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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. Adverse effects of Nifedipine - verapamil?
Penicillin.
Chronic gout.
- Penicillamine
dizziness - flushing - constipation (verapamil) - nausea

2. How does Ganciclovir's toxicity relate to that of Acyclovir?
decrease conduction velocity - increase ERP - increase PR interval
Ganciclovir is more toxic to host enzymes
Carbachol - pilocarpine - physostigmine - echothiophate
Tricyclic antidepressant.

3. What are common serious side effects of Aminoglycosides and What are these associated with?
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more
- acetylation - glucuron. - & sulfation - Conjugation - Polar product
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic

4. Loop diuretics (furosemide)- site of action?
edrophonium (extremely short acting anticholinesterase)
Decreased uptake or Increased transport out of cell
thick ascending limb
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention

5. What is the receptor affinity and clinical use of isoproterenol?
loop diuretics - spironolactone
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system
Beta - lactam antibiotics
It affects beta receptors equally and is used in AV heart block (rare).

6. What is the mechanism of action of the glucocorticoids?
Decrease the production of leukotrienes and protaglandins by inhibiting phospholipase A2 and expression of COX-2.
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system
Blood
NO

7. List the specific antidote for this toxin: Methemoglobin
- Methylene blue
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin

8. What organism is Imipenem/cilastatin the Drug of Choice for?
depresses ectopic pacemakers - especially in digoxin toxicity
CL= (rate of elimination of drug/ Plasma drug conc.)
Enterobacter
Penicillin.

9. What is the category of drug names ending in - pril (e.g. Captopril)
Penicillin - Cephalosporins - Vancomycin - Aminoglycosides - Fluoroquinolones - Metronidazole
penicillinase resistant
ACE inhibitor.
Stimulating beta receptors stimulates heart rate - but beta receptor induced vasodilation reduces peripheral resistance.

10. How is Ribavirin used clinically?
TMP- SMZ
Hypersensitivity reactions
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills
for RSV

11. What are signs of Sildenafil (Viagra) toxicity?
Headache - flushing - dyspepsia - blue - green color vision.
Penicillin.
Enterobacter
Cell membrane Ca2+ channels of cardiac sarcomere

12. List the mechanism - clinical use - & toxicity of Prednisone.

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13. What are two toxicities of the Sulfonylureas?
Oxygen
- B51Naloxone / naltrexone (Narcan)
1. Hypoglycemia (more common with 2nd - generation drugs: glyburide - glipizide) 2. Disulfiram - like effects (not seen with 2nd - generation drugs).
Malaria (P. falciparum)

14. Antiarrhythmic class II- effects?
decrease the slope of phase 4 - increase PR interval (the AV node is particularly sensitive)
- Tetracycline
CMV - esp in Immunocompromised patients
sedation - depression - nasal stuffiness - diarrhea

15. What are two processes Corticosteroids inhibit leading to decreased inflammation?
- ACE inhibitors (Losartan>no cough)
Malaria (P. falciparum)
AZT
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes

16. What are the clinical uses for Imipenem/cilastatin?
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.
Gram + cocci - Gram - rods - and Anerobes
GI distress - Tooth discoloration and Inhibition of bone growth in children - Fanconi's syndrome - Photosensitivity
Long.

17. What are the products and their toxicities of the metabolism of Methanol by / alcohol dehydrogenase?
Disulfiram - like reaction with EtOH - Headache
- Formaldehyde & formic acid - severe acidosis & retinal damage
Stimulating beta receptors stimulates heart rate - but beta receptor induced vasodilation reduces peripheral resistance.
carbonic anhydrase inhibitors - K+ sparing diuretics

18. What patients are at risk for life threatening hypotension When taking Sildenafil (Viagra)?
Cilastatin
Neutropenia
Only in limited amounts
Those patients who are taking nitrates.

19. For Warfarin What is the Structure
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT
Small lipid - soluble molecule
VACUUM your Bed Room'
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids

20. Preferential action of the Ca2+ channel blockers at vascular smooth muscle?
Blocks Norepi - but not Dopamine
vascular sm. Mus.: Nifedipine>Diltiazem>Verapamil
Clomiphene is a partial agonist at estrogen receptors in the pituitary gland. Prevents normal feedback inhibition and increses release of LH and FSHfrom the pituitary - Which stimulates ovulation.
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.

21. Beta Blockers - site of action?
- Niacin - Ca++ channel blockers - adenosine - vancomycin
Beta adrenergic receptors and Ca2+ channels (stimulatory)
The PT.
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.

22. How are the HIV drugs used clinically?

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23. What is the clinical use of Tacrolimus (FK506)?
Fast vs. Slow Acetylators
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide
Potent immunosuppressive used in organ transplant recipients.

24. What is the memory key for the effect of aluminum hydroxide overuse?
hypertension - CHF - diabetic renal disease
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
competitive inhibirot of aldosterone in the cortical collecting tubule
AluMINIMUM amount of feces.

25. What is the MOA for the Aminoglycosides?
The PTT.
Inhibits formation of Initiation Complex - causes misreading of mRNA - Bactericidal
Praziquantel
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.

