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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. Which diuretics increase urine NaCl?
cross - allergenic
- Acetaldehyde - Nausea - vomiting - headache - & hypotension
all of them
- Daunorubicin & Doxorubicin

2. What is the clinical use for Heparin?
anticholinesterase glaucoma
- Methylene blue
Immediate anticoagulation for PE - stroke - angina - MI - DVT.
Norepinephrine (Alpha1 -2 and beta 1)

3. The COX-2 inhibitors (celecoxib - rofecoxib) have similar side effects to the NSAIDs with What one exception?
Inhibits cell wall mucopeptide formation - Bactericidal
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.
- Halothane - Valproic acid - acetaminophen - Amantia phalloides

4. Acetaminophen has What two clinical uses and lacks What one clinical use of the NSAIDs?
Prevents the release of Ca from SR of skeletal muscle
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic
Reversibly inhibits cyclooxygenase - mostly in CNS. Inactivated peripherally.

5. How does a noncompetitive antagonist effect an agonist?
- Shifts the curve down - reduces Vmax
GET on the Metro
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis
- Flumazenil

6. Antiarrhythmic class IB- clinical uses?
Ototoxicity - Hypokalemia - Dehydration - Allergy (sulfa) - Nephritis (interstitial) - Gout
- Estrogen receptor antagonist - Breast CA - increased endometrial CA risk
Inhibits bacterial Dihydrofolate Reductase - Bacteriostatic
post MI and digitalis induced arrhythmias

7. What are Aminoglycosides synergistic with?
Beta - lactam antibiotics
- Methotrexate - 5 FU - 6 mercaptopurine
Post - op and neurogenic ileus and urinary retention - myasthenia gravis - and reversal of neuromuscular junction blockade (post - op) through anticholinesterase activity.
Methicillin - Nafcillin - and Dicloxacillin

8. Hydralazine - toxicity?
compensatory tachycardia - fluid retention - lupus - like syndrome
Well tolerated in general but occasionally - Nephrotoxicity - Ototoxicity - Thrombophlebitis - diffuse flushing='Red Man Syndrome'
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)
decrease conduction velocity - increase ERP - increase PR interval

9. Name three calcium channel blockers?
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.
Well tolerated in general but occasionally - Nephrotoxicity - Ototoxicity - Thrombophlebitis - diffuse flushing='Red Man Syndrome'
Nifedipine - Verapamil - Diltiazem
Modification via Acetylation

10. What is combined with Ampicillin - Amoxicillin - Carbenicillin - Piperacillin - and Ticarcillin to enhance their spectrum?
Clavulanic acid
Pentavalent Antimony
- Vinca alkaloids(inhibit MT) - Paclitaxel
Acute gout.

11. A common side effects of Interferon (INF) treatment is?
As an anticholinesterase it increases endogenous ACh and thus increases strength.
Diarrhea - Urination - Miosis - Bronchospasm - Bradycardia - Excitation of skeletal muscle and CNS - Lacrimation - Sweating - and Salivation = DUMBBELS; also abdominal cramping
Neutropenia
Beta1 more than B2

12. What are common side effects of Amphotericin B?
Teratogenic - Carcinogenic - Confusion - Headaches
Fever/Chills - Hypotension - Nephrotoxicity - Arrhythmias
bradycardia - AV block - CHF
Neutropenia

13. What is an additional side effect of Methicillin?
first dose orthostatic hypotension - dizziness - headache
Interstitial nephritis
Those patients who are taking nitrates.
No

14. What is the category of drug names ending in - oxin (e.g. Digoxin)
Cardiac glycoside (inotropic agent).
Cephalosporins
Bleeding.
1. Gastric ulceration 2. Bleeding 3. Hyperventilation 4. Reye's syndrome 5. Tinnitus (CN VIII)

15. What are four H2 Blockers?
Sulfonamides - Trimethoprim
Chronic (weeks or months)
hypertension - CHF - diabetic renal disease
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine

16. List the mechanism - clinical use - & toxicity of Vincristine.

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17. List the specific antidote for this toxin: Opioids
- B51Naloxone / naltrexone (Narcan)
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation
Blood
decrease conduction velocity - increase ERP - increase PR interval

18. Can Heparin be used during pregnancy?
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.
Yes - it does not cross the placenta.
GI upset - Superinfections - Skin rashes - Headache - Dizziness
Praziquantel

19. Antiarrhythmic class IC- effects?
- Chloramphenicol
Neutropenia
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.

20. Which cancer drugs work at the level of proteins(2)?
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia
- polymyxins
- Vinca alkaloids(inhibit MT) - Paclitaxel

21. Procainamide - toxicity?
proximal convoluted tubule - thin descending limb - and collecting duct
Headache - flushing - dyspepsia - blue - green color vision.
reversible SLE- like syndrome
- Haloperidol - chlorpromazine - reserpine - MPTP

22. List the specific antidote for this toxin: Acetaminophen
- N- acetylcystine
- Tetracycline - amiodarone - sulfonamides
Delirium - Tremor - Nephrotoxicity
Milk or Antacids - because divalent cations inhibit Tetracycline absorption in the gut

23. What are the clinical indications for bethanechol?
- Tamoxifen
reduce levels of Angiotensin II - thereby preventing the inactivation of bradykinin (a potent vasodilator); renin level is increased
- Clindamycin
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.

