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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.
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. For Heparin What is the Site of action
Blood
Methylxanthine.
In 4 half - lifes= (94%) T1/2 = (0.7x Vd)/CL
Immediate anticoagulation for PE - stroke - angina - MI - DVT.

2. ACE inhibitors - clinical use?
Choline acetyltransferase
hypertension - CHF - diabetic renal disease
- inhibits HGPRT (pur. Syn.) - Luk - Lymph
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

3. What is the memory aid for subunit distribution of ribosomal inhibitors?

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4. Is toxicity rare or common whith Cromolyn used in Asthma prevention?
toxic
check PFTs - LFTs - and TFTs
Blocks Influenza A and RubellA; causes problems with the cerebellA
Rare.

5. List the specific antidote for this toxin: Heparin
fetal renal toxicity - hyperkalemia
- Vitamin K & fresh frozen plasma
- Protamine
Increased systolic and pulse pressure - decreased diastolic pressure - and little change in mean pressure.

6. List the specific antidote for this toxin: TPA & Streptokinase
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.
IV vitamin K and fresh frozen plasma
Minor hepatotoxicity - Drug interactions (activates P450)
- Aminocaproic acid

7. Would blockade of muscarininc receptors in the bladder be useful in treating urinary retention?
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.
Antiprotozoal: Giardia - Entamoeba - Trichomonas - Gardnerella vaginalis Anaerobes: Bacteroides - Clostridium
Headache - flushing - dyspepsia - blue - green color vision.
These B-2 agonists cause respiratory smooth muscle to relax.

8. What is a possible result of overdose of Acetaminophen?
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
1)Binds penicillin - binding proteins 2) Blocks transpeptidase cross - linking of cell wall 3) Activates autolytic enzymes
- Chlorpromazine - thioridazine - haloperidol
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)

9. Name common Polymyxins
Those patients who are taking nitrates.
carbonic anhydrase inhibitors - K+ sparing diuretics
Polymyxin B - Polymyxin E
Paranteral (IV - SC)

10. What is Ketoconazole specifically used for?
- Hydralazine - Procainamide - INH - phenytoin
Cryptococcal meningitis in AIDS patients and Candidal infections of all types
Beta -2 agonist.
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism

11. What is clinical use for Carbenicillin - Piperacillin - and Ticarcillin?
Diuresis in pateints with sulfa allergy
Pseudomonas species and Gram - rods
vasodilator - increases cGMP to induce smooth muscle relaxation (arterioles>veins; afterload reduction)
post MI and digitalis induced arrhythmias

12. List the mechanism - clinical use - & toxicity of Cyclophosphamide.
Indirect agonist - uptake inhibitor
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.
CMV Retinitis in IC pts When Ganciclovir fails
Succinylcholine

13. What is the effect of TCA's on the adrenergic nerve?
Captopril - Enalapril - Lisinopril
aPTT (intrinsic pathway)
They inhibit reuptake of NE at the nerve terminal (as does cocaine).
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.

14. What is the possible mechanism and effect of Metformin in treating diabetes?
Bacitracin - Vancomycin
Pyridoxine (B6) administration
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels
Rash - Pseudomembranous colitis

15. Which RT inhibitors cause Lactic Acidosis?
Nucleosides
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
Acute (hours)
Rheumatoid and osteoarthritis.

16. ACE inhibitors - toxicity?
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Leukotrienes increasing bronchial tone.
- reduction - oxy - & hydrolysis - H2O sol. Polar product - P450

17. Where does Griseofulvin deposit?
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH
Same as penicillin. Act as narrow spectrum antibiotics
Keratin containing tissues - e.g. - nails
Pentamidine

18. Which RT inhibitor causes Megaloblastic Anemia?
VACUUM your Bed Room'
Prevents the release of ACh - Which results in muscle paralysis.
Blood
AZT

19. What microorganisms are Aminoglycosides ineffective against?
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents
distal convoluted tubule (early)
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.
Anaerobes

20. What are the major structural differences between Penicillin and Cephalosporin?
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation
Prefers beta's at low doses - but at higher doses alpha agonist effects are predominantly seen.
Cephalosporin: 1) has a 6 member ring attached to the Beta lactam instead of a 5 member ring 2)has an extra functional group ( attached to the 6 member ring)

21. ADH antagonists - site of action?
collecting ducts
Liver
It must be Phosphorylated by Viral Thymidine Kinase
Inhibits CMV DNA polymerase

22. What is a possible toxicity of Ticlopidine - Clopidogrel usage?
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents
Aminoglycosides
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.

23. Does Ampicillin or Amoxicillin have a greater oral bioavailability?
Ipratropium
AmOxicillin has greater Oral bioavailability
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride
Quinidine - Amiodarone - Procainamide - Disopyramide

24. Preferential action of the Ca2+ channel blockers at vascular smooth muscle?
vascular sm. Mus.: Nifedipine>Diltiazem>Verapamil
Modification via Acetylation - Adenylation - or Phosphorylation
Flecainide - Encainide - Propafenone
1. Addison's disease 2. Inflammation 3. Immune suppression 4. Asthma

25. Hydralazine - class and mechanism?
Succinylcholine
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes
Reversibly inhibits cyclooxygenase - mostly in CNS. Inactivated peripherally.
vasodilator - increases cGMP to induce smooth muscle relaxation (arterioles>veins; afterload reduction)