26. Adverse effects of Methyldopa?

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27. Which drug(s) cause this reaction: Neuro and Nephrotoxic?
Phosphorylation by a Viral Kinase
prevention of nodal arrhythmias (SVT)
- polymyxins
Sotalol - Ibutilide - Bretylium - Amiodarone

28. How is Amphotericin B administered for fungal meningitis?
Blocks Peptide Bond formation at the 50S subunit - Bacteriostatic
Intrathecally
Suramin
Ca2+ (Loops Lose calcium)

29. What are four clinical activities of Aspirin?
Aluminum sucrose sulfate polymerizes in the acid environment of the stomach and selectively binds necrotic peptic ulcer tissue. Acts as a barrier to acid - pepsin - and bile.
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).

30. List the mechanism - clinical use - & toxicity of Tamoxifen.
- Estrogen receptor antagonist - Breast CA - increased endometrial CA risk
- Vitamin K & fresh frozen plasma
- Upper respiratory tract infections - pneumonias - STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) - Mycoplasma - Legionella - Chlamydia - Neisseria
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.

31. What is the possible mechanism and effect of Metformin in treating diabetes?
Triple sulfas or SMZ
Beta adrenergic receptors and Ca2+ channels (stimulatory)
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels
glaucoma - urinary alkalinization - metabolic alkalosis - altitude sickness

32. Ca2+ channel blockers - clinical use?
hypertension - angina - arrhythmias
Inhibits cGMP phosphodiesterase - casuing increased cGMP - smooth muscle relaxation in the corpus cavernosum - increased blood flow - and penile erection.
all of them
Similar to cyclosporine; binds to FK- binding protein - inhibiting secretion of IL-2 and other cytokines.

33. Mg+- clinical use?
- Methotrexate - 5 FU - 6 mercaptopurine
- Bleomycin - amiodarone - busulfan
Imipenem
effective in torsade de pointes and digoxin toxicity

34. Aztreonam is not ________ with penicillins
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.
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.
cross - allergenic
- Haloperidol - chlorpromazine - reserpine - MPTP

35. What is clinical use for Carbenicillin - Piperacillin - and Ticarcillin?
Inhibits cell wall mucopeptide formation - Bactericidal
Bleeding.
torsade de pointes
Pseudomonas species and Gram - rods

36. Hydralazine - clinical use?
severe hypertension - CHF
- Alkalinize urine & dialysis
Protease Inhibitors and Reverse Transcriptase Inhibitors
first dose orthostatic hypotension - dizziness - headache

37. What organisms does Griseofulvin target?
Reversible block of histamine H2 receptors
Dermatophytes (tinea - ringworm)
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas
- Estrogen receptor antagonist - Breast CA - increased endometrial CA risk

38. What is the mechanism of action of Allopurinol used to treat chronic gout?
Amphotericin B - Nystatin - Fluconazole/azoles
Neostigmine - pyridostigmine edrophonium - physostigmine echothiophate
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.
torsade de pointes - excessive Beta block

39. Name the common Azoles
Penicillin - V
carbonic anhydrase inhibitors - K+ sparing diuretics
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole
Aminoglycosides

40. What is the memory key for the action of Sildenafil (Viagra)?
Teratogenic - Carcinogenic - Confusion - Headaches
Polymyxin B - Polymyxin E
Sildenafil fills the penis
Protamine sulfate

41. 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
Penicillin - G
Dopamine
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)
Small lipid - soluble molecule

42. Which drug(s) cause this reaction: Atropine - like side effects?
- Phenytoin
- Niacin - Ca++ channel blockers - adenosine - vancomycin
- Tricyclic antidepressants
Cell membrane Ca2+ channels of cardiac sarcomere

43. Which Tetracycline is used in patients with renal failure? / Why?
Pseudomembranous colitis (C. difficile) - fever - diarrhea
GET on the Metro
Doxycycline - because it is fecally eliminated
Sulfonamides - Trimethoprim

44. What is a possible toxicity of Alpha - glucosidase inhibitors used in type -2 diabetes?
GI disturbances.
1. Weight gain 2. Hepatotoxicity (troglitazone)
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis

45. Toxicities associated with Acyclovir?
Rare.
Imipenem
AluMINIMUM amount of feces.
Delirium - Tremor - Nephrotoxicity

46. Amprotericin B ___________ the BBB
Chronic Hepatitis A and B - Kaposi's Sarcoma
Does not cross
Severe Gram - rod infections.
Gram + - Gram - - Norcardia - Chlamydia

47. What drug is used to treat Trematode/fluke (e.g. - Schistosomes - Paragonimus - Clonorchis) or Cysticercosis
YES
Carbachol - pilocarpine - physostigmine - echothiophate
- Penicillin
Praziquantel

48. What is the mechanism of action of Heparin?
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal
Forms toxic metabolites in the bacterial cell - Bactericidal
Heparin catalyzes the activation of antithrombin III.
GI disturbances.

49. What are the side effects of Rifampin?
- Penicillamine
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin
Beta Blockers
Minor hepatotoxicity - Drug interactions (activates P450)

50. What is the mechanism of action of Omeprazole - Lansoprazole?
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.
- Hydralazine - Procainamide - INH - phenytoin
- DNA intercalator - testicular & lymphomas - Pulmonary fibrosis mild myelosuppression.
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species