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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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1. Mg+- clinical use?
atropine - homatropine - tropicamide
Reversibly inhibits cyclooxygenase - mostly in CNS. Inactivated peripherally.
effective in torsade de pointes and digoxin toxicity
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT

2. What is are two clinical uses of Cyclosporine?
Rare.
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.
Neostigmine - pyridostigmine edrophonium - physostigmine echothiophate
Tricyclic antidepressant.

3. What is the category of drug names ending in - ane (e.g. Halothane)
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
Inhalational general anesthetic.
hypertension - CHF - diabetic renal disease
cholestyramine - colestipol

4. Are not penicillinase resistant
Cardiac glycoside (inotropic agent).
Carbenicillin - Piperacillin - and Ticarcillin
Succinylcholine
None. No - because atropine would block the postganglionic muscarinic receptors involved in sweat gland stimulation.

5. Resistance mechanisms for Cephalosporins/Penicillins
Beta - lactamase cleavage of Beta - lactam ring
- Antipsychotics
is resistant
Inhibits Viral DNA polymerase

6. Digitalis - site of action?
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.
Pentavalent Antimony
Blood
Na/K ATPase

7. What are common toxicities associated with Tetracyclines?

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8. 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
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis
- ACE inhibitors (Losartan>no cough)
Inhibit Ergosterol synthesis

9. What is the category of drug names ending in - operidol (e.g. Haloperidol)
Butyrophenone (neuroleptic).
Sulfonamides - Trimethoprim
Ibuprofen - Naproxen - and Indomethacin
thick ascending limb

10. What is a sign of toxicity with the use of thrombolytics?
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
- Cimetidine - ketoconazole - grapefruit juice - erythromycin - INH - sulfonamides
-100% oxygen - hyperbaric
Bleeding.

11. Which drug(s) cause this reaction: Thrombotic complications?
Inhibits DNA dependent RNA polymerase
- Oral Contraceptives
Digitoxin 168hrs Digoxin 40 hrs
Blocks Influenza A and RubellA; causes problems with the cerebellA

12. K+ sparing diuretics - toxicity?
Spironolactone - Triamterene - Amiloride (the K+ STAys)
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)
Leukotrienes increasing bronchial tone.
Butyrophenone (neuroleptic).

13. How is Chloramphenical used clinically?
Meningitis (H. influenza - N. meningitidis - S. pneumoniae) - Conserative treatment due to toxicities
bradycardia - AV block - CHF
Interferes with microtubule function - disrupts mitosis - inhibits growth
- Daunorubicin & Doxorubicin

14. What is the formula for Clearance (CL)
Pentamidine
Md= (CpxCL)/F Cp= plas. Conc. CL=clear. F=bioaval.
Non - Nucleosides
CL= (rate of elimination of drug/ Plasma drug conc.)

15. What is the MOA of Ribavirin?
depresses ectopic pacemakers - especially in digoxin toxicity
Inhibits CMV DNA polymerase
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis
Chronic gout.

16. Antiarrhythmic class II- mechanism?
Indirect agonist - uptake inhibitor
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide
Increase target cell response to insulin.
blocking the beta adrenergic receptor leads to decreased cAMP - and decreased Ca2+ flux

17. What enzyme is responsible for the production of Ach from Acetyl CoA and Choline
Choline acetyltransferase
Megaloblastic anemia - Leukopenia - Granulocytopenia
GI discomfort
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.

18. List some specifics of lead poisoning(4)?
Methylation of rRNA near Erythromycin's ribosome binding site
local anesthetic. CNS stimulation or depression. CV depression.
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia
Similar to cyclosporine; binds to FK- binding protein - inhibiting secretion of IL-2 and other cytokines.

19. What is the possible mechanism and effect of Metformin in treating diabetes?
Triple sulfas or SMZ
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels
Hypersensitivity reactions

20. What microorganisms is Aztreonam not effective against?
Gram + and Anerobes
- aminoglycosides - loop diuretics - cisplatin
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state
Penicillin - Cephalosporins - Vancomycin - Aminoglycosides - Fluoroquinolones - Metronidazole

21. How is Acyclovir used clinically?
Phenothiazine (neuroleptic - antiemetic).
HSV - VZV - EBV - Mucocutaneous and Genital Herpes Lesions - Prophylaxis in Immunocompromised pts
Enterobacter
Choline acetyltransferase

22. How is Ribavirin used clinically?
Rifampin
for RSV
No - it inhibits the release of Nor Epi
Pseudomonas species and Gram - rods

23. What are the nondepolarizing neuromuscular blocking drugs?
Tubocurarine - atracurium - mivacurium - pancuronium - vecuronium - rapacuronium
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.
G6PD deficient individuals
Ipratropium

24. 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)
Diarrhea
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.
Epinephrine

25. Adverse effects of beta - blockers?
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills
Resistant Gram - infections
impotence - asthma - CV effects (bradycardia - CHF - AV block) - CNS effects (sedation - sleep alterations)
Anaerobic infections (e.g. - B. fragilis - C. perfringens)

26. What antimicrobial class is Aztreonam syngergestic with?
Aminoglycosides
The PT.
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity
Polymyxin B - Polymyxin E

27. What is the mechanism of action and clinical use of the antiandrogens Ketoconazole and Spironolactone?
Delirium - Tremor - Nephrotoxicity
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
1. Heavy bleeding 2. GI effects (n/v - anorexia) 3. Abdominal pain
Digitoxin 70% Digoxin 20-40%

