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Test your basic knowledge |
USMLE Step 1 Pharmacology
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health-sciences
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usmle-step-1
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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. Which drug(s) cause this reaction: Drug induced Parkinson's (4) ?
Primaquine
- Haloperidol - chlorpromazine - reserpine - MPTP
Mycobacterium tuberculosis - the only agent used as solo prophylaxis against TB
Captopril - Enalapril - Lisinopril
2. What are two toxicities of the Sulfonylureas?
prevention of nodal arrhythmias (SVT)
Keratin containing tissues - e.g. - nails
Captopril - Enalapril - Lisinopril
1. Hypoglycemia (more common with 2nd - generation drugs: glyburide - glipizide) 2. Disulfiram - like effects (not seen with 2nd - generation drugs).
3. For Warfarin What is the Lab value to monitor
PT
- Alkalate DNA - Brain tumors - CNS toxicity
- Clindamycin
Methylxanthine.
4. What is the mechanism of action of the Alpha - glucosidase inhibitors?
Inhibit intestinal bursh border Alpha - glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic
Post - op and neurogenic ileus and urinary retention - myasthenia gravis - and reversal of neuromuscular junction blockade (post - op) through anticholinesterase activity.
blocking the beta adrenergic receptor leads to decreased cAMP - and decreased Ca2+ flux
5. What are five possible toxic effects of Aspirin therapy?
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6. Name four HMG- CoA reductase inhibitors.
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )
Forms toxic metabolites in the bacterial cell - Bactericidal
Lovastatin - Pravastatin - Simvastatin - Atorvastatin
Clavulanic acid
7. Name common Polymyxins
Polymyxin B - Polymyxin E
- Corticosteroids - heparin
As an anticholinesterase it increases endogenous ACh and thus increases strength.
-100% oxygen - hyperbaric
8. What are the clinical indications for neostigmine?
Chronic gout.
Post - op and neurogenic ileus and urinary retention - myasthenia gravis - and reversal of neuromuscular junction blockade (post - op) through anticholinesterase activity.
Chagas' disease - American Trypanosomiasis (Trypanosoma cruzi)
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.
9. Is resistant to penicillinase?
GI upset - Superinfections - Skin rashes - Headache - Dizziness
Severe Gram - rod infections.
viral kinase
Imipenem
10. List the specific antidote for this toxin: Cyanide
These B-2 agonists cause respiratory smooth muscle to relax.
- Tetracycline
- Nitrate - hydroxocobalamin thiosulfate
1. Bleeding 2. Teratogenicity 3. Drug - drug interactions
11. List the mechanism - clinical use - & toxicity of Cyclophosphamide.
Tetracycline - Doxycycline - Demeclocycline - Minocycline
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
12. What is the MOA for the Macrolides?
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.
amphetamine and ephedrine
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic
13. A fellow passenger on a Carnival cruise ship looks pale and diaphoretic - What antimuscarinic agent would you give them?
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions
scopolamine
- Cimetidine - ketoconazole - spironolactone - digitalis - EtOH - estrogens
cortical collecting tubule
14. What is the clinical use for Nystatin?
Enterobacter
Topical and Oral - for Oral Candidiasis (Thrush)
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)
thiazides - amiloride
15. What is the mechanism of action and clinical use of the antiandrogen Flutamide?
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.
Decreased uptake or Increased transport out of cell
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
16. What patients are at risk for life threatening hypotension When taking Sildenafil (Viagra)?
Dopamine; causes its release from intact nerve terminals
Those patients who are taking nitrates.
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)
ACE inhibitor.
17. Thiazides - site of action?
edematous states (CHF - cirrhosis - nephrotic syndrome - pulm edema) - HTN - hypercalcemia
distal convoluted tubule (early)
Tricyclic antidepressant.
RESPIre
18. For Warfarin What is the Onset of action
Local anesthetic.
Slow - limited by half lives of clotting factors
new arrhythmias - hypotension
Delirium - Tremor - Nephrotoxicity
19. What is the memory key for Metronidazole's clinical uses?
GET on the Metro
Fast vs. Slow Acetylators
ACE inhibitor.
