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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 five disadvantages of Oral Contraceptives (synthetic progestins - estrogen)?
Blocks Influenza A and RubellA; causes problems with the cerebellA
1. Reliable (<1% failure) 2. Lowers risk of endometrial and ovarian cancer 3. Decreased incidence of ectopic pregnancy 4. Lower risk of pelvic infections 5. Regulation of menses
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state
Inhibits platelet aggregation by irreversibly inhibiting the ADP pathway involved in the binding of fibrinogen.

2. Decrease Digitoxin dose in renal failure?
Triple Therapy' 2 Nucleoside RT Inhibitors with a Protease Inhibitor
NO
Digitoxin 70% Digoxin 20-40%
1. Meningococcal carrier state 2. Chemoprophylaxis in contacts of children with H. influenzae type B

3. What is Imipenem always administered with?
These B-2 agonists cause respiratory smooth muscle to relax.
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load
Tricyclic antidepressant.
Cilastatin

4. How does dantrolene work?
for RSV
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.
Malaria (P. falciparum)
Pralidoxime regenerates active cholinesterase.

5. What is the category of drug names ending in - terol (e.g. Albuterol)
Blocks Influenza A and RubellA; causes problems with the cerebellA
Constant FRACTION eliminated per unit time.(exponential)
Abortifacient.
Beta -2 agonist.

6. What is the MOA of Isoniazid (INH)?
Triple sulfas or SMZ
Slow - limited by half lives of clotting factors
Decreases synthesis of Mycolic Acid
Depolymerizes microtubules - impairing leukocyte chemotaxis and degranulation.

7. How is Chloramphenical used clinically?
Penicillin - Cephalosporins - Vancomycin - Aminoglycosides - Fluoroquinolones - Metronidazole
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).
Meningitis (H. influenza - N. meningitidis - S. pneumoniae) - Conserative treatment due to toxicities
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.

8. What physiological effects was the Anes using Atropine to tx
Pseudomembranous colitis (C. difficile) - fever - diarrhea
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions
Polymyxin B - Polymyxin E
- Deferoxamine

9. What enzyme is responsible for the production of Ach from Acetyl CoA and Choline
Choline acetyltransferase
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity
Praziquantel
Rifampin (DOC) - minocycline

10. What are three complications of Warfarin usage?
Binding to the presynaptic alpha 2 release modulating receptors
Hemolytic anemia
1. Bleeding 2. Teratogenicity 3. Drug - drug interactions
Pituitary hormone.

11. What is the receptor affinity and clinical use of isoproterenol?
It affects beta receptors equally and is used in AV heart block (rare).
Those patients who are taking nitrates.
Similar to cyclosporine; binds to FK- binding protein - inhibiting secretion of IL-2 and other cytokines.
Yes - it does not cross the placenta.

12. What is the category of drug names ending in - oxin (e.g. Digoxin)
block Na+ channels in the cortical collecting tubule
Cardiac glycoside (inotropic agent).
Gemfibrozil - Clofibrate
Inhibits cGMP phosphodiesterase - casuing increased cGMP - smooth muscle relaxation in the corpus cavernosum - increased blood flow - and penile erection.

13. Which drug(s) cause this reaction: Fanconi's syndrome?
Methylation of rRNA near Erythromycin's ribosome binding site
narcolepsy - obesity - and attention deficit disorder (I wouldn't recommend this)
- Tetracycline
Verapamil - Diltiazem - Bepridil

14. Ganciclovir associated toxicities?
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.
scopolamine
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity

15. What is the MOA for Amphotericin B?
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT
Rifampin (DOC) - minocycline
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis
In 4 half - lifes= (94%) T1/2 = (0.7x Vd)/CL

16. What is the only depolarizing neuromuscular blocking agent?
- Disulfram & also sulfonylureas - metronidazole
Dopamine
Methylation of rRNA near Erythromycin's ribosome binding site
Succinylcholine

17. Name four HMG- CoA reductase inhibitors.
Delirium - Tremor - Nephrotoxicity
Modification via Acetylation - Adenylation - or Phosphorylation
Lovastatin - Pravastatin - Simvastatin - Atorvastatin
Mebendazole/Thiabendazole - Pyrantel Pamoate

18. Which drug increases Sys BP w/o affecting Pulse Pressure
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
severe hypertension - CHF
Epinephrine
Megaloblastic anemia - Leukopenia - Granulocytopenia

19. When is HIV therapy initiated?
Dopamine; causes its release from intact nerve terminals
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load
GI discomfort
- Oral Contraceptives

20. What is combination TMP- SMZ used to treat?
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia
Pyridoxine (B6) administration
Chronic gout.

21. What are the clinical uses for Imipenem/cilastatin?
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)
Gram + cocci - Gram - rods - and Anerobes
K+ wasting - metabolic alkalosis - hypotension - ototoxicity
AZT

22. What are three toxicities of Leuprolied?
1. Antiandrogen 2. Nausea 3. Vomiting
Sulfonylureas are oral hypoglycemic agents - they are used to stimulate release of endogenous insulin in NIDDM (type -2).
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.
Sulfonamide Loop Diuretic. Inhibits ion co - transport system of thick ascending loop. Abolishes hypertonicity of the medulla - thereby preventing concentration of the urine.

