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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. Antimicrobial prophylaxis for a history of recurrent UTIs
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis
proximal convoluted tubule - thin descending limb - and collecting duct
Choline acetyltransferase
TMP- SMZ

2. When is HIV therapy initiated?
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load
Bethanechol - Neostigmine - physostigmine
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions
Polymyxins

3. How do you treat coma in the ER (4)?
- B51Naloxone / naltrexone (Narcan)
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD
Mg = Must go to the bathroom.
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.

4. Why would a patient with cog - wheel rigidity and a shuffling gait be given benztropine?
vasodilator - increases cGMP to induce smooth muscle relaxation (arterioles>veins; afterload reduction)
Imipenem
Resistant Gram - infections
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.

5. What is the MOA for Amphotericin B?
- Cimetidine - ketoconazole - spironolactone - digitalis - EtOH - estrogens
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic
- Daunorubicin & Doxorubicin
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis

6. Describe Phase II metabolism in liver(3)?
- acetylation - glucuron. - & sulfation - Conjugation - Polar product
Gram + cocci - Proteus mirabilis - E. coli - Klebsiella pneumoniae (PEcK)
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol
cortical collecting tubule

7. Acetazolamide - site of action?
Cell membrane Ca2+ channels of cardiac sarcomere
effective in torsade de pointes and digoxin toxicity
Praziquantel
proximal convoluted tubule

8. For Heparin What is the Mechanism of action
Inhibit viral DNA polymerase
Constant FRACTION eliminated per unit time.(exponential)
Bleeding.
Activates antithrombin III

9. The COX-2 inhibitors (celecoxib - rofecoxib) have similar side effects to the NSAIDs with What one exception?
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.
amphetamine and ephedrine
aPTT (intrinsic pathway)
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time

10. What is the category of drug names ending in - triptyline (e.g. Amitriptyline)
Oral
Tricyclic antidepressant.
ACIDazolamide' causes acidosis
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis

11. Which drug(s) cause this reaction: Extrapyramidal side effects (3)?
Indirect agonist - uptake inhibitor
- Penicillin
- Chlorpromazine - thioridazine - haloperidol
Immediate anticoagulation for PE - stroke - angina - MI - DVT.

12. List the specific antidote for this toxin: Opioids
Inhibits Viral DNA polymerase
- B51Naloxone / naltrexone (Narcan)
- Methylene blue
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine

13. What cholinomimetic is useful in the diagnosis of Myasthenia Gravis
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.
Give an antichloinesterase - neostigmine - edrophonium - etc
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.
Edrophonium

14. Name two LPL stimulators.
1. Acarbose 2. Miglitol
- Sulfonamides - furosemide - methicillin - rifampin - NSAIDS (ex. ASA)
Gemfibrozil - Clofibrate
Inhibit intestinal bursh border Alpha - glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.

15. List the specific antidote for this toxin: Anticholinesterases (organophosphate.)
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin
- Atropine & pralidoxime
Blocks Influenza A and RubellA; causes problems with the cerebellA
reversible SLE- like syndrome

16. Furosemide - class and mechanism?
Aplastic anemia (dose independent) - Gray Baby Syndrome
1. Weight gain 2. Hepatotoxicity (troglitazone)
- acetylation - glucuron. - & sulfation - Conjugation - Polar product
Sulfonamide Loop Diuretic. Inhibits ion co - transport system of thick ascending loop. Abolishes hypertonicity of the medulla - thereby preventing concentration of the urine.

17. Which antimicrobial classes inhibit protein synthesis at the 30S subunit? (2)
is resistant
Chronic (weeks or months)
Neostigmine - pyridostigmine edrophonium - physostigmine echothiophate
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic

18. List some specifics of lead poisoning(4)?
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia
Cilastatin
competitive inhibirot of aldosterone in the cortical collecting tubule
severe hypertension - CHF

19. What are common toxicities associated with Tetracyclines?

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20. What is the MOA of Isoniazid (INH)?
proximal convoluted tubule
1)Binds penicillin - binding proteins 2) Blocks transpeptidase cross - linking of cell wall 3) Activates autolytic enzymes
Hypersensitivity reactions
Decreases synthesis of Mycolic Acid

21. Antiarrhythmic class IV- toxicity?
constipation - flushing - edema - CV effects (CHF - AV block - sinus node depression) - and torsade de pointes (Bepridil)
Digoxin=urinary Digitoxin=biliary
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.
It acts presynaptically to increase NE release.

22. 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
GI disturbances.
Tetracycline - Doxycycline - Demeclocycline - Minocycline
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia

23. Name three Antiarrhythmic drugs in class IC.
HTN - CHF - calcium stone formation - nephrogenic DI.
Gram + - Gram - - Norcardia - Chlamydia
Neutropenia
Flecainide - Encainide - Propafenone

24. What is Nifurtimox administered for?

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25. List the mechanism - clinical use - & toxicity of Methotrexate.
- Triggers apoptosis - CLL - Hodgkin's in MOPP - Cushing - like syndrome
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression
proarrhythmic
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy

26. Name three Antiarrhythmic drugs in class IB.
Oral treatment of superficial infections
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)
Lidocaine - Mexiletine - Tocainide
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.

