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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 is the clinical use for Heparin?
Neutropenia
Norepinephrine
Immediate anticoagulation for PE - stroke - angina - MI - DVT.
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins

2. Which drug(s) cause this reaction: Focal to massive hepatic necrosis (4)?
cyanide toxicity (releases CN)
1. Renal damage 2. Aplastic anemia 3. GI distress
No - it inhibits the release of Nor Epi
- Halothane - Valproic acid - acetaminophen - Amantia phalloides

3. When is Rifampin not used in combination with other drugs?
1. Antipyretic 2. Analgesic 3. Anti - inflammatory
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.
VACUUM your Bed Room'
1. Meningococcal carrier state 2. Chemoprophylaxis in contacts of children with H. influenzae type B

4. Explain potency in relation to full and partial agonists(2).
Amphetamine and Ephedrine
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis
1. Bleeding 2. Teratogenicity 3. Drug - drug interactions
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.

5. What is the category of drug names ending in - barbital (e.g. Phenobarbital)
severe hypertension - CHF
Babiturate.
Impairs the synthesis of vitamin K- dependent clotting factors
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).

6. What do you treat Nematode/roundworm (pinworm - whipworm) infections with?
1. Weight gain 2. Hepatotoxicity (troglitazone)
dizziness - flushing - constipation (verapamil) - nausea
Mebendazole/Thiabendazole - Pyrantel Pamoate
Interstitial nephritis

7. What are two Glitazones?
Stimulating beta receptors stimulates heart rate - but beta receptor induced vasodilation reduces peripheral resistance.
1. Pioglitazone 2. Rosiglitazone.
Alpha -1 antagonist
Phenothiazine (neuroleptic - antiemetic).

8. Dobutamine used for the tx of shock acts on Which receptors
Ceftriaxone
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic
Succinylcholine
Beta1 more than B2

9. For Heparin What is the Ability to inhibit coagulation in vitro
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas
Yes
Systemic mycoses
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.

10. What are common side effects of RT Inhibitors?
Beta1 more than B2
No - it inhibits the release of Nor Epi
cardiac depression - peripheral edema - flushing - dizziness - constipation
BM suppression (neutropenia - anemia) - Peripheral neuropathy

11. For Heparin What is the Lab value to monitor
Rapid (seconds)
aPTT (intrinsic pathway)
physostigmine
WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.

12. Which drug(s) cause this reaction: Hepatitis?
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia
narcolepsy - obesity - and attention deficit disorder (I wouldn't recommend this)
- Isoniazid
Phosphorylation by a Viral Kinase

13. Adverse effects of Captopril?
1. Predisposes to viral infections and lymphoma 2. Nephrotoxic (preventable with mannitol diuresis)
Carbenicillin - Piperacillin - and Ticarcillin
- Fluoroquinolones
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)

14. MOA: Disrupt bacterial/fungal cell membranes
1. Acarbose 2. Miglitol
Polymyxins
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation
Protease Inhibitors and Reverse Transcriptase Inhibitors

15. Explain differences between full and partial agonists(2).
- Chlorpromazine - thioridazine - haloperidol
- Act on same receptor - Full has greater efficacy
compensatory tachycardia - fluid retention - lupus - like syndrome
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol

16. What are the clinical indications for bethanechol?
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.
WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
Post - op and neurogenic ileus and urinary retention - myasthenia gravis - and reversal of neuromuscular junction blockade (post - op) through anticholinesterase activity.

17. What are the indications for using amphetamine?

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18. Name two bile acid resins.
Treatment of hypertension - especially with renal disease (lowers bp centrally - so flow is maintained to kidney).
- ACE inhibitors (Losartan>no cough)
cholestyramine - colestipol
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.

19. For Heparin What is the Route of administration
thiazides - amiloride
toxic
Paranteral (IV - SC)
cardiac muscle: Verapamil>Diltiazem>Nifedipine

20. Antiarrhythmic class II- mechanism?
Acute (hours)
- Chloramphenicol
blocking the beta adrenergic receptor leads to decreased cAMP - and decreased Ca2+ flux
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention

21. What is a prerequisite for Acyclovir activation?
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)
It must be Phosphorylated by Viral Thymidine Kinase
Antileukotriene; blocks synthesis by lipoxygenase.
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.

22. List the specific antidote for this toxin: Methemoglobin
Hydralazine and Minoxidil
- polymyxins
- Methylene blue
very short acting

23. Describe first - order kinetics?
Nephrotoxicity
Constant FRACTION eliminated per unit time.(exponential)
The PTT.
propanolol - esmolol - metoprolol - atenolol - timolol

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

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25. Toxic side effects of the Azoles?
local anesthetic. CNS stimulation or depression. CV depression.
Teratogenic - Carcinogenic - Confusion - Headaches
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills
With supplemental Folic Acid

26. What is a common drug interaction associated with Griseofulvin?
Delirium - Tremor - Nephrotoxicity
Increases coumadin metabolism
new arrhythmias - hypotension
No - hemicholinum block the uptake of Choline and thus Ach synthesis

27. What effect would atropine have on a patient with peptic ulcer disease?
for RSV
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal

