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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. How would you reverse the effect of a neuromuscular blocking agent?
Give an antichloinesterase - neostigmine - edrophonium - etc
Decreases synthesis of Mycolic Acid
Increased systolic and pulse pressure - decreased diastolic pressure - and little change in mean pressure.
- Class III antiarrhythmics (sotalol) - class IA (quinidine)

2. K+ sparing diuretics - toxicity?
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions
Prophylaxis for Influenza A - Rubella; Parkinson's disease
Same as penicillin. Extended spectrum antibiotics

3. What conditions are treated with Metronidazole?
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.
- Quinidine - quinine
Increase target cell response to insulin.

4. Hydralazine - toxicity?
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome
compensatory tachycardia - fluid retention - lupus - like syndrome
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids
cross - allergenic

5. How is Vancomycin used clinically?
For serious - Gram + multidrug - resistant organisms
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.
Abortifacient.

6. What is the MOA for Nystatin?
Enterobacter
Inhibt Assembly of new virus by Blocking Protease Enzyme
Verapamil - Diltiazem - Bepridil
Binds ergosterol - Disrupts fungal membranes

7. What is the category of drug names ending in - phylline (e.g. Theophylline)
- Fluoroquinolones
Methylxanthine.
Triple Therapy' 2 Nucleoside RT Inhibitors with a Protease Inhibitor
TCA

8. What antimuscarinic drug is useful for the tx of asthma
GI discomfort - Acute cholestatic hepatitis - Eosinophilia - Skin rashes
Ipratropium
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.)
- Clindamycin

9. What are three possible toxicities of NSAID usage?
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.
Hypersensitivity reactions
blocking the beta adrenergic receptor leads to decreased cAMP - and decreased Ca2+ flux
1. Renal damage 2. Aplastic anemia 3. GI distress

10. Name several common Macrolides (3)
Penicillin - V
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.
hyperaldosteronism - K+ depletion - CHF
Erythromycin - Azithromycin - Clarithromycin

11. Adverse effects of Prazosin?
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.
Buy AT 30 - CELL at 50'
Because they require some residual islet function.
first dose orthostatic hypotension - dizziness - headache

12. What are the nondepolarizing neuromuscular blocking drugs?
dizziness - flushing - constipation (verapamil) - nausea
Tubocurarine - atracurium - mivacurium - pancuronium - vecuronium - rapacuronium
Blood
viral kinase

13. What is the category - desired effect - and period of use of albuterol in the treatment of Asthma?
Inhibt Assembly of new virus by Blocking Protease Enzyme
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.
blocking the beta adrenergic receptor leads to decreased cAMP - and decreased Ca2+ flux
Lidocaine - Mexiletine - Tocainide

14. What are the products and their toxicities of the metabolism of Methanol by / alcohol dehydrogenase?
- Acetaldehyde - Nausea - vomiting - headache - & hypotension
- Formaldehyde & formic acid - severe acidosis & retinal damage
- Infections - Trauma - Seizures - CO - Overdose - Metabolic - Alcohol (IT'S COMA)
Gram + cocci - Gram - rods - and Anerobes

15. What is the major side effect for Carbenicillin - Piperacillin - and Ticarcillin?
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.
Hypersensitivity reactions
Ganciclovir is more toxic to host enzymes
decrease the slope of phase 4 - increase PR interval (the AV node is particularly sensitive)

16. Which diuretics increase urine NaCl?
- inhibits HGPRT (pur. Syn.) - Luk - Lymph
all of them
Interferes with microtubule function - disrupts mitosis - inhibits growth
Immediate anticoagulation for PE - stroke - angina - MI - DVT.

17. Digitalis - site of action?
Oxygen
Amphotericin B - Nystatin - Fluconazole/azoles
Na/K ATPase
Large anionic polymer - acidic

18. Acetaldehyde is metabolized by Acetaldehyde dehydrogenase - Which drug inhibs this enzyme?
Succinylcholine
- Tricyclic antidepressants
Early myocardial infarction.
- Disulfram & also sulfonylureas - metronidazole

19. What is the mechanism of action of Colchicine used to treat acute gout?
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression
Post - op and neurogenic ileus and urinary retention - myasthenia gravis - and reversal of neuromuscular junction blockade (post - op) through anticholinesterase activity.
Depolymerizes microtubules - impairing leukocyte chemotaxis and degranulation.

20. How is Ganciclovir activated?
for RSV
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)
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.
Phosphorylation by a Viral Kinase

21. Resistance mechanisms for Macrolides

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22. What type of gout is treated with Colchicine?
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis
Blocks Influenza A and RubellA; causes problems with the cerebellA
Acute gout.
Slow - limited by half lives of clotting factors

23. What is the clinical use for Penicillin?
Acute (hours)
Bactericidal for: Gram + rod and cocci - Gram - cocci - and Spirochetes
cardiac muscle: Verapamil>Diltiazem>Nifedipine
Beta antagonist.