27. Verapamil has similar action to?
Beta Blockers
Inhibt Assembly of new virus by Blocking Protease Enzyme
compensatory tachycardia - fluid retention - lupus - like syndrome
Liver

28. What is the clinical use for Sucralfate?
Scopolamine
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.
Digitoxin>95% Digoxin 75%
Peptic ulcer disease.

29. What are Fluoroquinolones indicated for? (3)
collecting ducts
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms

30. Which drug(s) cause this reaction: G6PD hemolysis(8)?
Butyrophenone (neuroleptic).
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol
1. Renal damage 2. Aplastic anemia 3. GI distress
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.

31. List the mechanism - clinical use - & toxicity of Prednisone.

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32. Foscarnet does not require activation by a...
- reduction - oxy - & hydrolysis - H2O sol. Polar product - P450
Antifungal.
- Clindamycin
viral kinase

33. Which Aminoglycoside is used for Bowel Surgery ?
BM suppression (neutropenia - anemia) - Peripheral neuropathy
Neomycin
GI upset - Superinfections - Skin rashes - Headache - Dizziness
- Steroids - Tamoxifen

34. Acetazolamide - mechanism?
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.
Post - op and neurogenic ileus and urinary retention - myasthenia gravis - and reversal of neuromuscular junction blockade (post - op) through anticholinesterase activity.
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.
proarrhythmic

35. What are the Macrolides used for clinically?
It acts presynaptically to increase NE release.
1. Heavy bleeding 2. GI effects (n/v - anorexia) 3. Abdominal pain
- Upper respiratory tract infections - pneumonias - STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) - Mycoplasma - Legionella - Chlamydia - Neisseria
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide

36. List the specific antidote for this toxin: Arsenic (all heavy metals)
Botulinum
- Quinidine - quinine
- Dimercaprol - succimer
Epinephirine(Alpha1 -2 and Beta 1 -2)

37. For Warfarin What is the Treatment for overdose
To inhibit renal Dihydropeptidase I and decrease Imipenem inactivation in the renal tubules
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.
IV vitamin K and fresh frozen plasma
The PTT.

38. Which cancer drugs effect nuclear DNA (4)?
Penicillin - V
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide
AZT

39. Name three Antiarrhythmic drugs in class IV.
first dose orthostatic hypotension - dizziness - headache
Rheumatoid and osteoarthritis.
Verapamil - Diltiazem - Bepridil
1. Antipyretic 2. Analgesic 3. Anti - inflammatory

40. How does resistance to Vancomycin occur?
- Haloperidol - chlorpromazine - reserpine - MPTP
With an amino acid change of D- ala D- ala to D- ala D- lac
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)
Epinephrine

41. Which drug(s) cause this reaction: Atropine - like side effects?
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.
impotence - exacerbation of asthma - CV effects - CNS effects - may mask hypoclycemia
- Tricyclic antidepressants
- inhibits HGPRT (pur. Syn.) - Luk - Lymph

42. Name three calcium channel blockers?
orthostatic and exercise hypotension - sexual dysfunction - diarrhea
In 4 half - lifes= (94%) T1/2 = (0.7x Vd)/CL
Nifedipine - Verapamil - Diltiazem
1. Bleeding 2. Thrombocytopenia 3. Drug - drug interactions

43. What are the products and their toxicities of the metabolism of ethanol by / alcohol dehydrogenase?
cardiac depression - peripheral edema - flushing - dizziness - constipation
- Acetaldehyde - Nausea - vomiting - headache - & hypotension
- Alkalate DNA - Brain tumors - CNS toxicity
anuria - CHF

44. What are the phases of succinylcholine neuromuscular blockade?
Neutropenia
Penicillin - V
No - warfarin - unlike heparin - can cross the placenta.
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.

45. Does Warfarin have a long - medium - or short half life?
Ganciclovir is more toxic to host enzymes
Chronic gout.
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.)
Long.

46. Adverse effects of Methyldopa?

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47. What are common side effects of RT Inhibitors?
1. Weight gain 2. Hepatotoxicity (troglitazone)
BM suppression (neutropenia - anemia) - Peripheral neuropathy
cyanide toxicity (releases CN)
Potent immunosuppressive used in organ transplant recipients.

48. What is a mnemonic to remember Amantadine's function?
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels
Blocks Influenza A and RubellA; causes problems with the cerebellA
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation
Anaerobic infections (e.g. - B. fragilis - C. perfringens)

49. Where does Griseofulvin deposit?
Keratin containing tissues - e.g. - nails
Systemic mycoses
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state

50. What is the mechanism of action of Aspirin?
dizziness - flushing - constipation (verapamil) - nausea
Cardiac glycoside (inotropic agent).
Dermatophytes (tinea - ringworm)
Acetylates and irreversibly inhibits cyclooxygenase (COX I and COX II) to prevent the conversion of arachidonic acid to prostaglandins.