23. What microorganisms are clinical indications for Tetracycline therapy?

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24. Which drug(s) cause this reaction: Cardiac toxicity?
- Daunorubicin & Doxorubicin
all of them
Oral
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic

25. Norepi feedbacks and inhibits the presynaptic receptor by What mechanism
Inhibt Assembly of new virus by Blocking Protease Enzyme
VACUUM your Bed Room'
- EDTA - dimercaprol - succimer - & penicillamine
Binding to the presynaptic alpha 2 release modulating receptors

26. What type of neurological blockade would hexamethonium create?
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.
- polymyxins
Hypersensitivity reactions

27. What are two mechanisms of action of Propythiouracil?
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.
Beta antagonist.
Gram + - Gram - - Norcardia - Chlamydia
- Ethosuxamide - sulfonamides - lamotrigine

28. List five common glucocorticoids.
- inhibits HGPRT (pur. Syn.) - Luk - Lymph
1. Hydrocortisone 2. Predisone 3. Triamcinolone 4. Dexamethasone 5. Beclomethasone
Potent immunosuppressive used in organ transplant recipients.
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)

29. Nifedipine has similar action to?
Nitrates
Hydralazine and Minoxidil
Rapid (seconds)
Albuterol - tertbutaline

30. What is the effect of TCA's on the adrenergic nerve?
compensatory tachycardia - fluid retention - lupus - like syndrome
Beta1 more than B2
They inhibit reuptake of NE at the nerve terminal (as does cocaine).
- DNA intercalator - Hodgkin's - myeloma - sarcoma - and solid tumors - Cardiotoxicity & alopecia

31. What are three types of antacids and the problems that can result from their overuse?
Rheumatoid and osteoarthritis.
Oral
1. Aluminum hydroxide: constipation and hypophosphatemia 2. Magnesium hydroxide: diarrhea 3. Calcium carbonate: Hypercalcemia - rebound acid increase - All may cause hypokalemia
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.

32. Name two LPL stimulators.
bradycardia - AV block - CHF
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic
Potent immunosuppressive used in organ transplant recipients.
Gemfibrozil - Clofibrate

33. How are the HIV drugs used clinically?

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34. Digoxin v. Digitoxin: protein binding?
- Lithium
Hypersensitivity reactions
Digitoxin 70% Digoxin 20-40%
Activates antithrombin III

35. How can the toxic effects of TMP be ameliorated?
- ED 50 is less than the Km (less than 50% of receptors)
YES
With supplemental Folic Acid
Small lipid - soluble molecule

36. Which drug(s) cause this reaction: P450 inhibition(6)?
- Phenytoin
physostigmine
- Cimetidine - ketoconazole - grapefruit juice - erythromycin - INH - sulfonamides
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome

37. Resistance mechanisms for Chloramphenicol
blocking the beta adrenergic receptor leads to decreased cAMP - and decreased Ca2+ flux
- Class III antiarrhythmics (sotalol) - class IA (quinidine)
Modification via Acetylation
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis

38. What are common toxic side effects of Sulfonamides? (5)
- Hypersensitivity reactions - Hemolysis - Nephrotoxicity (tubulointerstitial nephritis) - Kernicterus in infants Displace other drugs from albumin (e.g. - warfarin)
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
Large anionic polymer - acidic
Blocks Influenza A and RubellA; causes problems with the cerebellA

39. What is the MOA of Imipenem?
- Tricyclic antidepressants
H2 antagonist
Acts as a wide spectrum carbapenem
Blood

40. Adverse effect of Nitroprusside?
- Ethanol - dialysis - & fomepizole
Due to the presence of a bulkier R group
GET on the Metro
cyanide toxicity (releases CN)

41. Name two bile acid resins.
Chronic gout.
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide
cholestyramine - colestipol
Ataxia - Dizziness - Slurred speech

42. How do you treat coma in the ER (4)?
Sotalol - Ibutilide - Bretylium - Amiodarone
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD
Chronic gout.
Amphotericin B - Nystatin - Fluconazole/azoles

43. Describe Phase I metabolism in liver(3)?
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).
Sulfonamides - Trimethoprim
1. Antipyretic 2. Analgesic 3. Anti - inflammatory
- reduction - oxy - & hydrolysis - H2O sol. Polar product - P450

44. Which cancer drugs work at the level of mRNA(2)?
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
- Steroids - Tamoxifen
Choline acetyltransferase
Megaloblastic anemia - Leukopenia - Granulocytopenia

45. Preferential action of the Ca2+ channel blockers at cardiac muscle?
Acetylcholinesterase; ACh is broken down into choline and acetate.
Ca2+ (Loops Lose calcium)
cardiac muscle: Verapamil>Diltiazem>Nifedipine
- aminoglycosides - loop diuretics - cisplatin

46. Bretyllium - toxicity?
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
PT
new arrhythmias - hypotension
GI distress - Skin rash - and Seizures at high plasma levels

47. What are four unwanted effects of Clomiphene use?
1. Weight gain 2. Hepatotoxicity (troglitazone)
- Clindamycin
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances

48. How does a competitive antagonist effect an agonist?
ACIDazolamide' causes acidosis
Tricyclic antidepressant.
- Shifts the curve to the right - increases Km
Rare.

49. How can Isoniazid (INH)- induced neurotoxicity be prevented?
Decreased uptake or Increased transport out of cell
Pyridoxine (B6) administration
Rash - Pseudomembranous colitis
1. Gastric ulceration 2. Bleeding 3. Hyperventilation 4. Reye's syndrome 5. Tinnitus (CN VIII)

50. List the mechanism - clinical use - & toxicity of Cisplatin.
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
proximal convoluted tubule
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.