24. Which drug(s) cause this reaction: P450 inhibition(6)?
Immediate anticoagulation for PE - stroke - angina - MI - DVT.
GI side effects. (Indomethacin is less toxic - more commonly used.)
Chloramphenicol - Erythromycin/macrolides - Lincomycin - Clindamycin - Streptogramins (quinupristin - dalfopristin)
- Cimetidine - ketoconazole - grapefruit juice - erythromycin - INH - sulfonamides

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

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26. Which drug(s) cause this reaction: Photosensitivity(3)?
- Tetracycline - amiodarone - sulfonamides
aPTT (intrinsic pathway)
hypertension - angina - arrhythmias
Post - op and neurogenic ileus and urinary retention - myasthenia gravis - and reversal of neuromuscular junction blockade (post - op) through anticholinesterase activity.

27. What are two toxicities of the Sulfonylureas?
Praziquantel
1. Hypoglycemia (more common with 2nd - generation drugs: glyburide - glipizide) 2. Disulfiram - like effects (not seen with 2nd - generation drugs).
- Deferoxamine
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT

28. What is the difference in receptor affinity of epinephrine at low doses? High doses?

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29. What is the mechanism of action of Heparin?
Digitoxin 168hrs Digoxin 40 hrs
decrease
Heparin catalyzes the activation of antithrombin III.
local anesthetic. CNS stimulation or depression. CV depression.

30. Your patient wants an effective drug to treat his motion sickness - What would you prescribe
Beta Blockers
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.
blocks SR Ca2+ channels
Scopolamine

31. What are three toxicities of Propylthiouracil?
Polymyxins
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia
compensatory tachycardia - fluid retention - lupus - like syndrome
NO HYPERURICEMIA - NO SULFA AllERGY; same as furosemide otherwise

32. List the specific antidote for this toxin: Anticholinesterases (organophosphate.)
- Atropine & pralidoxime
AZT
Activates antithrombin III
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills

33. For Warfarin What is the Mechanism of action
effective in torsade de pointes and digoxin toxicity
Impairs the synthesis of vitamin K- dependent clotting factors
1. Predisposes to viral infections and lymphoma 2. Nephrotoxic (preventable with mannitol diuresis)
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.

34. What are the clinical uses for Imipenem/cilastatin?
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.
- acetylation - glucuron. - & sulfation - Conjugation - Polar product
Gram + cocci - Gram - rods - and Anerobes
- Ethanol - dialysis - & fomepizole

35. What microorganisms is Aztreonam not effective against?
Beta lactams - inhibit cell wall synthesis - Bactericidal
Inhalational general anesthetic.
1. Heavy bleeding 2. GI effects (n/v - anorexia) 3. Abdominal pain
Gram + and Anerobes

36. What are signs of Sildenafil (Viagra) toxicity?
HSV - VZV - EBV - Mucocutaneous and Genital Herpes Lesions - Prophylaxis in Immunocompromised pts
It acts presynaptically to increase NE release.
Headache - flushing - dyspepsia - blue - green color vision.
- Ammonium Chloride

37. What Sulfonamides are used for simple UTIs?
Triple sulfas or SMZ
- Daunorubicin & Doxorubicin
edrophonium (extremely short acting anticholinesterase)
Stimulating beta receptors stimulates heart rate - but beta receptor induced vasodilation reduces peripheral resistance.

38. Are penicillinase resistant
No - it inhibits the release of Nor Epi
Hypersensitivity reactions
Inhibits cell wall synthesis ( binds to PBP3). A monobactam
Methicillin - Nafcillin - and Dicloxacillin

39. What are common side effects of RT Inhibitors?
BM suppression (neutropenia - anemia) - Peripheral neuropathy
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.
Potent immunosuppressive used in organ transplant recipients.
Useful in muscle paralysis during surgery or mechanical ventilation.

40. What is a sign of toxicity with the use of thrombolytics?
Bleeding.
blocks SR Ca2+ channels
cardiac depression - peripheral edema - flushing - dizziness - constipation
Blocks Norepi - but not Dopamine

41. Ca2+ channel blockers - toxicity?
all of them
cardiac depression - peripheral edema - flushing - dizziness - constipation
not a sulfonamide - but action is the same as furosemide
cortical collecting tubule

42. Explain pH dependent urinary drug elimination?
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism
collecting ducts
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more

43. Ca2+ channel blockers - clinical use?
- polymyxins
Ca2+ (Loops Lose calcium)
Cyclooxygenases (COX I - COX II).
hypertension - angina - arrhythmias

44. How is Amphotericin B used clinically?
- Alkalinize urine & dialysis
Short.
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
Wide spectrum of systemic mycoses: Cryptococcus - Blastomyces - Coccidioides - Aspergillus - Histoplasma - Candida - Mucor

45. Can Warfarin be used during pregnancy?
No - warfarin - unlike heparin - can cross the placenta.
These B-2 agonists cause respiratory smooth muscle to relax.
Na/K ATPase
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity

46. What is the mechanism of action of Allopurinol used to treat chronic gout?
Edrophonium
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.

47. What are two conditions in Which COX-2 inhibitors might be used?
Modification via Acetylation
- Cloazapine - carbamazapine - colchicine - PTU
Rheumatoid and osteoarthritis.
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.

48. What is combination TMP- SMZ used to treat?
1. Heavy bleeding 2. GI effects (n/v - anorexia) 3. Abdominal pain
edrophonium (extremely short acting anticholinesterase)
Chronic anticoagulation.
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia

49. What are four clinical activities of Aspirin?
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills
Pentavalent Antimony
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.

50. Which drug(s) cause this reaction: Pseudomembranous colitis?
Vd= (Amt. of drug in body/ Plasma drug conc.)
- N- acetylcystine
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin
- Clindamycin