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)
20. Which drug(s) cause this reaction: Agranulocytosis (3)?
CL= (rate of elimination of drug/ Plasma drug conc.)
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.
depresses ectopic pacemakers - especially in digoxin toxicity
- Cloazapine - carbamazapine - colchicine - PTU
21. How can Vancomycin - induced 'Red Man Syndrome' be prevented?
Used in combination therapy with SMZ to sequentially block folate synthesis
Pretreat with antihistamines and a slow infusion rate
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy
Na/K ATPase
22. Can Heparin be used during pregnancy?
1. Aluminum hydroxide: constipation and hypophosphatemia 2. Magnesium hydroxide: diarrhea 3. Calcium carbonate: Hypercalcemia - rebound acid increase - All may cause hypokalemia
Epinephrine
Yes - it does not cross the placenta.
Disulfiram - like reaction with EtOH - Headache
23. What are two types of drugs that interfere with the action of Sucralfate and why?
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.
distal convoluted tubule (early)
- Aminocaproic acid
- DNA intercalator - testicular & lymphomas - Pulmonary fibrosis mild myelosuppression.
24. What are the major toxic side effects of the Cephalosporins?
1. Gastric ulceration 2. Bleeding 3. Hyperventilation 4. Reye's syndrome 5. Tinnitus (CN VIII)
TMP- SMZ
- Infections - Trauma - Seizures - CO - Overdose - Metabolic - Alcohol (IT'S COMA)
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
25. Common side effects associated with Clindamycin include?
Intrathecally
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia
Rifampin (DOC) - minocycline
Pseudomembranous colitis (C. difficile) - fever - diarrhea
26. What is a common side effect of Misoprostol?
- Acetaldehyde - Nausea - vomiting - headache - & hypotension
Tricyclic antidepressant.
Diarrhea
CMV Retinitis in IC pts When Ganciclovir fails
27. What is the memory key involving the '4 R's of Rifampin?'
Give an antichloinesterase - neostigmine - edrophonium - etc
1. Bleeding 2. Thrombocytopenia 3. Drug - drug interactions
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
With supplemental Folic Acid
28. Name the Protease Inhibitors (4)
Saquinavir - Ritonavir - Indinavir - Nelfinavir
Digitoxin 168hrs Digoxin 40 hrs
- aminoglycosides - loop diuretics - cisplatin
Verapamil - Diltiazem - Bepridil
29. How is Ganciclovir activated?
Phosphorylation by a Viral Kinase
INH: Injures Neurons and Hepatocytes
Post - op and neurogenic ileus and urinary retention - myasthenia gravis - and reversal of neuromuscular junction blockade (post - op) through anticholinesterase activity.
orthostatic and exercise hypotension - sexual dysfunction - diarrhea
30. Digoxin v. Digitoxin: bioavailability?
hypertension - angina - arrhythmias
No - warfarin - unlike heparin - can cross the placenta.
- Hypersensitivity reactions - Hemolysis - Nephrotoxicity (tubulointerstitial nephritis) - Kernicterus in infants Displace other drugs from albumin (e.g. - warfarin)
Digitoxin>95% Digoxin 75%
31. Ethacrynic Acid - toxicity?
impotence - exacerbation of asthma - CV effects - CNS effects - may mask hypoclycemia
NO HYPERURICEMIA - NO SULFA AllERGY; same as furosemide otherwise
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility
Captopril - Enalapril - Lisinopril
32. The MOA for Chloramphenicol is?
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).
- Upper respiratory tract infections - pneumonias - STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) - Mycoplasma - Legionella - Chlamydia - Neisseria
Inhibition of 50S peptidyl transferase - Bacteriostatic
1. Gastric ulceration 2. Bleeding 3. Hyperventilation 4. Reye's syndrome 5. Tinnitus (CN VIII)
33. How is Foscarnet used clinically?
Tubocurarine - atracurium - mivacurium - pancuronium - vecuronium - rapacuronium
HTN - CHF - calcium stone formation - nephrogenic DI.
