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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. Which drug increases Sys BP w/o affecting Pulse Pressure
- Daunorubicin & Doxorubicin
Delirium - Tremor - Nephrotoxicity
Epinephrine
Bethanechol - Neostigmine - physostigmine

2. Name two bile acid resins.
cholestyramine - colestipol
dizziness - flushing - constipation (verapamil) - nausea
CL= (rate of elimination of drug/ Plasma drug conc.)
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)

3. How do you calculate maintenance dose?
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis
- Phase I (clinical tests) - Phase II - Phase III - PhaseIV (surveillance)
Md= (CpxCL)/F Cp= plas. Conc. CL=clear. F=bioaval.
Binding to the presynaptic alpha 2 release modulating receptors

4. What conditions are treated with Metronidazole?
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity
Pituitary hormone.
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas

5. What is the MOA for Metronidazole?
Nevirapine - Delavirdine
Flecainide - Encainide - Propafenone
Forms toxic metabolites in the bacterial cell - Bactericidal
Protease inhibitor.

6. What is the MOA of Griseofulvin?
Short.
first dose orthostatic hypotension - dizziness - headache
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.
Interferes with microtubule function - disrupts mitosis - inhibits growth

7. What is the difference in receptor affinity of epinephrine at low doses? High doses?

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8. What is the category of drug names ending in - cillin (e.g. Methicillin)
Botulinum
Premature infants - because they lack UDP- glucuronyl transferase
Penicillin.
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).

9. ________ ae not resistant to penicillinase - - but they are less susceptible than the other Beta lactams
Cephalosporins
Prevention of NSAID- induced peptic ulcers - maintains a PDA.
- Chloramphenicol
Protease inhibitor.

10. The MOA for Chloramphenicol is?
1. Antipyretic 2. Analgesic 3. Anti - inflammatory
Mg = Must go to the bathroom.
proarrhythmic
Inhibition of 50S peptidyl transferase - Bacteriostatic

11. What is Nifurtimox administered for?

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12. Name two LPL stimulators.
Succinylcholine
Wide spectrum of systemic mycoses: Cryptococcus - Blastomyces - Coccidioides - Aspergillus - Histoplasma - Candida - Mucor
Gemfibrozil - Clofibrate
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome

13. What is the category of drug names ending in - azol (e.g. Ketoconazole)
1. Antipyretic 2. Analgesic 3. Anti - inflammatory
- Cimetidine - ketoconazole - spironolactone - digitalis - EtOH - estrogens
Antifungal.
To inhibit renal Dihydropeptidase I and decrease Imipenem inactivation in the renal tubules

14. What are the indications for using amphetamine?

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15. These drugs acts indirectly by releasing strored catecholamines in the presynaptic terminal
very short acting
Cell membrane Ca2+ channels of cardiac sarcomere
Amphetamine and Ephedrine
Pretreat with antihistamines and a slow infusion rate

16. Resistance mechanisms for Aminoglycosides
Modification via Acetylation - Adenylation - or Phosphorylation
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)
Ototoxicity - Hypokalemia - Dehydration - Allergy (sulfa) - Nephritis (interstitial) - Gout

17. Ganciclovir associated toxicities?
As an anticholinesterase it increases endogenous ACh and thus increases strength.
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity
physostigmine

18. Antimicrobial prophylaxis for Gonorrhea
Ceftriaxone
Inhibit Ergosterol synthesis
- aminoglycosides - loop diuretics - cisplatin
1. Hydrocortisone 2. Predisone 3. Triamcinolone 4. Dexamethasone 5. Beclomethasone

19. Hydralazine - clinical use?
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity
Butyrophenone (neuroleptic).
severe hypertension - CHF

20. What microorganisms is Aztreonam not effective against?
Tetracycline - Doxycycline - Demeclocycline - Minocycline
ACIDazolamide' causes acidosis
CMV - esp in Immunocompromised patients
Gram + and Anerobes

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

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22. List some specifics of lead poisoning(4)?
- Hypersensitivity reactions - Hemolysis - Nephrotoxicity (tubulointerstitial nephritis) - Kernicterus in infants Displace other drugs from albumin (e.g. - warfarin)
No - warfarin - unlike heparin - can cross the placenta.
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia
1. Pioglitazone 2. Rosiglitazone.

23. Classes of antihypertensive drugs?
Cilastatin
Interstitial nephritis
diuretics - sympathoplegics - vasodilators - ACE inhibitors - Angiotensin II receptor inhibitors
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA

24. Name the steps in drug approval(4)?
- Glucocorticoid withdrawal
decrease the slope of phase 4 - increase PR interval (the AV node is particularly sensitive)
- Phase I (clinical tests) - Phase II - Phase III - PhaseIV (surveillance)
Cardiac glycoside (inotropic agent).

