolone 4. Dexamethasone 5. Beclomethasone
Foscarnet = pyroFosphate analog
Bleeding.
Abortifacient.

34. MOA: Disrupt bacterial/fungal cell membranes
Polymyxins
pulmonary edema - dehydration
Cilastatin
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.

35. How is Ganciclovir activated?
- Nitrate - hydroxocobalamin thiosulfate
Phosphorylation by a Viral Kinase
anticholinesterase glaucoma
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.

36. List the specific antidote for this toxin: Lead
- EDTA - dimercaprol - succimer - & penicillamine
Topical and Oral - for Oral Candidiasis (Thrush)
Increases coumadin metabolism
cholestyramine - colestipol

37. What is the MOA of Isoniazid (INH)?
Decreases synthesis of Mycolic Acid
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)
Neostigmine - pyridostigmine edrophonium - physostigmine echothiophate
Bactericidal for: Gram + rod and cocci - Gram - cocci - and Spirochetes

38. What is an additional side effect of Methicillin?
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.)
Interstitial nephritis
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.
- Physostigmine salicylate

39. Isopoterenol was given to a patient with a developing AV block - why?
TCA
Binds to the Pyrophosphate Binding Site of the enzyme
Butyrophenone (neuroleptic).
Stimulates beta adrenergic receptors

40. What are the products and their toxicities of the metabolism of ethanol by / alcohol dehydrogenase?
Stimulates beta adrenergic receptors
- Acetaldehyde - Nausea - vomiting - headache - & hypotension
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
Protease inhibitor.

41. For Heparin What is the Onset of action
BM suppression (neutropenia - anemia) - Peripheral neuropathy
Rapid (seconds)
Digoxin=urinary Digitoxin=biliary
cross - allergenic

42. What is the effect of TCA's on the adrenergic nerve?
They inhibit reuptake of NE at the nerve terminal (as does cocaine).
Triple Therapy' 2 Nucleoside RT Inhibitors with a Protease Inhibitor
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation
glaucoma - urinary alkalinization - metabolic alkalosis - altitude sickness

43. What is an occasional side effect of Aztreonam?
GI upset
Chronic gout.
Liver
Flecainide - Encainide - Propafenone

44. Mannitol - clinical use?
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori
ARF - shock - drug overdose - decrease intracranial/intraocular pressure
1. Better bioavailability 2. 2 to 4 times longer half life 3. Can be administered subcutaneously 4. Does not require laboratory monitoring
Prevents the release of Ca from SR of skeletal muscle

45. What enzyme does Zileuton inhibit?
loop diuretics - thiazides
Lipoxygenase
Chronic gout.
edrophonium (extremely short acting anticholinesterase)

46. For Heparin What is the Lab value to monitor
For serious - Gram + multidrug - resistant organisms
collecting ducts
GI upset - Superinfections - Skin rashes - Headache - Dizziness
aPTT (intrinsic pathway)

47. For Heparin What is the Site of action
Imipenem
Blood
Inhibits Viral DNA polymerase
- Shifts the curve down - reduces Vmax

48. What is the memory key for Isoniazid (INH) toxicity?
INH: Injures Neurons and Hepatocytes
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
Delirium - Tremor - Nephrotoxicity
Gram + cocci - Gram - rods - and Anerobes

49. K+ sparing diuretics - clinical use?
Inhibits Viral DNA polymerase
Ototoxicity - Hypokalemia - Dehydration - Allergy (sulfa) - Nephritis (interstitial) - Gout
Mg = Must go to the bathroom.
hyperaldosteronism - K+ depletion - CHF

50. What is the only depolarizing neuromuscular blocking agent?
physostigmine
Succinylcholine
cortical collecting tubule
Dopamine