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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. What are the clinical uses for 1st Generation Cephalosporins?
- Aminocaproic acid
Gram + cocci - Proteus mirabilis - E. coli - Klebsiella pneumoniae (PEcK)
No
Nevirapine - Delavirdine

2. List the mechanism - clinical use - & toxicity of Cyclophosphamide.
- Tamoxifen
Norepinephrine
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.
No - warfarin - unlike heparin - can cross the placenta.

3. How is Ribavirin used clinically?
for RSV
Mg = Must go to the bathroom.
- inhibits HGPRT (pur. Syn.) - Luk - Lymph
AZT

4. What type of gout is treated with Allopurinol?
Chloramphenicol - Erythromycin/macrolides - Lincomycin - Clindamycin - Streptogramins (quinupristin - dalfopristin)
GI side effects. (Indomethacin is less toxic - more commonly used.)
Chronic gout.
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions

5. What is the MOA of the RT Inhibitors?
sedation - sleep alterations
proximal convoluted tubule - thin descending limb - and collecting duct
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA
Treatment of hypertension - especially with renal disease (lowers bp centrally - so flow is maintained to kidney).

6. Digoxin v. Digitoxin: half life?
Ipratropium
AluMINIMUM amount of feces.
- Ethosuxamide - sulfonamides - lamotrigine
Digitoxin 168hrs Digoxin 40 hrs

7. Clonidine is the preferred sym pathomimetic tx of HTN in pts with renal disease - why??
- Ammonium Chloride
Centrally acting alpha agonist - thus causing a decrease in central adrenergic outflow - spairing renal blood flow
- Hydralazine - Procainamide - INH - phenytoin
Pentavalent Antimony

8. Which drug(s) cause this reaction: Cardiac toxicity?
- Daunorubicin & Doxorubicin
NE acts presynaptically on alpha -2 receptors to inhibit its own release. ACh also acts presynaptically through M1 receptors to inhibit NE release.
cyanide toxicity (releases CN)
Prophylaxis for Influenza A - Rubella; Parkinson's disease

9. Can Warfarin be used during pregnancy?
Pregnant women - Children; because animal studies show Damage to Cartilage
- Ethosuxamide - sulfonamides - lamotrigine
No - warfarin - unlike heparin - can cross the placenta.
Disulfiram - like reaction with EtOH - Headache

10. What are common toxicities associated with Macrolides? (4)
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.
GI discomfort - Acute cholestatic hepatitis - Eosinophilia - Skin rashes
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole
- Deferoxamine

11. What two vasodilators require simultaneous treatment with beta blockers to prevent reflex tachycardia and diuretics to prevent salt retention?
Hydralazine and Minoxidil
- Glucagon
Mebendazole/Thiabendazole - Pyrantel Pamoate
Succinylcholine

12. How can Isoniazid (INH)- induced neurotoxicity be prevented?
Polymyxin B - Polymyxin E
Stimulating beta receptors stimulates heart rate - but beta receptor induced vasodilation reduces peripheral resistance.
Gram + cocci - Gram - rods - and Anerobes
Pyridoxine (B6) administration

13. For Warfarin What is the Onset of action
Slow - limited by half lives of clotting factors
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.
Alpha -1 antagonist
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.

14. What is the mechanism of action of Colchicine used to treat acute gout?
Depolymerizes microtubules - impairing leukocyte chemotaxis and degranulation.
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia
- Deferoxamine
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis

15. What is the mechanism of action of Aspirin?
Because they require some residual islet function.
Cimetidine is a potent inhibitor of P450; it also has an antiandrogenic effect and decreases renal excretion of creatinine. Other H2 blockers are relatively free of these effects.
- Disulfram & also sulfonylureas - metronidazole
Acetylates and irreversibly inhibits cyclooxygenase (COX I and COX II) to prevent the conversion of arachidonic acid to prostaglandins.

