Test your basic knowledge |

USMLE Step 1 Pharmacology

Subjects : health-sciences, usmle-step-1

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

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 are the major toxic side effects of Imipenem/cilastatin?
As PABA antimetabolites that inhibit Dihydropteroate Synthase - Bacteriostatic
physostigmine
1. Pioglitazone 2. Rosiglitazone.
GI distress - Skin rash - and Seizures at high plasma levels

2. Resistance mechanisms for Tetracycline
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic
- Triggers apoptosis - CLL - Hodgkin's in MOPP - Cushing - like syndrome
Decreased uptake or Increased transport out of cell
for RSV

3. Name the Protease Inhibitors (4)
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)
Saquinavir - Ritonavir - Indinavir - Nelfinavir
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.
- Hypersensitivity reactions - Hemolysis - Nephrotoxicity (tubulointerstitial nephritis) - Kernicterus in infants Displace other drugs from albumin (e.g. - warfarin)

4. For Heparin What is the Ability to inhibit coagulation in vitro
Rare.
Yes
Nitrates
- Penicillamine

5. Is resistant to penicillinase?
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
Imipenem
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)
- Physostigmine salicylate

6. What is the mechanism of Leuprolide?
- NaHCO3
Used in combination therapy with SMZ to sequentially block folate synthesis
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
Norepinephrine

7. What is the category of drug names ending in - azine (e.g. Chlorpromazine)
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.
Norepinephrine (Alpha1 -2 and beta 1)
Phenothiazine (neuroleptic - antiemetic).
TCA

8. Cautions When using Amiodarone?
check PFTs - LFTs - and TFTs
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.
Decreased uptake or Increased transport out of cell
- Oxalic acid - Acidosis & nephrotoxicity

9. What additional side effects exist for Ampicillin?
Verapamil - Diltiazem - Bepridil
orthostatic and exercise hypotension - sexual dysfunction - diarrhea
Rash - Pseudomembranous colitis
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia

10. Clonidine is the preferred sym pathomimetic tx of HTN in pts with renal disease - why??
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.
Inhibits cGMP phosphodiesterase - casuing increased cGMP - smooth muscle relaxation in the corpus cavernosum - increased blood flow - and penile erection.
- Cimetidine - ketoconazole - grapefruit juice - erythromycin - INH - sulfonamides
Centrally acting alpha agonist - thus causing a decrease in central adrenergic outflow - spairing renal blood flow

11. Hydralazine - clinical use?
G6PD deficient individuals
aPTT (intrinsic pathway)
severe hypertension - CHF
cardiac depression - peripheral edema - flushing - dizziness - constipation

12. What is the clinical use for Sildenafil (Viagra)?
Erectile dysfunction.
Hypersensitivity reactions
reversible SLE- like syndrome
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time

13. What is the category of drug names ending in - operidol (e.g. Haloperidol)
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.
1)Binds penicillin - binding proteins 2) Blocks transpeptidase cross - linking of cell wall 3) Activates autolytic enzymes
Butyrophenone (neuroleptic).
Teratogenic - Carcinogenic - Confusion - Headaches

14. Does Warfarin have a long - medium - or short half life?
Long.
1. Aluminum hydroxide: constipation and hypophosphatemia 2. Magnesium hydroxide: diarrhea 3. Calcium carbonate: Hypercalcemia - rebound acid increase - All may cause hypokalemia
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine
Bacitracin - Vancomycin

15. Amiodarone - toxicity?
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.
Sulfonamides - Trimethoprim
Pretreat with antihistamines and a slow infusion rate
YES

16. List the specific antidote for this toxin: Benzodiazepines
very short acting
Penicillin - V
- Flumazenil
- Penicillin

17. For Warfarin What is the Onset of action
Give an antichloinesterase - neostigmine - edrophonium - etc
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
Slow - limited by half lives of clotting factors
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time

18. List the specific antidote for this toxin: Arsenic (all heavy metals)
- NaHCO3
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia
- Dimercaprol - succimer

19. What parasites are treated with Pyrantel Pamoate (more specific)?
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)
Extended spectrum penicillin: certain Gram + bacteria and Gram - rods
- Tetracycline
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.)

20. Adverse effects of Reserpine?
- Antipsychotics
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Cilastatin
sedation - depression - nasal stuffiness - diarrhea

21. What is the category of drug names ending in - olol (e.g. Propranolol)
Md= (CpxCL)/F Cp= plas. Conc. CL=clear. F=bioaval.
Beta antagonist.
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA
The PT.

22. How is Ganciclovir used clinically?
CMV - esp in Immunocompromised patients
thiazides - amiloride
first dose orthostatic hypotension - dizziness - headache
Acts as a wide spectrum carbapenem

23. What is the MOA of Aztreonam?
Inhibits cell wall synthesis ( binds to PBP3). A monobactam
Saquinavir - Ritonavir - Indinavir - Nelfinavir
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal
penicillinase resistant

24. Which drug(s) cause this reaction: Tendonitis and rupture?
Only in limited amounts
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
- Fluoroquinolones
Lovastatin - Pravastatin - Simvastatin - Atorvastatin

25. What is the category of drug names ending in - oxin (e.g. Digoxin)
Cardiac glycoside (inotropic agent).
- Fluoroquinolones
Ibuprofen - Naproxen - and Indomethacin
TMP- SMZ

26. How would hemicholinium treatment affect cholinergic neurons?
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.
pulmonary edema - dehydration
Heparin catalyzes the activation of antithrombin III.
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )

27. What are the clinical indications for Azole therapy?
Systemic mycoses
1. Renal damage 2. Aplastic anemia 3. GI distress
Inhibits formation of Initiation Complex - causes misreading of mRNA - Bactericidal
Fast vs. Slow Acetylators

28. Preferential action of the Ca2+ channel blockers at cardiac muscle?
Ceftriaxone
cardiac muscle: Verapamil>Diltiazem>Nifedipine
Inhalational general anesthetic.
Heparin catalyzes the activation of antithrombin III.

