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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. 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
Dopamine
No - hemicholinum block the uptake of Choline and thus Ach synthesis
Methylxanthine.
Succinylcholine

2. Which cancer drugs work at the level of proteins(2)?
Clavulanic acid
- Vinca alkaloids(inhibit MT) - Paclitaxel
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)
- Vitamin K & fresh frozen plasma

3. Why are albuterol and terbutaline effective in tx of acute asthmatic attacks?
Suramin
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.
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).

4. What is the category - mechanism of action - and effect of Ipratroprium in Asthma treatment?
Muscarinic antagonist; competatively blocks muscarinic receptors - preventing bronchoconstriction.
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)
- inhibits HGPRT (pur. Syn.) - Luk - Lymph
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.

5. What is the mechanism of action of NSAIDs other than Aspirin?
Tetracycline - Doxycycline - Demeclocycline - Minocycline
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.
Severe Gram - rod infections.
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)

6. What is the only depolarizing neuromuscular blocking agent?
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity
Because they require some residual islet function.
Acetylates and irreversibly inhibits cyclooxygenase (COX I and COX II) to prevent the conversion of arachidonic acid to prostaglandins.
Succinylcholine

7. What is the clinical use for Warfarin?
Chronic anticoagulation.
Oxygen
As an anticholinesterase it increases endogenous ACh and thus increases strength.
Staphlococcus aureus

8. What are common side effects of Protease Inhibitors?
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)
Inhibits cell wall synthesis ( binds to PBP3). A monobactam
Methicillin - Nafcillin - and Dicloxacillin
Amphotericin B - Nystatin - Fluconazole/azoles

9. Does Warfarin have a long - medium - or short half life?
severe orthostatic hypotension - blurred vision - constipation - sexual dysfunction
Used in combination therapy with SMZ to sequentially block folate synthesis
thick ascending limb
Long.

10. What is the mecanism of action - effective period - and ineffective period of use for Cromolyn in treating Asthma?
effective in torsade de pointes and digoxin toxicity
Prevents release of mediators from mast cells. Effective only for the prophylaxis of asthma. Not effective during an acute attack.
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.
GI discomfort

11. How do you treat coma in the ER (4)?
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD
GI upset

12. Clonidine is the preferred sym pathomimetic tx of HTN in pts with renal disease - why??
Centrally acting alpha agonist - thus causing a decrease in central adrenergic outflow - spairing renal blood flow
- Tetracycline - amiodarone - sulfonamides
The only local anesthetic with vasoconstrictive properties.
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels

13. Antiarrhythmic class II- effects?
hypertension - CHF - diabetic renal disease
Chronic gout.
decrease the slope of phase 4 - increase PR interval (the AV node is particularly sensitive)
Blocks Norepi - but not Dopamine

14. Which drug(s) cause this reaction: SLE- like syndrome?
- Hydralazine - Procainamide - INH - phenytoin
diuretics - sympathoplegics - vasodilators - ACE inhibitors - Angiotensin II receptor inhibitors
Increases coumadin metabolism
1. Pioglitazone 2. Rosiglitazone.

15. Which drug(s) cause this reaction: Atropine - like side effects?
Aminoglycosides
- Tricyclic antidepressants
Nevirapine - Delavirdine
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.

16. List the mechanism - clinical use - & toxicity of Bleomycin.
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
anuria - CHF
- DNA intercalator - testicular & lymphomas - Pulmonary fibrosis mild myelosuppression.
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.

17. Name three Antiarrhythmic drugs in class IB.
Lidocaine - Mexiletine - Tocainide
1. Better bioavailability 2. 2 to 4 times longer half life 3. Can be administered subcutaneously 4. Does not require laboratory monitoring
- Hydralazine - Procainamide - INH - phenytoin
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)

18. Does Heparin have a long - medium - or short half life?
NO HYPERURICEMIA - NO SULFA AllERGY; same as furosemide otherwise
With an amino acid change of D- ala D- ala to D- ala D- lac
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.
Short.

19. What is the mechanism of action of the glucocorticoids?
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.
Penicillin.
Decrease the production of leukotrienes and protaglandins by inhibiting phospholipase A2 and expression of COX-2.
Cryptococcal meningitis in AIDS patients and Candidal infections of all types

20. What is the memory key for the action of Sildenafil (Viagra)?
Binds to the Pyrophosphate Binding Site of the enzyme
Sildenafil fills the penis
not a sulfonamide - but action is the same as furosemide
Dopamine; causes its release from intact nerve terminals

21. What physiological effects was the Anes using Atropine to tx
all of them
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions

22. What are two mechanisms of action of Propythiouracil?
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.
1. In liver - increases storage of glucose as glycogen. 2. In muscle - stimulates glycogen and protein synthesis - and K+ uptake. 3. In adipose tissue - facilitates triglyceride storage.
INH: Injures Neurons and Hepatocytes
hypertension - angina - arrhythmias

23. Which drug(s) cause this reaction: Diabetes insipidus?
- Lithium
Hemolysis (if G6PD deficient) - Neurotoxicity - Hepatotoxicity - SLE- like syndrome
Oral
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.

24. List the mechanism - clinical use - & toxicity of 6 MP.
Ceftriaxone
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
cardiac muscle: Verapamil>Diltiazem>Nifedipine
- inhibits HGPRT (pur. Syn.) - Luk - Lymph

25. Which drug(s) cause this reaction: Gingival hyperplasia?
Quinidine - Amiodarone - Procainamide - Disopyramide
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)
- Phenytoin

26. Antiarrhythmic class IV- clinical use?
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.
prevention of nodal arrhythmias (SVT)
Triple sulfas or SMZ
Rare.