28. Name the common Nucleoside Reverse Transcriptase Inhibitors
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.
Spironolactone - Triamterene - Amiloride (the K+ STAys)
Zidovudine (AZT) - Didanosine (ddI) - Zalcitabine (ddC) - Stavudine (d4T) - Lamivudine (3TC)

29. Ethacrynic Acid - toxicity?
NO HYPERURICEMIA - NO SULFA AllERGY; same as furosemide otherwise
To inhibit renal Dihydropeptidase I and decrease Imipenem inactivation in the renal tubules
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.
vascular sm. Mus.: Nifedipine>Diltiazem>Verapamil

30. What musculo - skeletal side effects in Adults are associated with Floroquinolones?
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal
glaucoma - urinary alkalinization - metabolic alkalosis - altitude sickness
Tendonitis and Tendon rupture
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy

31. What type of gout is treated with Colchicine?
Competitive inibitor of progestins at progesterone receptors.
Acute gout.
GI disturbances.
severe hypertension - CHF

32. What is the clinical use of Mifepristone (RU486)?
Chloramphenicol - Erythromycin/macrolides - Lincomycin - Clindamycin - Streptogramins (quinupristin - dalfopristin)
TCA
Increased systolic and pulse pressure - decreased diastolic pressure - and little change in mean pressure.
Abortifacient.

33. If a patient is given hexamethonium - What would happen to his/her heart rate?
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas
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.
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)

34. What is the memory key for Isoniazid (INH) toxicity?
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.
YES
INH: Injures Neurons and Hepatocytes
CMV Retinitis in IC pts When Ganciclovir fails

35. Acetazolamide - toxicity?
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load
- aminoglycosides - loop diuretics - cisplatin
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome

36. What are Aminoglycosides used for clinically?
loop diuretics - thiazides
Severe Gram - rod infections.
Hemolysis (if G6PD deficient) - Neurotoxicity - Hepatotoxicity - SLE- like syndrome
Antifungal.

37. What type of gout is treated with Probenacid?
cross - allergenic
GI discomfort - Acute cholestatic hepatitis - Eosinophilia - Skin rashes
Chronic gout.
Paranteral (IV - SC)

38. Hydrochlorothiazide - toxicity? (hyperGLUC - plus others)
Hypokalemic metabolic alkalosis - hyponatremia - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia - sulfa allergy.
- Ammonium Chloride
- DNA intercalator - Hodgkin's - myeloma - sarcoma - and solid tumors - Cardiotoxicity & alopecia
1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone When used of Leprosy 3. Used in combination with other drugs

39. What are five possible toxic effects of Aspirin therapy?

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40. What are three clinical uses of the NSAIDs?
- ED 50 is less than the Km (less than 50% of receptors)
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes
1. Antipyretic 2. Analgesic 3. Anti - inflammatory

41. Which antimicrobial classes inhibit protein synthesis at the 30S subunit? (2)
Cilastatin
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic
Inhibits cell wall synthesis ( binds to PBP3). A monobactam
Those patients who are taking nitrates.

42. What is the clinical use for Sildenafil (Viagra)?
Erectile dysfunction.
is resistant
Sulfonamides - Trimethoprim
- Haloperidol - chlorpromazine - reserpine - MPTP

43. For Heparin What is the Route of administration
VACUUM your Bed Room'
Indomethacin is used to close a patent ductus arteriosus.
sedation - depression - nasal stuffiness - diarrhea
Paranteral (IV - SC)

44. Hydralazine - class and mechanism?
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.
cyanide toxicity (releases CN)
vasodilator - increases cGMP to induce smooth muscle relaxation (arterioles>veins; afterload reduction)
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills

45. For Warfarin What is the Treatment for overdose
Epinephirine(Alpha1 -2 and Beta 1 -2)
IV vitamin K and fresh frozen plasma
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.
Binds to cyclophilins (peptidyl proline cis - trans isomerase) - blocking the differentiation and activation of T cells mainly by inhibiting the production of IL-2 and its receptor.

46. What is the category - method of use - and adverse effects of Salmeterol in Asthma treatment?
Nephrotoxicity
- Antipsychotics
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.
AmOxicillin has greater Oral bioavailability

47. What are two Glitazones?
1. Pioglitazone 2. Rosiglitazone.
Digoxin=urinary Digitoxin=biliary
1. Hydrocortisone 2. Predisone 3. Triamcinolone 4. Dexamethasone 5. Beclomethasone
Neurotoxicity - Acute renal tubular necrosis

48. Where does Griseofulvin deposit?
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression
Erythromycin - Azithromycin - Clarithromycin
Keratin containing tissues - e.g. - nails
Treatment of infertility.

49. Why are albuterol and terbutaline effective in tx of acute asthmatic attacks?
Similar to cyclosporine; binds to FK- binding protein - inhibiting secretion of IL-2 and other cytokines.
These B-2 agonists cause respiratory smooth muscle to relax.
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).
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

50. How is Rifampin used clinically?
Sotalol - Ibutilide - Bretylium - Amiodarone
Md= (CpxCL)/F Cp= plas. Conc. CL=clear. F=bioaval.
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic
1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone When used of Leprosy 3. Used in combination with other drugs