29. For Warfarin What is the Treatment for overdose
cardiac muscle: Verapamil>Diltiazem>Nifedipine
Neutropenia
Pregnant women - Children; because animal studies show Damage to Cartilage
IV vitamin K and fresh frozen plasma

30. Hydralazine - class and mechanism?
vascular sm. Mus.: Nifedipine>Diltiazem>Verapamil
Dermatophytes (tinea - ringworm)
vasodilator - increases cGMP to induce smooth muscle relaxation (arterioles>veins; afterload reduction)
- Dimercaprol - succimer

31. Beta Blockers - CNS toxicity?
Praziquantel
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
sedation - sleep alterations
- inhibits HGPRT (pur. Syn.) - Luk - Lymph

32. Adverse effects of Hydrochlorothiazide?
Dopamine; causes its release from intact nerve terminals
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.
hypokalemia - slight hyperlipidemia - hyperuricemia - lassitude - hypercalcemia - hyperglycemia
- Act on same receptor - Full has greater efficacy

33. What is the mechanism of action of Heparin?
Beta lactams - inhibit cell wall synthesis - Bactericidal
YES
Heparin catalyzes the activation of antithrombin III.
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins

34. What is the memory key for the effect of aluminum hydroxide overuse?
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)
cortical collecting tubule
AluMINIMUM amount of feces.
Potent immunosuppressive used in organ transplant recipients.

35. List the specific antidote for this toxin: Antimuscarinic (anticholinergic)
Cryptococcal meningitis in AIDS patients and Candidal infections of all types
- Physostigmine salicylate
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids
Inhibits cell wall mucopeptide formation - Bactericidal

36. What is the effect of TCA's on the adrenergic nerve?
None. No - because atropine would block the postganglionic muscarinic receptors involved in sweat gland stimulation.
Diuresis in pateints with sulfa allergy
They inhibit reuptake of NE at the nerve terminal (as does cocaine).
thick ascending limb

37. How can the t1/2 of INH be altered?
compensatory tachycardia - fluid retention - lupus - like syndrome
Fast vs. Slow Acetylators
Liver
Pyridoxine (B6) administration

38. A fellow passenger on a Carnival cruise ship looks pale and diaphoretic - What antimuscarinic agent would you give them?
vasodilator - increases cGMP to induce smooth muscle relaxation (arterioles>veins; afterload reduction)
The only local anesthetic with vasoconstrictive properties.
Chloramphenicol - Erythromycin/macrolides - Lincomycin - Clindamycin - Streptogramins (quinupristin - dalfopristin)
scopolamine

39. Which of these three drugs will cause a reflex bradycardia in your pt (Norepi - Epi - or Isoporterenol)
Norepinephrine
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol
Neurotoxicity - Acute renal tubular necrosis
Prophylaxis for Influenza A - Rubella; Parkinson's disease

40. What microorganisms are clinical indications for Tetracycline therapy?

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183

41. Which drug(s) cause this reaction: Cutaneous flushing (4)?
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.
distal convoluted tubule (early)
- Niacin - Ca++ channel blockers - adenosine - vancomycin
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.

42. List the specific antidote for this toxin: Acetaminophen
Inhibit viral DNA polymerase
- N- acetylcystine
Same as penicillin. Extended spectrum antibiotics
Modification via Acetylation

43. Isopoterenol was given to a patient with a developing AV block - why?
- NaHCO3
Stimulates beta adrenergic receptors
reversible SLE- like syndrome
- Oral Contraceptives

44. Adverse effects of Prazosin?
Staphlococcus aureus
prevention of nodal arrhythmias (SVT)
first dose orthostatic hypotension - dizziness - headache
- Bleomycin - amiodarone - busulfan

45. What is the category of drug names ending in - navir (e.g. Saquinavir)
Protease inhibitor.
- Shifts the curve down - reduces Vmax
Due to the presence of a bulkier R group
decrease

46. List the specific antidote for this toxin: Beta Blockers
- Glucagon
- Glucocorticoid withdrawal
Pyridoxine (B6) administration
Small lipid - soluble molecule

47. Adverse effects of Captopril?
INH: Injures Neurons and Hepatocytes
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Buy AT 30 - CELL at 50'
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)

48. What are three common NSAIDS other than Aspirin?
Rapid (seconds)
- Shifts the curve to the right - increases Km
Malaria (P. falciparum)
Ibuprofen - Naproxen - and Indomethacin

49. Antiarrhythmic class IV- clinical use?
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).
sedation - sleep alterations
Chronic gout.
prevention of nodal arrhythmias (SVT)

50. What are common side effects of Amphotericin B?
Keratin containing tissues - e.g. - nails
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.
Fever/Chills - Hypotension - Nephrotoxicity - Arrhythmias
GI side effects. (Indomethacin is less toxic - more commonly used.)