27. Explain potency in relation to full and partial agonists(2).
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.
Because they require some residual islet function.
No
Cyclooxygenases (COX I - COX II).

28. Which drug(s) cause this reaction: Osteoporosis (2)?
- Corticosteroids - heparin
Modification via Acetylation - Adenylation - or Phosphorylation
Anaerobic infections (e.g. - B. fragilis - C. perfringens)
1. Weight gain 2. Hepatotoxicity (troglitazone)

29. What is the definition of zero - order kinetics? Example?
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia
- Constant AMOUNT eliminated per unit time. - Etoh & ASA
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
effective in torsade de pointes and digoxin toxicity

30. What is the MOA of the RT Inhibitors?
1. Hypoglycemia (more common with 2nd - generation drugs: glyburide - glipizide) 2. Disulfiram - like effects (not seen with 2nd - generation drugs).
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA
Severe Gram - rod infections.
Amphetamine and Ephedrine

31. What is the MOA for the Cephalosporins?
Beta lactams - inhibit cell wall synthesis - Bactericidal
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.
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)
Meningitis (H. influenza - N. meningitidis - S. pneumoniae) - Conserative treatment due to toxicities

32. Why would you use pralidoxime after exposure to an organophosphate?
Pralidoxime regenerates active cholinesterase.
Rheumatoid and osteoarthritis.
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome
Oral treatment of superficial infections

33. What enzyme is responsible for the breakdown of ACh in the synaptic cleft?
Inhibition of 50S peptidyl transferase - Bacteriostatic
Aplastic anemia (dose independent) - Gray Baby Syndrome
Acetylcholinesterase; ACh is broken down into choline and acetate.
Protamine sulfate

34. List the specific antidote for this toxin: Warfarin
Amphotericin B - Nystatin - Fluconazole/azoles
- Vitamin K & fresh frozen plasma
Short.
1. Better bioavailability 2. 2 to 4 times longer half life 3. Can be administered subcutaneously 4. Does not require laboratory monitoring

35. What is the mechanism of action of the thrombolytics?
Directly of indirectly aid conversion of plasminogen to plasmin Which cleaves thrombin and fibrin clots. (It is claimed that tPA specifically converts fibrin - bound plasminogen to plasmin.)
- Tricyclic antidepressants
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.
1. Bleeding 2. Thrombocytopenia 3. Drug - drug interactions

36. Adverse effects of Losartan?
propanolol - esmolol - metoprolol - atenolol - timolol
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia
- Glucagon
fetal renal toxicity - hyperkalemia

37. Would blockade of muscarininc receptors in the bladder be useful in treating urinary retention?
Verapamil - Diltiazem - Bepridil
Nifedipine - Verapamil - Diltiazem
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.
Bacitracin - Vancomycin

38. What is Metronidazole combined with for 'triple therapy'? Against What organism?
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori
Digitoxin 168hrs Digoxin 40 hrs
Amphetamine and Ephedrine

39. What are Fluoroquinolones indicated for? (3)
Inhibit Ergosterol synthesis
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention

40. What is action of insulin in the liver - in muscle - and in adipose tissue?
thick ascending limb
Succinylcholine
1. In liver - increases storage of glucose as glycogen. 2. In muscle - stimulates glycogen and protein synthesis - and K+ uptake. 3. In adipose tissue - facilitates triglyceride storage.
Treatment of infertility.

41. What is the MOA for Methicillin - Nafcillin - and Dicloxacillin?
Same as penicillin. Act as narrow spectrum antibiotics
Depolymerizes microtubules - impairing leukocyte chemotaxis and degranulation.
Short.
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia

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

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43. What type of gout is treated with Allopurinol?
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.
Norepinephrine
1. Aluminum hydroxide: constipation and hypophosphatemia 2. Magnesium hydroxide: diarrhea 3. Calcium carbonate: Hypercalcemia - rebound acid increase - All may cause hypokalemia
Chronic gout.

44. Ca2+ channel blockers - site of action?
Amphetamine and Ephedrine
Cell membrane Ca2+ channels of cardiac sarcomere
Erectile dysfunction.
Treatment of infertility.

45. What are three types of antacids and the problems that can result from their overuse?
Hypokalemic metabolic alkalosis - hyponatremia - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia - sulfa allergy.
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis
Neurotoxicity - Acute renal tubular necrosis
1. Aluminum hydroxide: constipation and hypophosphatemia 2. Magnesium hydroxide: diarrhea 3. Calcium carbonate: Hypercalcemia - rebound acid increase - All may cause hypokalemia

46. Which diuretics increase urine NaCl?
all of them
Gram + - Gram - - Norcardia - Chlamydia
Activates antithrombin III
Epinephrine

47. For Heparin What is the Mechanism of action
Modification via Acetylation
Fast vs. Slow Acetylators
diuretics - sympathoplegics - vasodilators - ACE inhibitors - Angiotensin II receptor inhibitors
Activates antithrombin III

48. K+ sparing diuretics - site of action?
- Nitrate - hydroxocobalamin thiosulfate
1. Better bioavailability 2. 2 to 4 times longer half life 3. Can be administered subcutaneously 4. Does not require laboratory monitoring
cortical collecting tubule
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.

49. MOA for Penicillin (3 answers)?
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
Suramin
Give an antichloinesterase - neostigmine - edrophonium - etc
1)Binds penicillin - binding proteins 2) Blocks transpeptidase cross - linking of cell wall 3) Activates autolytic enzymes

50. Beta Blockers - site of action?
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
Beta adrenergic receptors and Ca2+ channels (stimulatory)
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids
Quinolones