26. Which drug(s) cause this reaction: Oto and Nephrotoxicity (3)?
Blocks Norepi - but not Dopamine
Butyrophenone (neuroleptic).
- aminoglycosides - loop diuretics - cisplatin
Topical and Oral - for Oral Candidiasis (Thrush)

27. Adverse effects of Losartan?
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT
Blocks Peptide Bond formation at the 50S subunit - Bacteriostatic
fetal renal toxicity - hyperkalemia
carbonic anhydrase inhibitors - K+ sparing diuretics

28. Which drug(s) cause this reaction: SLE- like syndrome?
It affects beta receptors equally and is used in AV heart block (rare).
- Hydralazine - Procainamide - INH - phenytoin
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA
check PFTs - LFTs - and TFTs

29. Can Warfarin be used during pregnancy?
No - warfarin - unlike heparin - can cross the placenta.
blocks SR Ca2+ channels
Norepinephrine
Dopamine

30. What is the major toxic side effect of Penicillin?
With supplemental Folic Acid
Hypersensitivity reactions
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.

31. Which diuretics increase urine K+?
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.
amphetamine and ephedrine
Norepinephrine (Alpha1 -2 and beta 1)

32. Ganciclovir associated toxicities?
- N- acetylcystine
1. Buffalo hump 2. Moon facies 3. Truncal obesity 4. Muscle wasting 5. Thin skin 6. Easy bruisability 7. Osteoporosis 8. Adrenocortical atrophy 9. Peptic ulcers
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity
- Phase I (clinical tests) - Phase II - Phase III - PhaseIV (surveillance)

33. Antiarrhythmic class II- toxicity?
Norepinephrine
impotence - exacerbation of asthma - CV effects - CNS effects - may mask hypoclycemia
Methylzanthine; desired effect is bronchodilation - may cause bronchodilation by inhibiting phosphodiesterase - enzyme involved in degrading cAMP (controversial).
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)

34. What is the MOA of Griseofulvin?
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis
- Hypersensitivity reactions - Hemolysis - Nephrotoxicity (tubulointerstitial nephritis) - Kernicterus in infants Displace other drugs from albumin (e.g. - warfarin)
Interferes with microtubule function - disrupts mitosis - inhibits growth
Zidovudine (AZT) - Didanosine (ddI) - Zalcitabine (ddC) - Stavudine (d4T) - Lamivudine (3TC)

35. Which drug(s) cause this reaction: Extrapyramidal side effects (3)?
- Chlorpromazine - thioridazine - haloperidol
Blocks Norepi - but not Dopamine
Post - op and neurogenic ileus and urinary retention - myasthenia gravis - and reversal of neuromuscular junction blockade (post - op) through anticholinesterase activity.
Protease inhibitor.

36. Why are the Sulfonylureas inactive in IDDM (type -1)?
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
Because they require some residual islet function.
- Phenytoin
Small lipid - soluble molecule

37. Antimicrobial prophylaxis for Meningococcal infection
Oral treatment of superficial infections
compensatory tachycardia - fluid retention - lupus - like syndrome
fetal renal toxicity - hyperkalemia
Rifampin (DOC) - minocycline

38. ________ ae not resistant to penicillinase - - but they are less susceptible than the other Beta lactams
- Sulfonamides - furosemide - methicillin - rifampin - NSAIDS (ex. ASA)
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.
Cephalosporins
It acts presynaptically to increase NE release.

39. What is the clinical utility of cocaine?
The only local anesthetic with vasoconstrictive properties.
Methylxanthine.
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.

40. What is the clinical use for Nystatin?
Topical and Oral - for Oral Candidiasis (Thrush)
Bleeding.
TMP- SMZ
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.

41. K+ sparing diuretics - clinical use?
hyperaldosteronism - K+ depletion - CHF
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
Chronic anticoagulation.
Decreased uptake or Increased transport out of cell

42. What is the major side effect for Carbenicillin - Piperacillin - and Ticarcillin?
Hypersensitivity reactions
Chronic Hepatitis A and B - Kaposi's Sarcoma
not a sulfonamide - but action is the same as furosemide
Sildenafil fills the penis

43. What is a common drug interaction associated with Griseofulvin?
Pentavalent Antimony
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.
Increases coumadin metabolism
Chronic gout.

44. Mannitol - contraindications?
BM suppression (neutropenia - anemia) - Peripheral neuropathy
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.
anuria - CHF
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome

45. What enzymes are inhibited by NSAIDs - acetaminophen and COX II inhibitors?
Phenothiazine (neuroleptic - antiemetic).
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia
- Alkalate DNA - Brain tumors - CNS toxicity
Cyclooxygenases (COX I - COX II).

46. List the specific antidote for this toxin: Anticholinesterases (organophosphate.)
Sildenafil fills the penis
- Triggers apoptosis - CLL - Hodgkin's in MOPP - Cushing - like syndrome
It affects beta receptors equally and is used in AV heart block (rare).
- Atropine & pralidoxime

47. 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)
Leukotrienes increasing bronchial tone.
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.

48. What is the category of drug names ending in - zosin (e.g. Prazosin)
Mg = Must go to the bathroom.
Alpha -1 antagonist
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)

49. Which drug(s) cause this reaction: Cough?
- EDTA - dimercaprol - succimer - & penicillamine
- ACE inhibitors (Losartan>no cough)
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH

50. 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.
GI upset - Superinfections - Skin rashes - Headache - Dizziness
Small lipid - soluble molecule
Acute gout.