- Niacin - Ca++ channel blockers - adenosine - vancomycin
CMV Retinitis in IC pts When Ganciclovir fails
34. Which drug(s) cause this reaction: Tendonitis and rupture?
Chagas' disease - American Trypanosomiasis (Trypanosoma cruzi)
- Fluoroquinolones
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide
- Estrogen receptor antagonist - Breast CA - increased endometrial CA risk
35. Amprotericin B ___________ the BBB
hypokalemia - slight hyperlipidemia - hyperuricemia - lassitude - hypercalcemia - hyperglycemia
Increase target cell response to insulin.
Imipenem
Does not cross
36. Name two bile acid resins.
Peptic ulcer disease.
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.
cholestyramine - colestipol
proximal convoluted tubule - thin descending limb - and collecting duct
37. What is the MOA of Griseofulvin?
Benzathine penicillin G
For serious - Gram + multidrug - resistant organisms
Interferes with microtubule function - disrupts mitosis - inhibits growth
Amphotericin B - Nystatin - Fluconazole/azoles
38. What parasites are treated with Pyrantel Pamoate (more specific)?
- NaHCO3
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)
- Hypersensitivity reactions - Hemolysis - Nephrotoxicity (tubulointerstitial nephritis) - Kernicterus in infants Displace other drugs from albumin (e.g. - warfarin)
sedation - sleep alterations
39. Adverse effects of Losartan?
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA
fetal renal toxicity - hyperkalemia
1. Addison's disease 2. Inflammation 3. Immune suppression 4. Asthma
40. What is the category of drug names ending in - ane (e.g. Halothane)
Prevents the release of ACh - Which results in muscle paralysis.
K+ wasting - metabolic alkalosis - hypotension - ototoxicity
narcolepsy - obesity - and attention deficit disorder (I wouldn't recommend this)
Inhalational general anesthetic.
41. What is the mechanism of action of Sildenafil (Viagra)?
- Penicillin
Inhibits cGMP phosphodiesterase - casuing increased cGMP - smooth muscle relaxation in the corpus cavernosum - increased blood flow - and penile erection.
- Lithium
To inhibit renal Dihydropeptidase I and decrease Imipenem inactivation in the renal tubules
42. List the mechanism - clinical use - & toxicity of Bleomycin.
- DNA intercalator - testicular & lymphomas - Pulmonary fibrosis mild myelosuppression.
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome
- Methotrexate - 5 FU - 6 mercaptopurine
Modification via Acetylation - Adenylation - or Phosphorylation
43. ADH antagonists - site of action?
Bactericidal for: Gram + rod and cocci - Gram - cocci - and Spirochetes
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).
Erectile dysfunction.
collecting ducts
44. Adverse effects of Hydralazine?
Prevents the release of Ca from SR of skeletal muscle
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention
Peptic ulcer disease.
45. How is Ganciclovir used clinically?
- Clindamycin
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.
CMV Retinitis in IC pts When Ganciclovir fails
CMV - esp in Immunocompromised patients
46. What is the MOA for the Aminoglycosides?
Resistant Gram - infections
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.
Inhibits formation of Initiation Complex - causes misreading of mRNA - Bactericidal
1. Predisposes to viral infections and lymphoma 2. Nephrotoxic (preventable with mannitol diuresis)
47. What are the products and their toxicities of the metabolism of ethanol by / alcohol dehydrogenase?
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins
Intrathecally
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.
- Acetaldehyde - Nausea - vomiting - headache - & hypotension
48. What are the phases of succinylcholine neuromuscular blockade?
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.
K+ wasting - metabolic alkalosis - hypotension - ototoxicity
- ED 50 is less than the Km (less than 50% of receptors)
Babiturate.
49. MOA: Disrupt fungal cell membranes
G6PD deficient individuals
Amphotericin B - Nystatin - Fluconazole/azoles
Norepinephrine
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal
50. What is the mechanism of action of Acetaminophen?
- Deferoxamine
penicillinase resistant
cardiac muscle: Verapamil>Diltiazem>Nifedipine
Reversibly inhibits cyclooxygenase - mostly in CNS. Inactivated peripherally.
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