28. Name the common Fluoroquinolones (6)
Quinidine - Amiodarone - Procainamide - Disopyramide
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis
Ciprofloxacin - Norfloxacin - Ofloxacin - Grepafloxacin - Enoxacin - Nalidixic acid
- Methotrexate - 5 FU - 6 mercaptopurine

29. What is the MOA for Vancomycin?
Constant FRACTION eliminated per unit time.(exponential)
Inhibits cell wall mucopeptide formation - Bactericidal
Anaerobes
- Ammonium Chloride

30. What antimuscarinic drug is useful for the tx of asthma
Ipratropium
Prophylaxis for Influenza A - Rubella; Parkinson's disease
1. Hydrocortisone 2. Predisone 3. Triamcinolone 4. Dexamethasone 5. Beclomethasone
- Oral Contraceptives

31. Which drug(s) cause this reaction: G6PD hemolysis(8)?
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol
GI discomfort
pulmonary edema - dehydration

32. What is the category of drug names ending in - caine (e.g. Lidocaine)
Methylation of rRNA near Erythromycin's ribosome binding site
Local anesthetic.
toxic
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.

33. What are the Anti - TB drugs?
Rifampin - Ethambutol - Streptomycin - Pyrazinamide - Isoniazid (INH)
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
Pretreat with antihistamines and a slow infusion rate
is resistant

34. What are toxicities associated with Chloramphenicol?
Treatment of hypertension - especially with renal disease (lowers bp centrally - so flow is maintained to kidney).
- Tetracycline - amiodarone - sulfonamides
Aplastic anemia (dose independent) - Gray Baby Syndrome
Peptic ulcer disease.

35. Which diuretics cause acidosis?
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide
- Flumazenil
carbonic anhydrase inhibitors - K+ sparing diuretics
cortical collecting tubule

36. Which cancer drugs work at the level of mRNA(2)?
NE acts presynaptically on alpha -2 receptors to inhibit its own release. ACh also acts presynaptically through M1 receptors to inhibit NE release.
Indomethacin is used to close a patent ductus arteriosus.
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
- Steroids - Tamoxifen

37. Why would dopamine be useful in treating shock?
- Penicillamine
Acetylates and irreversibly inhibits cyclooxygenase (COX I and COX II) to prevent the conversion of arachidonic acid to prostaglandins.
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)
Binds to the Pyrophosphate Binding Site of the enzyme

38. What is the category of drug names ending in - tidine (e.g. Cimetidine)
H2 antagonist
edrophonium (extremely short acting anticholinesterase)
Tricyclic antidepressant.
Anaerobic infections (e.g. - B. fragilis - C. perfringens)

39. Triamterene and amiloride - mechanism?
block Na+ channels in the cortical collecting tubule
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia
AmOxicillin has greater Oral bioavailability
- Chloramphenicol

40. For Warfarin What is the Route of administration
Beta - lactamase cleavage of Beta - lactam ring
Hypersensitivity reactions
No - it inhibits the release of Nor Epi
Oral

41. What is the category - desired effect - and period of use of albuterol in the treatment of Asthma?
Nucleosides
viral kinase
- Protamine
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.

42. Why would a patient with cog - wheel rigidity and a shuffling gait be given benztropine?
K+ wasting - metabolic alkalosis - hypotension - ototoxicity
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.
Imipenem

43. Secretion of What drug is inhibited by Probenacid used to treat chronic gout?
sedation - positive Coombs' test
Inhibits cell wall synthesis ( binds to PBP3). A monobactam
Penicillin.
Methylxanthine.

44. MOA: Block DNA topoisomerases
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation
Quinolones
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
- Protamine

45. How is Vancomycin used clinically?
For serious - Gram + multidrug - resistant organisms
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances
Severe Gram - rod infections.

46. Digoxin v. Digitoxin: bioavailability?
Digitoxin>95% Digoxin 75%
- Bleomycin - amiodarone - busulfan
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
Protease inhibitor.

47. Name the common Non - Nucleoside Reverse Transcriptase Inhibitors
Nevirapine - Delavirdine
- Tetracycline - amiodarone - sulfonamides
Amphotericin B - Nystatin - Fluconazole/azoles
Oral

48. For Warfarin What is the Treatment for overdose
Hydralazine and Minoxidil
IV vitamin K and fresh frozen plasma
Reserpine inhibits dopamine transport into vesicles - attenuating its conversion to NE by dopamine beta - hydroxylase.
Protease inhibitor.

49. What is the difference between the affinity for beta receptors between albuterol/terbutaline and dantroline?
Severe Gram - rod infections.
Dobutamine has more of an affintiy for beta -1 than beta -2 - and is used for treating heart failure and shock. Albuterol and terbutaline is the reverse - and is used in treatment of acute asthma.
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )
Cryptococcal meningitis in AIDS patients and Candidal infections of all types

50. What are the clinical indications for Azole therapy?
Systemic mycoses
- Oral Contraceptives
Sulfonamide Loop Diuretic. Inhibits ion co - transport system of thick ascending loop. Abolishes hypertonicity of the medulla - thereby preventing concentration of the urine.
Staphlococcus aureus