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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. Hydrochlorothiazide - clinical use?
- DNA intercalator - testicular & lymphomas - Pulmonary fibrosis mild myelosuppression.
Interstitial nephritis
HTN - CHF - calcium stone formation - nephrogenic DI.
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)

2. What is the formula for Volume of distribution (Vd)
Vd= (Amt. of drug in body/ Plasma drug conc.)
Aluminum sucrose sulfate polymerizes in the acid environment of the stomach and selectively binds necrotic peptic ulcer tissue. Acts as a barrier to acid - pepsin - and bile.
- Steroids - Tamoxifen
Rapid (seconds)

3. How can Vancomycin - induced 'Red Man Syndrome' be prevented?
Amphotericin B - Nystatin - Fluconazole/azoles
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.
Pretreat with antihistamines and a slow infusion rate
Heparin catalyzes the activation of antithrombin III.

4. What is the clinical use for Nystatin?
Chronic Hepatitis A and B - Kaposi's Sarcoma
cyanide toxicity (releases CN)
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).
Topical and Oral - for Oral Candidiasis (Thrush)

5. Mannitol - clinical use?
- NaHCO3
ARF - shock - drug overdose - decrease intracranial/intraocular pressure
- Penicillin
Binds to the Pyrophosphate Binding Site of the enzyme

6. What is the category of drug names ending in - operidol (e.g. Haloperidol)
-100% oxygen - hyperbaric
Butyrophenone (neuroleptic).
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.

7. Why would dopamine be useful in treating shock?
Acetylcholinesterase; ACh is broken down into choline and acetate.
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)
Clavulanic acid
- Tetracycline - amiodarone - sulfonamides

8. Acetazolamide - clinical uses?
Oral
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.
Inhibit Ergosterol synthesis
glaucoma - urinary alkalinization - metabolic alkalosis - altitude sickness

9. Are Ampicillin and Amoxicillin are not...
penicillinase resistant
- Clindamycin
Aminoglycosides
Bacitracin - Vancomycin

10. List some specifics of lead poisoning(4)?
Long.
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more
- DNA intercalator - Hodgkin's - myeloma - sarcoma - and solid tumors - Cardiotoxicity & alopecia
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia

11. What two vasodilators require simultaneous treatment with beta blockers to prevent reflex tachycardia and diuretics to prevent salt retention?
Hydralazine and Minoxidil
1. Antiandrogen 2. Nausea 3. Vomiting
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility
bradycardia - AV block - CHF

12. How does NE modulate its own release? What other neurotransmitter has this same effect?
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis
NE acts presynaptically on alpha -2 receptors to inhibit its own release. ACh also acts presynaptically through M1 receptors to inhibit NE release.
Modification via Acetylation - Adenylation - or Phosphorylation
Treatment of hypertension - especially with renal disease (lowers bp centrally - so flow is maintained to kidney).

13. Explain differences between full and partial agonists(2).
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
Neomycin
Ca2+ (Loops Lose calcium)
- Act on same receptor - Full has greater efficacy

14. What are two conditions in Which COX-2 inhibitors might be used?
Give an antichloinesterase - neostigmine - edrophonium - etc
Rheumatoid and osteoarthritis.
- EDTA - dimercaprol - succimer - & penicillamine
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).

15. Antiarrhythmic class IB- effects?
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system
local anesthetic. CNS stimulation or depression. CV depression.
AluMINIMUM amount of feces.
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome

16. What drug is used to diagnose myasthenia gravis?
Gemfibrozil - Clofibrate
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more
Activates antithrombin III
edrophonium (extremely short acting anticholinesterase)

17. What are two indirect acting adrenergic agonists?
GnRH analog with agonist properties When used in pulsatile fashion and antagonist properties When used in continuous fashion - causing a transient initial burst of LH and FSH
- Clindamycin
Blocks Influenza A and RubellA; causes problems with the cerebellA
amphetamine and ephedrine

18. What is the clinical use for Warfarin?
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic
Chronic anticoagulation.
Carbenicillin - Piperacillin - and Ticarcillin
first dose orthostatic hypotension - dizziness - headache

19. What are Polymyxins used for?
Resistant Gram - infections
Triple Therapy' 2 Nucleoside RT Inhibitors with a Protease Inhibitor
Chronic gout.
Epinephrine

20. What is the mechanism of action of the Alpha - glucosidase inhibitors?
Because they require some residual islet function.
Inhibit Ergosterol synthesis
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin
Inhibit intestinal bursh border Alpha - glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.

21. What type of gout is treated with Colchicine?
Hypersensitivity reactions
Benzodiazepine.
Acute gout.
TMP- SMZ

22. How does dantrolene work?
Na/K ATPase
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.
HTN - CHF - calcium stone formation - nephrogenic DI.

23. What is the category of drug names ending in - navir (e.g. Saquinavir)
- Disulfram & also sulfonylureas - metronidazole
GET on the Metro
Protease inhibitor.
Saquinavir - Ritonavir - Indinavir - Nelfinavir

24. What is the MOA for Carbenicillin - Piperacillin - and Ticarcillin?
thick ascending limb
Hypersensitivity reactions
Same as penicillin. Extended spectrum antibiotics
amphetamine and ephedrine

25. Which drug(s) cause this reaction: Thrombotic complications?
- Act on same receptor - Full has greater efficacy
atropine - homatropine - tropicamide
- Hypersensitivity reactions - Hemolysis - Nephrotoxicity (tubulointerstitial nephritis) - Kernicterus in infants Displace other drugs from albumin (e.g. - warfarin)
- Oral Contraceptives

26. Which drug(s) cause this reaction: Tendonitis and rupture?
Antiprotozoal: Giardia - Entamoeba - Trichomonas - Gardnerella vaginalis Anaerobes: Bacteroides - Clostridium
- Fluoroquinolones
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention
propanolol - esmolol - metoprolol - atenolol - timolol

27. Which diuretics cause acidosis?
Mebendazole/Thiabendazole - Pyrantel Pamoate
carbonic anhydrase inhibitors - K+ sparing diuretics
amphetamine and ephedrine
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.