16. Which antimuscarinic agents are used in producing mydriasis and cycloplegia?
GI upset - Superinfections - Skin rashes - Headache - Dizziness
Inhibition of 50S peptidyl transferase - Bacteriostatic
Abortifacient.
atropine - homatropine - tropicamide

17. How are Interferons (INF) used clinically?

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18. Name the Protease Inhibitors (4)
Same as penicillin. Extended spectrum antibiotics
Diarrhea - Urination - Miosis - Bronchospasm - Bradycardia - Excitation of skeletal muscle and CNS - Lacrimation - Sweating - and Salivation = DUMBBELS; also abdominal cramping
Saquinavir - Ritonavir - Indinavir - Nelfinavir
Nitrates

19. What is the mechanism of action of Warfarin (Coumadin)?
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.
Penicillin - G
Modification via Acetylation
Warfarin interferes with the normal synthesis and gamma - carboxylation of vitamin K- dependent clotting factors II - VII - IX - and X - Protein C and S via vitamin K antagonism.

20. Which drug(s) cause this reaction: Pulmonary fibrosis(3)?
- Bleomycin - amiodarone - busulfan
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)
Dry flushed skin - due to inhibition of sympathetic post - ganglionic blockade on muscarinic receptors of sweat glands. All others are opposite of What would be expected.
penicillinase resistant

21. Antiarrhythmic class IC- effects?
- DNA intercalator - testicular & lymphomas - Pulmonary fibrosis mild myelosuppression.
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT
- Formaldehyde & formic acid - severe acidosis & retinal damage
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions

22. What are five toxicities associated with Tacrolimus (FK506)?
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.
orthostatic and exercise hypotension - sexual dysfunction - diarrhea
Dry flushed skin - due to inhibition of sympathetic post - ganglionic blockade on muscarinic receptors of sweat glands. All others are opposite of What would be expected.
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.

23. For Heparin What is the Onset of action
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances
GI distress - Tooth discoloration and Inhibition of bone growth in children - Fanconi's syndrome - Photosensitivity
Chagas' disease - American Trypanosomiasis (Trypanosoma cruzi)
Rapid (seconds)

24. What are toxicities associated with Chloramphenicol?
HTN - CHF - calcium stone formation - nephrogenic DI.
GI discomfort
The only local anesthetic with vasoconstrictive properties.
Aplastic anemia (dose independent) - Gray Baby Syndrome

25. What is the category of drug names ending in - ane (e.g. Halothane)
Ca2+ (Loops Lose calcium)
Inhalational general anesthetic.
Sulfonylureas are oral hypoglycemic agents - they are used to stimulate release of endogenous insulin in NIDDM (type -2).
Increases coumadin metabolism

26. Ibutilide - toxicity?
Neomycin
- Protamine
torsade de pointes
1. Better bioavailability 2. 2 to 4 times longer half life 3. Can be administered subcutaneously 4. Does not require laboratory monitoring

27. Name the common Azoles
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.
Edrophonium
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole
- Phenytoin

28. How is Amphotericin B used clinically?
Wide spectrum of systemic mycoses: Cryptococcus - Blastomyces - Coccidioides - Aspergillus - Histoplasma - Candida - Mucor
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity
Ganciclovir is more toxic to host enzymes

29. Antiarrhythmic class IV- clinical use?
prevention of nodal arrhythmias (SVT)
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.
Oral treatment of superficial infections
Inhibits cGMP phosphodiesterase - casuing increased cGMP - smooth muscle relaxation in the corpus cavernosum - increased blood flow - and penile erection.

30. Why would you use pralidoxime after exposure to an organophosphate?
Inhibit viral DNA polymerase
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression
Pralidoxime regenerates active cholinesterase.
Prefers beta's at low doses - but at higher doses alpha agonist effects are predominantly seen.

31. What are the clinical uses for 2nd Generation Cephalosporins?
- Penicillin
- Glucagon
Protease Inhibitors and Reverse Transcriptase Inhibitors
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )

32. These drugs acts indirectly by releasing strored catecholamines in the presynaptic terminal
anuria - CHF
Primaquine
Amphetamine and Ephedrine
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.

