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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. What is the MOA for Metronidazole?
Nephrotoxicity
- Shifts the curve down - reduces Vmax
Acetylates and irreversibly inhibits cyclooxygenase (COX I and COX II) to prevent the conversion of arachidonic acid to prostaglandins.
Forms toxic metabolites in the bacterial cell - Bactericidal

2. What drug is given for Pneumocystis carinii prophylaxis?
Hypersensitivity reactions
Pentamidine
GI upset - Superinfections - Skin rashes - Headache - Dizziness
They inhibit reuptake of NE at the nerve terminal (as does cocaine).

3. What are common toxicities related to Vancomycin therapy?

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4. Adverse effects of Prazosin?
first dose orthostatic hypotension - dizziness - headache
constipation - flushing - edema - CV effects (CHF - AV block - sinus node depression) - and torsade de pointes (Bepridil)
- Cimetidine - ketoconazole - spironolactone - digitalis - EtOH - estrogens
blocks SR Ca2+ channels

5. Furosemide - toxicity? (OH DANG)
GI upset - Superinfections - Skin rashes - Headache - Dizziness
cortical collecting tubule
Ototoxicity - Hypokalemia - Dehydration - Allergy (sulfa) - Nephritis (interstitial) - Gout
GI distress - Tooth discoloration and Inhibition of bone growth in children - Fanconi's syndrome - Photosensitivity

6. Quinidine - toxicity?
Norepinephrine
Protamine sulfate
Sulfonamide Loop Diuretic. Inhibits ion co - transport system of thick ascending loop. Abolishes hypertonicity of the medulla - thereby preventing concentration of the urine.
cinchonism: HA - tinnitus - thrombocytopenia - torsade de pointes due to increased QT interval

7. What is Imipenem always administered with?
Those patients who are taking nitrates.
Cilastatin
Choline acetyltransferase
Acute gout.

8. Which cancer drugs work at the level of proteins(2)?
- Vinca alkaloids(inhibit MT) - Paclitaxel
Edrophonium
Methicillin - Nafcillin - and Dicloxacillin
Teratogenic - Carcinogenic - Confusion - Headaches

9. Amiodarone - toxicity?
Leukotrienes increasing bronchial tone.
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.
Polymyxin B - Polymyxin E
Gemfibrozil - Clofibrate

10. Esmolol - short or long acting?
pulmonary edema - dehydration
very short acting
Warfarin interferes with the normal synthesis and gamma - carboxylation of vitamin K- dependent clotting factors II - VII - IX - and X - Protein C and S via vitamin K antagonism.
Antileukotriene; blocks leukotriene receptors.

11. What is the mechanism of action of Colchicine used to treat acute gout?
Anaerobic infections (e.g. - B. fragilis - C. perfringens)
Centrally acting alpha agonist - thus causing a decrease in central adrenergic outflow - spairing renal blood flow
Depolymerizes microtubules - impairing leukocyte chemotaxis and degranulation.
first dose orthostatic hypotension - dizziness - headache

12. Are penicillinase resistant
Methicillin - Nafcillin - and Dicloxacillin
TCA
1. Pioglitazone 2. Rosiglitazone.
Stimulates beta adrenergic receptors

13. For Heparin What is the Treatment for overdose
Protamine sulfate
anuria - CHF
- polymyxins
Nephrotoxicity

14. ADH antagonists - site of action?
prevention of nodal arrhythmias (SVT)
TCA
collecting ducts
GI upset - Superinfections - Skin rashes - Headache - Dizziness

15. What is the effect of the Glitazones in diabetes treatment?
NO
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state
Increase target cell response to insulin.
Acts as a wide spectrum carbapenem

16. What are the Macrolides used for clinically?
- Upper respiratory tract infections - pneumonias - STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) - Mycoplasma - Legionella - Chlamydia - Neisseria
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)
Sotalol - Ibutilide - Bretylium - Amiodarone
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)

17. As an Anes you want to use a depolarizing neuromuscular blocking drug on your pt - What do you use
Binds to cyclophilins (peptidyl proline cis - trans isomerase) - blocking the differentiation and activation of T cells mainly by inhibiting the production of IL-2 and its receptor.
Ibuprofen - Naproxen - and Indomethacin
Succinylcholine
Indirect agonist - uptake inhibitor

18. MOA: Block mRNA synthesis
Beta antagonist.
It affects beta receptors equally and is used in AV heart block (rare).
Rifampin
Diarrhea - Urination - Miosis - Bronchospasm - Bradycardia - Excitation of skeletal muscle and CNS - Lacrimation - Sweating - and Salivation = DUMBBELS; also abdominal cramping

19. MOA: Block protein synthesis at 50s subunit
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)
Chloramphenicol - Erythromycin/macrolides - Lincomycin - Clindamycin - Streptogramins (quinupristin - dalfopristin)
DHPG (dihydroxy-2- propoxymethyl guanine)
No - it inhibits the release of Nor Epi

20. Which drug(s) cause this reaction: G6PD hemolysis(8)?
cross - allergenic
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Leukotrienes increasing bronchial tone.

