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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. MOA: Block mRNA synthesis
all of them
Rifampin
Digitoxin 168hrs Digoxin 40 hrs
Praziquantel

2. What is the lab value used to monitor the effectiveness of Warfarin therapy?
Prevention of NSAID- induced peptic ulcers - maintains a PDA.
The PT.
compensatory tachycardia - fluid retention - lupus - like syndrome
- ED 50 is less than the Km (less than 50% of receptors)

3. What is the mechanism of action of Ticlopidine - Clopidogrel
- Alkalinize urine & dialysis
Inhibits cGMP phosphodiesterase - casuing increased cGMP - smooth muscle relaxation in the corpus cavernosum - increased blood flow - and penile erection.
Inhibits platelet aggregation by irreversibly inhibiting the ADP pathway involved in the binding of fibrinogen.
Cardiac glycoside (inotropic agent).

4. When is Rifampin not used in combination with other drugs?
1. Meningococcal carrier state 2. Chemoprophylaxis in contacts of children with H. influenzae type B
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide
Lovastatin - Pravastatin - Simvastatin - Atorvastatin
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.

5. What should not be taken with Tetracyclines? / Why?
- Tetracycline
Beta - lactamase cleavage of Beta - lactam ring
Milk or Antacids - because divalent cations inhibit Tetracycline absorption in the gut
dizziness - flushing - constipation (verapamil) - nausea

6. How are the HIV drugs used clinically?

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7. Mnemonic for Foscarnet?
- Fluoroquinolones
DOC in diagnosing and abolishing AV nodal arrhythmias
Foscarnet = pyroFosphate analog
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.

8. What are the Anti - TB drugs?
With supplemental Folic Acid
fetal renal toxicity - hyperkalemia
It must be Phosphorylated by Viral Thymidine Kinase
Rifampin - Ethambutol - Streptomycin - Pyrazinamide - Isoniazid (INH)

9. Resistance mechanisms for Vancomycin
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity
VACUUM your Bed Room'
Oxygen
Bleeding.

10. What is used to reverse the action of Heparin?
Alpha -1 antagonist
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).
Zidovudine (AZT) - Didanosine (ddI) - Zalcitabine (ddC) - Stavudine (d4T) - Lamivudine (3TC)
Nitrates

11. What is the category of drug names ending in - operidol (e.g. Haloperidol)
Triple Therapy' 2 Nucleoside RT Inhibitors with a Protease Inhibitor
YES
Butyrophenone (neuroleptic).
Pseudomonas species and Gram - rods

12. Hydrochlorothiazide - mechanism?
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.
Competitive inibitor of progestins at progesterone receptors.
Acetylcholinesterase; ACh is broken down into choline and acetate.
For serious - Gram + multidrug - resistant organisms

13. What drug is used to diagnose myasthenia gravis?
Protease inhibitor.
first dose orthostatic hypotension - dizziness - headache
torsade de pointes
edrophonium (extremely short acting anticholinesterase)

14. How are Sulfonamides employed clinically?
- Tamoxifen
Corticosteroids; prevent production of leukotrienes from arachodonic acid by blocking phospholipase A2. Drugs of choice in a patient with status asthmaticus (in combination with albuterol.)
- Ethosuxamide - sulfonamides - lamotrigine
Gram + - Gram - - Norcardia - Chlamydia

15. What is the category - mechanism of action - and effect of Ipratroprium in Asthma treatment?
penicillinase resistant
Hypersensitivity reactions
Muscarinic antagonist; competatively blocks muscarinic receptors - preventing bronchoconstriction.
Triple sulfas or SMZ

16. Ibutilide - toxicity?
Antileukotriene; blocks synthesis by lipoxygenase.
torsade de pointes
Nephrotoxicity
Primaquine

17. Which RT inhibitors cause a Rash?
Megaloblastic anemia - Leukopenia - Granulocytopenia
Primaquine
Non - Nucleosides
As PABA antimetabolites that inhibit Dihydropteroate Synthase - Bacteriostatic

18. What is the MOA of Foscarnet?
Phenothiazine (neuroleptic - antiemetic).
Inhibits Viral DNA polymerase
- Methylene blue
pulmonary edema - dehydration

19. Hydralazine - clinical use?
Mycobacterium tuberculosis - the only agent used as solo prophylaxis against TB
Neurotoxicity - Acute renal tubular necrosis
Nucleosides
severe hypertension - CHF

20. What are four thrombolytics?
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine
Competitive inibitor of progestins at progesterone receptors.
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome

21. Which RT inhibitor causes Megaloblastic Anemia?
AZT
Digoxin=urinary Digitoxin=biliary
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism
Tendonitis and Tendon rupture

22. What are toxic side effects for Metronidazole?
cardiac depression - peripheral edema - flushing - dizziness - constipation
Milk or Antacids - because divalent cations inhibit Tetracycline absorption in the gut
Extended spectrum penicillin: certain Gram + bacteria and Gram - rods
Disulfiram - like reaction with EtOH - Headache

23. What enzyme is responsible for the breakdown of ACh in the synaptic cleft?
Inhibits cell wall mucopeptide formation - Bactericidal
- Infections - Trauma - Seizures - CO - Overdose - Metabolic - Alcohol (IT'S COMA)
Acetylcholinesterase; ACh is broken down into choline and acetate.
Blocks Norepi - but not Dopamine

24. What type of gout is treated with Colchicine?
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances
Malaria (P. falciparum)
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA
Acute gout.

25. What is a sign of toxicity with the use of thrombolytics?
- Fluoroquinolones
scopolamine
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.
Bleeding.

26. What is the memory key for organisms treated with Tetracyclines?

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27. Which RT inhibitors cause Lactic Acidosis?
Keratin containing tissues - e.g. - nails
Foscarnet = pyroFosphate analog
competitive inhibirot of aldosterone in the cortical collecting tubule
Nucleosides

28. What is Ketoconazole specifically used for?
- Cloazapine - carbamazapine - colchicine - PTU
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism
Only in limited amounts
Premature infants - because they lack UDP- glucuronyl transferase

29. For Warfarin What is the Route of administration
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.
Oral
CL= (rate of elimination of drug/ Plasma drug conc.)
Same as penicillin. Act as narrow spectrum antibiotics

30. What is the definition of zero - order kinetics? Example?
- Constant AMOUNT eliminated per unit time. - Etoh & ASA
These B-2 agonists cause respiratory smooth muscle to relax.
Same as penicillin. Extended spectrum antibiotics
Quinolones

31. What are three types of antacids and the problems that can result from their overuse?
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.
DHPG (dihydroxy-2- propoxymethyl guanine)
Edrophonium
1. Aluminum hydroxide: constipation and hypophosphatemia 2. Magnesium hydroxide: diarrhea 3. Calcium carbonate: Hypercalcemia - rebound acid increase - All may cause hypokalemia

32. Cocaine casues vasoconstriction and local anesthesia by What mechanism
Indirect agonist - uptake inhibitor
Lipoxygenase
Same as penicillin. Extended spectrum antibiotics
Does not cross

33. Esmolol - short or long acting?
Tetracycline - Doxycycline - Demeclocycline - Minocycline
Centrally acting alpha agonist - thus causing a decrease in central adrenergic outflow - spairing renal blood flow
Butyrophenone (neuroleptic).
very short acting

34. Dobutamine used for the tx of shock acts on Which receptors
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
Abortifacient.
Beta1 more than B2
- Penicillamine

35. Which individuals are predisposed to Sulfonamide - induced hemolysis?
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
Beta antagonist.
new arrhythmias - hypotension
G6PD deficient individuals

36. What are four unwanted effects of Clomiphene use?
Chronic Hepatitis A and B - Kaposi's Sarcoma
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances

37. What is the category of drug names ending in - ane (e.g. Halothane)
- Fluoroquinolones
Prevention of NSAID- induced peptic ulcers - maintains a PDA.
- EDTA - dimercaprol - succimer - & penicillamine
Inhalational general anesthetic.

38. Nifedipine has similar action to?
GI discomfort
Potent immunosuppressive used in organ transplant recipients.
Nitrates
impotence - asthma - CV effects (bradycardia - CHF - AV block) - CNS effects (sedation - sleep alterations)

39. What are two toxicities of the Sulfonylureas?
1. Hypoglycemia (more common with 2nd - generation drugs: glyburide - glipizide) 2. Disulfiram - like effects (not seen with 2nd - generation drugs).
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome
Ciprofloxacin - Norfloxacin - Ofloxacin - Grepafloxacin - Enoxacin - Nalidixic acid
Methylzanthine; desired effect is bronchodilation - may cause bronchodilation by inhibiting phosphodiesterase - enzyme involved in degrading cAMP (controversial).

40. Acetazolamide - site of action?
Rifampin - Ethambutol - Streptomycin - Pyrazinamide - Isoniazid (INH)
proximal convoluted tubule
Butyrophenone (neuroleptic).
scopolamine

41. What is the clinical utility of cocaine?
The only local anesthetic with vasoconstrictive properties.
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
not a sulfonamide - but action is the same as furosemide

42. Spironolactone - mechanism?
Tricyclic antidepressant.
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.
Hydralazine and Minoxidil
competitive inhibirot of aldosterone in the cortical collecting tubule

43. What is action of insulin in the liver - in muscle - and in adipose tissue?
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.
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.
Ca2+ (Loops Lose calcium)
Used in combination therapy with SMZ to sequentially block folate synthesis

44. Which receptors does phenylephrine act upon?
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)
NO
Sotalol - Ibutilide - Bretylium - Amiodarone

45. For Warfarin What is the Duration of action
Chronic (weeks or months)
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
PT
Hydralazine and Minoxidil

46. What are Methicillin - Nafcillin - and Dicloxacillin used for clinically?
Staphlococcus aureus
reversible SLE- like syndrome
Antileukotriene; blocks synthesis by lipoxygenase.
Cell membrane Ca2+ channels of cardiac sarcomere

47. List the specific antidote for this toxin: Benzodiazepines
1. Antipyretic 2. Analgesic 3. Anti - inflammatory
- MT polymerization inhibitor(M phase) - MOPP - lymphoma - Willm's & choriocarcinoma - neurotoxicity and myelosuppression
- Flumazenil
Staphlococcus aureus

48. What is Niclosamide used for?
- Chlorpromazine - thioridazine - haloperidol
- Vinca alkaloids(inhibit MT) - Paclitaxel
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis
Mg = Must go to the bathroom.

49. What are the clinical indications for bethanechol?
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.
The PT.
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.

50. What is the only depolarizing neuromuscular blocking agent?
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia
ACIDazolamide' causes acidosis
Succinylcholine
- Normalize K+ - Lidocaine - & Anti - dig Mab