33. Ca2+ channel blockers - clinical use?
first dose orthostatic hypotension - dizziness - headache
proximal convoluted tubule - thin descending limb - and collecting duct
Treatment of hypertension - especially with renal disease (lowers bp centrally - so flow is maintained to kidney).
hypertension - angina - arrhythmias

34. How do Sulfonamides act on bacteria?
Same as penicillin. Act as narrow spectrum antibiotics
As PABA antimetabolites that inhibit Dihydropteroate Synthase - Bacteriostatic
not a sulfonamide - but action is the same as furosemide
Binding to the presynaptic alpha 2 release modulating receptors

35. Which drug(s) cause this reaction: Disulfram - like reaction (4) ?
Methicillin - Nafcillin - and Dicloxacillin
Increases coumadin metabolism
Ca2+ (Loops Lose calcium)
- Metronidazole - certain cephalosporins - procarbazine - sulfonylureas

36. Which drug(s) cause this reaction: Pseudomembranous colitis?
The PTT.
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes
- Clindamycin
impotence - asthma - CV effects (bradycardia - CHF - AV block) - CNS effects (sedation - sleep alterations)

37. Antiarrhythmic class IB- effects?
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system
Neurotoxicity - Acute renal tubular necrosis
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.
Activates antithrombin III

38. What is combination TMP- SMZ used to treat?
first dose orthostatic hypotension - dizziness - headache
Ototoxicity - Hypokalemia - Dehydration - Allergy (sulfa) - Nephritis (interstitial) - Gout
Antiprotozoal: Giardia - Entamoeba - Trichomonas - Gardnerella vaginalis Anaerobes: Bacteroides - Clostridium
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia

39. Antiarrhythmic class II- effects?
Hemolytic anemia
scopolamine
Amphetamine and Ephedrine
decrease the slope of phase 4 - increase PR interval (the AV node is particularly sensitive)

40. What are four Sulfonylureas?
Cardiac glycoside (inotropic agent).
Indomethacin is used to close a patent ductus arteriosus.
not a sulfonamide - but action is the same as furosemide
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide

41. How is Griseofulvin used clinically?
Praziquantel
Oral treatment of superficial infections
Mg = Must go to the bathroom.
Hypersensitivity reactions

42. What are Aminoglycosides used for clinically?
DHPG (dihydroxy-2- propoxymethyl guanine)
glaucoma - urinary alkalinization - metabolic alkalosis - altitude sickness
Beta lactams - inhibit cell wall synthesis - Bactericidal
Severe Gram - rod infections.

43. What is Metronidazole combined with for 'triple therapy'? Against What organism?
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori
Antiprotozoal: Giardia - Entamoeba - Trichomonas - Gardnerella vaginalis Anaerobes: Bacteroides - Clostridium
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).

44. Antimicrobial prophylaxis for a history of recurrent UTIs
TMP- SMZ
Phenothiazine (neuroleptic - antiemetic).
loop diuretics - spironolactone
Inhibits reabsorption of uric acid.

45. For Warfarin What is the Ability to inhibit coagulation in vitro
Pseudomonas species and Gram - rods
No
- Cimetidine - ketoconazole - spironolactone - digitalis - EtOH - estrogens
Heparin catalyzes the activation of antithrombin III.

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

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47. What is the clinical utility of cocaine?
- Sulfonamides - furosemide - methicillin - rifampin - NSAIDS (ex. ASA)
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH
Mebendazole/Thiabendazole - Pyrantel Pamoate
The only local anesthetic with vasoconstrictive properties.

48. Adenosine - clinical use?
vascular sm. Mus.: Nifedipine>Diltiazem>Verapamil
cyanide toxicity (releases CN)
With an amino acid change of D- ala D- ala to D- ala D- lac
DOC in diagnosing and abolishing AV nodal arrhythmias

49. What is the category of drug names ending in - cillin (e.g. Methicillin)
Methylation of rRNA near Erythromycin's ribosome binding site
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention
Penicillin.
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).

50. Name the common Non - Nucleoside Reverse Transcriptase Inhibitors
Increases coumadin metabolism
- Penicillin
Nevirapine - Delavirdine
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)