25. What are the major structural differences between Penicillin and Cephalosporin?
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.
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)
depresses ectopic pacemakers - especially in digoxin toxicity
1. Gastric ulceration 2. Bleeding 3. Hyperventilation 4. Reye's syndrome 5. Tinnitus (CN VIII)

26. What should not be taken with Tetracyclines? / Why?
Oral treatment of superficial infections
Bleeding.
Milk or Antacids - because divalent cations inhibit Tetracycline absorption in the gut
Mycobacterium tuberculosis - the only agent used as solo prophylaxis against TB

27. A common side effects of Interferon (INF) treatment is?
The PTT.
- Hydralazine - Procainamide - INH - phenytoin
Neutropenia
sedation - positive Coombs' test

28. Hydrochlorothiazide - toxicity? (hyperGLUC - plus others)
Penicillin - V
check PFTs - LFTs - and TFTs
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention
Hypokalemic metabolic alkalosis - hyponatremia - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia - sulfa allergy.

29. Adverse effects of Clonidine?
dry mouth - sedation - severe rebound hypertension
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.
- Tricyclic antidepressants
Albuterol - tertbutaline

30. What drug is used to diagnose myasthenia gravis?
edrophonium (extremely short acting anticholinesterase)
Useful in muscle paralysis during surgery or mechanical ventilation.
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome

31. What are three possible complications of Heparin therapy?
Gram + and Anerobes
Non - Nucleosides
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.
1. Bleeding 2. Thrombocytopenia 3. Drug - drug interactions

32. How would hemicholinium treatment affect cholinergic neurons?
GI upset
new arrhythmias - hypotension
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.
G6PD deficient individuals

33. Which drug(s) cause this reaction: Pseudomembranous colitis?
- Clindamycin
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.
Indomethacin is used to close a patent ductus arteriosus.

34. What is the effect of the Glitazones in diabetes treatment?
Diarrhea
Increase target cell response to insulin.
Small lipid - soluble molecule
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.)

35. How do you treat coma in the ER (4)?
Penicillin.
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride
- Oxalic acid - Acidosis & nephrotoxicity
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD

36. Which drug(s) cause this reaction: P450 induction(6)?
block Na+ channels in the cortical collecting tubule
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine
Decreases synthesis of Mycolic Acid
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more

37. Name three Antiarrhythmic drugs in class IC.
Flecainide - Encainide - Propafenone
Cyclooxygenases (COX I - COX II).
Inhibit viral DNA polymerase
Acute gout.

38. How are the Latent Hypnozoite (Liver) forms of Malaria (P. vivax - P.ovale) treated?
Primaquine
cardiac depression - peripheral edema - flushing - dizziness - constipation
- NaHCO3
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.

39. What is the MOA of the RT Inhibitors?
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.
Hemolytic anemia
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA

40. Beta Blockers - BP?
GET on the Metro
decrease
- Ethosuxamide - sulfonamides - lamotrigine
- Alkalinize urine & dialysis

41. What is the formula for Volume of distribution (Vd)
atropine - homatropine - tropicamide
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
1. Heavy bleeding 2. GI effects (n/v - anorexia) 3. Abdominal pain
Vd= (Amt. of drug in body/ Plasma drug conc.)

42. How is Ganciclovir used clinically?
Pyridoxine (B6) administration
CMV - esp in Immunocompromised patients
Rifampin (DOC) - minocycline
Succinylcholine

43. What is combined with Ampicillin - Amoxicillin - Carbenicillin - Piperacillin - and Ticarcillin to enhance their spectrum?
1. Addison's disease 2. Inflammation 3. Immune suppression 4. Asthma
Clavulanic acid
Sulfonamides - Trimethoprim
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels

44. While at a tail gait party - you bite into a sandwich that a yellow jacket is also enjoying. Knowing your allergy to this creature - What should you do?
Pituitary hormone.
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.
1. Weight gain 2. Hepatotoxicity (troglitazone)

45. For Warfarin What is the Site of action
Megaloblastic anemia - Leukopenia - Granulocytopenia
1)Binds penicillin - binding proteins 2) Blocks transpeptidase cross - linking of cell wall 3) Activates autolytic enzymes
1. Heavy bleeding 2. GI effects (n/v - anorexia) 3. Abdominal pain
Liver

46. What is the mechanism of action of NSAIDs other than Aspirin?
Diarrhea - Urination - Miosis - Bronchospasm - Bradycardia - Excitation of skeletal muscle and CNS - Lacrimation - Sweating - and Salivation = DUMBBELS; also abdominal cramping
physostigmine
- Disulfram & also sulfonylureas - metronidazole
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.

47. List the mechanism - clinical use - & toxicity of Tamoxifen.
- Estrogen receptor antagonist - Breast CA - increased endometrial CA risk
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression
Vd= (Amt. of drug in body/ Plasma drug conc.)
Triple sulfas or SMZ

48. Toxicities associated with Acyclovir?
Epinephirine(Alpha1 -2 and Beta 1 -2)
Delirium - Tremor - Nephrotoxicity
very short acting
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )

49. Antiarrhythmic Class III- effects?
Beta - lactamase cleavage of Beta - lactam ring
Blocks Peptide Bond formation at the 50S subunit - Bacteriostatic
Pentamidine
increase AP duration - increase ERP - increase QT interval - for use When other arrhythmics fail

50. Ca2+ channel blockers - mechanism?
Pretreat with antihistamines and a slow infusion rate
Chronic gout.
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin