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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. Ibutilide - toxicity?
torsade de pointes
- Infections - Trauma - Seizures - CO - Overdose - Metabolic - Alcohol (IT'S COMA)
carbonic anhydrase inhibitors - K+ sparing diuretics
Suramin

2. What is the category of drug names ending in - tidine (e.g. Cimetidine)
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia
Babiturate.
- Chlorpromazine - thioridazine - haloperidol
H2 antagonist

3. List the specific antidote for this toxin: Digitalis
YES
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.
- Normalize K+ - Lidocaine - & Anti - dig Mab
Hemolysis (if G6PD deficient) - Neurotoxicity - Hepatotoxicity - SLE- like syndrome

4. Adverse effects of Minoxidil?
- Methotrexate - 5 FU - 6 mercaptopurine
Anaerobic infections (e.g. - B. fragilis - C. perfringens)
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin

5. What is the MOA for Methicillin - Nafcillin - and Dicloxacillin?
post MI and digitalis induced arrhythmias
Norepinephrine
Same as penicillin. Act as narrow spectrum antibiotics
No - warfarin - unlike heparin - can cross the placenta.

6. Loop diuretics (furosemide)- site of action?
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
distal convoluted tubule (early)
thick ascending limb

7. Which drug(s) cause this reaction: Gray baby syndrome?
- Chloramphenicol
Erectile dysfunction.
Aminoglycosides - Tetracyclines
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.

8. What is the clinical use for Sildenafil (Viagra)?
Yes
- Upper respiratory tract infections - pneumonias - STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) - Mycoplasma - Legionella - Chlamydia - Neisseria
Erectile dysfunction.
Imipenem

9. What is the category of drug names ending in - oxin (e.g. Digoxin)
- Cimetidine - ketoconazole - spironolactone - digitalis - EtOH - estrogens
Cardiac glycoside (inotropic agent).
Mebendazole/Thiabendazole - Pyrantel Pamoate
Modification via Acetylation - Adenylation - or Phosphorylation

10. What is the effect of norepinephrine on bp and pulse pressure?
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.
competitive inhibirot of aldosterone in the cortical collecting tubule
ARF - shock - drug overdose - decrease intracranial/intraocular pressure
Rare.

11. Name the common Non - Nucleoside Reverse Transcriptase Inhibitors
Nevirapine - Delavirdine
Imipenem
all of them
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity

12. What is a common side effect of Misoprostol?
CMV Retinitis in IC pts When Ganciclovir fails
- Nitrate - hydroxocobalamin thiosulfate
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine
Diarrhea

13. What is a prerequisite for Acyclovir activation?
Methylxanthine.
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.
Zidovudine (AZT) - Didanosine (ddI) - Zalcitabine (ddC) - Stavudine (d4T) - Lamivudine (3TC)
It must be Phosphorylated by Viral Thymidine Kinase

14. List the specific antidote for this toxin: Tricyclic antidepressants
G6PD deficient individuals
- Methylene blue
- NaHCO3
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.

15. Decrease Digitoxin dose in renal failure?
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.
NO
Useful in muscle paralysis during surgery or mechanical ventilation.

16. List the specific antidote for this toxin: Warfarin
Penicillin.
- Vitamin K & fresh frozen plasma
Stimulates beta adrenergic receptors
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome

17. What cholinergic inhibitor acts by directly inhibiting Ach release at the presynaptic terminal
Diarrhea - Urination - Miosis - Bronchospasm - Bradycardia - Excitation of skeletal muscle and CNS - Lacrimation - Sweating - and Salivation = DUMBBELS; also abdominal cramping
Acetylcholinesterase; ACh is broken down into choline and acetate.
Botulinum
Ipratropium

18. Acetazolamide - site of action?
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.
Acts as a wide spectrum carbapenem
proximal convoluted tubule
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.

19. Why does NE result in bradycardia?
Hypokalemic metabolic alkalosis - hyponatremia - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia - sulfa allergy.
post MI and digitalis induced arrhythmias
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
1. Weight gain 2. Hepatotoxicity (troglitazone)

20. Antimicrobial prophylaxis for a history of recurrent UTIs
TMP- SMZ
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy
Choline acetyltransferase

21. What is the memory aid for subunit distribution of ribosomal inhibitors?

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22. The MOA for Chloramphenicol is?
hyperaldosteronism - K+ depletion - CHF
Aminoglycosides
- Triggers apoptosis - CLL - Hodgkin's in MOPP - Cushing - like syndrome
Inhibition of 50S peptidyl transferase - Bacteriostatic

23. What physiological effects was the Anes using Atropine to tx
Used in combination therapy with SMZ to sequentially block folate synthesis
Peptic ulcer disease.
Inhibit intestinal bursh border Alpha - glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions

24. Antiarrhythmic class IA effects?
propanolol - esmolol - metoprolol - atenolol - timolol
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.
Ibuprofen - Naproxen - and Indomethacin
- Penicillin

25. For Heparin What is the Ability to inhibit coagulation in vitro
Centrally acting alpha agonist - thus causing a decrease in central adrenergic outflow - spairing renal blood flow
Inhibits CMV DNA polymerase
Hemolytic anemia
Yes

26. What microorganisms are clinical indications for Tetracycline therapy?

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27. What can result due to antacid overuse?
compensatory tachycardia - fluid retention - lupus - like syndrome
Inhibits cell wall mucopeptide formation - Bactericidal
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.
very short acting

28. What are two Glitazones?
None. No - because atropine would block the postganglionic muscarinic receptors involved in sweat gland stimulation.
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori
Ceftriaxone
1. Pioglitazone 2. Rosiglitazone.

