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Test your basic knowledge |
USMLE Step 1 Pharmacology
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health-sciences
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usmle-step-1
Instructions:
Answer 50 questions in 15 minutes.
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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 mechanism of action of Aspirin?
Rifampin (DOC) - minocycline
hypertension - angina - arrhythmias
Acetylates and irreversibly inhibits cyclooxygenase (COX I and COX II) to prevent the conversion of arachidonic acid to prostaglandins.
Antileukotriene; blocks synthesis by lipoxygenase.
2. What are two toxicities of the Glitazones?
Neomycin
1. Weight gain 2. Hepatotoxicity (troglitazone)
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)
Sulfonylureas are oral hypoglycemic agents - they are used to stimulate release of endogenous insulin in NIDDM (type -2).
3. Resistance mechanisms for Chloramphenicol
anticholinesterase glaucoma
Modification via Acetylation
cortical collecting tubule
Dry flushed skin - due to inhibition of sympathetic post - ganglionic blockade on muscarinic receptors of sweat glands. All others are opposite of What would be expected.
4. Adverse effects of Losartan?
Decreased uptake or Increased transport out of cell
Blocks Peptide Bond formation at the 50S subunit - Bacteriostatic
fetal renal toxicity - hyperkalemia
- Act on same receptor - Full has greater efficacy
5. Resistance mechanisms for Vancomycin
torsade de pointes
Acetylcholine esterase
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity
Foscarnet = pyroFosphate analog
6. Acetazolamide causes?
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7. Name some common Tetracyclines (4)
The PT.
Bactericidal for: Gram + rod and cocci - Gram - cocci - and Spirochetes
Minor hepatotoxicity - Drug interactions (activates P450)
Tetracycline - Doxycycline - Demeclocycline - Minocycline
8. Which H2 Blocker has the most toxic effects and What are they?
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis
edematous states (CHF - cirrhosis - nephrotic syndrome - pulm edema) - HTN - hypercalcemia
Cimetidine is a potent inhibitor of P450; it also has an antiandrogenic effect and decreases renal excretion of creatinine. Other H2 blockers are relatively free of these effects.
Paranteral (IV - SC)
9. Name three K+ sparing diuretics?
Spironolactone - Triamterene - Amiloride (the K+ STAys)
- Fluoroquinolones
Inhibt Assembly of new virus by Blocking Protease Enzyme
- Ethanol - dialysis - & fomepizole
10. How can Isoniazid (INH)- induced neurotoxicity be prevented?
impotence - asthma - CV effects (bradycardia - CHF - AV block) - CNS effects (sedation - sleep alterations)
Due to the presence of a bulkier R group
Non - Nucleosides
Pyridoxine (B6) administration
11. Ethacrynic Acid - toxicity?
NO HYPERURICEMIA - NO SULFA AllERGY; same as furosemide otherwise
Anaerobes
Beta1 more than B2
diuretics - sympathoplegics - vasodilators - ACE inhibitors - Angiotensin II receptor inhibitors
12. What is the clinical use for Sucralfate?
As PABA antimetabolites that inhibit Dihydropteroate Synthase - Bacteriostatic
Milk or Antacids - because divalent cations inhibit Tetracycline absorption in the gut
Chagas' disease - American Trypanosomiasis (Trypanosoma cruzi)
Peptic ulcer disease.
13. ACE inhibitors - clinical use?
Gram + - Gram - - Norcardia - Chlamydia
hypertension - CHF - diabetic renal disease
very short acting
HTN - CHF - calcium stone formation - nephrogenic DI.
14. For Heparin What is the Onset of action
Dopamine
Dopamine; causes its release from intact nerve terminals
Rapid (seconds)
- aminoglycosides - loop diuretics - cisplatin
15. Explain pH dependent urinary drug elimination?
Oral treatment of superficial infections
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
RESPIre
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more
16. List the mechanism - clinical use - & toxicity of 6 MP.
Disulfiram - like reaction with EtOH - Headache
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia
- inhibits HGPRT (pur. Syn.) - Luk - Lymph
Abortifacient.
17. What enzyme does Zileuton inhibit?
Lipoxygenase
Pretreat with antihistamines and a slow infusion rate
Inhibit viral DNA polymerase
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
18. What is the mechanism of action and clinical use of the antiandrogen Flutamide?
- Sulfonamides - furosemide - methicillin - rifampin - NSAIDS (ex. ASA)
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.
Protease inhibitor.
Methylation of rRNA near Erythromycin's ribosome binding site
19. What are common toxicities associated with Tetracyclines?
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20. What are the side effects of Rifampin?
Pseudomembranous colitis (C. difficile) - fever - diarrhea
Minor hepatotoxicity - Drug interactions (activates P450)
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride
AZT
21. Norepi feedbacks and inhibits the presynaptic receptor by What mechanism
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.
Erythromycin - Azithromycin - Clarithromycin
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances
Binding to the presynaptic alpha 2 release modulating receptors
22. Common side effects associated with Clindamycin include?
Tendonitis and Tendon rupture
Pseudomembranous colitis (C. difficile) - fever - diarrhea
- Deferoxamine
Hemolysis (if G6PD deficient) - Neurotoxicity - Hepatotoxicity - SLE- like syndrome
23. Antiarrhythmic class IV- clinical use?
dry mouth - sedation - severe rebound hypertension
prevention of nodal arrhythmias (SVT)
impotence - asthma - CV effects (bradycardia - CHF - AV block) - CNS effects (sedation - sleep alterations)
Extended spectrum penicillin: certain Gram + bacteria and Gram - rods
24. What are the nondepolarizing neuromuscular blocking drugs?
Neurotoxicity - Acute renal tubular necrosis
Peptic ulcer disease.
Hypersensitivity reactions
Tubocurarine - atracurium - mivacurium - pancuronium - vecuronium - rapacuronium
25. Is toxicity rare or common whith Cromolyn used in Asthma prevention?
Erythromycin - Azithromycin - Clarithromycin
Blocks Norepi - but not Dopamine
Polymyxins
Rare.
26. Is resistant to penicillinase?
1. Gastric ulceration 2. Bleeding 3. Hyperventilation 4. Reye's syndrome 5. Tinnitus (CN VIII)
Minor hepatotoxicity - Drug interactions (activates P450)
Headache - flushing - dyspepsia - blue - green color vision.
Imipenem
27. Which drug(s) cause this reaction: Cardiac toxicity?
- Daunorubicin & Doxorubicin
With supplemental Folic Acid
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
Meningitis (H. influenza - N. meningitidis - S. pneumoniae) - Conserative treatment due to toxicities
28. What is the mechanism of action of the H2 Blockers?
Ipratropium
Immediate anticoagulation for PE - stroke - angina - MI - DVT.
Wide spectrum of systemic mycoses: Cryptococcus - Blastomyces - Coccidioides - Aspergillus - Histoplasma - Candida - Mucor
Reversible block of histamine H2 receptors
29. What is the difference in receptor affinity of epinephrine at low doses? High doses?
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30. Name five Antiarrhythmic drugs in class II?
Tricyclic antidepressant.
Quinidine - Amiodarone - Procainamide - Disopyramide
Cephalosporins
propanolol - esmolol - metoprolol - atenolol - timolol
31. Reserpine will block the syntheis of this drug and but not its precursor.
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
Blocks Norepi - but not Dopamine
Cryptococcal meningitis in AIDS patients and Candidal infections of all types
severe hypertension - CHF
32. How can the toxic effects of TMP be ameliorated?
Digitoxin 70% Digoxin 20-40%
Antibiotic - protein synthesis inhibitor.
With supplemental Folic Acid
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).
33. What is Metronidazole used for clinically?
impotence - asthma - CV effects (bradycardia - CHF - AV block) - CNS effects (sedation - sleep alterations)
No - warfarin - unlike heparin - can cross the placenta.
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin
Antiprotozoal: Giardia - Entamoeba - Trichomonas - Gardnerella vaginalis Anaerobes: Bacteroides - Clostridium
34. Which diuretics increase urine Ca2+?
- Nitrate - hydroxocobalamin thiosulfate
loop diuretics - spironolactone
- Hypersensitivity reactions - Hemolysis - Nephrotoxicity (tubulointerstitial nephritis) - Kernicterus in infants Displace other drugs from albumin (e.g. - warfarin)
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.
35. What are four advantages of newer low - molecular - weight heparins (Enoxaparin)?
Lipoxygenase
1. Better bioavailability 2. 2 to 4 times longer half life 3. Can be administered subcutaneously 4. Does not require laboratory monitoring
Enterobacter
- Formaldehyde & formic acid - severe acidosis & retinal damage
36. Name four Antiarrhythmic drugs in class IA.
Succinylcholine
Bactericidal for: Gram + rod and cocci - Gram - cocci - and Spirochetes
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.
Quinidine - Amiodarone - Procainamide - Disopyramide
37. Ca2+ channel blockers - site of action?
Abortifacient.
- Atropine & pralidoxime
Cell membrane Ca2+ channels of cardiac sarcomere
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state
38. What is combined with Ampicillin - Amoxicillin - Carbenicillin - Piperacillin - and Ticarcillin to enhance their spectrum?
Cilastatin
Clavulanic acid
Decreases synthesis of Mycolic Acid
Triple sulfas or SMZ
39. List the specific antidote for this toxin: Opioids
- B51Naloxone / naltrexone (Narcan)
decrease conduction velocity - increase ERP - increase PR interval
- N- acetylcystine
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.
40. Which Tetracycline is used in patients with renal failure? / Why?
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
Doxycycline - because it is fecally eliminated
Nucleosides
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
41. What neurotransmitter does Amantadine affect? How does it influence this NT?
The only local anesthetic with vasoconstrictive properties.
Primaquine
Dopamine; causes its release from intact nerve terminals
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD
42. What is the memory key involving the '4 R's of Rifampin?'
Oral treatment of superficial infections
Buy AT 30 - CELL at 50'
Interferes with microtubule function - disrupts mitosis - inhibits growth
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
43. Antiarrhythmic class IC- effects?
GI distress - Tooth discoloration and Inhibition of bone growth in children - Fanconi's syndrome - Photosensitivity
Stimulates beta adrenergic receptors
Disulfiram - like reaction with EtOH - Headache
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT
44. Which drug(s) cause this reaction: Tendonitis and rupture?
Hypersensitivity reactions
- Fluoroquinolones
- Isoniazid
GI side effects. (Indomethacin is less toxic - more commonly used.)
45. What is Ketoconazole specifically used for?
anticholinesterase glaucoma
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism
Binds to the Pyrophosphate Binding Site of the enzyme
Inhibits DNA dependent RNA polymerase
46. Name the Protease Inhibitors (4)
Chronic gout.
Saquinavir - Ritonavir - Indinavir - Nelfinavir
Only in limited amounts
Gram + cocci - Gram - rods - and Anerobes
47. A 57 yo heart failure pt develops cardiac decompensation - What drug will give you adequate perfusion of his kidneys as well as tx for his Hypotension
Dopamine
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Ca2+ (Loops Lose calcium)
Does not cross
48. What type of patient should not take Misoprostol and why?
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine
TCA
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.
49. What are Polymyxins used for?
Dopamine
Inhibits platelet aggregation by irreversibly inhibiting the ADP pathway involved in the binding of fibrinogen.
Penicillin.
Resistant Gram - infections
50. List the mechanism - clinical use - & toxicity of 5 FU.
Penicillin - V
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression
atropine - homatropine - tropicamide
Erectile dysfunction.
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