21. What sympathomimetic would you not prescribe for hypotension in a pt with renal artery sclerosis.
TMP- SMZ (DOC) - aerosolized pentamidine
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.)
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity
Norepinephrine (Alpha1 -2 and beta 1)

22. Cautions When using Amiodarone?
Chronic Hepatitis A and B - Kaposi's Sarcoma
- Tetracycline - amiodarone - sulfonamides
Yes - it does not cross the placenta.
check PFTs - LFTs - and TFTs

23. For Heparin What is the Duration of action
It affects beta receptors equally and is used in AV heart block (rare).
loop diuretics - thiazides
Acute (hours)
- MT polymerization inhibitor(M phase) - MOPP - lymphoma - Willm's & choriocarcinoma - neurotoxicity and myelosuppression

24. What is the clinical use for Clomiphene?
Sotalol - Ibutilide - Bretylium - Amiodarone
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic
Treatment of infertility.
AV nodal cells

25. What is the MOA of Polymyxins?
AV nodal cells
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents
- Act on same receptor - Full has greater efficacy
Amphotericin B - Nystatin - Fluconazole/azoles

26. What are three unwanted effects of Mifepristone?
It acts presynaptically to increase NE release.
- Penicillin
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)
1. Heavy bleeding 2. GI effects (n/v - anorexia) 3. Abdominal pain

27. ___________ are Teratogenic
Aminoglycosides
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.
osmotic diuretic - increase tubular fluid osmolarity - thereby increasing urine flow
decrease conduction velocity - increase ERP - increase PR interval

28. Is toxicity rare or common whith Cromolyn used in Asthma prevention?
Imipenem
Rare.
NO HYPERURICEMIA - NO SULFA AllERGY; same as furosemide otherwise
thiazides - amiloride

29. What is the MOA for Carbenicillin - Piperacillin - and Ticarcillin?
Same as penicillin. Extended spectrum antibiotics
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state
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.

30. What is the major side effect for Carbenicillin - Piperacillin - and Ticarcillin?
Hypersensitivity reactions
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.
orthostatic and exercise hypotension - sexual dysfunction - diarrhea
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).

31. Which drug increases Sys BP w/o affecting Pulse Pressure
1. Pioglitazone 2. Rosiglitazone.
Inhibits cell wall mucopeptide formation - Bactericidal
Epinephrine
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions

32. List the specific antidote for this toxin: Methanol & Ethylene glycol
Reversibly inhibits cyclooxygenase - mostly in CNS. Inactivated peripherally.
- Ethanol - dialysis - & fomepizole
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
It would increase to ~ 100 beats/min. Both sympathetic and vagal stimulation would be knocked out - but the SA node has an intrinsic pace of 100 beats/min - Which is normally checked by vagal stimulation.

33. Acetazolamide - mechanism?
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.
Same as penicillin. Act as narrow spectrum antibiotics
penicillinase resistant

34. Resistance mechanisms for Tetracycline
1. Bleeding 2. Thrombocytopenia 3. Drug - drug interactions
- Methotrexate - 5 FU - 6 mercaptopurine
Decreased uptake or Increased transport out of cell
No - hemicholinum block the uptake of Choline and thus Ach synthesis

35. Mnemonic for Foscarnet?
Foscarnet = pyroFosphate analog
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia
1. Bleeding 2. Teratogenicity 3. Drug - drug interactions
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills

36. What are four conditions in Which H2 Blockers are used clinically?
Oral treatment of superficial infections
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents
GI distress - Tooth discoloration and Inhibition of bone growth in children - Fanconi's syndrome - Photosensitivity
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome

37. What microorganisms are clinical indications for Tetracycline therapy?

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38. 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
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state
Dopamine
Inhibits cell wall mucopeptide formation - Bactericidal
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation

39. What is the MOA for the Tetracyclines?
bradycardia - AV block - CHF
WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic
Norepinephrine

40. MOA: Block DNA topoisomerases
Same as penicillin. Extended spectrum antibiotics
Protease Inhibitors and Reverse Transcriptase Inhibitors
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels
Quinolones

41. What is the category - mechanism of action - and effect of Ipratroprium in Asthma treatment?
- Methylene blue
Muscarinic antagonist; competatively blocks muscarinic receptors - preventing bronchoconstriction.
- Cloazapine - carbamazapine - colchicine - PTU
Scopolamine

42. Which drug(s) cause this reaction: Tendonitis and rupture?
Useful in muscle paralysis during surgery or mechanical ventilation.
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy
Those patients who are taking nitrates.
- Fluoroquinolones

43. For Heparin What is the Onset of action
impotence - asthma - CV effects (bradycardia - CHF - AV block) - CNS effects (sedation - sleep alterations)
Stimulating beta receptors stimulates heart rate - but beta receptor induced vasodilation reduces peripheral resistance.
- DNA intercalator - Hodgkin's - myeloma - sarcoma - and solid tumors - Cardiotoxicity & alopecia
Rapid (seconds)

44. Adverse effects of Nifedipine - verapamil?
Tendonitis and Tendon rupture
dizziness - flushing - constipation (verapamil) - nausea
Bleeding.
penicillinase resistant

45. Which cancer drugs effect nuclear DNA (4)?
Prevention of NSAID- induced peptic ulcers - maintains a PDA.
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide
Praziquantel
competitive inhibirot of aldosterone in the cortical collecting tubule

46. Toxic side effects of the Azoles?
Same as penicillin. Extended spectrum antibiotics
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills
AmOxicillin has greater Oral bioavailability
Decreased uptake or Increased transport out of cell

47. For Warfarin What is the Duration of action
Chronic (weeks or months)
- Methylene blue
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes
Potent immunosuppressive used in organ transplant recipients.

48. What is the clinical use for Nystatin?
Topical and Oral - for Oral Candidiasis (Thrush)
all of them
BM suppression (neutropenia - anemia) - Peripheral neuropathy
In 4 half - lifes= (94%) T1/2 = (0.7x Vd)/CL

49. Antiarrhythmic class IC- toxicity?
- Formaldehyde & formic acid - severe acidosis & retinal damage
proarrhythmic
Rapid (seconds)
dry mouth - sedation - severe rebound hypertension

50. What cholinomimetic is useful in the diagnosis of Myasthenia Gravis
Due to the presence of a bulkier R group
- Fluoroquinolones
Edrophonium
Inhibits DNA dependent RNA polymerase