29. What are the clinical uses for Aztreonam?
check PFTs - LFTs - and TFTs
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.
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone When used of Leprosy 3. Used in combination with other drugs

30. What are the products and their toxicities of the metabolism of ethanol by / alcohol dehydrogenase?
Onchocerciasis ('river blindness'-- rIVER- mectin)
Only in limited amounts
Zidovudine (AZT) - Didanosine (ddI) - Zalcitabine (ddC) - Stavudine (d4T) - Lamivudine (3TC)
- Acetaldehyde - Nausea - vomiting - headache - & hypotension

31. What is the memory key involving the '4 R's of Rifampin?'
1. Acarbose 2. Miglitol
Scopolamine
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
- MT polymerization inhibitor(M phase) - MOPP - lymphoma - Willm's & choriocarcinoma - neurotoxicity and myelosuppression

32. List the specific antidote for this toxin: Cyanide
- Nitrate - hydroxocobalamin thiosulfate
vascular sm. Mus.: Nifedipine>Diltiazem>Verapamil
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia
It affects beta receptors equally and is used in AV heart block (rare).

33. Aztreonam ________ to penicillinase
cortical collecting tubule
is resistant
- Constant AMOUNT eliminated per unit time. - Etoh & ASA
GI distress - Skin rash - and Seizures at high plasma levels

34. In What population does Gray Baby Syndrome occur? Why?
anuria - CHF
Premature infants - because they lack UDP- glucuronyl transferase
is resistant
Inhibt Assembly of new virus by Blocking Protease Enzyme

35. What are three clinical uses of the NSAIDs?
Ataxia - Dizziness - Slurred speech
Stimulating beta receptors stimulates heart rate - but beta receptor induced vasodilation reduces peripheral resistance.
1. Antipyretic 2. Analgesic 3. Anti - inflammatory
propanolol - esmolol - metoprolol - atenolol - timolol

36. How does Ganciclovir's toxicity relate to that of Acyclovir?
Ganciclovir is more toxic to host enzymes
Megaloblastic anemia - Leukopenia - Granulocytopenia
Inhibits DNA dependent RNA polymerase
Beta Blockers

37. What neurotransmitter does Amantadine affect? How does it influence this NT?
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine
cross - allergenic
1. Heavy bleeding 2. GI effects (n/v - anorexia) 3. Abdominal pain
Dopamine; causes its release from intact nerve terminals

38. What are two toxicities of the Glitazones?
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).
1. Weight gain 2. Hepatotoxicity (troglitazone)
Butyrophenone (neuroleptic).
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention

39. What is the mecanism of action of the COX-2 inhibitors (celecoxib - rofecoxib)?
Forms toxic metabolites in the bacterial cell - Bactericidal
pulmonary edema - dehydration
Selectively inhibit cyclooxygenase (COX) isoform 2 - Which is found in inflammatory cells nad mediates inflammation and pain; spares COX-1 Which helps maintain the gastric mucosa.
Ipratropium

40. Hydrochlorothiazide - toxicity? (hyperGLUC - plus others)
Interferes with microtubule function - disrupts mitosis - inhibits growth
Hypokalemic metabolic alkalosis - hyponatremia - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia - sulfa allergy.
CMV Retinitis in IC pts When Ganciclovir fails
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.

41. Clinical use of Isoniazid (INH)?
Mycobacterium tuberculosis - the only agent used as solo prophylaxis against TB
Abortifacient.
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Beta antagonist.

42. What drug is used to diagnose myasthenia gravis?
Same as penicillin. Act as narrow spectrum antibiotics
Scopolamine
Epinephrine
edrophonium (extremely short acting anticholinesterase)

43. Which RT inhibitor causes Megaloblastic Anemia?
- Chlorpromazine - thioridazine - haloperidol
ARF - shock - drug overdose - decrease intracranial/intraocular pressure
AZT
amphetamine and ephedrine

44. What enzyme is responsible for the breakdown of ACh in the synaptic cleft?
Fever/Chills - Hypotension - Nephrotoxicity - Arrhythmias
NE acts presynaptically on alpha -2 receptors to inhibit its own release. ACh also acts presynaptically through M1 receptors to inhibit NE release.
Acetylcholinesterase; ACh is broken down into choline and acetate.
- Shifts the curve to the right - increases Km

45. What is the effect of guanethidine on adrenergic NE release?
It inhibits release of NE.
- ED 50 is less than the Km (less than 50% of receptors)
Sulfonamide Loop Diuretic. Inhibits ion co - transport system of thick ascending loop. Abolishes hypertonicity of the medulla - thereby preventing concentration of the urine.
sedation - sleep alterations

46. What is the major side effect for Carbenicillin - Piperacillin - and Ticarcillin?
decrease the slope of phase 4 - increase PR interval (the AV node is particularly sensitive)
Hypersensitivity reactions
- polymyxins
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.

47. What is used to reverse the action of Heparin?
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
- Methotrexate - 5 FU - 6 mercaptopurine
Rash - Pseudomembranous colitis
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).

48. What type of neurological blockade would hexamethonium create?
Depolymerizes microtubules - impairing leukocyte chemotaxis and degranulation.
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.
Acetylcholine esterase
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic

49. What Sulfonamides are used for simple UTIs?
Gram + - Gram - - Norcardia - Chlamydia
- Penicillin
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity
Triple sulfas or SMZ

50. What are four conditions in Which H2 Blockers are used clinically?
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
Inhibt Assembly of new virus by Blocking Protease Enzyme
- Hypersensitivity reactions - Hemolysis - Nephrotoxicity (tubulointerstitial nephritis) - Kernicterus in infants Displace other drugs from albumin (e.g. - warfarin)
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species