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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. List the mechanism - clinical use - & toxicity of Cisplatin.
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.
1. Hypoglycemia (more common with 2nd - generation drugs: glyburide - glipizide) 2. Disulfiram - like effects (not seen with 2nd - generation drugs).
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
1. Antiandrogen 2. Nausea 3. Vomiting

2. Mnemonic for Foscarnet?
Similar to cyclosporine; binds to FK- binding protein - inhibiting secretion of IL-2 and other cytokines.
Foscarnet = pyroFosphate analog
Aminoglycosides
AV nodal cells

3. List the specific antidote for this toxin: Salicylates
Protease inhibitor.
- Alkalinize urine & dialysis
Epinephrine
It inhibits release of NE.

4. What is the main clinical use for the thrombolytics?
amphetamine and ephedrine
Neurotoxicity - Acute renal tubular necrosis
Early myocardial infarction.
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)

5. Aztreonam is not usually...
Hypersensitivity reactions
Carbachol - pilocarpine - physostigmine - echothiophate
- Sulfonamides - furosemide - methicillin - rifampin - NSAIDS (ex. ASA)
toxic

6. Which drug(s) cause this reaction: Gynecomastia (6)?
Competitive inibitor of progestins at progesterone receptors.
Beta Blockers
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.
- Cimetidine - ketoconazole - spironolactone - digitalis - EtOH - estrogens

7. What are two clinical uses of Azathioprine?
Binding to the presynaptic alpha 2 release modulating receptors
Antileukotriene; blocks leukotriene receptors.
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine

8. List the mechanism - clinical use - & toxicity of Cyclophosphamide.
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis
Pentamidine
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.
torsade de pointes - excessive Beta block

9. What is the MOA for Acyclovir?
Impairs the synthesis of vitamin K- dependent clotting factors
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions
Inhibit viral DNA polymerase
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide

10. What is the MOA for Clindamycin?
Potent immunosuppressive used in organ transplant recipients.
Centrally acting alpha agonist - thus causing a decrease in central adrenergic outflow - spairing renal blood flow
Blocks Peptide Bond formation at the 50S subunit - Bacteriostatic
- Oral Contraceptives

11. Furosemide increases the excretion of What ion?
Ca2+ (Loops Lose calcium)
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
Prevents release of mediators from mast cells. Effective only for the prophylaxis of asthma. Not effective during an acute attack.
Amphetamine and Ephedrine

12. ACE inhibitors - mechanism?
Selectively inhibit cyclooxygenase (COX) isoform 2 - Which is found in inflammatory cells nad mediates inflammation and pain; spares COX-1 Which helps maintain the gastric mucosa.
reduce levels of Angiotensin II - thereby preventing the inactivation of bradykinin (a potent vasodilator); renin level is increased
Polymyxins
increase AP duration - increase ERP - increase QT interval - for use When other arrhythmics fail

13. ___________ are Teratogenic
Tendonitis and Tendon rupture
Aminoglycosides
toxic
Flecainide - Encainide - Propafenone

14. Adverse effects of beta - blockers?
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)
impotence - asthma - CV effects (bradycardia - CHF - AV block) - CNS effects (sedation - sleep alterations)
first dose orthostatic hypotension - dizziness - headache
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more

15. What are the indications for using amphetamine?

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16. List the specific antidote for this toxin: Cyanide
- Nitrate - hydroxocobalamin thiosulfate
- Upper respiratory tract infections - pneumonias - STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) - Mycoplasma - Legionella - Chlamydia - Neisseria
fetal renal toxicity - hyperkalemia
Ibuprofen - Naproxen - and Indomethacin

17. How are the HIV drugs used clinically?

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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
Gemfibrozil - Clofibrate
1. Meningococcal carrier state 2. Chemoprophylaxis in contacts of children with H. influenzae type B
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
- Clindamycin

19. What is the category of drug names ending in - pril (e.g. Captopril)
Forms toxic metabolites in the bacterial cell - Bactericidal
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
ACE inhibitor.
Inhibits CMV DNA polymerase

20. Beta Blockers - site of action?
Lovastatin - Pravastatin - Simvastatin - Atorvastatin
proximal convoluted tubule
Beta adrenergic receptors and Ca2+ channels (stimulatory)
- Alkalinize urine & dialysis

21. MOA: Block cell wall synthesis by inhib. Peptidoglycan cross - linking (7)
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins
Succinylcholine
Protease Inhibitors and Reverse Transcriptase Inhibitors
pulmonary edema - dehydration

22. What is the clinical use for Penicillin?
proximal convoluted tubule
first dose orthostatic hypotension - dizziness - headache
Fast vs. Slow Acetylators
Bactericidal for: Gram + rod and cocci - Gram - cocci - and Spirochetes

23. Will Hemicholinum affect the release of stored Ach during Cholinergic Stimulation
No - hemicholinum block the uptake of Choline and thus Ach synthesis
- Metronidazole - certain cephalosporins - procarbazine - sulfonylureas
Systemic mycoses
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.

24. What is the category of drug names ending in - azepam (e.g. Diazepam)
- Glucocorticoid withdrawal
Aminoglycosides - Tetracyclines
- Fluoroquinolones
Benzodiazepine.