28. What are the clinical indications for bethanechol?
Tetracycline - Doxycycline - Demeclocycline - Minocycline
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.
reversible SLE- like syndrome

29. What drug is given for Pneumocystis carinii prophylaxis?
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load
Rapid (seconds)
Pentamidine
Antileukotriene; blocks synthesis by lipoxygenase.

30. How is Foscarnet used clinically?
physostigmine
new arrhythmias - hypotension
Acute (hours)
CMV Retinitis in IC pts When Ganciclovir fails

31. What are five toxicities associated with Tacrolimus (FK506)?
Succinylcholine
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
Aminoglycosides - Tetracyclines
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.

32. How is Ganciclovir used clinically?
Pretreat with antihistamines and a slow infusion rate
Antileukotriene; blocks synthesis by lipoxygenase.
CMV - esp in Immunocompromised patients
Neurotoxicity - Acute renal tubular necrosis

33. List the specific antidote for this toxin: Tricyclic antidepressants
first dose orthostatic hypotension - dizziness - headache
G6PD deficient individuals
proarrhythmic
- NaHCO3

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

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35. What cholinomimetics might your pt be taking for his glaucoma
Carbachol - pilocarpine - physostigmine - echothiophate
1. Reliable (<1% failure) 2. Lowers risk of endometrial and ovarian cancer 3. Decreased incidence of ectopic pregnancy 4. Lower risk of pelvic infections 5. Regulation of menses
Pralidoxime regenerates active cholinesterase.
Rapid (seconds)

36. Common toxicities associated with Fluoroquinolones?
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis
Impairs the synthesis of vitamin K- dependent clotting factors
GI upset - Superinfections - Skin rashes - Headache - Dizziness
- Methotrexate - 5 FU - 6 mercaptopurine

37. What is a common side effect of Misoprostol?
Diarrhea
Ototoxicity - Hypokalemia - Dehydration - Allergy (sulfa) - Nephritis (interstitial) - Gout
Peptic ulcer disease.
HTN - CHF - calcium stone formation - nephrogenic DI.

38. A common side effects of Interferon (INF) treatment is?
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.
CL= (rate of elimination of drug/ Plasma drug conc.)
Interferes with microtubule function - disrupts mitosis - inhibits growth
Neutropenia

39. Side effects of Isoniazid (INH)?
Dermatophytes (tinea - ringworm)
It affects beta receptors equally and is used in AV heart block (rare).
Hemolysis (if G6PD deficient) - Neurotoxicity - Hepatotoxicity - SLE- like syndrome
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)

40. Which drug(s) cause this reaction: P450 induction(6)?
hypokalemia - slight hyperlipidemia - hyperuricemia - lassitude - hypercalcemia - hyperglycemia
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine
Imipenem

41. Name two organisms Vancomycin is commonly used for?
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)
- Antipsychotics
Similar to cyclosporine; binds to FK- binding protein - inhibiting secretion of IL-2 and other cytokines.
collecting ducts

42. Which drug(s) cause this reaction: Hepatitis?
- Isoniazid
- Infections - Trauma - Seizures - CO - Overdose - Metabolic - Alcohol (IT'S COMA)
Gram + - Gram - - Norcardia - Chlamydia
prevention of nodal arrhythmias (SVT)

43. For Warfarin What is the Duration of action
- Vitamin K & fresh frozen plasma
Prevents release of mediators from mast cells. Effective only for the prophylaxis of asthma. Not effective during an acute attack.
Chronic (weeks or months)
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone

44. What is the MOA for the Fluoroquinolones?
Oxygen
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal
Antimetabolite derivative of 6- mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.
- Penicillin

45. What is the category - mechanism of action - and effect of Ipratroprium in Asthma treatment?
Muscarinic antagonist; competatively blocks muscarinic receptors - preventing bronchoconstriction.
- Atropine & pralidoxime
Methylzanthine; desired effect is bronchodilation - may cause bronchodilation by inhibiting phosphodiesterase - enzyme involved in degrading cAMP (controversial).
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)

46. What conditions would you use dantrolene?
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.
- EDTA - dimercaprol - succimer - & penicillamine
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)
Erythromycin - Azithromycin - Clarithromycin

47. Which drug(s) cause this reaction: Torsade de pointes (2)?
The PTT.
- Class III antiarrhythmics (sotalol) - class IA (quinidine)
Modification via Acetylation - Adenylation - or Phosphorylation
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.

48. What is the category of drug names ending in - cycline (e.g. Tetracycline)
Aminoglycosides
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.
Antibiotic - protein synthesis inhibitor.

49. Name three ACE inhibitors?
Captopril - Enalapril - Lisinopril
impotence - asthma - CV effects (bradycardia - CHF - AV block) - CNS effects (sedation - sleep alterations)
Rifampin (DOC) - minocycline
Lidocaine - Mexiletine - Tocainide

50. Resistance mechanisms for Tetracycline
Keratin containing tissues - e.g. - nails
- Oxalic acid - Acidosis & nephrotoxicity
Inhibition of 50S peptidyl transferase - Bacteriostatic
Decreased uptake or Increased transport out of cell