24. What is the effect of the Glitazones in diabetes treatment?
Increase target cell response to insulin.
Same as penicillin. Extended spectrum antibiotics
Mycobacterium tuberculosis - the only agent used as solo prophylaxis against TB
Albuterol - tertbutaline

25. Ca2+ sensitizers'- site of action?
Decreases synthesis of Mycolic Acid
Sildenafil fills the penis
Rare.
troponin - tropomyosin system

26. Are Ampicillin and Amoxicillin are not...
Tricyclic antidepressant.
penicillinase resistant
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.
Useful in muscle paralysis during surgery or mechanical ventilation.

27. What are common side effects of RT Inhibitors?
Slow - limited by half lives of clotting factors
- Quinidine - quinine
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
BM suppression (neutropenia - anemia) - Peripheral neuropathy

28. Name two LPL stimulators.
Malaria (P. falciparum)
Ipratropium
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity
Gemfibrozil - Clofibrate

29. What drug is given for Pneumocystis carinii prophylaxis?
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin
Pentamidine
Lovastatin - Pravastatin - Simvastatin - Atorvastatin
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)

30. What sympathomimetic would you not prescribe for hypotension in a pt with renal artery sclerosis.
Norepinephrine (Alpha1 -2 and beta 1)
Penicillin.
prevention of nodal arrhythmias (SVT)
- ED 50 is less than the Km (less than 50% of receptors)

31. Nifedipine has similar action to?
Nitrates
block Na+ channels in the cortical collecting tubule
GI discomfort
Stimulates beta adrenergic receptors

32. What is the clinical use for Heparin?
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation
Immediate anticoagulation for PE - stroke - angina - MI - DVT.
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas
It acts presynaptically to increase NE release.

33. Would blockade of muscarininc receptors in the bladder be useful in treating urinary retention?
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
Useful in muscle paralysis during surgery or mechanical ventilation.

34. What are two types of drugs that interfere with the action of Sucralfate and why?
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)
Pentavalent Antimony
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.

35. While at a tail gait party - you bite into a sandwich that a yellow jacket is also enjoying. Knowing your allergy to this creature - What should you do?
Quinolones
Beta - lactamase cleavage of Beta - lactam ring
vascular sm. Mus.: Nifedipine>Diltiazem>Verapamil
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.

36. What is the mechanism of action of Allopurinol used to treat chronic gout?
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.
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.
Protamine sulfate
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.

37. What is the mechanism of action of Omeprazole - Lansoprazole?
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.
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.
Succinylcholine
Reversibly inhibits cyclooxygenase - mostly in CNS. Inactivated peripherally.

38. List the specific antidote for this toxin: Opioids
Diuresis in pateints with sulfa allergy
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.
Ototoxicity - Hypokalemia - Dehydration - Allergy (sulfa) - Nephritis (interstitial) - Gout
- B51Naloxone / naltrexone (Narcan)

39. Name two bile acid resins.
cholestyramine - colestipol
Antibiotic - protein synthesis inhibitor.
For serious - Gram + multidrug - resistant organisms
- Tricyclic antidepressants

40. What is the effect of epinephrine infusion on bp and pulse pressure?
Wide spectrum of systemic mycoses: Cryptococcus - Blastomyces - Coccidioides - Aspergillus - Histoplasma - Candida - Mucor
Digitoxin 168hrs Digoxin 40 hrs
Increased systolic and pulse pressure - decreased diastolic pressure - and little change in mean pressure.
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)

41. Acetazolamide - mechanism?
amphetamine and ephedrine
Well tolerated in general but occasionally - Nephrotoxicity - Ototoxicity - Thrombophlebitis - diffuse flushing='Red Man Syndrome'
Peptic ulcer disease.
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.

42. What is the loading dose formula?
- Halothane - Valproic acid - acetaminophen - Amantia phalloides
GI distress - Skin rash - and Seizures at high plasma levels
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic

43. What is the mechanism of action of the H2 Blockers?
Reversible block of histamine H2 receptors
- Antipsychotics
No - warfarin - unlike heparin - can cross the placenta.
Binds to the Pyrophosphate Binding Site of the enzyme

44. What conditions would you use dantrolene?
post MI and digitalis induced arrhythmias
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.

45. What are four Sulfonylureas?
1. Bleeding 2. Teratogenicity 3. Drug - drug interactions
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide
No - hemicholinum block the uptake of Choline and thus Ach synthesis
Small lipid - soluble molecule

46. What is the memory key to remember Which pathway (extrinsic vs. intrinsic) and Which lab value Warfarin affects?
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity
Leukotrienes increasing bronchial tone.
propanolol - esmolol - metoprolol - atenolol - timolol
WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.

47. What are the classic symptoms of cholinesterase inhibitor poisoning (parathion or other organophosphates)?
Diarrhea - Urination - Miosis - Bronchospasm - Bradycardia - Excitation of skeletal muscle and CNS - Lacrimation - Sweating - and Salivation = DUMBBELS; also abdominal cramping
- Ethanol - dialysis - & fomepizole
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)
Hypersensitivity reactions

48. What is the mecanism of action - effective period - and ineffective period of use for Cromolyn in treating Asthma?
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.
Prevents release of mediators from mast cells. Effective only for the prophylaxis of asthma. Not effective during an acute attack.
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
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)

49. Adverse effects of Methyldopa?

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50. What is the category of drug names ending in - terol (e.g. Albuterol)
Beta -2 agonist.
prevention of nodal arrhythmias (SVT)
amphetamine and ephedrine
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.