25. What do you treat Nematode/roundworm (pinworm - whipworm) infections with?
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome
Hypersensitivity reactions
Mebendazole/Thiabendazole - Pyrantel Pamoate
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide

26. Adverse effects of Captopril?
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
- Upper respiratory tract infections - pneumonias - STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) - Mycoplasma - Legionella - Chlamydia - Neisseria
HTN - CHF - calcium stone formation - nephrogenic DI.
Ganciclovir is more toxic to host enzymes

27. For Warfarin What is the Treatment for overdose
None. No - because atropine would block the postganglionic muscarinic receptors involved in sweat gland stimulation.
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.
Methicillin - Nafcillin - and Dicloxacillin
IV vitamin K and fresh frozen plasma

28. How are the Latent Hypnozoite (Liver) forms of Malaria (P. vivax - P.ovale) treated?
Primaquine
CMV Retinitis in IC pts When Ganciclovir fails
Tricyclic antidepressant.
dizziness - flushing - constipation (verapamil) - nausea

29. What is used to reverse the action of Heparin?
Lovastatin - Pravastatin - Simvastatin - Atorvastatin
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).
Cyclooxygenases (COX I - COX II).
Nitrates

30. What are three toxicities of Leuprolied?
- Phase I (clinical tests) - Phase II - Phase III - PhaseIV (surveillance)
edematous states (CHF - cirrhosis - nephrotic syndrome - pulm edema) - HTN - hypercalcemia
1. Antiandrogen 2. Nausea 3. Vomiting
Reserpine inhibits dopamine transport into vesicles - attenuating its conversion to NE by dopamine beta - hydroxylase.

31. List the mechanism - clinical use - & toxicity of Doxorubicin.

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32. Quinidine - toxicity?
cinchonism: HA - tinnitus - thrombocytopenia - torsade de pointes due to increased QT interval
Erythromycin - Azithromycin - Clarithromycin
cholestyramine - colestipol
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD

33. Side effects of Isoniazid (INH)?
Increases coumadin metabolism
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.
cross - allergenic
Hemolysis (if G6PD deficient) - Neurotoxicity - Hepatotoxicity - SLE- like syndrome

34. What is the mechanism of action of Acetaminophen?
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine
Choline acetyltransferase
Reversibly inhibits cyclooxygenase - mostly in CNS. Inactivated peripherally.
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)

35. How do the Protease Inhibitors work?
- Class III antiarrhythmics (sotalol) - class IA (quinidine)
Inhibt Assembly of new virus by Blocking Protease Enzyme
Sulfonylureas are oral hypoglycemic agents - they are used to stimulate release of endogenous insulin in NIDDM (type -2).
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility

36. What is the MOA of Ganciclovir?
Inhibits CMV DNA polymerase
prevention of nodal arrhythmias (SVT)
No - hemicholinum block the uptake of Choline and thus Ach synthesis
Topical and Oral - for Oral Candidiasis (Thrush)

37. MOA: Disrupt bacterial/fungal cell membranes
Pretreat with antihistamines and a slow infusion rate
Inhibits platelet aggregation by irreversibly inhibiting the ADP pathway involved in the binding of fibrinogen.
Polymyxins
cholestyramine - colestipol

38. If a patient is given hexamethonium - What would happen to his/her heart rate?
Does not cross
- Tamoxifen
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents
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.

39. Which antimuscarinic agents are used in producing mydriasis and cycloplegia?
narcolepsy - obesity - and attention deficit disorder (I wouldn't recommend this)
- Penicillamine
atropine - homatropine - tropicamide
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)

40. What is the category of drug names ending in - barbital (e.g. Phenobarbital)
Babiturate.
collecting ducts
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide
- Deferoxamine

41. List the specific antidote for this toxin: Benzodiazepines
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression
cross - allergenic
DHPG (dihydroxy-2- propoxymethyl guanine)
- Flumazenil

42. K+- clinical use?
HTN - CHF - calcium stone formation - nephrogenic DI.
- Niacin - Ca++ channel blockers - adenosine - vancomycin
depresses ectopic pacemakers - especially in digoxin toxicity
- Antipsychotics

43. What is the clinical use for Sucralfate?
Peptic ulcer disease.
decrease conduction velocity - increase ERP - increase PR interval
Cell membrane Ca2+ channels of cardiac sarcomere
Decreased uptake or Increased transport out of cell

44. What is the clinical use for Ampicillin and Amoxicillin?
- Estrogen receptor antagonist - Breast CA - increased endometrial CA risk
Activates antithrombin III
Extended spectrum penicillin: certain Gram + bacteria and Gram - rods
Decreased uptake or Increased transport out of cell

45. Common toxicities associated with Fluoroquinolones?
blocking the beta adrenergic receptor leads to decreased cAMP - and decreased Ca2+ flux
GI upset - Superinfections - Skin rashes - Headache - Dizziness
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state
Ca2+ (Loops Lose calcium)

46. What is Imipenem always administered with?
Gram + cocci - Proteus mirabilis - E. coli - Klebsiella pneumoniae (PEcK)
Ipratropium
Cilastatin
viral kinase

47. These drugs acts indirectly by releasing strored catecholamines in the presynaptic terminal
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes
toxic
Amphetamine and Ephedrine
Diuresis in pateints with sulfa allergy

48. What are two mechanisms of action of Propythiouracil?
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.
Dermatophytes (tinea - ringworm)
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances
Antiprotozoal: Giardia - Entamoeba - Trichomonas - Gardnerella vaginalis Anaerobes: Bacteroides - Clostridium

49. Which drug(s) cause this reaction: Diabetes insipidus?
Clavulanic acid
Verapamil - Diltiazem - Bepridil
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
- Lithium

50. Antiarrhythmic Class III- effects?
Polymyxin B - Polymyxin E
Selectively inhibit cyclooxygenase (COX) isoform 2 - Which is found in inflammatory cells nad mediates inflammation and pain; spares COX-1 Which helps maintain the gastric mucosa.
increase AP duration - increase ERP - increase QT interval - for use When other arrhythmics fail
Muscarinic antagonist; competatively blocks muscarinic receptors - preventing bronchoconstriction.